Relationships between Frailty and the Risk of Glaucoma in Middle-aged and Older Adults

PURPOSE

Increased frailty in older individuals increases health risks, but its relationship with glaucoma, the leading cause of irreversible blindness in middle-aged and older adults, is unclear. We investigated the association between frailty and glaucoma in a large-scale representative sample and explored possible causal relationships.

DESIGN

Combined cross-sectional and Mendelian randomization (MR) study.

PARTICIPANTS

In the cross-sectional analysis, we included 5744 participants of the US National Health and Nutrition Examination Surveys 2005 to 2008 ≥ 40 years of age. For the MR analysis, frailty genome-wide association study (GWAS) data were sourced from a UK Biobank and TwinGen meta-analysis, and GWAS data on glaucoma subtypes were derived from FinnGen.

METHODS

According to the 49-item frailty index, we classified participants into nonfrail (≤ 0.10), prefrail (0.10-0.21), and frail (> 0.21) groups. Using survey-weighted logistic regression models adjusted for multiple covariates, we explored the association between frailty and glaucoma. We further assessed causation using MR.

MAIN OUTCOME MEASURES

The associations between different levels of frailty (nonfrail, prefrail, and frail) and glaucoma, as well as causal relationships between genetically predicted frailty and various subtypes of glaucoma (primary open-angle glaucoma [POAG], primary angle-closure glaucoma [PACG], normotensive glaucoma [NTG], exfoliation glaucoma, and suspected glaucoma).

RESULTS

After adjusting for covariates, higher frailty levels were significantly associated with glaucoma in frail individuals (odds ratio [OR] = 1.83, 95% confidence interval [CI] = 1.05-3.19, P = 0.036) but not prefrail (OR = 1.90, 95% CI = 0.99-3.64, P = 0.052). The association was significantly stronger among male participants (P interaction = 0.042). The variation in the association between frailty and glaucoma did not reach statistical significance across age groups (P interaction = 0.575) or race groups (P interaction = 0.092). Mendelian randomization revealed that genetically predicted frailty was linked to greater risks for POAG (OR = 1.67, 95% CI = 1.24-2.25, P = 0.001), PACG (OR = 2.78, 95% CI = 1.48-5.20, P = 0.001), exfoliation glaucoma (OR = 1.70, 95% CI = 1.18-2.43, P = 0.004), and suspected glaucoma (OR = 1.74, 95% CI = 1.30-2.34, P < 0.001) but not for NTG (OR = 1.01, 95% CI = 0.61-1.68, P = 0.956).

CONCLUSIONS

Our study revealed an association between frailty and increased glaucoma risk and emphasized the significance of glaucoma screening in frail individuals. Targeted health-care strategies can help prevent or delay irreversible blindness among middle-aged and older adults.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

An Overview of Existing and Emerging Weight-Loss Drugs to Target Obesity-Related Complications: Insights from Clinical Trials

Obesity requires treatment as it is associated with health problems such as type 2 diabetes, hypertension, dyslipidemia, cardiovascular diseases, and some cancers, which increase mortality rates. Achieving sufficient weight loss to reduce obesity-related diseases requires a variety of interventions, including comprehensive lifestyle modification of diet and exercise, change in behavior, anti-obesity medications, and surgery. To date, anti-obesity agents with various mechanisms of action have been developed, and mostly reduce energy intake, resulting in weight loss of about 5% to 10% compared to baseline. Recently developed drugs and those currently under development have been shown to reduce body weight by more than 10% and are expected to reduce obesity-related complications. This article summarizes existing and emerging anti-obesity medications, with a particular focus on those evaluated in clinical trials.

A New Strategy for Obesity Treatment: Revealing the Frontiers of Anti-obesity Medications

Obesity dramatically increases the risk of type 2 diabetes, fatty liver, hypertension, cardiovascular disease, and cancer, causing both declines in quality of life and life expectancy, which is a serious worldwide epidemic. At present, more and more patients with obesity are choosing drug therapy. However, given the high failure rate, high cost, and long design and testing process for discovering and developing new anti-obesity drugs, drug repurposing could be an innovative method and opportunity to broaden and improve pharmacological tools in this context. Because different diseases share molecular pathways and targets in the cells, anti-obesity drugs discovered in other fields are a viable option for treating obesity. Recently, some drugs initially developed for other diseases, such as treating diabetes, tumors, depression, alcoholism, erectile dysfunction, and Parkinson's disease, have been found to exert potential anti-obesity effects, which provides another treatment prospect. In this review, we will discuss the potential benefits and barriers associated with these drugs being used as obesity medications by focusing on their mechanisms of action when treating obesity. This could be a viable strategy for treating obesity as a significant advance in human health.

An Analysis of Age-Related Body Composition Changes and Metabolic Patterns in Korean Adults Using FDG-PET/CT Health Screening Data

BACKGRUOUND

F-18-fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) can be used to measure bone mineral density (BMD), cross-sectional muscle area (CSMA), Hounsfield units (HU) of liver and muscle, subcutaneous adipose tissue (SAT), abdominal visceral adipose tissue (VAT), and glucose metabolism. The present study aimed to identify age-related changes in body composition and glucose metabolism in Korean using opportunistic FDG-PET/CT imaging.

METHODS

We analyzed FDG-PET/CT, clinical history, and laboratory data abstracted from the medical records of patients who underwent health screening at a single institute between 2017 and 2022.

RESULTS

In total, 278 patients were included in the analysis (male:female=140:138). Age and body mass index were positively correlated in female, but negatively correlated in male. BMD decreased with age more in female, and CSMA decreased with age more in male. Muscle HU decreased with age for both sexes. In female, SAT and VAT increased with age; and in male, SAT decreased slightly while VAT remained stable. Muscle glucose metabolism showed no association with age in male but increased with age in female. CSMA correlated positively with BMD overall; and positively correlated with VAT and SAT in male only. In female only, both SAT and VAT showed negative correlations with glucose metabolism and correlated positively with muscle glucose metabolism. Liver HU values were inversely correlated with VAT, especially in female; and positively correlated with muscle glucose metabolism in female only.

CONCLUSION

FDG-PET/CT demonstrated distinct patterns of age-related changes in body composition and glucose metabolism, with significant differences between sexes.

The association of fatty liver index and metabolic syndrome with cardiovascular outcomes, liver-related mortality, and all-cause mortality: a nationwide cohort study

We investigated the risk of cardiovascular events, all-cause mortality, and liver-related mortality according to the presence of metabolic syndrome (MetS) and fatty liver index (FLI). In this retrospective longitudinal population-based cohort study, we used Korean National Health Insurance Service data from 2009 to 2012. Nonalcoholic fatty liver disease (NAFLD) was defined as FLI ≥ 60. Risk of all-cause mortality, liver-related mortality, and major adverse cardiovascular events (MACE) including myocardial infarction (MI), stroke, heart failure (HF), and cardiovascular disease (CVD)-related mortality was assessed according to the presence of MetS and FLI among adults (aged 40 to 80 years) who underwent health examinations (n = 769,422). During a median 8.59 years of follow up, 44,356 (5.8%) cases of MACE, 24,429 (3.2%) cases of all-cause mortality, and 1114 (0.1%) cases of liver-related mortality were detected in the entire cohort. When the FLI < 30 without MetS group was set as a reference, the FLI ≥ 60 with MetS group had the highest risk of MACE (adjusted hazard ratio [aHR] 2.05, 95% confidence interval [CI] 1.98-2.13) and all-cause mortality (aHR 1.96, 95% CI 1.86-2.07). The risk of liver-related mortality (aHR 10.71, 95% CI 8.05-14.25) was highest in the FLI ≥ 60 without MetS group. The FLI ≥ 60 with MetS group had a higher risk of MACE (aHR 1.39, 95%CI 1.28-1.51), a lower risk of liver-related mortality (aHR 0.44, 95%CI 0.33-0.59), and no significant difference in all-cause mortality compared with the FLI ≥ 60 without MetS group. The FLI ≥ 60 with MetS group was associated with the highest risk of MACE and the FLI ≥ 60 without MetS group had the highest risk liver-related mortality, but there was no significant difference in all-cause mortality between two groups. In conclusion, as FLI levels increase, the risk of MACE increases, and the risk increases additively in the presence of MetS. The risk of liver-related mortality increases with higher FLI levels, the effect of high FLI on increased risk is more significant in groups without MetS compared to those with MetS.

Bioactive oligopeptides and the application in skin regeneration and rejuvenation

Oligopeptides, composed of 2-10 amino acid residues, are protein fragments with unique structural characteristics, including small molecular size, high biocompatibility, and modifiable functional groups. These features endow oligopeptides with excellent permeability, safety, and versatile biological activities, making them widely applicable in disease treatment, drug delivery, and skincare. In particular, oligopeptides have emerged as advanced ingredients in skincare, offering anti-aging, anti-wrinkle, and whitening effects by regulating key biological processes such as collagen synthesis, antioxidant defense, and melanin production. This review comprehensively discusses the structural properties, functional mechanisms, and diverse applications of oligopeptides and their derivatives, highlighting their potential in skin regeneration, rejuvenation, and anti-aging medicine. By providing insights into the latest advancements, this review aims to serve as a valuable reference for future research and development in oligopeptide-based therapeutics and skincare innovations.

Glucagon-like Peptide-1 Receptor Agonists in the Management of Diabetic Retinopathy

Glucagon-like peptide-1 (GLP-1) receptor agonists are a family of drugs, most well known by the third-generation once-weekly subcutaneous semaglutide, that act on the incretin pathway of metabolic, hormonal signaling to modulate pancreatic insulin release, gastric emptying, energy intake, and subjective feelings of satiety. This class of drugs' efficacy and safety in the treatment of type 2 diabetes and obesity have been demonstrated across multiple large randomized controlled trials. These data have propelled GLP-1 receptor agonists to ubiquity in diabetic management and weight loss therapy, leading them to be frequently encountered in ophthalmic practice. The effect of GLP-1 receptor agonists like semaglutide on diabetic retinopathy (DR) is at this point unclear; some studies indicate a worsening of DR with the initiation of GLP-1 agonists, especially semaglutide. Overall, the macrovascular reduction of cardiovascular and stroke risks from GLP-1 receptor agonists should be prioritized over the potential microvascular progression of DR, as long as the patient is regularly followed by ophthalmology.

