Trends in obesity prevalence and cardiometabolic risk factor control in US adults with diabetes, 1999-2020

Trends in cardiovascular health among US adults by glycemic status based on Life's Essential 8

OBJECTIVE

We aimed to assess the secular trends in cardiovascular health (CVH) among U.S. adults with different glycemic statuses based on the Life's Essential 8 (LE8).

METHODS

This cross-sectional study used nationally representative data from 6 cycles of the National Health and Nutrition Examination Surveys between 2007 and 2018. Survey-weighted linear models were used to assess time trends in LE8 scores. Stratified analyses and sensitivity analyses were conducted to validate the stability of the results.

RESULTS

A total of 23,616 participants were included in this study. From 2007 to 2018, there was no significant improvement in overall CVH and the proportion of ideal CVH among participants with diabetes and prediabetes. We observed an opposite trend between health behavior and health factors in the diabetes group, mainly in increasing physical activity scores and sleep scores (P for trend<0.001), and declining BMI scores [difference, -6.81 (95% CI, -12.82 to -0.80)] and blood glucose scores [difference, -6.41 (95% CI, -9.86 to -2.96)]. Dietary health remained at a consistently low level among participants with different glycemic status. The blood lipid scores in the prediabetes group improved but were still at a lower level than other groups. Education/income differences persist in the CVH of participants with diabetes or prediabetes, especially in health behavior factors. Sensitivity analyses of the absolute difference and change in proportion showed a consistent trend.

CONCLUSIONS

Trends in CVH among participants with diabetes or prediabetes were suboptimal from 2007 to 2018, with persistent education/income disparities.

Newer pharmacological interventions directed at gut hormones for obesity

The objective is to review the newer pharmacological interventions for obesity, specifically single, dual and triple incretin receptor agonists that are either available or in the pipeline for treatment of obesity. The three incretin receptor targets are glucagon like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP) and glucagon. There are several approved single or dual incretin agonists which can be administered subcutaneously daily (e.g., liraglutide) or weekly (e.g., semaglutide, dulaglutide, and exenatide QW), and other experimental dual or triple incretin agonists. Analogues of amylin, peptide YY and oxyntomodulin, as well as the combination of a GLP1R agonist and GIPR antagonist also are in development. Oral semaglutide (administered daily) is approved for type 2 diabetes mellitus and is on track for regulatory review for obesity. The review includes specifically perspectives on the effects of these mechanisms and pharmacological agents on gastric emptying, which contribute to satiation and weight loss, in addition to the established evidence on effects on central mechanisms controlling appetite. In the future, it is anticipated that small molecule GLP-1 receptor agonists (e.g., oral danuglipron) will be developed for treating obesity. These pharmacological agents are having significant impact on glycaemic control and obesity and on their co-morbidities.

Composite Dietary Antioxidant Index is inversely associated with visceral adipose tissue area among U.S. adults: A cross-sectional study

Obesity is becoming a global health problem. Visceral adiposity is the main cause of metabolic and cardiovascular diseases. Dietary improvement is the key to controlling obesity. We hypothesized that a higher Composite Dietary Antioxidant Index (CDAI) was associated with a lower visceral adipose tissue (VAT) area. In this cross-sectional study, 10,389 adults were selected from the National Health and Nutrition Examination Survey 2011-2018. CDAI was calculated based on 6 micronutrients: zinc, selenium, total carotenoids, vitamin A, vitamin C, and vitamin E. VAT area was determined by the dual-energy X-ray absorptiometry scan. Linear regression models were constructed to evaluate the association between CDAI and VAT area. Subgroup analyses were also performed. The mean age of participants was 39.68 years, 5240 were male, and 3841 of those were non-Hispanic White. The inverse associations were observed in all models. In model 3, CDAI was inversely associated with VAT area as a continuous variable, β (95% confidence interval), -0.56 (-0.85 to -0.27). When compared with the first tertile, the third tertile of CDAI was also inversely associated with VAT area, β (95% confidence interval), -6.72 (-10.44 to -2.99). No interactions were found in the subgroup analyses. In conclusion, an inverse association between CDAI and VAT area was found among U.S. adults aged 20 to 59 years. These results suggest the possible benefit of an antioxidant diet in relieving visceral obesity. More prospective studies are needed to identify this dietary benefit.

