Prevalence of childhood and adult obesity in the United States, 2011-2012

Innovative Nutrition Policies and Programs to Reduce Low-Income Children's Sodium Intake in the United States: Implication for Social Work

Globally, high sodium intake is the leading dietary risk factor of morality. Most Americans, including children, consume too much sodium compared with the federal guidelines. Socioeconomic and racial disparities place children, many of color, from low-income households and neighborhoods, at higher risk of consuming foods high in sodium. Preferences in sodium levels are determined during childhood and can be challenging to modify in adulthood. Thus, early intervention and health promotion in children's sodium intake is crucial to reducing health consequences and extending the overall life expectancy of Americans. This article highlights innovative health policies and programs that aim to reduce sodium levels in food that American children consume. Additionally, the implications of federal food assistance programs are discussed. Furthermore, the role of social workers is noted regarding providing education and guidance around food selection and eating practices to support the health of American children and families.

Impact of a 12-week High-Intensity Interval Training With Spirulina Supplementation on Insulin Resistance-Mediated by Apo-A, -B, and -J in Men With Obesity HIIT With Spirulina on Apolipoproteins

Obesity is a significant public health issue associated with an elevated risk of chronic diseases. Discovering appropriate exercise interventions combined with beneficial herbal supplements has always been investigated. Hence, our study aimed to assess the impact of 12 weeks of high-intensity interval training (HIIT) and spirulina supplementation on the apolipoproteins, insulin resistance, and body composition of men with obesity. Forty-four men with obesity (height: 168.42 ± 2.63 cm, body mass: 93.24 ± 2.23 kg; BMI: 32.89 ± 1.23 kg/m2; age: 25-40 years) were divided into four groups: control group (CG, n = 11), spirulina group (SG, n = 11), high-intensity interval training group (HIITG, n = 11), and SG + HIIT group (n = 11). The intervention involved the daily administration of either spirulina or a placebo and HIIT three times a week for the training groups. Anthropometric indices, HOMA-IR, insulin, and apolipoproteins (Apo-A, Apo-B, and Apo-J) were measured before and after the 12-week intervention. Post-intervention analysis indicated differences between the CG and the three interventional groups for percent body fat (%BF), insulin, HOMA-IR, and apolipoproteins levels (p < 0.05). Spirulina supplementation with HIIT increased Apo-A while causing decreases in Apo-B and Apo-J levels and improved body composition (weight, %fat), BMI, and HOMA-IR (p < 0.05). It can be concluded that the combined intervention of high-intensity interval training (HIIT) and spirulina supplementation has a significant impact on mitigating obesity, managing weight, and reducing the risk of cardiovascular diseases.

Association between paternal physique and obesity in children at the age of 3 years: the Japan Environment and Children's Study

Obesity during development has been reported to be a determinant factor in the future development of non-communicable diseases (NCDs). Parental obesity is suggested to be a predictor of children's obesity, and it is important to consider parental factors to prevent NCDs in the progeny. Previously, we showed that paternal height had a stronger association with infant birth weight than paternal body mass index (BMI) in the Japanese population. However, only a few studies have examined the association between paternal physique and postnatal obesity. This study aimed to investigate the association between parental physique and obesity in children at the age of 3. This study used fixed data on 33,291 parent-child pairs from the Japan Environment and Children's Study, an ongoing national birth cohort study. The association between paternal physique (BMI and height) and children's obesity at the age of 3 was examined using multivariate logistic regression analysis. The higher the paternal BMI quartiles, the higher the odds ratio for obesity in male and female children at 3 years of age (P < 0.0001). However, paternal height quartiles were not associated with male or female obesity. These results differ from the association between paternal physique and infant birth weight, and it is possible that prenatal epigenetic and environmental factors of paternal origin were responsible for the differences between these two studies. The association between paternal BMI and obesity in children at the age of 3 suggests that paternal factors may be involved in the development of NCDs in future progeny.

Mechanistic target of rapamycin signaling activity in the human placenta across gestation and in maternal obesity†

The mechanistic target of rapamycin system is vital to placental development, formation, and function. Alterations in this system in the placenta have been associated with altered fetal growth. However, changes in placental mechanistic target of rapamycin signaling across gestation are poorly understood. We collected 81 human placental samples from 4 to 40 weeks gestation to test the hypothesis that placental mechanistic target of rapamycin signaling activity increases over gestation and is activated in maternal obesity in early gestation. Proteins involved in upstream mechanistic target of rapamycin regulation and mTORC1/2 downstream signaling were quantified using immunoblotting in placentas of male or female fetuses. Readouts of mTORC1 activation, phospho-rpS6, and phospho-4EBP1 were highest in first trimester and decreased across gestation. Phosphorylation of AKT (308 and 473) increased over gestation. Interestingly, abundance of cytochrome c oxidase I and mitochondrial ATP synthase, key subunits of mitochondrial complexes III/IV and V, respectively, were elevated in first trimester obese placentas compared to control, but only in placenta from female fetuses. We suggest that the high placental mechanistic target of rapamycin signaling activity in early pregnancy may be related to the high anabolism and active trophoblast proliferation and invasion in the second half of the first trimester. In addition, we conclude that maternal obesity has only limited impact on this key placental signaling pathway across gestation in women.

Long-Term Effects of a Responsive Parenting Intervention on Child Weight Outcomes Through Age 9 Years: The INSIGHT Randomized Clinical Trial

Importance

Behavioral interventions to treat childhood obesity have had limited success. Primary prevention is desirable, but whether intervention effectiveness can be sustained is unknown.

Objective

To examine the effect of an intervention designed for the primary prevention of obesity and delivered through age 2 years on weight outcomes through age 9 years.

Design, Setting, and Participants

A longitudinal observation of a single-center randomized clinical trial comparing a responsive parenting intervention vs a home safety intervention (control) among primiparous mother-child dyads who completed the assessment at age 3 years with follow-up to age 9 years. All data were analyzed from January 21 to November 15, 2024.

Interventions

Research nurses conducted 4 home visits during infancy and research center visits at ages 1 and 2 years totaling less than 10 contact hours. The responsive parenting curriculum focused on feeding, sleep, interactive play, and emotion regulation.

Main Outcomes and Measures

The primary outcome is body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) across 4 assessments from age 3 through 9 years, with the assessment of study group differences using repeated-measures analysis. A test for an interaction between sex and study group was planned. Secondary outcomes include BMI z scores and prevalence of overweight (BMI ≥85th to <95th percentile) and obesity (BMI ≥95th percentile) at 5, 6, and 9 years.

Results

Of the 232 primiparous mother-child dyads (116 per group) (7 Asian [3%], 11 Black [5%], 1 Native Hawaiian or Other Pacific Islander [0.4%], 207 White [89%], and 6 children with other race and ethnicity [including Asian, Indian, Hispanic, Dominican, and other race; 2.5%]; 121 male children [52%]), 177 (76%) had anthropometric data at age 9 years. From ages 3 to 9 years, children in the responsive parenting group had a lower mean (SD) BMI than controls (16.64 [0.21] vs 17.07 [0.20]; absolute difference, -0.43; P = .049). Sex moderated this effect; female participants in the responsive parenting group had a lower mean (SD) BMI than female participants in the control group (16.32 [0.26] vs 17.32 [0.26]; absolute difference, -1.00; P = .007), with no group differences among male participants. Cross-sectional analyses revealed no differences in BMI z scores or prevalence of overweight or obesity at ages 5, 6, and 9 years between the responsive parenting group and the control group.

Conclusions and Relevance

An early-life responsive parenting intervention resulted in lower BMI from age 3 to 9 years compared with a control intervention. This group difference was driven by effects on female participants, with differences appearing to dissipate over time. A life-course approach may be required to sustain the benefits of early-life responsive parenting interventions for obesity prevention.

Trial Registration

ClinicalTrials.gov Identifier: NCT03555331.

Feasibility of an Obesity Prevention Program for Latino Families from First Trimester of Pregnancy to Child Age 18 Months and Predictors of Program Attendance

Background: The high prevalence of obesity in Latino families with low income necessitates prevention beginning in pregnancy and continuing through infancy. Due to systemic inequities, adverse social determinants of health (SDoH) and mental health symptoms may limit program efficacy by presenting barriers to attendance. We sought to assess: (1) the feasibility of the Starting Early Program (StEP) Prenatal, a 17-session intervention beginning early in pregnancy and continuing to 18 months postpartum; and (2) the effects of adverse SDoH (material hardship, low social support) and mental health symptoms (depression, anxiety, stress) on program attendance. Methods: We conducted a single-arm feasibility trial of StEP Prenatal, enrolling from December 2018 to February 2020 (n = 231). We assessed feasibility (recruitment, retention, fidelity, attendance) and direct and interactive effects of adverse SDoH and mental health symptoms on attendance. We used zero-inflated Poisson regression, adjusting for maternal age, marital status, nativity, education, and pandemic timing. Results: We recruited 57% of eligible participants, with 213 remaining eligible to receive the full program. Retention was 75%. Median fidelity for group format was 64%; median attendance per session was 69%; median number of program sessions attended was 13. Baseline material hardship and high perceived stress predicted approximately one additional session attended. Similar effects were seen for low social support in the absence of anxiety symptoms. Conclusion: Despite pandemic disruptions, StEP Prenatal was feasible to deliver and participants with adverse SDoH at baseline were particularly motivated to attend. Futures studies should tailor programs to baseline SDoH and test flexible implementation models.

Effects of BMI on prognosis, disease-free survival and overall survival of breast cancer

BACKGROUND

Obese breast cancer patients have worse prognosis than normal weight patients, but the level at which obesity is prognostically unfavorable is unclear. This study aimed to investigate different effects of Body Mass Index (BMI) on prognosis disease-free survival and overall survivor of breast cancer patients.

METHOD

This retrospective cohort study analyzed the medical records of breast cancer patients who sought treatment at Namazi hospital in Shiraz, Iran between 2014 and 2019. Three groups of patients were divided according to BMI. Menopausal status, BMI status, clinicopathological characteristics, treatment, and overall survival (OS), and disease free survival (DFS) were comprehensively evaluated. The World Health Organization (WHO) BMI classification was used to categorize patients into three groups: normal weight (BMI < 25.0 kg/m2), overweight (25.0 ≤ BMI < 30.0 kg/m2), and obese (BMI ≥ 30.0 kg/m2).