The Physiologic Effect of Augmented Reality Simulation Versus Traditional Simulation: A Noninferiority, Randomized Controlled Trial

Background

Traditional medical simulations leverage stressful scenarios to potentiate memory. Augmented reality (AR) simulations provide cost-effective experiences using holograms instead of mannequins. This study investigated the physiologic response to AR simulations.

Methods

This was a noninferiority, controlled trial at an academic, pediatric hospital in Northern California among health care workers randomized to AR or traditional, in situ medical simulations. The primary outcome investigated parasympathetic tone. Biometric sensors assessed parasympathetic tone as respiratory sinus arrhythmia (RSA). A difference in RSA of less than 10% between groups was considered noninferior. Secondary outcomes explored usability, ergonomics, satisfaction, and recall with the System Usability Scale (SUS), ISO 9241-400, Simulation Design Scale (SDS), and an electronic questionnaire 5 months after the intervention, respectively.

Results

A total of 111 participants were enrolled and 106 analyzed. Both groups experienced a decrease in mean RSA from baseline to during the simulation (P < .001 for both groups). Subsequently, there was an increase in RSA from the simulation period to the recovery period (P < .001 for the AR group and P = .035 for the traditional group). Regarding secondary outcomes, the mean SUS score of 70.5 suggested good usability, 65.38% of AR participants reported feeling comfortable using the headset, and satisfaction in both groups was similar except for differences in use of real-life factors. The recall assessment was completed by 12 AR and 15 traditional participants, with similar scores between the 2 groups (P = .4).

Conclusions

AR simulations produced a noninferior change in parasympathetic tone compared with traditional simulations. Future investigations may explore the effectiveness of AR simulations for developing nontechnical skills during remote training. (Registration: Clinical Trials Registry NCT05674188.).

Association of Obesity and Skeletal Muscle with Postoperative Survival in Non-Small Cell Lung Cancer

Background A comprehensive assessment of skeletal muscle health is crucial to understanding the association between improved clinical outcomes and obesity as defined by body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) in lung cancer, but limited studies have been conducted on this topic. Purpose To investigate the association between BMI-defined obesity and survival in patients with non-small cell lung cancer who underwent curative resection, with a specific focus on the status of skeletal muscle assessed at CT. Materials and Methods This retrospective study investigated Korean patients with non-small cell lung cancer who underwent curative resection between January 2008 and December 2019. Patients were classified into nonobese (BMI <25) or obese (BMI ≥25) groups. Skeletal muscle status was assessed at CT at the level of the third lumbar vertebrae. Low skeletal muscle mass (LSMM) was defined as the sex-specific lowest quartile. Cox regression analysis was used to evaluate the associations of BMI and muscle status with overall survival. Results A total of 7076 patients (mean age, 62.5 years ± 9.7 [SD]; 4081 male) were included, of whom 2512 (35.5%) had a BMI greater than or equal to 25 (obese group). In the setting of absent LSMM and myosteatosis, patients in the obese group had longer overall survival compared with patients in the nonobese group (hazard ratio [HR], 0.77; 95% CI: 0.66, 0.90; P = .001). The associations between obesity and lower mortality were observed only in male patients (HR, 0.72; 95% CI: 0.60, 0.85; P < .001) and patients who had ever smoked (HR, 0.71; 95% CI: 0.60, 0.85; P < .001) who were without LSMM and myosteatosis, with effect differing according to sex and smoking status (P value range, <.001 to .02 for interaction). Conclusion Obesity is associated with improved overall survival in patients with non-small cell lung cancer after curative resection when skeletal muscle mass and radiodensity are preserved. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Vannier in this issue.

Obesity and postpartum hospital use among individuals without additional medical comorbidities

OBJECTIVE

The objective of this study was to examine whether obesity without preexisting or gestational comorbidities is associated with postpartum hospital use (PHU).

METHODS

We studied 2016 to 2018 birth certificate and discharge data on 178,729 New York City births without International Classification of Diseases, Tenth Revision (ICD-10) codes at delivery for diabetes; hypertension; placental disease; anemia; thyrotoxicosis; bariatric surgery; and pulmonary, cardiac, renal, bleeding, autoimmune, digestive, neuromuscular, mental, or substance-use disorders. We defined PHU as ≥1 readmission or emergency department visit within 30 days of delivery discharge. We used ICD-10 codes to specify postpartum hypertension, infection, or hemorrhage during PHU (i.e., "cause-specific PHU") because these are leading mortality causes. We examined associations between prepregnancy BMI and PHU using multivariable logistic regression.

RESULTS

PHU incidence was 3.7% for those with normal weight, 5.1% for those with overweight, 6.3% for those with class 1 or 2 obesity, and 9.1% for those with class 3 obesity. A positive association persisted after adjustment. Obesity was associated with cause-specific PHU of postpartum hypertension (adjusted odds ratio [aOR]: 2.2, 95% confidence limits [CL]: 1.8-2.7, normal weight referent) and wound infection (aOR: 1.5, 95% CL: 1.2-1.8), but not hemorrhage (aOR: 0.9, 95% CL: 0.7-1.3), mastitis, or genitourinary infection (aOR: 1.1, 95% CL: 0.9-1.3).

CONCLUSIONS

Among individuals without other comorbidities, elevated BMI was associated with PHU. Findings can inform obstetric management to reduce morbidity during the critical fourth trimester.

Risk factors for abdominal aortic aneurysm in patients with diabetes

OBJECTIVE

Although diabetes has been shown to be negatively associated with development of abdominal aortic aneurysm (AAA), patients with diabetes may still develop aneurysms. In this study, we examined risk factors for the development of AAA in patients with diabetes.

METHODS

Adults >50 years of age with diabetes who underwent health screening between 2009 and 2012 were followed for incident AAA until December 31, 2019. Cox proportional hazard regression models were used to calculate multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk factors associated with AAA.

RESULTS

Among 1,913,066 participants (55.3% men), 6996 AAA cases were identified during a mean follow-up of 7.7 years. Increased AAA risk was observed for age ≥65 years (HR, 2.69; 95% CI, 2.55-2.83), men (HR, 1.81; 95% CI, 1.69-1.94), smoking (former smoker ≥20 pack-years [PY]; HR, 1.75; 95% CI, 1.61-1.89; current smoker <20 PY; HR, 1.76; 95% CI, 1.59-1.94; current smoker ≥20 PY; HR, 2.40; 95% CI, 2.23-2.59), abdominal obesity (HR, 1.30; 95% CI, 1.23-1.38), and comorbidities, including hypertension (HR, 1.63; 95% CI, 1.53-1.73), dyslipidemia (HR, 1.35; 95% CI, 1.29-1.42), chronic kidney disease (HR, 1.52; 95% CI, 1.44-1.61), and cardiovascular disease (HR, 1.71; 95% CI, 1.58-1.86). Heavy (HR, 0.67; 95% CI, 0.61-0.74) and mild alcohol consumption (HR, 0.78; 95% CI, 0.74-0.83), overweight (HR, 0.87; 95% CI, 0.81-0.93) and obesity (HR, 0.81; 95% CI, 0.75-0.87), longer diabetes duration (≥5 years: HR, 0.74; 95% CI, 0.70-0.78), and using three or more oral hypoglycemic agents (OHA) (HR, 0.84; 95% CI, 0.79-0.90) were associated with decreased AAA risk, whereas insulin use was associated with a marginally increased risk (HR, 1.09; 95% CI, 1.00-1.18). Among the OHAs, metformin (HR, 0.95; 95% CI, 0.90-1.00), thiazolidinediones (HR, 0.87; 95% CI, 0.79-0.97), and sulfonylureas (HR, 0.88; 95% CI, 0.83-0.93) were associated with a decreased risk of AAA.

CONCLUSIONS

Although diabetes is associated with decreased AAA risk, those with comorbid cardiometabolic diseases, abdominal obesity, and a smoking history should be aware of an increased AAA risk. Further studies are warranted to verify the potential use of OHAs for decreasing AAA risk.

Influence of waist circumference measurement site on the cardiometabolic risk factors in Korean adults

BACKGROUND

Waist circumference (WC) has been recognized as a simple anthropometric measure of abdominal obesity and associated health risk. We compared WC values at five measurement sites, and examined whether measurement sites influence the relationships between WC and cardiometabolic risk in Korean adults.

METHODS

In this cross-sectional study, participants included 180 men and 176 women (age: 30-60 years, BMI: 18.5-30.0 kg/m2) who underwent a regular health examination between 2021 and 2022. WC was measured at the following sites; lowest rib, superior border of the iliac crest, midpoint between the lowest rib and the iliac crest, umbilicus, and narrowest waist. Fasting glucose and lipids, and resting blood pressure were measured after a 10-hour overnight fast. Cardiometabolic risk factors were defined using the modified National Cholesterol Education Program Adult Treatment Panel-III.

RESULTS

All WC measures at five sites were highly correlated (P < 0.01) with each other in men (r = 0.933-0.995) and women (r = 0.893-0.990). Differences in absolute mean WC values existed in both men and women. The prevalence of abdominal obesity (men: 17.2 %-34.4 %, women: 5.7 %-40.9 %) and metabolic syndrome (men: 30.6 %-38.9 % women: 13.6 %-22.2 %) varied depending on the measurement site. All five WC sites were similarly associated (P < 0.05) with an increased odd ratio for elevated glucose, elevated triglycerides, low HDL cholesterol and cardiometabolic risk clustering in men, and elevated blood pressure and cardiometabolic risk clustering in women.

