Overweight and obesity in 16 European countries

Trend and projection of non-communicable diseases risk factors in Iran from 2001 to 2030

This study aims to investigate the trends and project the major risk factors of Non-communicable Diseases (NCDs) in Iran. We obtained the trend of prevalence of main risk factors related to NCDs in 30 to 70-year-old-individuals. The data were extracted from WHO STEP wise approach to NCDs risk factor surveillance (STEPS) survey. Also,the previous studies conducted at national and subnational levels from 2001 to 2016 were employed. The prevalence of risk factors was projected by 2030 using Bayesian Model Averaging (BMA) and Spatio-temporal model stratified by sex and province. The percent change for the age-standardized prevalence of smoking in men between 2001 and 2016 was calculated to be - 27.0. Also, the corresponding values for the risk factors of diabetes, hypertension, obesity and overweight, physical inactivity (PI), and mean of salt intake were - 26.1, 29.0, 70.0, 96.8, 116.6, and 7.5, respectively. It is predicted that smoking and these risk factors will undergo a change to show values of - 1.26, 38.7, 43.7, 2.36, and 15.3 by 2030, respectively. The corresponding values in women for the time interval of 2001-2016 were - 27.3, 26.3, 82.8, 1.88, 75.2, and 4.2, respectively. Plus, projections indicate that the 2030 variation values are expected to be - 25.0, 16.7, 37.5, 28.7, 26.7, and 10.9 respectively. This study showed that the prevalence of four risk factors of PI, overweight and obesity, hypertension, and diabetes is increasing in Iran. Therefor, it is necessary to carry out effective interventions to adopt a healthy lifestyle and reduce the risk factors.

The economic burden of obesity in 4 south-eastern European countries associated with obesity-related co-morbidities

OBJECTIVE

To provide an assessment of the cost burden of obesity across a spectrum of obesity-related comorbidities (ORCs) for four countries in South-Eastern Europe (SEE).

METHODS

A micro-costing analysis from the public payer perspective was conducted to estimate direct healthcare costs associated with ten obesity-related comorbidities (ORCs) in Czech Republic, Greece, Hungary, and Romania. A survey was administered to obtain healthcare resource use and unit cost data. Cost estimates were validated by local steering committees which comprised at least one public sector clinician and a panel of independent industry experts.

RESULTS

Chronic kidney disease and cardiovascular diseases were the costliest ORCs across all 4 countries, where annual cost burden per ORC exceeded 1,500 USD per patient per year. In general, costs were driven by the tertiary care resources allocated to address treatment-related adverse events, disease complications, and associated inpatient procedures.

CONCLUSIONS

Our findings confirm that the high prevalence of obesity and its comorbidities result in substantial financial burden to all 4 SEE public payers. By quantifying the burden of obesity from a public healthcare perspective, our study aims to support policy efforts that promote health education and promotion in combating obesity in the region.

Association between metabolic syndrome and myocardial infarction among patients with excess body weight: a systematic review and meta-analysis

BACKGROUND

Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide. Controversial views exist over the effects of metabolically unhealthy obesity phenotypes on CVDs. This study aimed to perform a meta-analysis to assess the association between metabolic syndrome and myocardial infarction (MI) among individuals with excess body weight (EBW).

METHODS

We searched PubMed/Medline, Scopus, and Web of Science databases as of December 9, 2023. Cohort studies involving patients with overweight or obesity that reported the relevant effect measures for the association between metabolic syndrome and MI were included. We excluded studies with incomplete or unavailable original data, reanalysis of previously published data, and those that did not report the adjusted effect sizes. We used the Newcastle Ottawa Scale for quality assessment. Random-effect model meta-analysis was performed. Publication bias was assessed by Begg's test.

RESULTS

Overall, nine studies comprising a total of 61,104 participants were included. There was a significant positive association between metabolic syndrome and MI among those with obesity (hazard ratio (HR): 1.68; 95% confidence interval (CI): 1.27, 2.22). Subgroup analysis showed higher HRs for obesity (1.72; 1.03, 2.88) than overweight (1.58; 1.-13-2.21). Meta-regression revealed no significant association between nationality and risk of MI (p = 0.75). All studies had high qualities. There was no significant publication bias (p = 0.42).

CONCLUSIONS

Metabolic syndrome increased the risk of MI in those with EBW. Further studies are recommended to investigate other risk factors of CVDs in EBW, in order to implement preventive programs to reduce the burden of CVD in obesity.

Cognitive Job Demands and Sports Participation among Young Workers: What Moderates the Relationship?

Cognitive job demands are theoretically and empirically associated with sports participation in various ways. Workers may be overwhelmed by stress and fatigue from their workload and therefore refrain from sports activities, but they can also feel the need to use sports as a way to recover and detach from work. The strategy to which workers adhere can depend on workers' resources that moderate the cognitive job demands and sports participation relationship, such as educational attainment, being a parent, or having worktime and work location control. To test our expectations, we used recent information on sports participation by young working adults from the Netherlands (N = 2032). Using multinomial logistic regression modelling, we found that workers in mentally demanding jobs were more likely to participate in sports more than three times a week. In particular, workers without children reported a higher likelihood of participating in sports more than three times a week when they experienced high cognitive job demands. Among the higher-educated, workers with high cognitive job demands were less likely to participate in sports one to three times a week. We reflect on the academic and policy-related implications of our findings.

Evaluating the association of female obesity with the risk of live birth following IVF: Implications for clinical practice

Obesity is a well-established risk factor for infertility. Consequentially, women living with obesity may require fertility treatment to support them to conceive. Due to evidence suggesting obesity is also linked with poorer outcomes following in vitro fertilisation (IVF), local commissioning guidelines on assisted conception recommend a BMI of <30kg/m2 before IVF can commence. However, it is currently unclear if these guidelines are evidence based. This commentary aims to critically appraise a recent systematic review by Sermondade et al, 2019 and expand upon the implications of the findings for clinical practice.

Real life results of direct-acting oral anticoagulants recommended-dose in obese vs normal-weight patients with venous thromboembolism

BACKGROUND

There is scarce evidence on the effectiveness and safety of recommended-dose direct acting oral anticoagulants (DOACs) in obese patients with venous thromboembolism (VTE).

MATERIAL AND METHODS

We used the data in the RIETE registry to compare the rates of VTE recurrences and major bleeding during long-term therapy with DOACs at recommended doses in patients with body mass index ≥30 kg/m2 (obese) vs. those with BMI 18.5-24.9 kg/m2 (normal weight). We performed regression models with competing risks for death.

RESULTS

From January 2013 through October 2022, 2885 obese patients and 2676 with normal weight in RIETE received rivaroxaban (n = 3020), apixaban (n = 1754), edoxaban (n = 636) or dabigatran (n = 151). Median age was 63 years and 52 % were female. At baseline, obese patients were more likely to have diabetes (18.6 % vs. 8.4 %), hypertension (51.9 % vs. 31.4 %) or pulmonary embolism (67.7 % vs. 61 %), and less likely to have renal insufficiency (5.3 % vs. 16 %) or anaemia (21.8 % vs. 28 %%). During anticoagulation (median, 147 vs. 101 days), the obese had a similar rate of VTE recurrences (1.71 vs. 2.14 events per 100 patients-years; hazard ratio (HR): 0.81; 95 % CI: 0.49-1.34) or major bleeding (1.45 vs. 1.76 per 100 patients-years; HR: 0.91; 95 % CI: 0.52-1.59) than those with normal weight. These findings persisted after multivariable analysis (recurrent VTE, HR: 0.80; 95 % CI: 0.48-1.32; major bleeding, HR: 1.11; 95 % CI: 0.60-2.07).

CONCLUSION

The use of DOACs at recommended doses in obese patients with VTE was associated with similar rates of VTE recurrences or major bleeding than in patients with normal weight.

Cancers attributable to overweight and obesity in Italy

BACKGROUND & AIMS

Overweight and obesity are associated with multiple cancers. We quantified the burden of cancer attributable to overweight and obesity in Italy.

