Reprint: 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults

Cardiac rehabilitation for patients with obesity: lessons learned from the OPTICARE XL trial

Obesity is a known and commonly encountered risk factor for the development of cardiac diseases. Patients with cardiac diseases who also have obesity do not benefit optimally from standard cardiac rehabilitation (CR) programs. Exercises performed during CR are not the best fit for patients with obesity and counselling sessions often do not address their specific needs. OPTICARE XL is the first large multicentre randomised controlled trial to investigate the added value of a dedicated one-year CR program specifically designed for patients with obesity and integrated in daily practice. The short-term effects on body weight and physical activity were promising and patients with obesity experienced the program as highly desirable. However, the OPTICARE XL CR program did not show long-term added value compared with standard CR on health-related quality of life, psychosocial well-being, body weight, physical activity and physical fitness, nor on costs. The current article offers an overview of the background of this trial and discusses the most important results of the OPTICARE XL trial and the reasons behind the unanticipated long-term outcomes. Furthermore, it offers recommendations for future research and how to redesign the OPTICARE XL CR program to expand the short-term results.

Risk Stratification and Treatment of Obesity for Primary and Secondary Prevention of Cardiovascular Disease

PURPOSE OF REVIEW

In this review, we discuss contemporary and emerging approaches for risk stratification and management of excess adiposity for the primary and secondary prevention of cardiovascular disease.

RECENT FINDINGS

Obesity is simultaneously a pandemic-scale disease and major risk factor for the incidence and progression of a wide range of cardiometabolic conditions, but risk stratification and treatment remain clinically challenging. However, sex-, race-, and ethnicity-sensitive anthropometric measures, body composition-focused imaging, and health burden-centric staging systems have emerged as important facilitators of holistic risk prediction. Further, expanding therapeutic approaches, including comprehensive lifestyle programs, anti-obesity pharmacotherapies, device/endoscopy-based interventions, metabolic surgery, and novel healthcare delivery resources offer new empowerment for cardiovascular risk reduction in individuals with obesity. Personalized risk stratification and weight management are central to reducing the lifetime prevalence and impact of cardiovascular disease. Further evidence informing long-term safety, efficacy, and cost-effectiveness of novel approaches targeting obesity are critically needed.

Increased body weight and central adiposity markers are positively associated with the 20-year incidence of cardiovascular disease: The ATTICA epidemiological study (2002-2022)

Increased adiposity predisposes to cardiovascular disease (CVD). We hypothesized that the presence of obesity would be positively associated with CVD risk, and that the co-presence of central obesity would modify/enhance this association. This was a prospective study (2002-2022) among 1845 Greek adults (mean age, 44.8 ± 13.5 years; men, 49.8%). At baseline, the presence of overweight/obesity was assessed via body mass index (BMI), whereas central obesity was defined as waist circumference ≥102/88 cm, waist-to-hip-ratio ≥0.95/0.80, or waist-to-height-ratio ≥0.50 in men/women. BMI was reevaluated at 10 years and longitudinal BMI trajectories (2002-2012) were identified. CVD incidence was recorded at 20 years (ratio of new cases to the number of participants assessed). Compared with participants with normal weight at baseline, those with obesity exhibited a 27% higher 20-year CVD risk after adjustment for age, sex, lifestyle habits, and medical status (hazard ratio, 1.271; 95% confidence interval, 1.012-1.597). In similar multiadjusted models, compared with participants who were always non-overweight/obese, those who were always overweight/obese exhibited a 40% higher 20-year CVD risk (hazard ratio, 1.403; 95% confidence interval, 1.018-1.936). Additional control for high-sensitivity C-reactive protein attenuated the associations. In the combined baseline body weight classification analysis, CVD incidence was the lowest in participants with normal weight without central obesity, moderate in those with overweight/obesity without central obesity, and highest in those with normal weight and central obesity and overweight/obesity and central obesity (P < .001). Obesity leads to increased CVD risk, partly mediated by inflammation. The combination of BMI with simple measures of abdominal adiposity is superior for CVD risk screening.

Revisiting Waist Circumference: A Hypertension Risk Factor that Requires a More In-depth Understanding

As a major cause of various cardiovascular diseases, the prevalence of hypertension has been increasing in the past 30 years, leading to significant socioeconomic and health burdens. Obesity is one of the major risk factors for hypertension. Body mass index (BMI) is the most used anthropometric index to measure obesity in clinical practice and to assess the risk of obesity-related diseases. However, obesity is a heterogeneous disease, and the accumulation of fat in different body regions leads to differences in cardiovascular and metabolic risks. BMI only reflects the overall obesity but does not consider the distribution of fat and muscle mass. The limitation of BMI makes it insufficient to assess the risk of hypertension attributed to obesity. In addition, waist circumference is an easily obtainable anthropometric index to evaluate abdominal fat distribution. High waist circumference is an independent risk factor for various cardiovascular diseases and all-cause mortality regardless of BMI. Preliminary data indicate that waist circumference is significantly associated with the risk of hypertension at different BMI levels. However, routine measurement of waist circumference is currently not required in current clinical guidelines or is only recommended for obese populations, indicating an insufficient understanding of waist circumference. In this review, we summarize the measurement methods and diagnostic thresholds of waist circumference for abdominal obesity, the trend of central obesity prevalence, the superiority of waist circumference over other anthropometric indices, and recent cross-sectional and longitudinal studies on the association between obesity and hypertension.

Implementation of a Scalable Online Weight Management Programme in Clinical Settings: Protocol for the PROPS 2.0 Programme (Partnerships for Reducing Overweight and Obesity with Patient-Centered Strategies 2.0)

INTRODUCTION

There is an urgent need for scalable strategies for treating overweight and obesity in clinical settings. PROPS 2.0 (Partnerships for Reducing Overweight and Obesity with Patient-Centered Strategies 2.0) aims to adapt and implement the combined intervention from the PROPS Study at scale, in a diverse cross-section of patients and providers.

METHODS AND ANALYSIS

We are implementing PROPS 2.0 across a variety of clinics at Brigham and Women's Hospital, targeting enrolment of 5000 patients. Providers can refer patients or patients can self-refer. Eligible patients must be ≥20 years old and have a body mass index (BMI) of ≥30 kg/m2 or a BMI of 25-29.9 kg/m2 plus another cardiovascular risk factor or obesity-related condition. After enrolment, patients register for the RestoreHealth online programme/app (HealthFleet Inc.) and participate for 12 months. Patients can engage with the programme and receive personalized feedback from a coach. Patient navigators help to enrol patients, enter updates in the electronic health record, and refer patients to additional resources. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is guiding the evaluation.

ETHICS AND DISSEMINATION

The Mass General Brigham Human Research Committee approved this protocol. An implementation guide will be created and disseminated, to help other sites adopt the intervention in the future.

TRIAL REGISTRATION NUMBER

NCT0555925.

Food as medicine: a quasi-randomized control trial of two healthy food interventions for chronic disease management among ambulatory patients at an urban academic center

BACKGROUND

Globally, poor nutrition is a driver of many chronic diseases and is responsible for more deaths than any other risk factor. Accordingly, there is growing interest in the direct provision of healthy foods to patients to tackle diet-linked chronic diseases and mortality.

AIM

To assess the effect of two healthy food interventions in conjunction with nutrition counseling and education on select chronic disease markers, food insecurity, diet quality, depression, and on self-efficacy for healthy eating, healthy weight, and chronic disease management.

METHODS

This parallel-arm quasi-randomized control trial will be conducted between January 2022 and December 2023. Seventy adult patients recruited from a single academic medical center will be randomly assigned to receive either: i) daily ready-made frozen healthy meals or ii) a weekly produce box and recipes for 15 weeks. Participants will, additionally, take part in one individual nutrition therapy session and watch videos on healthy eating, weight loss, type 2 diabetes, and hypertension. Data on weight, height, glycated hemoglobin, blood pressure, and diabetes and blood pressure medications will be collected in-person at the baseline visit and at 16 weeks from baseline and via medical chart review at six months and 12 months from enrollment. The primary outcome of the study is weight loss at 16 weeks from baseline. Pre- and post-intervention survey data will be analyzed for changes in food insecurity, diet quality, depression, as well as self-efficacy for health eating, healthy weight, and chronic disease management. Through retrospective chart review, patients who received standard of care will be matched to intervention group participants as controls based on body mass index, type 2 diabetes, and/or hypertension.

FINDINGS

By elucidating the healthy food intervention with better health outcomes, this study aims to offer evidence that can guide providers in their recommendations for healthy eating options to patients.

The cardiovascular effects of novel weight loss therapies

The prevalence of overweight and obesity has reached pandemic proportions. Obesity is known to increase the risk for Type 2 diabetes and hypertension, as well as the risk for overt cardiovascular (CV) disease, including myocardial infarction, heart failure, and stroke. The rising prevalence of obesity may counteract the recent advances in primary and secondary prevention of CV disease. Overweight and obesity are common in patients with CV disease; however, cardiologists face several challenges in managing body weight in this population. Many may not consider obesity as a therapeutic target probably because there were no previous highly effective and safe pharmacologic interventions to consider. In addition, they may not have the expertise or resources to implement lifestyle interventions and may have limited familiarity with obesity pharmacotherapy. Moreover, the long-term CV effects of obesity pharmacotherapy remain uncertain due to limited CV outcome data with weight loss as the primary intervention. Although current CV guidelines recognize the importance of weight loss, they primarily focus on lifestyle modifications, with fewer details on strategies to utilize obesity pharmacotherapy and surgery. However, the recent 2022 American Diabetes Association/European Association for the Study of Diabetes consensus on the management of Type 2 diabetes has moved up weight management to the front of the treatment algorithm, by prioritizing the use of pharmacologic interventions such as glucagon-like peptide-1 receptor agonists and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists, which have potent weight-lowering effects, in addition to glucose-lowering effects. This review appraises the current evidence regarding the CV effects of weight-loss interventions. Considering this evidence, practical guidance is provided to assist cardiologists in developing and implementing treatment plans, which may allow optimal weight management while maximizing CV benefits and minimizing side effects to improve the overall well-being of people with CV disease.