CONCLUSION

Although the differences in absolute WC values existed, the associations between WC at each site and cardiometabolic risk were similar in Korean adults.

Rebound of Reflux-Related Symptoms After Helicobacter pylori Eradication in Patients With Gastroesophageal Reflux Disease: A Prospective Randomized Study

BACKGROUND/PURPOSE

We aimed to assess the effects of Helicobacter pylori (H. pylori) eradication on the rebound of reflux-related symptoms among gastroesophageal reflux disease (GERD) patients.

METHODS

This prospective randomized study recruited patients with typical reflux symptoms and reflux esophagitis on esophagogastroduodenoscopy (NCT02934152). Patients positive for H. pylori via a urea breath test (UBT) were randomly assigned to receive bacterial eradication with triple therapy for 2 weeks either before or after proton-pump inhibitor (PPI) treatment for 4 weeks. Follow-up was implemented with serial GerdQ evaluation and a subsequent UBT. The primary outcome was the incidence rates of symptom rebound between patients with and without H. pylori infection. The secondary outcomes included the severity of symptom rebound, incidence rates of symptom rebound, and successful eradication rates between the early and late eradication groups.

RESULTS

A total of 248 patients were enrolled, of whom 107 (43.1%) tested positive for H. pylori infection. All patients with and without concurrent H. pylori infection had significant symptom improvement over the entire treatment. Patients with H. pylori infection had significantly lower rates of symptom rebound (19.8% vs. 34.2%, p = 0.034) and rebound severity (1.8 ± 0.7 vs. 2.8 ± 1.6, p = 0.031) 4 weeks after eradication and PPI treatment than those without. The incidence rates of symptom rebound and successful eradication rates were not significantly different between the early and late eradication groups.

CONCLUSIONS

GERD patients with concurrent H. pylori infection were less susceptible to symptom rebound after H. pylori eradication compared to those without.

TRIAL REGISTRATION

ClinicalTrial.gov (NCT02934152).

A compositional analysis of time spent in physical activity, sedentary behaviour, and sleep with quality of life in Canadian older adults aged 65 years and above: findings from the Canadian Longitudinal Study on Aging

Associations between daily time spent in physical activity (PA), sedentary behaviour (SB), and sleep (collectively referred to as "movement behaviour") and quality of life (QOL) are typically studied without considering they are compositional, co-dependant variables. Study objectives were to use compositional data analysis to: (1) examine the relationship between movement behaviour composition and QOL, (2) estimate the degree to which changing time spent in any movement behaviour within the movement behaviour composition is associated with QOL. 7918 older Canadian adults ≥65 years of age from the Canadian Longitudinal Study on Aging were studied using a quasi-longitudinal study design. Daily time spent in PA and SB were derived from self-reported Physical Activity Scale for the Elderly responses. Nighttime sleep was self-reported separately. QOL was assessed through the Satisfaction with Life Scale. Movement behaviour composition was significantly associated with QOL. Relative time spent in SB was negatively associated with QOL (HR = 0.89 (95% CI: 0.86-0.93)). Relative time spent in sleep was positively associated with QOL (HR = 1.10 (95% CI: 1.05-1.16)). Time displacement estimates revealed that greatest change in QOL occurred when time spent in PA was decreased and replaced with SB (HR = 0.96 (95% CI: 0.92-0.99) for 45 min/day displacement). Using compositional data analysis is advantageous because it shows how reduction in SB and increase in PA and sleep can lead to improvements in QOL for older Canadian adults.

Diet-induced Obesity: Pathophysiology, Consequences and Target Specific Therapeutic Strategies

Diet has emerged as a pivotal factor in the current time for diet-induced obesity (DIO). A diet overloaded with fats and carbohydrates and unhealthy dietary habits contribute to the development of DIO through several mechanisms. The prominent ones include the transition of normal gut microbiota to obese microbiota, under-expression of AMPK, and abnormally high levels of adipogenesis. DIO is the root of many diseases. The present review deals with various aspects of DIO and its target proteins that can be specifically used for its treatment. Also, the currently available treatment strategies have been explored. It was found that the expression of five proteins, namely, PPARγ, FTO, CDK4, 14-3-3 ζ protein, and Galectin-1, is upregulated in DIO. They can be used as potential targets for drug-designing studies. Thus, with these targets, the treatment strategy for DIO using natural bioactive compounds can be a safer alternative to medications and bariatric surgeries.

Predisposing, enabling, and need factors influencing health-related quality of life among people with metabolic syndrome

BACKGROUND

Metabolic syndrome (MetS) continues to impact the health-related quality of life (HRQoL) of patients despite various available therapeutic interventions. There is a dearth of information on how patient-centered factors holistically predict HRQoL to provide more insights on addressing MetS.

OBJECTIVE

To predict the HRQoL of patients with MetS in the Southern states, using the predisposing, enabling, and need factors.

METHODS

The study adopted a cross-sectional approach in collecting 706 complete surveys on HRQoL assessment using the EQ-5D-5L survey and demographic characteristics based on the predisposing, enabling, and need factors of Andersen's Behavioral model. The study focused on people with MetS in the southern states of the United States. Multinomial logistic regression was conducted to investigate the relationship between the number of comorbidities and each HRQoL dimension. Ordinal regression was used to explore factors predicting HRQoL. Sensitivity analysis was conducted using bootstrapping analysis to evaluate the regression's robustness.

RESULTS

Over 70% were females and 30% had at least a bachelor's degree, while 47% were married. Most respondents (71.1%) had no problem with self-care. However, 20.0% had severe problems with pain, while the highest proportion (8.6%) was observed for extreme problems with anxiety or depression. A unit increase in comorbidities resulted in higher odds of having extreme problems with mobility (odds ratio [OR] = 1.95), usual activities (OR = 1.73), and pain (OR = 1.70). Only 40.8% of the respondents had good HRQoL, compared to 26.2% with poor HRQoL. Age, race, geographical area, marital status, household income, number of prescription drugs, comorbidities, and body mass index were predictors of HRQoL.

CONCLUSION

An increase in comorbidities significantly increased the odds of having challenges with the HRQoL dimensions. Demographic, socioeconomic, and health-related factors significantly predicted HRQoL. Therefore, health care providers must consider these factors as a component of patient-centered care to address health disparities and promote optimal health outcomes among people with MetS.

Association between body mass index and chronic obstructive pulmonary disease in young individuals: a nationwide population‑based cohort study

Body mass index (BMI) is associated with chronic obstructive pulmonary disease (COPD) risk. We investigated the association between BMI and the risk of COPD among young individuals. Using the Korean National Health Information Database, we screened individuals aged 20-39 years who participated in the national health examination between 2009 and 2012. We identified 6,304,769 eligible individuals, and 13,784 had newly developed COPD. BMI was categorized according to the Asian BMI criteria. We performed multivariate Cox proportional hazards models to estimate the adjusted hazard ratio (aHR) of risk factors for COPD development. Their mean age was 30.8 ± 5.0 years, and 3,732,656 (59.2%) were men. The incidence rate for developing COPD was 0.22/1,000 person-years. Compared to individuals with normal BMI (18.5-22.9 kg/m2), those who were underweight (< 18.5 kg/m2) had higher risks of COPD development (aHR: 1.37, 95% confidence interval [CI]: 1.29-1.46). Meanwhile, overweight or obese individuals (23-24.9 or 25-29.9 kg/m2) had lower risks for COPD development (aHR 0.90, 95% CI 0.86-0.95, and aHR 0.90, 95% CI 0.85-0.94, respectively). Although males showed tendencies similar to those of the total population, the risk was increased with increasing BMI among females. In the subgroup analysis, the risk reduction was not observed among non-smokers as BMI increased. In young individuals, being underweight was associated with an increased risk for COPD development, whereas being overweight and obese were associated with a decreased risk for COPD.

Smoking timing, genetic susceptibility, and the risk of incident atrial fibrillation: a large prospective cohort study

AIMS

Although smoking is a well-known risk factor for atrial fibrillation (AF), the association of smoking timing with AF risk remains unclear. This study aimed to prospectively investigate the association of smoking timing with the risk of incident AF and test the modification effect of genetic susceptibility.

METHODS AND RESULTS

A total of 305 627 participants with detailed information for time from waking to the first cigarette were enrolled from UK Biobank database. The Cox proportional hazard model was employed to assess the relationship between smoking timing and AF risk. The weighted genetic risk score for AF was calculated. Over a median 12.2-year follow-up, 13 410 AF cases were documented. Compared with non-smokers, time from waking to the first cigarette showed gradient inverse associations with the risk of incident AF (P-trend <0.001). The adjusted hazard ratio related to smoking timing was 1.13 [95% confidence interval (CI): 0.96-1.34] for >120 min, 1.20 (95% CI: 1.01-1.42) for 61-120 min, 1.34 (95% CI: 1.19-1.51) for 30-60 min, 1.43 (95% CI: 1.26-1.63) for 5-15 min, and 1.49 (95% CI: 1.24-1.63) for <5 min, respectively. Additionally, we found that the increased risk of AF related to shorter time from waking to the first cigarette was strengthened by the genetic susceptibility to AF.

CONCLUSION

Our findings suggest gradient inverse association between time from waking to the first cigarette and risk of incident AF, and the association is strengthened by the genetic susceptibility to AF.

Prevalence of antihypertensive medication adherence and associated factors in India: A systematic review and meta-analysis

BACKGROUND

Non-adherence to antihypertensive medication is a key factor contributing to uncontrolled blood pressure and the subsequent complications of hypertension. Despite its importance, there is a lack of data regarding the prevalence of and factors associated with non-adherence to medication among individuals with hypertension in India. This review aimed to assess medication adherence rates among hypertensive patients in India and identify the factors influencing non-adherence.