METHODS

We estimated sex- and cancer site-specific population attributable fractions (PAFs) combining relative risks (from recent meta-analyses) with national obesity prevalence data (from a large sample survey conducted in 2005, to account for a 15-year lag period). Using nationwide mortality statistics and cancer registries data, we estimated the number of cancer cases and deaths attributable to overweight and obesity in Italy in 2020, based on the counterfactual scenario of a body mass index < 25 kg/m2.

RESULTS

3.6% of cancers in men and 4.0% in women in Italy were attributable to overweight and obesity, corresponding, respectively, to over 6900 and 7200 diagnoses in 2020. Attributable deaths were over 3600 in men and 2700 in women. PAFs (attributable cases) of overweight and obesity in men and women were, respectively, 38.1% (215 cases) and 21.8% (49 cases) for esophageal adenocarcinoma, 19.1% (1715 cases) and 14.5% (585 cases) for liver, 18.7% (1692 cases) and 16.7% (747 cases) for kidney, 13.7% (938 cases) and 10.1% (749 cases) for pancreatic, and 10.2% (2389 cases) and 3.4% (690 cases) for colorectal cancers. In women, PAFs were 22.3% (1859 cases) for endometrial and 5.7% (2556 cases) for post-menopausal breast cancer.

CONCLUSIONS

The cancer burden associated with overweight and obesity in Italy is considerable, but smaller compared to other high income countries, likely because of the lower prevalence of overweight and obesity in the Italian population.

Effect of female body mass index on intrauterine insemination outcomes: a systematic review and meta-analysis

The prevalence of women with a raised body mass index (BMI) seeking assisted conception treatment is increasing. Findings of existing studies evaluating the effect of female BMI on intrauterine insemination (IUI) treatment outcomes remain inconsistent. This systematic review and meta-analysis evaluate the effect of female BMI on IUI treatment outcomes. Two authors independently conducted data extraction and assessed study quality. Risk ratios (RR) and 95% confidence intervals were calculated using the Mantel-Haenszel approach for dichotomous outcomes. 11 studies involving 23,145 IUI treatment events, comprising 21,211 cycles from 8 studies, and 1,934 participants in three studies, met the inclusion criteria for the meta-analysis. Two cohorts of women undergoing IUI treatment were compared - women with normal BMI < 25 kg/m2 were compared with a second cohort of women with a BMI category ≥ 25 kg/m2. There was no statistically significant difference in live birth rate (LBR) (RR 1.06, 95% CI 0.86-1.307); clinical pregnancy rate (CPR) (RR 0.94, 95% CI 0.78-1.13); miscarriage (RR 0.92, 95% CI 0.31-2.74) or ectopic pregnancy rate (RR 2.20, 95% CI 0.78-6.23). Our meta-analysis showed that a raised female BMI did not affect IUI treatment outcomes. Nevertheless, weight loss counselling should be offered to women with a raised BMI undergoing IUI, to reduce the associated obstetric morbidity.

Cancer mortality associated with low education in Italy

BACKGROUND

This study provides a nationwide representative quantification of the impact of educational inequalities on cancer mortality in Italy.

METHODS

The study is based on prevalence data and mortality rate ratios according to levels of education obtained from the Italian 2011 census cohort, including >35 million individuals aged 30-74. We estimated the population attributable fraction (PAF) and the number of cancer deaths associated with low education (below university degree) in Italy by sex.

RESULTS

PAFs for low levels of education were 29.1% among men and 13.3% among women, corresponding to 22,271 cancer deaths associated with low education in men and 7456 in women in 2019. PAFs by cancer site in men were: 53.0% for upper aerodigestive tract (UADT), 44.6% for liver, 41.3% for stomach, 41.3% for lung, 37.0% for bladder, 18.5% for colorectal, 9.8% for prostate and 9.1% for pancreatic cancers. PAFs in women were: 44.5% for cervical, 36.1% for UADT, 34.9% for stomach and 13.9% for colorectal cancers. The cancer sites with the highest number of deaths associated with low education were lung among men (7902/22,271, 35.5%) and colorectum among women (780/7456, 10.5%).

CONCLUSIONS

About a quarter of cancer deaths in 2019 in Italy may be prevented by reducing the socioeconomic determinants that contribute to educational disparities in cancer mortality.

European trends in ovarian cancer mortality, 1990-2020 and predictions to 2025

INTRODUCTION

Over the last decades, ovarian cancer mortality in Europe has been decreasing, but disparities in trends were observed. In this paper, we analysed ovarian cancer mortality trends in Europe over the period 1990-2020 and predicted the number of deaths and rates by 2025.

METHODS

We extracted population and death certification data from ovarian cancer in women for 31 European countries, between 1990 and 2020 from the World Health Organization database. We computed age-standardised mortality rates (ASMR) per 100,000 women-years, based on the world standard population. We also obtained predictions for 2025 using a joinpoint regression model and calculated the number of avoided deaths over the period 1994-2025.

RESULTS

Over the observed period, mortality from ovarian cancer showed a favourable pattern in most countries. In the EU-27, rates declined by 5.9% from 2010-2014 to 2015-2019, reaching an ASMR of 4.66/100,000. During the same period, the decline in ovarian cancer mortality was more pronounced in the EU-14 countries (-7.0%) compared to Transitional countries (-2.1%). Declines were also observed in the United Kingdom, to reach an ASMR of 5.29. Decreases in mortality from ovarian cancer are predicted until 2025, to 4.17/100,000 for the EU-27.

CONCLUSIONS

Favourable trends in ovarian cancer mortality are expected to persist in Europe and can be mainly attributed to the increased use of oral contraceptives in subsequent generations of European women. Decreased use of menopausal Hormone Replacement Therapy and improved diagnosis and management may also have played a role.

Opposite trends in incidence of breast cancer in young and old female cohorts in Hungary and the impact of the Covid-19 pandemic: a nationwide study between 2011-2020

Background

This nationwide study examined breast cancer (BC) incidence and mortality rates in Hungary between 2011-2019, and the impact of the Covid-19 pandemic on the incidence and mortality rates in 2020 using the databases of the National Health Insurance Fund (NHIF) and Central Statistical Office (CSO) of Hungary.

Methods

Our nationwide, retrospective study included patients who were newly diagnosed with breast cancer (International Codes of Diseases ICD)-10 C50) between Jan 1, 2011 and Dec 31, 2020. Age-standardized incidence and mortality rates (ASRs) were calculated using European Standard Populations (ESP).

Results

7,729 to 8,233 new breast cancer cases were recorded in the NHIF database annually, and 3,550 to 4,909 all-cause deaths occurred within BC population per year during 2011-2019 period, while 2,096 to 2,223 breast cancer cause-specific death was recorded (CSO). Age-standardized incidence rates varied between 116.73 and 106.16/100,000 PYs, showing a mean annual change of -0.7% (95% CI: -1.21%-0.16%) and a total change of -5.41% (95% CI: -9.24 to -1.32). Age-standardized mortality rates varied between 26.65-24.97/100,000 PYs (mean annual change: -0.58%; 95% CI: -1.31-0.27%; p=0.101; total change: -5.98%; 95% CI: -13.36-2.66). Age-specific incidence rates significantly decreased between 2011 and 2019 in women aged 50-59, 60-69, 80-89, and ≥90 years (-8.22%, -14.28%, -9.14%, and -36.22%, respectively), while it increased in young females by 30.02% (95%CI 17,01%- 51,97%) during the same period. From 2019 to 2020 (in first COVID-19 pandemic year), breast cancer incidence nominally decreased by 12% (incidence rate ratio [RR]: 0.88; 95% CI: 0.69-1.13; 2020 vs. 2019), all-cause mortality nominally increased by 6% (RR: 1.06; 95% CI: 0.79-1.43) among breast cancer patients, and cause-specific mortality did not change (RR: 1.00; 95%CI: 0.86-1.15).