Diabesity and Dietary Interventions: Evaluating the Impact of Mediterranean Diet and Other Types of Diets on Obesity and Type 2 Diabetes Management

BACKGROUND

Diabesity, the intersection of obesity and diabetes, presents a global health crisis with profound implications. Addressing diabesity requires multifaceted strategies, with diet playing a pivotal role. Over the last 15 years, clinical studies have intensified their exploration of various dietary approaches in diabesity management. This literature review aims to synthesize findings from clinical studies conducted in the last 15 years, shedding light on the efficacy, mechanisms, and nuances of different diet types in diabesity management with special focus on the Mediterranean diet (MD).

METHODS

Thorough research of academic databases yielded a collection of relevant clinical studies. These studies encompassed a range of dietary strategies, including the MD, low-carbohydrate diets, plant-based diets, high-protein diets, low-fat regimens, and intermittent fasting. Key findings, methodologies, and outcomes were thoroughly extracted and analyzed.

RESULTS

The last 15 years have witnessed considerable improvements in recognizing the role of human nutritional habits in diabesity management. The MD appears to be the most well-recognized diet, exerting favorable effects against both obesity and diabetes. Low-carbohydrate diets were found to enhance glycemic regulation and decrease insulin resistance. Plant-based diets demonstrated potential benefits in weight management and cardiometabolic health. High-protein, low-fat dietary models exhibited positive effects on satiety and body weight decline. Intermittent fasting regimens also exerted metabolic improvements and body weight decline. Personalization emerged as a crucial factor in dietary recommendations.

CONCLUSIONS

Clinical studies from the last 15 years underscore the intricate relationship between diet types and diabesity management. The above results contribute to an increasing body of evidence, emphasizing the need for tailored dietary approaches and especially the MD. Healthcare providers can utilize this knowledge to offer personalized dietary recommendations for individuals with diabesity, potentially curbing the rise of these twin epidemics and improving the well-being of affected populations.

Predicting Waist Circumference From a Single Computed Tomography Image Using a Mobile App (Measure It): Development and Evaluation Study

Background

Despite the existing evidence that waist circumference (WC) provides independent and additive information to BMI when predicting morbidity and mortality, this measurement is not routinely obtained in clinical practice. Using computed tomography (CT) scan images, mobile health (mHealth) has the potential to make this abdominal obesity parameter easily available even in retrospective studies.

Objective

This study aimed to develop a mobile app as a tool for facilitating the measurement of WC based on a cross-sectional CT image.

Methods

The development process included three stages: determination of the principles of WC measurement from CT images, app prototype design, and validation. We performed a preliminary validity study in which we compared WC measurements obtained both by the conventional method using a tape measurement in a standing position and by the mobile app using the last abdominal CT slice not showing the iliac bone. Pearson correlation, student t tests, and Q-Q and Bland-Altman plots were used for statistical analysis. Moreover, to perform a diagnostic test evaluation, we also analyzed the accuracy of the app in detecting abdominal obesity.

Results

We developed a prototype of the app Measure It, which is capable of estimating WC from a single cross-sectional CT image. We used an estimation based on an ellipse formula adjusted to the gender of the patient. The validity study included 20 patients (10 men and 10 women). There was a good correlation between both measurements (Pearson R=0.906). The student t test showed no significant differences between the two measurements (P=.98). Both the Q-Q dispersion plot and Bland-Altman analysis graphs showed good overlap with some dispersion of extreme values. The diagnostic test evaluation showed an accuracy of 83% when using the mobile app to detect abdominal obesity.

Conclusions

This app is a simple and accessible mHealth tool to routinely measure WC as a valuable obesity indicator in clinical and research practice. A usability and validity evaluation among medical teams will be the next step before its use in clinical trials and multicentric studies.

A Mediterranean Eating Pattern Combining Energy and Time-Restricted Eating Improves Vaspin and Omentin Concentrations Compared to Intermittent Fasting in Overweight Individuals

Athonian Orthodox fasting (AOF) is characterized by energy- and time-restricted eating (TRE) and is based on the Mediterranean diet. We aimed to investigate the impact of AOF compared to another TRE model on vaspin, omentin, nesfatin, and visfatin levels. We included 25 individuals (mean age 50.3 ± 8.6 years, 24% men) who practiced AOF and abstained from animal products, with the exception of seafood and fish. This group adopted a 12 h eating interval (08.00 to 20.00). In total, 12 participants (mean age 47.7 ± 8.7 years, 33.3% men) who practiced 16:8 TRE (eating from 09:00 to 17:00) and were allowed to consume meat served as the controls. Anthropometric and dietary data and adipokine levels were prospectively collected at three time points: at baseline, after the end of the diets (7 weeks), and 5 weeks after the participants returned to their typical eating habits (12 weeks from baseline). Vaspin levels decreased [795.8 (422.1-1299.4) (baseline) vs. 402.7 (203.8-818.9) (7 weeks) pg/mL, p = 0.002] and omentin levels increased [568.5 (437.7-1196.5) (baseline) vs. 659.0 (555.7-1810.8) (12 weeks) pg/mL, p = 0.001] in the AOF group, while none of the analyzed adipokines changed significantly in the TRE group. The variations observed in vaspin and omentin concentrations in the AOF group were independent of age, sex, changes in anthropometry and fat intake. In conclusion, AOF can significantly reduce vaspin and increase omentin, whose levels are known to increase and decrease, respectively, in obesity and type 2 diabetes. The implications of these findings for cardiometabolic health warrant further investigation.

Effect of carbohydrate restriction on body weight in overweight and obese adults: a systematic review and dose-response meta-analysis of 110 randomized controlled trials

Introduction

Carbohydrate-restricted diets are one of the most effective dietary interventions for weight loss. However, the optimum carbohydrate intake for implementing the most effective weight-loss interventions is still being discussed. We aimed to determine the optimum carbohydrate intake for short- and long-term weight loss in adults with overweight and obesity.

Methods

We searched PubMed, Scopus, Web of Science, and CENTRAL from inception to May 2021 for randomized controlled trials examining the effect of a carbohydrate-restricted diet (≤45% of energy intake) as compared to a control diet (carbohydrate intake >45% of energy intake) on body weight in adults with overweight/obesity. A random-effects dose-response meta-analysis was conducted to calculate the mean difference for each 10% decrease in carbohydrate intake at the 6-month follow-up (1 to 6 months), 12-month follow-up (6 to 12 months), and follow-up longer than 12 months. The shape of the dose-dependent effects was also evaluated. The certainty of the evidence was rated using the GRADE approach. The minimal clinically important difference (MCID) threshold was defined as 5% weight loss (equal to 4.39 kg).

Results

A total of 110 trials were selected for the present meta-analysis. In the linear dose-response meta-analysis, each 10% decrease in carbohydrate intake reduced body weight by 0.64 kg (95% CI: -0.79 to -0.49; n = 101 trials with 4,135 participants, high-certainty evidence) at the 6-month follow-up and by 1.15 kg (95% CI: -1.61 to -0.69; 42 trials with 2,657 participants, moderate-certainty evidence) at the 12-month follow-up. Non-linear dose-response meta-analyses indicated a monotonic reduction in body weight with the decrease in carbohydrate intake, with the greatest reduction at 5% at the 6-month follow-up (mean difference 5%: -3.96 kg, 95% CI: -4.92 to -3.00) and 10% at the 12-month follow-up (mean difference 10%: -6.26 kg, 95% CI: -10.42 to -2.10). At follow-up longer than 12 months, dose-response analyses suggested a non-linear effect, wherein carbohydrate intakes higher than 40% and lower than 30% were not effective for weight loss.

Discussion

Carbohydrate restriction is an effective dietary strategy for important weight loss in adults with overweight and obesity. At 6-month and 12-month follow-ups, body weight decreased proportionally, more than the MCID threshold, along with the decrease in carbohydrate intake. At follow-up longer than 12 months, there was a non-linear effect, with the greatest reduction at 30% carbohydrate intake.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022315042.

Post-diagnosis weight trajectories and mortality among women with breast cancer

Weight gain after breast cancer diagnosis is associated with adverse health outcomes. Yet, few studies have characterized post-diagnosis weight change in the modern treatment era or populations most at risk for weight changes. Among women diagnosed with stages I-III breast cancer in the Smilow Care Network (2013-2019; N = 5441), we abstracted demographic and clinical characteristics from electronic health records and survival data from tumor registries. We assessed if baseline characteristics modified weight trajectories with nonlinear multilevel mixed-effect models. We evaluated body mass index (BMI) at diagnosis and weight change 1-year post-diagnosis in relation to all-cause and breast cancer-specific mortality with Cox proportional hazard models. Women had 34.4 ± 25.5 weight measurements over 3.2 ± 1.8 years of follow-up. Weight gain was associated with ER/PR-, HER2+ tumors, BMI ≤ 18.5 kg/m2, and age ≤ 45 years (+4.90 kg (standard error [SE] = 0.59), +3.24 kg (SE = 0.34), and +1.75 kg (SE = 0.10), respectively). Weight loss was associated with BMI ≥ 35 kg/m2 and age ≥ 70 years (-4.50 kg (SE = 0.08) and -4.34 kg (SE = 0.08), respectively). Large weight loss (≥10%), moderate weight loss (5-10%), and moderate weight gain (5-10%) 1-year after diagnosis were associated with higher all-cause mortality (hazard ratio [HR] = 2.93, 95% confidence interval [CI] = 2.28-3.75, HR = 1.32, 95% CI = 1.02-1.70 and HR = 1.39, 95% CI = 1.04-1.85, respectively). BMI ≥ 35 kg/m2 or BMI ≤ 18.5 kg/m2 at diagnosis were also associated with higher all-cause mortality. Weight change after a breast cancer diagnosis differed by demographic and clinical characteristics highlighting subgroups at-risk for weight change during a 5-year period post-diagnosis. Monitoring and interventions for weight management early in clinical care are important.

Visceral adipose tissue increases the risk of periodontal disease: Results from the 2011-2014 National Health and Nutrition Examination Survey and Mendelian randomization analysis

AIM

This study aimed to investigate the relationship and potential causal effect of visceral adipose tissue (VAT) on periodontal disease (PD). Despite prior research on this, there has been no definitive conclusion. Therefore, this study aimed to provide additional insight into these associations.

