Link Between Metabolic Syndrome, Inflammation, and Eye Diseases

Metabolic syndrome (MetS)-a cluster of conditions including obesity, hypertension, dyslipidemia, and insulin resistance-is increasingly recognized as a key risk factor for the development of various eye diseases. The metabolic dysfunctions associated with this syndrome contribute to vascular and neurodegenerative damage within the eye, influencing disease onset and progression. Understanding these links highlights the importance of early diagnosis and management of metabolic syndrome to prevent vision loss and improve ocular health outcomes. This review explores the intricate interplay between metabolic syndrome, chronic low-grade inflammation, and eye diseases such as diabetic retinopathy, age-related macular degeneration, glaucoma, and dry eye syndrome. It highlights how inflammatory mediators, oxidative damage, and metabolic dysregulation converge to compromise ocular structures, including the retina, optic nerve, and ocular surface. We discuss the molecular and cellular mechanisms underpinning these associations and examine evidence from clinical and experimental studies. Given the rising global prevalence of metabolic syndrome, addressing this connection is crucial for improving overall patient outcomes and quality of life. Future research should focus on delineating the precise mechanisms linking these diseases as well as exploring targeted interventions that address both metabolic and ocular health.

Evaluation of gut microbiota alterations following orlistat administration in obese mice

Background

The gut microbiota plays a pivotal role in various metabolic disorders. Orlistat has shown beneficial effects on weight loss and metabolism, but its direct impact on the gut microbiota has not been extensively reported. Thus, this study aimed to explore the effects of orlistat on the gut microbiota in mice with high-fat diet-induced obesity.

Methods

Thirty male C57BL/6J mice were randomly divided into a normal control group (fed a standard diet, N), and a model group (fed a 60% fat diet). A body weight exceeding the basal body weight by 130% defined a successfully established obesity model. The model group was further divided into a positive control group (fed a 60% fat diet, F), and an orlistat group (fed a 60% fat diet and treated with orlistat at 30 mg/kg, bid, A), with 10 mice in each group. The parameters assessed included weight loss, fasting plasma glucose (FPG) levels, and intestinal hormones. Gut microbiota diversity was analyzed using high-throughput sequencing.

Results

Orlistat treatment significantly reduced body weight and FPG levels, and increased glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP) levels in obese mice. High-fat diet-fed mice exhibited increased microbial diversity and richness, which were significantly diminished by orlistat administration. Additionally, orlistat treatment led to a significant decrease in the proportion of Bacteroidetes and an increase in the proportion of Helicobacter and Allobaculum. Notable shifts in the abundances of Bacteroidetes were observed, correlating with changes in several functional metabolic pathways, including "cell motility" and "neurodegenerative diseases." Co-occurrence network analysis suggested a more complex bacterial network in orlistat-treated mice, alongside a reduction in the density of bacterial correlation networks.

Conclusions

Our study demonstrates that orlistat's beneficial effects on body weight, FPG, GLP-1, and GIP are likely mediated through modifications in the gut microbiota composition.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Sex differences in the relationship between short sleep duration and obesity among koreans

This cross-sectional study examined the relationship between short sleep duration and obesity by analysing data from 3,950 participants aged 40-69 years who took part in the 2003-2004 follow-up survey of the Korean Genome and Epidemiologic Study. Based on the subjective experience of morning fatigue, short sleep duration was defined as < 5 h of sleep. Short sleep duration was significantly associated with general obesity, as measured by body mass index (adjusted odds ratios [confidence intervals], 1.246 [1.016-1.529]); these associations became stronger as the severity of general obesity worsened. Analysing data separately by sex, we detected a relationship between short sleep duration and general obesity in females only. Considering the impact of age, the relationship was detected only in females aged 40-59 years old. In females aged 40-59 years, both general obesity (1.518 [1.110-2.075]) and neck obesity (1.425 [1.045-1.945]) were associated with short sleep duration. Our study established a correlation between short sleep duration and general obesity, specifically in females and those aged 40-59 years. This finding highlights the importance of adequate sleep to treat and prevent obesity in this demographic group.

Therapeutic Potential of Gynostemma pentaphyllum Extract for Hair Health Enhancement: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Background: Hair health critically influences both aesthetic appearance and psychological well-being. Existing treatments often show limited efficacy and may cause side effects. Gynostemma pentaphyllum (GP), known for its antioxidant and anti-inflammatory properties, has emerged as a promising botanical agent, although clinical evidence regarding its hair health benefits remains limited. Purpose: This study aimed to evaluate the efficacy and safety of GP extract in improving hair parameters through a randomized controlled trial. Methods: This randomized, double-blind, placebo-controlled trial involved 100 eligible adults aged 19-60 years who were randomly allocated to either the GP or placebo group. Participants consumed 340 mL/day of the test product for 24 weeks. The primary outcomes included hair elasticity, density, diameter, glossiness, and subjective satisfaction. Safety was evaluated through laboratory tests and adverse event monitoring. Results: After 24 weeks, the GP group showed a threefold increase in hair elasticity and density and a fourfold increase in hair diameter compared to the placebo group. The subjective satisfaction scores corroborated these findings: the GP users reported better outcomes in terms of reducing hair damage and dryness. No significant differences in hair glossiness were observed based on the instrumental and visual assessments (p > 0.05). The safety evaluations revealed no severe adverse events. All the safety evaluation metrics demonstrated no significant abnormalities. Conclusions: This study provides compelling evidence of the efficacy of GP extract in enhancing hair health, demonstrating both significant functional improvements and an excellent safety profile. These findings substantiate its potential as a promising functional food ingredient for comprehensive hair care interventions.

Comprehensive implementations of multiple imputation using retrieved dropouts for continuous endpoints

BACKGROUND

In the metabolic disease area, there has been a long-time debate against using mixed models for repeated measures (MMRM) as the primary analysis of longitudinal continuous endpoints. As missing data arising from missing not at random assumptions are not addressed in MMRM, multiple imputation based on specific assumptions has been brought into play. Among many missing not at random assumptions with varying degrees of conservativeness, multiple imputation based on retrieved dropouts (MIRD) has been accepted by regulatory agencies in several type 2 diabetes and chronic weight management products in recent years, marking the beginning of a new standard for analysis of longitudinal data in this disease area.

METHODS

On top of the established MIRD approach of which the imputation is based on last on-treatment data of retrieved dropout (RD)s, we propose a new class of MIRD approaches utilizing all available data from RDs. The imputation implementation can be one-step Markov Chain Monte Carlo (MCMC) or two-step (creating monotone missingness, followed by regression approach). ANCOVA can be applied to the complete dataset post imputation and Rubin's rule can be used to combine all estimates into a single estimate. Simulation studies in a wide range of scenarios are conducted to understand the type-I error and power rates of the new class versus the established MIRD approach and other reference statistical methods such as MMRM.

RESULTS

Overall, the new class has very similar performance compared to the established MIRD approach based on last on-treatment data. What's more interesting is the one-step MCMC approach has better controlled type-I error and is more powerful than the established MIRD approach in certain scenarios with the difference gradually diminishing with larger sample size. The data analyses based on two real phase 3 datasets further manifest the power conclusions, with the results based on the new class applied to the larger of the two datasets almost identical to that of on-study MMRM.

CONCLUSIONS

We have presented comprehensive implementations of the MIRD approach for continuous endpoints in a longitudinal setting that fully fit within the strategy of treatment policy. The proposed new class based on all observed data of RDs is proved to be as powerful as the established MIRD approach based on last on-treatment visit in most scenarios. The one-step MCMC approach is more powerful than the established MIRD approach in certain scenarios. Since the new class involves less programming derivation of additional flags, it's anticipated to be more easily implemented in clinical trial reporting.

Relationship between bone mineral density and oral health: a cross sectional observational study

PURPOSE

Bone mineral density (BMD) is related to oral health. This study investigated how changes in BMD influence tooth loss risk and dental caries prevalence.

METHODS

This cross-sectional observational study included 224 people (199 males and 25 females). The BMD scores of the participants' lumbar spine, femoral neck, and total hip were categorized as normal, osteopenia, or osteoporosis. Oral health was assessed using the Decayed, Missing, Filled Teeth (DMFT) index and Oral Hygiene Index-Simplified (OHI-S) scores. Based on the number of surviving teeth, the participants were categorized into low (< 20) and high (≥ 20) groups. Differences between groups were assessed using independent sample T tests and one-way analysis of variance.

RESULTS

The normal, osteopenia, and osteoporosis groups comprised 72, 87, and 65 participants, respectively. The OHI-S scores showed no notable variations across the groups. The DMFT index scores were highest (18.69) in the osteoporosis group and lowest (14.08) in the normal group (p < 0.001). Although the number of remaining teeth was lower in the osteoporosis and osteopenia groups compared to the normal group (p < 0.001), that in the osteopenia group approximated the normal group, but was substantially higher than in the osteoporosis group. The group with the lowest number of remaining teeth had lower total hip T-scores, despite significantly higher DMFT indexes (p < 0.001).

CONCLUSIONS

Tooth loss and dental decay rates were significantly high in patients with osteoporosis. Although bone resorption during osteopenia is not excessive, it constitutes a crucial risk factor for dental health. Therefore, attention must be paid to bone resorption treatment in patients with osteopenia.

Metabolomic Signatures in Adults with Metabolic Syndrome Indicate Preclinical Disruptions in Pathways Associated with High-Density Lipoprotein Cholesterol, Sugar Alcohols

Background

Metabolic syndrome is a pressing public health issue and risk factor for the development of type 2 diabetes (T2D) and cardiovascular disease (CVD), yet clinical practice is lacking in biomarkers that represent pre-clinical perturbations of the heterogenous subtypes of risk. This study aimed to characterize the baseline metabolome in relation to known clinical characteristics of risk in a sample of obese adults.

Methods

Untargeted metabolome data from N = 126 plasma samples with baseline data from a previously completed study including obese adults with metabolic syndrome. Metabolites were acquired using validated liquid chromatography mass spectrometry methods with 15-25 internal standards quantified by peak heights. Pearson's correlations were used to determine relationships between baseline metabolites, sample characteristics (e.g., age, body mass index (BMI)), and atherosclerotic clinical characteristics (e.g., high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides), adjusting for multiple comparisons using the Benjamini-Hochberg False Discovery Rate (FDR) method. Differences in metabolite levels between clinical classifications of dysglycemia (e.g., normal, prediabetes, diabetes) at baseline were assessed using ANOVA and adjusted for multiple comparisons and adjusted for covariates.