METHODS

A comprehensive search was conducted across PubMed, Scopus, Embase, and Google Scholar. Studies reporting medication adherence/non-adherence to antihypertensive medications in India, using the Morisky Medication Adherence Scale (MMAS), with publication dates up to July 2023, were included.

RESULTS

Twelve studies were included, involving a total of 3164 participants. The pooled rate of medication adherence to antihypertensive medications in India was determined to be 15.8% (95% CI: 4.4; 43.4). The important factors associated with non-adherence included higher age, medication regimen complexity, low socioeconomic status, low education levels, uncontrolled blood pressure, and comorbidities.

CONCLUSIONS

The adherence rate to antihypertensive medication was observed to be quite low. Therefore, it is imperative to enhance the rate of medication adherence among individuals with hypertension in order to attain effective blood pressure control and reduce the burden of non-communicable diseases.

Disease burden and health inequality of older adults with edentulism and the projected trend until 2040: based on the global burden of disease study 2021

OBJECTIVES

To comprehensively analyze the current situation and the trends over the next 21 years, focusing on health inequalities related to edentulism among the elderly across global regions.

MATERIALS AND METHODS

Data on edentulism in older adults were collected from the 2021 global burden of disease (GBD) study. Disease burden trends were analyzed using a joinpoint model. We used the Slope Index of Inequality (SII) and the Concentration Index (CI) to assess health inequalities. A Bayesian age-period-cohort (BAPC) model was used to analyze the projected trend of prevalence up to 2040.

RESULTS

The number of incident, prevalent, and years lived with disability (YLD) cases of edentulism in older adults is increasing globally, while the rate is declining. According to the analysis of health inequality, the burden of edentulism among older adults was gradually concentrated in countries with lower Sociodemographic Index (SDI). Significant downward trends were expected in the global age-standardized prevalence rate (ASPR) of edentulism for both genders from 2020 to 2040; however, the number is increasing.

CONCLUSIONS

Taken together, the burden of edentulism in older people remains high and generally shifts from higher-SDI countries to lower-SDI countries. There are great differences between countries, and effective measures should be taken in countries with poorer economies.

CLINICAL RELEVANCE

The disease burden of edentulism in older adults is gradually shifting towards lower SDI countries. It is crucial to optimize the utilization and allocation of healthcare resources to reduce health inequities in edentulism in older adults.

The Greater the Number of Altered Eating Behaviors in Obesity, the More Severe the Psychopathology

Background: Altered eating behaviors (AEBs) are not only associated with eating disorders but also play a role in obesity. This study assessed AEBs in individuals with obesity and their association with general and eating psychopathology, using the "Eating Behaviors Assessment for Obesity" (EBA-O). The hypothesis posited that a higher frequency of pathological eating behaviors would correlate with more severe psychopathology. Methods: Participants seeking weight loss treatment answered the EBA-O and other measures of eating and general psychopathology. The analysis employed MANOVA to estimate psychopathological variance based on AEBs and a cluster analysis to identify patient clusters by AEB type and number. Results: Out of the 244 participants, approximately two-thirds reported clinically relevant AEBs, with almost half exhibiting more than two AEBs. Predominant AEBs included sweet eating, binge eating, and hyperphagia. A significant impact of the numbers of AEBs on both eating and general psychopathology severity (p < 0.001; η2 = 0.167) was evident. Three clusters emerged, with Cluster 3 showing the highest AEB frequency and greater psychopathological impairment. Conclusions: The present findings confirm the correlation between the frequency of AEBs and the severity of general and eating psychopathology in individuals with obesity. AEBs deserve clinical attention, and their screening might aid their clinical characterization and foster more tailored treatments.

Integrating the metabolic and molecular circuits in diabetes, obesity and cancer: a comprehensive review

The progressive globalization of sedentary lifestyles and diets rich in lipids and processed foods has caused two major public health hazards-diabetes and obesity. The strong interlink between obesity and type 2 diabetes mellitus and their combined burden encompass them into a single term 'Diabesity'. They have also been tagged as the drivers for the onset of cancer. The clinical association between diabetes, obesity, and several types of human cancer demands an assessment of vital junctions correlating the three. This review focuses on revisiting the molecular axis linking diabetes and obesity to cancer through pathways that get imbalanced owing to metabolic upheaval. We also attempt to describe the functional disruptions of DNA repair mechanisms due to overwhelming oxidative DNA damage caused by diabesity. Genomic instability, a known cancer hallmark results when DNA repair does not work optimally, and as will be inferred from this review the obtruded metabolic homeostasis in diabetes and obesity creates a favorable microenvironment supporting metabolic reprogramming and enabling malignancies. Altered molecular and hormonal landscapes in these two morbidities provide a novel connection between metabolomics and oncogenesis. Understanding various aspects of the tumorigenic process in diabesity-induced cancers might help in the discovery of new biomarkers and prompt targeted therapeutic interventions.

Association between metabolic syndrome and the risk of glaucoma: a meta-analysis of observational studies

BACKGROUND

The potential link between metabolic syndrome (MetS) and the risk of glaucoma has been proposed but remains inconclusive. This meta-analysis aimed to systematically evaluate the association between MetS and the risk of glaucoma.

METHODS

We conducted a comprehensive search of PubMed, Embase, and Web of Science from inception to August 12, 2024, for observational studies assessing the relationship between MetS and glaucoma risk. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate the association. Heterogeneity was assessed using I² statistics, and a random-effects model was applied.

RESULTS

Nine studies involving 2,258,797 participants were included. The pooled results showed that MetS was significantly associated with an increased risk of glaucoma (OR: 1.34, 95% CI 1.15-1.55, p < 0.001; I² = 75%). Subgroup analyses according to the individual component of MetS suggested that hypertension and hyperglycemia were significantly associated with glaucoma, but not for obesity or dyslipidemia, although the difference among subgroups was not significant (p = 0.05). Further subgroup and meta-regression analyses suggested that the results were not significantly affected by study design, average age, sex, method of glaucoma diagnosis, or glaucoma subtype (primary open-angle glaucoma or normal-tension glaucoma). Sensitivity analysis confirmed the robustness of the findings.

CONCLUSIONS

This meta-analysis suggests that MetS is significantly associated with an increased risk of glaucoma. These findings highlight the need for heightened awareness and potential screening strategies for glaucoma in individuals with MetS. Further studies are required to elucidate underlying mechanisms and causality.

The effect of heated tobacco products on metabolic syndrome: A cohort study

INTRODUCTION

Evidence concerning the health effects of using heated tobacco products is needed. The aim of the present study is to investigate the effects of conventional cigarettes (CCs), electronic vaping cigarettes (EVCs), and heated tobacco products (HTPs) on the development of metabolic syndrome.

METHODS

We conducted a cohort study in South Korea using data from the Korea Medical Institute. The study included 183870 people who visited the Korea Medical Institute, responded to a smoking status questionnaire in 2019, and were followed up in 2020 - ever and current use of CCs, EVCs, and HTPs. We defined the main outcome as incident metabolic syndrome among participants with at least two health checkups separated by a follow-up period of at least a year.

RESULTS

The association of using HTPs with risk for metabolic syndrome was estimated after controlling for age, sex, exercise, drinking history, and smoking regular cigarettes and using EVCs, with the Cox proportional hazards model. The risk of incident metabolic syndrome was increased by 68% (HR=1.68; 95% CI: 1.25-2.26) for current HTP users compared to never users. Among HTP users who did not currently smoke conventional cigarettes, the risk was doubled (HR=2.17; 95% CI: 1.31-3.62) when their smoking duration was ≥3 years. The risk of metabolic syndrome increased by 33% (HR=1.33; CI: 1.18-1.49) among HTP users who used them more than 16 times a day. The use of HTP was found to increase the risk of developing metabolic syndrome, with a particularly elevated risk observed among those who used HTPs for more than three years. The risk was higher than that observed in conventional cigarette users.

CONCLUSIONS

Our findings indicate that HTP use poses comparable risks in relation to metabolic syndrome development.

Application value of continuous nursing in the treatment of obese patients with laparoscopic sleeve gastrectomy

AIM

To explore the value and effectiveness of continuous nursing in obese patients undergoing laparoscopic sleeve gastrectomy.

METHODS

A total of 164 obese patients who were admitted to Nanjing Drum Tower Hospital and underwent planned laparoscopic sleeve gastrectomy in 2022 were retrospectively selected as the control group, and another 164 obese patients undergoing the same surgery in 2022 were chosen as the research group. The control group received routine care, while the research group received continuous nursing care. Comparisons were made between the two groups regarding the patient's body weight, fasting blood glucose levels, dietary habits, exercise and rest compliance, anxiety and depression status, quality of life and sleep, postoperative complications, and satisfaction.

RESULTS

Compared with the control group, the research group showed significant decreases in the patient's body weight, body mass index (BMI), and fasting blood glucose levels, with a significant increase in excess weight loss percentage (%EWL) (all P<0.05). Dietary, exercise, and rest compliance were significantly higher in the research group than those in the control group (all P<0.05). Additionally, patients in the research group scored higher in dimensions such as physical function, general health, social function, emotional role, and mental health compared to the control group (all P<0.05). The Pittsburgh sleep quality index (PSQI) was significantly lower in the research group than that in the control group (P<0.05). The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores were significantly lower in the research group than those in the control group (all P<0.05). The complication rate in the research group was significantly lower than that in the control group (all P<0.05). Patient satisfaction with outpatient continuous nursing care was significantly higher in the research group than that in the control group (all P<0.05).

CONCLUSION

Continuous care applied following laparoscopic sleeve gastrectomy significantly improves patients' body weight, BMI, and %EWL. It can also effectively reduce fasting blood sugar levels and improve overall quality of life. Additionally, continuous care significantly enhances patients' compliance with dietary, exercise, and rest recommendations, thereby leading to a significant decrease in anxiety and depression symptoms, and an improvement in patient satisfaction and sleep quality.