MATERIALS AND METHODS

This study used data from the National Health and Nutrition Examination Survey 2011-2014 to examine the association between VAT and PD in a cross-sectional study design. Various analytical methods were employed, such as multivariable logistic regression, restricted cubic spline analysis, and p-value for trend. Additionally, two-sample Mendelian randomization (MR) analysis was performed to evaluate the potential causal effect of VAT on PD risk. These methods enabled us to evaluate the association between VAT and PD and to establish whether VAT could be a causal factor in PD development.

RESULTS

The study examined a sample of 3535 participants, and the findings suggested that higher VAT levels were associated with an increased risk of PD. In addition, multivariable regression analysis conducted in six models revealed a statistically significant association between VAT and PD risk. Restricted cubic spline analysis showed an inverted U-shaped association between VAT and PD, with a turning point at 733 g of VAT. Finally, a two-sample MR analysis provided evidence for a potential causal relationship between VAT and PD risk, with an odds ratio of 1.16 (95% confidence interval: 1.02-1.33, p = .027) per kg increase in genetically predicted VAT.

CONCLUSIONS

The results of this study suggest that there is a significant association between VAT and PD and that VAT could be a potential causal factor in PD risk. Our results also suggest that although there is a potential link between VAT levels and PD risk, the effect size is modest. Therefore, interventions designed to reduce VAT levels should not be considered a primary strategy for PD risk reduction but could be one of many strategies used in a comprehensive approach to PD risk management.

Wellness Achieved Through Changing Habits: A Randomized Controlled Trial of an Acceptance-Based Intervention for Adolescent Girls With Overweight or Obesity

Background: Obesity prevalence among adolescent girls continues to rise. Acceptance-based therapy (ABT) is effective for weight loss in adults and feasible and acceptable for weight loss among adolescents. This pilot randomized controlled trial (RCT) assessed effectiveness of an adolescent-tailored ABT intervention on decreasing weight-related outcomes and improving psychological outcomes compared with enhanced care. Methods: In this 6-month, two-arm pilot RCT, participants were randomized to the ABT intervention or to enhanced care. The ABT intervention condition attended 15 virtual, 90-minute group sessions. The enhanced care comparison received 15 healthy lifestyle handouts and virtually met twice with a registered dietitian. The primary outcome assessed was change in BMI expressed as a percentage of the 95th percentile (%BMIp95). Results: Participants included 40 girls (ages 14-19) assigned to ABT (n = 20) or enhanced care (n = 20). A decrease in %BMIp95 was observed within the ABT intervention [d = -0.19, 95% confidence interval, CI: (-0.36 to -0.02)], however, not within the enhanced care comparison [d = -0.01, 95% CI: (-0.09 to 0.07)]. The ABT group showed slight changes in psychological flexibility [d = -0.34, 95% CI: (-0.62 to -0.06)] over enhanced care [d = -0.11, 95% CI: (-0.58 to 0.37)]. There was no significant intervention effect noted between groups. Conclusion: In this pilot RCT, the ABT intervention was as effective as enhanced care for weight loss. However, previous ABT studies occurred in person, and this study was conducted virtually due to COVID-19. Thus, future research investigating the potential effectiveness of ABT in-person among adolescents and optimization of virtual interventions is needed.

Effects of an oral biodegradable device used for 12 weeks on weight reduction, cardiovascular risk factors, satiety, snacking, and meal size

Background

The Epitomee Capsule (EC) is an, oral, self-use, bio-degradable device for weight management, composed of absorbent polymers that self-expands in the stomach (pH-sensitive) and creates a triangular shape, space-occupying super-absorbent gel structure. A recent study reported that 42 % of study completers obtained >5 % weight reduction at 12 weeks. We performed exploratory analyses of this study to evaluate its effect on cardiovascular risk factors and on self-reported satiety, between-meal snacking and meal-size.

Methods

This single-center observational study (Israel) enrolled 78 volunteers, with mean age 41 years, BMI 32.5 kg/m2, systolic/diastolic blood pressure (SBP/DBP) 124/77 mmHg. The EC was given in addition to diet and physical activity counseling. Assessments included anthropometrics, BP, lipids, and three questions (translated from Hebrew) scored 1 (not at all) to 5 (very much) for "Do you feel the EC - Q1:helps you to consume less snacks in between meals? Q2:helps you to eat less in the meal?; Q3:is causing an early sense of satiety?". Changes from baseline were assessed using a mixed model and included all patients with at least one measure. Correlation-analysis between weight-change and PROs used Kendall's tau.

Result

Compared to baseline, at 12 weeks, SBP/DBP were reduced (ΔSBP: -5.5 mmHg, p = 0.0003/ΔDBP: -1.9 mmHg, p = 0.1341), with a larger effect in people with hypertension at baseline (ΔSBP: -13.2 mmHg, p < 0.00001/ΔDBP: -6.1, p = 0.008). Triglyceride-level was also significantly reduced, but not other lipids. Mean scores to Q1-3 were high throughout, with slight decreases (Q1 at W2 3.9 ± 1.1/W12 3.0 ± 1.6; Q2 at W2 3.7 ± 1.1/W12 3.1 ± 1.6; Q3 at W2 3.8 ± 1.2/W12 2.9 ± 1.6). There was a moderate correlation between PROs and weight reduction, although significance was not observed for all weeks.

Conclusions

Exploratory analyses of 12 weeks treatment with EC demonstrated significant reductions in SBP, DBP, and triglycerides. The weight reduction correlated with satiety, less snacking, and reduced meal size.

Use and continuity of weight-modifying medications among adults with diabetes and overweight/obesity: US population study

OBJECTIVE

Trends in use and continuity of use of diabetes-specific and non-diabetes weight-reducing (WR), weight-inducing (WI), and weight-neutral (WN) medications were examined among US adults with diabetes and overweight/obesity.

METHODS

Serial cross-sectional data from Medical Expenditure Panel Surveys (2010-2019) for adults (≥18 years) with diabetes and BMI ≥27 kg/m2 (≥25 kg/m2 for Asians) were analyzed.

RESULTS

Among 7402 US adults with diabetes and overweight/obesity (mean age 60.0 years [SD 13], 50% female), 64.9% of participants used any WI medications, decreasing from 68.9% (95% CI: 64.3%-73.5%) in 2010 to 58.6% (95% CI: 54.7%-62.5%) in 2019. It was estimated that 13.5% used WR medications, increasing 3.31-fold, from 6.4% (95% CI: 4.1%-8.7%) to 21.2% (95% CI: 18.0%-24.4%) and that 73.1% used WN medications, ranging from 70.5% (95% CI: 66.5-74.6) to 75.0% (95% CI: 71.7%-78.4%). Among adults using diabetes-specific WI (53.7%), WR (7.1%), and WN (62.4%) medications during the first year, 7.3%, 16.4%, and 9.0% discontinued it in the second year, respectively.

CONCLUSIONS

Over 2010-2019, 64.9% of adults with diabetes and overweight/obesity were treated with WI medications, 13.5% with WR medications, and 73.1% with WN medications. Discontinuation of WR medications was nearly twice that of WI medications.

A pilot study evaluating the prefeasibility of a behavioral weight loss program in people with multiple sclerosis

Weight loss interventions seldom include individuals with neurologic disease. The aims of the present study were to: 1) develop and assess the prefeasibility of a 6-month telehealth behavioral weight loss program for people with multiple sclerosis (MS) and obesity and 2) examine changes in weight loss (primary outcome), physical activity, and fruit/vegetable consumption at follow-up. Participants with obesity and MS engaged in a 24-week weight loss program. Participants followed established diet, exercise, and self-monitoring guidelines and attended weekly online group meetings. Median percentage weight loss was 10.54 % (SD = 7.19). Participants who adhered more closely to the self-monitoring guidelines (r = 0.81, p =.02), and who averaged higher weekly active minutes (r = 0.91, p =.002) achieved greater percentage weight loss. Six of the eight pilot participants achieved clinically meaningful weight loss (>5%) after 6-months.

Examining paradoxical session attendance and weight loss relationships in a clinic based lifestyle modification intervention

Objective

Evaluations of lifestyle modification interventions (LMIs), modeled after the Diabetes Prevention Program, have repeatedly shown a dose-response relationship between session attendance and weight loss. Despite this, not all participants had "average" weight loss experiences. Nearly one-third of LMI participants experienced unexpected, paradoxical outcomes (i.e., high attendance with little weight loss, and low attendance with clinically significant weight loss). Paradoxical weight-loss outcomes were characterized based on session attendance among participants in a group-based LMI in a real-world healthcare setting. This group-based LMI was delivered over 1 year to participants with the possibility of attending up to 25 sessions total.

Methods

LMI participants identified in 2010-2017 from electronic health records were characterized as having low (<75%) or high (≥75%) session attendance. Weight-loss outcomes were defined as expected (≥5%, high-attendance; <5%, low-attendance) or paradoxical (≥5%, low-attendance; <5%, high-attendance). Paradoxical-outcome-associated characteristics were identified using logistic regression.

Results

Among 1813 LMI participants, 1498 (82.6%) had low and 315 (17.4%) high session attendance; 555 (30.6%) had paradoxical outcomes, comprising 415 (74.8%) responders (≥5% weight-loss) and 140 (25.2%) non-responders (<5% weight-loss). Among participants with high session attendance, paradoxical non-responders were more likely to be female (odds ratio [OR]: 2.76; 95% confidence interval [CI]: 1.32, 5.77) and have type 2 diabetes (OR: 3.32; 95% CI: 1.01, 10.95). Among low-attendance participants, paradoxical responders were more likely to be non-Hispanic White and less likely to be non-Hispanic Black (OR: 0.35; 95% CI: 0.18, 0.69), non-Hispanic Asian (OR: 0.40; 95% CI: 0.22, 0.73), or Hispanic (OR: 0.53; 95% CI: 0.35, 0.80).

Conclusions

In a healthcare setting, nearly one-third of LMI participants experienced paradoxical outcomes. More research is needed to understand the facilitators and barriers to weight loss above and beyond session attendance.

Obesity Management in Adults: A Review

Importance

Obesity affects approximately 42% of US adults and is associated with increased rates of type 2 diabetes, hypertension, cardiovascular disease, sleep disorders, osteoarthritis, and premature death.