Results

The sample consisted primarily of female (74%) participants, predominantly white (70%), with an average age of 56 years. After FDR adjustment, two baseline metabolites were significantly associated with age (xylose, threitol), two with BMI (shikimic acid, propane-1,3-diol), one with LDL (tocopherol-alpha), and 42 with HDL cholesterol. Three metabolites were significantly associated with fasting blood glucose (FBG) levels at baseline (glucose, gluconic acid lactone, pelargonic acid).

Conclusions

This study identified novel metabolite associations with known markers of T2D and CVD risk. Specific metabolites, such as alpha-tocopherol, branched-chain amino acids (BCAAs), and sugar-derived metabolites like mannose and xylose, were significantly associated with age, BMI, lipid profiles, and glucose measures. Although most sample participants had normal HDL cholesterol at baseline, 42 metabolites including branched chain amino acids were significantly associated with HDL, suggesting pre-clinical perturbations in biological pathways associated with both diabetes and cardiovascular comorbidities. Metabolomic signatures Specific to prediabetes and metabolic syndrome can enhance risk stratification and enable targeted prevention strategies for T2D. Longitudinal studies are needed to understand how these associations change over time in at-risk individuals compared with controls.

Prospective Single-Arm Study of Remifentanil-Propofol Anesthesia with Manual Right Hypochondrial Compression for Painless Gastroscopy in Obese Patients

Purpose

The provision of comfortable and safe environment for painless gastroscopy in obese patients is an urgent clinical problem. This study aimed to determine the efficacy and safety of the novel Li anesthetic protocol for obesity (LAPO) which included remifentanil-propofol regimen, manual right hypochondrial compression (MRHC), easy-to-create mask, and jaw thrust at preoperative painless gastroscopy in obese patients.

Patients and Methods

This prospective, single-center, single-arm trial recruited 106 participants underwent LAPO for gastroscopy. The primary outcome was the incidence of hypoxemia (peripheral oxygen saturation [SpO2]: 75% ≤ SpO2 <90%, for >10 s and ≤60 s). Second outcomes included severe hypoxemia, the lowest SpO2 (L-SpO2), duration of hypoxemia, and other events.

Results

The 98 obese patients under LAPO, the median body mass index (BMI) was 39.2 kg/m2 and the incidence of hypoxemia was 27.5%, while the conventional anesthetic protocol for obesity (CAPO) in the reference was 40.4% with BMI 31.4 kg/m2. With the increase of class of obesity, a significant rise in the incidence of hypoxemia was observed, from class I by 11.8%, to 15.1% in class II, and 41.7% in class III. Paired t test showed that the L-SpO2 was significantly higher than L-SpO2 in overnight polysomnography (Nadir SpO2) (92% vs 76%, P<0.001). Moreover, severe obstructive sleep apnea (OSA) was associated with a 4.019-fold higher risk of hypoxemia (Odds ratios [OR], 4.019; 95% confidence interval [CI], 1.184 to 14.610; P=0.028); diabetes was associated with a 4.790-fold higher risk of hypoxemia (OR, 4.790; 95% CI, 1.288 to 23.600; P=0.030).

Conclusion

Compared with CAPO, LAPO reduced the incidence of hypoxemia from 40.4% to 27.5%, so, LAPO was safe and effective for painless gastroscopy. The finding might provide some new schedules for anesthetic management in the absence of advanced airway support instruments.

Clinical Trial Registration

ChiCTR2300077889.

Harnessing Artificial Intelligence in Obesity Research and Management: A Comprehensive Review

Purpose: This review aims to explore the clinical and research applications of artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL), in understanding, predicting, and managing obesity. It assesses the use of AI tools to identify obesity-related risk factors, predict outcomes, personalize treatments, and improve healthcare interventions for obesity. Methods: A comprehensive literature search was conducted using PubMed and Google Scholar, with keywords including "artificial intelligence", "machine learning", "deep learning", "obesity", "obesity management", and related terms. Studies focusing on AI's role in obesity research, management, and therapeutic interventions were reviewed, including observational studies, systematic reviews, and clinical applications. Results: This review identifies numerous AI-driven models, such as ML and DL, used in obesity prediction, patient stratification, and personalized management strategies. Applications of AI in obesity research include risk prediction, early detection, and individualization of treatment plans. AI has facilitated the development of predictive models utilizing various data sources, such as genetic, epigenetic, and clinical data. However, AI models vary in effectiveness, influenced by dataset type, research goals, and model interpretability. Performance metrics such as accuracy, precision, recall, and F1-score were evaluated to optimize model selection. Conclusions: AI offers promising advancements in obesity management, enabling more personalized and efficient care. While technology presents considerable potential, challenges such as data quality, ethical considerations, and technical requirements remain. Addressing these will be essential to fully harness AI's potential in obesity research and treatment, supporting a shift toward precision healthcare.

Associations of four obesity indices with diabetes mellitus in Korean middle-aged and older adults using the Korean Genome and Epidemiology Study (KoGES)

BACKGROUND

Obesity is associated with a high risk of diabetes mellitus (DM); therefore, obesity-related indices are strongly associated with DM. This study evaluated the association of obesity indices, including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and a body shape index (ABSI), with DM in Korean middle-aged and older adults.

METHODS

Data from three population-based cohorts (Ansan and Ansung, Health Examinee, and Cardiovascular Disease Association Study, derived from the Korean Genome and Epidemiology Study) were analyzed. Logistic analysis was used to evaluate the association of BMI, WC, WHR, and ABSI with DM, after adjusting for covariates according to sex and age. The integrated discrimination index (IDI) and category-free net reclassification improvement (cfNRI) and area under the curve (AUC) of the receiver operating characteristic (ROC) curve were analyzed by age group to investigate index-specific model performance.

RESULTS

Among the 160,585 participants, 13,846 had DM (6,837; men [11.86%] and 7,009 women [6.81%]). Age increase was associated with an increased prevalence of DM: 2,339 (4.01%), 5,313 (8.74%), and 6,194 (14.93%) in the 40-49, 50-59, and ≥ 60 years age groups. After adjusting for covariates, the odds ratios (OR) for DM of WHR and WC were higher than those of the other indices in every age group. However, the OR for WHR, WC, and BMI decreased with age in both sexes. ABSI showed steady and slightly increasing ORs with increasing age although the ORs in both sexes were generally low for DM. For IDI and cfNRI, WHR had the highest values among all age groups. The AUC of the ROC curve showed that the WHR had the highest value in all age groups.

CONCLUSION

The WHR had the strongest association with DM, but was not a good DM index in older people. Therefore, age-related index criteria for DM, especially in women, were needed for the effective prevention and management of DM.

The influence of uterine leiomyomatosis on the onset of psoriasis: a nationwide population-based study of 2.5 million Korean females

BACKGROUND

Uterine leiomyomatosis and psoriasis are prevalent conditions and shared pathophysiological factors indicate a potential association. However, a direct correlation has not been established. We investigated the relationship between uterine leiomyomatosis and the risk of new-onset psoriasis in Korean females of reproductive age.

METHODS

This nationwide population-based study used data from the Korean National Health Insurance System database. Data from 2,755,790 Korean females 20-39 years of age who underwent health check-ups from 2009 to 2012 were analyzed. Monitoring began at the initial national health assessment within the time frame and continued until either the diagnosis of emerging psoriasis or until December 2018.

RESULTS

Among 2,503,769 females included, 1.96% were diagnosed with psoriasis and 0.72% with uterine leiomyomatosis. The incidence ratio for new-onset psoriasis was higher in uterine leiomyomatosis patients (3.13 per 1,000) than in subjects without uterine leiomyomatosis (2.72 per 1,000). The hazard ratio for psoriasis occurrence was 1.18 (1.07-1.31) in uterine leiomyomatosis patients, 1.22 (1.08-1.37) in subjects who did not undergo myomectomy, and 1.12 (0.94-1.33) in patients who underwent myomectomy.

CONCLUSIONS

Uterine leiomyomatosis patients, especially those not undergoing myomectomy, showed an increased risk of psoriasis. Lifestyle modifications and surgical intervention for uterine leiomyomatosis may also be beneficial for psoriasis occurrence.

A Decade of Progress in Ultrasound Assessments of Subcutaneous and Total Body Fat: A Scoping Review

Body composition assessment by ultrasonography is a vivid research field. Ultrasound (US) can be used to quantify subcutaneous and visceral fat, to evaluate the quantity and quality of skeletal muscle, and to infer intracellular fat content. This scoping review aimed to summarize recent advancements in subcutaneous fat estimation using US and related applications. A systematic search was conducted on PubMed, MEDLINE, Scopus, Google Scholar, and Web of Science to identify original articles published in English between 1 January 2014 and 20 December 2024. A total of 1869 articles were screened based on their titles and abstracts, and 283 were retrieved for full-text evaluation. Our search and selection strategy resulted in 89 eligible documents. The literature discussed in this review suggests that US is a reliable and valid technique for measuring subcutaneous fat thickness at selected anatomic locations. Standardized measurement protocols enabled accurate subcutaneous adipose tissue (SAT) patterning in various populations (e.g., athletes, children, adults, and patients with anorexia nervosa). Further research is warranted to establish clinically relevant cutoff values. US-derived SAT thicknesses can also provide whole-body fat estimates of fat mass (FM), fat-free mass (FFM), and body fat percentage (%BF). To this end, prediction formulas were developed to ensure agreement with criterion measures given by laboratory techniques, or multicompartment models based on combinations thereof. The resulting assessments of global adiposity were reliable but inaccurate in certain populations (e.g., overweight and obese). Nevertheless, due to its high reliability, US might be used to track changes in body fat content during nutritional and/or lifestyle interventions. Future investigations will be needed to evaluate its accuracy in this respect and to improve the validity of whole-body fat estimation compared to multicompartment models.