Conclusion

The incidence of breast cancer significantly decreased in older age groups (≥50 years), oppositely increased among young females between 2011 and 2019, while cause-specific mortality in breast cancer patients showed a non-significant decrease. In 2020, the Covid-19 pandemic resulted in a nominal, but not statistically significant, 12% decrease in breast cancer incidence, with no significant increase in cause-specific breast cancer mortality observed during 2020.

Toxoplasmosis Screening during Pregnancy in a Romanian Infectious Diseases Tertiary Center: Results of a 15 Years Follow-Up Program

Maternal infection with Toxoplasma gondii during pregnancy may have serious consequences for the fetus. In Romania, screening for toxoplasmosis is included in the first antenatal visit. A retrospective study was performed on all toxoplasmosis antenatal screening patients between May 2008 and February 2023. Twenty-seven thousand one hundred sixty-nine (27,169) pregnant women presented for prenatal screening once (22,858) or several times: during the same pregnancy (209) or during multiple pregnancies (4102). Thirty-one thousand six hundred fifty-eight (31,658) tests for IgM and IgG antibodies were performed. Nine thousand eighty-three (9083) tests (28.69%), corresponding to 7911 women (29.12%), were positive for IgG antibodies. The seroprevalence increased with patients' age, decreased in time intervals, and was more frequently associated with rural residence. At risk for acquiring the infection during the pregnancy were women with negative anti-Toxoplasma IgG antibodies (70.88%), but only 0.9% of them presented for rescreening during the same pregnancy. Acute Toxoplasma infection (ATI) was suspected in 44 patients (0.16%) due to IgG seroconversion and/or low or borderline IgG avidity. A questionnaire follow-up interview was performed, and no congenital toxoplasmosis was identified in children born from mothers with probable ATI. Our study demonstrates poor compliance with the screening program in the Romanian population.

The COVID-19 Pandemic and Elective Spine Surgery-A Single Center Experience

Background and objective: The COVID-19 pandemic had a profound impact on medical practice worldwide. In this study, we aimed to investigate the trends of elective spine surgery in our department before and during the pandemic. Materials and methods: Total number of spine procedures due to disc herniation (DH) or spinal stenosis (SS) was collected during 2019-2021 in the Department of Neurosurgery, University Hospital Center Osijek, Croatia. In order to elucidate potential risk factors in the post-pandemic period, demographic data were collected for patients who underwent surgery during 2021. Results: In 2020, there was a 22.1% decrease in the number of surgeries compared to 2019 (205 vs. 263), but during 2021 we observed an increase of 36.1% compared to 2020 (279 vs. 205). The mean age of patients in 2021 was 53.14 years (53.14 ± 13.05) with body mass index of 28.31 kg/m2 (28.31 ± 4.89). There were 179 overweight patients (74%) and 103 smokers (42.6%). Although male and female patients were equally represented (121 each), there was a significant interaction of weight class and sex (p = 0.013). Patients younger than 65 were more likely to undergo surgery due to DH (p < 0.001), whereas older patients were more likely to suffer from SS (p < 0.001). Conclusions: The volume of elective spine surgeries decreased in the first year of the pandemic and increased the following year. Our results suggest that public health policies in the early pandemic period reduced elective surgical procedures, which was followed by a compensatory increase in the following period.

Explaining gender inequalities in overweight people: a Blinder-Oaxaca decomposition analysis in northern Sweden

BACKGROUND

Being overweight and obesity are considered serious public health concerns worldwide. At the population level, factors contributing to overweight as well as the differences in overweight between men and women in terms of prevalence or associated factors are relatively well-known. What is less known is what explains the inequalities in overweight between men and women. In this study, we examined the contribution of material, behavioural, and psychosocial factors in explaining the gender differences in overweight among adults in northern Sweden.

METHODS

This study was based on the 2018 Swedish Health on Equal Terms survey, which was carried out in Sweden's four northernmost regions. The analytical sample consisted of 20,855 participants (47% men) aged 20-84 years. Overweight (including obesity) was the outcome, and the selected explanatory variables were grouped according to three theoretical perspectives: material, behavioural and psychosocial. Descriptive statistics and Blinder-Oaxaca decomposition were applied for analysing the data.

RESULTS

Our study showed that the prevalence of overweight was 64% and 52% among men and women, respectively. It, therefore, revealed a gender gap in overweight people of 11.7% points with explanatory factors accounting for 39% of that gap. This gender gap in overweight people was mostly explained by behavioural variables (19.3%), followed by the materialistic variables and age accounting for 16.2% and 3.1%, respectively. Specifically, having low education, being in the lowest income quintile, alcohol drinking and snus usage contributed to explain 8.4%, 8.9%, 2.8% and 6.3% of the gender difference, respectively.

CONCLUSIONS

We found a considerable gender inequality in overweight between men and women. The findings highlight that future overweight prevention initiatives would benefit from targeting the uncovered contributing factors to reduce gender inequalities in overweight people.

The level of education is associated with an anxiety-depressive state among men and women - findings from France during the first quarter of the COVID-19 pandemic

CONTEXT

It is widely recognised that the COVID-19 pandemic has negatively impacted individuals' mental health. However, little emphasis has been put on the possible influence of socio-economic factors in the relationship. In the context of the COVID-19 pandemic, our objectives were (i) to assess the relationship between education level and mental health in French adults, and (ii) to study the influence of the economic, social, health and the COVID-19-related factors in men and women respectively.

METHOD

Data are from 32,581 individuals representative of the French population who responded to the weekly survey "Baromètre COVID-19" between April 7^th and May 31^st 2020. Education level was self-reported (university degree, high school qualification, vocational certificate/qualification, no diploma). Anxiety-depressive state was derived from four items related to the frequency of occurrence of depressive and anxiety symptoms, and summarized in an overall validated anxiety-depressive score. Multivariate linear regression analyses were carried out with nested adjustments of variables related to economic, social, health and COVID-19 contexts to assess the relationship between education and anxiety-depressive state.

RESULTS

In total, 45% of individuals reported symptoms of anxiety-depressive state (53% in women versus 36% in men). Among men, those with a vocational certificate/qualification and those with no diploma had a greater risk of having a higher anxiety-depressive state compared to those with a university degree (β_{Vocational certificate/qualification} = 0.16 [0.04; 0.27]; β_{No diploma} = 0.75 [0.43; 1.07]) while among women, the risk of anxiety-depressive state increased as education level decreased (β_{Baccalaureate} = 0.37 [0.25; 0.49]; β_{Vocational certificate/qualification} = 0.41 [0.28; 0.54]; β_{No diploma} = 0.8 [0.49; 1.12]). For both men and women, economic, health, and COVID-19 factors partly attenuate these associations while social factors marginally modified the relationship. After accounting for confounders and intermediate variables, the absence of a diploma remained associated with anxiety-depressive state among men, while the whole educational gradient of anxiety-depressive state persisted among women.

CONCLUSION

In France, at the end of the first wave of COVID-19, individuals with a lower level of education had a higher risk of anxiety-depressive state. This association was more pronounced for women, highlighting a process of social inequality in health possibly related to gender. This should be considered in future prevention and public health interventions.

Patient-Related Predictors for Seeking and Receiving Obesity Surgery

INTRODUCTION

The decision for obesity surgery (OS) is complex and strongly driven by patients' preference. This study aimed to examine patients' preference for OS before and after behavioral weight loss treatment (BWLT), associated patient characteristics, its role in predicting the receipt of OS after BWLT, and potential mediators.

METHODS

Data of N = 431 adults with obesity starting a 1-year routine care obesity BWLT were analyzed. Patients were interviewed before (pre-BWLT) and after BWLT (post-BWLT) regarding their preference for OS, and anthropometric, medical, and psychological data were collected.