RESULTS

Of the 7134 breast cancer patients, the majority (42.6%) were in 25-30 kg/m2. Menopausal status significantly were associated with obesity (P < 0 .001). The majority of patients were categorized as grade 2 and stage 2 according to the BMI categories (P = 0.12, P = 0.08, respectively). BMI categories regardless of menopausal status displayed increased 1, 3, and 5-year DFS and 5- year OS in stage 1 and increased 1, 3, and 5-year OS and 1 and 3-year DFS in stage 2. In stage 3, the risks of relapse and death were significantly decreased in all three groups of BMI patients with post-menopausal period.

CONCLUSION

Obesity leads to worse DFS and OS in patients with BC and the effects of obesity on the breast cancer prognosis seem to be clinically related to menopausal status. Once validated, these results should be considered in the development of prevention programs.

Diabetes distress among immigrants of south Asian descent living in New York City: baseline results from the DREAM randomized control trial

BACKGROUND

Type 2 diabetes (T2D) disproportionately affects individuals of South Asian descent. Additionally, diabetes distress (DD) may lead to complications with diabetes management. This study examines the prevalence of DD among foreign-born individuals of South Asian descent in New York City (NYC) and its association with sociodemographic and clinical factors.

METHODS

Baseline data was collected from the Diabetes Research, Education, and Action for Minorities (DREAM) Initiative, an intervention designed to reduce hemoglobin A1c (HbA1c) among South Asian individuals with uncontrolled T2D at primary care practices in NYC. The Diabetes Distress Scale (DDS) measured DD, and Core Healthy Days Measures assessed physical and mental healthy days. Sociodemographic variables were analyzed using descriptive statistics, Chi-square tests assessed categorical variables, and Wilcoxon Rank Sum tests evaluated continuous variables (Type I error rate = 0.05). Logistic regression models examined associations between HbA1c, mental health, and other covariates with dichotomized DD subscales.

RESULTS

Overall, 414 participants completed the DDS at baseline (median age = 55.2 years; SD = 9.8). All were born outside of the US; the majority were born in Bangladesh (69.8%) followed by India, Pakistan, and Nepal (24.7%) and Guyana and Trinidad and Tobago (5.5%). High emotional burden, regimen-related distress and physician-related distress were reported by 25.9%, 21.9%, and 6.2% of participants, respectively. In adjusted analyses, individuals with ≥ 1 day of poor mental health had higher odds of overall distress (OR:3.8, p = 0.013), emotional burden (OR:4.5, p < 0.001), and physician-related distress (OR:4.6, p = 0.007) compared to individuals with no days of poor mental health. Higher HbA1c (OR:1.45, p = < 0.001) was associated with regimen-related distress; and lower emotional support was associated with overall distress (OR:0.92, p < 0.001) and regimen-related distress (OR:0.95, p = 0.012). Individuals born in Bangladesh had significantly lower odds of overall distress, emotional burden, and regimen-related distress compared to individuals born in Guyana and Trinidad and Tobago.

CONCLUSIONS

Findings highlight the rate and risk factors of DD among individuals of South Asian descent living in NYC. Screening for DD in patients with prediabetes or diabetes should be integrated to address mental and physical health needs. Future research can benefit from a longitudinal analysis of the impact of DD on diabetes self-management and health outcomes.

TRIAL REGISTRATION

This study uses baseline data from "Diabetes Management Intervention for South Asians" (NCT03333044), which was registered with clinicaltrials.gov on 6/11/2017.

Social, cultural and ethnic determinants of obesity: From pathogenesis to treatment

AIMS

Obesity is a multifactorial disease influenced by several factors including poor diet, physical inactivity, and genetic predisposition. In recent years, the social and environmental context, along with race/ethnicity and gender, have been recognized as factors influencing obesity risk beyond traditional risk factors. This review aims to increase knowledge of these causal determinants and their implications for the treatment and management of obesity, addressing not only the individual but also the societal sphere.

DATA SYNTHESIS

A growing body of evidence emphasizes the interaction between the physical and social environments in shaping personal behaviors related to obesity. Social disparities, such as socioeconomic status (income, education, employment), racial/ethnic differences, and gender, contribute significantly to weight gain from childhood to adulthood. These factors increase the risk of obesity and related cardiovascular risk factors, independent of clinical and demographic variables, and may lead to stigma and discrimination against those affected.

CONCLUSIONS

Obesity prevention solutions, from community programs to national policies, may be more effective if they address social, gender, and ethnic barriers. Understanding obesity requires a comprehensive approach that includes social, environmental, and psychological factors, as well as biological causes, to help obesity experts develop more effective interventions tailored to obesity and related diseases.

Contemporary Burden of Cardiovascular Disease in Pregnancy: Insights from a Real-World Pregnancy Electronic Health Record Cohort

Importance

Cardiovascular disease (CVD) is the leading cause of maternal morbidity and mortality, however the contemporary burden and secular trends in pregnancy-related CV complications are not well characterized.

Objective

We sought to examine contemporary trends in prevalence of maternal cardiometabolic comorbidities and established CVD, as well as future pregnancy-related CV complications across a large multi-institutional health system.

Design

Retrospective analysis of longitudinal electronic health record (EHR)-based cohort of pregnancies.

Setting

Multi-institutional healthcare network in New England.

Participants

Pregnancy encounters between 2001 to 2019 identified using diagnosis and procedure codes followed by manual adjudication within a previously validated primary care EHR cohort. Estimated gestational ages recovered from unstructured notes using regular expressions (RegEx) were used to define individual pregnancy episodes.

Main Outcomes and Measures

We quantified the prevalence of maternal cardiometabolic comorbidities and established CVD at time of pregnancy, as well as the incidence of pregnancy-related CV complications assessed within 1 year postpartum. We examined trends in cardiometabolic risk factors and CVD burden over nearly two decades.

Results

Our EHR pregnancy cohort comprised 57,683 pregnancies among 38,997 individuals (mean age range at start of pregnancy 27 to 37 years). RegEx recovered gestational age for 74% of pregnancies, with good correlation between gestational age ascertained via RegEx vs manual review (Pearson r 0.9). Overall prevalence of maternal CVD was 4% (age-adjusted 7%) and increased over 19 years of follow-up (age-adjusted prevalence of maternal CVD: 1% in 2001 to 7% in 2019, p <0.001). The incidence of pregnancy-related CV complications was 15% (age-adjusted 17%) and also increased over the follow-up period (age-adjusted incidence 11% in 2001 to 14% in 2019, p <0.001). Finally, CV complications were more likely to occur in individuals with greater burden of maternal CV comorbidities and CVD (diabetes: 6% vs 3%, hypertension: 23% vs 5%, pre-existing CVD: 10% vs 3%, P<0.001 for all).

Conclusions and Relevance

Analysis of a large-scale EHR-based pregnancy cohort spanning two decades demonstrates rising prevalence of both maternal cardiometabolic comorbidities and CVD at the time of pregnancy, as well as increasing incidence of subsequent pregnancy-related CV complications. Pregnancy represents a critical opportunity for cardiometabolic health optimization.

KEY POINTS

Question: What are the contemporary real-world trends in the prevalence of maternal cardiovascular comorbidities and cardiovascular disease and incidence of cardiovascular complications in pregnancy?Findings: In an analysis of 57,683 pregnancies among 38,997 individuals from a large scale EHR-based pregnancy cohort, prevalence of maternal cardiometabolic comorbidities and cardiovascular disease and incidence of pregnancy-related cardiovascular complications increased over the course of nearly two decades.Meaning: The contemporary burden of pregnancy-related cardiovascular complications is rising at an alarming rate and highlights pregnancy as a critical opportunity for cardiovascular health optimization.

Endoscopic sleeve gastroplasty (ESG): indications and results-a systematic review

Obesity is a major global health problem and at the same time a financial burden for social security systems. For a long time, conventional lifestyle interventions have tried unsuccessfully to find a solution. It has been proven that only interventions that ultimately address the central control centers of hunger, appetite and satiety will lead to sustained weight loss. As a result, metabolic and bariatric surgery (MBS) has become the gold standard in the treatment of obesity and has been shown to be effective and safe in both the short and long term. Processed via the gut-brain axis, MBS not only leads to weight loss, but also-and, in addition, independently through the modification of the intestinal tract in bypass surgery-to a significant remission rate of type 2 diabetes mellitus, the typical co-morbidity of obesity. However, MBS is not suitable for all patients. Some patients are ineligible due to a high-risk profile or do not wish to undergo surgery, whilst others do not meet the criteria for MBS but still suffer from obesity. This treatment gap has been a driving force behind the development of endoscopic solutions such as endoscopic sleeve gastroplasty (ESG). ESG offers a less invasive, endoluminal and anatomy-sparing alternative that reduces gastric volume by suturing tissue folds along the greater curvature. Such a reduction in gastric volume, which is also one principle of action of MBS, can induce earlier satiety and lead to weight loss. The evidence behind this procedure, in particular its efficacy and safety, should be objectified through this review.

Efficacy of a Community- and Family-Based Intervention on Cardiovascular Fitness and Cardiometabolic Disease Risk Factors Among Primarily Latino Families

BACKGROUND

Targeting cardiovascular fitness (CVF), rather than weight loss, may be a more acceptable and feasible outcome among Latinos.

PURPOSE

The purpose of this study was to test the short-term efficacy of Athletes for Life (AFL), a fitness- and lifestyle-focused behavioral intervention to improve CVF and performance among Latino families.

METHODS

Latino parent-child dyads (n = 137) were randomized to either AFL program or a waitlist control condition. AFL consisted of 24 group family-based, nutrition and sport/fitness oriented 90-minute sessions (twice-weekly). Measures included 1-mile run/walk time, three-minute step test, accelerometer-measured physical activity, body mass index (BMI), waist circumference, DEXA-measured % body fat, cardiometabolic risk biomarkers, and sociodemographic characteristics. Group differences at post-intervention were tested using ANCOVA analyses adjusting for outcome values at baseline and demographic variables.