The impact of HPV/HIV co-infection on immunosuppression, HPV genotype, and cervical cancer biomarkers

BACKGROUND

Human papillomavirus (HPV) and human immunodeficiency virus (HIV) co-infection present a significant impact on women's health globally, especially in immunocompromised individuals. HIV-induced immunosuppression promotes the persistence of high-risk HPV infection and increased the progression to cervical cancer. The aim of this systematic review was to assessed the impact of HPV/HIV co-infection on the prevalence and distribution of HR-HPV genotypes, the level of immunosuppression and expression of cervical cancer biomarkers.

METHOD

The article selection method for this review was based on the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The total of eighty-four (84) articles from standard electronic databases mainly Web of Science, PubMed, and Scopus were extracted and reviewed. The articles were published in English between 2008 and 2024 and comprised a total of 80023 participants.

RESULTS

The HR-HPV genotypes reported across various studies include HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 54, 56, 58, 59, 66, 68, 70, 73, and 82. Among HIV positive individuals, the most common circulating HR-HPV genotypes were HPV16, 18, 45, 35, and 58, accounted for 11%, 10%, 9%, 8%, and 8% of cases, respectively. Approximately 29.1% and 30.0% of patients had CD4 counts of 200-400 cells/L and 300-400 cells/L, respectively. The most commonly reported cervical cancer biomarkers were p16INK4a and Ki-67, according to the analysis.

CONCLUSION

The findings indicate high prevalence of multiple HR-HPV genotypes among HIV positive individuals, indicating the impact of HPV/HIV co-infection on immunosuppression and persistence of HPV infection. The expression of cervical cancer biomarker such as p16INK4a and Ki-67 emphasized target screening and early detection strategy in high-risk population. However, there was no direct impact of HPV/HIV co-infection reported on these biomarkers and required to be studied more especially in people living with HIV.

Progress on mitochondria and hair follicle development in androgenetic alopecia: relationships and therapeutic perspectives

Hair loss has long been a significant concern for many individuals. Recent studies have indicated that mitochondria play a more crucial role in hair loss than previously recognized. This review summarizes the connection between mitochondrial dysfunction and hair follicle development, outlines the links between diseases related to mitochondrial disorders and hair issues, and highlights the influence of mitochondrial dysfunction on androgenetic alopecia. We discuss the cellular and signaling mechanisms associated with hair loss and examine how mitochondrial dysfunction, such as insufficient energy supply, signaling irregularities, protein/gene abnormalities, and programmed cell death, can hinder the normal proliferation, differentiation, and growth of hair follicle cells. Furthermore, we discuss current treatment approaches and potential innovative therapies, including mitochondrion-targeting drugs and advanced techniques that directly target hair follicle cells, providing fresh insights into the crucial role of mitochondria in maintaining hair follicle health and managing hair disorders. Furthermore, this review explores future therapeutic strategies and proposes that mitochondrial research could lead to groundbreaking treatments for hair loss, thus providing optimism and new avenues for the treatment of individuals experiencing hair loss. This review not only underscores the central importance of mitochondria in hair health but also emphasizes the importance of advancing research and treatment in this field.

Association between weekend catch-up sleep and depression in US adults

BACKGROUND

Depression is one of the most prevalent mental disorders and causes a serious economic and medical burden on society. This research assessed the correlation between weekend catch-up sleep (WCS) and depression in US adults aged ≥ 20 years.

METHODS

Cross-sectional data were obtained from individuals with complete WCS and Patient Health Questionnaire (PHQ-9) data who participated in the 2017-2020 National Health and Nutrition Examination Survey (NHANES). A logistic regression analysis was conducted to evaluate the possible independent conjunction between depression and WCS. Subgroup analysis and interaction tests have been carried out.

RESULTS

A total of 7,795 individuals with an average PHQ-9 level of 3.27 ± 4.25 were analyzed. The prevalence of depression was 9.11% overall, and participants in the quartile 3 (WCS 1-2 h) tended to have lowest rates of depression (Quartile 1: 9.49%; Quartile 2: 9.95%; Quartile 3: 7.03%; Quartile 4: 8.75%; p = 0.014). The incidence of depression was found to be less correlated with 1-2 h of WCS (OR = 0.74, 95% CI: 0.55, 0.99). Individuals with less than one hour or more than two hours of WCS did not have a significantly different risk of depression than individuals without WCS.

CONCLUSIONS

Moderate catch-up sleep on weekends was linked to a decreased likelihood of depression.

Obesity as a Risk Factor for Hyperglycemia, Electrolyte Disturbances, and Acute Kidney Injury in the Emergency Department

Background/Objectives: Obesity is a global health challenge linked to a higher risk of metabolic and cardiovascular complications. This study investigates the role of cardiovascular markers in predicting metabolic crises in obese patients, focusing on the prevalence and clinical implications of these markers. Methods: This retrospective cohort study included 433 patients presenting with metabolic crises at the Emergency Department of Timișoara Municipal Emergency Hospital between 2019 and 2024. Patients were classified into obese (n = 161) and non-obese (n = 272) groups, with obesity further stratified into four grades based on body mass index (BMI). Cardiovascular markers, including NT-proBNP, troponin I, CRP, CK-MB, and D-dimer, alongside metabolic parameters, were analyzed. Results: Metabolic crises were significantly more prevalent in obese patients in all metabolic emergencies: hyperglycemia (27.9% vs. 11.0%, p < 0.001), electrolyte imbalance (23.6% vs. 9.2%, p < 0.001), and acute kidney injury (AKI) (12.4% vs. 5.5%, p = 0.01). NT-proBNP levels independently predicted AKI in obese patients (adjusted OR: 1.14 per 1000 pg/mL, 95% CI: 1.10-1.19, p < 0.001), with excellent discriminatory power (AUC: 0.88). Troponin I and D-dimer were higher in hyperglycemia and electrolyte imbalance, respectively, emphasizing the role of cardiac stress and pro-thrombotic states. Inflammatory markers such as CRP were significantly associated with metabolic disturbances, supporting the contribution of systemic inflammation. Comorbidities, particularly heart failure and atrial fibrillation, further increased the risk of metabolic crises. Conclusions: Cardiovascular markers suggest potential utility for early risk stratification of metabolic crises in obese patients. However, further studies are needed to validate their clinical applicability and to establish standardized approaches for integrating these biomarkers into routine practice, especially in patients with advanced obesity grades.

Clustering-Based Identification of BMI-Associated Metabolites with Mechanistic Insights from Network Analysis in Korean Men

BACKGROUND

Epidemiological studies using metabolomics often encounter challenges due to metabolite profiles being influenced by multiple modifiable behavioral factors, including regular exercise, smoking, drinking, and weight control. This study aimed to identify modifiable behavioral factors reflected in metabolites by clustering subjects based on their metabolite profiles. Networks of metabolites were constructed to visualize their relationships and the differences between clustering groups.

METHODS

Sixty-four healthy men were included in this study. Information on regular exercise, smoking, and drinking was collected by questionnaires, and body mass index (BMI), an indicator of weight control, was calculated based on measured height and weight. Through targeted metabolomics, the concentrations of 149 metabolites were quantified. Subjects were clustered using the k-means method based on metabolite composition. Correlation-based networks were constructed for each cluster using Cytoscape software, followed by network analysis.

RESULTS

The subjects were divided into two clusters, with BMI identified as a distinguishing feature. Four lyso-phosphatidylcholines (PCs), six diacyl-PCs, and one acyl-alkyl-PC were positively associated with BMI. In the constructed network, acyl-alkyl-PCs exhibited the highest degrees, suggesting their central role in BMI-associated metabolic pathways.

CONCLUSIONS

These findings suggest that metabolites can reflect behavioral factors, with BMI exerting a significant influence on metabolite profiles, particularly through its associations with phosphatidylcholines.

The blood pressure-lowering property of subcutaneous semaglutide: a systematic review, meta-analysis, and meta-regression

PURPOSE

Semaglutide is a glucagon-like peptide (GLP1) receptor agonist with unprecedented weight-lowering and anti-hyperglycemic properties. Recent clinical trials reported that subcutaneous semaglutide can modulate blood pressure; however, its effect on blood pressure widely varied in different studies and different subgroups of patients.

METHODS

PubMed, Web of Science, Scopus, and the Cochrane Library were systematically searched from the inception to July 18, 2024. Due to high heterogeneity, a random-effects model was adopted to pool data.

RESULTS

Twenty clinical trials with 15,312 participants in the placebo group and 18,231 participants in the semaglutide group were included in this study. Subcutaneous semaglutide significantly decreased both systolic (WMD - 3.71 mmHg, 95% CI (-4.29, -3.13), I2: 50.2%) and diastolic (WMD - 1.10 mmHg, 95% CI (-1.58, -0.63), I2: 69.7%) blood pressure. Subgroup analyses indicated that the blood pressure-lowering property of subcutaneous semaglutide was greater among patients without diabetes, with lower baseline hemoglobin A1c (HbA1c), baseline body mass index (BMI) greater than 35 kg/m2, dose of semaglutide more than 1 mg/week, baseline systolic blood pressure equal or less than 130 mmHg, weight loss greater than 10 kg, and BMI reduction greater than 3 kg/m2. In addition, a treatment length of 50 to 100 weeks was associated with greater blood pressure-lowering effects in subgroup analysis. After adjusting for other factors, meta-regression revealed that placebo-adjusted weight change was independently correlated with the effect of semaglutide on systolic and diastolic blood pressure.

CONCLUSION

Subcutaneous semaglutide can significantly decrease systolic and diastolic blood pressure, particularly in selected groups of patients.

Subcutaneous and Visceral Adipose Tissue Reference Values From the Framingham Heart Study Thoracic and Abdominal CT

BACKGROUND

Computed tomography (CT) captures the quantity, density, and distribution of subcutaneous and visceral (SAT and VAT) adipose tissue compartments. These metrics may change with age and sex.

OBJECTIVE

The study aims to provide age-, sex-, and vertebral level-specific reference values for SAT on chest CT and for SAT and VAT on abdomen CT.

MATERIALS AND METHODS

This secondary analysis of an observational study describes SAT and VAT measurements in participants of the Framingham Heart Study without known cancer diagnosis who underwent at least 1 of 2 CT examinations between 2002 and 2011. We used a previously validated machine learning-assisted pipeline and rigorous quality assurance to segment SAT at the fifth, eighth, and tenth thoracic vertebra (T5, T8, T10) and SAT and VAT at the third lumbar vertebra (L3). For each metric, we measured cross-sectional area (cm 2 ) and mean attenuation (Hounsfield units [HU]) and calculated index (area/height 2 ) (cm 2 /m 2 ) and gauge (attenuation × index) (HU × cm 2 /m 2 ). We summarized body composition metrics by age and sex and modeled sex-, age-, and vertebral level-specific reference curves.

