Differences in Obesity Prevalence by Demographic Characteristics and Urbanization Level Among Adults in the United States, 2013-2016

Multilevel Longitudinal Functional Principal Component Model

Sensor devices, such as accelerometers, are widely used for measuring physical activity (PA). These devices provide outputs at fine granularity (e.g., 10-100 Hz or minute-level), which while providing rich data on activity patterns, also pose computational challenges with multilevel densely sampled data, resulting in PA records that are measured continuously across multiple days and visits. On the other hand, a scalar health outcome (e.g., BMI) is usually observed only at the individual or visit level. This leads to a discrepancy in numbers of nested levels between the predictors (PA) and outcomes, raising analytic challenges. To address this issue, we proposed a multilevel longitudinal functional principal component analysis (mLFPCA) model to directly model multilevel functional PA inputs in a longitudinal study, and then implemented a longitudinal functional principal component regression (FPCR) to explore the association between PA and obesity-related health outcomes. Additionally, we conducted a comprehensive simulation study to examine the impact of imbalanced multilevel data on both mLFPCA and FPCR performance and offer guidelines for selecting optimal methods.

Adherence to dietary approaches to stop hypertension diet and visceral adipose tissue area among U.S. adults, a cross-sectional study

Excessive visceral adipose tissue (VAT) is a significant risk factor for various diseases. Diet plays a crucial role in controlling obesity. This study examined the association between the Dietary Approaches to Stop Hypertension (DASH) diet and VAT in 9027 adults using data from the National Health and Nutrition Examination Survey. Linear regression models were used to explore this association, with subgroup analyses included. Results showed a significant inverse association between DASH scores and VAT area, even after adjusting for covariates (β = -2.18, 95% CI: -3.10, -1.27). Participants in the highest DASH score tertile had significantly lower VAT areas compared to those in the lowest tertile (β = -7.2, 95% CI: -10.40, -4.01). This inverse association was most pronounced in middle-aged participants. Further prospective cohort studies are necessary to confirm these findings.

Total Knee Arthroplasty With or Without Prior Bariatric Surgery: A Systematic Review and Meta-Analysis

BACKGROUND

Studies comparing the outcomes of bariatric surgery followed by total knee arthroplasty (TKA) versus TKA alone in obese patients have disparate results. This systematic review and meta-analysis sought to compare TKA with and without prior bariatric surgery in obese patients.

METHODS

MEDLINE, PubMed, and Embase were searched from inception to April 9, 2023. There were twelve included studies that yielded 2,876,547 patients, of whom 62,818 and 2,813,729 underwent TKA with and without prior bariatric surgery, respectively. Primary outcomes were medical complications (ie, urinary tract infection, pneumonia, renal failure, respiratory failure, venous thromboembolism [VTE], arrhythmia, myocardial infarction, and stroke); surgical complications (ie, wound complications [eg, infection, hematoma, dehiscence, delayed wound healing, and seroma], periprosthetic joint infection, mechanical complications, periprosthetic fracture, knee stiffness, and failed hardware); revision, and mortality. Secondary outcomes were blood transfusion, length of stay (day), and readmission.

RESULTS

The odds ratios (OR) of 90-day VTE (OR = 0.75 [0.66, 0.85], P < .00001), 90-day stroke (OR = 0.58 [0.41, 0.81], P = .002), and 1-year periprosthetic fracture (OR = 0.74 [0.55, 0.99], P = .04) were lower in those who underwent bariatric surgery before TKA. Although the mean difference in hospital stays (-0.19 days [-0.23, -0.15], P < .00001) was statistically less in those who underwent bariatric surgery before TKA, it was not clinically relevant. The other outcomes were similar between the groups.

CONCLUSIONS

Bariatric surgery before TKA is beneficial in terms of a lower risk of VTE, stroke, and periprosthetic fracture. This analysis suggests surgeons consider discussing bariatric surgery before TKA in obese patients, especially those who are at risk of VTE and stroke.

Weight status underestimation and weight management goals among adults in the rural South of the United States

PURPOSE

To examine factors associated with weight status underestimation and the relationship between weight status underestimation and weight loss as a weight management goal among adults living in the rural South.

METHODS

An anonymous survey was distributed at six primary care clinics and two churches in rural, South Carolina counties. Weight status underestimation was determined based on the difference between perceived weight status using standard body mass index (BMI) categories (underweight, normal weight, overweight, and obese) and BMI category from self-reported height and weight. Participants reported whether their weight management goal was to lose, maintain, or gain weight. Chi-square and binary logistic regressions were used for data analysis.

FINDINGS

A total of 185 respondents (76% female) at least partially completed the survey. Nearly 60% underestimated their weight status. Increasing BMI was associated with higher odds of weight status underestimation (OR: 1.10, 95%: 1.04, 1.15) and perceptions of being in fair or poor health was associated with lower odds of weight status underestimation relative to perceiving health as good or better (OR: 0.21, 95% CI: 0.06, 0.66). Among those with overweight and obesity, the association between underestimating weight status and having weight loss as a weight management goal was strong but not statistically significant (OR: 0.20, 95% CI: 0.04, 1.04).

CONCLUSIONS

Underestimating weight status was common among adults in the rural US South and was related to BMI and health status. Research is needed to determine if improving the accuracy of weight perceptions can promote weight management in the rural South.

Addressing rural health disparities by optimizing "high-touch" intervention components in digital obesity treatment: The iREACH Rural study

BACKGROUND

Rural residents are more impacted by obesity and related comorbidities than their urban counterparts. Digital weight management interventions may produce meaningful weight loss among rural residents.

OBJECTIVES

The iREACH Rural Study aims to identify "high-touch" component(s) that contribute to meaningful weight loss (≥1.5 kg) at 6-months, over and above what the 24-week core online program produces. Three treatment components are assessed: group video sessions (yes/no); self-monitoring feedback (counselor-crafted/pre-scripted, modular); and individual coaching calls (yes/no).

DESIGN

The iREACH Rural Study is a factorial experiment (n = 616).

METHODS

Participants receive up to 3 "high-touch" components (weekly synchronous facilitated group video sessions, weekly counselor-crafted self-monitoring feedback, and individual coaching calls) to determine which contribute meaningfully to 6-month weight loss. Participants complete assessments at baseline, 2 months, 6 months, and 12 months. Weight loss at 6 months (primary outcome) and 12 months (secondary outcome) is measured by Bluetooth-enabled scales. The study seeks to identify the weight loss approach for underserved rural residents which optimizes weight change outcomes and also examines costs associated with delivering different treatment constellations.

SUMMARY

The iREACH Rural Study is the first of its kind to isolate digital weight loss intervention components to determine which meaningfully contribute to long-term weight loss among rural residing individuals. The results may be used to refine digital weight loss programs by enhancing their effectiveness to allow broad dissemination.

Arriba por la Vida Estudio: a randomized controlled trial promoting standing behavior to reduce sitting time among postmenopausal Latinas

Postmenopausal Hispanic/Latina (N = 254) women with a body mass index (BMI) ≥ 25 kg/m2 were randomized to an intervention to reduce sitting time or a comparison condition for 12 weeks. The standing intervention group received three in-person health-counseling sessions, one home visit, and up to eight motivational interviewing calls. The heart healthy lifestyle comparison group (C) received an equal number of contact hours to discuss healthy aging. The primary outcome was 12-week change in sitting time measured via thigh-worn activPAL. Group differences in outcomes were analyzed using linear mixed-effects models. Participants had a mean age of 65 (6.5) years, preferred Spanish language (89%), BMI of 32.4 (4.8) kg/m2, and sat for an average of 540 (86) minutes/day. Significant between-group differences were observed in reductions of sitting time across the 12-week period [Mdifference (SE): C - 7.5 (9.1), SI - 71.0 (9.8), p < 0.01]. Results demonstrate that coaching models to reduce sitting are feasible and effective.