RESULTS

Parents were primarily female (93%), aged 38.3 ± 6.9 years, and 96% Latino and children were 8.8 ± 1.7 years old and 58% female. Intervention participants showed significantly faster adjusted post-intervention 1-mile run/walk times compared to control group participants (difference of -76.6 seconds P < 0.01 and -44 seconds P = 0.04, respectively). Parents also showed a significantly higher adjusted relative VO2 max (ml/kg/min) compared to control group parents (43.91, SE = 0.41 vs 42.93, SE = 0.44, respectively, P < 0.01). There were no significant post-intervention group differences on physical activity, BMI, waist circumference, % body fat or cardiometabolic biomarkers P > 0.05.

CONCLUSIONS

The AFL program successfully improved aerobic performance among underserved Latino families with no observable changes in adiposity. These results support that fitness may be a more viable and acceptable outcome among Latino families than weight loss.

Hispanic Patients Undergoing Spinal Fusion for Neuromuscular Scoliosis Sustain Health Inequalities

Introduction

Pre- and postoperative optimization remains a complex process impacted by various demographic factors. Our study aims to identify and describe those demographic factors associated with poor outcomes after spinal fusion with instrumentation in neuromuscular scoliosis to reduce health disparities and improve postoperative outcomes.

Methods

A retrospective analysis was conducted using Healthcare Cost and Utilization Project data from 2016 to 2020, encompassing a random sample of 20% of procedures in the United States. Data included demographic and hospital variables, including days from admission to the procedure, length of stay, recovery time, total charge, discharge disposition, and mortality rates. In addition to ANOVA, Chi-Squares, and t-tests, multiple-linear and multiple-logistic regression models were designed and run to generate adjusted odds ratios.

Results

Compared to non-Hispanic patients (N=1829), Hispanic patients (N=431) had spinal fusion with instrumentation at younger ages (12.9 vs. 14.1 years old, p=0.011) and had significantly different household incomes with less representation in the 75th to 100th percentile (16.8% vs. 26.5%, p<0.001). Additionally, Hispanic patients were more likely to be Medicaid users (67.2% vs. 46.0%, p<0.001). Hispanic patients undergoing spinal fusion with instrumentation had longer lengths of stay (LOS) (10.0 vs. 7.6 days, p<0.001), longer periods from admission to surgery (wait time) (1.6 vs. 1.0 days, p=0.046), and longer recovery times (8.5 vs. 6.7 days, p<0.001).

Conclusions

Hispanic patients with NMS often have longer lengths of stay, longer periods between admission and surgery, and longer recovery times than non-Hispanic patients. This difference in hospital courses and surgical timing could be an effect of disparities in healthcare access and socioeconomic standing. Further efforts are required to both understand and reduce barriers to healthcare access in the Hispanic patient population undergoing spinal fusion with instrumentation.

Identifying high-risk population segments for underweight, overweight, and obesity among reproductive-age women in sub-Saharan Africa

Background

Despite significant progress in addressing underweight in developing countries, the recent rise in the number of overweight and obese individuals has confirmed that the double burden of malnutrition will remain a crucial problem in the foreseeable future. Some countries that previously succeeded in reducing underweight rates are now experiencing a resurgence. Initiatives in sub-Saharan African (SSA) countries aimed at reducing malnutrition often lack robust evidence. This study aimed to identify risk groups for malnutrition among women of reproductive age in SSA countries and prioritize intervention areas.

Methods

This analysis utilized data from 247,911 reproductive-age women across recent demographic and health surveys conducted in 33 SSA countries. Nutritional status was assessed using body mass index (BMI). We computed the pooled prevalence of different forms of malnutrition using the random effects inverse variance method. We evaluated the factors associated with different forms of malnutrition using multilevel multinomial regression. We reported the adjusted odds ratios and 95% confidence intervals (CIs).

Results

The pooled prevalence of underweight, overweight, and obesity among SSA women was 11% (95% CI: 9-12%), 18% (95% CI: 16-20%), and 10% (95% CI: 8-12%), respectively. Significant factors influencing malnutrition included women's age, highest educational level, wealth index, current breastfeeding status, contraceptive use, parity, media exposure, marital status, place of residence, and regional location within SSA. Factors such as education, wealth, age, contraceptive use, parity, and marital status were risk factors for overweight and obesity but were protective against underweight. Employment was protective against all three malnutrition forms.

Conclusion

Increased age, wealth index, not-breastfeeding status during the survey, contraceptive use, higher parity, marital status, urban residency, and living in southern or central Africa are associated with higher odds of increased BMI and lower odds of underweight. In designing interventions for overweight and obesity, emphasis should be given to the wealthy, reproductive-age women in later age, urban residents, and multiparous. Whereas the poorest and youngest is priority intervention segments for underweight.

Global trends and hotspots of type 2 diabetes in children and adolescents: A bibliometric study and visualization analysis

BACKGROUND

Epidemiological surveys indicate an increasing incidence of type 2 diabetes mellitus (T2DM) among children and adolescents worldwide. Due to rapid disease progression, severe long-term cardiorenal complications, a lack of effective treatment strategies, and substantial socioeconomic burdens, it has become an urgent public health issue that requires management and resolution. Adolescent T2DM differs from adult T2DM. Despite a significant increase in our understanding of youth-onset T2DM over the past two decades, the related review and evidence-based content remain limited.

AIM

To visualize the hotspots and trends in pediatric and adolescent T2DM research and to forecast their future research themes.

METHODS

This study utilized the terms "children", "adolescents", and "type 2 diabetes", retrieving relevant articles published between 1983 and 2023 from three citation databases within the Web of Science Core Collection (SCI, SSCI, ESCI). Utilizing CiteSpace and VoSviewer software, we analyze and visually represent the annual output of literature, countries involved, and participating institutions. This allows us to predict trends in this research field. Our analysis encompasses co-cited authors, journal overlays, citation overlays, time-zone views, keyword analysis, and reference analysis, etc.

RESULTS

A total of 9210 articles were included, and the annual publication volume in this field showed a steady growth trend. The United States had the highest number of publications and the highest H-index. The United States also had the most research institutions and the strongest research capacity. The global hot journals were primarily diabetes professional journals but also included journals related to nutrition, endocrinology, and metabolism. Keyword analysis showed that research related to endothelial dysfunction, exposure risk, cardiac metabolic risk, changes in gut microbiota, the impact on comorbidities and outcomes, etc., were emerging keywords. They have maintained their popularity in this field, suggesting that these areas have garnered significant research interest in recent years.

CONCLUSION

Pediatric and adolescent T2DM is increasingly drawing global attention, with genes, behaviors, environmental factors, and multisystemic interventions potentially emerging as future research hot spots.

Sleep Quality, Nutritional Habits, and Physical Activity in Pediatric Cancer Survivors: A Dyadic Analysis Approach

BACKGROUND/OBJECTIVES

Sleep disturbances are prevalent among pediatric cancer survivors (PCSs) and their caregivers, often leading to poorer dietary choices and reduced physical activity. Additionally, the sleep quality and health behaviors of parents and children can affect each other. This study examined bi-directional associations between PCSs and their parents' sleep quality and health-related behaviors.

METHODS

127 parent-child dyads enrolled in a behavioral intervention for pediatric cancer survivors (Mage = 11.04; 53.2% female) and their families completed the Patient Sleep Quality Inventory (PSQI) and USDA Parent or Child Food and Activity Questionnaire (FAQ). Two actor-partner interdependence models, using multi-level modeling and adjusting for relevant confounds, estimated the bidirectional associations between the parent-child dyad's sleep quality and composite food and physical activity quality.

RESULTS

After controlling for partner BMI and actor and partner age, the effect of children's PSQI scores on parent's FAQ scores was statistically significant (β = -0.23, p = 0.036). Poorer sleep quality in children was associated with worse physical activity and dietary behaviors in parents. Second, after adjusting for race, a significant partner effect for parents' FAQ scores on children's PSQI scores was shown-greater parental food and physical activity quality was associated with better sleep quality in PCS (β = -0.20, p = 0.041).

CONCLUSIONS

Better food and activity quality for parents is linked to improved sleep quality for children, while children's poor sleep quality is associated with lower food and activity quality in parents. The findings highlight the prospective value of systems-focused clinical interventions to manage sleep quality and promote positive health behaviors among PCS.

Abdominal visceral and subcutaneous adipose tissue associations with postmenopausal breast cancer incidence

BACKGROUND

Obesity, classified by body mass index (BMI), is associated with higher postmenopausal breast cancer (BCa) risk. Yet, the associations between abdominal visceral (VAT) and subcutaneous adipose tissue (SAT) with BCa are unclear.

METHODS

We assessed BCa associations with abdominal VAT and SAT in a prospective cohort of postmenopausal women without a history of cancer and with 27 years follow-up (N = 9950), during which all new cancers were adjudicated. Dual-energy x-ray absorptiometry scans assessed adiposity at baseline, year 3, and year 6. Competing-risks multivariable sub-hazard ratios (SHR), with adjustments for sociodemographic, behavioral, reproductive, and anthropometric characteristics, were estimated for baseline and time-dependent associations between VAT, SAT, and incident BCa.

RESULTS

Participants averaged 63.3 ± 7.4 years of age and a BMI of 28.20 ± 5.72 kg/m2 at baseline. The models included 738 incident BCa case patients (N = 593 invasive; N = 145 in situ). Baseline VAT and SAT area were associated with statistically significantly increased BCa risk, by 36% and 19%, respectively. Increasing VAT/SAT ratio was associated with an 8% increase in incident BCa. Time-dependent models produced similar results. VAT and VAT/SAT associated BCa risk was highest for African American/Black women, although not statistically significantly different from other groups. Quartiles (Q) of VAT/SAT were also explored; the SHR for Q4 compared with Q1 was 1.49 (95% CI = 1.18 to 1.87).

CONCLUSION

Higher abdominal VAT and SAT are associated with an increased risk of postmenopausal BCa, and VAT/SAT may provide a distinctive risk estimate. Potential racial and ethnic differences require replication in a larger sample (Women's Health Initiative; NCT00000611; https://clinicaltrials.gov/study/NCT00000611).