RESULTS

We included 14,898 single-level measurements from up to 4 vertebral levels of 3797 scans of 3730 Framingham Heart Study participants (1889 [51%] male with a mean [standard deviation] age of 55.6 ± 10.6 years; range, 38-81 years). The mean VAT index increased with age from 65 (cm 2 /m 2 ) in males and 29 (cm 2 /m 2 ) in females in the <45-year-old age group to 99 (cm 2 /m 2 ) in males and 60 (cm 2 /m 2 ) in females in >75-year-old age group. The increase of SAT with age was less pronounced, resulting in the VAT/SAT ratio increasing with age. A free R package and online interactive visual web interface allow access to reference values.

CONCLUSIONS

This study establishes age-, sex-, and vertebral level-specific reference values for CT-assessed SAT at vertebral levels T5, T8, T10, and L3 and VAT at vertebral level L3.

Cyclosorus terminans extract mitigates submandibular gland changes associated with high-fat diet consumption in male rats

OBJECTIVES

To investigate whether the prophylactic effect of Cyclosorus terminans extract mitigates metabolic impairment and submandibular gland changes, as indicated by increased aquaporin5 expression, decreased fibrosis, oxidative stress and inflammation, improved mitochondrial homeostasis/dynamics, and decreased cell death in the submandibular glands of high-fat diet (HFD)-feeding rats.

METHODS

Thirty-two male Wistar rats were assigned to either a normal diet (ND) as control rats (n=8) or a HFD (n=24) for 12 weeks. The HFD-treated rats were divided into 3 subgroups to receive either: 1) vehicle (HDV), 2) Cyclosorus terminans at a dose of 100 mg/kg/d (HF100), or 3) Cyclosorus terminans at a dose of 200 mg/kg/d (HF200). At week 13, metabolic parameters, systemic oxidative stress, and submandibular gland parameters were assessed.

RESULTS

Twelve weeks of HFD-feeding rats induced obese-insulin resistance and submandibular gland changes. Both HF100- and HF200-treated groups improved metabolic parameters and prevented gland changes by reducing fibrosis (TGF-β and p-38), malondialdehyde levels, inflammation (TNF-α, NF-κB, and Ifng), and cell death markers (Caspase 3, GSDMD, and MLKL). Both treatments supported balanced mitochondrial homeostasis/dynamics, as indicated by regulating related genes (Cpt1b, Ndufb8, Mfn1, Mfn2, Opa1, and Dnm1l). However, only the HF200-treated rats restored aquaporin-5 and antioxidants (SOD2 and GPX4) expression to control levels.

CONCLUSIONS

Cyclosorus terminans mitigates metabolic disturbances and submandibular gland changes in HFD-feeding rats. The high dose was more effective, improving gland function by increasing aquaporin5 and antioxidants. These results suggest Cyclosorus terminans may be a promising therapeutic for metabolic disturbances and submandibular gland changes in obese-insulin resistant patients.

Long-Term Clinical and Economic Effects of Switching to Once-Weekly Semaglutide from Other GLP-1 RAs Among Patients with Type 2 Diabetes in China: A Modeling Projection Study

INTRODUCTION

Previous studies, using clinical trial data, demonstrated that once-weekly (OW) semaglutide is dominant versus other glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in China. This study aims to evaluate the long-term clinical and economic effects of switching to OW semaglutide from other GLP-1 RAs among patients with type 2 diabetes mellitus (T2DM) in China.

METHODS

The Institute of Health Economics Diabetes Cohort Model (IHE-DCM) was used to project life expectancy, quality-adjusted life years (QALYs), and total direct medical cost over 40 years from a Chinese healthcare system perspective. Baseline characteristics, clinical effectiveness, and the treatment dose of OW semaglutide were derived from previously real-world studies. Patients were assumed to switch to semaglutide or continue previous GLP-1 RAs for 3 years and change to intensive therapy. Drug prices were based on the median bidding price in January 2024 in China. Costs of other GLP-1 RAs were calculated on the basis of their market share in China. All costs were accounted as 2023 Chinese yuan (CNY). A discount of 5% was applied. One-way sensitivity analyses and probabilistic sensitivity analyses were used to test the robustness of the base-case result.

RESULTS

The results show that switching to OW semaglutide from other GLP-1 RAs among patients with T2DM in China can improve life expectancy by 0.02 years and afford an additional 0.12 QALYs per patient. Meanwhile, switching to OW semaglutide is associated with decreased total lifetime direct medical costs of 4204 CNY per patient, mainly resulting from savings in microvascular costs (2214 CNY) and macrovascular costs (1228 CNY). Sensitivity analyses show the robustness of modeling projection findings.

CONCLUSION

Based on real-world data from China, this modeling projection study demonstrates that switching to OW semaglutide from other GLP-1 RAs can have better clinical and economic effects for patients with T2DM in China, indicating it as a dominant treatment choice.

Determining Insulin Resistance Cutoffs in Mexican Adults: Percentile Distribution vs. Receiver Operating Characteristic Curve Analysis

Introduction Insulin resistance (IR) plays a key role in the development of metabolic syndrome (MetS), type 2 diabetes, and cardiovascular disease. The Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) is widely used to estimate IR, but there is no consensus on the optimal cutoff values for identifying individuals at risk. This study aims to compare two methodologies, percentile distributions and receiver operating characteristic (ROC) curve analysis, for determining optimal HOMA-IR cutoff values in a population from Mexico City. Methods This cross-sectional study included 765 adults recruited from a hospital outpatient clinic in Mexico City. Participants were divided into two groups: a reference group of individuals with healthy weight and fasting plasma glucose and a MetS group of overweight or obese individuals classified based on the presence or absence of MetS. HOMA-IR values were analyzed using the 75th percentile in the reference group and ROC curve analysis in the MetS group. Optimal cutoffs were determined using the Youden index. Results We include a total of 765 patients, 218 subjects in the reference group and 547 for the ROC curve analysis. HOMA-IR percentiles 75th and 90th were 2.72 and 3.71, respectively. ROC curve analysis yielded higher cutoff values for MetS diagnosis than the percentile-based method. The percentile-based approach allowed for earlier identification of individuals at risk, including those without clinical manifestations of MetS. Conclusions This study highlights the variability in HOMA-IR cutoff values across methodologies and emphasizes the importance of population-specific reference values. A percentile-based approach proves effective for early detection of IR, facilitating preventive interventions during the preclinical stage. These findings support using percentile-based cutoffs as a practical tool for improving risk assessment and guiding clinical decision-making.

Kidney fat by magnetic resonance spectroscopy in type 2 diabetes with chronic kidney disease

BACKGROUND AND HYPOTHESIS

The kidneys may be susceptible to ectopic fat and its lipotoxic effects, disposing them to chronic kidney disease (CKD) in type 2 diabetes (T2D). We investigated whether the kidney parenchyma fat content and kidney sinus fat volume would be higher in persons with T2D and CKD.

METHODS

Cross-sectional study including 29 controls, 27 persons with T2D and no CKD, and 48 persons with T2D and early CKD (urine albumin creatinine ratio (UACR) ≥ 30 mg/g). Kidney parenchyma fat content and kidney sinus fat volume were assessed using magnetic resonance spectroscopy and Dixon scans respectively.

RESULTS

In the control, T2D without CKD and T2D with CKD groups, respectively, median [1st - 3rd quartile] UACR was 5 [4 - 6], 6 [5 - 10] and 95 [43 - 278] mg/g. and mean ± standard deviation estimated glomerular filtration rate was 89 ± 11, 94 ± 11 and 77 ± 22 ml/min/1.73m2. Kidney parenchyma fat content was, respectively, 1.0 [0.5-2.4], 0.7 [0.2-1.2], 1.0 [0.3-2.0] % (p = 0.26). Kidney sinus fat volume was 2.8 [1.6-7.6], 8.0 [4.7-11.3], 10.3 [5.7-14.0] ml (p < 0.01). Around 90 % of T2D participants received a sodium-glucose cotransporter-2 inhibitor or glucagon-like peptide-1 receptor agonist.

CONCLUSIONS

In a setting of modern, multifactorial T2D management, kidney parenchyma fat content, evaluated with magnetic resonance spectroscopy, was similar among healthy controls and persons with T2D irrespective of CKD status. Still, kidney sinus fat volume was higher in the presence of T2D and higher still with CKD.

Effects of glucagon-like peptide-1 receptor agonists on blood pressure in overweight or obese patients: a meta-analysis of randomized controlled trials

INTRODUCTION

Glucagon-like peptide-1 receptor agonists are novel medications with proven efficacy in treating type 2 diabetes mellitus, and are increasingly being used for weight loss. They may potentially have benefit in treating metabolic disorders; however, evidence is sparse with regards to treating high blood pressure (BP). We performed a systematic review, meta-analysis and meta-regression investigating the efficacy of GLP-1 RAs in lowering BP in obese or overweight patients.

METHODS

Three electronic databases (PubMed, EMBASE, and CENTRAL) were systematically searched for randomized controlled trials (RCTs) published from inception to 13 February 2024. Pair-wise meta-analysis and random effects meta-regression models were utilized. Fixed effects meta-analysis was used to unify treatment effects across different GLP-1 RA doses.

RESULTS

We included a total of 30 RCTs with a combined population of 37 072 patients. GLP-1 RAs demonstrated a mean systolic BP (SBP) reduction of -3.37 mmHg [95% confidence interval (CI) -3.95 to -2.80] and a mean diastolic BP (DBP) reduction of -1.05 mmHg (95% CI -1.46 to -0.65) compared with placebo. This effect was consistent across subgroups for diabetic status, formulation of GLP-1 RA, follow-up duration and route of administration for both SBP and DBP, with the exception of subgroups investigating exenatide. Meta-regression suggested no significant correlation between BP reduction and baseline characteristics such as age, percentage of male patients, HbA1c, weight, BMI, and percentage of patients with hypertension.