Observations

A body mass index (BMI) of 25 or greater is commonly used to define overweight, and a BMI of 30 or greater to define obesity, with lower thresholds for Asian populations (BMI ≥25-27.5), although use of BMI alone is not recommended to determine individual risk. Individuals with obesity have higher rates of incident cardiovascular disease. In men with a BMI of 30 to 39, cardiovascular event rates are 20.21 per 1000 person-years compared with 13.72 per 1000 person-years in men with a normal BMI. In women with a BMI of 30 to 39.9, cardiovascular event rates are 9.97 per 1000 person-years compared with 6.37 per 1000 person-years in women with a normal BMI. Among people with obesity, 5% to 10% weight loss improves systolic blood pressure by about 3 mm Hg for those with hypertension, and may decrease hemoglobin A1c by 0.6% to 1% for those with type 2 diabetes. Evidence-based obesity treatment includes interventions addressing 5 major categories: behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures. Comprehensive obesity care plans combine appropriate interventions for individual patients. Multicomponent behavioral interventions, ideally consisting of at least 14 sessions in 6 months to promote lifestyle changes, including components such as weight self-monitoring, dietary and physical activity counseling, and problem solving, often produce 5% to 10% weight loss, although weight regain occurs in 25% or more of participants at 2-year follow-up. Effective nutritional approaches focus on reducing total caloric intake and dietary strategies based on patient preferences. Physical activity without calorie reduction typically causes less weight loss (2-3 kg) but is important for weight-loss maintenance. Commonly prescribed medications such as antidepressants (eg, mirtazapine, amitriptyline) and antihyperglycemics such as glyburide or insulin cause weight gain, and clinicians should review and consider alternatives. Antiobesity medications are recommended for nonpregnant patients with obesity or overweight and weight-related comorbidities in conjunction with lifestyle modifications. Six medications are currently approved by the US Food and Drug Administration for long-term use: glucagon-like peptide receptor 1 (GLP-1) agonists (semaglutide and liraglutide only), tirzepatide (a glucose-dependent insulinotropic polypeptide/GLP-1 agonist), phentermine-topiramate, naltrexone-bupropion, and orlistat. Of these, tirzepatide has the greatest effect, with mean weight loss of 21% at 72 weeks. Endoscopic procedures (ie, intragastric balloon and endoscopic sleeve gastroplasty) can attain 10% to 13% weight loss at 6 months. Weight loss from metabolic and bariatric surgeries (ie, laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass) ranges from 25% to 30% at 12 months. Maintaining long-term weight loss is difficult, and clinical guidelines support the use of long-term antiobesity medications when weight maintenance is inadequate with lifestyle interventions alone.

Conclusion and Relevance

Obesity affects approximately 42% of adults in the US. Behavioral interventions can attain approximately 5% to 10% weight loss, GLP-1 agonists and glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists can attain approximately 8% to 21% weight loss, and bariatric surgery can attain approximately 25% to 30% weight loss. Comprehensive, evidence-based obesity treatment combines behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures as appropriate for individual patients.

Increasing the reach of evidence-based interventions for weight management and diabetes prevention among Medicaid patients: study protocol for a pilot Sequential Multiple Assignment Randomised Trial

INTRODUCTION

Over 40% of US adults meet criteria for obesity, a major risk factor for chronic disease. Obesity disproportionately impacts populations that have been historically marginalised (eg, low socioeconomic status, rural, some racial/ethnic minority groups). Evidence-based interventions (EBIs) for weight management exist but reach less than 3% of eligible individuals. The aims of this pilot randomised controlled trial are to evaluate feasibility and acceptability of dissemination strategies designed to increase reach of EBIs for weight management.

METHODS AND ANALYSIS

This study is a two-phase, Sequential Multiple Assignment Randomized Trial, conducted with 200 Medicaid patients. In phase 1, patients will be individually randomised to single text message (TM1) or multiple text messages (TM+). Phase 2 is based on treatment response. Patients who enrol in the EBI within 12 weeks of exposure to phase 1 (ie, responders) receive no further interventions. Patients in TM1 who do not enrol in the EBI within 12 weeks of exposure (ie, TM1 non-responders) will be randomised to either TM1-Continued (ie, no further TM) or TM1 & MAPS (ie, no further TM, up to 2 Motivation And Problem Solving (MAPS) navigation calls) over the next 12 weeks. Patients in TM+ who do not enrol in the EBI (ie, TM+ non-responders) will be randomised to either TM+Continued (ie, monthly text messages) or TM+ & MAPS (ie, monthly text messages, plus up to 2 MAPS calls) over the next 12 weeks. Descriptive statistics will be used to characterise feasibility (eg, proportion of patients eligible, contacted and enrolled in the trial) and acceptability (eg, participant opt-out, participant engagement with dissemination strategies, EBI reach (ie, the proportion of participants who enrol in EBI), adherence, effectiveness).

ETHICS AND DISSEMINATION

Study protocol was approved by the University of Utah Institutional Review Board (#00139694). Results will be disseminated through study partners and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

clinicaltrials.gov; NCT05666323.

A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association

A growing appreciation of the pathophysiological interrelatedness of metabolic risk factors such as obesity and diabetes, chronic kidney disease, and cardiovascular disease has led to the conceptualization of cardiovascular-kidney-metabolic syndrome. The confluence of metabolic risk factors and chronic kidney disease within cardiovascular-kidney-metabolic syndrome is strongly linked to risk for adverse cardiovascular and kidney outcomes. In addition, there are unique management considerations for individuals with established cardiovascular disease and coexisting metabolic risk factors, chronic kidney disease, or both. An extensive body of literature supports our scientific understanding of, and approach to, prevention and management for individuals with cardiovascular-kidney-metabolic syndrome. However, there are critical gaps in knowledge related to cardiovascular-kidney-metabolic syndrome in terms of mechanisms of disease development, heterogeneity within clinical phenotypes, interplay between social determinants of health and biological risk factors, and accurate assessments of disease incidence in the context of competing risks. There are also key limitations in the data supporting the clinical care for cardiovascular-kidney-metabolic syndrome, particularly in terms of early-life prevention, screening for risk factors, interdisciplinary care models, optimal strategies for supporting lifestyle modification and weight loss, targeting of emerging cardioprotective and kidney-protective therapies, management of patients with both cardiovascular disease and chronic kidney disease, and the impact of systematically assessing and addressing social determinants of health. This scientific statement uses a crosswalk of major guidelines, in addition to a review of the scientific literature, to summarize the evidence and fundamental gaps related to the science, screening, prevention, and management of cardiovascular-kidney-metabolic syndrome.

Acquired cardiovascular disease in adults with congenital heart disease

Rates of successful surgical repair and life expectancy for patients with congenital heart disease have increased dramatically in recent decades. Thanks to advances in diagnosis, treatment, and follow-up care, an ever-increasing number of individuals with congenital heart disease are reaching advanced age. The exposure to cardiovascular risk factors during their lifetime is modifying the outlook and late clinical trajectory of adult congenital heart disease (ACHD). Their disease burden is shifting from congenital to acquired, primarily atherosclerotic cardiovascular disease (ASCVD) with worrisome consequences. In addition, the complex background of ACHD often curbs appropriate preventive strategies by general practitioners or adult cardiologists. Comprehensive guidance for the prevention and management of acquired heart disease in ACHD patients is currently not available, as this topic has not been covered by the European Society of Cardiology (ESC) guidelines on cardiovascular disease prevention or the ESC guidelines for the management of ACHD. In this document, a state-of-the-art overview of acquired heart disease in ACHD patients and guidance on ASCVD prevention for both ACHD specialists and non-ACHD cardiologists are provided. The aim is to provide a clinical consensus statement to foster the development of a sustainable strategy for the prevention of ASCVD in a practical and simple-to-follow way in this ever-growing cardiovascular cohort, thus reducing their cardiovascular burden.

Emerging Medical Therapies for the Treatment of Obesity in Women with Cardiovascular Diseases

PURPOSE OF REVIEW

In this review, the impact of obesity on cardiovascular disease in women and emerging anti-obesity pharmacologic treatments are discussed.

RECENT FINDINGS

Robust evidence demonstrates the burden of obesity across the lifespan in women and links obesity to a diverse set of cardiovascular diseases. Female-specific risk factors including sex hormones and pregnancy factors intersect with obesity and cardiovascular risk. Sustained weight loss has potential for cardiovascular benefits. Recent trials demonstrate cardiovascular benefits of emerging agents with weight loss effects including GLP-1 RA and SGLT2 inhibitors in women. Treatment and prevention strategies for cardiovascular disease in obese women should include integration of weight management strategies including the targeted use of emerging pharmacologic therapies.

Relationship of body mass index and visceral fat area combination with arterial stiffness and cardiovascular risk in cardiovascular disease-free people: NHANES (2011-2018)

Background

Obesity and arterial stiffness are strongly associated with cardiovascular disease; however, their relationship remains controversial.

Methods

Body mass index was measured using anthropometric evaluation, and visceral fat area was calculated using an absorptiometry scan.

Results

The data of 5309 participants were collected from NHANES (National Health and Nutrition Examination Survey) (2011-2018). Based on the normal-weight normal visceral fat group that was considered as a reference, ePWV increased in all other groups, with the obese grade 2 visceral obesity group increasing the most by 26.35 cm/s (95% CI: 13.52, 39.18, P < 0.001), followed by normal-weight visceral obesity group 24.43 cm/s (95% CI: 1.88, 46.98, P = 0.035), which was even higher than obese grade 1 visceral obesity (β: 21.16, 95% CI: 9.24, 33.07, P = 0.001), obese grade 2 normal visceral fat group (β: 13.8; 95% CI: 0.10, 27.5, P = 0.048) and overweight visceral obesity group (β: 10.23; 95% CI: 1.89, 18.57, P = 0.018). For the 10-year cardiovascular risk, the obese grade 2 visceral obesity group had a 9.56-fold increase in compared with the control (OR: 10.56, 95% CI: 4.06, 27.51, P < 0.0001). Normal-weight visceral obesity, obese grade 1 visceral obesity, and overweight visceral obesity groups increased by 8.03-fold (OR: 9.03, 95% CI: 2.66, 30.69; P < 0.001), 7.91-fold (OR: 8.91, 95% CI: 3.82, 20.79, P < 0.001), and 7.28-fold (OR: 8.28, 95% CI: 3.19, 21.46, P < 0.001). The risk was lower in the normal visceral fat group. Except for the obese grade 2 normal visceral fat group, there was no significant difference in other groups.