Longitudinal Exposure to Neighborhood Concentrated Poverty Contributes to Differences in Adiposity in Midlife Women

Background: Neighborhood poverty is associated with adiposity in women, though longitudinal designs, annually collected residential histories, objectively collected anthropometric measures, and geographically diverse samples of midlife women remain limited. Objective: To investigate whether longitudinal exposure to neighborhood concentrated poverty is associated with differences in body mass index (BMI) and waist circumference (WC) among 2,328 midlife women (age 42-52 years at baseline) from 6 U.S. cities enrolled in the Study of Women's Health Across the Nation (SWAN) from 1996 to 2007. Methods: Residential addresses and adiposity measures were collected at approximately annual intervals from the baseline visit through a 10-year follow-up. We used census poverty data and local spatial statistics to identify hot-spots of high concentrated poverty areas and cold-spots of low concentrated poverty located within each SWAN site region, and used linear mixed-effect models to estimate percentage differences (95% confidence interval [CI]) in average BMI and WC levels between neighborhood concentrated poverty categories. Results: After adjusting for individual-level sociodemographics, health-related factors, and residential mobility, compared to residents of moderate concentrated poverty communities, women living in site-specific hot-spots of high concentrated poverty had 1.5% higher (95% CI: 0.6, 2.3) BMI and 1.3% higher (95% CI: 0.5, 2.0) WC levels, whereas women living in cold-spots of low concentrated poverty had 0.7% lower (95% CI: -1.2, -0.1) BMI and 0.3% lower (95% CI: -0.8, 0.2) WC. Site-stratified results remained in largely similar directions to overall estimates, despite wide CIs and small sample sizes. Conclusions: Longitudinal exposure to neighborhood concentrated poverty is associated with slightly higher BMI and WC among women across midlife.

Patient Perceptions of Weight Stigma Experiences in Healthcare: A Qualitative Analysis

BACKGROUND

Weight stigma is the social devaluation and denigration of individuals because of their excess body weight, resulting in poorer physical and mental health and healthcare avoidance. Attribution Theory and Goffman's theory of spoiled identity provided a general overarching framework for understanding weight stigma experiences.

OBJECTIVE

Our purpose was to explore weight stigma experiences from a broad range of perspectives emphasizing identities typically excluded in the weight stigma literature.

DESIGN

We conducted a qualitative descriptive study with data drawn from 73 substantive narrative comments from participants who responded to a larger survey.

RESULTS

Analysis developed five themes: Working on weight, Not being overweight, Lack of help and empathy, Exposure and embarrassment and Positive experiences. Individuals who would be clinically assessed as overweight, especially men, often did not identify with having a weight problem and found the framing of personal responsibility for weight empowering. Participants with larger body sizes more often attributed embarrassment and shame about weight to treatment in the clinical setting. Older participants were more likely to have positive experiences.

CONCLUSIONS

The findings suggest ongoing tension between the framing of weight as a personal responsibility as opposed to a multifactorial condition with many uncontrollable aspects. Gender, age and body size shaped respondent perspectives, with some young male respondents finding empowerment through perceived personal control of weight. The healthcare system perpetuates weight stigma through lack of adequate equipment and excessively weight-centric medical counselling. Recommending a healthy lifestyle to patients without support or personalized medical assessment may perpetuate weight stigma and associated detrimental health outcomes.

PATIENT OR PUBLIC CONTRIBUTION

Patients with obesity and overweight were integral to this study, providing comments for our qualitative analyses.

Prevalence of Cardiometabolic Risk Factors in Women: Insights From the Houston HeartReach Study

BACKGROUND

Cardiovascular disease is the leading cause of death among women in the United States. Past research has highlighted the importance of the relationship between female-specific demographics and traditional risk factors. The present analysis aimed to identify the prevalence of modifiable risk factors in women attending a community cardiovascular health screening.

METHODS

Data collected between 2011 and 2019 were obtained from the Houston HeartReach Registry. Participants were classified as having or not having each of 4 traditional cardiometabolic risk factors: hypertension, diabetes, body mass index indicating overweight or obesity, and dyslipidemia. Differences in prevalence were compared using the Pearson χ2 test.

RESULTS

Most participants had hypertension, overweight or obesity, and dyslipidemia. Older women (≥65 years) had the highest prevalence of all cardiometabolic risk factors. Black participants had a higher prevalence of hypertension (P = .006) and a lower prevalence of dyslipidemia (P = .009) than non-Black participants. Hispanic participants had a lower prevalence of hypertension (P < .001) and a higher prevalence of overweight or obesity (P = .03) than non-Hispanic participants. Participants in the lowest household income bracket (<$25,000) were more likely to have diabetes (P = .001) and overweight or obesity (P = .004) than participants in the highest income bracket (≥$50,000). Unemployed participants had a higher prevalence of diabetes (P < .001), overweight or obesity (P = .004), and dyslipidemia (P < .001) than employed participants. Comorbidity analysis revealed clustering of multiple cardiometabolic risk factors. Moreover, risk factor hot spots were identified by zip code, which could help select future sites for targeted screening.

CONCLUSION

The analysis found that cardiometabolic risk factor prevalence varies with demographic and socioeconomic status. Geographic areas where cardiometabolic risk factor prevalence was highest were also identified. Further participant recruitment and analysis are required to create predictive models of cardiovascular disease risk in women.

Environmental mixtures and body mass index in two prospective US-based cohorts of female nurses

We estimated the joint effect of particulate matter ≤ 2.5 µm in diameter (PM2.5), nitrogen dioxide (NO2), seasonal temperature, noise, greenness, light at night, and neighborhood socioeconomic status (NSES) on body mass index (BMI) in a mixture context among 194,966 participants from the Nurses' Health Study (NHS) and Nurses' Health Study II (NHSII) over 30 years. BMI was calculated from self-reported weight and height. Single- and multi-exposure generalized estimating equations models were used to estimate the difference in BMI per interquartile range (IQR) increase of environmental factors, and quantile g-computation methods were used to estimate joint associations. In both cohorts, we consistently observed positive associations of BMI with PM2.5 and NO2 concentrations as well as negative associations with light at night and NSES regardless modeling approach. A positive association with noise was only observed in NHS. Negative associations with greenness and winter temperature were only observed in NHSII. Overall, the changes in BMI per quintile increase in all eight exposures were -0.11 (-0.13, -0.08) in NHS and -0.39 (-0.41, -0.37) in NHSII, which were largely driven by air pollution and nighttime noise (18-45 %) in the positive direction and NSES (>70 %) in the negative direction. Future intervention on environmental factors, especially reducing PM2.5, NO2 and noise or improving the NSES, might be helpful to lower BMI.

Utilizing Relative Autonomy Index Scores to Evaluate the Impact of Age on Motivation to Exercise in Black Women

BACKGROUND

Black women are disproportionately affected by overweight and obesity. One theory that may have utility in increasing the amount of exercise among Black women is self-determination theory, a psychology-based theory commonly used to investigate motivation in the context of exercise. The objective of this study was to determine whether motivation towards exercise behavior differs between younger and older Black women.

METHODS

A cross-sectional study was conducted by administering a survey to Black women in the Midwestern United States to elicit factors which may impact their motivation to exercise. The survey consisted of questions to gather sociodemographic information as well as responses to the Behavioral Regulations in Exercise Questionnaire (BREQ-2). Responses on the BREQ-2 were utilized to derive the Relative Autonomy Index (RAI) which is a direct measure of self-determination that provides insight into the extent of an individual's motivation to exercise. Multiple linear regression was utilized to determine if age was predictive of relative RAI scores after adjusting for marital status and receipt of a memorable message regarding health.

RESULTS

Mean RAI scores among respondents at least 40 years old were significantly higher in comparison to the RAI among respondents younger than 40. When adjusting for marital status and receipt of a memorable message regarding health, women at least 40 had a mean RAI score approximately 4.2 points higher than those under age 40. Women at least 40 years of age also had significantly higher scores on the identified regulation and intrinsic regulation subscales of the BREQ-2 questionnaire when compared to women younger than 40 after adjusting for marital status and recalling a memorable message related to health.

CONCLUSION

These findings suggest that exercise motivations differ among age groups of Black women. Additionally, these results highlight the importance of understanding exercise motivations to further improve health outcomes.

Growth hormone-releasing hormone deficiency confers extended lifespan and metabolic resilience during high-fat feeding in mid and late life

Growth hormone-releasing hormone-deficient (GHRH-KO) mice have previously been characterized by lower body weight, disproportionately high body fat accumulation, preferential metabolism of lipids compared to carbohydrates, improved insulin sensitivity, and an extended lifespan. That these mice are long-lived and insulin-sensitive conflicts with the notion that adipose tissue accumulation drives the health detriments associated with obesity (i.e., diabetes), and indicates that GH signaling may be necessary for the development of adverse effects linked to obesity. This prompts investigation into the ultimate effect of diet-induced obesity on the lifespan of these long-lived mice. To this end, we initiated high-fat feeding in mid and late-life in GHRH-KO and wild-type (WT) mice. We carried out extensive lifespan analysis coupled with glucose/insulin tolerance testing and indirect calorimetry to gauge the metabolic effect of high-fat dietary stress through adulthood on these mice. We show that under high-fat diet (HFD) conditions, GHRH-KO mice display extended lifespans relative to WT controls. We also show that GHRH-KO mice are more insulin-sensitive and display less dramatic changes in their metabolism relative to WT mice, with GHRH-KO mice fed HFD displaying respiratory exchange ratios and glucose oxidation rates comparable to control-diet fed GHRH-KO mice, while WT mice fed HFD showed significant reductions in these parameters. Our results indicate that GH deficiency protects against the adverse effects of diet-induced obesity in later life.