CONCLUSION

Our meta-analysis suggests significant BP reduction benefits from GLP-1 RA use in obese or overweight patients, consistent across diabetic status, duration of treatment, and across route of administration.

Effect of semaglutide 2.4 mg on use of antihypertensive and lipid-lowering treatment in five randomized controlled STEP trials

OBJECTIVE

The objective of this study was to assess antihypertensive and lipid-lowering treatment changes in participants receiving semaglutide 2.4 mg versus placebo across pooled populations from five Semaglutide Treatment Effect in People with Obesity (STEP) trials.

METHODS

Efficacy and safety of semaglutide 2.4 mg were evaluated in the STEP clinical trials. In this post hoc analysis, STEP 1, 3, 6, and 8 (which included people with overweight or obesity) and, separately, STEP 2 and 6 (which included people with overweight or obesity and type 2 diabetes) were pooled for analysis. Changes in antihypertensive or lipid-lowering treatment intensity from randomization to end of treatment were evaluated.

RESULTS

In both pooled samples, a higher proportion of participants in the semaglutide 2.4 mg group versus placebo underwent antihypertensive or lipid-lowering treatment intensity reduction by end of treatment. A smaller proportion underwent antihypertensive or lipid-lowering treatment intensification by end of treatment in the semaglutide 2.4 mg group of both samples versus placebo. In participants receiving antihypertensive or lipid-lowering medications in both samples, greater numeric reductions in body weight were observed in the semaglutide 2.4 mg group versus placebo.

CONCLUSIONS

These results support a relationship between semaglutide 2.4 mg treatment of overweight and obesity and reduced need for antihypertensive and lipid-lowering treatment, facilitating treatment intensity reduction/discontinuation and abating treatment intensification.

The added value of an AI-based body composition analysis in a lung cancer screening population: preliminary results

BACKGROUND AND AIMS

Body composition has been linked with clinical and prognostic outcomes in patients with cancer and cardiovascular diseases. Body composition analysis in lung cancer screening (LCS) is very limited. This study aimed at assessing the association of subcutaneous fat volume (SFV) and subcutaneous fat density (SFD), measured on chest ultra-low dose computed tomography (ultra-LDCT) images by a fully automated artificial intelligence (AI)-based software, with clinical and anthropometric characteristics in a LCS population.

METHODS AND RESULTS

Demographic, clinical, and dietary data were obtained from the written questionnaire completed by each participant at the first visit, when anthropometric measurements, blood sample collection and chest ultra-LDCT were performed. Images were analyzed for automated 3D segmentation of subcutaneous fat and muscle. The analysis included 938 volunteers (372 females); men with a smoking history of ≥40 pack-years had higher SFV (p = 0.0009), while former smokers had lower SFD (p = 0.0019). In female participants, SFV and SFD differed significantly according to age. SFV increased with rising BMI, waist circumference, waist-hip ratio, and CRP levels ≥2 mg/L (p < 0.0001), whereas SFD decreased with rising BMI, waist circumference, waist-hip ratio, and CRP levels ≥2 mg/L (p < 0.001) in both sexes. SFV was associated with glycemia and triglycerides levels (p = 0.0067 and p=<0.0001 in males, p = 0.0074 and p < 0.0001 in females, respectively), while SFD with triglycerides levels (p < 0.0001).

CONCLUSION

We observed different associations of SFV and SFD with age and smoking history between men and women, whereas the association with anthropometric data, CRP, glycemia and triglycerides levels was similar in the two sexes.

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.

Mesenchymal stem cell-derived protein extract induces periodontal regeneration

BACKGROUND

Periodontal disease is characterized by chronic inflammation and destruction of supporting periodontal tissues, ultimately leading to tooth loss. In recent years, "cell-free treatment" without stem cell transplantation has attracted considerable attention for tissue regeneration. This study investigated the effects of extracts of mesenchymal stem cells (MSC-extract) and their protein components (MSC-protein) on the proliferation and migration of periodontal ligament (PDL) cells and whether MSC-protein can induce periodontal regeneration.

METHODS

MSC-extract and MSC-protein were obtained by subjecting mesenchymal stem cells (MSCs) to freeze-thaw cycles and acetone precipitation. Cell proliferation was examined using a WST-8 assay and Ki67 immunostaining, and cell migration was examined using Boyden chambers. The MSC-protein content was analyzed using liquid chromatography-mass spectrometry, protein arrays, and enzyme-linked immunosorbent assays (ELISAs). Gene expression in MSC-protein-treated PDL cells was examined using RNA-sequencing and Gene Ontology analyses. The regenerative potential of MSC-protein was examined using micro-computer tomography (CT) and histological analyses after transplantation into a rat periodontal defect model.

RESULTS

MSC-extract and MSC-protein promoted the proliferation and migration of PDL cells. Protein array and ELISA revealed that MSC-protein contained high concentrations of basic fibroblast growth factor (bFGF) and hepatocyte growth factor (HGF). Exogenous bFGF promoted the proliferation and migration of PDL cells. Furthermore, the transplantation of MSC-protein enhanced periodontal tissue regeneration with the formation of new alveolar bone and PDLs.

CONCLUSIONS

These results indicate that the MSC-protein promotes the proliferation and migration of PDL cells and induces significant periodontal tissue regeneration, suggesting that the MSC-protein could be used as a new cell-free treatment for periodontal disease.

Association of sleep timing, sleep duration, and sleep latency with metabolic syndrome in middle-aged adults in Korea: A cross-sectional and longitudinal study

OBJECTIVE

Sleep is a potential risk factor for metabolic syndrome. We investigated the associations of various sleep characteristics with the status and incidence of metabolic syndrome in middle-aged Koreans.

METHODS

Using data from a community-based Korean Medicine Daejeon Citizen Cohort study on participants aged 30-50years, cross-sectional (n = 1984) and longitudinal (n = 1216, median follow-up: 2.1years) analyses were performed. To study the association of metabolic syndrome and five components with various sleep characteristics, measured using the Pittsburgh Sleep Quality Index, we used Poisson and logistic regression and Cox proportional hazard regression analyses, adjusting for covariates.

RESULTS

Of 1984 participants, 66%, 19%, and 15% belonged to the non-metabolic syndrome, pre-metabolic syndrome, and metabolic syndrome groups, respectively. After covariate adjustments, the pre-metabolic syndrome group was associated with late mid-sleep time (≥5:00; prevalence ratios 1.61, 95% confidence interval 1.01-2.54) and late bedtime (≥2:00; prevalence ratios 1.55, 95% confidence interval 1.03-2.34), and the metabolic syndrome group was associated with long sleep latency (prevalence ratios 1.33, 95% confidence interval 1.03-1.73), poor sleep quality (prevalence ratios 1.38, 95% confidence interval 1.07-1.78), and early wake time (<6:00; prevalence ratios 1.29, 95% confidence interval 1.01-1.63). Longitudinal analysis of participants without metabolic syndrome at baseline indicated a significant increase in metabolic syndrome risk associated with very short sleep duration (<6 hours; hazard ratio 1.72, 95% confidence interval 1.06-2.79), long sleep latency (>30 minutes; hazard ratio 1.86, 95% confidence interval 1.1-3.12), and early wake time (<6:00 o'clock; hazard ratio 1.73, 95% confidence interval 1.01-2.97).

CONCLUSION

Sleep characteristics, such as short duration, long latency, and early wake time, were associated with an increased risk of metabolic syndrome in middle-aged adults.

Oral Supplementation with l-Cystine, Serenoa repens, Cucurbita pepo, and Pygeum africanum in Chronic Telogen Effluvium and Androgenetic Alopecia: A Double-Blind, Placebo-Controlled, Randomized Clinical Study

Introduction

Chronic telogen effluvium (TE) and androgenetic alopecia represent two prevalent forms of hair loss that can significantly impact individuals' quality of life. Insufficiency of essential micronutrients has been associated with hair loss. The objective of this study was to evaluate the safety and efficacy of an oral supplement containing l-Cystine, Serenoa repens, Cucurbita pepo, Pygeum africanum, vitamins, and micronutrients in chronic TE (CTE) and androgenetic alopecia (AGA).

Methods

Eighty patients of both sexes aged 18-60 years with CTE or AGA were randomized to receive one capsule daily of the oral supplement or placebo for 6 months. Dermatological evaluations, clinical pictures and phototrichograms were done at baseline, 3 months and 6 months. The overall hair volume and appearance were assessed before and after treatment as well as subject's self-assessment via standardized questionnaire.

Results

Hair density increased by 9.9 hairs/cm2 after 3 months and 12.3 hairs/cm2 after 6 months in the oral supplement group and it is statistically significant when compared to placebo. Overall hair volume after 1, 3, and 6 months is better in the supplement group than in the placebo group. The oral supplement was well tolerated. No moderate or severe adverse events were reported.

Conclusion

Oral supplementation can increase hair density, anagen hairs, and overall hair appearance in patients with AGA or CTE.

Association between weight reduction achieved with tirzepatide and quality of life in adults with obesity: Results from the SURMOUNT-1 study

AIMS

The SURMOUNT-1 trial investigated effects of tirzepatide, a glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, on body weight in participants with obesity or overweight. This analysis evaluated changes in patient-reported outcomes (PROs) assessing physical function, psychosocial well-being, and overall health aspects of participants' health-related quality of life (HRQoL) in SURMOUNT-1.

METHODS

PRO instruments included the Impact of Weight on Quality of Life-Lite Clinical Trials version (IWQOL-Lite-CT), Short Form Survey-36 version 2 (SF-36v2) and EQ-5D-5L. Scores were analysed by treatment group and by categorical degree of weight reduction group: >0 to <5%, ≥5 to <10%, ≥10 to <20% and ≥20%. Relevant PROs were evaluated for participants with or without physical or psychosocial limitations at baseline, as measured by Patient Global Impression of Status for physical activity (PGIS) and Patient Health Questionnaire-2 (PHQ-2), respectively.

RESULTS

All tirzepatide groups demonstrated significant improvements in PRO scores versus placebo. There was a consistent trend of incremental PRO improvement with greater degrees of weight reduction, starting from ≥5% weight reduction. Participants achieving ≥20% weight reduction demonstrated the greatest changes from baseline to week 72 (SF-36v2 Physical Component Summary, 4.60; SF-36v2 Mental Component Summary, 0.80; IWQOL-Lite CT Total score, 24.7). Those with baseline physical and psychosocial limitations experienced greater improvements than those without.