Conclusions

Normal-weight visceral obesity was associated with higher arterial stiffness and 10-year cardiovascular risk.

Lower-Intensity Interventions for Prediabetes: A Systematic Review

INTRODUCTION

Systematic reviews of interventions for diabetes prevention have focused on lifestyle interventions, including the Diabetes Prevention Program (DPP) and translations of the DPP. However, nationally, few people with prediabetes have joined or completed a DPP, with one cited barrier being committing to a yearlong program. This study was a systematic review to evaluate the effectiveness of lower-intensity lifestyle interventions for prediabetes on weight change, glycemia, and health behaviors.

METHODS

English-language studies from PubMed, Embase, PsycINFO, and CINAHL from 2000 to February 23, 2022 were searched for RCTs of nonpregnant adults with prediabetes and elevated BMI and lower-intensity interventions (defined as ≤12 months and <14 sessions over 6 months). Two reviewers independently identified 11 trials, assessed study quality (using Cochrane risk-of-bias tool), and extracted data serially. A qualitative synthesis was conducted by outcome.

RESULTS

Only 1 of 11 trials of lower-intensity interventions was of high quality (>80% follow-up rate and low risk of bias). This 6-month study compared an app with standardized dietary advice, showing a 3-kg greater body weight reduction and 0.2% greater reduction of HbA1c.

DISCUSSION

The evidence on lower-intensity lifestyle interventions for diabetes prevention is limited by the small number and methodologic weaknesses of previous trials, and future research is needed in this area. Given the low uptake of and retention in evidence-based high-intensity programs, future work is needed to investigate the effectiveness of novel lower-intensity interventions offered with established DPP content of varying duration and intensity.

Analysis of semen parameters, and hormonal changes of FSH, LH, testosterone, and libido following bariatric surgery

Introduction

Although studies have shown that bariatric surgery can have a positive effect on the patient's sexual function, there are still disagreements and contradictions in this regard. The present study is aimed to evaluate semen parameters, hormonal changes of FSH, LH, testosterone, and libido following bariatric surgery.

Methods

The present research as a prospective study was performed on 20 male candidates for bariatric surgery referred to Golestan and Aria hospitals in Ahvaz in 2021. Semen parameters (volume, count, motility, and the percentage of sperm with normal morphology), hormonal profile (including FSH, LH test hormones), and sexual function were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire before and 6 months after the surgery.

Results

The results of this study indicated that semen parameters did not change significantly 6 months after surgery in comparison with before the surgery (P < 0.05). After the operation, just the total level of testosterone increased significantly (2.23 nmol/L vs. 2.74, P = 0.009). However, LH and FSH levels did not change significantly six months after surgery (P = 0.858 and P = 0.287). The results indicated significant improvement in IIEF score after the operation (P = 0.011).

Conclusion

The findings of the present study indicated that the decrement of weight as a result of bariatric surgery had a favorable effect on the levels of serum testosterone and sexual performance, while semen parameters did not improve after surgery.

The impact of obesity and LVAD-bridging on heart transplant candidate outcomes: a linked STS INTERMACS - OPTN/UNOS data analysis

BACKGROUND

Limited data integrating waitlist and postheart transplant (HT) mortality have evaluated outcomes of left ventricular assist device (LVAD)-bridged strategy vs no LVAD according to patient characteristics. We evaluated waitlist and post-HT mortality in LVAD-bridged vs nonbridged patients based on body mass index (BMI).

METHODS

We included linked adults listed for HT in Organ Procurement and Transplant Network/United Network for Organ Sharing and patients receiving durable LVAD as bridge to HT or candidacy in Society of Thoracic Surgeons/Interagency Mechanical Circulatory Support databases (2010-2019). Using BMI at listing or LVAD implant, we categorized patients as underweight (<18.5 kg/m2), normal weight (18.5-24.99 kg/m2), overweight (25-29.99 kg/m2), and obese (≥30 kg/m2). Kaplan-Meier analysis and multivariable Cox proportional hazards models informed the effect of LVAD-bridged and nonbridged strategy by BMI on waitlist, post-HT, and overall mortality (including waitlist and post-HT mortality).

RESULTS

Among 11,216 LVAD-bridged and 17,122 nonbridged candidates, bridged candidates were more frequently obese (37.3% vs 28.6%) (p < 0.001). Multivariable analysis indicated increased waitlist mortality in LVAD-bridged vs nonbridged with overweight (Hazard ratio (HR) 1.18, 95% confidence interval (CI) 1.02-1.36) or obesity (HR 1.35, 95%CI 1.17-1.56) in comparison to normal weight candidates (HR 1.02, 95%CI 0.88-1.19) (p-interaction < 0.001). Post-transplant mortality was not statistically different in LVAD-bridged vs nonbridged patients across BMI categories (p-interaction = 0.26). There was a nonsignificant graded increase in overall mortality in LVAD-bridged with overweight (HR 1.53, 95%CI 1.39-1.68) or obesity (HR 1.61, 95%CI 1.46-1.78) compared to nonbridged patients (p-interaction = 0.13).

CONCLUSIONS

LVAD-bridged candidates with obesity had higher waitlist mortality compared to nonbridged candidates with obesity. Post-transplant mortality was similar in LVAD-bridged and nonbridged patients, but obesity remained associated with increased mortality in both groups. This study may aid clinicians and advanced heart failure patients with obesity in decision-making.

The inverted U-shaped relationship between weight loss percentage and cardiovascular health scores

PURPOSE

Obesity is a significant risk factor for cardiovascular disease; however, the impact of weight loss on cardiovascular health (CVH) in individuals with specific obesity patterns remains incompletely understood. The objective of our study was to investigate the relationship weight loss percentage and CVH scores across individuals with various obesity patterns.

METHODS

Our study utilized data from the National Health and Nutrition Examination Survey conducted between 2007 and 2018, involving a total of 12,835 participants aged 16 years or older, to conduct a cross-sectional analysis. Multiple linear regression and multinomial logistic regression methods were used to assess the correlation between the weight loss percentage and the CVH scores. Additionally, restricted cubic spline analysis was employed to examine the nonlinear relationship between the two variables.

RESULTS

Compared to individuals with a weight loss percentage < 0%, participants with weight loss percentages of 0-5% and 5.1-10% showed improved CVH scores, with β values of 2.85 (95% CI 2.32-3.38) and 2.55 (95% CI 1.69-3.4), respectively. Regarding different obesity patterns, compared to participants with a weight loss percentage < 0%, participants with a weight loss percentage of 0-5% showed an increase in CVH scores in the normal weight and overweight/general obesity (OGO) groups, with β values of 1.45 (95% CI 0.7-2.19) and 1.22 (95% CI 0.46-1.97), respectively. Restricted cubic spline analysis revealed a significant inverted U-shaped relationship between the weight loss percentage and the CVH scores (with optimal CVH scores at 3%).

CONCLUSIONS

There was an inverted U-shaped relationship between weight loss percentage and CVH scores, with moderate weight loss (0-10%, optimal value of 3%) being associated with improved CVH scores, especially among individuals with OGO.

LEVEL V

Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

The prognostic impact of body mass index on female breast cancer patients in underdeveloped regions of northern China differs by menopause status and tumor molecular subtype

There is growing evidence that higher body mass index (BMI) is associated with lower survival in breast cancer patients. The aim of this study was to investigate whether there is an association between body mass index (BMI) at breast cancer diagnosis and breast cancer prognosis and whether this association is dependent on menopausal status and tumor subtype in a less developed population in northern China. We collected 1,225 patients with primary invasive cancer in stage I-IIIC for retrospective analysis from October 2010 to December 2020. We used Kaplan-Meier and Cox regression analyses and estimated the relationship between baseline BMI and breast cancer-specific survival (BCSS). Next, we further evaluated whether the effect of BMI on breast cancer prognosis differed by menopausal status and tumor subtype. We found that death rate and prognosis were worse for patients with BMI ≥ 24, more than four positive lymph nodes, and triple negative status. Interestingly, BMI played a different prognostic role depending on tumor subtype and menopausal status. For premenopausal women, patients with BMI ≥ 24 had significantly lower BCSS compared to those with BMI < 24 in human epidermal growth factor receptor 2 (HER2) overexpression (HR: 4.305, p = 0.004) and triple negative subtypes (HR: 1.775, p = 0.048). By contrast, there was no association between BMI ≥ 24 and higher death regardless of tumor subtype in post-menopausal patients (p > 0.05). BMI influences breast cancer outcome depending on tumor subtype and menopause. BMI ≥ 24 might be a risk factor for BCSS, particularly in premenopausal women with HER2 overexpression or triple negative subtype. In contrast, BMI ≥ 24 was not associated with higher death regardless of tumor subtype in post-menopausal patients.

Effects of 12 Weeks of Family and Individual Multi-Disciplinary Intervention in Overweight and Obese Adolescents under Cardiometabolic Risk Parameters: A Clinical Trial

Adolescence is a complex period of human development in which young people are susceptible to unhealthy behaviors, such as physical inactivity and an unbalanced diet. This study aimed to analyze the effects of 12 weeks of multi-disciplinary family and individual intervention on cardiometabolic risk parameters in overweight and obese adolescents and compare sub-groups, considering possible differences between sexes (males vs. females vs. intervention approach). Forty-three adolescents (13.73 ± 2.46 years old) of both sexes were divided into two groups: family group (FG) (n = 21; 14.24 ± 2.61 years old) and individual group (IG) (n = 22; 13.23 ± 2.27 years old). The following parameters were evaluated: anthropometry (body weight, height, waist circumference (WC), hip circumference (HC), abdominal circumference (AC), calculation of body mass index (BMI), and waist-hip ratio (WHR)), body composition (fat mass (FM), lean mass (LM), fat-free mass (FFM), skeletal muscle mass (SMM), body fat percentage (BF), and visceral fat), biochemical measures (fasting glucose, triglycerides (TG), total cholesterol (TC), low-density lipoproteins (LDL-c), and high-density lipoproteins (HDL-c)), and the measurement of systolic and diastolic blood pressure (SBP and DBP) before and after the interventions. The multi-disciplinary interventions occurred for 12 weeks (three days a week lasting 1 h and 30 min, in which 30 min were dedicated to theoretical interventions (nutrition: nutritional education and psychology: psychoeducation) and 1 h to physical exercises. A time effect was observed for LM, FFM, SMM, FM, and HDL-c, with higher values after intervention and a significant decrease for FM, BF, visceral fat, fasting glucose, TG, TC, LDL-c, and DBP (p < 0.05). However, no group, sub-group, or interaction effects were observed when comparing FG, IG, or sexes (p > 0.05). The responses of the present study show that both multi-disciplinary approaches (family and individual) promoted improvement in the body composition indicators, biochemical markers, and DBP of overweight and obese adolescents independently of the intervention group. Given this finding, health professionals, families, and adolescents could choose the type of intervention based on their preferences.