How rural is All of Us? Comparing characteristics of rural participants in the National Institute of Health's All of Us Research Program to other national data sources

PURPOSE

The National Institute of Health's All of Us Research Program represents a national effort to develop a database to advance health research, especially among individuals historically underrepresented in research, including rural populations. The purpose of this study was to describe the rural populations identified in the All of Us Research Program using the only proxy measure currently available in the dataset.

METHODS

Currently, the All of Us Research Program provides a proxy measure of rurality that identifies participants who self-reported delaying care due to far travel distances associated with living in rural areas. Using the All of Us Controlled Tier Dataset v6, we compared sociodemographic and health characteristics of All of Us rural participants identified via this proxy to rural US residents from nationally representative data sources using chi-squared tests.

RESULTS

3.1% of 160,880 All of Us participants were rural, compared to 15%-20% of US residents based on commonly accepted rural definitions. Proportionally more rural All of Us participants reported fair or poor health status, history of cancer, and history of heart disease (P<.01).

CONCLUSIONS

The All of Us measure may capture a subset of underserved participants who live in rural areas and experience health care access barriers due to distance. Researchers who use this proxy measure to characterize rurality should interpret their findings with caution due to differences in population and health characteristics using this proxy measure rural compared to other commonly used rural definitions.

Social and Structural Determinants of Health and Social Injustices Contributing to Obesity Disparities

PURPOSE OF REVIEW: To analyze how social and structural determinants of health and social injustice impact the risk of obesity, its treatment and treatment outcomes, and to explore the implications for prevention and future treatment interventions. RECENT FINDINGS: Racial and ethnic minorities, such as non-Hispanic Black adults and Hispanic adults, and adults with a low socioeconomic status have a greater risk of obesity than non-Hispanic white adults and adults with a high socioeconomic status. The underlying causes of obesity disparities include obesogenic neighborhood environments, inequities in access to obesity treatment, and lack of access to affordable nutrient-dense foods. Experts have called for interventions that address the social and structural determinants of obesity disparities. Population-based interventions that focus on improving neighborhood conditions, discouraging the consumption of unhealthy foods and beverages, expanding access to obesity treatment, and ensuring equitable access to fruits and vegetables have been proven to be effective. There is a growing body of evidence that shows the relationship between social and structural determinants of health and injustice on disparities in obesity among racial and ethnic minorities and individuals with a low SES. Population-based, equity-focused interventions that address the underlying causes of obesity disparities are needed to reduce obesity disparities and improve the health outcomes of minoritized and marginalized groups.

Associations of Longitudinal BMI-Percentile Classification Patterns in Early Childhood with Neighborhood-Level Social Determinants of Health

Background: Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable. Methods: We extracted electronic health record data from 2012 to 2019 for a children's health system that includes two hospitals and wide network of outpatient clinics spanning five East Coast states in the United States. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately. Results: From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n = 429; 1.16%), overweight most of the time (n = 15,006; 40.65%), increasing BMI percentile (n = 9,060; 24.54%), decreasing BMI percentile (n = 5,058; 13.70%), and always normal weight (n = 7,357; 19.89%). Compared to children in the decreasing BMI percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment. Conclusions: Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.

Prevalence of childhood obesity in Spain and its relation with socioeconomic status and health behaviors: Population-based cross-sectional study

OBJECTIVES

This study aims to assess the current state of childhood overweight and obesity in Spain, and its relationship with socioeconomic status and health-related behaviors.

METHODS

Population-based cross-sectional observational study, based on the 2017 National Health Survey in minors in Spain. This study included all children surveyed who were aged 1-14 years. Childhood obesity was estimated from the z-score of the body mass index.

RESULTS

The study included 4882 children aged 1-14 years (mean 7.5). The prevalence of obesity was 18.6% (95% confidence interval [CI] 18.5-18.7), while 13.5% (95% CI 13.4-13.6) were overweight. These figures represent over a million children in Spain who are obese and nearly 750,000 who are overweight. A north-south geographic gradient was apparent, with higher prevalence of unhealthy body weight in southern Spain. Factors associated with childhood obesity were low socioeconomic status, poor diet and sedentarism, among others.

CONCLUSIONS

Childhood overweight in Spain is strongly associated with socioeconomic status and other factors such as diet and sedentarism. Multidisciplinary public health interventions are needed to reduce this serious health problem in children.

Common Non-Rheumatic Medical Conditions Mimicking Fibromyalgia: A Simple Framework for Differential Diagnosis

Fibromyalgia (FM) is a chronic non-inflammatory disorder mainly characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and a constellation of other symptoms. For this reason, delineating a clear distinction between pure FM and FM-like picture attributable to other common diseases can be extremely challenging. Physicians must identify the most significant confounders in individual patients and implement an appropriate diagnostic workflow, carefully choosing a minimal (but sufficient) set of tests to be used for identifying the most plausible diseases in the specific case. This article discusses prevalent non-rheumatological conditions commonly observed in the general population that can manifest with clinical features similar to primary FM. Given their frequent inclusion in the differential diagnosis of FM patients, the focus will be on elucidating the distinctive clinical characteristics of each condition. Additionally, the most cost-effective and efficient diagnostic methodologies for accurately discerning these conditions will be examined.

Perceptions of an acceptance-based weight management treatment among adults living in rural areas

Obesity and obesity-related comorbidities disproportionately affect rural communities. Research has emerged in support of a novel acceptance-based behavioural weight management treatment (ABT) that integrates the principles and procedures of acceptance-commitment therapy (ACT) with traditional components of standard behavioural treatment (SBT). The current study assessed the perceptions of community stakeholders in rural areas to session materials of a commercially available ABT program. Surveys and focus groups were used to solicit feedback from three former interventionists with experience delivering SBTs in rural counties and from 17 former participants in these programs. Qualitative responses encompassed four overarching themes: (1) recommendations to support participant engagement, (2) comments about preferences for specific ABT and SBT strategies, (3) concerns about specific aspects of treatment delivery, and (4) requests for aesthetic changes to session materials to enhance clarity and engagement. Overall, participants viewed ABT materials and concepts favourably but believed it would be important to begin the intervention with rapport building and training in traditional SBT strategies prior to delving into ACT strategies. Future studies should investigate the efficacy of ABT for weight loss in adults with obesity living in rural communities and continue to solicit feedback from rural community stakeholders.

Associations of longitudinal BMI percentile classification patterns in early childhood with neighborhood-level social determinants of health

Background

Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable.

Methods

We extracted EHR data from 2012-2019 for a children's health system that includes 2 hospitals and wide network of outpatient clinics spanning 5 East Coast states in the US. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately.

Results

From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n=429; 1.16%), overweight most of the time (n=15,006; 40.65%), increasing BMI-percentile (n=9,060; 24.54%), decreasing BMI-percentile (n=5,058; 13.70%), and always normal weight (n=7,357; 19.89%). Compared to children in the decreasing BMI-percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment.

Conclusions

Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.

Impact Statement

This study demonstrates the association between longitudinal BMI-percentile patterns and SDOH in early childhood. Five distinct clusters with different BMI-percentile trajectories are found and a strong association between these clusters and SDOH is observed. Our findings highlight the importance of targeted prevention and treatment interventions based on children's SDOH.

Spatial analysis of the prevalence of abdominal obesity in middle-aged and older adult people in China: exploring the relationship with meteorological factors based on gender differences

Background

In recent years, the incidence of abdominal obesity among the middle-aged and older adult population in China has significantly increased. However, the gender disparities in the spatial distribution of abdominal obesity incidence and its relationship with meteorological factors among this demographic in China remain unclear. This gap in knowledge highlights the need for further research to understand these dynamics and inform targeted public health strategies.

Methods

This study utilized data from the 2015 China Health and Retirement Longitudinal Study (CHARLS) to analyze the incidence of abdominal obesity among the middle-aged and older adult population in China. Additionally, meteorological data were collected from the National Meteorological Information Center. Using Moran's I index and Getis-Ord Gi* statistical methods, the spatial distribution characteristics of abdominal obesity incidence were examined. The influence of various meteorological factors on the incidence of abdominal obesity in middle-aged and older adult males and females was investigated using the q statistic from the Geodetector method. Furthermore, Multi-Scale Geographically Weighted Regression (MGWR) analysis was employed to explore the impact of meteorological factors on the spatial heterogeneity of abdominal obesity incidence from a gender perspective.