CONCLUSIONS

Tirzepatide treatment was associated with improved HRQoL compared to placebo in people with overweight or obesity. Higher percentages of weight reduction were associated with greater improvements. Clinical trial registration number for SURMOUNT-1: NCT04184622.

The Association Between Physical Activity and Uterine Leiomyoma and Its Symptoms: A Systematic Review and Meta-Analysis

Background and Aims

Although many studies have focused on the impact of physical activity on hormone-mediated tumors, its effect on uterine leiomyomas (UL) remains unclear. This systematic review synthesizes the scientific evidence on the role of physical activity in the occurrence and symptomatology of UL while putting forward a research agenda.

Methods

The PubMed, Scopus, Web of Science, SciELO, and Cochrane Library databases were searched for studies published up to January 10, 2025. The Newcastle‒Ottawa Scale was used to assess study quality, and the GRADE tool was used to determine evidence certainty. Dear-Simonian and Laird random effects models were used to estimate the pooled odds ratio (OR) and 95% confidence interval (CI) of the association between physical activity and UL. The PRISMA guidelines were followed.

Results

Fifteen studies were included (three cross-sectional, 6 case-control, and 6 cohort studies), of which 11 were considered in the meta-analysis. The difference between women who did and did not regularly practice physical activity (OR = 0.93; 95% CI: 0.82, 1.05; I 2 = 77.6%, n = 8 studies) in the likelihood of having UL did not meet conventional levels of statistical significance. Moreover, those women who engaged in more intense physical activity were less likely to have UL (OR = 0.86; 95% CI: 0.75, 0.99; I 2 = 80.5%, n = 5 studies) than those who engaged in less intense physical activity.

Conclusion

Increased physical activity is associated with a slight decrease in the risk of UL and may provide relief from associated symptoms. Since current evidence is still limited to supporting specific physical activity recommendations, a research agenda is proposed for future studies on this subject.

PROSPERO Registration

CRD42021247505.

Trends in Allergic Sensitization and Diseases in the Korean General Population Over a 9-Year Period

OBJECTIVES

The prevalence of allergic sensitization and diseases varies over time due to changes in climate, environment, and lifestyle. This study analyzed changes in sensitization to house dust mites (HDM) and dogs, as well as the prevalence of allergic diseases in the Korean general population over a 9-year period and identified contributing factors.

METHODS

This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey conducted in 2010 and 2019. Participants were aged ≥10 years, with the analysis stratified by adolescents (10-18 years) and adults (≥19 years). We evaluated the prevalence of allergic sensitization and diseases and examined links to clinicodemographic factors across the two survey years. Multivariate logistic regression was performed to evaluate the association between sensitization and clinicopathological factors.

RESULTS

In total, 4,084 participants (2010: n=2,019, 2019: n=2,065) were enrolled. In 2010, HDM sensitization was 36.9%, declining to 36.6% in 2019. Dog sensitization decreased from 6.1% in 2010 to 5.8% in 2019. There were no significant differences between the two years among total participants; however, dog sensitization increased significantly among adolescents (2010: 8.7% vs. 2019: 15.3%; P=0.027). In 2010, HDM sensitization was negatively associated with urban residence (odds ratio [OR], 0.76; 95% CI, 0.60-0.96) and apartment dwelling (OR, 0.78; 95% CI, 0.64-0.95) but was without significance in 2019. In adolescents, dog sensitization was strongly correlated with urban residence (OR, 8.06; 95% CI, 1.53-42.49) in 2010, whereas HDM sensitization was associated with obesity (OR, 2.02; 95% CI, 1.04-3.91) in 2019. In adults, heavy drinking was linked to dog sensitization (OR, 2.35; 95% CI, 1.20-4.62) in 2010 and HDM sensitization in 2019 (OR, 1.44; 95% CI, 1.03-2.02).

CONCLUSION

The prevalence of HDM sensitization remained stable over 9 years, while dog sensitization increased in adolescents. The factors associated with sensitization differed between age groups and years. Understanding these trends and related factors in the general population can help healthcare providers develop new strategies to reduce allergic sensitization and diseases.

Sex-Specific Obesity Paradox in Critically Ill Patients With Severe Acute Kidney Injury: A Retrospective Analysis

OBJECTIVES

Although obesity is typically correlated with adverse outcomes in various diseases, certain acute critical illnesses exhibit a phenomenon known as the obesity paradox. This study evaluated sex-specific differences in the prognostic implications of the body mass index (BMI) of patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).

DESIGN

A multicenter retrospective cohort study.

SETTING

Data from eight tertiary hospitals in Korea.

PATIENTS

A total of 3805 critically ill patients receiving CRRT. Patients were categorized into four BMI groups: underweight, normal weight, overweight, and obese.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

There were 2308 male and 1497 female patients. The 90-day mortality risk significantly differed among BMI groups in the overall patient population and the male subpopulation but not the female subpopulation. Following adjustment for confounding variables, the 90-day mortality risk was higher in the underweight group than in the obese group (hazard ratio [HR], 1.20; 95% CI, 1.05-1.36; p = 0.006). Among male patients, the 90-day mortality risk was higher in both the underweight and normal weight groups than in the obese group (underweight: HR, 1.30; 95% CI, 1.10-1.53; p = 0.002 and normal weight: HR, 1.18; 95% CI, 1.04-1.35; p = 0.010); however, no such association was observed among female patients. Subgroup analysis demonstrated the obesity paradox in male patients of old age, with septic AKI, or with low albumin levels.

CONCLUSIONS

There were sex differences in the association between BMI and mortality in critically ill patients with severe AKI. Although the precise distribution of fat mass and muscle mass was not identified, obese male patients had a more favorable prognosis, which was not evident among female patients. These findings highlight the importance of considering sex-specific factors in understanding the complex relationship between obesity and mortality in critically ill patients with AKI.

Artificial intelligence-based body composition analysis using computed tomography images predicts both prevalence and incidence of diabetes mellitus

AIM/INTRODUCTION

We assess the efficacy of artificial intelligence (AI)-based, fully automated, volumetric body composition metrics in predicting the risk of diabetes.

MATERIALS AND METHODS

This was a cross-sectional and 10-year retrospective longitudinal study. The cross-sectional analysis included health check-up data of 15,330 subjects with abdominal computed tomography (CT) images between January 1, 2011, and September 30, 2012. Of these, 10,570 subjects with available follow-up data were included in the longitudinal analyses. The volume of each body segment included in the abdominal CT images was measured using AI-based image analysis software.

RESULTS

Visceral fat (VF) proportion and VF/subcutaneous fat (SF) ratio increased with age, and both strongly predicted the presence and risk of developing diabetes. Optimal cut-offs for VF proportion were 24% for men and 16% for women, while VF/SF ratio values were 1.2 for men and 0.5 for women. The subjects with higher VF/SF ratio and VF proportion were associated with a greater risk of having diabetes (adjusted OR 2.0 [95% CI 1.7-2.4] in men; 2.9 [2.2-3.9] in women). In subjects with normal glucose tolerance, higher VF proportion and VF/SF ratio were associated with higher risk of developing prediabetes or diabetes (adjusted HR 1.3 [95% CI 1.1-1.4] in men; 1.4 [1.2-1.7] in women). These trends were consistently observed across each specified cut-off value.

CONCLUSIONS

AI-based volumetric analysis of abdominal CT images can be useful in obtaining body composition data and predicting the risk of diabetes.

Metabolic Syndrome in the Amazon: Customizing Diagnostic Methods for Urban Communities

Background/Objectives: Metabolic syndrome is a significant public health issue, particularly in urbanizing regions like the Peruvian Amazon, where lifestyle changes have increased the prevalence of metabolic disorders. This study aimed to develop and validate a simple, cost-effective diagnostic model for early detection of metabolic syndrome in the urban population of San Juan Bautista, Iquitos. Methods: A cross-sectional study was conducted with 251 adults aged over 18 years. Data collection included anthropometric measurements, body composition analysis, and biochemical assessments. Logistic regression analyses identified key predictors of metabolic syndrome, and clinical decision trees were developed to enhance diagnostic accuracy. Results: The prevalence of metabolic syndrome was 47.9%. Systolic blood pressure, triglycerides, and very-low-density lipoprotein cholesterol were the strongest predictors. The most effective diagnostic model, combining very-low-density lipoprotein cholesterol and systolic blood pressure, achieved a sensitivity of 91.6% and a specificity of 78.5%, demonstrating high diagnostic accuracy. Conclusions: The proposed model offers a practical, low-cost tool for early detection of metabolic syndrome in resource-limited urban settings. However, its findings are limited by the small sample size and the lack of external validation, requiring further studies to confirm its generalizability and applicability to other populations. Its implementation in primary healthcare could facilitate timely interventions, reducing the risk of chronic diseases in vulnerable populations.

Methodologies and characteristics of studies investigating the cost of the palliative phase of cancer: a systematic review

PURPOSE

Improvements in the treatment of advanced cancer have increased life expectancy but have also increased the costs to healthcare systems, patients and their families. A systematic review is needed to summarize research work on the cost of cancer. The primary objective was to describe the characteristics and methodology of studies investigating the cost of cancer during the palliative phase. Secondary objectives were to assess whether palliative care interventions influence the costs of advanced cancer and to describe the costs explored and models used in cost-effectiveness studies.

METHOD

According to the PRISMA guideline (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), Pubmed, Web of Science, NHS, EconLit and Google Scholar databases were screened from 11/01/2020 to 03/01/2024. All types of methods about the costs of the palliative phase of solid cancer were accepted. Study characteristics, economic perspective, time horizon and the type of costs explored were collected.

RESULTS

Of the 498 studies identified, 66 were included in the final analysis. Most (60%) used a retrospective methodology. Almost all (65, 98%) studied direct costs, and only 12 (18%) studied indirect costs. No article assessed intangible costs or the total cost of the palliative phase of cancer. The payer's perspective was most commonly adopted (39, 59%). The time horizon was less than 6 months in most cases (41, 63%). Eighteen studies (86%) highlighted that PC interventions were cost-effective.

