Effects of Moderate and Subsequent Progressive Weight Loss on Metabolic Function and Adipose Tissue Biology in Humans with Obesity

Real-world use and effectiveness of tirzepatide among individuals without type 2 diabetes: Results from the Optum Market Clarity database

AIMS

To understand real-world tirzepatide utilization and effectiveness (change in weight and body mass index [BMI]) among people without type 2 diabetes (T2D) in the United States.

MATERIALS AND METHODS

This retrospective, observational study used Optum's de-identified Market Clarity database (index date: first-observed tirzepatide claim; index period: 13 May 2022-30 September 2023). Outcomes were assessed in 3 cohorts: (1) Overall cohort: age ≥18 years; ≥1 tirzepatide claim; no baseline T2D diagnosis codes, anti-diabetes medication use (except metformin) or glycated haemoglobin ≥6.5%; continuous medical and pharmacy enrolment for ≥12 months pre-index. (2) Utilization cohort: all above criteria and anti-obesity medication (AOM)-eligible individuals (BMI ≥30 kg/m2, or ≥27 kg/m2 with ≥1 obesity-related complication [ORC]) for assessment of tirzepatide utilization (persistence, discontinuation, dose escalation and switching 6 months post-index). (3) Effectiveness cohort: all above criteria and AOM-eligible glucagon-like peptide-1 receptor agonist (GLP-1 RA)-naive individuals persistent on tirzepatide for ≥6 months with pre- and post-index weight and BMI measurements for assessment of tirzepatide effectiveness (mean absolute and percent bodyweight/BMI change from baseline and bodyweight/BMI reduction ≥5%, ≥10%, ≥15% and ≥20%). All analyses were descriptive.

RESULTS

Overall cohort included 20,998 individuals (mean age: 47.4 years, female: 74.9%, mean BMI: 36.9 kg/m2). At index, 66.0% of individuals had ≥1 ORC, while 44.4% had ≥2 ORCs. Persistence in the utilization cohort was 55.4%; 30.8% switched to a different AOM/GLP-1 RA analogue or restarted tirzepatide after discontinuation, and by the sixth prescription fill, 74.2% were on <10 mg tirzepatide. Mean weight reduction in the effectiveness cohort was 11.9% at 6 months post-index (≥5%: 85.8%; ≥10%: 61.5%).

CONCLUSIONS

Real-world evidence suggests multimorbidity is common among tirzepatide initiators. While tirzepatide dose escalation was slower than in clinical trials, individuals achieved weight reduction at 6 months, consistent with clinical trials.

Semaglutide and bariatric surgery induce distinct changes in the composition of mouse white adipose tissue

Adipose tissue is a central player in energy balance and glucose homeostasis, expanding in the face of caloric overload in order to store energy safely. If caloric overload continues unabated, however, adipose tissue becomes dysfunctional, leading to systemic metabolic compromise in the form of insulin resistance and type 2 diabetes. Changes in adipose tissue during the development of metabolic disease are varied and complex, made all the more so by the heterogeneity of cell types within the tissue. Here we present detailed comparisons of atlases of murine WAT in the setting of diet-induced obesity, as well as after weight loss induced by either vertical sleeve gastrectomy (VSG) or treatment with the GLP-1 receptor agonist semaglutide. We focus on identifying populations of cells that return to a lean-like phenotype versus those that persist from the obese state, and examine pathways regulated in these cell types across conditions. These data provide a resource for the study of the cell type changes in WAT during weight loss, and paint a clearer picture of the differences between adipose tissue from lean animals that have never been obese, versus those that have.

Characterization of the effect of naltrexone/bupropion on body composition

AIMS

Oral treatment extended-release naltrexone/bupropion (NB) leads to significant weight loss, but its effect on body composition remains unclear. We investigated changes in body composition with dual-energy x-ray absorptiometry after treatment with NB or placebo in a subgroup of participants from a randomized control phase 3 study (COR-I).

MATERIALS AND METHODS

Observed changes from baseline to week 52 were estimated for total, lean, and fat mass. Changes in body composition were evaluated using linear regression and adjusted for baseline covariates.

RESULTS

The analysis included 82 participants (placebo, n = 26; NB, n = 56) with comparable baseline characteristics (age, BMI, sex). The NB group experienced a significant -7.8% change of total mass (-12.9% change in fat mass and -4.1% in lean mass), compared with a -2.8% change of total mass (-4.8% change in fat mass and -1.4% in lean mass) in the placebo group. The adjusted changes in lean-to-fat mass ratio of 0.069 in the NB group and -0.056 in the placebo group were significantly different (p < 0.05).