Results

The spatial distribution of abdominal obesity among middle-aged and older adult individuals in China exhibits a decreasing trend from northwest to southeast, with notable spatial autocorrelation. Hotspots are concentrated in North and Northeast China, while cold spots are observed in Southwest China. Gender differences have minimal impact on spatial clustering characteristics. Meteorological factors, including temperature, sunlight, precipitation, wind speed, humidity, and atmospheric pressure, influence incidence rates. Notably, temperature and sunlight exert a greater impact on females, while wind speed has a reduced effect. Interactions among various meteorological factors generally demonstrate bivariate enhancement without significant gender disparities. However, gender disparities are evident in the influence of specific meteorological variables such as annual maximum, average, and minimum temperatures, as well as sunlight duration and precipitation, on the spatial heterogeneity of abdominal obesity incidence.

Conclusion

Meteorological factors show a significant association with abdominal obesity prevalence in middle-aged and older adults, with temperature factors playing a prominent role. However, this relationship is influenced by gender differences and spatial heterogeneity. These findings suggest that effective public health policies should be not only gender-sensitive but also locally adapted.

Planning healthy food environments: An analysis of local government municipal public health and wellbeing policy in regional Victoria

ISSUE ADDRESSED

While there has been an increased focus on how local governments can support the creation of healthy food environments through healthy public policy, little is known about how this is reflected in public health policy in regional areas. The aim of this study was to understand how improvements to the food environment are prioritised, implemented and evaluated by local governments in regional Victoria.

METHODS

Using a qualitative descriptive approach, content analysis was undertaken of Municipal Public Health and Wellbeing Plans and Council Plans from 10 regional local governments in Victoria, Australia.

RESULTS

Seventeen policy documents were analysed including 10 Council Plans, 6 Municipal Public Health and Wellbeing Plans and 1 Food Systems Strategy. Findings highlight regional public health and wellbeing plans have very few concrete actions in place to improve food environments.

CONCLUSION

There is an opportunity for Australian regional local governments to include in their public health and wellbeing plans a greater emphasis on supporting healthy food behaviours, and therefore seeking opportunities to improve food environments through clearly aligned priorities, objectives, actions and measures of success. SO WHAT?: Improving the quality of public health and wellbeing plans can support local government to use policy to drive improvements in food environments leading to improved health and wellbeing for regional communities.

Using Plan, Do, Study, Act Cycles to Improve a Maternal Self-Care Intervention With Audience Input

Maternal self-care, including healthy eating, physical activity, and stress management behaviors, is influenced by environmental, social, and individual factors. Plan-Do-Study-Act (PDSA) Cycling is an effective quality improvement process using rapid cycling to refine interventions to fit audience-specific contexts and to address socioecological influences on behavior change. To refine components of the Healthy EnviROnmentS Self-Care intervention, a mindful self-care program for mothers of preschool-aged children in rural communities, PDSA cycles were used to examine: (A) acceptability of content, (B) suitability of implementation strategies, and (C) feasibility of digital supports across three stages of program development. Stage 1 included a group discussion with an expert panel (n = 8). Stage 2 used brief interviews and group discussion with a convenience sample (n = 5). Stage 3 included in-depth interviews with the focal population (n = 6). In-depth interviews were transcribed and analyzed using a directed approach, and data were compiled from group discussion notes and assessed for congruence and analyzed for emergent themes. PDSA cycles relating to content led to the addition of activities to introduce mindfulness and foster social support and the revision of handouts. Implementation strategies were refined with respect to workshop duration, activity order, and meeting type. Digital supports resulted in refinement to the study website and tablet applications. Utilization of PDSA cycles allowed for input from the focus population at every point of intervention design and considered socioecological factors that can influence behavior change.

Training Promotoras to Implement a Mindfulness-Based Healthy Lifestyle Program in Rural Communities

Partnering with promotoras to implement a healthy lifestyle intervention has proven efficacious in reaching community members whom they serve. However, there are no clearly defined guidelines for implementing promotora training, especially when it involves developing mindfulness skills in promotoras unfamiliar with this concept. This is a report about the facilitators and barriers to training promotoras to implement a mindfulness-enhanced healthy eating and physical activity intervention, ADAPT+, using the Train-the-Trainer model. Following this model, we laid the foundations for sustained implementation of ADAPT+ even after the training process. Future studies may examine how these guidelines help map promotora training in other mindfulness-related interventions.

Advanced microbiome therapeutics as a novel modality for oral delivery of peptides to manage metabolic diseases

The rising prevalence of metabolic diseases calls for innovative treatments. Peptide-based drugs have transformed the management of conditions such as obesity and type 2 diabetes. Yet, challenges persist in oral delivery of these peptides. This review explores the potential of 'advanced microbiome therapeutics' (AMTs), which involve engineered microbes for delivery of peptides in situ, thereby enhancing their bioavailability. Preclinical work on AMTs has shown promise in treating animal models of metabolic diseases, including obesity, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease. Outstanding challenges toward realizing the potential of AMTs involve improving peptide expression, ensuring predictable colonization control, enhancing stability, and managing safety and biocontainment concerns. Still, AMTs have potential for revolutionizing the treatment of metabolic diseases, potentially offering dynamic and personalized novel therapeutic approaches.

Optimization of Naringenin-loaded nanoparticles for targeting of Vanin-1, iNOS, and MCP-1 signaling pathway in HFD-induced obesity

Naringenin, a natural dihydrochalcone flavonoid, exhibits diverse pharmacological properties. This study investigates the hypolipidemic effects of Nar-NPs on obese mice. The characteristics of Nar-NPs, including morphology, particle size, zeta potential, UV-vis, and FT-IR spectra, were examined. The anti-obesity properties of Nar-NPs were evaluated in obese rats, considering LD50, 1/20 LD50, and 1/50 LD50 for treatment preparation. Results indicated that synthesized Nar-NPs were uniform, spherical, and well-dispersed, with a size of 130.06 ± 1.98 nm and with a zeta potential of -25.6 ± 0.8 mV. Nar-NPs exhibited enhancement in the cumulative release of naringenin (56.87 ± 2.45 %) as compared to pure naringenin suspension 87.83 ± 1.84 % in 24 h of the study. The LD50 of Nar-NPs was determined as 412.5 mg/kg.b.w. HFD induced elevated glycemic, oxidative stress, and inflammatory biomarkers while reducing HDL-C, GSH, and superoxide dismutase (SOD) levels. Administration of Nar-NPs significantly mitigated body weight, glucose, insulin, leptin, TC, TG, SREBP1c, pAMPK, PPAR-α, as well as vanin-1, MCP-1, and iNOS mRNA gene expression. Histological investigations supported the biochemical and PCR findings. In a nutshell, the study suggests that the Nar-NPs could serve as a promising and viable pharmacological strategy for the treatment of obesity-related disorders.

Childhood Adversity and Adolescent Smartphone Use Across Sexual Orientation and Gender Expression

Importance

Nonheterosexual and gender-nonconforming (GNC) individuals tend to report adverse childhood experiences (ACEs) more frequently compared with heterosexual and gender-conforming individuals, and individuals who have experienced ACEs, identify as nonheterosexual, or exhibit moderate to high levels of GNC are more prone to engaging in problematic smartphone use (PSU). However, there is limited school-based data among adolescents regarding this matter.

Objectives

To explore the associations between ACEs and PSU among adolescents across different sexual orientation and gender expression groups.

Design, setting, and participants

Using data from the 2021 School-Based Chinese Adolescents Health Survey, this cross-sectional study includes participants from 288 public high schools across 8 provinces in China. Statistical analysis was performed from October 2023 to February 2024.

Exposures

Data on ACEs, sexual orientations, and gender expressions (high, moderate, and low GNC) were collected.

Main outcomes and measures

PSU was assessed using the 10-item Smartphone Addiction Scale-Short Version (SAS-SV). Weighted linear, logistic, or Poisson regression models were used.