Dietary ω-3 Fatty Acids Mitigate Intestinal Barrier Integrity Alterations in Mice Fed a High-Fat Diet: Implications for Pancreatic Carcinogenesis

BACKGROUND

Although body fatness is a recognized risk factor for pancreatic ductal adenocarcinoma (PDAC), the underlying mechanisms of how fat composition affects pancreatic carcinogenesis are poorly understood. High-fat diets (HFDs) can disrupt intestinal barrier function, potentially accelerating carcinogenesis. Omega-3 (ω-3) polyunsaturated fatty acids (FAs) have anti-inflammatory properties and help preserve intestinal integrity.

OBJECTIVE

The objective of this study was to evaluate how ω-3 FAs affect the colonic barrier in the context of HFD-induced changes, in a mouse model of PDAC [p48-Cre; LSL-KrasG12D (KC)].

METHODS

Male and female KC mice were randomly assigned into 1 of the following 4 groups: 1) a control diet containing ∼11% total calories from fat with an ω-6:ω-3 FA ratio of 10:1 (C), 2) the control diet with high concentrations of ω-3 FA with an ω-6:ω-3 FA ratio of 1:1 (Cω3), 3) an HFD containing 60% total calories from fat with an ω-6:ω-3 FA ratio of approximately 10:1 (HF), and 4) an HFD with high concentrations of ω-3 FA with an ω-6:ω-3 FA ratio of 1:1 (HFω3).

RESULTS

Consumption of an HFD for 8 wk caused: 1) disruption of tight junction structure and function; 2) decreased goblet cell number; 3) higher colonic Toll-like receptor 4 (TLR4) and NADPH oxidase 1 expression; 4) activation of TLR4-triggered pathways, that is, NF-κB, c-Jun N-terminal kinase; 5) elevated plasma lipopolysaccharide concentrations; and 6) higher pancreatic TLR4 expression, and 7) accelerated acinar-to-ductal metaplasia. All of these events were mitigated in mice fed the HFω3.

CONCLUSIONS

Our findings support the concept that, in the context of obesity, ω-3 FAs have protective effects during early-stage pancreatic carcinogenesis through the regulation of intestinal permeability and endotoxemia.

A retrospective cohort review of BMI on SI joint fusion outcomes: examining the evidence to improve insurance guidelines

PURPOSE

The demand for SIJ fusion among obese patients has grown substantially. However, the clinical relevance of obesity in the context of SI joint fusion has not been well investigated specifically, whether there is a BMI cutoff above which the benefit-risk ratio is low.

METHODS

Adult patients ≥ 21 years of age who underwent minimally invasive SIJ fusion between 2020 and 2023. Participants were classified using the National Institutes for Health body mass index (BMI). Patients with a BMI of 30 to 39 with no significant comorbidity are considered obese, patients with a BMI of 35 to 39 with a significant comorbidity or a BMI of 40 or greater are considered morbidly obese. All subjects completed the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at baseline and 12 months. One-way analysis of variance was used to examine the impact of BMI category on score changes.

RESULTS

Overall, mean VAS improved at 12 months by 2.5 points (p < .006). Over the 12-month follow-up period, BMI category did not impact mean improvement in VAS (ANOVA p = .08). Mean ODI at 12 months improved by 23.2 points (p < .001). BMI category did impact mean improvement in ODI (ANOVA p = .03).

CONCLUSION

This study demonstrates similar benefits across all BMI categories. This data suggests that obese patients do benefit from minimally invasive SIJ fusion, specifically the 35-40 BMI cohort of patients, and should not be denied this procedure based on arbitrary healthcare organizations BMI criteria.

Effects of elevated body mass index on the success of total knee and total hip arthroplasty: a comprehensive overview

INTRODUCTION

The average body mass index (BMI) in the United States has tripled over the last five decades despite concerted population-based efforts for weight management. Elevated BMI and, in particular, obesity are risk factors for osteoarthritis. This trend has led to increased demands for total knee (TKA) and total hip arthroplasty (THA), necessitating an in-depth understanding of how elevated BMI impacts TKA and THA.

AREAS COVERED

This paper reviews the literature investigating the effects of elevated BMI, primarily obesity, on TKA and THA, focusing on preoperative, intraoperative, and postoperative considerations. It describes the associated risks, economic implications, and ethical considerations of patients with high BMIs undergoing TKA or THA. To ensure all relevant literature was included, Ovid Medline and Google Scholar databases were searched for the following terms, 'body mass index,' 'obesity,' 'knee,' 'hip,' and 'arthroplasty' for articles published from January 2019 through July 2024.

EXPERT OPINION

Despite the challenges of high BMI in TKA and THA, a deeper understanding of obesity as a chronic illness, coupled with advances in surgical techniques, can improve patient outcomes. A multidisciplinary approach and further research will optimize the care of patients with elevated BMIs undergoing total joint arthroplasty (TJA).

Is excessive body weight related to energy level of injury in tibial tubercle fractures in adolescents?

To assess whether excessive body weight or obesity predisposes adolescents to tibial tubercle fractures from less energetic traumas, prolongs the period of rehabilitation from these injuries or leads to worse outcomes. A retrospective study of patients who underwent surgical treatment for fracture of the tibial tubercle in the period from March 2013 to March 2022. Patients were classified according to age, gender, fracture type, BMI, mechanism and energy levels of injury, time to complete painless range of motion was achieved and rate of complications. We have surgically treated 33 patients who have sustained 34 tibial tubercle fractures. Twenty of our patients had a BMI in the 'healthy weight' range while 13 were either overweight or obese. A significant difference in the distribution of injury types between the two groups has been statistically confirmed, whereby more severe injuries were recorded in the 'healthy weight' group of patients. A statistically significant higher proportion of patients who sustained a fracture after a blow to the knee or during light activity could have been confirmed in the 'overweight/obese' group while patients in the 'healthy weight' group more often sustained fractures after a powerful concentric or eccentric contraction of the quadriceps muscle. All of the patients achieved full painless range of motion and a radiologically confirmed osseous union. The healthy weight group had a significantly shorter period of rehabilitation. Two minor complications have been recorded. A higher BMI may lead to tibial tubercle fractures caused by less energetic injuries in adolescent patients. We may also conclude that blows to the knee or injuries sustained while running most often do not cause the most severe type of fractures. However, operative treatment provides a good outcome regardless of the type of injury or BMI.

Effects of Diabetes and Hyperlipidemia in Physiological Conditions - A Review

BACKGROUND

Diabetes mellitus (DM) is an autoimmune manifestation defined by persistent hyperglycemia and alterations in protein, fatty substances, and carbohydrate metabolism as an effect of problems with the secretion of insulin action or both. Manifestations include thirst, blurred eyesight, weight loss, and ketoacidosis, which can majorly lead to coma. There are different types of diabetes according to class or by cellular level. They are interrelated with hyperlipidemia as they are involved in the metabolism and regulation of physiological factors. Most parameters are seen at cellular or humoral levels, yet the underlying concern remains the same.

OBJECTIVE

To create a systematic correlation between the disease and locate the exact mechanism and receptors responsible for it. So, this article covers a proper way to resolve the conditions and their manifestation through literacy and diagrammatic.

CONCLUSION

Hence, this will be an insight for many scholars to understand the exact mechanism involved in the process.

Assessing the longitudinal association between sleep, diet quality and BMI z-score among Black adolescent girls

BACKGROUND

Cross-sectional research has suggested associations between diet, sleep and obesity, with sparse longitudinal research.

OBJECTIVES

To identify longitudinal mechanistic associations between sleep, diet and obesity.

METHODS

We used longitudinal data from a sample of Black adolescent girls. At T1 (enrolment), 6 months (T2) and 18 months (T3), we estimated sleep duration and quality (7-day accelerometry), diet quality (Healthy Eating Index [HEI-2020]) and body mass z-scores (zBMI) from measured height and weight. Longitudinal mediation using structural equation models examined the mechanistic roles of sleep, diet quality and zBMI.

RESULTS

At enrolment, girls (n = 441) were mean age 12.2 years (±0.71), 48.3% had overweight/obesity, and mean HEI 55.8 (±7.49). The association between sleep and diet quality did not vary over time. Sleep duration at T1 was not associated with diet quality at T2 nor was diet associated with zBMI at T3. The bootstrapped indirect effect was not significant. Sleep quality at T1 was not associated with diet quality at T2 nor was diet associated with zBMI at T3. The bootstrapped indirect effect was not significant.

CONCLUSIONS

Diet was not a mediator between sleep and obesity. Study strengths are the longitudinal design and direct measures of sleep and zBMI among a homogeneous sample.

Childhood Mediterranean Diet Compliance Is Associated with Lower Incidence of Childhood Obesity, Specific Sociodemographic, and Lifestyle Factors: A Cross-Sectional Study in Children Aged 6-9 Years

BACKGROUND

Mediterranean diet (MD) constitutes a commonly examined dietary model. It includes a plethora of bioactive ingredients with strong antioxidant, anti-inflammatory, antithrombotic and anticancer properties. Several substantial studies support strong evidence that MD can exert preventing actions against human morbidity and mortality, promoting human well-being and quality of life. The present study aims to evaluate whether childhood MD compliance may be associated with socio-demographic, anthropometric, and lifestyle factors in children at the age of 6-9 years.

METHODS

This is a cross-sectional survey on 3875 children aged 6-9 years old with their matched mothers. Qualified questionnaires were used to evaluate and collect by one-to-one interviews with trained professionals the above data.

RESULTS

Elevated MD adherence was observed only in 22.2% of the enrolled children, while 37.5% of children maintained intermediate MD adherence and 40.3% of children adopted lower MD levels. Children MD compliance was related at an independent manner with maternal education level, childhood anthropometric factors such as Body Mass Index (BMI), Waist circumference to Height ratio (WtHR), quality of life, and exclusively breastfeeding behaviors after adjusting for several possible confounders (p ˂ 0.05).