CONCLUSIONS

NB-induced weight loss is associated with significant reductions in total percent fat mass, increase in total percent lean mass, and change in lean-to-fat mass ratio, in comparison to placebo. Larger studies are needed to further elucidate the clinical significance of these changes and impact of a potentially healthier metabolism.

Optimized RNA sequencing deconvolution illustrates the impact of obesity and weight loss on cell composition of human adipose tissue

OBJECTIVE

Cellular heterogeneity of human adipose tissue is linked to the pathophysiology of obesity and may impact the response to energy restriction and changes in fat mass. Herein, we provide an optimized pipeline to estimate cellular composition in human abdominal subcutaneous adipose tissue (ASAT) bulk RNA sequencing (RNA-seq) datasets using a single-nuclei RNA-seq signature matrix.

METHODS

A deconvolution pipeline for ASAT was optimized by benchmarking publicly available algorithms using a signature matrix derived from ASAT single-nuclei RNA-seq data from 20 adults and then applied to estimate ASAT cell-type proportions in publicly available obesity and weight loss studies.

RESULTS

Individuals with obesity had greater proportions of macrophages and lower proportions of adipocyte subpopulations and vascular cells compared with lean individuals. Two months of diet-induced weight loss increased the estimated proportions of macrophages; however, 2 years of diet-induced weight loss reduced the estimated proportions of macrophages, thereby suggesting a biphasic nature of cellular remodeling of ASAT during weight loss.

CONCLUSIONS

Our optimized high-throughput pipeline facilitates the assessment of composition changes of highly characterized cell types in large numbers of ASAT samples using low-cost bulk RNA-seq. Our data reveal novel changes in cellular heterogeneity and its association with cardiometabolic health in humans with obesity and following weight loss.

Effect of interdisciplinary obesity care on metabolic markers and body weight in people with type 2 diabetes in a rural setting: A randomised controlled trial

Management of type 2 diabetes includes medications that can unintentionally increase obesity and insulin resistance. This unblinded, single-centre, randomised controlled trial focused on rural Australian adults with type 2 diabetes (aged 18-75 and body mass index [BMI] >30 kg/m2), measuring the effectiveness of a tailored interdisciplinary obesity care approach compared with usual diabetes care. Led by a nurse practitioner with allied health support (dietitian ± psychologist and physiotherapist), the bariatric treatment involved reducing weight-gaining medications, a 500-calories/day deficit, an unsupervised exercise program emphasising movement/strength and psychotherapy, 3-monthly to 24-months with support phone calls at weeks 2, 4, 8 and 10. Outcomes from the 224 (113 intervention/111 control) participants were differences in biomedical and physical markers within- and between-groups estimated using multivariate mixed-effects linear regression between recruitment and 6-monthly follow-ups. Greater change occurred in intervention compared with control groups at 12 and 24 months in mean: body weight (-5.9 kg [95% confidence interval, CI: -8.53, -3.23] and -9.0 kg [95% CI: -13.2, -4.77]); BMI (-2.03 kg/m2 [95% CI: -2.92, -1.15] and -3.51 kg/m2 [95% CI: -4.93, -2.08]); and glycated haemoglobin (-0.26% [95% CI: -0.69%, 0.18%] and -0.63% [95% CI: -1.17%, 0.08%]). The control group showed a significant increase in mean leptin level, resulting in a between-group difference (-27.1 [95% CI: -42.7, -11.5]). Lipids and blood pressure differences were inconclusive, while exploratory analysis showed greater decline in estimated glomerular filtration rate in the control group. The interdisciplinary obesity approach, compared with usual diabetes care, resulted in sustained weight loss and improved diabetes control over 2 years. Trial registration number: ACTRN12622000240741.

Resistance and Impact Training During Weight Loss Improves Physical Function and Body Composition in Older Adults With Obesity

BACKGROUND

Weight loss achieved via energy restriction leads to significant losses in muscle and bone mass, potentially increasing risk for sarcopenia and osteoporosis. High-intensity resistance and impact training (HiRIT) might attenuate weight loss-induced musculoskeletal declines. Our objective was to compare changes in physical function and body composition in older adults with obesity undertaking dietary weight loss combined with HiRIT or aerobic training (AT).

METHODS

Sixty older adults (aged ≥ 60 years) with obesity (dual-energy x-ray absorptiometry determined body fat percentage ≥ 30% in men and ≥ 40% in women) and a mobility limitation (Short Physical Performance Battery [SPPB] score ≤ 11) were randomly assigned to either 12 weeks of supervised, centre-based HiRIT or self-directed, home-based AT while consuming a hypocaloric diet (750-1000 kcal/day reduction in energy intake). Changes in physical function (primary outcome: gait speed) and body composition were compared between groups.