RESULTS

Only a minority of patients (11.6%) had an explicit preference for OS pre-BWLT. Post-BWLT, the number of patients preferring OS significantly increased (27.4%). Patients with a constant or emerging preference for OS showed less favorable anthropometric, psychological, and medical characteristics than patients without or with a vanishing preference for OS. Patients' pre-BWLT preference for OS significantly predicted receiving OS post-BWLT. This association was mediated by higher body mass index pre- and post-BWLT, but not by less percentage total body weight loss (%TBWL) through BWLT.

CONCLUSION

Although the preference for OS pre-BWLT predicted the receipt of OS post-BWLT, it was not associated with %TBWL during BWLT. Further prospective studies with multiple assessment time points during BWLT may help understand when and why patients' attitude toward OS changes, and identify possible mediators on the association between the preference and receipt of OS.

Global Impact of Obesity

The prevalence of preobesity and obesity is rising globally, multiple epidemiologic studies have identified preobesity and obesity as predisposing factors to a number of noncommunicable diseases including type 2 diabetes (T2DM), cardiovascular disease (CVD), and cancer. In this review, we discuss the epidemiology of obesity in both children and adults in different regions of the world. We also explore the impact of obesity as a disease not only on physical and mental health but also its economic impact.

The European Organisation for Research and Treatment of Cancer Quality of Life Utility-Core 10 Dimensions: Development and Investigation of General Population Utility Norms for Canada, France, Germany, Italy, Poland, and the United Kingdom

OBJECTIVES

The European Organisation for Research and Treatment of Cancer Quality of Life Utility-Core 10 Dimensions (EORTC QLU-C10D) is a cancer-specific preference-based measure, providing health utilities for use in economic evaluations derived from the widely used health-related quality of life measure, EORTC QLQ-C30. Several EORTC QLU-C10D country-specific value sets are available. This article aimed to provide EORTC QLU-C10D general population utility norms for Canada, France, Germany, Italy, Poland, and the United Kingdom, to aid interpretability of obtained utilities in these countries.

METHODS

Data were collected in aforementioned countries via a quota-sampled, cross-sectional online survey (n = 100/age-sex group; N = approximately 1000/country). Participants were asked to complete the EORTC QLQ-C30 and provide sociodemographic data. Country-specific utility norms were calculated using the respective country tariff on the country's EORTC QLQ-C30 data after weighting to achieve population representativeness for age and sex. Norm values are provided as means (SDs) by country, age, and sex groups. Tukey's multiple comparison test investigated mean differences among countries. The impact of country, age, and sex on utility values was investigated with a multiple linear regression model.

RESULTS

Country-specific mean utilities range from 0.724 (United Kingdom) to 0.843 (Italy). Country-, sex-, and age-specific mean utilities range from 0.664 for 30- to 39-year-old male Canadians to 0.899 for > 70-year-old male Italians. Utilities were lower in females in 4 of 6 countries, and the impact of age differed among countries. Independent of the impact of age and sex, between-country differences were found (P ≤ .05).

CONCLUSION

Results showed a varying impact of age and sex on EORTC QLU-C10D utilities and significant between-country differences. Using national utility norms and utility decrements is recommended.

Leuconostoc Citreum Inhibits Adipogenesis and Lipogenesis by Inhibiting p38 MAPK/Erk 44/42 and Stimulating AMPKα Signaling Pathways

Probiotics provide a range of health benefits. Several studies have shown that using probiotics in obesity treatment can reduce bodyweight. However, such treatments are still restricted. Leuconostoc citreum, an epiphytic bacterium, is widely used in a variety of biological applications. However, few studies have investigated the role of Leuconostoc spp. in adipocyte differentiation and its molecular mechanisms. Therefore, the objective of this study was to determine the effects of cell-free metabolites of L. citreum (LSC) on adipogenesis, lipogenesis, and lipolysis in 3T3-L1 adipocytes. The results showed that LSC treatment reduced the accumulation of lipid droplets and expression levels of CCAAT/ enhancer-binding protein-α & β (C/EBP-α & β), peroxisome proliferator-activated receptor-γ (PPAR-γ), serum regulatory binding protein-1c (SREBP-1c), adipocyte fatty acid binding protein (aP2), fatty acid synthase (FAS), acetyl CoA carboxylase (ACC), resistin, pp38MAPK, and pErk 44/42. However, compared to control cells, adiponectin, an insulin sensitizer, was elevated in adipocytes treated with LSC. In addition, LSC treatment increased lipolysis by increasing pAMPK-α and suppressing FAS, ACC, and PPAR-γ expression, similarly to the effects of AICAR, an AMPK agonist. In conclusion, L. citreum is a novel probiotic strain that can be used to treat obesity and its associated metabolic disorders.

Trends in obesity-related cancer burden in Czechia

BACKGROUND AND OBJECTIVE

Obesity is a major lifestyle risk factor that contributes greatly to the burden of disease, including cancer. Overweight and obesity have shown association with several types of cancer. As Czechia is one of the most overweight countries in Europe, and has high cancer mortality, this study aims to investigate the country's long-term burden of obesity-related cancer.

METHODS

Using the Czech National Cancer Register and the NCD Risk Factor Collaboration (NCD-RisC), standardized incidence and mortality rates were calculated for 12 types of cancer related to obesity for the years 1985-2018. Population attributable fractions (PAF) were calculated. Finally, the standardized attributable rates were calculated from the standardized incidence and mortality rates and the PAFs.

RESULTS

Approximately 11.0% of selected cancer cases in the male population and 12.3% in the female population were attributable to overweight and obesity in 2018. Since the beginning of the millennium, obesity attributable cancer mortality has dropped, while incidence has remained constant. The incidence throughout the whole period was almost twice as high (18.7 cases per 100,000 population in 2018) in women than in men (10.9 cases per 100,000 population in 2018).

CONCLUSION

Obesity-related cancer mortality in Czechia has declined in the last two decades, but the incidence has remained constant. Given the increasing prevalence of overweight and obesity in western countries, this issue needs to be prioritized in future healthcare and policy making.

An age-period-cohort approach to studying long-term trends in obesity and overweight in England (1992-2019)

OBJECTIVE

This study aims to understand long-term trends in obesity and overweight in England by estimating life-course transitions as well as historical and birth cohort trends for both children and adults.

METHODS

Data on individuals aged 5 to 85 years old from the Health Survey for England were used, covering the period 1992 to 2019 and birth cohorts born between 1909 and 2013. Individual BMI values were classified as healthy weight, overweight, or obesity. Trends were compared, and an age-period-cohort model was estimated using logistic regression and categorical age, period, and cohort groups.

RESULTS

There was significant variation in age trajectories by birth cohorts for healthy weight and obesity prevalence. The odds of having obesity compared with a healthy weight increased consistently with age, increased throughout the study period (but faster between 1992 and 2001), and were higher for birth cohorts born between 1989 and 2008. The odds of having overweight showed an inverted U-shape among children, increased through adulthood, have been stable since 2012, and were considerably higher for the youngest birth cohort (2009-2013).

CONCLUSIONS

Younger generations with higher overweight prevalence coupled with increasing obesity prevalence with age suggest that obesity should remain a high priority for public health policy makers in England.

Transferability of Published Population Pharmacokinetic Models for Apixaban and Rivaroxaban to Subjects with Obesity Treated for Venous Thromboembolism: A Systematic Review and External Evaluations

Apixaban and rivaroxaban have first-line use for many patients needing anticoagulation for venous thromboembolism (VTE). The pharmacokinetics of these drugs in non-obese subjects have been extensively studied, and, while changes in pharmacokinetics have been documented in obese patients, data remain scarce for these anticoagulants. The aim of this study was to perform an external validation of published population pharmacokinetic (PPK) models of apixaban and rivaroxaban in a cohort of obese patients with VTE. A literature search was conducted in the PubMed/MEDLINE, Scopus, and Embase databases following the PRISMA statement. External validation was performed using MonolixSuite software, using prediction-based and simulation-based diagnostics. An external validation dataset from the university hospitals of Brest and Rennes, France, included 116 apixaban pharmacokinetic samples from 69 patients and 121 rivaroxaban samples from 81 patients. Five PPK models of apixaban and 16 models of rivaroxaban were included, according to the inclusion criteria of the study. Two of the apixaban PPK models presented acceptable performances, whereas no rivaroxaban PPK model did. This study identified two published models of apixaban applicable to apixaban in obese patients with VTE. However, none of the rivaroxaban models evaluated were applicable. Dedicated studies appear necessary to elucidate rivaroxaban pharmacokinetics in this population.