Smart control lipid-based nanocarriers for fine-tuning gut hormone secretion

Modulating the endogenous stores of gastrointestinal hormones is considered a promising strategy to mimic gut endocrine function, improving metabolic dysfunction. Here, we exploit mouse and human knock-in and knockout intestinal organoids and show that agents used as commercial lipid excipients can activate nutrient-sensitive receptors on enteroendocrine cells (EECs) and, when formulated as lipid nanocarriers, can bestow biological effects through the release of GLP-1, GIP, and PYY from K and L cells. Studies in wild-type, dysglycemic, and gut Gcg knockout mice demonstrated that the effect exerted by lipid nanocarriers could be modulated by varying the excipients (e.g., nature and quantities), the formulation methodology, and their physiochemical properties (e.g., size and composition). This study demonstrates the therapeutic potential of using nanotechnology to modulate release of multiple endogenous hormones from the enteroendocrine system through a patient-friendly, inexpensive, and noninvasive manner.

Longitudinal trends and predictors of limitations in activities of daily living in community-dwelling older adults: evidence from the KLoSA study

Background

As life expectancy increases, the number of older adults with functional limitations is also increasing. Functional limitations are associated with adverse health outcomes such as reduced independence, diminished quality of life (QoL), and disability. Therefore, identifying which activities of daily living (ADLs) are limiting and understanding the influencing factors are crucial for developing tailored interventions. Although various factors influence ADL limitations, few studies have identified the longitudinal factors associated with each ADL. This study explores the longitudinal trends and factors associated with the ADL total score and functional limitations with each ADL among older adults in Korea.

Methods

Using data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2020, we analyzed 1,388 people aged 65 and older who had no ADL limitations in 2006. An ADL limitation was defined as partial or complete dependence in any of the following ADLs: getting dressed, washing face and hands, bathing, eating, transferring, toileting, and continence. We used repeated measures analysis of variance and multivariate logistic regression to investigate the trends and predictors of ADL limitations over a 14-year period.

Results

In 2006, the mean age of the participants was 69.88 years (SD = ±4.11), and 60.20% were female. The prevalence of total ADL limitations and limitations in each of the seven ADLs increased gradually during the 14 years of follow up. In 2020, the ADL items with the highest prevalence of limitations were bathing, getting dressed, and washing face and hands. The common significant predictors for total ADL limitations and limitation in the top three ADLs were age and cognitive function.

Conclusion

ADL limitations among Korean older adults significantly increase over time, which highlights the need for integrated early intervention and continuous support for bathing limitations, including the application of integrated assistive technologies. In particular, because age and cognitive function were identified as the major predictors for limitations in both total ADLs and the top three ADLs, early assessment and appropriate intervention strategies need to consider those factors to prevent ADL limitations in older adults or to meet the immediate needs of those already experiencing ADL limitations. This approach could enhance the QoL for older adults and contribute to the development of long-term healthcare plans.

Quantitative analysis of the caloric restriction versus isocaloric diets models based on macronutrients composition: impacts on body weight regulation, anthropometric, and bioimpedance parameters in women with obesity

Introduction

Obesity is a growing public health issue, especially among young adults, with long-term management strategies still under debate. This prospective study compares the effects of caloric restriction and isocaloric diets with different macronutrient distributions on body composition and anthropometric parameters in obese women during a 12-week weight loss program, aiming to identify the most effective dietary strategies for managing obesity-related health outcomes.

Methods

A certified clinical nutritionist assigned specific diets over a 12-week period to 150 participants, distributed as follows: hypocaloric diets-low-energy diet (LED, 31 subjects) and very low-energy diet (VLED, 13 subjects); isocaloric diets with macronutrient distribution-low-carbohydrate diet (LCD, 48 subjects), ketogenic diet (KD, 23 subjects), and high-protein diet (HPD, 24 subjects); and isocaloric diet without macronutrient distribution-time-restricted eating (TRE, 11 subjects). Participants were dynamically monitored using anthropometric parameters: body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and bioelectrical impedance analysis (BIA) using the TANITA Body Composition Analyzer BC-418 MA III (T5896, Tokyo, Japan) at three key intervals-baseline, 6 weeks, and 12 weeks. The following parameters were evaluated: body weight, basal metabolic rate (BMR), percentage of total body fat, trunk fat, muscle mass, fat-free mass, and hydration status.

Results

All diets led to weight loss, but differences emerged over time. The TRE model resulted in significantly less weight loss compared to LED at the final follow-up (6.30 kg, p < 0.001), similar to the VLED (4.69 kg, p < 0.001). Isocaloric diets with varied macronutrient distributions showed significant weight loss compared to LED (p < 0.001). The KD reduced waist circumference at both 6 and 12 weeks (-4.08 cm, p < 0.001), while significant differences in waist-to-hip ratio reduction were observed across diet groups at 12 weeks (p = 0.01). Post-hoc analysis revealed significant fat mass differences at 12 weeks, with HPD outperforming IF (p = 0.01) and VLED (p = 0.003). LCD reduced trunk fat at 6 weeks (-2.36%, p = 0.001) and 12 weeks (-3.79%, p < 0.001). HPD increased muscle mass at 12 weeks (2.95%, p = 0.001), while VLED decreased it (-2.02%, p = 0.031). TRE showed a smaller BMR reduction at 12 weeks compared to LED.

Conclusion

This study highlights the superior long-term benefits of isocaloric diets with macronutrients distribution over calorie-restrictive diets in optimizing weight, BMI, body composition, and central adiposity.

The Effects of Metformin on Weight Loss, Cardiovascular Health, and Longevity

Metformin, a biguanide derived from Galega officinalis, was first synthesized by Werner and Bell in 1922. Metformin was approved for the treatment of diabetes by the US Food and Drug Administration in 1994. It has since become the most widely used oral antidiabetic agent. The exact mechanisms by which metformin exerts its clinical effects remain the subject of ongoing research. Metformin interacts with multiple molecular pathways, and the downstream effects of which affect weight, cardiovascular health, and longevity. Metformin reduces hunger by mitigating insulin resistance in the hypothalamic pro-opiomelanocortin neurons. It enhances satiety by stimulating the enteral release of glucagon-like peptide 1. It also induces favorable changes to enteric microbiota, enhancing metabolism. These effects cumulatively contribute to metformin-induced weight loss. Metformin use has shown associations with improved cardiovascular outcomes including reduced all-cause mortality, lower rates of myocardial infarctions, and improved heart failure outcomes. Many of these actions are mediated through the direct activation of adenosine monophosphate-activated kinase (AMPK), which, in turn, enhances cellular energy production and endothelial nitric oxide synthase-mediated vascular relaxation. It antagonizes proinflammatory cytokines, reducing cardiac fibrosis and remodeling. The metformin-AMPK pathway may also explain the potential utility of metformin in mitigating aging. Acting through AMPK, it inhibits the mammalian target of rapamycin, leading to increased autophagy and cell growth. The metformin-AMPK-sirtuin pathway may also contribute to longevity. In this review, we will discuss the use of metformin in weight loss, cardiovascular health, and longevity, highlighting the historic background, molecular mechanisms, and current evidence.

Higher Animal-Based Protein Intake Levels Show a Greater Likelihood of Having Metabolic Syndrome in Single-Person Households Among Korean Adults

BACKGROUND/OBJECTIVES

Despite the increasing intake of animal-based protein and the growing number of single-person households (SPHs) in Korean populations, no studies have analyzed the relationship of protein intake by source with metabolic syndrome (MetS) according to household type. This study examined the association between protein intake (plant- and animal-based sources) and MetS risk factors in SPH and multi-person households (MPHs) among Korean adults.

METHOD

A total of 12,022 participants aged 30-64 years (SPH: 982; MPH: 11,040) were selected from the 2016-2021 Korea National Health and Nutrition Examination Survey. Protein intake level was defined as the percentage contribution of food source to daily intake, assessed using 24 h recall dietary data.

RESULTS

The animal-based protein intake level was slightly higher in SPHs (51.2%) compared to MPHs (49.5%), whereas the contributions of plant sources from vegetables, fruits, and whole grains were higher in MPHs (p < 0.01). The prevalence of MetS and abdominal obesity increased with higher animal-based protein intake levels across all household types. Only in SPHs, each 1% rise in the proportion of animal-based protein was positively associated with increased blood pressure (OR = 1.013, 95% CI: 1.004-1.022). Moreover, the interaction between animal-based protein intake levels and household type was significantly associated with a higher prevalence of elevated triglycerides (TGs) (MPH[Q1] vs. SPH[Q4] OR = 1.51; p for interaction = 0.0335). However, these two risk factors did not show significant association in MPHs.

CONCLUSIONS

The results suggest that reducing dietary animal protein could help manage MetS risk factors, particularly increased blood pressure, and elevated TGs in SPHs of Korean adults. In conclusion, dietary guidelines that promote a higher intake of plant-based protein over animal-based protein for the health of the SPH population would be valuable from a public health perspective.

National-level and state-level prevalence of overweight and obesity among children, adolescents, and adults in the USA, 1990-2021, and forecasts up to 2050

BACKGROUND

Over the past several decades, the overweight and obesity epidemic in the USA has resulted in a significant health and economic burden. Understanding current trends and future trajectories at both national and state levels is crucial for assessing the success of existing interventions and informing future health policy changes. We estimated the prevalence of overweight and obesity from 1990 to 2021 with forecasts to 2050 for children and adolescents (aged 5-24 years) and adults (aged ≥25 years) at the national level. Additionally, we derived state-specific estimates and projections for older adolescents (aged 15-24 years) and adults for all 50 states and Washington, DC.