Novel insights into transfer RNA-derived small RNA (tsRNA) in cardio-metabolic diseases

Cardio-metabolic diseases, including a cluster of metabolic disorders and their secondary affections on cardiovascular physiology, are gradually brought to the forefront by researchers due to their high prevalence and mortality, as well as an unidentified pathogenesis. tRNA-derived small RNAs (tsRNAs), cleaved by several specific enzymes and once considered as some "metabolic junks" in the past, have been proved to possess numerous functions in human bodies. More interestingly, such a potential also seems to influence the progression of cardio-metabolic diseases to some extent. In this review, the biogenesis, classification and mechanisms of tsRNAs will be discussed based on some latest studies, and their relations with several cardio-metabolic diseases will be highlighted in sequence. Lastly, some future prospects, such as their clinical applications as biomarkers and therapeutic targets will also be mentioned, in order to provide researchers with a comprehensive understanding of the research status of tsRNAs as well as its association with cardio-metabolic diseases, thus presenting as a beacon to indicate directions for the next stage of study.

The impact of consuming technologically processed functional foods enriched/fortified with (poly)phenols on cardiometabolic risk factors: a systematic review of randomized controlled trials

Cardiovascular diseases are a major global cause of death and healthcare costs, emphasizing the need for effective prevention and management of cardiometabolic risk factors. One promising approach is the consumption of technologically processed functional foods enriched/fortified with (poly)phenols. The current systematic review aimed to evaluate the human clinical trials evidence on the effect of intake of these foods on reducing the most common cardiometabolic risk factors. 12 randomized controlled studies were included in the systematic review, with varying food intake amounts (27-360 g/day) and (poly)phenol doses (32.5-850 mg/day). These interventions included consumption of functional bakery goods, cereal bars, pasta, chocolate, and yogurt, with supplementation periods spanning from 2 to 52 wk. Several foods, such as green tea extract-fortified rye bread and olive fruit (poly)phenol-fortified yogurt, significantly lowered blood pressure. Flavonoid-enriched chocolate, hydroxytyrosol-fortified bread, and other products influenced glucose metabolism. Additionally, various functional foods were associated with improved blood lipid levels. While these results indicate the health advantages of consuming technologically processed functional foods enriched/fortified with (poly)phenols, caution is warranted due to the scarcity and limitations of existing studies. Further research is needed to confirm and expand upon these results in the prevention and management of cardiometabolic risk factors.

Obesity bias in diagnostic radiography students: A survey of attitudes, perceptions and technical confidence

INTRODUCTION

Obesity bias exists in healthcare professionals and students from numerous disciplines and negatively impacts the quality of care, outcomes, engagement, and satisfaction of their patients. With obesity rates continuing to rise in the United Kingdom (UK), more patients will be affected than ever, and it is becoming an increasingly important issue to tackle. This study aims to assess the attitudes to obesity of student diagnostic radiographers and determine if obesity bias exists in this population.

METHOD

Student radiographers (n = 140) at a single university in the UK were invited to complete an online survey comprising measures designed to assess levels of bias and attitudes towards obesity, including the Attitude Towards Obese Persons (ATOP) scale. Likert-type scales were used to collect quantitative data, and data analysis included descriptive statistics, frequencies, and Spearman's rank correlation coefficient.

RESULTS

Responses were received from n = 38 students. The mean ATOP score for participants was 70.37 (SD = 19.26). With 26 % (n = 10) scoring below 60, demonstrating strong negative attitudes towards obese individuals. Additionally, students (76.3 %; n = 29) indicated that they observed high levels of obesity bias whilst on clinical placement. There was a statistically significant correlation between levels of weight bias and students' confidence in working with obese patients (r(36) = 0.4, p 0.01). Students who are less confident working with obese patients had higher levels of obesity bias.

CONCLUSIONS

Obesity bias exists in radiography students at levels comparable to those that have been found previously in other healthcare professionals and students. Furthermore, radiography students lacked confidence in their technical ability to work with obese patients and lower confidence levels were associated with higher levels of obesity bias.

IMPLICATIONS FOR PRACTICE

The findings of this study provide preliminary knowledge upon which future research can be built.