Results

Among the 85 064 adolescents included (mean [SD] age, 14.92 [1.77] years), 42 632 (50.1%) were female, 70 157 (83.2%) identified as Han Chinese, and 14 208 (16.8) identified as other ethnicities (Miao, Hui, Yi, Dai, and other ethnic groups). The prevalence of PSU among participants was 35.4%. Weighted Poisson regression models indicated that the interaction between GNC and ACE was significant (adjusted prevalence ratio [APR], 0.98; 95% CI, 0.97-0.99). Further stratified analysis demonstrated homosexual adolescents who experienced 4 or more ACEs showed a significantly increased prevalence of PSU (APR, 1.79; 95% CI, 1.64-1.96). Similarly, a markedly higher prevalence of PSU was observed among bisexual individuals with 4 or more ACEs (APR, 1.60; 95% CI, 1.41-1.80). Regarding gender expression categories, a significantly higher prevalence of PSU was noted among high GNC adolescents with 4 or more ACEs (APR, 1.78; 95% CI, 1.60-1.98) compared with low GNC adolescents without ACEs. Furthermore, experiencing any 3 ACE categories (abuse, neglect, and household dysfunction) was associated with an increased prevalence of PSU across different sexual orientation and gender expression subgroups.

Conclusions and relevance

In this cross-sectional study, the amalgamation of elevated ACE scores with nonheterosexual orientations or GNC identities was significantly associated with increased PSU prevalence. These findings underscore that preventing ACEs may be beneficial in mitigating PSU among adolescents, particularly for nonheterosexual adolescents and those with high levels of GNC.

High-fat diets promote peritoneal inflammation and augment endometriosis-associated abdominal hyperalgesia

Immune dysfunction is one of the central components in the development and progression of endometriosis by establishing a chronic inflammatory environment. Western-style high-fat diets (HFD) have been linked to greater systemic inflammation to cause metabolic and chronic inflammatory diseases, and are also considered an environmental risk factor for gynecologic diseases. Here, we aimed to examine how HFD cause an inflammatory environment in endometriosis and discern their contribution to endometriotic-associated hyperalgesia. Our results showed that HFD-induced obesity enhanced abdominal hyperalgesia that was induced by endometriotic lesions. Peritoneal inflammatory macrophages and cytokine levels increased by lesion induction were elevated by chronic exposure to HFD. Increased expression of pain-related mediators in the dorsal root ganglia was observed after lesion induction under the HFD condition. Although HFD did not affect inflammatory macrophages in the peritoneal cavity without lesion induction, the diversity and composition of the gut microbiota were clearly altered by HFD as a sign of low-grade systemic inflammation. Thus, HFD alone might not establish a local inflammatory environment in the pelvic cavity, but it can contribute to further enhancing chronic inflammation, leading to the exacerbation of endometriosis-associated abdominal hyperalgesia following the establishment and progression of the disease.

The coupling coordination characteristics of China's health production efficiency and new urbanization and its influencing factors

Urbanization leads to dramatic changes in habitat quality, which significantly affects population health. Research on the coupling coordination relationship between new urbanization and health production efficiency is conducive to improving residents' well-being and urban sustainable development. In this article, we adopted the super-efficient SBM model and entropy value method separately to evaluate the spatiotemporal variation characteristics of health production efficiency and new urbanization in China. Then, we used the coupling coordination degree model to investigate the interactive coercing relationship between new urbanization and health production efficiency. Finally, the panel Tobit model is used to analyze the factors influencing the coupled coordination of the two systems. The results showed that the new urbanization levels of 31 provinces in China have all steadily increased from 2003 to 2018. Health production efficiency exhibited a fluctuating but increasing trend, and its regional differences are gradually narrowing. Health production efficiency and new urbanization have developed in a more coordinated direction, with a spatial pattern of "high in the southeast and low in the northwest." Meanwhile, the relative development characteristics between the two systems have constantly changed, from the new urbanization lagged type to the two systems synchronized type and the health production efficiency lagged type. Population density, economic development level, government financial investment, and government health investment positively impact the coupling coordination degree of the two systems. In comparison, individual health investment harms the harmonization of the two systems.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

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

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

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

CONCLUSIONS

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

Differences in Intakes of Select Nutrients by Urbanization Level in the United States Population 2 Years and Older, NHANES 2013-2018

BACKGROUND

Differences in nutrient intakes by urbanization level in the Unites States is not well understood.

OBJECTIVE

Describe, by urbanization level: 1) intake of protein, fiber, percent of energy from added sugars (AS) and saturated fat (SF), calcium, iron, potassium, sodium, and vitamin D; 2) the percent of the population meeting nutrient recommendations.

METHODS

Twenty-four-hour dietary recalls from 23,107 participants aged 2 y and over from the 2013-2018 National Health and Nutrition Examination Surveys were analyzed. Usual intakes were estimated, and linear regression models adjusted for age, sex, race and Hispanic origin, and whether family income met the 130% threshold examined intake differences by urbanization levels-large urban areas (LUA), small to medium metro areas (SMMA), and rural areas (RA).

RESULTS

A small percentage of the population met the nutrient recommendations, except for protein (92.8%) and iron (70.5%). A higher percentage of the population met recommendations than SMMA and RA for fiber (11.8% compared with 8.1% and 5.3%, P < 0.001), AS (40.2% compared with 33.4% and 31.3%, P < 0.001), SF (26.8% compared with 18.2% and 20.1%, P < 0.001), and potassium (31.5% compared with 25.5% and 22.0%, P < 0.001). Mean protein intake were also higher in LUA than RA (80.0 g compared with 77.7 g, P = 0.003) and fiber intake higher in LUA than SMMA (16.5 g compared with 15.9 g, P = 0.01) and RA (16.5 g compared with 15.2 g, P = 0.001). In addition, contributions to energy intake were lower in LUA than SMMA for AS (11.3% compared with 12.0%, P < 0.001) and SF (11.5% compared with 11.7%, P < 0.001), and for LUA than RA for AS (11.3% compared with 12.9%, P < 0.001) and SF (11.5% compared with 11.8%, P < 0.001).

CONCLUSIONS

RA had some markers of poorer diet quality-lower protein and fiber intake and higher AS intake-compared with LUA, and these differences persisted in adjusted regression models. These results may inform public health efforts to address health disparities by urbanization levels in the Unites States.

Roux-en-Y Gastric Bypass vs Vertical Sleeve Gastrectomy in the Remission of Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

<b><br>Introduction:</b> Obesity's associated comorbidities and treatment costs have risen significantly, highlighting the importance of early weight loss strategies. Bariatric surgeries like Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) have been effective in promoting weight loss and improving type 2 diabetes mellitus (T2DM) management.</br> <b><br>Aim:</b> The aim was to determine whether Roux-en-Y gastric bypass is more effective than vertical sleeve gastrectomy in the remission of type 2 diabetes mellitus (T2DM).</br> <b><br>Methods:</b> A systematic review and meta-analysis was performed. A literature search was performed in the databases Web of Science, Medline/PubMed, Embase, Scopus, and Medline/Ovid. A total of 1323 results were identified; after screening, 14 articles were selected and included in the systematic review. Primary and secondary outcomes were measured by RR with a 95% CI.</br> <b><br>Results:</b> The primary outcome of T2DM remission was 15% in favor of VSG (RR: 1.15, [95% CI: 1.04-1.28]). For secondary outcomes, hypertension remission was 7% in favor of VSG (RR: 1.07, [95% CI: 1.00-1.16]). Remission of dyslipidemia was 16% in favor of VSG (RR: 1.16, [95% CI: 1.06-1.26]). BMI after surgery was in favor of RYGB (MD: -1.31, [95% CI: -1.98 to -0.64]). For weight loss, the results favored VSG (MD: 6.50, [95% CI: 4.99-8.01]). In relation to total cholesterol, they were 65% favorable for RYGB (MD: -0.35, [95% CI: -0.46 to -0.24]), with a value of p <0.05. For LDL values, our results were 69% favorable for RYGB (MD: -0.31, [95% CI: -0.45 to -0.16]), p <0.01 value.</br> <b><br>Conclusions:</b> Laparoscopic sleeve gastrectomy is more effective in T2DM remission, hypertension remission, dyslipidemia remission, and weight loss compared to Roux-en-Y gastric bypass. Roux-en-Y gastric bypass is more effective at lowering BMI, total cholesterol, LDL, and TG compared to laparoscopic sleeve gastrectomy.</br>.