Crucial Regulatory Role of Organokines in Relation to Metabolic Changes in Non-Diabetic Obesity

Obesity is characterized by an excessive accumulation of fat leading to a plethora of medical complications, including coronary artery disease, hypertension, type 2 diabetes mellitus or impaired glucose tolerance and dyslipidemia. Formerly, several physiological roles of organokines, including adipokines, hepatokines, myokines and gut hormones have been described in obesity, especially in the regulation of glucose and lipid metabolism, insulin sensitivity, oxidative stress, and low-grade inflammation. The canonical effect of these biologically active peptides and proteins may serve as an intermediate regulatory level that connects the central nervous system and the endocrine, autocrine, and paracrine actions of organs responsible for metabolic and inflammatory processes. Better understanding of the function of this delicately tuned network may provide an explanation for the wide range of obesity phenotypes with remarkable inter-individual differences regarding comorbidities and therapeutic responses. The aim of this review is to demonstrate the role of organokines in the lipid and glucose metabolism focusing on the obese non-diabetic subgroup. We also discuss the latest findings about sarcopenic obesity, which has recently become one of the most relevant metabolic disturbances in the aging population.

Perinatal Obesity Sensitizes for Premature Kidney Aging Signaling

Chronic Kidney Disease (CKD), a global health burden, is strongly associated with age-related renal function decline, hypertension, and diabetes, which are all frequent consequences of obesity. Despite extensive studies, the mechanisms determining susceptibility to CKD remain insufficiently understood. Clinical evidence together with prior studies from our group showed that perinatal metabolic disorders after intrauterine growth restriction or maternal obesity adversely affect kidney structure and function throughout life. Since obesity and aging processes converge in similar pathways we tested if perinatal obesity caused by high-fat diet (HFD)-fed dams sensitizes aging-associated mechanisms in kidneys of newborn mice. The results showed a marked increase of γH2AX-positive cells with elevated 8-Oxo-dG (RNA/DNA damage), both indicative of DNA damage response and oxidative stress. Using unbiased comprehensive transcriptomics we identified compartment-specific differentially-regulated signaling pathways in kidneys after perinatal obesity. Comparison of these data to transcriptomic data of naturally aged kidneys and prematurely aged kidneys of genetic modified mice with a hypomorphic allele of Ercc1, revealed similar signatures, e.g., inflammatory signaling. In a biochemical approach we validated pathways of inflammaging in the kidneys after perinatal obesity. Collectively, our initial findings demonstrate premature aging-associated processes as a consequence of perinatal obesity that could determine the susceptibility for CKD early in life.

On-campus food purchase behaviors, choice determinants, and opinions on food availability in a Spanish university community

OBJECTIVE

The aim of this study was to investigate food purchasing behaviors, choice determinants, and opinions about on-campus food availability by a university community and to analyze differences in these aspects between students, education and/or research staff (ERS), and administrative and services staff (ASS), and between males and females.

METHODS

This was a cross-sectional study that involved a representative sample of students (n = 1089), ERS (n = 396), and ASS (n = 300) who completed an anonymous online survey. A previously adapted version of the questionnaire was administered. The results were weighted to ensure representativeness of this community population using weighted coefficients.

RESULTS

The results showed that most of the participants purchased food on campus (91.6%), especially for lunch (67.4% of foods and 37.4% of drinks) and snack (65.4% of foods and 45.4% of drinks). Hot drinks (i.e., coffee, tea, hot chocolate etc.; 60.5%), bottled water (49.2%), and hot foods (i.e., small servings [38.2%] and sandwiches/hamburgers [31.7%]) were the most purchased items. Taste (98.6%) was the most important determinant in choice, followed by price for students, nutritional value for ASS, and health value for ERS. The "top 5" opinions suggested for the campus food environment and potential changes were "greater capacity to access free filtered drinking water", "greater capacity to recycle food packaging," "more healthy options in vending machines", "discounts for healthy choices," and "allergen labeling."

CONCLUSION

Interventions that improve sustainability and the affordability of products with high nutritional quality, price-manipulation directives, and allergen information on labeling would be well received among this community.

Body mass index and quality of life in individuals with polycystic ovary syndrome: Dysmorphic concerns and eating disorders as mediators

Objective

Weight issues, dysmorphic concerns and eating disorders are common among individuals with polycystic ovary syndrome (PCOS) and are linked to poor quality of life (QoL). The goal of the current study was to examine whether the association between body mass index (BMI) and QoL was mediated by dysmorphic concerns, examining also the relations with eating disorder symptomatology.

Methods

Questionnaires were administered to 435 individuals with PCOS aged between 18 and 40 years (M = 27.62; SD = 4.83) to measure dysmorphic concerns, eating disorder symptoms and QoL. Participants were also asked to report their height and weight to compute their BMI.

Results

Structural equation modeling was used to observe the relationship between the variables. The results revealed a direct relationship between QoL, BMI, dysmorphic concerns and eating disorder symptomatology. In addition, dysmorphic concerns were related to BMI and eating disorder symptomatology. Furthermore, the results showed the mediating role of dysmorphic concerns and eating disorder symptoms in the relationship between BMI and QoL.

Conclusion

The current results highlight the potential importance of harmful relationships with one's own body and food, explaining why weight issues may be linked to different levels of QoL in PCOS individuals. The implications of these findings are discussed.

Masculinity, Perceived Vulnerability to COVID-19, and Adoption of Protective Behaviors

Epidemiological data show that men and women have similar probabilities of contracting COVID-19. However, men with COVID-19 tend to have more severe outcomes than women. We performed two studies to analyze the associations between gender, adherence to traditional masculinity ideology, perceived vulnerability to COVID-19, and the adoption of protective behaviors against COVID-19. In Study 1 (quota sample of the Italian adult population, N = 1,142), we found no differences between men and women in terms of the perceived probability of contracting COVID-19. However, compared to women, men perceived themselves to be less likely to suffer severe consequences if falling ill. In Study 2 (Italian community sample, N = 305), a moderated mediation model showed that adherence to traditional masculinity ideology moderated the association between being man and the perceived severity of the consequences of COVID-19, which, in turn, showed negative associations with three protective behaviors against COVID-19. The article ends with a discussion of the strengths and limitations of this research.

Review article: obesity and colorectal cancer

BACKGROUND

Obesity is a growing global public health problem. More than half the European and North American population is overweight or obese. Colon and rectum cancers are still the second leading cause of cancer death worldwide, and epidemiological data support an association between obesity and colorectal cancers (CRCs).

AIM

To review the literature on CRC epidemiology in obese subjects, assessing the effects of obesity, including childhood or maternal obesity, on CRC, diagnosis, management, and prognosis, and discussing targeted prophylactic measures.

METHOD

We searched PubMed for obesity/overweight/metabolic syndrome and CRC. Other key words included 'staging', 'screening', 'treatment', 'weight loss', 'bariatric surgery' and 'chemotherapy'.

RESULTS

In Europe, about 11% of CRCs are attributed to overweight and obesity. Epidemiological data suggest that obesity is associated with a 30%-70% increased risk of colon cancer in men, the association being less consistent in women. Visceral fat or abdominal obesity seems to be of greater concern than subcutaneous fat obesity, and any 1 kg/m² increase in body mass index confers more risk (hazard ratio 1.03). Obesity might increase the likelihood of recurrence or mortality of the primary cancer and may affect initial management, including accurate staging. The risk maybe confounded by different factors, including lower adherence to organised CRC screening programmes. It is unclear whether bariatric surgery helps reduce rectal cancer risk.