METHODS

In this analysis, self-reported and measured anthropometric data were extracted from 134 unique sources, which included all major national surveillance survey data. Adjustments were made to correct for self-reporting bias. For individuals older than 18 years, overweight was defined as having a BMI of 25 kg/m2 to less than 30 kg/m2 and obesity was defined as a BMI of 30 kg/m2 or higher, and for individuals younger than 18 years definitions were based on International Obesity Task Force criteria. Historical trends of overweight and obesity prevalence from 1990 to 2021 were estimated using spatiotemporal Gaussian process regression models. A generalised ensemble modelling approach was then used to derive projected estimates up to 2050, assuming continuation of past trends and patterns. All estimates were calculated by age and sex at the national level, with estimates for older adolescents (aged 15-24 years) and adults aged (≥25 years) also calculated for 50 states and Washington, DC. 95% uncertainty intervals (UIs) were derived from the 2·5th and 97·5th percentiles of the posterior distributions of the respective estimates.

FINDINGS

In 2021, an estimated 15·1 million (95% UI 13·5-16·8) children and young adolescents (aged 5-14 years), 21·4 million (20·2-22·6) older adolescents (aged 15-24 years), and 172 million (169-174) adults (aged ≥25 years) had overweight or obesity in the USA. Texas had the highest age-standardised prevalence of overweight or obesity for male adolescents (aged 15-24 years), at 52·4% (47·4-57·6), whereas Mississippi had the highest for female adolescents (aged 15-24 years), at 63·0% (57·0-68·5). Among adults, the prevalence of overweight or obesity was highest in North Dakota for males, estimated at 80·6% (78·5-82·6), and in Mississippi for females at 79·9% (77·8-81·8). The prevalence of obesity has outpaced the increase in overweight over time, especially among adolescents. Between 1990 and 2021, the percentage change in the age-standardised prevalence of obesity increased by 158·4% (123·9-197·4) among male adolescents and 185·9% (139·4-237·1) among female adolescents (15-24 years). For adults, the percentage change in prevalence of obesity was 123·6% (112·4-136·4) in males and 99·9% (88·8-111·1) in females. Forecast results suggest that if past trends and patterns continue, an additional 3·33 million children and young adolescents (aged 5-14 years), 3·41 million older adolescents (aged 15-24 years), and 41·4 million adults (aged ≥25 years) will have overweight or obesity by 2050. By 2050, the total number of children and adolescents with overweight and obesity will reach 43·1 million (37·2-47·4) and the total number of adults with overweight and obesity will reach 213 million (202-221). In 2050, in most states, a projected one in three adolescents (aged 15-24 years) and two in three adults (≥25 years) will have obesity. Although southern states, such as Oklahoma, Mississippi, Alabama, Arkansas, West Virginia, and Kentucky, are forecast to continue to have a high prevalence of obesity, the highest percentage changes from 2021 are projected in states such as Utah for adolescents and Colorado for adults.

INTERPRETATION

Existing policies have failed to address overweight and obesity. Without major reform, the forecasted trends will be devastating at the individual and population level, and the associated disease burden and economic costs will continue to escalate. Stronger governance is needed to support and implement a multifaceted whole-system approach to disrupt the structural drivers of overweight and obesity at both national and local levels. Although clinical innovations should be leveraged to treat and manage existing obesity equitably, population-level prevention remains central to any intervention strategies, particularly for children and adolescents.

FUNDING

Bill & Melinda Gates Foundation.

Optimization of Naringin Extraction, Synthesis of Dihydrochalcone and Its Effects on Reducing Blood Lipid Levels In Vitro

Response surface methodology (RSM) was used to optimize the extraction process of naringin. The central component design included three parameters of extraction, namely temperature (X1), solid-liquid ratio (X2), and extraction time (X3). The optimum extraction temperature was 67 °C; the ratio of feed to solvent was 54:1 mL/g, and the extraction time was 2.8 h. According to the best extraction conditions, naringin was processed to verify the accuracy of the model. Five parallel experiments were set up, and a yield of 3.248% naringin was obtained, which was equivalent to the predicted yield of 3.256%. Naringin was purified to obtain naringin-refined products using DM101 macroporous adsorption resin. Naringin dihydrochalcone was synthesized following catalytic hydrogenation of purified naringin. The structures of naringin and naringin dihydrochalcone were determined via Fourier infrared spectrometer and nuclear magnetic resonance spectrometry. In vitro determination of the lipid-lowering activity of naringin dihydrochalcone was also conducted. Further focusing on HepG2 cells, a high cholesterol-induced high-fat HepG2 cell model was established. We measured the effects of different concentrations of naringin dihydrochalcone on intracellular lipids in denatured HepG2 cells and further validated the lipid-lowering effect of naringin at the cellular level. The results showed that naringin dihydrochalcone has a potential application in functional foods for lowering blood lipids.

Biomarkers and Seaweed-Based Nutritional Interventions in Metabolic Syndrome: A Comprehensive Review

Metabolic Syndrome (MetS) is a complex, multifactorial condition characterized by risk factors such as abdominal obesity, insulin resistance, dyslipidemia and hypertension, which significantly contribute to the development of cardiovascular disease (CVD), the leading cause of death worldwide. Early identification and effective monitoring of MetS is crucial for preventing serious cardiovascular complications. This article provides a comprehensive overview of various biomarkers associated with MetS, including lipid profile markers (triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio), inflammatory markers (interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), plasminogen activator inhibitor type 1 (PAI-1), C-reactive protein (CRP), leptin/adiponectin ratio, omentin and fetuin-A/adiponectin ratio), oxidative stress markers (lipid peroxides, protein and nucleic acid oxidation, gamma-glutamyl transferase (GGT), uric acid) and microRNAs (miRNAs) such as miR-15a-5p, miR5-17-5p and miR-24-3p. Additionally, this review highlights the importance of biomarkers in MetS and the need for advancements in their identification and use for improving prevention and treatment. Seaweed therapy is also discussed as a significant intervention for MetS due to its rich content of fiber, antioxidants, minerals and bioactive compounds, which help improve cardiovascular health, reduce inflammation, increase insulin sensitivity and promote weight loss, making it a promising nutritional strategy for managing metabolic and cardiovascular health.

Association and interaction effect of shift work and the risk for obstructive sleep apnea on diabetes mellitus in middle-aged Korean workers

PURPOSE

To investigate the association of shift work and the risk for obstructive sleep apnea (OSA) with diabetes mellitus (DM), and the interaction effect of shift work and the risk for OSA on DM.

METHODS

Data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2019-2021 were used. The participants were 3012 employees aged 40 to 59 years. Shift work was assessed using self-reporting questionnaires. The risk for OSA was assessed by STOP-BANG score. The distribution of demographic factors was calculated using the chi-square test. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression. An interaction effect between shift work and the risk for OSA on DM was evaluated using relative excess risk owing to interaction (RERI) and attributable proportion (AP) with 95% CIs. The synergic index (SI) was also calculated.

RESULTS

Shift work and the risk for OSA were each significantly associated with DM. There was also a significant interaction effect between shift work and the risk for OSA on DM. The RERI was 0.543 (95% CI 0.205-1.361) and the AP was 0.230 (95% CI 0.145-0.342). The SI was 1.662 (95% CI 1.481-1.843).

CONCLUSIONS

There was an association and a significant interaction effect of shift work and the risk for OSA on DM. The management of OSA in shift workers should be implemented to prevent DM.

Fucosylated chondroitin sulfate alleviates diet-induced obesity by modulating intestinal lipid metabolism and colonic microflora

Fucosylated chondroitin sulfate from Pearsonothuria graeffei (FCS-Pg), a natural macromolecular polysaccharide, has been proven to prevent obesity, but its underlying molecular mechanism is still unclear. C57BL/6 J mice fed on high fat diet (HFD) were administered FCS-Pg lasting for ten weeks. The results demonstrated that FCS-Pg supplementation reduced body weight with dosage manner compared with HFD group. The expressions of intestinal lipid synthesis related proteins such as cluster of differentiation 36 (CD36) in FCS-Pg group were lower than those in the HFD group. Compared with the normal group, HFD caused gut microbiota disorder in the colon. FCS-Pg supplementation at high dosage restored the gut microbiota composition with higher abundance of Alistipes and Bacteroidetes and lower abundance of Colidextribacter, Bilophila and Firmicutes compared with HFD group. Moreover, FCS-Pg decreased the expression of proteins involved in triglyceride synthesis such as glycerol 3-phosphate dehydrogenase 1 (GPD1) and increased the expression of proteins involved in lipolysis and thermogenesis such as adipose triglyceride lipase (ATGL) and uncoupling protein 1 (UCP1) in the white adipose tissue (WAT) compared with HFD group. In conclusion, our study suggested that FCS-Pg significantly prevented obesity and improved WAT function in HFD-fed mice by regulating intestinal lipid metabolism and microflora composition.

Bacillus lipopeptides inhibit lipase activity and promote 3T3-L1 preadipocyte differentiation

Bacillus lipopeptides have been reported to display anti-obesity effects. In the present study, Lipopeptides from Bacillus velezensis FJAT-45028 that consisted of iturin, fengycin and surfactin were reported. The lipopeptides exhibited a strong lipase inhibition activity in a concentration-dependent manner with a half maximal inhibitory concentration of 0.012 mg/mL, and the inhibition mechanism and type were reversible and competitive, respectively. Results of CCK8 assay showed that 3T3-L1 preadipocyte cells were completely viable under treatment of 0.050-0.2 mg/mL lipopeptides for 24 or 48 h. It was found that the lipopeptides could increase lipid droplets in the differentiated 3T3-L1 adipocytes in tested concentration and suppress the expression of peroxisome proliferator-activated receptor gamma (PPARγ). These results indicated the potential anti-obesity mechanism of the tested lipopeptides might be to inhibit lipase activity but not to suppress lipid accumulation in the adipocytes. Moreover, the lipopeptides could elevate glucose utilisation by 14.43%-33.81% in the differentiated 3T3-L1 adipocytes.

Arm muscle area is correlated to handgrip strength in postmenopausal women

OBJECTIVE

To analyze the correlation between arm muscle area and handgrip strength among postmenopausal community dwelling low-income women in order to provide an easy anthropometric indicator to assess muscle mass quantity and quality.