United States Long-Term Trends in Adult BMI (1959-2018): Unraveling the Roots of the Obesity Epidemic

The escalating rates of obesity since the 1950s poses a critical public health challenge across all age groups in the United States. While numerous studies have examined cross-sectional disparities across racial, ethnic, and socioeconomic groups, there has been limited research on long-term trends. To address this gap, we analyzed average adult body mass index (BMI) trends from 1959 to 2018, using data from the National Health and Nutrition Examination Survey (NHANES) and the National Health Examination Survey (NHES). Employing time series analysis, we evaluated BMI trends across income, education, and race/ethnicity. The results revealed a consistent upward trajectory in average BMI across all groups over the six-decade period, with no significant differences by income or education levels among high school graduates. However, individuals with less than a high school education displayed a more gradual increase in BMI. Racial disparities were also evident, with Black adults showing higher BMI growth rates compared to White adults, while Hispanic and other racial groups experienced slower increases. These findings underscore the need for systemic interventions to address the ongoing obesity epidemic, emphasizing the importance of research to identify trends over time and a system-thinking approach to inform effective population-level interventions and policy decisions.

Characterizing alterations in the gut microbiota following postpartum weight change

IMPORTANCE

Previous research has reported differences in the gut microbiome associated with varying body compositions. More specifically, within populations of mothers, the focus has been on the impact of gestational weight gain. This is the first study to examine postpartum weight change and its association with changes in the gut microbiome, similarly, it is the first to use a Latina cohort to do so. The results support the idea that weight gain may be an important factor in reducing gut microbiome network connectivity, diversity, and changing abundances of specific microbial taxa, all measures thought to impact host health. These results suggest that weight gain dynamically alters mothers' gut microbial communities in the first 6 months postpartum, with comparatively little change in mothers who lost weight; further research is needed to examine the health consequences of such changes.

Effects of Episodic Food Insecurity on Psychological and Physiological Responses in African American Women With Obesity (RESPONSES): Protocol for a Longitudinal Observational Cohort Study

BACKGROUND

Food insecurity is a risk factor for multiple chronic diseases, including obesity. Importantly, both food insecurity and obesity are more prevalent in African American women than in other groups. Furthermore, food insecurity is considered a cyclic phenomenon, with episodes of food adequacy (ie, enough food to eat) and food shortage (ie, not enough food to eat). More research is needed to better understand why food insecurity is linked to obesity, including acknowledging the episodic nature of food insecurity as a stressor and identifying underlying mechanisms.

OBJECTIVE

The objective of this study is to investigate the episodic nature of food insecurity as a stressor via responses in body weight and psychological and physiological parameters longitudinally and do so in a health-disparate population-African American women.

METHODS

We enrolled 60 African American women (food-insecure cohort: n=30, 50%; food-secure cohort: n=30, 50%) aged 18-65 years with obesity (BMI 30-50 kg/m2) to measure (1) daily body weight remotely over 22 weeks and (2) psychological and physiological parameters via clinic assessments at the beginning and end of the 22-week study. Furthermore, we are assessing episodes of food insecurity, stress, hedonic eating, and appetite on a weekly basis. We hypothesize that food-insecure African American women with obesity will demonstrate increased body weight and changes in psychological and physiological end points, whereas food-secure African American women with obesity will not. We are also examining associations between changes in psychological and physiological parameters and changes in body weight and performing a mediation analysis on the psychological parameters assessed at the study midpoint. Psychological questionnaires are used to assess stress; executive function, decision-making, and motivation; and affect and nonhomeostatic eating. Physiological measurements are used to evaluate the levels of cortisol, dehydroepiandrosterone-sulfate (DHEA-S), C-reactive protein, thyroid hormones, blood glucose, glycated hemoglobin, and insulin, as well as allostatic load.

RESULTS

This study has completed participant recruitment (n=60). At the time of study enrollment, the mean age of the participants was almost 47 (SD 10.8) years, and they had a mean BMI of 39.6 (SD 5.31) kg/m2. All data are anticipated to be collected by the end of 2023.

CONCLUSIONS

We believe that this is the first study to examine changes in body weight and psychological and physiological factors in food-insecure African American women with obesity. This study has significant public health implications because it addresses the cyclic nature of food insecurity to identify underlying mechanisms that can be targeted to mitigate the adverse relationship between food insecurity and obesity and reduce health disparities in minority populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05076487; https://clinicaltrials.gov/study/NCT05076487.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52193.

Nutraceutical Properties of Syringic Acid in Civilization Diseases-Review

Civilization diseases account for a worldwide health issue. They result from daily behavioral, environmental, and genetic factors. One of the most significant opportunities to prevent and alleviate the occurrence of these diseases is a diet rich in antioxidants like polyphenols. This review paper is concentrated on syringic acid (SA), one of the representative compounds of phenolic acids subgroups. There are many in vitro and in vivo studies on SA that assess its pivotal effects on oxidative stress and inflammation parameters. It is effective on metabolic risk factors as well, including hyperglycemia, high blood pressure, and hyperlipidemia. SA is one of the prominent polyphenolic compounds that may help address health issues related to civilization diseases.

Association of body mass index with the development of metabolic acidosis in patients with chronic kidney disease

Aims

Higher body mass index (BMI) is associated with higher bone mass and bone serves as a buffer during the development of metabolic acidosis. The authors sought to examine the relationship between BMI and metabolic acidosis in patients with chronic kidney disease (CKD).

Materials and Methods

The study utilized a large US longitudinal data repository including over 103 million patients from healthcare provider organizations to evaluate the relationship between the exposure variable (BMI) and the prevalence and incidence of metabolic acidosis among patients with estimated glomerular filtration rate <60 ml/min/1.73 m2. Incident metabolic acidosis was identified at the first of two consecutive post-index serum bicarbonate values, 10-365 days apart, between 12 and <22 mEq/L in patients with normal index serum bicarbonate. Cox proportional hazard models were adjusted for multiple variables including demographics, comorbidities, income, education, and kidney function.

Results

103,766 patients qualified for this study; 6472 (6.2%) had metabolic acidosis at index. An inverse association between BMI category and metabolic acidosis was observed for both baseline (prevalence) and new-onset (incidence) metabolic acidosis. Compared to BMI category of 18.5 to <25 kg/m2, each category of incrementally higher BMI was associated with a decreasing risk of incident metabolic acidosis; the adjusted hazard ratios (95% confidence interval) were 0.866 (0.824-0.911), 0.770 (0.729-0.813), 0.664 (0.622-0.709), and 0.612 (0.571-0.655) for BMI 25 to <30, 30 to <35, 35 to <40, and 40+ kg/m2, respectively.

Conclusions

Among patients with CKD, an incremental increase in BMI was inversely associated with both the prevalence and incidence of metabolic acidosis. These associations suggest that increased body weight may protect against the development of metabolic acidosis, a risk factor for progressive loss of kidney function.

Differences in obesity-related health behaviors and health outcomes by rural and Appalachian residency

PURPOSE

Obesity and health behaviors are the major modifiable contributors to cancer and health disparities. We examined the differences in obesity-related health behaviors, and health outcomes by rural and Appalachian residency in Ohio.

METHODS

Cross-sectional survey data from the 2011-2019 Behavioral Risk Factor Surveillance System were obtained from the Ohio Department of Health. County-level identifiers were used to classify urban non-Appalachian, urban Appalachian, rural non-Appalachian, and rural Appalachian residency. Self-reported weight, height, health behaviors, and health conditions were used. Logistic regression was used to assess the difference in health behaviors and health outcomes by rural and Appalachian residency. All analyses incorporated with sample weights.

RESULTS

Among Ohio residents, compared to urban non-Appalachian residents, urban Appalachian and rural Appalachian residents had a higher prevalence of obesity, hypertension, high cholesterol, and cardiovascular diseases, as well as lower rates of healthy diet and physical activity. No difference was found in trends of obesity and obesity-related health outcomes in 2011-2019 by rural and Appalachian residency. However, rural Appalachian residents had a greater increase in obesity, hypertension, and diabetes, whereas rural non-Appalachian had favorable changes in obesity-related health behaviors. Additionally, associations between health behaviors and obesity-related health outcomes differed by rural and Appalachian residency.

CONCLUSIONS

Findings underscore the importance of distinguishing between urban non-Appalachian, urban Appalachian, rural non-Appalachian, and rural Appalachian populations when assessing health disparities. While the trends of obesity and obesity-related health outcomes did not differ, the association between health behaviors and obesity-related outcomes differed by rural and Appalachian residency.