CONCLUSIONS

Elevated MD adherence of children aged 6-9 years old showed a lower obesity of overweight/obesity, including abdominal obesity. A higher maternal educational status and adopting exclusively breastfeeding practices were associated with greater levels of children's MD adherence, promoting their quality of life and well-being. Based on the present results, future prospective surveys need to be performed to evaluate if there is a causality relation concerning this topic.

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.

IFSO Bariatric Endoscopy Committee Evidence-Based Review and Position Statement on Endoscopic Sleeve Gastroplasty for Obesity Management

BACKGROUND

Obesity is a significant global health issue. Metabolic and bariatric surgery (MBS) is the gold standard in the treatment of obesity due to its proven effectiveness and safety in the short and long term. However, MBS is not suitable for all patients. Some individuals are at high surgical risk or refuse surgical treatment, while others do not meet the criteria for MBS despite having obesity-related comorbidities. This gap has driven the development of endoscopic solutions like endoscopic sleeve gastroplasty (ESG), which offers a less invasive alternative that preserves organ function and reduces risks. A recent IFSO International Delphi consensus study highlighted that multidisciplinary experts agree on the utility of ESG for managing obesity in patients with class I and II obesity and for those with class III obesity who do not wish to pursue or qualify for MBS. This IFSO Bariatric Endoscopy Committee position statement aims to augment these consensus statements by providing a comprehensive systematic review of the evidence and delivering an evidence-based position on the value of ESG within the spectrum of obesity management.

METHODS

A comprehensive systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Cochrane guidelines.

RESULTS

Systematic Review: The systematic review included 44 articles encompassing 15,714 patients receiving ESG. The studies varied from large case series to cohort studies and a randomized controlled trial (RCT). The mean baseline BMI was 37.56 kg/m2. The review focused on weight loss outcomes and safety data.

META-ANALYSIS

Time point Mean %EWL Mean %TBWL 6 months 48.04 15.66 12 months 53.09 17.56 18 months 57.98 16.25 24 months 46.57 15.2 36 months 53.18 14.07 60 months 45.3 15.9 These results demonstrate significant weight loss following ESG.

SAFETY

The pooled serious adverse event (SAE) rate was 1.25%. This low rate of SAEs indicates that ESG is a relatively safe procedure.

QUALITY OF EVIDENCE

The quality of evidence from the included observational studies was assessed as very low, primarily due to the inherent limitations associated with observational study designs, such as potential biases and lack of randomization. In contrast, the quality of evidence from the single randomized controlled trial was rated as MODERATE, reflecting a more robust study design that provides a higher level of evidence despite some limitations.

CONCLUSIONS

The IFSO Bariatric Endoscopy Committee, after conducting a comprehensive systematic review and meta-analysis, endorses endoscopic sleeve gastroplasty (ESG) as an effective and valuable treatment for obesity. ESG is particularly beneficial for patients with class I and II obesity, as well as for those with class III obesity who are not suitable candidates for metabolic bariatric surgery. ESG provides significant weight loss outcomes and demonstrates a favorable safety profile with a low rate of serious adverse events. Despite the limitations of the included observational studies, the randomized controlled trial included in the analysis reinforces the efficacy and safety of ESG and provides an evidence-based foundation for the position statement. Thus, the IFSO position statement supports and provides an evidence base for the role of ESG within the broader spectrum of obesity management.

Mitochondrial Health Markers and Obesity-Related Health in Human Population Studies: A Narrative Review of Recent Literature

PURPOSE OF REVIEW

This narrative review summarizes current literature on the relationship of mitochondrial biomarkers with obesity-related characteristics, including body mass index and body composition.

RECENT FINDINGS

Mitochondria, as cellular powerhouses, play a pivotal role in energy production and the regulation of metabolic process. Altered mitochondrial functions contribute to obesity, yet evidence of the intricate relationship between mitochondrial dynamics and obesity-related outcomes in human population studies is scarce and warrants further attention. We discuss emerging evidence linking obesity and related health outcomes to impaired oxidative phosphorylation pathways, oxidative stress and mtDNA variants, copy number and methylation, all hallmark of suboptimal mitochondrial function. We also explore the influence of dietary interventions and metabolic and bariatric surgery procedures on restoring mitochondrial attributes of individuals with obesity. Finally, we report on the potential knowledge gaps in the mitochondrial dynamics for human health for future study.

Impact of Obesity on Breast Cancer Clinicopathological Characteristics in Underserved US Community Safety-Net Hospital: A Retrospective Single-Center Study

BACKGROUND

Breast cancer continues to pose a significant public health challenge, with its incidence and disproportionate impact on underserved populations in the United States. The relationship between obesity and clinicopathological characteristics at presentation remains a critical area of investigation. Safety-net hospitals caring for underserved communities provide a unique setting to explore these associations. This study seeks to explore a critical gap in knowledge on obesity and breast cancer characteristics in underserved populations in the United States.

MATERIALS AND METHODS

In this retrospective study, 927 breast cancer patients were included. Analysis was conducted to assess the association between body mass index (BMI), age of diagnosis, tumor clinicopathologic characteristics, and molecular types stratified by menopausal status at diagnosis. Analysis was performed using the Statistical Package for Social Sciences version 29.

RESULTS

A significant association was found between BMI and menopausal status (P < .05). Disease stage at presentation was significantly associated with BMI (P < .05). Further investigation into BMI categories and tumor characteristics revealed a significant correlation in postmenopausal women, with obesity linked to tumor size and lymph node status (P < .05). No significant associations were observed between HER-2 status, ER/PR status, and obesity in either premenopausal or postmenopausal groups.

CONCLUSION

This observational retrospective hypothesis-generating study revealed the association between obesity and disease stage and menopause status at diagnosis. In postmenopausal patients, obesity correlated with larger tumor size and advanced lymph node disease involvement. Additionally, ethnic variations were observed, with a higher prevalence of obesity among African American patients.

Rheumatic diseases and metabolism: where centre and periphery meet

Over the past few decades, the connection between metabolism and various inflammatory and rheumatic diseases has been an area of active investigation. Nonetheless, the precise mechanisms underlying these relationships remain a topic of ongoing debate, owing in part to conflicting data. This discrepancy can be attributed to the predominant focus on peripheral mechanisms in research into the metabolic consequences of rheumatic diseases. However, a wealth of evidence supports the notion that the central nervous system, specifically the hypothalamus, has an important influence on metabolic homeostasis. Notably, links have been established between crucial hypothalamic mechanisms responsible for regulating energy balance (including food intake, thermogenesis, and glucose and lipid metabolism), such as AMP-activated protein kinase, and the pathophysiology of rheumatoid arthritis. This Review aims to comprehensively examine the current understanding of central metabolic control in rheumatic diseases and explore potential therapeutic options that target this pathophysiological mechanism.

Role of Human Milk Microbiota in Infant Neurodevelopment: Mechanisms and Clinical Implications

BACKGROUND

Human milk (HM) is recognized as an ideal source of nutrition for newborns; as a result, its multiple bioactive molecules can support the growth of healthy newborns and reduce the risk of mortality and diseases such as asthma, respiratory infections, diabetes (type 1 and 2), and gastrointestinal disorders such as ulcerative colitis and Crohn's disease. Furthermore, it can reduce the severity of necrotizing enterocolitis (NEC) in preterm infants. Moreover, human milk oligosaccharides (HMOs) present in breast milk show an immunomodulatory, prebiotic, and neurodevelopmental effect that supports the microbiota-gut-brain axis.

MATERIAL AND METHODS

This study examined the state-of-the-art research, using keywords such as "breastfeeding", "human milk oligosaccharides", "microbiota-gut-brain axis", "infants", and "malnutrition". The literature review was conducted by selecting articles between 2013 and 2024, as the most recent ones. The databases used were Web Science, PubMed, and Scopus.

RESULTS

We found multiple studies examining the composition of HM and infant formula (IF). However, further longitudinal studies and randomized control trials (RCTs) are needed to better understand the clinical outcomes that bioactive components exert on healthy and hospitalized children and how, in conditions of malnutrition, it is necessary to support the growth of the newborn.

CONCLUSIONS

In this review, we affirm the importance of human milk and, through it, the modulation of the microbiota and the neuroprotective role in newborns, determining the health of the following years of life.

Prevalence of Oral Diseases and the Influence of the Presence of Overweight/Obesity in Schoolchildren Population in Mallorca

Background: The pediatric population is one of the social groups most affected by oral pathology, and overweight and/or obesity is increasingly frequently observed. This work presents a study of the prevalence of oral disease in the school population in Mallorca and its relationship with overweight/obesity. Methods: A cross-sectional study was carried out with a sample of 718 students aged 5-6 (n = 255), 12 (n = 230) and 15 years (n = 233). The WHO criteria for diagnosing and coding examined teeth and overweight/obesity prevalence values. To explore the differences in data, the mean was analyzed using the Student's t-test or a one-way analysis of variance followed by the Bonferroni post hoc analysis. Results: Results found that students aged 15 years have a caries prevalence rate of 45.49%, higher than those aged 12 (27.39%). The presence of dental calculus in 15-year-old students is 52.8%, even higher than in 12-year-olds (30%). Students aged 6 and 12 with lower weight percentiles have fewer healthy teeth than those with higher percentiles. Conclusions: The schoolchildren have experienced a decrease in caries and an increase in periodontitis, with weight percentile potentially influencing the number of healthy teeth.

Association between homocysteine levels and mortality in CVD: a cohort study based on NHANES database

BACKGROUND

Cardiovascular disease (CVD) is a major global health concern with increasing incident cases and deaths. Homocysteine (Hcy) has been investigated for its potential association with CVD, researchers have debated the extent to which Hcy should be considered a risk factor for cardiovascular diseases, as only 50% of CVD can be explained by classical risk factors.

METHODS

We conducted a prospective cohort study using NHANES 1999-2006 data, analyzing 1,739 US patients aged at least 30 with CVD. Cox proportional hazards regression and restricted cubic splines were used to examine the relationship between Hcy levels and mortality, adjusting for covariates.