CONCLUSION

Existing evidence suggests that palliative care is cost-effective from the hospital and payer's perspective. More research is needed to evaluate the cost of informal caregiving and out-of-pocket expenses borne by patients.

Prevalence of cardiometabolic co-morbidities in patients with vs persons without chronic hepatitis B: The FitLiver cohort study

BACKGROUND

Chronic hepatitis B (CHB) affects > 300 million people worldwide. The combination of CHB and cardiometabolic co-morbidities increases the risk of liver-related morbidity and mortality. However, international guidelines for CHB treatment do not provide recommendations for follow-up examinations or treatment of patients with CHB and cardiometabolic comorbidities. In studies investigating cardiometabolic co-morbidity in patients with CHB, inconsistent findings have been observed, and both lower and higher prevalence of cardiometabolic co-morbidities compared to the general population have been reported. It is unclear whether patients with CHB living in Denmark have an increased prevalence of cardiometabolic co-morbidities.

AIM

To investigate the prevalence of cardiometabolic comorbidities in patients with CHB and matched non-CHB comparison group.

METHODS

We examined patients with CHB and age-, sex-, body mass index (BMI)-, and country-of-birth matched comparison group. Defining cardiometabolic co-morbidity: Obesity (BMI > 25 kg/m2/abnormal waist-to-hip ratio), metabolic dysfunction-associated steatotic liver disease (MASLD), hypercholesterolemia (total-cholesterol > 5 mmol/L/statin use), hypertension (systolic ≥ 135 mmHg/ diastolic ≥ 85 mmHg/antihypertensive medication) and type 2 diabetes (T2D) (2-hour oral glucose tolerance test glucose > 11.1 mmol/L/HbA1c > 48 mmol/mol/ antidiabetic medication). Physical activity was evaluated using maximal oxygen consumption (VO2max), activity monitors, and a questionnaire.

RESULTS

We included 98 patients with CHB and 49 persons in the comparison group. The two groups were well-matched, showing no significant differences in age, sex, BMI, country-of-birth, education, or employment. Among patients with CHB, the following prevalence of cardiometabolic co-morbidity was found: 77% were obese, 45% had MASLD, 38% had hypercholesterolemia, 26% had hypertension, and 7% had T2D, which did not differ significantly from the comparison group, apart from lower prevalence of hemoglobin A1c (HbA1c) ≥ 48 mmol/L or known T2D. Both groups had low VO2max of 27 mL/kg/minute in the patients with CHB and 30 mL/kg/minute in the comparison group, and the patients with CHB had a shorter self-assessed sitting time.

CONCLUSION

The patients with CHB and the comparison group were well-matched and had a similar prevalence of cardiometabolic comorbidities. Furthermore, both groups had low levels of physical fitness.

Healthy lifestyle before and during pregnancy to prevent childhood obesity: study protocol for a parallel group randomised trial - the PRE-STORK trial

INTRODUCTION

The global prevalence of people living with overweight has tripled since 1975 and more than 40% of Danish women enter pregnancy being overweight. With the increasing rates of obesity observed in children, adolescents and adults, there is an urgent need for preventive measures. Risk factors for childhood obesity include maternal overweight or obesity before conception and excessive weight gain during pregnancy. Interventions aimed at modifying maternal lifestyle during pregnancy have demonstrated minimal positive or no impact on the health of the children. The 'healthy lifestyle before and during pregnancy to prevent childhood obesity - the PRE-STORK trial' aims to provide insights into the effect of a lifestyle intervention initiated before conception and continued during pregnancy in women with overweight or obesity, on neonatal adiposity in their children.

METHODS AND ANALYSIS

In this randomised, two-arm, parallel-group, controlled trial, we will include 360 women with overweight or obesity (aged 18-40; body mass index 25-44 kg/m2) and their partners. The women will be randomised to receive either standard of care or a lifestyle intervention focused on preconception body weight reduction, regular physical exercise, healthy diet and support from a mentor before and during pregnancy. The primary outcome is the difference in neonatal adiposity measured in their children at birth. Children conceived during the trial will constitute a birth cohort, monitoring the effects on their health until the age of 18 years.

ETHICS AND DISSEMINATION

The trial has been approved by the Regional Committee on Health Research Ethics in the Capital Region of Denmark (identification number H-22011403) and will be conducted in agreement with the Declaration of Helsinki. All results, whether positive, negative and inconclusive, will be disseminated at national or international scientific meetings and in peer-reviewed scientific journals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov: NCT05578690 (October 2022).

Effect of long-term exercise on circulating ghrelin in overweight and obese individuals: a systematic review and meta-analysis

Objective

Ghrelin, also known as the "hunger hormone," is a pivotal hormone in controlling appetite, and it is the only known gastrointestinal hormone that promotes food intake, contributing to the regulation of energy balance and body weight. However, studies on the long-term effects of exercise on ghrelin levels in obese populations have shown conflicting results. This study aims to summarize RCT experiments exploring changes in ghrelin levels following long-term exercise in obese or overweight individuals through meta-analysis.

Methods

This study employed meta-analytical techniques, searching databases such as PubMed, Web of Science, and EMBASE, to gather research on exercise and ghrelin. The quality of the studies was assessed according to the Cochrane Handbook standards, and data analysis for ghrelin, BMI, and weight was performed using RevMan 5.4 and Stata 16.0 software. A total of 13 interventions involving 944 participants were included to systematically investigate the regulatory effects of exercise on ghrelin levels in obese and overweight individuals. Meta-analytical results were calculated using standardized mean differences (SMDs).

Results

Exercise interventions significantly increased ghrelin levels (SMD =1.16, 95% CI = 0.52 to 1.80, p < 0.0001), with high inter-study heterogeneity (I 2 = 90%). Subgroup analysis suggested that RT and AE + RT were more effective than AE. For BMI, exercise led to a significant reduction (SMD = -0.43, 95% CI = -0.69 to -0.16, p = 0.002), with low heterogeneity (I 2 = 21%). Similarly, exercise significantly reduced weight (SMD = -0.54, 95% CI = -0.98 to -0.11, p = 0.01), though with high heterogeneity (I 2 = 75%). These results suggest exercise effectively improves ghrelin levels, BMI, and weight.

Conclusion

Prolonged exercise interventions demonstrated a statistically significant effect on ghrelin levels. This indicates that exercise interventions can elevate ghrelin levels, which may be associated with reductions in BMI and weight.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, CRD42024588259.

The Effects of a Food Supplement, Based on Co-Micronized Palmitoylethanolamide (PEA)-Rutin and Hydroxytyrosol, in Metabolic Syndrome Patients: Preliminary Results

BACKGROUND

Metabolic syndrome (MetS) patients have impaired hypothalamic regulatory functions involved in food intake and energy expenditure and suffer from a state of meta-inflammation. Pre-clinical studies demonstrated that ultramicronized palmitoylethanolamide (PEA) acts both on the adipose tissue and the central nervous system, while hydroxytyrosol (HTyr) counteracts several types of dysmetabolism.

OBJECTIVES

The aim of our randomized crossover double-blind placebo-controlled pilot study was to evaluate the potential effects of a food supplement (FS) containing a co-micronized formulation of PEA and rutin along with HTyr, combined with a tailored calorie-controlled Mediterranean diet, in patients with MetS.

METHODS

Nineteen patients were enrolled and block-randomized to an eight-week MD together with the FS or placebo. After a two-week washout period, the treatments were reversed. Data on laboratory parameters and those detected by capillary sampling, anthropometry, body composition analysis, ultrasound examination, blood pressure monitoring, the 36-Item Short-Form Health Survey questionnaire, handgrip strength test, and physical performance tests were collected at each time point (protocol code R.S. 262.22, registered on 20 December 2022).

RESULTS

At the end of the study, patients supplemented with the FS showed a significant reduction in body weight, body mass index, fat mass, and inflammation biomarkers (CRP and ESR), compared to placebo-supplemented patients. In contrast, the fat-free mass, phase angle, and body cell mass were increased in FS compared to placebo patients.

CONCLUSIONS

Although preliminary, the results of our clinical study suggest that co-micronized PEA-rutin and HTyr may be of help against adiposopathy in patients with MetS.

The Impact of the Brain Wave Modulation Technique (BMW-T) on Heart Rate Variability: A Single Session for Short-Term Stress Reduction

Background: Recent advances in psychophysiology have underscored the importance of autonomic nervous system modulation in managing short-term stress. While several interventions have demonstrated efficacy in reducing short-term stress and anxiety symptoms, there remains a gap in understanding how different short-term techniques compare in terms of both psychological and physiological outcomes. This study investigated the effects of a single session of the Brain Wave Modulation Technique (BWM-T) compared with a psychoeducational session on short-term stress management. Methods: A total of 72 university students participated in this study (mean age = 27.5 years, 79% female). They were randomly assigned to either an experimental group (n = 36) receiving BWM-T or a control group (n = 36) receiving a standard psychoeducational short-term stress management session. Pre- and post-intervention measures included HRV parameters, perceived stress (using the Distress Thermometer, DT), and anxiety (using the STAI-Y State Anxiety Scale, S-ANX). Results: Both groups experienced significant reductions in perceived stress (DT: MD = 1.42, p < 0.001) and anxiety (S-ANX: MD = 6.93, p < 0.001). However, only the experimental group demonstrated physiological changes indicative of improved autonomic function: decreased low-frequency (LF) power (MD = -0.369, p < 0.05) and a lower LF/HF ratio (MD = -1.09, p < 0.05). These findings highlight the unique physiological benefits of BWM-T, beyond the general psychological improvements seen in both interventions. Conclusions: BWM-T appears to be a promising, effective short-term intervention for reducing short-term stress and enhancing autonomic regulation. Further studies are needed to evaluate its long-term effects and potential for broader implementation.

Case report: Long-term efficacy and safety of semaglutide in the treatment of syndromic obesity in Prader Willi syndrome - case series and literature review

Introduction

Prader-Willi syndrome (PWS) is the most prevalent cause of syndromic obesity. Obesity development in PWS is driven by dysfunction in neural pathways involved in satiety and reward, dysregulation in hormones regulating satiety and food intake, altered body composition and reduced energy expenditure, as well as the presence of various hormone deficiencies. As hyperphagia, satiety dysfunction and consequent food-seeking behaviors are intrinsic to PWS, obesity management can be challenging.