High-fat diets promote peritoneal inflammation and augment endometriosis-associated abdominal hyperalgesia

Immune dysfunction is one of the central components in the development and progression of endometriosis by establishing a chronic inflammatory environment. Western-style high-fat diets (HFD) have been linked to greater systemic inflammation to cause metabolic and chronic inflammatory diseases, and are also considered an environmental risk factor for gynecologic diseases. Here, we aimed to examine how HFD alter an inflammatory environment in endometriosis and discern their contribution to endometriotic-associated hyperalgesia. Our results showed that HFD-induced obesity enhanced abdominal mechanical allodynia that was induced by endometriotic lesions. Peritoneal inflammatory macrophages and cytokine levels increased by lesion induction were elevated by chronic exposure to HFD. Pain-related mediators in the dorsal root ganglia were further stimulated after lesion induction under the HFD condition. Although HFD did not affect inflammatory macrophages in the peritoneal cavity without lesion induction, the diversity and composition of the gut microbiota were clearly altered by HFD as a sign of low-grade systemic inflammation. Thus, HFD alone might not establish a local inflammatory environment in the pelvic cavity, but it can contribute to further enhancing chronic inflammation, leading to the exacerbation of endometriosis-associated abdominal hyperalgesia following the establishment and progression of the disease.

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

Association between racial residential segregation and walkability in 745 U.S. cities

Despite higher chronic disease prevalence, minoritized populations live in highly walkable neighborhoods in US cities more frequently than non-minoritized populations. We investigated whether city-level racial residential segregation (RRS) was associated with city-level walkability, stratified by population density, possibly explaining this counterintuitive association. RRS for Black-White and Latino-White segregation in large US cities was calculated using the Index of Dissimilarity (ID), and walkability was measured using WalkScore. Median walkability increased across increasing quartiles of population density, as expected. Higher ID was associated with higher walkability; associations varied in strength across strata of population density. RRS undergirds the observed association between walkability and minoritized populations, especially in higher population density cities.

Lifestyle interventions in nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a dynamic chronic liver disease that develops in close association with metabolic irregularities. Between 2016 and 2019, the global prevalence among adults was reported as 38% and among children and adolescents it was about 10%. NAFLD can be progressive and is associated with increased mortality from cardiovascular disease, extrahepatic cancers and liver complications. Despite these numerous adverse outcomes, no pharmacological treatments currently exist to treat nonalcoholic steatohepatitis, the progressive form of NAFLD. Therefore, the main treatment is the pursuit of a healthy lifestyle for both children and adults, which includes a diet rich in fruits, nuts, seeds, whole grains, fish and chicken and avoiding overconsumption of ultra-processed food, red meat, sugar-sweetened beverages and foods cooked at high heat. Physical activity at a level where one can talk but not sing is also recommended, including leisure-time activities and structured exercise. Avoidance of smoking and alcohol is also recommended. Policy-makers, community and school leaders need to work together to make their environments healthy by developing walkable and safe spaces with food stores stocked with culturally appropriate and healthy food items at affordable prices as well as providing age-appropriate and safe play areas in both schools and neighbourhoods.

Trends in Maternal Weight Disparities: Statewide Differences in Rural and Urban Minnesota Residents From 2012 to 2019

INTRODUCTION

Despite research showing substantial weight disparities along the rural-urban continuum, little work has attempted to identify differences in prepregnancy weight status or gestational weight gain (GWG) outcomes between rural and urban birthing people. As such, the goals of this research were to 1) document the prevalence of prepregnancy overweight and obesity and excessive GWG in rural and urban birthing people and 2) examine changes in rural and urban prepregnancy overweight or obesity and excessive GWG over time.

METHODS

Birth certificate data provided sociodemographic variables, prepregnancy body mass index, GWG, and rurality status on 465,709 respondents who gave birth in Minnesota from 2012 to 2019. A series of regression models estimated risk differences in 1) prepregnancy weight status and 2) excessive GWG between rural and urban respondents over time, controlling for relevant covariates.

RESULTS

Rural individuals had a 4.9 percentage-point (95% confidence interval, 4.5-5.3) higher risk of having prepregnancy overweight or obesity compared with urban individuals, and a 2.6 percentage-point (95% confidence interval, 1.9-3.3) higher risk of gaining excessive gestational weight. The disparities in prepregnancy overweight or obesity and excessive gestational weight between rural and urban individuals widened over time.

CONCLUSIONS

These findings contribute to accumulating evidence documenting notable health disparities between rural and urban individuals during the perinatal period and support the need to develop prevention and treatment efforts focused on improving the weight-related health of individuals living in rural communities.

Identifying Young Adults at High Risk for Weight Gain Using Machine Learning

INTRODUCTION

Weight gain among young adults continues to increase. Identifying adults at high risk for weight gain and intervening before they gain weight could have a major public health impact. Our objective was to develop and test electronic health record-based machine learning models to predict weight gain in young adults with overweight/class 1 obesity.

METHODS

Seven machine learning models were assessed, including three regression models, random forest, single-layer neural network, gradient-boosted decision trees, and support vector machine (SVM) models. Four categories of predictors were included: 1) demographics; 2) obesity-related health conditions; 3) laboratory data and vital signs; and 4) neighborhood-level variables. The cohort was split 60:40 for model training and validation. Area under the receiver operating characteristic curves (AUC) were calculated to determine model accuracy at predicting high-risk individuals, defined by ≥ 10% total body weight gain within 2 y. Variable importance was measured via generalized analysis of variance procedures.

RESULTS

Of the 24,183 patients (mean [SD] age, 32.0 [6.3] y; 55.1% females) in the study, 14.2% gained ≥10% total body weight. Area under the receiver operating characteristic curves varied from 0.557 (SVM) to 0.675 (gradient-boosted decision trees). Age, sex, and baseline body mass index were the most important predictors among the models except SVM and neural network.

CONCLUSIONS

Our machine learning models performed similarly and had modest accuracy for identifying young adults at risk of weight gain. Future models may need to incorporate behavioral and/or genetic information to enhance model accuracy.

Whole systems approach to diet and healthy weight: a longitudinal process evaluation in East Scotland

AIMS

Obesity contributes to morbidity and early mortality, affecting people of all ages and sociodemographic backgrounds. Despite attempts to address obesity, efforts to date have only had limited success. Adopting a whole systems approach (WSA) may potentially address obesity and emphasise complex inter-relating factors beyond individual choice. This study aimed to assess implementation of WSA to diet and healthy weight in two council areas of Scotland, longitudinally exploring enablers and barriers. One area followed a Leeds Beckett WSA model (LBM) of implementation, while the other used a hybrid model incorporating existing working systems.

METHODS

To assess the process of implementing a WSA, interviews and focus groups were conducted after initiation and 1 year later.

RESULTS

Main enablers included: belief in WSA effectiveness; positive relationships between key personnel; buy-in at community and national levels; funding availability; the working group responsible for coordinating the system development comprising individuals with diverse expertise; good communication; and existing governance structures. Barriers included: insufficient funding; high staff turnover; inadequate training in WSA methodology; engaging all relevant stakeholders and reverting to 'old ways' of non-WSA working. The LBM provided a framework for system setup and generating an action plan.

CONCLUSION

This study provides the first independent longitudinal process evaluation of WSAs that have incorporated Leeds Beckett methodology, and offers insights into how a WSA can be implemented to address diet and healthy weight.

Rural African American Women With Severe Obesity: A Cross-Sectional Analysis of Lifestyle Behaviors and Psychosocial Characteristics

PURPOSE

To examine differences in lifestyle behavioral and psychosocial factors between rural African American women with Class 3 obesity and those with overweight, and Class 1-2 obesity.

DESIGN

Cross-sectional study.

SETTING

Rural Southeastern United States.

SUBJECTS

Participants included 289 African American women with a mean age of 56 years, 66% with a high school education or less, and a mean body mass index (BMI) of 38.6 kg/m2; 35% (n = 102) were classified with Class 3 obesity.

MEASURES

We objectively measured height, weight, and physical activity steps/day. Self-reported dietary and physical activity behaviors, general health-related quality of life, mental health, and social support were measured with validated surveys.

ANALYSIS

Chi-Square analysis for categorical variables and analysis of variance (ANOVA) - via multiple linear regression - for continuous variables.

RESULTS

There were no significant demographic differences between BMI groups, except for age, where women with Class 3 obesity were on average younger (51 vs 58 y, P < .001). Although dietary behaviors did not differ significantly between groups, we observed significant group differences in self-reported and objective measures of physical activity. The age-adjusted difference in means for self-reported total physical activity minutes/wk. was 91 minutes, with women categorized with Class 3 obesity reporting significantly fewer weekly minutes than those with overweight/Class 1-2 obesity (64.3 vs 156.4 min/wk. respectively, P < .01). Among psychosocial variables, only in the physical component scores of health-related quality of life did we find significant group differences - lower physical well-being among women with Class 3 obesity compared to those with overweight/Class 1-2 obesity (P = .02).