Association between weight change and the predicted 10-year risk for atherosclerosis cardiovascular disease among U.S. older adults: data from National Health and Nutrition Examination Survey 1999-2018

Background

It remains controversial regarding the association between weight change and cardiovascular disease risk in older adults (aged ≥60 years). This study aimed to evaluate the association between weight change and the predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risks in older adults.

Methods

This study used data from the National Health and Nutrition Examination Survey (NHANES). Older adults aged 60-79 years who were free of self-reported ASCVD at the time of the NHANES interview were included. Data were collected from January 1999 to December 2018 and analyzed in March 2022. We focused on the associations between weight change and the 10-year ASCVD risks with the percentage change in weight during short-term (1 year) and long-term (10 years), which categorized as moderate to high weight loss (≥10%), small weight loss (5.1-9.9%), stable weight (±5%), small weight gain (5.1-9.9%), and moderate to high weight gain (≥10%).

Results

The number of participants was 1,867 (mean age 67.49 years; 42.10% female) for the long-term interval (10 years) in our analysis, and 1894 for the short-term interval (1 years). We only observed an inverse association between long-term weight loss and the 10-year ASCVD risk in fully adjusted model (loss ≥ 10%: β = 2.52, 95%CI = 0.98, 4.05; loss 5.1% ~ 9.9%: β = 2.99, 95% CI = 1.30, 4.68), but all intervals of weight gain ≥5% were not significant associated with higher risk than stable weight. However, in the subgroup analyses, the association between long-term weight loss and the 10-year ASCVD risk was not significant in old-old (aged 75-79), obesity (BMI ≥ 35 kg/m2), intentional weight loss, moderate physical activity and diabetics.

Conclusion

Older adults (aged 60-79 years) with weight loss >5% over the past 10 years have excess predicted 10-year ASCVD risk. Our study supports the benefits of stable weight in promoting cardiovascular health in older adults.

System inflammation response index: a novel inflammatory indicator to predict all-cause and cardiovascular disease mortality in the obese population

AIM

This study aims to investigate the relationship between two novel inflammatory markers, namely, the Systemic Inflammatory Response Index (SIRI) and the Systemic Immune Inflammatory Index (SII), as well as the all-cause and cardiovascular disease (CVD) mortality in the obese population.

MATERIALS AND METHODS

We conducted a prospective cohort study based on the data of 13,026 obese adults (age ≥ 18 years) from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 and followed until December 2019. SIRI was calculated by the formula: (neutrophil count × monocyte count) / lymphocyte count, while that of SII was: (platelet count × neutrophil count)/lymphocyte count. The association of SIRI and SII with all-cause and CVD mortality was evaluated using Cox regression. In addition, the nomogram was performed to predict 10-year survival probability.

RESULTS

During a median follow-up of 137 months, 1959 and 553 all-cause and CVD deaths were recorded, respectively. Spearman correlation analysis indicated that SIRI and SII were unrelated to almost all baseline characteristics (r < 0.15). Multivariate Cox regression models displayed that each standard deviation (SD) increase in SIRI was associated with a 16% (HR 1.16; 95% CI 1.09-1.24) and 22% (HR 1.22; 95% CI 1.10-1.36) increase in the risk of all-cause and CVD mortality, respectively. Likewise, every SD increase in SII was correlated with a 9% (HR 1.09; 95% CI 1.02-1.16) and 14% (HR 1.14; 95% CI 1.04-1.26) increase in the risk of all-cause and CVD mortality, respectively. The predictive value of SIRI for all-cause and CVD mortality (AUC = 0.601 and 0.624) exceeded that of SII (AUC = 0.528 and 0.539). Moreover, the nomogram displayed a substantial predictive value for 10-year survival (AUC = 0.847) with sensitivity and specificity exceeding 75%.

CONCLUSIONS

In the obese population, SIRI and SII are independent risk factors for all-cause and CVD mortality. Notably, the predictive ability of SIRI for both all-cause and CVD mortality significantly outperforms that of SII, suggesting that SIRI is a more valuable marker of inflammation.

Team-Based Approach to Reduce Malignancies in People with Diabetes and Obesity

PURPOSE OF REVIEW

Numerous observations have indicated an increased risk of developing various types of cancers, as well as cancer-related mortality, among patients with diabetes and obesity. The purpose of this review is to outline multiple-cancer screening among these patients through a team-based approach and to present the findings of a pioneering integrated care program designed for patients with obesity with a specific emphasis on cancer prevention.

RECENT FINDINGS

A community-based multi-cancer prevention program, which provides all services in one location and utilizes team-based approaches, is reported to be feasible and has the potential to enhance the uptake rate of multiple cancers screening among patients with diabetes and obesity. The team-based approach is a commonly utilized method for managing patients with diabetes, obesity, and cancer, and has been shown to be efficacious. Nevertheless, research on team-based cancer screening programs for patients with diabetes and obesity remains limited. Providing a comprehensive screening for colorectal, prostate, and breast cancer, as well as metabolic syndrome, during a single clinic visit has been proven effective and well-received by participants.

Impact of visceral fat on coronary artery disease as defined by quantitative computed tomography angiography

OBJECTIVE

Obesity is associated with all-cause mortality and cardiovascular disease (CVD). Visceral fat (VF) is an important CVD risk metric given its independent correlation with myocardial infarction and stroke. This study aims to clarify the relationship between the presence and severity of VF with the presence and severity of coronary artery plaque.

METHODS

In 145 consecutive asymptomatic patients, atherosclerosis imaging-quantitative computed tomography was performed for total plaque volume (TPV) and percentage atheroma volume, as well as the volume of noncalcified plaque (NCP), calcified plaque, and low-density NCP (LD-NCP), diameter stenosis, and vascular remodeling. This study also included VF analysis and subcutaneous fat analysis, recording of outer waist circumference, and percentage body fat analysis.

RESULTS

The mean age of the patients was 56.1 [SD 8.5] years, and 84.0% were male. Measures of visceral adiposity (mean [SD, Q1-Q3 thresholds]) included estimated body fat, 28.7% (9.0%, 24.1%-33.0%); VF, 169.8 cm2 (92.3, 102.0-219.0 cm2 ); and subcutaneous fat, 223.6 mm2 (114.2, 142.5-288.0 mm2 ). The Spearman correlation coefficients of VF and plaque volume included TPV 0.22 (p = 0.0074), calcified plaque 0.12 (p = 0.62), NCP 0.25 (p = 0.0023), and LD-NCP 0.37 (p < 0.0001). There was a progression of the median coronary plaque volume for each quartile of VF including TPV (Q1: 19.8, Q2: 48.1, Q3: 86.4, and Q4: 136.6 mm3 [p = 0.0098]), NCP (Q1: 15.7, Q2: 35.4, Q3: 86.4, and Q4: 136.6 mm3 [p = 0.0032]), and LD-NCP (Q1: 0.6, Q2: 0.81, Q3: 2.0, and Q4: 5.0 mm3 [p < 0.0001]).

CONCLUSIONS

These findings demonstrate progression with regard to VF and TPV, NCP volume, and LD-NCP volume. Notably, there was a progression of VF and amount of LD-NCP, which is known to be high risk for future cardiovascular events. A consistent progression may indicate the future utility of VF in CVD risk stratification.

Effect of bariatric surgery on cardio-psycho-metabolic outcomes in severe obesity: A randomized controlled trial

OBJECTIVE

Randomized evidence comparing the cardiovascular effects of surgical and conservative weight management is lacking.

PATIENTS & METHODS

In this single-center, open-label randomized trial, obese patients with indication for Roux-en-Y gastric bypass (RYGB) and able to perform treadmill cardiopulmonary exercise testing (CPET) were included. After a 6-12 month run-in phase of multimodal anti-obesity treatment, patients were randomized to RYGB or psychotherapy-enhanced lifestyle intervention (PELI) and co-primary endpoints were assessed 12 months later. Thereafter, PELI patients could opt for surgery and patients were reassessed 24 months after randomization. Co-primary endpoints were mean change (95 % confidence intervals) in peak VO2 (ml/min/kg body weight) in CPET and the physical functioning scale (PFS) of the Short Form health survey (SF-36).

RESULTS

Of 93 patients entering the study, 60 were randomized. Among these (median age 38 years; 88 % women; mean BMI 48·2 kg/m2), 46 (RYGB: 22 and PELI: 24) were evaluated after 12 months. Total weight loss was 34·3 % after RYGB vs. 1·2 % with PELI, while peak VO2 increased by +4·3 ml/min/kg (2·7, 5·9) vs +1·1 ml/min/kg (-0·2, 2·3); p < 0·0001. Respective improvement in PFS score was +40 (30, 49) vs +10 (1, 15); p < 0·0001. 6-minute walking distance also favored the RYGB group: +44 m (17, 72) vs +6 m (-14, 26); p < 0·0001. Left ventricular mass decreased after RYGB, but not with PELI: -32 g (-46, -17) vs 0 g (-13,13); p < 0·0001. In the non-randomized follow-up, 34 patients were assessed. Favorable changes were sustained in the RYGB group and were repeated in the 15 evaluated patients that opted for surgery after PELI.