Obesity, Cardiorespiratory Fitness, and Cardiovascular Disease

PURPOSE OF REVIEW

Obesity, generally defined by body mass index (BMI), is an established risk factor for the development of cardiovascular disease (CVD), while cardiorespiratory fitness (CRF) decreases risk. In chronic CVD, an obesity survival paradox in which higher BMI is associated with improved prognosis has been reported. This paper will examine the effect of obesity on CVD risk, explore obesity as a risk factor in patients with established CVD, and investigate the relationship between CRF, obesity, and CVD.

RECENT FINDINGS

Through metabolic and hemodynamic changes, obesity increases the risk for CVD and contributes to the development of other cardiovascular risk factors such as diabetes, dyslipidemia, and hypertension. Obesity is associated with metabolic, hormonal, and inflammatory changes that leads to atherosclerosis increasing the risk for coronary artery disease, and myocardial remodeling increasing the risk for heart failure. However, it has also been observed that overweight/obese patients with established CVD have a better prognosis when compared to non-obese individuals termed the obesity paradox. CRF is a vital component of health associated with improved cardiovascular outcomes and furthermore has been shown to markedly attenuate or nullify the relationship between obesity and CVD risk/prognosis. Increasing CRF mitigates CVD risk factors and improves overall prognosis in CVD regardless of obesity status.

Polyphenols as NLRP3 inflammasome modulators in cardiometabolic diseases: a review of in vivo studies

The nucleotide-binding domain and leucine-rich repeat containing receptors (NLRs) are components of the innate immune system, important in coordinating the inflammatory response. Among them, NLRP3 can form inflammasomes, multiprotein complexes activating the inflammatory caspase-1 and leading, through a cell death-mediated signaling cascade, to the release of several proinflammatory cytokines. Dietary polyphenols, plant secondary metabolites, have been reported to exhibit anti-inflammatory properties, although studies have focused most on their effect on the expression of the final circulating cytokines rather than on the upstream signals activating the NLRP3 inflammasome. The present review explores current knowledge on the potential of dietary polyphenols to regulate the whole NLRP3 inflammasome pathway, in the context of cardiometabolic pathologies (obesity, cardiovascular diseases, type 2 diabetes and non-alcoholic fatty liver disease), based on in vivo studies. A clear tendency towards a decrease in the expression of the whole NLRP3 inflammasome signaling pathway when several animal models were supplemented with polyphenols was observed, commonly showing a dose-response effect; these modifications were concomitant with clinical improvements in the pathologies. Nevertheless, the diversity of doses used, the disparity in polyphenol structures tested and, particularly, the scarce clinical trials and exploration of mechanisms of action show the need to develop further research on the topic.

Cross-walk of the Chronic Liver Disease Questionnaire for Nonalcoholic Steatohepatitis (CLDQ-NASH) and the EuroQol EQ-5D-5L in patients with NASH

BACKGROUND

Nonalcoholic steatohepatitis (NASH) is a chronic progression of nonalcoholic fatty liver disease, which can negatively impact the health-related quality of life (HRQoL) of affected individuals. HRQoL in NASH has been assessed using the disease-specific Chronic Liver Disease Questionnaire for NASH (CLDQ-NASH) and the generic EuroQol EQ-5D-5L. As the performance of these instruments relative to each other is unknown, we performed a cross-walk analysis of CLDQ-NASH to EQ-5D-5L using data from a real-world NASH population.

METHODS

Data were drawn from the Adelphi Real World 2019 NASH Disease Specific Programme, a cross-sectional survey of physicians and their patients in the United States. Patients with physician-diagnosed NASH completed a questionnaire that included the CLDQ-NASH and EQ-5D-5L. Mapping from CLDQ-NASH to EQ-5D-5L was done using tenfold cross-validation; performance was assessed using root-mean squared error as accuracy measure. Subgroup analyses compared performance of the models in obese versus non-obese patients and patients with versus without type 2 diabetes (T2D).

RESULTS

Data from 347 patients were included in this analysis. Overall, 2172 models were tested for predicting EQ-5D-5L index score from CLDQ-NASH score. The best model for this mapping was a generalized linear model using Gaussian distribution and a power link. The best model for mapping from CLDQ-NASH domains to the EQ-5D-5L was a fractional logistic model. Models performed better at predicting upper versus lower values of EQ-5D-5L, for non-obese versus obese patients, and for patients without versus with T2D.

CONCLUSION

We describe a scoring algorithm for cross-walking the CLDQ-NASH to the EQ-5D-5L enabling health status comparisons of HRQoL across studies.