Case series

We present a long-term follow-up of treatment with GLP-1 receptor agonist (GLP-1 RA) semaglutide in three patients with PWS without diabetes, one of whom had previously undergone metabolic surgery. Semaglutide treatment at dosages from 0.5 mg to 2 mg weekly demonstrated variable efficacy, from preventing further weight gain in patient 1, to achieving weight loss of up to 14.4% and 11% relative to baseline, in Patient 2 and Patient 3. It was well tolerated, even after metabolic surgery.

Conclusion

Long-term randomized placebo-controlled trials with larger sample sizes are needed to provide stronger evidence on the long-term efficacy and safety of semaglutide for obesity treatment in PWS as well as explore the potential synergistic effects of GLP-1 RA treatment combined with other therapeutic interventions.

Investigating the role of the metabolic score for visceral Fat in assessing the prevalence of chronic kidney disease from the NHANES 1999-2018

This study investigates the association between the Metabolic Score for Visceral Fat (METS-VF) and chronic kidney disease (CKD), assessing METS-VF as a potential predictor of CKD risk. Utilizing data from the 1999-2018 National Health and Nutrition Examination Survey (NHANES), this cross-sectional study included 24,387 adult participants. Multivariable logistic regression, restricted cubic spline models, and threshold effect analyses were employed to explore the relationship. The results revealed a significant positive association, with multivariable logistic regression showing that each unit increase in METS-VF was associated with an 86% higher risk of CKD (OR: 1.86, 95% CI: 1.48-2.34). Critical METS-VF thresholds (6.10 and 7.55) were identified, at which CKD risk increased substantially. Subgroup analyses indicated that the association was particularly pronounced among older adults and males. These findings suggest that METS-VF is a reliable predictor for assessing CKD risk and that lifestyle interventions, including dietary modifications and exercise programs, may mitigate this risk.

Sex and gender differentials in the prevalence of obesity and its association with multimorbidity among reproductive-aged individuals in India

Introduction

The increase in the prevalence of obesity has become a common public health issue worldwide, with low- and middle-income countries (LMICs) like India witnessing an equal rise. It makes a considerable contribution to chronic diseases as it is a major risk factor for other chronic illnesses. Multimorbidity, or the presence of two or more chronic illnesses, is becoming more common in LMICs, resulting in poor health outcomes. However, research on obesity and multimorbidity in younger populations in LMICs is scarce, with most studies focusing on older persons. The study analyzed sex differences in the prevalence of obesity among reproductive-aged persons and its association with multimorbidity, as well as investigated their health-seeking behaviors.

Methods

Data from the National Family Health Survey (NFHS-5) involving 751,831 females and 100,656 males were analyzed. Multimorbidity was defined by the presence of two or more chronic conditions out of the eight included chronic conditions. Multivariable logistic regression was applied to identify factors associated with obesity.

Result

The prevalence of obesity was 48.90% (95% CI: 48.60-49.20%) among males and 57.10% (95% CI: 57.00-57.22%) among females. Waist-to-Hip Ratio (WHR) revealed higher obesity rates in females with multiple chronic conditions (70.8%) compared to males (65.1%). Males with multimorbidity had a 47% higher likelihood of having obesity (AOR: 1.47, 95% CI: 1.13-1.89, p < 0.003) compared to individuals without obesity.

Conclusion

The study highlights high obesity prevalence among reproductive-aged individuals in India, with females having higher obesity rates overall. However, males with multimorbidity exhibit a significantly greater likelihood of obesity than males without. These findings emphasize the need for gender-specific public health strategies addressing obesity and multimorbidity, including promoting healthier diets, increasing physical activity, and improving disease management for both women and men.

Epidemiological features of uterine fibroid-associated imaging changes in Chinese women of reproductive age: a retrospective study

OBJECTIVES

To investigate uterine fibroid (UF)-associated imaging changes, and their prevalence, incidence and potential risk factors in the Chinese population.

DESIGN

This was a retrospective observational study using health examination data.

SETTING

A physical examination centre in Nanchong, China, between October 2017 and December 2020.

PARTICIPANTS

A total of 33 915 Chinese women older than 15 years of age underwent uterine imaging during the study period.

PRIMARY AND SECONDARY OUTCOME MEASURES

This study identified entries of UF-associated imaging changes through a two-round expert consultation and calculated prevalence and incidence of UF-associated imaging changes. Logistic regression estimated the association (OR, 95% CI of body mass index, high blood pressure (HBP), blood lipid profile, and fasting blood glucose level) with UF-associated imaging changes. Age-stratified (≤40 years and >40 years) risks were ascertained.

RESULTS

Besides the entry 'Potential UF', 17 other entries of UF-associated imaging changes screened by the expert consultation were included, involving a total of 46 864 records (n=33 915), and crude prevalence=25.18%; crude incidence density/1000-woman-years=63.28. Incidence and prevalence increased with age during reproductive age (15-49 years) and decreased thereafter. The greatest burden was in women aged 40-54 years, the prevalence was 38.60%-45.38% and the incidence was 14.73%-17.96%. In the incident younger population (age ≤40 years), overweight (OR: 1.48, 95% CI 1.03 to 2.14) and HBP (OR: 2.16, 95% CI 1.10 to 4.24) were associated with a higher risk for UF-associated imaging changes; in the >40 years group, no association was observed.

CONCLUSION

UF incidence and prevalence in Asians were higher than previously reported, showed age-related increase in reproductive age, and UF incidence increased with overweight and HBP in ≤40-year-old participants. Variation in UF burden and factors with higher risk noted in different age ranges, and the correlations identified in younger women make it possible for early preventive measures for women with a higher risk of UF.

Income Dynamics and Risk of Colorectal Cancer in Individuals With Type 2 Diabetes: A Nationwide Population-based Cohort Study

BACKGROUND

Individuals with type 2 diabetes mellitus (T2DM) have increased colorectal cancer (CRC) risk, but it is unknown whether income dynamics are associated with CRC risk in these individuals. We examined whether persistent low- or high-income and income changes are associated with CRC risk in non-elderly adults with T2DM.

METHODS

Using nationally representative data from the Korean Health Insurance Service database, 1,909,492 adults aged 30 to 64 years with T2DM and no history of cancer were included between 2009 and 2012 (median follow-up of 7.8 years). We determined income levels based on health insurance premiums and assessed annual income quartiles for the baseline year and the four preceding years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for sociodemographic factors, CRC risk factors, and diabetes duration and treatment.

RESULTS

Persistent low income (ie, lowest income quartile) was associated with increased CRC risk (HR5 years vs 0 years 1.11; 95% CI, 1.04-1.18; P for trend = 0.004). Income declines (ie, a decrease ≥25% in income quantile) were also associated with increased CRC risk (HR≥2 vs 0 declines 1.10; 95% CI, 1.05-1.16; P for trend = 0.001). In contrast, persistent high income (ie, highest income quartile) was associated with decreased CRC risk (HR5 years vs 0 years 0.81; 95% CI, 0.73-0.89; P for trend < 0.0001), which was more pronounced for rectal cancer (HR 0.64; 95% CI, 0.53-0.78) and distal colon cancer (HR 0.70; 95% CI, 0.57-0.86).

CONCLUSION

Our findings underscore the need for increased public policy awareness of the association between income dynamics and CRC risk in adults with T2DM.

The comparison of post-proximal gastrectomy digestive tract reconstruction methods

OBJECTIVE

Proximal gastrectomy (PG) is commonly used to remove proximal gastric cancer leading to gastroesophageal reflux and requires digestive tract reconstruction. This study is to compare the performance of esophagogastrostomy (EG), jejunal interposition (JI), and double tract reconstruction (DTR) on post-PG reconstruction effectiveness.

METHODS

A retrospective study was conducted using the clinical data of 94 PG patients who underwent digestive tract reconstruction by EG (37 patients), JI (29 patients) or DTR (28 patients). The safety of the reconstruction procedure and the incidence of surgical complications were evaluated using the Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Questionnaire (GERD-Q) scale score, gastroscopy, barium meal examination of digestive tract, and 24-h pH monitoring.

RESULTS

The DTR group showed significantly lower GERD-Q scores (p < 0.05) and RSI scores (p < 0.05) compared to the EG and JI groups. This indicates that DTR is more effective in preventing reflux esophagitis. The pre- and post-surgical GERD-Q scores assessed by esophageal 24-h pH acidity measurements and Los Angeles Grading were reduced in all patient groups, with the DTR group showing better results than the other two (p < 0.05). The results of the EORTC QLQ-STO22 questionnaire indicated that the DTR group had a higher overall health status score than the other two groups (p < 0.001).

CONCLUSION

EG had a short surgical duration and less bleeding. JI reduced the prevalence of reflux esophagitis. DTR presented improved prevention of reflux esophagitis and enhanced quality of life.

Association between exclusive or dual use of combustible cigarettes and heated tobacco products and depressive symptoms

PURPOSE

Despite the advent of heated tobacco products (HTPs), their relationship to mental health remains unclear. This study aimed to determine associations between the use of combustible cigarettes (CCs) and HTPs with depressive symptoms.

METHODS

This descriptive-analytical cross-sectional study was conducted in March 2023. Using the 8th Korea National Health and Nutrition Examination Survey, 5,349 adults aged 19 years or older were classified into four groups: non-users, CC-only users, HTP-only users, and dual users. Relationships between exclusive or dual use of CCs and HTPs and depressive symptoms were analyzed using item scores and total scores of the Patient Health Questionnaire-9 (PHQ-9). To examine associations between exclusive or dual use of CCs and HTPs and depressive symptoms, a multinomial regression analysis was performed using the PHQ-9 total score.

RESULTS

HTP-only users had the highest proportion of those with anhedonia and depressed mood. CC-only users had the highest proportion of individuals with trouble sleeping, while dual users had a higher proportion of those with fatigue and appetite problems. After adjusting for general characteristics, compared to non-users, CC-only users were more likely to have mild and moderate to severe depressive symptoms. HTP-only users and dual users were also more likely to have moderate to severe depressive symptoms.

CONCLUSIONS

All smokers have a higher risk of depression than non-smokers. Health care providers should closely monitor depressive symptoms, especially in HTP users and dual users of tobacco products.