CONCLUSIONS

Despite a growing body of evidence linking obesity to CRC, many questions remain unanswered, including whether we should screen patients with obesity earlier or propose prophylactic bariatric surgery for certain patients with obesity.

Prevalence of Overweight and Obesity in Children: Variation in Different Ethnicities, Age, and Sex in North Macedonia

Childhood obesity is assuredly one of the most important health challenges of the 21st century, particularly regarding long-term metabolic complications. In the last four decades, there has been a tenfold increase in childhood and adolescence obesity. This cross-sectional study aimed to show the prevalence of overweight and obesity compared by age, sex, and ethnicity in n=1034 healthy male and female children, aged 6-13 years in North Macedonia. Out of the total 1034 children included in the study, 589 (57.0%) were observed with normal weight, 202 (19.5%) children were obese, 140 (13.5%) children were overweight and, 103 (10.0%) children underweight. The study presents an insight that 33% of primary school children are at >85th percentile overweight; or at ≥95th percentile with increased weight due to obesity. The data show that boys have a higher prevalence of obesity and overweight with 37.1%, compared to girls with 29.1%. Also, all age groups demonstrate an exponential increase of the prevalence of overweight: in 6-7 years (5.8%); 8-9 years (12%); 10-11 years (15%); and, 12-13 years old with 19.5%. A jump of prevalence of overweight and obesity between the age groups of 6-7 years, and 8-9 years was observed (17.9% to 25.4% obese and 5.8% to 12.0% overweight). The onset of puberty may be the possible cause. According to the Global Atlas of Childhood Obesity, North Macedonia is graded with a risk index of 7/11; i.e. it is expected that in the next decade until 2030 the obesity rate will rise to 52.5% for children aged 5-19 years old. It is with utmost importance to emphasize that continuous monitoring of children's nutritional status and their risk of obesity is essential, as to further prevent obesity and overweight in the pediatric population.

Changes in anthropometric, biochemical, oxidative, and DNA damage parameters after 3-weeks-567-kcal-hospital-controlled-VLCD in severely obese patients with BMI ≥ 35 kg m-2

BACKGROUND & AIMS

Severe obesity and its comorbidities relate to increased genomic instability/cancer risk. Obesity in Croatia is rapidly increasing, and long diets are sometimes the reason for obese to quit health improvement programs. A shorter diet with more strict calorie reduction could also lead to weight reduction and health improvements, but data are scarce. We tested for the first time if a very low-calorie diet (VLCD) can improve anthropometric, biochemical and genomic stability parameters in severely obese with BMI ≥ 35 kg m^-2.

METHODS

22 participants were chosen among those regularly attending the hospital for obesity control, with no other previous treatment for bodyweight reduction. Under 24 h medical surveillance, patients received 3-weeks-567-kcal-hospital-controlled-VLCD composed of 50-60% complex carbohydrates, 20-25% proteins, and 25-30% fat, with the attention to food carbo-glycemic index, in 3 meals freshly prepared in hospital. We analyzed changes in body weight, BMI, basal metabolism rate, waist-hip ratio, visceral fat level, body fat mass, percent body fat, skeletal muscle mass, basal metabolism, energy intake, lipid profile, thyroid hormones, TSH, and genomic instability (alkaline and oxidative FPG comet assay) before and on the last VLCD day.

RESULTS

Diet caused BMI reduction (in average 3-4 BMI units' loss), excessive weight loss (between 10 and 35%), significant weight loss (average 9 kg, range 4.8-14.4 kg) and a significant decrease in glucose, insulin, urea, cholesterol, HDL-c, LDL-c, oxidative (FPG) and DNA damage (alkaline comet assay) levels.

CONCLUSIONS

The diet can lead to ≥10% excessive weight loss, significant health, and genomic stability improvement, and keep severely obese interest in maintaining healthy habits. The study was registered at ClinicalTrials.gov as NCT05007171 (10.08.2021).

A Serious Game for the Prevention of Obesity in School Children–Impact of Parent’s Involvement: A Randomized Controlled Trial

Serious games convey information and use interactive components to reinforce and train behaviours. A serious game addressing nutrition, physical activity and stress coping—the Kids Obesity Prevention Program (KOP)—was previously evaluated for efficacy in children. This study aimed at evaluating the KOP-game regarding: (i) its acceptance and efficacy with respect to parents of primary school children receiving the same game intervention as the children; and (ii) whether the children could benefit by parental involvement. A randomized controlled trial with two groups of children aged 9 to 12 years was conducted which included a 6-month follow-up period. All children played the game twice in two weeks. In the family-intervention group, the parents additionally played the game. The primary outcome was the gain in knowledge in parents and children measured with a pretested questionnaire. The secondary outcomes were knowledge maintenance as well as several behavior changes. Parents and children in both groups improved and maintained their knowledge equally. The KOP-game increases knowledge of nutrition in children independently of the involvement of their parents. KOP games are well accepted in children; further research should examine the structured involvement of parents.

Does the socio-demographic profile of patients limit access to bariatric surgery?

PURPOSE

Surgery remains the only treatment allowing for a significant and sustainable weight loss in case of severe obesity. Patients undergo a specific multidisciplinary preparation and selection before the operation. This study aims to correlate the psychosocial profile with the likelihood of undergoing bariatric surgery in patients enrolled in the preparation program of a Swiss reference center.

METHODS

All patients referred to an obesity center between January 1, 2016, and June 30, 2017, seeking a first bariatric procedure were included. Socio-demographic data, BMI, preoperative psychological and dietary evaluations were collected. Usually, the preoperative process lasts 1 year. Patients who left the preparation or who had not undergone surgery after more than 2 years of follow-up were considered withdrawers. Surgery completion predictors were reviewed with bivariate analysis and socio-demographic clusters established using the K-means method.

RESULTS

Out of a total of 221 patients, 99 (45%) patients had not undergone bariatric surgery 2 years after their first consultation. The patients were divided into four distinct socio-demographic clusters, among which a particularly deprived one. Criteria such as unfavorable psychological (p < 0.001) and dietary (p < 0.001) evaluations, and male gender (p < 0.05) were significantly associated with non-operation, unlike socio-demographic indicators and clusters (p > 0.1).

CONCLUSION

Almost half of the patients starting a bariatric program are not operated on, which is related to an unfavorable psychological or dietary evaluation and to the male gender. This study also demonstrates that a significant share of patients combines several factors of social deprivation, without influencing the likelihood of surgery completion.

LEVEL OF EVIDENCE

Level V: Descriptive study.

Novel Bacillus ginsengihumi CMRO6 Inhibits Adipogenesis via p38MAPK/Erk44/42 and Stimulates Glucose Uptake in 3T3-L1 Pre-Adipocytes through Akt/AS160 Signaling

The health benefits of probiotics have been known for decades, but there has only been limited use of probiotics in the treatment of obesity. In this study, we describe, for the first time, the role of cell-free metabolites (CM) from Bacillus ginsengihumi-RO6 (CMRO6) in adipogenesis and lipogenesis in 3T3-L1 pre-adipocytes. The experimental results show that CMRO6 treatment effectively reduced lipid droplet accumulation and the expression of CCAAT/enhancer-binding protein α and β (C/EBPα and C/EBPβ), peroxisome proliferator-activated receptor γ (PPAR-γ), serum regulatory binding protein 1c (SREBP-1c), fatty acid-binding protein 4 (FABP4), fatty acid synthase (FAS), acetyl CoA carboxylase (ACC), phosphorylated p38MAPK, and Erk44/42. Additionally, CMRO6 treatment significantly increased glucose uptake and phosphorylated Akt (S473), AS160, and TBC1D1 protein expressions. Considering the results of this study, B. ginsengihumi may be a novel probiotic used for the treatment of obesity and its associated metabolic disorders.