RESULT

A total of 1,739 participants with cardiovascular disease (CVD) were enrolled, with a median follow-up period of 126 months. Among them, 1,194 participants died, including 501 deaths due to cardiovascular causes. After adjusting for covariates, the hazard ratios (HR) and 95% confidence intervals (CI) for CVD mortality at different levels of homocysteine (Hcy) (T1 (< 9.3), T2 (9.3-12.5), T3 (> 12.5)) were 1.26 (0.92, 1.73) (T2), and 1.69 (1.14, 2.51) (T3) (P for trend = 0.0086). The HR and 95% CI for all-cause mortality at different levels of Hcy were 1.22 (1.05, 1.42) (T2) and 1.64 (1.29, 2.09) (T3) (P for trend < 0.0001). Elevated Hcy levels were associated with increased risks of all-cause mortality and CVD deaths, even at levels below the conventional threshold. The nonlinear relationship was observed, with inflection points at 14.5 µmol/L for all-cause mortality and 14.6 µmol/L for CVD mortality. Subgroup analyses revealed interactions with age, serum vitamin B12, and smoking.

CONCLUSION

Our study supports the notion that elevated Hcy levels are associated with higher all-cause and CVD mortality risks in CVD participants. The impact of Hcy on health outcomes can be observed at lower concentrations than previously thought.

Effects of Responsiveness and Responsibility Parenting Factors on Family Mealtime Outcomes in Overweight African American Adolescents

BACKGROUND/OBJECTIVES

Family meals have been shown to be an important protective factor for positive health outcomes. This study assessed the associations of parenting factors with family mealtime among overweight African American adolescents over a period of 4 months. It was hypothesized that increases in warm and responsive parenting (parental responsiveness, parental responsibility) would be associated with increased frequency and quality of family mealtimes, while more demanding and controlling parenting (parental demandingness, parental monitoring) would be associated with a reduced frequency and quality of family mealtimes over time.

METHODS

Data from baseline to 16 weeks were collected from 241 African American adolescent-parent dyads (adolescent: Mage = 12.8 ± 1.7 years; 64% female; MBMI%= 96.6 ± 4.2) that participated in the Families Improving Together (FIT) for Weight Loss randomized controlled trial.

RESULTS

Multilevel models revealed significant positive main effects of parental responsiveness and parental responsibility (p < 0.05) on the increased frequency of family meals (p < 0.01). Significant two-way interactions also showed that parental responsiveness (p < 0.05) predicted improved quality of family mealtimes, whereas parental demandingness (p < 0.01) predicted reduced quality of family mealtimes from baseline to 16 weeks.

CONCLUSIONS

Results from this study have important implications for African American adolescent obesity prevention and future family-based intervention program guidelines.

Hands-On Gardening in Childcare Centers to Advance Preschool-Age Children's Fruit and Vegetable Liking in Semi-Arid Climate Zone

Hands-on gardening is linked with healthy eating behaviors, increased outdoor activities, and overall well-being, all contributing factors to preventing obesity. Although these positive associations are widely established for adults and school-aged children, little evidence can be found on how such relationships may extend to early childhood, especially in the preschool years (3-5 years). One recent study conducted in North Carolina (NC) showed that participating in hands-on gardening significantly increased preschoolers' accurate identification of fruits and vegetables (FV) and FV consumption compared to children who did not participate in hands-on gardening, but no association was found between participation in hands-on gardening and the children's liking (eating preferences) of FV. FV identification and liking during the early years may lead to lifelong healthy eating behaviors and preferences, making hands-on gardening a critical health intervention in early childhood environments, especially in childcare centers where a majority of the 13 million children in the United States between the ages of 0 and 5 spend most of their waking hours. This research aimed to investigate how hands-on gardening in childcare centers may impact preschoolers' (3-5 years old) FV knowledge (identification) and liking in a semi-arid climate zone with a high concentration of Hispanic families by conducting experimental research with eight childcare centers and one hundred forty-nine children (n = 149) in Lubbock County, located in West Texas. The findings showed changes in average liking scores are generally positive in the experimental group of children who participated in hands-on gardening (compared to the control non-gardening group), implying an improved liking. The findings indicate that the benefits of hands-on gardening in childcare centers for enhancing healthy eating preferences are evident even in a semi-arid climate zone, where high temperatures and limited rainfall present significant gardening challenges. This research underscores the importance of integrating hands-on gardening into childcare programs, highlighting its potential as an effective obesity prevention strategy not only within the US but also in other regions with similar environmental constraints.

Cardiovascular reactivity during conversations about discrimination is buffered by social support among U.S. Latines

Racial discrimination is conceptualized as an acute and chronic stressor. Like other acute stressors, lab-based studies demonstrate acute effects of discrimination-related stressors on stress-related cardiovascular outcomes, including total cardiac output, blood pressure, and indices of sympathetic and parasympathetic nervous system activity. Critically, it is important to understand how individual and social factors buffer the experience of race-related acute stress. The current study extends existing work by measuring cardiovascular indices of stress during conversations about racial/ethnic discrimination and examines the moderating role of social support. Latine/Hispanic participants (N = 97) talked about personal discrimination experiences with either a close other or a research assistant they had never previously met. Participants in both conditions exhibited cardiovascular reactivity indicative of stress during the conversation. Additionally, patterns of reactivity reflected a more adaptive stress response and recovery profile when participants talked about discriminatory experiences with a close other relative to a stranger (less parasympathetic withdrawal during the stressor and more parasympathetic rebound during recovery). These patterns are consistent with a stress buffering account of social support, which suggests social bonds and community-level support are critical to consider in interventions to mitigate the harms of experiencing discrimination and prevent chronic health disparities.

Prenatal Diet and Infant Growth From Birth to Age 24 Months

Importance

Being born either small for gestational age (SGA) or large for gestational age (LGA) and experiencing rapid or slow growth after birth are associated with later-life obesity. Understanding the associations of dietary quality during pregnancy with infant growth may inform obesity prevention strategies.

Objective

To evaluate the associations of prenatal dietary quality according to the Healthy Eating Index (HEI) and the Empirical Dietary Inflammatory Pattern (EDIP) with infant size at birth and infant growth from birth to age 24 months.

Design, Setting, and Participants

This cohort study used data from birthing parent-child dyads in 8 cohorts participating in the Environmental influences on Child Health Outcomes program between 2007 and 2021. Data were analyzed from March 2021 to August 2024.

Exposures

The HEI and the EDIP dietary patterns.

Main Outcomes and Measures

Outcomes of interest were infant birth weight, categorized as SGA, reference range, or LGA, and infant growth from birth to ages 6, 12, and 24 months, categorized as slow growth (weight-for-length z score [WLZ] score difference <-0.67), within reference range (WLZ score difference -0.67 to 0.67), or rapid (WLZ score difference, >0.67).

Results

The study included 2854 birthing parent-child dyads (median [IQR] maternal age, 30 [25-34] years; 1464 [51.3%] male infants). The cohort was racially and ethnically diverse, including 225 Asian or Pacific Islander infants (7.9%), 640 Black infants (22.4%), 1022 Hispanic infants (35.8%), 664 White infants (23.3%), and 224 infants (7.8%) with other race or multiple races. A high HEI score (>80), indicative of a healthier diet, was associated with lower odds of LGA (adjusted odds ratio [aOR], 0.88 [95% CI, 0.79-0.98]), rapid growth from birth to age 6 months (aOR, 0.80 [95% CI, 0.37-0.94]) and age 24 months (aOR 0.82 [95% CI, 0.70- 0.96]), and slow growth from birth to age 6 months (aOR, 0.65 [95% CI, 0.50-0.84]), 12 months (aOR, 0.74 [95% CI, 0.65-0.83]), and 24 months (OR, 0.65 [95% CI, 0.56-0.76]) compared with an HEI score 80 or lower. There was no association between high HEI and SGA (aOR, 1.14 [95% CI, 0.95-1.35]). A low EDIP score (ie, ≤63.6), indicative of a less inflammatory diet, was associated with higher odds of LGA (aOR, 1.24 [95% CI, 1.13-1.36]) and rapid infant growth from birth to age 12 months (aOR, 1.50 [95% CI, 1.18-1.91]) and lower odds of rapid growth to age 6 months (aOR, 0.77 [95% CI, 0.71-0.83]), but there was no association with SGA (aOR, 0.80 [95% CI, 0.51-1.25]) compared with an EDIP score of 63.6 or greater.

Conclusions and Relevance

In this cohort study, a prenatal diet that aligned with the US Dietary Guidelines was associated with reduced patterns of rapid and slow infant growth, known risk factors associated with obesity. Future research should examine whether interventions to improve prenatal diet are also beneficial in improving growth trajectory in children.

Does Body Mass Index Affect the Success of Two-Stage Management of Periprosthetic Joint Infection?

BACKGROUND

Obesity is associated with increased infection risk after primary total joint arthroplasty. In this retrospective cohort analysis, we sought to assess the association between body mass index (BMI) and infection recurrence after two-stage revision total joint arthroplasty for periprosthetic joint infection (PJI).

METHODS

Patients were grouped by BMI (< 30, 30 to 40, and ≥ 40) as non-obese, obese, and morbidly obese, and assessed for associations and timing of PJI reinfection as well as readmissions and complications.

RESULTS

Following the two-stage revision, PJI reinfections increased from 11.5% in nonobese to 19.0% in obese and 25.9% in morbidly obese patients (P = 0.011). As BMI increased across the three groups, 90-day readmission rates following two-stage PJI revision significantly increased (8.6, 19.7, and 16.7%, respectively (P = 0.042)). The average time to reinfection decreased with obesity tercile (restricted-mean times of 4.5, 4.2, and 3.8 years with non-obese, obese, and morbidly obese, respectively (P = 0.023)).

CONCLUSIONS

The success of PJI management with two-stage arthroplasty is significantly impacted by patient BMI, with morbidly obese subjects having the worst outcomes. Attempts to modify BMI before completion of two-stage PJI treatment should be considered in the morbidly obese given high rates of recurrence.