METHODS

This was a cross-sectional study involving postmenopausal women (n = 171) from three urban-marginal communities of Guayaquil, Ecuador. Corrected arm muscle area was calculated using the Frisancho formula. Dynapenia was defined as HGS < 16 kg. Spearman's correlation coefficient was calculated at a 5% significance level to test the correlation between corrected arm muscle area and handgrip strength.

RESULTS

Median (interquartile range: IQR) age of the sample was 72.0 years (17.0). The median of corrected arm muscle area was 34.8 cm2 (20.7). The overall prevalence of dynapenia was 57.9% (n = 99). There was a significant decreasing trend with age regarding all anthropometric characteristics and handgrip strength, as well as a higher prevalence of dynapenia with age. For the whole sample, a statistically significant positive correlation was found between corrected arm muscle area and handgrip strength [r = 0.267; p < .001].

There was a significant yet weak positive correlation between corrected arm muscle area and handgrip strength in this postmenopausal sample. There is a need for additional research in this regard.

A key role for P2RX5 in brown adipocyte differentiation and energy homeostasis

Brown adipocytes are defined based on a distinct morphology and genetic signature that includes, amongst others, the expression of the Purinergic 2 Receptor X5 (P2RX5). However, the role of P2RX5 in brown adipocyte and brown adipose tissue function is poorly characterized. In the present study, we conducted a metabolic characterization of P2RX5 knockout male mice; next, we characterized this purinergic pathway in a cell-autonomous context in brown adipocytes. We then tested the role of the P2RX5 receptor agonism in metabolic responses in vivo in conditions of minimal adaptive thermogenesis requirements. Our data show that loss of P2RX5 causes reduced brown adipocyte differentiation in vitro, and browning in vivo. Lastly, we unravel a previously unappreciated role for P2RX5 agonism to exert an anti-obesity effect in the presence of enhanced brown adipose tissue recruitment in male mice housed at thermoneutrality. Altogether, our data support a role for P2RX5 in mediating brown adipocyte differentiation and function that could be further targeted for benefits in the context of adipose tissue pathology and metabolic diseases.

Obstructive sleep apnea and obesity: A review of epidemiology, pathophysiology and the effect of weight-loss treatments

Despite the commonly-accepted paradigm that patients with obstructive sleep apnea (OSA) also invariably have obesity, OSA prevalence extends beyond obesity. This necessitates a reevaluation of screening strategies, biomarkers of increased OSA risk, and heightened awareness among healthcare providers about the array of OSA treatments for diverse adult populations. While obesity contributes importantly to OSA pathogenesis, there is substantial evidence that non-anatomical factors also play a crucial role, especially in patients who do not have obesity. In recent years, notwithstanding the recognition of diverse contributors to OSA pathogenesis, research has frequently focused on weight reduction to address OSA. Insights from past experiences with bariatric surgery in OSA serve as a lens to anticipate potential outcomes of emerging anti-obesity pharmacotherapies. Pharmacological alternatives, particularly incretin agonists, exhibit promise in weight reduction and OSA improvement, but encounter obstacles such as potential side effects and high costs. With this comprehensive narrative review, we delve into the complex epidemiological and pathophysiological connections between OSA and obesity. Additionally, we emphasize the importance of a multifaceted approach to OSA treatment, recognizing that while weight management is crucial, there is a need for comprehensive strategies that go beyond traditional weight-centric perspectives.

The association of obesity and the risk of rheumatoid arthritis according to abdominal obesity status: a nationwide population-based study in Korea

OBJECTIVES

This study aimed to assess the association between obesity or changes in body mass index (BMI) and the risk of RA considering the abdominal obesity status.

METHODS

We included individuals aged 23 to 60 who underwent a national health examination in 2012-2013 (baseline) and four years prior. Obesity was defined by a BMI  ≥ 25 kg/m2. The change in BMI over 4 years was divided into quartiles. Cox proportional hazard analysis was performed to assess the association of obesity and BMI change with the risk of RA.

RESULTS

A total of 6,207,246 subjects were included, and 7,859 incident cases of RA were identified. Obesity was associated with a reduced risk of RA in males (HR 0.78, 95% CI 0.71-0.85) and females (HR 0.91, 95% CI 0.85-0.97). In subgroup analysis according to abdominal obesity status, the associations were observed for obesity with normal waist circumference (WC) in males (HR 0.75, 95% CI 0.67-0.84) and females (HR 0.88, 95% CI 0.81-0.95). In terms of BMI change, compared to the stable BMI group (quartile 2), the third (HR 0.92, CI 0.85-0.99) and highest quartile (HR 0.89, CI 0.83-0.96) showed an inverse association with the risk of RA in females, particularly in those with normal WC.

CONCLUSION

Obesity was associated with a lower risk of RA, especially among individuals with a normal WC. Increased BMI was also associated with a lower risk of RA, but this association was mainly observed in females and specifically for those with normal WC.

Circulating lipoprotein(a) in patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis

BACKGROUND AND AIM

Although nonalcoholic fatty liver disease (NAFLD) and lipoprotein(a) [Lp(a)] are associated with cardiovascular diseases, existing data on Lp(a) in NAFLD are conflicting. The aim of this systematic review and meta-analysis was to summarize and compare data on circulating Lp(a) between NAFLD patients and non-NAFLD controls.

METHODS

A systematic literature search was performed in PubMed, Scopus, and Cochrane Library. This meta-analysis included 18 studies containing data on 74 691 individuals (20 220 patients with NAFLD and 54 471 controls).

RESULTS

Circulating Lp(a) was similar between patients with NAFLD and controls (standardized mean difference [SMD] 0.09; 95% confidence interval [95% CI] -0.21, 0.38). The heterogeneity among studies was high (I2 = 100%); no publication bias was detected (Egger's test P = 0.941). However, in subgroup analysis, Lp(a) was lower in NAFLD patients than controls, when Lp(a) was measured with nephelometry (SMD -0.26; 95% CI -0.46, -0.06), but not turbidimetry; this analysis also resulted in mild reduction of heterogeneity within the subgroup of nephelometry (I2 = 87%). The sensitivity analyses, based on the exclusion of studies with Newcastle-Ottawa Scale score ≤6 (n = 5), studies in which liver biopsy was used for NAFLD diagnosis (n = 4) or studies that adopted the criteria of metabolic dysfunction-associated fatty liver disease (n = 2), and meta-regression analysis did not explain the high heterogeneity among studies.

CONCLUSIONS

Overall, circulating Lp(a) was similar between NAFLD patients and non-NAFLD controls; however, patients with NAFLD had lower circulating Lp(a) compared with controls, when Lp(a) was measured with nephelometry. These results should be cautiously interpreted, because of the high heterogeneity among studies.

Are the lipid-lowering effects of incretin-based therapies relevant for cardiovascular benefit?

PURPOSE OF REVIEW

This review examines the impact of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on lipid profiles in individuals with type 2 diabetes mellitus and/or obesity, crucial for optimizing cardiovascular risk management.

RECENT FINDINGS

GLP-1RAs affect lipid levels by reducing intestinal apolipoprotein B48 production and mesenteric lymph flow, while increasing catabolism of apolipoprotein B100. It remains unknown whether these effects are direct or indirect, but the improvements in lipid levels are strongly correlated to the drug-induced weight loss. Clinical trials demonstrate improvements in lipid profiles, with different effects per agent and dose. We deem it unlikely that improved lipid levels are sufficient to explain the beneficial effects of GLP-1RA on cardiovascular risk, especially given the improvement of many other risk factors (body weight, glycemic control, inflammation) while using these agents. Posthoc mediation analyses of large cardiovascular outcome trials may shed some light on the relative importance of each risk factor.

SUMMARY

GLP-1RAs improve lipid profiles in clinical trials, but their complete cardiovascular benefits likely involve multifactorial mechanisms beyond lipid modulation.

Seven glucagon-like peptide-1 receptor agonists and polyagonists for weight loss in patients with obesity or overweight: an updated systematic review and network meta-analysis of randomized controlled trials

PURPOSE

This study aimed to provide evidence-based support and a reference for the efficacy and safety of seven glucagon-like peptide-1 (GLP-1) receptor agonists and polyagonists for weight loss in patients with obesity or overweight through a network meta-analysis.

METHODS

Relevant randomized controlled trials (RCTs) with an intervention duration of at least 16 weeks assessing seven GLP-1 receptor agonists and polyagonists (mazdutide, 6 or 4.5 mg; retatrutide, 12 or 8 mg; tirzepatide, 15 or 10 mg; liraglutide, 3.0 mg; semaglutide, 2.4 mg; orforglipron, 45 or 36 mg; and beinaglutide, 0.2 mg) in patient with obesity or overweight was searched using three databases (Cochrane Library, PubMed, and Embase) from creation to August 30, 2024. The primary outcome was the percentage change in body weight from baseline. Secondary outcomes included changes in waist circumference, hemoglobin A1c, and fasting plasma glucose level from baseline; adverse events, serious adverse events, adverse event withdrawal, and hypoglycemic events. We conducted a frequentist random-effects network meta-analysis to analyze the data extracted from the RCTs using Stata 16.1 software.

RESULTS

Twenty-seven RCTs of seven GLP-1 receptor agonists and polyagonists and 15,584 patients were included in the network meta-analysis. In terms of efficacy, compared with placebo, retatrutide 12 mg (-22.10 % in body weight and - 17.00 cm in waist circumference), retatrutide 8 mg (-20.70 % and - 15.90 cm), and tirzepatide 15 mg (-16.53 % and - 13.23 cm) were the three most efficacious treatments for reducing body weight and waist circumference. However, these treatments were less effective in patients with type 2 diabetes mellitus (T2DM). In addition, patients with a high body mass index (BMI) or longer treatment cycles exhibited significantly greater weight loss than those with a low BMI or shorter treatment cycles. In terms of safety, patients without T2DM had a higher incidence of adverse events than those with T2DM. None of the interventions increased the incidence of serious adverse or hypoglycemic events (˂54 mg/dL). There was no significant difference in the incidence of adverse event withdrawal for all interventions in head-to-head comparisons. In addition, disparities in race, BMI, and treatment cycles did not significantly increase the incidence of adverse events. Finally, the sensitivity and publication bias analyses indicated that the basic analysis results were reliable.