Personalized Self-Monitoring of Energy Balance through Integration in a Web-Application of Dietary, Anthropometric, and Physical Activity Data

Self-monitoring of weight, diet and physical activity is a valuable component of behavioral weight loss treatment. The validation and user-friendliness of this approach is not optimal since users are selected from homogeneous pools and rely on different applications, increasing the burden and achieving partial, generic and/or unrelated information about their metabolic state. Moreover, studies establishing type, time, duration, and adherence criteria for self-monitoring are lacking. In this study, we developed a digital web-based application (ArmOnIA), which integrates dietary, anthropometric, and physical activity data and provides a personalized estimation of energy balance. Moreover, we determined type, time, duration, and adherence criteria for self-monitoring to achieve significant weight loss in a highly heterogeneous group. A single-arm, uncontrolled prospective study on self-monitored voluntary adults for 7 months was performed. Hierarchical clustering of adherence parameters yielded three behavioral approaches: high (HA), low (LA), and medium (MA) adherence. Average BMI decrease is statistically significant between LA and HA. Moreover, we defined thresholds for the minimum frequencies and duration of dietary and weight self-monitoring. This approach can provide the correct clues to empower citizens with scientific knowledge, augmenting their self-awareness with the aim of achieving long-lasting results when pursuing a healthy lifestyle.

Addressing the gaps in nutritional care before and during pregnancy

The present paper outlines current issues in the nutritional care of women during pregnancy and potential resources to address them. Globally, overnutrition, undernutrition and nutritional imbalances are widespread among women of reproductive age; increasing the risk of pregnancy complications and non-communicable diseases in both mothers and their children. Most women do not meet dietary guidelines for pregnancy. The World Health Organisation (WHO) recommends nutrition and weight counselling during pregnancy for all women. However, clinical practices focusing on nutrition vary and there is no consensus on which outcomes are most important for pregnancy nutrition interventions, with little consideration for the 'patient voice'. The International Federation of Gynaecology and Obstetrics (FIGO) nutrition checklist is a clinical practice tool that is available for healthcare professionals that will address this issue. The pregnancy nutrition core outcome set will also support advancement of antenatal nutrition by identifying the most critical nutrition-related outcomes from the perspective of healthcare professionals, researchers and women with experience of pregnancy. While poor nutrition can result in adverse outcomes across women of all weight categories, those with obesity may require specialist care to reduce their risk. Obesity is a chronic, progressive, relapsing disease that has high individual variability in its prognosis. The use of obesity staging systems, which consider mental, physical and functional health, can stratify individuals into risk categories and aid in treatment prioritisation in pregnancy. As the prevalence of obesity continues to rise, an obesity staging approach may support clinicians, especially those in limited resource settings.

Diet and Lifestyle Habits in Early-Onset Colorectal Cancer: A Pilot Case-Control Study

BACKGROUND

Early-onset colorectal cancer (eoCRC), defined as a colorectal cancer (CRC) in patients younger than 50 years old, shows an increasing incidence worldwide in the latest years. The role of exogenous factors associated with CRC has been largely overlooked in eoCRC. Here, we conducted a case-control study to evaluate the diet and the lifestyle habits in an Italian population of patients with eoCRC, compared to age-matched healthy controls (HCs).

METHODS

We enrolled 118 subjects (47 cases, 71 controls) in a third-level academic hospital. We analyzed epidemiological features (age, sex, body mass index), lifestyle behaviors (smoking habits, physical activity, type of diet, use of dietary supplements), and eating habits (semiquantitative food-frequency questionnaire) in eoCRCs and HCs, covering the previous 5 years.

RESULTS

In our cohort, positive family history of CRC was significantly associated with the development of eoCRC (p = 0.004). Fresh meat (p = 0.003), processed meat (p < 0.001), dairy products (p = 0.013), and smoking (p = 0.0001) were significantly associated with eoCRC compared to controls. Other variables did not differ significantly between the two groups.

CONCLUSION

Fresh and processed meat, dairy products, and smoking could be considered significant risk factors for eoCRC, although further confirmation by international multicenter studies is desirable. Diet and smoking could be the main areas of future interventions for eoCRC primary prevention.

Human transgenerational observations of regular smoking before puberty on fat mass in grandchildren and great-grandchildren

Previously, using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) we showed that sons of fathers who had started smoking regularly before puberty (< 13 years) had increased fat mass during childhood, adolescence, and early adulthood. We now show that if the paternal grandfather had started smoking pre-puberty, compared with later in childhood (13–16 years), his granddaughters, but not grandsons, had evidence of excess fat mass at two ages: mean difference + 3.54 kg; (P with 1-tailed test) = 0.043 at 17 years, and + 5.49 kg; (P₁ = 0.016) at age 24. When fathers of maternal grandfathers had started smoking pre-puberty, their great-granddaughters, but not great-grandsons, had excess body fat: + 5.35 kg (P₁ = 0.050) at 17, and + 6.10 kg (P₁ = 0.053) at 24 years. Similar associations were not found with lean mass, in a sensitivity analysis. To determine whether these results were due to the later generations starting to smoke pre-puberty, further analyses omitted those in subsequent generations who had smoked regularly from < 13 years. The results were similar. If these associations are confirmed in another dataset or using biomarkers, this will be one of the first human demonstrations of transgenerational effects of an environmental exposure across four generations.

Transcriptome study of receptive endometrium in overweight and obese women shows important expression differences in immune response and inflammatory pathways in women who do not conceive

Obesity and being overweight are growing worldwide health problems that also affect women of reproductive age. They impair women’s fertility and are associated with lower IVF success rates. The mechanism by which increased body weight disrupts fertility has not yet been established. One possibility is that it affects the process of embryo implantation on the endometrial level. The purpose of our study was to determine the differences in enriched biological pathways in the endometrium of overweight and obese women undergoing IVF procedures. For this purpose, 14 patients (5 pregnant, 9 non-pregnant) were included in the study. Endometrial samples were obtained during the window of implantation and RNA sequencing was performed. There were no differences in general patient’s and IVF cycle characteristics between pregnant and non-pregnant women. In the endometrial samples of women who did not conceive, pathways related to the immune response, inflammation, and reactive oxygen species production were over-expressed. Our findings show that the reason for implantation failure in overweight and obese women could lie in the excessive immune and inflammatory response at the endometrial level.

Effects of a 3-Week Hospital-Controlled Very-Low-Calorie Diet in Severely Obese Patients

Although a very-low-calorie diet (VLCD) is considered safe and has demonstrated benefits among other types of diets, data are scarce concerning its effects on improving health and weight loss in severely obese patients. As part of the personalized weight loss program developed at the Duga Resa Special Hospital for Extended Treatment, Croatia, we evaluated anthropometric, biochemical, and permanent DNA damage parameters (assessed with the cytochalasin B-blocked micronucleus cytome assay-CBMN) in severely obese patients (BMI ≥ 35 kg m-2) after 3-weeks on a 567 kcal, hospital-controlled VLCD. This is the first study on the permanent genomic (in)stability in such VLCD patients. VLCDs caused significant decreases in weight (loss), parameters of the lipid profile, urea, insulin resistance, and reduced glutathione (GSH). Genomic instability parameters were lowered by half, reaching reference values usually found in the healthy population. A correlation was found between GSH decrease and reduced DNA damage. VLCDs revealed susceptible individuals with remaining higher DNA damage for further monitoring. In a highly heterogeneous group (class II and III in obesity, differences in weight, BMI, and other categories) consisting of 26 obese patients, the approach demonstrated its usefulness and benefits in health improvement, enabling an individual approach to further monitoring, diagnosis, treatment, and risk assessment based on changing anthropometric/biochemical VLCD parameters, and CBMN results.

Timing of parenteral nutrition in ICU patients: A transatlantic controversy

BACKGROUND AND AIMS

European and North American guidelines on Parenteral Nutrition (PN) and large Randomized Controlled Trials give divergent advices on nutritional therapeutic strategies for critically ill patients. We therefore investigated differences in therapeutic strategies of clinicians between European and Non-European Intensive Care Units (ICU) regarding start day of PN, preferred route of administration and prescription of total energy targets over the years.