CONCLUSION

For African American women with Class 3 obesity living in rural setting, these findings suggest behavioral weight loss interventions may need to target physical activity strategies that address physical, psychosocial, and environmental barriers.

Geographic differences in the magnitude of black-white disparities in having obesity

Background

Obesity disparities in the United States are well documented, but the limited body of research suggests that geographic factors may alter the magnitude of these disparities. A growing body of evidence has identified a "rural mortality penalty" where morbidity and mortality rates are higher in rural than urban areas, even after controlling for other factors. Black-White differences in health and mortality are more pronounced in rural areas than in urban areas.

Objective

Therefore, the purpose of this study was to explore how rural-urban status and region moderate Black-White health disparities in obesity.

Methods

Data were abstracted from the 2012 Behavioral Risk Factor Surveillance System, with the sample being restricted to Black and White respondents (n = 403,231). Respondents' county of residence was linked to US Census information to obtain the county-level Index of Relative Rurality (IRR) and Census division. Crude and adjusted logistic regression models were utilized to assess the magnitude of Black-White disparities in having obesity (yes/no) by IRR quartile and by Census division.

Results

Overall, Black-White differences in obesity were wider in rural than in urban counties, with a significant linear trend (p < 0.001). Furthermore, when stratified by US Census division, results revealed that disparities were significantly wider in rural than urban areas for respondents living in the Middle Atlantic and South Atlantic divisions. In contrast, the association was reversed for the remaining divisions (New England, East North Central, West North Central, Mountain, and Pacific), where the magnitude of the Black-White difference was the largest in urban areas.

Conclusion

Findings highlight the need to understand and account for critical place-based factors that exacerbate racial obesity disparities to develop and maximize the effectiveness of policies and programs designed to reduce racial inequalities and improve population health.

Association between the Dietary Inflammatory Index and All-Cause Mortality in Adults with Obesity

INTRODUCTION

The dietary inflammatory index (DII) is associated with numerous chronic noncommunicable diseases. Previous studies have shown that the pro-inflammatory DII categories are associated with abdominal and simple obesity. However, the association between DII and mortality in patients with abdominal obesity and simple overweight or obesity remains unclear.

METHODS

We used data from the US National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. A DII >0 (positive DII) was defined as a pro-inflammatory diet. A restricted cubic spline curve was used to describe the trend between DII and all-cause mortality. We then examined the association between DII and all-cause mortality in different body types using a Cox regression analysis and investigated the differences between sexes. Finally, the mediating effects of systemic inflammation were explored.

RESULTS

A pro-inflammatory diet increased all-cause mortality in adults with abdominal obesity (aHR: 1.31, 95% confidence interval [CI]: 1.11-1.54; p < 0.001) and with simple overweight or obesity (aHR: 1.30, 95% CI: 1.11-1.53; p < 0.001). In addition, the most pro-inflammatory DII increased the risk of mortality by 43% (hazard ratio [HR]: Q4 vs. Q1 = 1.43, 95% CI = 1.14-1.79; p = 0.002; p for trend = 0.003) and 39% (HR: Q4 vs. Q1 = 1.39, 95% CI = 1.13-1.74; p = 0.003; p for trend = 0.009) in participants with abdominal obesity and with simple overweight or obesity, respectively. However, this association was not present in normal-sized participants. Compared with men, women resisted the effects of a pro-inflammatory diet. Mediation analysis showed that white blood cell and neutrophil were mediators of the association between DII and all-cause mortality (p < 0.001).

CONCLUSION

A pro-inflammatory diet is associated with all-cause mortality in adults with abdominal obesity and simple overweight or obesity, and this effect differs between men and women. Systemic inflammation may mediate the association between DII and all-cause mortality.

Daily Early-Life Exposures to Diet Soda and Aspartame Are Associated with Autism in Males: A Case-Control Study

Since its introduction, aspartame-the leading sweetener in U.S. diet sodas (DS)-has been reported to cause neurological problems in some users. In prospective studies, the offspring of mothers who consumed diet sodas/beverages (DSB) daily during pregnancy experienced increased health problems. We hypothesized that gestational/early-life exposure to ≥1 DS/day (DSearly) or equivalent aspartame (ASPearly: ≥177 mg/day) increases autism risk. The case-control Autism Tooth Fairy Study obtained retrospective dietary recalls for DSB and aspartame consumption during pregnancy/breastfeeding from the mothers of 235 offspring with autism spectrum disorder (ASD: cases) and 121 neurotypically developing offspring (controls). The exposure odds ratios (ORs) for DSearly and ASPearly were computed for autism, ASD, and the non-regressive conditions of each. Among males, the DSearly odds were tripled for autism (OR = 3.1; 95% CI: 1.02, 9.7) and non-regressive autism (OR = 3.5; 95% CI: 1.1, 11.1); the ASPearly odds were even higher: OR = 3.4 (95% CI: 1.1, 10.4) and 3.7 (95% CI: 1.2, 11.8), respectively (p < 0.05 for each). The ORs for non-regressive ASD in males were almost tripled but were not statistically significant: DSearly OR = 2.7 (95% CI: 0.9, 8.4); ASPearly OR = 2.9 (95% CI: 0.9, 8.8). No statistically significant associations were found in females. Our findings contribute to the growing literature raising concerns about potential offspring harm from maternal DSB/aspartame intake in pregnancy.

Subcutaneous and visceral fat are associated with worse outcomes in gunshot injuries but not stab injuries to the torso

Purpose

The effect of obesity in penetrating trauma outcomes is poorly understood. The purpose of this study was to determine if there is a protective effect of subcutaneous or visceral fat from stab and gunshot wounds.

Methods

443 patients admitted after penetrating traumatic injury of the torso were retrospectively identified from our institution's trauma registry. CT scans performed at presentation were used to determine cross-sectional area of visceral and subcutaneous fat at the level of the umbilicus via manual segmentation. Obesity-associated parameters including body mass index, visceral and subcutaneous fat were compared with injury severity score, length of hospital/intesive care unit (ICU) stay, and number of operating room (OR) visits. Parameters were compared between patients who sustained stab wounds versus gunshot injuries.

Results

Comparing all patients with gunshot injuries with those with stab injuries, gunshots resulted in increased hospital and ICU length of stay, and injury severity score (ISS). For patients with gunshot wounds, all obesity-related parameters correlated with increased length of stay and total ICU stay; subcutaneous fat and visceral fat were correlated with increased OR visits, but there was no significant correlation between obesity-related parameters and ISS. In contrast, with stab wounds there were no statistically significant associations between obesity parameters and any of the outcome measures.

Conclusion

For penetrating trauma in the torso, obesity is correlated with worse outcomes with gunshot injuries but not in stab injuries.

Level of evidence

Level III, prognostic and epidemiological.

Association of body mass index with morbidity following elective ventral hernia repair

Background

Prior work has linked body mass index (BMI) with postoperative outcomes of ventral hernia repair (VHR), though recent data characterizing this association are limited. This study used a contemporary national cohort to investigate the association between BMI and VHR outcomes.

Methods

Adults ≥ 18 years undergoing isolated, elective, primary VHR were identified using the 2016-2020 American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by BMI. Restricted cubic splines were utilized to ascertain the BMI threshold for significantly increased morbidity. Multivariable models were developed to evaluate the association of BMI with outcomes of interest.

Results

Of ~89,924 patients, 0.5 % were considered Underweight, 12.9 % Normal Weight, 29.5 % Overweight, 29.1 % Class I, 16.6 % Class II, 9.7 % Class III, and 1.7 % Superobese. After risk adjustment, class I (Adjusted Odds Ratio [AOR] 1.22, 95 % Confidence Interval [95%CI]: 1.06-1.41), class II (AOR 1.42, 95%CI: 1.21-1.66), class III obesity (AOR 1.76, 95%CI: 1.49-2.09) and superobesity (AOR 2.25, 95 % CI: 1.71-2.95) remained associated with increased odds of overall morbidity relative to normal BMI following open, but not laparoscopic, VHR. A BMI of 32 was identified as the threshold for the most significant increase in predicted rate of morbidity. Increasing BMI was linked to a stepwise rise in operative time and postoperative length of stay.

Conclusion

BMI ≥ 32 is associated with greater morbidity following open, but not laparoscopic VHR. The relevance of BMI may be more pronounced in open VHR and must be considered for stratifying risk, improving outcomes, and optimizing care.

Key message

Body mass index (BMI) continues to be a relevant factor in morbidity and resource use for elective open ventral hernia repair (VHR). A BMI of 32 serves as the threshold for significant increase in overall complications following open VHR, though this association is not observed in operations performed laparoscopically.