First semester changes in college students' objectively-measured physical activity and dietary behaviors

Objective: The objective of this study was to examine changes in freshman students' objectively measured body mass index (BMI), physical activity (PA), and dietary behaviors (consumption of trans fats, sugars, and added sugars) during their first college semester. Methods: Twenty-eight participants (18.32 ± 2.2) completed the dietary (ASA24-US) and PA (wrist-worn ActiGraph accelerometer) assessments. Non-parametric Paired-Wilcoxon signed-rank tests were used to identify the changes in BMI, moderate-to-vigorous intensity PA (MVPA), vigorous-intensity PA (VPA), and nutrition. Results: The analyses showed a statistically significant increase in BMI (Mbaseline = 22.85[2.87] kg/m2; Mpost = 23.53[3.21] kg/m2; p = .002, r = .53) and MVPA (Mbaseline = 200.94[81.08]; Mpost = 216.92[78.33]; p = .031, r = .41), but there were no statistically significant changes in VPA or dietary behaviors. Conclusions: Although freshman students' PA and dietary behaviors were relatively healthy, efforts to increase VPA and reduce consumption of added sugars are well warranted.

From prevention to treatment: Prescription medication, information, and health behaviors

Medical innovations may lessen the perceived risk of disease which can decrease the take-up of healthy behaviors, a phenomenon known as risk compensation. In contrast, a diagnosis provides updated information about the state of one's health which may motivate positive behavior change. In this paper, I consider how behavior changes in response to a diagnosis of cardiovascular disease (CVD) before and after the FDA approval of new classes of drugs to treat high blood pressure and high cholesterol in 1973. I find that individuals diagnosed with CVD are more likely to follow a diet and decrease body-mass index in response to the diagnosis, irrespective of medication approvals. Nonsmoking is a notable exception. Prior to medication availability, there is no change in smoking behavior in response to a CVD diagnosis. Conversely, when medication is available, there is a significant decline in smoking. The empirical complementarity of medication and smoking cessation may be driven by increased exposure to medical professionals (who emphasize the harms of smoking) or because medication decreases the risk of CVD death which heightens the importance of investing in future health.

Novel Insights Into the Causal Effects and Shared Genetics Between Body Fat and Parkinson Disease

AIMS

Existing observational studies examining the effect of body fat on the risk of Parkinson disease (PD) have yielded inconsistent results. We aimed to investigate this causal relationship at the genetic level.

METHODS

We employed two-sample Mendelian randomization (TSMR) to investigate the causal effects of body fat on PD, with multiple sex-specific body fat measures being involved. We performed Bayesian colocalization analysis and cross-trait meta-analysis to reveal pleiotropic genomic loci shared between body mass index (BMI) and PD. Finally, we used the MAGMA tool to perform tissue enrichment analysis of the genome-wide association study hits of BMI.

RESULTS

TSMR analysis suggests that except waist circumference, higher measures of body fatness are associated with a decreased risk of PD, including BMI (OR: 0.83), body fat percentage (OR: 0.69), body fat mass (OR: 0.77), and hip circumference (OR: 0.83). The observed effects were slightly more pronounced in females than males. Colocalization analysis highlighted two colocalized regions (chromosome 3p25.3 and chromosome 17p12) shared by BMI and PD and pointed to some genes as possible players, including SRGAP3, MTMR14, and ADORA2B. Cross-trait meta-analysis successfully identified 10 novel genomic loci, involving genes of TOX3 and MAP4K4. Tissue enrichment analysis showed that BMI-associated genetic variants were enriched in multiple brain tissues.

CONCLUSIONS

We found that nonabdominal body fatness exerts a robust protective effect against PD. Our colocalization analysis and cross-trait meta-analysis identified pleiotropic genetic variation shared between BMI and PD, providing new clues for understanding the association between body fat and PD.

Effectiveness of Nutrition Education on Weight Loss and Body Metrics Among Obese Adults: An Interventional Study

Background Obesity has detrimental personal, societal, and economic consequences and raises the risk of developing chronic diseases such as diabetes and cardiovascular diseases. Diet and exercise behaviors are frequently the focus of weight loss programs. Effective nutrition education is associated with a reduced risk of chronic diseases and body weight management. Individualized lifestyle and counseling sessions with follow-ups reduce weight loss compared to single combined sessions. Objectives The objective of this study was to assess the effectiveness of nutrition education intervention on weight loss among adults aged 18-40 years in Lahore through an interventional study. Methods This study was conducted in Lahore. According to the inclusion criteria, overweight/obese (Body Mass Index (BMI) ≥ 23 kg/m²), young (18-40 years old) men and women were part of this study. A total of 50 participants were randomized into two groups, one as the control group and the other one as the intervention group. Group counseling was provided to the control group. The intervention group was assessed individually through follow-ups for 3 months of online and on-campus sessions. Data was collected at four intervals at baseline, month 1, month 2, and month 3 through a self-administered assessment form. Data was analyzed using the statistical package for social science, SPSS version 25 (IBM Corp., Armonk, USA). Results Out of the 50 participants, 54% (27) were women while 46% (23) were men (mean age 29.90, SD = 6.26, BMI at baseline 32.18 kg/m², 26. 49 kg/m²), and randomized by a blinded researcher. At three months, the mean differences in BMI, waist circumference, waist-to-hip ratio, and body fat percentage between the groups were 3 kg (23.44 ± 0.58, 95% CI 22.86-24.02), 33.90 cm (95% CI 32.50-35.30), 0.86 (95% CI 0.74-0.98), and 24.79% (95% CI 18.00-31.58), respectively, in favor of the intervention group (p < 0.005).  Conclusion This study demonstrates that a structured dietary intervention combined with physical activity guidance leads to significant weight loss and improved body composition in obese adults. These findings support the effectiveness of comprehensive weight loss strategies for managing obesity.

The Saudi Gastroenterology Association consensus on the clinical care pathway for the diagnosis and treatment of GERD

ABSTRACT

Gastroesophageal reflux disease (GERD) is one of the most common problems encountered in outpatient general medicine and gastroenterology clinics. GERD may present with classic esophageal symptoms, extraesophageal symptoms, or mixed symptoms. The diagnosis and treatment of GERD are challenging due to the variety of symptoms and multifactorial pathophysiology. Since there is no consensus on the diagnosis and treatment of GERD in Saudi Arabia, the Saudi Gastroenterology Association established an expert group to formulate a consensus on the clinical care pathway for the diagnosis and treatment of GERD to update health-care providers in Saudi Arabia. The expert group reviewed the literature including recently published international guidelines, clinical trials, and expert opinion and conducted virtual and in-person meetings. A total of 22 statements on the definition, diagnosis, and treatment of GERD were formulated, and three algorithms for the clinical care of GERD were developed with a detailed description for each step. The expert group endorsed the new definition of GERD, the practical principles of interpretation of the diagnostic GERD evaluation, and the practical guidance for GERD treatment including medical, surgical, and endoscopic therapy. The expert group recommends further studies to investigate local data on the diagnosis and treatment of GERD.

Causal Relationship between Television Viewing Time, Cardiovascular Diseases, and Potential Mechanisms

BACKGROUND

As the predominant leisure-time sedentary behavior, television viewing was documented to increase cardiovascular diseases in observational studies, yet the causal relationship and potential mechanisms remain to be determined.

OBJECTIVES

To systematically investigate the causal relationship between television viewing time, cardiovascular diseases, and potential mechanisms.

METHODS

We conducted a two-sample Mendelian randomization (MR) analysis to estimate causal associations with cardiovascular diseases and biomarkers of cardiometabolic risk. The random inverse-variance weighted method was used as the primary estimate. To account for multiple comparisons, a Bonferroni correction p value for cardiovascular diseases and biomarkers of cardiometabolic risk was 0.0045 and 0.0024, respectively.

RESULTS

Genetically instrumented television viewing time was associated with higher risks of type 2 diabetes (odd ratio [OR]=2.51; 95% confidence interval [CI]: 1.89-3.33; p<0.00001), hypertension (OR=2.11; 95% CI: 1.67-2.66; p<0.00001), coronary heart disease (OR=1.53; 95% CI: 1.23-1.91; p=0.00015), and heart failure (OR=1.42; 95% CI: 1.18-1.70; p=0.00017). Suggestive evidence of harmful associations was also observed for peripheral artery disease (OR=1.58; 95% CI: 1.07-2.34; p=0.02253) and ischemic stroke (OR=1.34; 95% CI: 1.10-1.63; p=0.00328). Biomarkers of cardiometabolic risk, including interleukin 10, leptin, visceral adipose, abdominal subcutaneous adipose, liver fat, body mass index, waist circumference, triglycerides, and C-reactive protein, were increased. Systolic blood pressure, heart rate, low-density lipoprotein, and total cholesterol were potentially increased while high-density lipoprotein was decreased. However, television viewing time had no effect on venous thromboembolism or pulmonary embolism.

CONCLUSION

Television viewing time was causally associated with increased risks of cardiovascular diseases, which may be explained by metabolic and inflammatory mechanisms.

BACKGROUND

An overview of the effect of television viewing time on cardiovascular diseases and biomarkers of cardiometabolic risk.

Trajectory of Obesity and the Impact of Eating Behaviors on Obesity in Preschool Children: A Nationwide Population-Based Cohort Study in Korea

Background: Early childhood obesity is highly associated with obesity in adolescents and adults. However, studies on specific eating behaviors that have a decisive effect on obesity in early childhood (aged 3-5 years) are scarce. We hypothesized that critical risk factors associated with eating behaviors leading to obesity at ages of 3-5 years may be different. To confirm this hypothesis, we conducted a study on the risk factors of obesity related to eating behaviors in preschool children. Methods: Using the National Health Screening Program for Infants and Children (NHSPIC) in Korea's general population cohort, we found the obesity trends in 3-5-year-olds. The risk factors of obesity in 3-5-year-olds were analyzed through logistic regression. Results: Among children with obesity at 3 years old, but without obesity at 4 years old, only 10.1% (107/1063) transitioned to obesity at 5 years old, whereas among children with obesity at 3-4 years old, 62.7% (398/635) transitioned to obesity at 5 years old. The risk factors for obesity at 3 years old were inclusion of meat in complementary food, prolonged breastfeeding, and consumption of sweetened beverages; at ages 4-5 years, the risk factors were the inclusion of meat in complementary food and consumption of sweetened beverages. Conclusions: Obesity at 4 years is more likely to lead to obesity in the following year than obesity at 3 years. The dietary factor with the greatest impact on obesity in children aged 3-5 years has been found to be consumption of sweetened beverages.