CONCLUSIONS

Among adults with severe obesity, RYGB in comparison to PELI resulted in improved cardiopulmonary capacity and quality of life. The observed effect sizes suggest that these changes are clinically relevant.

Effects of Pharmacotherapy for the Treatment of Obesity in an Urban, Safety-Net Population

OBJECTIVE

To evaluate the effect of common weight loss pharmacotherapies among low-income, racially diverse adult patients at an urban safety-net weight management clinic.

METHODS

Our retrospective review from 2015 to 2019 examined patients who took either GLP-1 analog (GL) or phentermine/topiramate (PT) for ≥90 days and patients who exclusively pursued non-pharmacologic treatment for comparison. Changes in weight, blood pressure, and hemoglobin A1c at 1-year follow-up were reported.

RESULTS

We analyzed 22 GL and 26 PT patients and included 40 patients who pursued only lifestyle modifications (LM). All three groups achieved significant weight loss at one year: GL -3.69 (interquartile range (IQR): -11.0, -1.77) kg (p=0.0004), PT -7.01 (IQR: -13.4, -1.45) kg (p<0.001), and LM -3.01 (IQR: -6.81, 1.13) kg (p=0.005). There was no significant difference in the median weight loss (p=0.11) between the three groups. We observed no significant changes in systolic blood pressure but saw a significant change of -0.75 in hemoglobin A1c (IQR: -1.35, -0.25) (p=0.01) among patients with diabetes in the GL group.

CONCLUSIONS

Our real-world applications of GLP-1 and phentermine/topiramate suggest that both are effective weight loss medication regimens in low-socioeconomic status patients.

Investigation of time-dependent alterations in adipokine levels and endoplasmic reticulum stress markers in obese patients with laparoscopic sleeve gastrectomy

BACKGROUND AND AIMS

We aimed to investigate the time-dependent alterations of serum, adipose tissue WISP1, Nrg4, asprosin, SPX adipokines and serum ER stress markers GRP78, XBP1, ATF6, CHOP in obese patients who underwent laparoscopic sleeve gastrectomy (LSG).

MATERIALS AND METHODS

Morbidly obese patients (n = 19) and normal-weight individuals (n = 19) were compared. Preoperative (control, obese) and postoperative 1st, 3rd and 6th month (obese) follow-up measurements were obtained. Levels of adipokines, ER stress markers were measured with commercial kits.

RESULTS

Body mass index (BMI), total fat, trunk fat mass, fat percentage of obese patients decreased after LSG. Postoperative serum glucose, insulin, HOMA-IR, triglyceride levels of obese patients decreased, HDL increased. In obese patients, preoperative LDL and total cholesterol, which were not different from control, were higher in the postoperative 6th month measurements. Omentum WISP1, subcutaneous adipose tissue WISP1 and SPX, and serum WISP1, asprosin, CHOP levels were higher, Nrg4 lower in obese patients. Serum Nrg4 was still lower in the postoperative 1st month measurements, while WISP1 was higher in the 3rd and asprosin in the 3rd, 6th months compared to control. 1st and 3rd month ATF6 and 3rd month CHOP concentrations were lower than preoperative values. Serum CHOP measured at the 6th month was significantly higher than control. Negative correlations were observed between serum Nrg4 and fat percentage, TG concentration. CHOP was negatively correlated with fat percentage.

CONCLUSION

The correlations between changes in serum Nrg4, CHOP and fat percentage highlight the roles of Nrg4 and CHOP in the fat loss following LSG.

Weight loss trend after bariatric surgery in a population of obese patients

BACKGROUND AND AIMS

Bariatric Surgery (BS) is a therapeutic option in patients with severe obesity whose non-surgical techniques have failed. No work has previously explored trajectories of weight loss and how long this was maintained. Aim of study is to describe effect of BS and nutritional intervention on body weight trend in patients with obesity.

METHODS

792 patients who underwent BS from 1996 to 2021 were included. The Protocol provides Laparoscopic Sleeve Gastrectomy (LSG), Vertical Gastroplasty (VBG) and Roux-en-Y Gastric Bypass (GB). %Total Weight Loss (%TWL) and %Excess Weight Loss (%EWL) were evaluated in three cohort of patients. Cumulative incidence of clinical goal after surgery was calculated at two and five years after BS.

RESULTS

At two years of follow-up, average %TWL and %EWL were 31.2% (95% CI = 29.0-33.4%) and 71% (95% CI = 65.4-76.5%) for VBG, 34.7% (95% CI = 33.8-35.6%) and 78.0% (95% CI = 75.9-89.1%) for GB and 33.8% (95% CI = 32.5-35.1%) and 68.8% (95% CI = 66.1-71.6%) for LSG. At two years from surgery the cumulative incidence of clinical goal was 70.7% (95% CI = 59.1-79.1%) for VBG, 86.4% (95% CI = 82.4-89.6%) for GB and 83.4% (95% CI = 76.0-87.1%) for LSG. At five years from surgery, average % TWL and % EWL were 22.5% (95% CI = 10.2-34.8%) and 58.2% (95% CI = 28.4-88.1%) for VBG, 31.8% (95% CI = 30.2-33.3%) and 70.8% (95% CI = 67.5-74.1%) for GB and 29.5% (95% CI = 26.2-32.8%) and 62.0% (95% CI = 53.4-70.6%) for LSG respectively. At five years after having reached clinical goal the share of people who were able to maintain their weight was 49.5% (95% CI = 30.8-79.6%) for VBG, 69.5% (95% CI = 58.3-82.8%) for GB and 55.9% (95% CI = 42.1-74.3%) for LSG. The median time of clinical goal maintaining was 4.8 years for VBG (95% CI lower limit = 4.1), 6.6 years for GB (95% CI lower limit = 6.2) and 5.3 years for LSG (95% CI lower limit = 4.8).

CONCLUSIONS

Our work confirm effectiveness of BS in patients with obesity and show that who do not reach clinical goal within 2 years, hardly will reach it later and suggest necessity for a medium and long-term follow-up to prevent weight regain.

A Systematic Approach to Treating Early Metabolic Disease and Prediabetes

At least 70% of US adults have metabolic disease. However, less is done to address early disease (e.g., overweight, obesity, prediabetes) versus advanced disease (e.g., type 2 diabetes mellitus, coronary artery disease). Given the burden of advanced metabolic disease and the burgeoning pandemics of obesity and prediabetes a systematic response is required. To accomplish this, we offer several recommendations: (A) Patients with overweight, obesity, and/or prediabetes must be consistently diagnosed with these conditions in medical records to enable population health initiatives. (B) Patients with early metabolic disease should be offered in-person or virtual lifestyle interventions commensurate with the findings of the Diabetes Prevention Program. (C) Patients unable to participate in or otherwise failing lifestyle intervention must be screened to assess if they require pharmacotherapy. (D) Patients not indicated for, refusing, or failing pharmacotherapy must be screened to assess if they need bariatric surgery. (E) Regardless of treatment approach or lack of treatment, patients must be consistently screened for the progression of early metabolic disease to advanced disease to enable early control. Progression of metabolic disease from an overweight yet otherwise healthy person includes the development of prediabetes, obesity ± prediabetes, dyslipidemia, hypertension, type 2 diabetes, chronic kidney disease, coronary artery disease, and heart failure. Systematic approaches in health systems must be deployed with clear protocols and supported by streamlined technologies to manage their population's metabolic health from early through advanced metabolic disease. Additional research is needed to identify and validate optimal system-level interventions. Future research needs to identify strategies to roll out systematic interventions for the treatment of early metabolic disease and to improve the metabolic health among the progressively younger patients being impacted by obesity and diabetes.

The effect of exercise training level on arterial stiffness after clinically significant weight loss

Arterial stiffness is improved by weight loss. However, no data exist on the impact of aerobic exercise levels on arterial stiffness during weight maintenance. Adults who were  overweight or with obesity (N = 39) participated in a 10-week weight loss program. Participants who achieved ≥7% weight loss were randomized to aerobic training at the minimum physical activity guidelines (PA-REC, 550 MET min/week) or weight maintenance guidelines (WM-REC, 970 MET min/week) for 18 additional weeks. Arterial stiffness (carotid-to-femoral pulse wave velocity [cfPWV], augmentation index normalized for 75 beats/min [AIX75]) and blood pressure [aortic and brachial]) were assessed at baseline, the end of the weight loss phase (week 10), and follow-up (week 28). There was a reduction in cfPWV in participants who met the weight loss goal (-0.34 m/s, p = .02) and approached significance for the entire sample (p = .051). Similarly, there were reductions in AIX75, brachial blood pressure, and aortic blood pressure (p < .05) in the full sample. In the weight maintenance phase, no differences were observed between the PA-REC and the WM-REC groups for change in arterial stiffness or blood pressure (p > .05). However, changes in cfPWV were independently associated with changes in LDL (r2 : 0.45, p = .004) and exercise intensity (r2 : 0.17, p = .033). Aerobic exercise level at the minimum physical activity guidelines or weight maintenance guidelines does not affect the change in PWV or the change in cfPWV after clinically significant weight loss. However, interventions which limit increases in LDL cholesterol and promote high-intensity aerobic exercise may prevent increases in stiffness during weight maintenance.

A phenotypic approach to obesity treatment

Obesity is a chronic disease that increases morbidity and mortality and adversely affects quality of life. The rapid rise of obesity has outpaced the development and deployment of effective therapeutic interventions, thereby creating a global health crisis. The presentation, complications, and response to obesity treatments vary, yet lifestyle modification, which is the foundational therapeutic intervention for obesity, is often "one size fits all." The concept of personalized medicine uses genetic and phenotypic information as a guide for disease prevention, diagnosis, and treatment and has been successfully applied in diseases such as cancer, but not in obesity. As we gain insight into the pathophysiologic mechanisms of obesity and its phenotypic expression, specific pathways can be targeted to yield a greater, more sustained therapeutic impact in an individual patient with obesity. A phenotype-based pharmacologic treatment approach utilizing objective measures to classify patients into predominant obesity mechanism groups resulted in greater weight loss (compared with a non-phenotype-based approach) in a recent study by Acosta and colleagues. In this review, we discuss the application of lifestyle modifications, behavior therapy and pharmacotherapy using the obesity phenotype-based approach as a framework.