RESULTS

A total of 49/60 randomised participants (mean age: 69.6 ± 6 years; 58% women; mean BMI: 32.9 ± 4.1 kg/m2) completed the trial. Gait speed increased following HiRIT compared with AT (mean difference: 0.07 m/s [95% CI: 0.01, 0.13]). Chair stand times decreased in both groups (HiRIT: -1.3 s [95% CI: -2.1, -0.4] vs. AT: -0.8 s [95% CI: -1.6, -0.04]) and HiRIT, but not AT, increased handgrip strength (HiRIT: 2.2 kg [95% CI: 0.6, 3.9] vs. AT: 0.7 kg [95% CI: -0.9, 2.3]) and SPPB scores (HiRIT: 0.9 [95% CI: 0.4, 1.3] vs. AT: 0.4 [95% CI: -0.04, 0.8]). Similar decreases in total body mass (HiRIT: -5.1 kg [95% CI: -6.7, -3.4] vs. AT: -4.9 kg [95% CI: -6.5, -3.3]), fat mass (HiRIT: -3.6 kg [95% CI: -5.0, -2.2] vs. AT: -3.3 kg [95% CI: -4.7, -2.0]), visceral fat (HiRIT: -32.1 cm2 [95% CI: -47.4, -16.8] vs. AT: -31.4 cm2 [95% CI: -46.1, -16.8]) and appendicular lean mass (HiRIT: -0.8 kg [95% CI: -1.4, -0.2] vs. AT: -1.2 kg [95% CI: -1.8, -0.6]) were observed. HiRIT was well tolerated with only seven minor adverse events compared with five reported in those who completed AT.

CONCLUSION

HiRIT appears to be safe and more effective than AT for improving gait speed in older adults with obesity undertaking dietary weight loss. Additional trials with larger sample sizes and longer durations are warranted to explore whether HiRIT can attenuate weight loss-related muscle and bone mass declines.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials: ACTRN12618001146280.

Very low-calorie ketogenic diet reduces central blood pressure and cardiometabolic risk in post-menopausal women with essential hypertension and obesity: a single-center, prospective, open-label, clinical study

BACKGROUND AND AIMS

Obesity represents a crucial modifiable risk factor for cardiovascular complications. Two dietary approaches, Very Low-Calorie Ketogenic (VLCKD) and Intermittent Fasting (IFD) diets, have demonstrated to reduce blood pressure (BP) and produce cardiovascular and metabolic advantages. We aimed to evaluate the effects of VLCKD or IFD compared to Free Diet (FD) on office brachial and central systolic BP levels. Secondary outcomes included changes from baseline of diastolic BP and several weight-related indexes.

METHODS AND RESULTS

In this single-center, open-label, prospective clinical study, post-menopausal women with treated uncomplicated hypertension and obesity were assigned to 3 dietary programs: VLCKD, IF, and FD. All patients underwent BP measurements, dietary consultation with personalized dietary program, and blood tests for metabolic parameters. All outcome variables were measured at baseline (T0), two (T1) and six months (T2). We included 18 patients in the VLCKD, 16 in the IFD and 9 in the FD groups, respectively. At T2 VLCKD patients showed significantly lower brachial systolic (p = 0.005) and diastolic (p = 0.038), central systolic (p = 0.02) and diastolic (p = 0.03) BP levels than those in other groups. VLCKD also induced reductions in weight (p = 0.03), WC (p < 0.01), WHR (p < 0.01), BFP (p < 0.01); TOT-C (p = 0.01), LDL-C (p < 0.01), and triglycerides (p = 0.02). No relevant changes were observed in IF and FD groups.

CONCLUSIONS

KD emerged as the clear front-runner in reducing brachial and central office systolic/diastolic BP levels and weight-related parameters in post-menopausal women with treated hypertension and obesity.

Subcutaneous adipose tissue and skeletal muscle mitochondria following weight loss

Obesity is a major global health issue with various metabolic complications. Both bariatric surgery and dieting achieve weight loss and improve whole-body metabolism, but vary in their ability to maintain these improvements over time. Adipose tissue and skeletal muscle metabolism are crucial in weight regulation, and obesity is linked to mitochondrial dysfunction in both tissues. The impact of bariatric surgery versus dieting on adipose tissue and skeletal muscle mitochondrial metabolism remains to be elucidated. Understanding the molecular pathways that modulate tissue metabolism following weight loss holds potential for identifying novel therapeutic targets in obesity management. This narrative review summarizes current knowledge on mitochondrial metabolism following bariatric surgery and diet-induced weight loss in adipose tissue and skeletal muscle, and sheds light on their respective effects.