Development, usability, and preliminary efficacy of a virtual reality experience to promote healthy lifestyle behaviors in children: pilot randomized controlled trial

Background

Virtual reality (VR) shows promise for supporting behavior change in children. This study used user-centered design to translate key tenets of behavioral health interventions into VR for children aged 6-12 years and their caregivers and examined the feasibility, acceptability, and preliminary efficacy of the VR experience in a pilot parallel, two-group randomized controlled trial (RCT).

Methods

The VR experience incorporates psychoeducational content from evidence-based behavioral health interventions using voiceover and an interactive go-kart game related to the concepts of "food as fuel" and nutrition guidelines. Study 1 involved usability testing with n=5 child-caregiver dyads, which informed technical and content refinements to the experience. Study 2 involved children aged 6-12 years with body mass index (BMI) ≥85th percentile for age and sex who were comfortable speaking English and their caregivers with BMI ≥25 kg/m2. After participants completed baseline assessments in lab on eating-related behavioral cognitions and behaviors, participants were randomly assigned to the 10-minute VR experience or a control condition (i.e., nutrition education video and mobile phone food game), and were unblinded to condition. Child and caregivers completed assessments immediately post-intervention (eating-related behavioral cognitions) and at 2-week follow-up (behaviors, caregiver readiness to change). The objectives were to evaluate the feasibility, usability, and acceptability of the VR experience, and examine the preliminary efficacy of VR compared to the control condition on the primary outcomes of child behavioral cognitions and behaviors. Non-parametric tests examined differences in change scores across conditions as well as overall and within-group changes in outcomes.

Results

Twenty-seven child-caregiver dyads (14 in VR, 13 in control) were enrolled (child mean age =10.4 years; 14 girls). Caregivers reported good usability and excellent immersion in the virtual environment. Children reported significantly greater acceptability of VR compared to control (P=0.02). Child self-efficacy for healthy eating, self-efficacy for physical activity, attitudes toward healthy eating, and behavioral intentions for healthy eating increased from pre- to post-test in both conditions. From baseline to 2-week follow-up, all children reported greater weekly vegetable servings and more active days in the past week. Children in the VR condition had greater change in attitudes towards healthy eating from pre- to post-test compared to children in the control condition [effect size r=0.44, 95% confidence interval (CI): 0.03-0.72]. Readiness to help child change significantly increased for caregivers in the VR condition from pre- to 2-week follow-up, but did not change for caregivers in the control condition. No adverse events were reported.

Conclusions

A VR program to promote healthy eating among children shows high feasibility and acceptability, and high potential for improving child and caregiver behavioral cognitions in this pilot RCT. Future work should examine the impact of repeated exposure to the experience over time, and examine long-term effects.

Trial Registration

ClinicalTrials.gov Identifier: NCT04845568.

Feasibility of a culturally adapted technology-delivered, family-based childhood obesity intervention for Latino/Hispanic families in rural Nebraska: the Hispanic Family Connections study protocol

INTRODUCTION

Addressing childhood obesity risk factors like home environment, parental roles, excess weight, physical activity and healthy eating among Latino/Hispanic (L/H) families living in rural communities is an important priority. However, evidence supporting these interventions among L/H families living in rural communities is missing. Our trial will use cultural adaptation and implementation science frameworks to evaluate the feasibility of delivering a culturally appropriate family-based childhood obesity (FBCO) programme via an automated telephone system (interactive voice response) to L/H families in rural Nebraska.

METHODS AND ANALYSIS

A mixed-methods feasibility trial for L/H families with overweight or obese children. Aim 1 will focus on collaboratively adapting and evaluating all intervention materials to fit the rural L/H community profile better, including translation of materials to Spanish, culturally relevant content and images, and use of health communication strategies to address different levels of health literacy. In aim 2, a 6-month feasibility trial with contextual evaluation will randomise 48 dyads (parent and child) to either Family Connections (FC; n=29) or a waitlist standard-care group (n=29) to determine overall study reach, preliminary effectiveness in reducing child body mass index (BMI) z-scores, potential for programme adoption, implementation and sustainability through local health departments (RE-AIM outcomes). We will also evaluate health department perceptions of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs (innovation, context, recipient characteristics) and FC participants' view of the intervention (ie, relative advantage, observability, trialability, complexity, compatibility). The study will answer three critical questions: (1) is a telephone-delivered FBCO programme in rural Nebraska culturally relevant, usable and acceptable by L/H families?; (2) is a telephone-delivered FBCO programme effective at reducing BMI z-scores in L/H children living in rural Nebraska? and (3) what real-world institutional and contextual factors influence the impact of the intervention and might affect its potential ability to sustainably engage a meaningful population of L/H families who stand to benefit?

ETHICS AND DISSEMINATION

This protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB#:0745-20-EP). Dissemination of findings will occur through ClinicalTrials.gov, in scientific forums and to the local rural communities, pilot data to inform the design of a larger clinical trial.

TRIAL REGISTRATION NUMBER

NCT04731506.

Trophoblast-specific overexpression of adiponectin receptor 2 causes fetal growth restriction in pregnant mice

Maternal obesity in pregnancy is strongly associated with complications such as fetal overgrowth and infants of obese mothers have an increased risk to develop obesity, diabetes, and cardiovascular disease later in life. However, the underlying mechanisms are not well established. Circulating levels of adiponectin are low in obese pregnant women and maternal circulating adiponectin is negatively associated with birth weight. We have reported that normalizing maternal adiponectin in obese pregnant mice prevents placental dysfunction, fetal overgrowth, and programming of offspring cardio-metabolic disease. However, the mechanistic link between maternal adiponectin, placental function, and fetal growth remains to be established. We hypothesized that trophoblast-specific overexpression of the adiponectin receptor 2 (Adipor2) in healthy pregnant mice inhibits placental mTORC1 signaling and nutrient transport, resulting in fetal growth restriction. Using lentiviral transduction of blastocysts with a mammalian gene expression lentiviral vector for up-regulation of Adipor2 (Adipor2-OX), we achieved a ~ 3-fold increase in placenta Adipor2 mRNA levels and a 2-fold increase of the ADIPOR2 protein in the trophoblast plasma membrane. Placenta-specific Adipor2-OX increased placental peroxisome proliferator-activated receptor-α phosphorylation, ceramide synthase expression and ceramide concentrations. Furthermore, Adipor2-OX inhibited placental mTORC1 signaling and reduced in vivo placental transport of glucose and amino acids. Lastly, Adipor2-OX reduced fetal weight by 11%. These data provide mechanistic evidence that placental Adipor2 signaling directly affects fetal growth. We propose that low circulating adiponectin in maternal obesity causes fetal overgrowth and programs the offspring for cardio-metabolic disease mediated by a direct effect on placental function.

Accuracy of the international growth charts to diagnose obesity according to the body composition analysis in US children and adolescents

This study verified the accuracy of the international BMI references and the allometric BMI reference to diagnose obesity in children and adolescents from the USA. Data from 17 313 subjects were obtained from the National Health and Nutrition Examination Survey between the years 1999-2006 and 2011-2018. Fat Mass Index, Allometric Fat Mass Index and fat mass/fat-free mass were calculated. Receiver operating characteristic curve, AUC, sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were estimated to evaluate the accuracy of the growth references for diagnosing obesity. The International Obesity Task Force, MULT BMI 17 years, MULT BMI 18 years and allometric BMI 19 years achieved the best sensitivity-specificity trade-off for boys, with sensitivities ranging from 0·92 to 0·96 and specificities of 0·94, with positive likelihood ratio of 15·51, 16·17, 13·46 and 18·01, respectively. The negative likelihood ratios were notably low, ranging from 0·04 to 0·08. In girls, the International Obesity Task Force, MULT BMI 17 years and MULT allometric BMI 17 years also demonstrated high sensitivity (0·95-0·97) and specificity (0·92), with positive likelihood ratio values of 11·54, 11·82 and 11·77, respectively and low negative likelihood ratio values (0·03-0·05). In summary, these international growth references presented satisfactory performance to diagnose obesity. However, the MULT growth reference performed better, and the MULT allometric BMI was the only indicator capable of detecting that girls have a higher proportion of fat mass than boys for the same index values. These findings suggest that the MULT growth reference may be a better tool to assess the nutritional status of children and adolescents internationally.

Regulation of pro-apoptotic and anti-apoptotic factors in obesity-related esophageal adenocarcinoma

BACKGROUND

Obesity is a risk factor for esophageal adenocarcinoma (EAC). It was reported that obesity -associated inflammation correlates with insulin resistance and increased risk of EAC. The objective of the study is to investigate the role of obesity associated inflammatory mediators in the development of EAC.

METHODS

We included 23 obese and nonobese patients with EAC or with or without Barrett's esophagus (BE) after IRB approval. We collected 23 normal, 10 BE, and 19 EAC tissue samples from endoscopy or esophagectomy. The samples were analyzed for the expression levels of pro-apoptotic and anti-apoptotic factors, PKC-δ, cIAP2, FLIP, IGF-1, Akt, NF-kB and Ki67 by immunofluorescence and RT-PCR. We compared the expression levels between normal, BE, and EAC tissue using Students' t-test between two groups.

RESULTS

Our results showed decreased gene and protein expression of pro-apoptotic factors (bad, bak and bax) and increased expression of anti-apoptotic factors (bcl-2, Bcl-xL) in BE and EAC compared to normal tissues. There was increased gene and protein expression of PKC-δ, cIAP2, FLIP, NF-kB, IGF-1, Akt, and Ki67 in BE and EAC samples compared to normal esophagus. Further, an increased folds changes in mRNA expression of proapoptotic factors, antiapoptotic factors, PKC-δ, IGF-1, Akt, and Ki-67 was associated with obesity.

CONCLUSION

Patients with EAC had increased expression of cIAP2 and FLIP, and PKC-δ which is associated with inhibition of apoptosis and possible progression of esophageal adenocarcinoma.