CONCLUSION

Retatrutide (both doses) and tirzepatide exhibited superior efficacy compared to other GLP-1 receptor agonists and polyagonists in reducing body weight and waist circumference. Patients without T2DM, those with a high BMI, and individuals undergoing longer treatment cycles demonstrated significantly greater weight loss and reductions in waist circumference. Dual or triple receptor agonists (GLP-1 plus glucose-dependent insulinotropic polypeptide and/or Glucagon receptor) are more effective for weight loss than GLP-1 receptor agonists.

Efficacy of Probiotics in Overweight and Obesity Control: An Umbrella Review and Subgroup Meta-Analysis

Numerous primary and secondary studies have consistently demonstrated that probiotics, including lactobacillus and Bifidobacterium, possess a potential anti-obesity effect. However, it is worth noting that some studies have yielded contrasting results. Considering this, our study aims to present a comprehensive overview of published systematic reviews and meta-analyses, focusing on the efficacy and safety of probiotics in managing obesity. To achieve this objective, we conducted an umbrella review following the PRISMA protocol and Cochrane guidelines. We searched databases such as Embase, PubMed, Cochrane Library, and Google Scholar for relevant systematic reviews and meta-analyses published in English, without imposing any date restrictions. Our inclusion criteria encompassed studies evaluating the anti-obesity impact of probiotics, with a specific focus on changes in body mass index (BMI), fat mass percentage (FMP), body weight (BW), and body fat mass (BFM). These studies were meticulously reviewed by two independent reviewers. Our analysis included five systematic reviews and 18 meta-analyses that met the predefined inclusion and exclusion criteria. The meta-analyses revealed statistically significant reductions in the following parameters: BMI, a decrease of 0.30 kg/m2 (p < 0.00001, 95% CI - 0.36 to - 0.25); BFM, a reduction of 0.86 kg (p < 0.00001, 95% CI - 1.02 to - 0.71); BW, a decrease of 0.59 kg (p < 0.00001, 95% CI - 0.74 to - 0.44); and FMP, a substantial decline of 78% (p < 0.00001, 95% CI - 1.02 to - 0.54). In summary, our umbrella review suggests that existing evidence supports the potential benefits of probiotics in managing obesity and overweight. However, it is essential to acknowledge that the credibility of this evidence is somewhat limited due to the inclusion of studies with poor-quality designs and relatively small participant numbers. To establish the true efficacy of probiotics in obesity management, we recommend conducting robust studies involving larger participant cohorts.

Sleep characteristics and hearing loss in middle-aged and older adults: The National Health and Nutrition Examination Survey 2015-2018✰

Background

Population-based evidence linking sleep characteristics with hearing is limited and how the associations change with age remains unknown. We aim to investigate cross-sectional associations between sleep characteristics and hearing by age in a nationally representative sample of U.S. adults.

Methods

We included 3,100 participants aged 40 years and older from the National Health and Nutrition Examination Survey 2015-18. Audiometric hearing thresholds at 0.5, 1, 2 and 4 kilohertz were averaged to calculate better-ear pure-tone average (PTA). Sleep questions were self-reported, including sleep duration on weekdays or workdays, snoring, snorting or stopping breathing, trouble sleeping, and daytime sleepiness. Multivariable-adjusted linear regression with an interaction term between sleep characteristic (categorical) and age (continuous in years) was used. Primary models adjusted for demographic and lifestyle factors with additional adjustment for cardiovascular factors in secondary models.

Results

There was no association of reported sleep duration with PTA at age 50; however, compared to those reporting 7-8 h of sleep, there was a borderline-significant association at age 60 (<7 h: 1.72 dB, 95 % confidence interval [CI], -0.21, 3.66; >8 h: 1.25 dB, 95 % CI, -0.01, 2.51), and a significant association at age 70 (<7 h: 2.52 dB, 95 % CI, -0.27, 5.31; >8 h: 2.67 dB, 95 % CI, 0.56, 4.79). No consistent associations for other sleep characteristics were found.

Conclusions

Long sleep duration is associated with worse hearing among middle-aged and older adults and the association differs by age. Longitudinal evidence is needed to establish temporality and examine changes in hearing associated with sleep characteristics.

Obesity medicine provider-directed health coaching in a commercial weight loss program: Proof of concept

Background

Obesity remains a leading serious chronic disease and cause of death in the U.S. Despite previous research in diets (i.e., caloric restriction), physical activity levels, and biochemical markers, no studies to date have investigated the combination of an obesity medicine physician with a health coach alongside a commercial program for reducing body weight. As a result, this pilot study aims to assess the relationship between a commercial diet program and health and wellness coaching (HWC) for weight reduction outcomes when delivered in conjunction with an obesity medicine physician chronic disease care model, as a proof-of-concept study.

Methods

This 24-week proof-of-concept study was pragmatic, being an unblinded, unrandomized, uncontrolled, longitudinal, observational study. Its purpose was to assess participant weight reduction from a commercial weight reduction program using a pre-packaged portion-controlled reduced-calorie diet while meeting with a health coach and obesity medicine physician for counseling and support. Participants in the sample underwent a commercial weight reduction program through dietary control while meeting with an HWC. A repeated measures ANOVA was conducted to determine the weight reduction trends across a 24-week program.

Results

This study included n = 53 participants; a majority were white females (n = 45; 85 %), with an average (SD) age of 50.3 (12.2) years. There was a significant improvement in weight reduction (21.8 ± 9.4 lbs. WL) seen throughout the 24-week program (F (7, 364) = 33.129, p < 0.001), with a large effect (η2 = 0.922).

Conclusion

This proof-of-concept project found that Obesity Medicine Physician-directed, portion-controlled meals and HWC can improve weight reduction across a 24-week program using portioned-controlled meals. Confirmation of these findings and their clinical significance requires a follow-up randomized, controlled clinical trial using validated assessment tools.

Associations of metabolic disorders with hypertension and cardiovascular disease: recent findings and therapeutic perspectives

We theoretically know that metabolic disorders, including overweight/obesity, insulin resistance, diabetes, dyslipidemia, and relevant tissue/organ damage, play a critical role in elevating blood pressure and developing hypertension. However, staying abreast of the ever-evolving and current research on the various metabolic disorder topics is difficult. At the same time, as hypertension in childhood and adolescence is attracting significant attention globally, it is becoming increasingly evident that metabolic disorders exert an important role in its pathogenesis. In order to effectively prevent hypertension, it is essential to appropriately approach metabolic disorders, and importantly, this approach must be practiced continuously throughout all generations. Thus, focusing on metabolic disorders is the first and essential step in effectively managing and preventing hypertension. In this Mini-Review, we introduce cutting-edge research findings on "Metabolism," published in 2023 by Hypertension Research, and discuss relevant topics and therapeutic and future perspectives.

Recent achievements and future directions of anti-obesity medications

Pharmacological management of obesity long suffered from a reputation of a 'Mission Impossible,' with inefficient weight loss and/or unacceptable tolerability. However, the tide has turned with recent progress in biochemical engineering and the development of long-acting agonists at the receptor for glucagon-like peptide-1 (GLP-1), and with unimolecular peptides that simultaneously possess activity at the receptors for GLP-1, the glucose-dependent insulinotropic polypeptide (GIP) and glucagon. Some of these novel therapeutics not only improve body weight and glycemic control in individuals with obesity and type 2 diabetes with hitherto unmet efficacy and tolerable safety, but also exhibit potential therapeutic value in diverse areas such as neurodegenerative diseases, fatty liver disease, dyslipidemia, atherosclerosis, and cardiovascular diseases. In this review, we highlight recent advances in incretin-based therapies and discuss their pharmacological potential within and beyond the treatment of obesity and diabetes, as well as their limitations in use, side effects, and underlying molecular mechanisms.

Glucagon-like peptide-1 receptor agonist semaglutide reduces atrial fibrillation incidence: A systematic review and meta-analysis

BACKGROUND

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are new anti-hyperglycaemic drugs with proven cardiovascular (CV) benefit in diabetic and non-diabetic patients at high CV risk. Despite a neutral class effect on arrhythmia risk, data on semaglutide suggest a possible drug-specific benefit in reducing atrial fibrillation (AF) occurrence.

OBJECTIVE

To perform a meta-analysis of randomized clinical trials (RCTs) to assess the risk of incident AF in patients treated with semaglutide compared to placebo.

METHODS AND RESULTS

Ten RCTs were included in the analysis. Study population encompassed 12,651 patients (7285 in semaglutide and 5366 in placebo arms), with median follow-up of 68 months. A random effect meta-analytic model was adopted to pool relative risk (RR) of incident AF. Semaglutide reduces the risk of AF by 42% (RR .58, 95% CI .40-.85), with low heterogeneity across the studies (I2 0%). At subgroup analysis, no differences emerged between oral and subcutaneous administration (oral: RR .53, 95% CI .23-1.24, I2 0%; subcutaneous: RR .59, 95% CI .39-.91, I2 0%; p-value .83). In addition, meta-regression analyses did not show any potential influence of baseline study covariates, in particular the proportion of diabetic patients (p-value .14) and body mass index (BMI) (p-value .60).

CONCLUSIONS

Semaglutide significantly reduces the occurrence of incident AF by 42% as compared to placebo in individuals at high CV risk, mainly affected by type 2 diabetes mellitus. This effect appears to be consistent independently of the route of administration of the drug (oral or subcutaneous), the presence of underlying diabetes and BMI.