METHODS

In this study 16,032 patients from 1389 different ICUs were included. Data collection was performed in 28 different European and Non-European ICUs from 2007 to 2018 via nutritionDay, a worldwide-standardized one-day multinational cross-sectional audit.

RESULTS

In this analysis an abrupt delay in PN start days was observed in 2011 (7.64 days (4.31; 19.97); p = 0.001) and 2012 (6.41 days (3.1; 9.72); p = 0.001), which was significantly reversed within the following years until 2018. In European, compared to Non-European countries PN prescription was increased (27% versus 13%). Patients from North-America received significantly less kcal per day compared to Europe (-4.3 kcal kg^-1 (-6.9; -1.6); p = 0.001).

CONCLUSIONS

Our study provides further evidence on transatlantic discrepancies in nutritional therapy of ICU patients. Regular audits, such as nutritionDay are substantial for self-reflection of clinical daily practice of intensivists. It is time for worldwide consensus in nutritional therapy by developing worldwide guidelines and supporting standardization in nutrition care of critically ill patients.

Transitioning to an obese India: Demographic and structural determinants of the rapid rise in overweight incidence

India, which has long suffered from undernutrition, has seen a rapid rise in overweight incidence in the last decade and a half. These changes are characterized by significant within-country differences in overweight incidence that vary by gender and regional development levels. In this paper, we provide an integrative framework, linking the income-gradient hypothesis of obesity with biological, obesogenic, and environmental factors to provide an explanation on the emergence of within-country differences in overweight patterns. We utilize measured body mass index (BMI), along with individual- and household-level data of over 800,000 men and women surveyed in the National Family Health Surveys of 2005-06 and 2015-16 to identify correlates of within-country differences in overweight incidence. A decomposition analysis reveals that among women, in addition to increasing access to obesogenic technologies, biological factors are associated with overweight incidence. Among men, obesogenic factors related to technology use and health behaviors are associated with the rise in overweight incidence, but biological factors are not. At lower levels of regional development, overweight incidence is associated with greater access to obesogenic technology such as motorized transport, which reduces physical activity among men at higher rates than women. At higher levels of economic development, obesogenic behaviors, such as watching more television and reducing smoking, are associated with overweight incidence. Our results corroborate the call by public health experts for group-specific policies to stem the rise of overweight incidence in developing countries.

The Role of Socioeconomic Status in Adherence to the Mediterranean Diet and Body Mass Index Change: A Follow-Up Study in the General Population of Southern Croatia

The Mediterranean diet (MD) is one of the most healthful dietary patterns, beneficial for humans and the environment. However, the MD has recently exhibited a declining trend, especially in younger and less affluent people. This study investigated the association between socioeconomic indicators and adherence to the MD in 4671 adult subjects from Dalmatia, Croatia (age range 18–98 years; 61.9% were women). Additionally, in the follow-up we examined the change in adherence to the MD and in BMI (subsample, N = 1342; 62.5% were women; mean follow-up time of 5.8 years). The adherence to the MD was based on the Mediterranean Diet Serving Score (range 0–24 points, cut-off value ≥ 14 points), with a prevalence in the overall sample of 28.5%. Higher odds of adherence to the MD were recorded in women, older subjects, and those with higher level of objective material status, while it was less likely in the period after economic crisis of 2007–2008. Additionally, we detected no change in adherence to the MD in the follow-up subsample (−8.5%, p = 0.056), but there was an increase in BMI (+6.5%, p < 0.001). We recorded an increase in adherence for nuts (+127.5%), sweets (+112.6%), red meat (+56.4%), and wine (+50.0%), unlike the reduction in adherence for vegetables (−35.1%), fish (−23.4%), white meat (−11.6%), cereals (−10.9%), and dairy products (−9.6%). Similar results were obtained across all quartiles of objective material status. Over time, the absolute change in the MD score was positively associated with female gender, age, higher education, and moderate physical activity, but it was negatively associated with adherence to the MD at baseline. BMI change was positively associated with female gender, and negatively with initial BMI, initial adherence to the MD, and MD change. Our findings point towards a less than ideal adherence to the MD in the general population of southern Croatia, and identify important characteristics associated with adherence change over time, informing necessary interventions aimed at increasing MD uptake.

Social inequalities in obesity and overweight: secular changes in Poland between 1983 and 2020

BACKGROUND

Human development is strongly influenced by environmental factors, including the socioeconomic status (SES) of the family. The aim of this study is to analyze the prevalence of excess body weight among Polish children and adolescents from families of varying SES examined in 1983 and 2020.

METHODS

The study group included 3-15-year olds from two cross-sectional surveys (1983 and 2020) conducted in kindergartens and schools. The 1983 cohort consisted of 3394 individuals and the one from 2020-of 1253 children and adolescents. Body height and weight were measured and body mass index was calculated. Inclusion into underweight, normal weight and overweight/obese categories was based on Cole's cutoff points. SES was established based on the place of the parents' birth, parents', education status and the number of children in the family, which were self-reported in a questionary by the parents of the examined individuals.

RESULTS

The mean overall SES was higher in the 2020 cohort, in comparison to the one examined in 1983. This change was also reflected by the changing prevalence of excess body weight, which, in 1983 was the greatest in the high socioeconomic category. On the other hand, in 2020 overweight/obesity was the most prevalent among individuals from families of low SES.

CONCLUSIONS

The present results confirm the findings obtained in other countries, which suggest that changing the level of socioeconomic development modifies the changes regarding the prevalence of excess body weight. It is an important observation because a study of this type has not yet been conducted in the Polish population.

Public Perceptions of the Role of Lifestyle Factors in Cancer Development: Results from the Spanish Onco-Barometer 2020

The European Code against Cancer recommends not to smoke, to avoid alcohol consumption, to eat a healthy diet, and maintain a healthy weight to prevent cancer. To what extent is the public aware of the influence of these lifestyle factors on cancer development? The goal of the current study was to describe the perceived influence of four lifestyle factors (tobacco, alcohol, diet, and weight) on cancer development in the general population and identify factors related to low perceptions of influence. We analyzed data from the 2020 Onco-barometer (n = 4769), a representative population-based survey conducted in Spain. With the exception of smoking, lifestyle factors were among those with the least perceived influence, more so among the demographic groups at higher risk from cancer including men and older individuals (65+ years). Individuals from lower socio-economic groups were more likely to report not knowing what influence lifestyle factors have on cancer. Lower perceived influence was also consistently related to perceiving very low risk from cancer. Overall, although there is variation in perceptions regarding the different lifestyle factors, low perceived influence clusters among those at higher risk for cancer. These results signal the need for public health campaigns and messages informing the public about the preventive potential of lifestyle factors beyond avoiding tobacco consumption.

Enhancing community weight loss groups in a low socioeconomic status area: Application of the COM-B model and Behaviour Change Wheel

Background

Obesity rates are higher among people of lower socioeconomic status. While numerous health behaviour interventions targeting obesity exist, they are more successful at engaging higher socioeconomic status populations, leaving those in less affluent circumstances with poorer outcomes. This highlights a need for more tailored interventions. The aim of this study was to enhance an existing weight loss course for adults living in low socioeconomic communities.

Methods

The Behaviour Change Wheel approach was followed to design an add‐on intervention to an existing local authority‐run weight loss group, informed by mixed‐methods research and stakeholder engagement.

Results

The COM‐B analysis of qualitative data revealed that changes were required to psychological capability, physical and social opportunity and reflective motivation to enable dietary goal‐setting behaviours. The resulting SMART‐C booklet included 6 weeks of dietary goal setting, with weekly behavioural contract and review.

Conclusion

This paper details the development of the theory‐ and evidence‐informed SMART‐C intervention. This is the first report of the Behaviour Change Wheel being used to design an add‐on tool to enhance existing weight loss services. The process benefitted from a further checking stage with stakeholders.