Relevance of body composition in phenotyping the obesities

Obesity is the most extended metabolic alteration worldwide increasing the risk for the development of cardiometabolic alterations such as type 2 diabetes, hypertension, and dyslipidemia. Body mass index (BMI) remains the most frequently used tool for classifying patients with obesity, but it does not accurately reflect body adiposity. In this document we review classical and new classification systems for phenotyping the obesities. Greater accuracy of and accessibility to body composition techniques at the same time as increased knowledge and use of cardiometabolic risk factors is leading to a more refined phenotyping of patients with obesity. It is time to incorporate these advances into routine clinical practice to better diagnose overweight and obesity, and to optimize the treatment of patients living with obesity.

Accessible weight loss program for adults who are legally blind: A pilot study

BACKGROUND

Compared to those without vision impairments, adults with low vision have higher rates of obesity and face more barriers to participation in traditional weight loss programs.

OBJECTIVE

This pilot study examined the usability and helpfulness of an adaptive, evidence-based weight loss program for adults who are legally blind.

METHODS

The study was a remotely delivered, single-arm weight loss trial for adults who were legally blind with a body mass index (BMI) ≥ 25. At weeks 4 and 8, participants reported usability and helpfulness of program components using a five-point scale (0-4) with higher numbers indicating greater usability and helpfulness. Weight data were collected at baseline, week 4, and week 8 using a scale with cellular technology. The adaptive 8-week weight loss program included evidence-based lifestyle recommendations for diet, physical activity, and self-weighing. The program provided support through text messages, emails, and video-based problem-solving sessions.

RESULTS

Participants (N = 28) were aged 53.4 ± 10.2 years, 89.3% female, 35.7% Black, and 57.1% non-Hispanic White with an average BMI of 35.4 ± 8.8 kg/m2. Most program components had a median score of 4 for usability and helpfulness except educational materials (helpfulness, median 3). Compared to baseline weight, participants had a weight loss of 2.2 ± 2.1% (p < .001) at week 4 and 3.6 ± 3.0% (p < .001) at week 8.

CONCLUSIONS

This study has provided evidence that an all-remote weight loss program can be a useable, helpful, and effective approach for adults who are legally blind. More work is needed to develop scalable, sustainable, and fully accessible evidence-based weight loss programs.

TRIAL REGISTRATION

Clinicaltrials. gov identifier: NCT05419063.

Application of the D3 -creatine muscle mass assessment tool to a geriatric weight loss trial: A pilot study

BACKGROUND

Traditionally, weight loss (WL) trials utilize dual energy X-ray absorptiometry (DXA) to measure lean mass. This method assumes lean mass, as the sum of all non-bone and non-fat tissue, is a reasonable proxy for muscle mass. In contrast, the D3 -creatine (D3 Cr) dilution method directly measures whole body skeletal muscle mass, although this method has yet to be applied in the context of a geriatric WL trial. The purpose of this project was to (1) describe estimates of change and variability in D3 Cr muscle mass in older adults participating in an intentional WL intervention and (2) relate its change to other measures of body composition as well as muscle function and strength.

METHODS

The INVEST in Bone Health trial (NCT04076618), used as a scaffold for this ancillary pilot project, is a three-armed, 12-month randomized, controlled trial designed to determine the effects of resistance training or weighted vest use during intentional WL on a battery of musculoskeletal health outcomes among 150 older adults living with obesity. A convenience sample of 24 participants (n = 8/arm) are included in this analysis. At baseline and 6 months, participants were weighed, ingested a 30 mg D3 Cr tracer dose, provided a fasted urine sample 3-6 days post-dosage, underwent DXA (total body fat and lean masses, appendicular lean mass) and computed tomography (mid-thigh and trunk muscle/intermuscular fat areas) scans, and performed 400-m walk, stair climb, knee extensor strength, and grip strength tests.

RESULTS

Participants were older (68.0 ± 4.4 years), mostly White (75.0%), predominantly female (66.7%), and living with obesity (body mass index: 33.8 ± 2.7 kg/m2 ). Six month total body WL was -10.3 (95% confidence interval, CI: -12.7, -7.9) kg. All DXA and computed tomography-derived body composition measures were significantly decreased from baseline, yet D3 Cr muscle mass did not change [+0.5 (95% CI: -2.0, 3.0) kg]. Of muscle function and strength measures, only grip strength significantly changed [+2.5 (95% CI: 1.0, 4.0) kg] from baseline.

CONCLUSIONS

Among 24 older adults, significant WL with or without weighted vest use or resistance training over a 6-month period was associated with significant declines in all bioimaging metrics, while D3 Cr muscle mass and muscle function and strength were preserved. Treatment assignment for the trial remains blinded; therefore, full interpretation of these findings is limited. Future work in this area will assess change in D3 Cr muscle mass by parent trial treatment group assignment in all study participants.

Association Between Dietary Copper Intake and Cognitive Decline: A Perspective Cohort Study in Chinese Elderly

OBJECTIVE

The association between dietary copper (Cu) intake and cognitive decline remains uncertain. We aim to investigate the longitudinal association of dietary Cu with cognitive decline in Chinese elderly.

METHODS

A total of 3,106 Chinese adults aged older than or equal to 55 years from China Health and Nutrition Survey (CHNS) were included. Dietary nutrients information was collected by 24-hours dietary recalls in combination with a food-weighted method. The 5-year change rates in global or composite cognitive scores based on a subset of items from the Telephone Interview for Cognitive Status-modified (TICS-m) was calculated as the last-survey score minus the baseline score, then divided by the follow-up time (unit, years) and multiplied by five.

RESULTS

The median follow-up duration was 5.9 years. There was a nonlinear association of dietary Cu intake with the 5-year change rates in global or composite cognitive scores, with the inflection point at approximately 1.3 mg/day of dietary Cu intake. Accordingly, for the composite cognitive score, compared to the first quantile (<1.28 mg/day), those with dietary Cu in quantiles 2-8 (≥1.28 mg/day) had a significantly slower cognitive decline rate (B, 0.30; 95% CI, 0.13, 0.47). Similar results were found for the global cognitive score. Moreover, the inverse association between dietary Cu and cognitive decline was stronger in those with lower dietary fat intake and lower levels of physical activity (All p-interactions <0.05).

CONCLUSION

There was a nonlinear inverse association of dietary Cu intake with cognitive decline in the elderly, with an inflection point at approximately 1.3 mg/day of dietary Cu intake.

Mediation of the Association Between Vascular Risk Factors and Depressive Symptoms by C-Reactive Protein

Background

This study examined whether C-reactive protein (CRP), a marker of low-grade systemic inflammation, mediates the association between vascular risk factor (VRF) burden and depressive symptoms.

Methods

We drew on the prospective design of the UK Biobank to include participants with longitudinal data on VRF burden, CRP, and depressive symptoms. Total, direct, and indirect effects were estimated using regression-based mediation models while controlling for confounding by sociodemographic factors, baseline CRP, and baseline depression. Sensitivity analyses probed the robustness of results to unmeasured confounding.

Results

We analyzed data from 10,470 participants from the UK Biobank (mean age = 56.75 years at baseline). Net of covariates, VRFs at baseline were associated with higher depressive symptoms at follow-up (total effect = 0.099; 95% CI, 0.002-0.163). CRP mediated this association (indirect effect = 0.010; 95% CI, 0.004-0.017), accounting for 10.0% (95% CI, 0.3%-30.0%) of the total effect of VRF burden on depressive symptoms. Exploratory analyses suggested that the total and indirect effects pertained to somatic depressive symptoms (tiredness and appetite).

Conclusions

These results suggest that inflammation-promoting effects of VRFs may contribute to depressive symptoms in mid- and later life. However, the mediating pathway via CRP explains only a small part of the association between VRFs and depression after accounting for important covariates and may pertain to specific depressive symptoms. Future studies leveraging similar longitudinal designs are needed to further disentangle the time-varying effects between VRFs, inflammation, and certain depressive symptoms while addressing important confounders.

Meeting at the Crossroad between Obesity and Hepatic Carcinogenesis: Unique Pathophysiological Pathways Raise Expectations for Innovative Therapeutic Approaches

The escalating global prevalence of obesity and its intricate association with the development of hepatocellular carcinoma (HCC) pose a substantial challenge to public health. Obesity, acknowledged as a pervasive epidemic, is linked to an array of chronic diseases, including HCC, catalyzing the need for a comprehensive understanding of its molecular underpinnings. Notably, HCC has emerged as a leading malignancy with rising incidence and mortality. The transition from viral etiologies to the prominence of metabolic dysfunction-associated fatty liver disease (MAFLD)-related HCC underscores the urgent need to explore the intricate molecular pathways linking obesity and hepatic carcinogenesis. This review delves into the interwoven landscape of molecular carcinogenesis in the context of obesity-driven HCC while also navigating using the current therapeutic strategies and future prospects for combating obesity-related HCC. We underscore the pivotal role of obesity as a risk factor and propose an integrated approach encompassing lifestyle interventions, pharmacotherapy, and the exploration of emerging targeted therapies. As the obesity-HCC nexus continues to challenge healthcare systems globally, a comprehensive understanding of the intricate molecular mechanisms and innovative therapeutic strategies is imperative to alleviate the rising burden of this dual menace.

Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis: The Patient and Physician Perspective

Diagnosing and managing metabolic dysfunction-associated steatotic liver disease (MASLD) remains a major challenge in primary care due to lack of agreement on diagnostic tools, difficulty in identifying symptoms and determining their cause, absence of approved pharmacological treatments, and limited awareness of the disease. However, prompt diagnosis and management are critical to preventing MASLD from progressing to more severe forms of liver disease. This highlights the need to raise awareness and improve understanding of MASLD among both patients and physicians. The patient perspective is invaluable to advancing our knowledge of this disease and how to manage it, as their perspectives have led to the growing recognition that patients experience subtle symptoms and that patient-reported outcomes should be incorporated into drug development. This review and expert opinion examine MASLD and metabolic dysfunction-associated steatohepatitis from the patient and physician perspective from pre-diagnosis to diagnosis and early care, through to progression to advanced liver damage. Specifically, the paper dives into the issues patients and physicians experience, and, in turn, what is required to improve diagnosis and management, including tips and tools to empower patients and physicians dealing with MASLD.