Non-pharmacological management strategies for type 2 diabetes in children and young adults: A systematic review

PURPOSE

The evidence for effective non-pharmacological management of type 2 diabetes in children and young adults is scarce. This systematic review aims to identify the available evidence for non-pharmacological interventions in managing type 2 diabetes in children and young adults.

METHODS

A systematic search of OVID MEDLINE, Ovid Emcare, EMBASE, CINAHL, Cochrane, APA PsycINFO, Joanna Briggs, ACP Journal Club, Global Health, Scopus databases, INFORMIT, Circumpolar Health, Native Health Database, Indigenous Studies Portal, OpenGrey and Clinicaltrials.gov was performed up to March 2024. Information on author, year, study design, setting and population, intervention characteristics, and results were extracted by three reviewers independently.

RESULTS

Seven studies met criteria for inclusion. Very low-energy diet (VLED) was associated with reduction in hemoglobin A1c (HbA1c), weight, and body mass index (BMI). No other interventions (intensive group-based lifestyle program, occupational-therapist conducted support program or peer support program) improved HbA1c. Interventions positively impacted well-being, mental health and cardiometabolic outcomes.

DISCUSSION

Evidence for non-pharmacological management of youth onset type 2 diabetes is scarce. Available evidence demonstrated that VLED is associated with improved glycemia and weight loss. The role of social support from peers, family, and health professionals shows mixed results.

Personalized predictions to identify individuals most likely to achieve 10% weight loss with a lifestyle intervention

OBJECTIVE

The objective of this study is to generate an algorithm for making predictions about individual treatment responses to a lifestyle intervention for weight loss to maximize treatment effectiveness and public health impact.

METHODS

Using data from Action for Health in Diabetes (Look AHEAD), a national, multisite clinical trial that ran from 2001 to 2012, and machine-learning techniques, we generated predicted individual treatment effects for each participant. We tested for heterogeneity in treatment response and computed the degree to which treatment effects could be improved by targeting individuals most likely to benefit.

RESULTS

We found significant individual differences in effects of the Look AHEAD intervention. Based on these predictions, two-thirds of the sample was predicted to experience a treatment effect within ±2% weight loss from the average treatment effect. If the treatment was targeted to the 69% of patients expected to meet a 7% weight-loss target at 1-year follow-up, the average treatment effect increases, with 10% average observed weight loss in the intervention group.

CONCLUSIONS

The Look AHEAD intervention would achieve a 10% average weight reduction if targeted to those most likely to benefit. Future research must seek external validation of these predictions. We make this algorithm available with instructions for use to demonstrate its potential capacity to inform shared decision-making and patient-centered care.

Weight Management Strategies to Reduce Metabolic Morbidity in Women With Polycystic Ovary Syndrome

PURPOSE OF REVIEW

Polycystic Ovary Syndrome (PCOS) affects 10-15% of women of reproductive age and is associated with a heightened risk of metabolic morbidity, exacerbated by insulin resistance and obesity. Current weight management strategies have limited effectiveness in reducing metabolic morbidity in this subgroup. This review examines the potential of Intensive Weight Management Programmes (IWMPs) and Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to reduce metabolic risks in women with PCOS, drawing from studies in both PCOS-specific and related populations.

RECENT FINDINGS

IWMPs, including total diet replacement, achieve substantial and sustained weight loss (5-15% over 1-5 years) in individuals with obesity and type 2 diabetes, alongside improvements in metabolic markers like blood pressure and glycemic control. GLP-1 RAs, particularly semaglutide, similarly deliver significant weight loss (10-15% over 1-2 years) and metabolic benefits. While there is limited data specifically targeting PCOS, emerging studies suggest GLP-1 RAs can improve weight, insulin sensitivity, and menstrual regularity in this group. However, evidence for both interventions in PCOS remains insufficient. Women with PCOS face unique metabolic challenges, including heightened insulin resistance, compounded by obesity. While IWMPs and GLP-1 RAs are promising interventions, evidence for their effectiveness in PCOS-specific populations is insufficient. Addressing this research gap through targeted trials is essential to improve outcomes in individuals affected by PCOS and metabolic disorders.

Weight and cardiometabolic effects of a novel oral shape-shifting superabsorbent hydrogel capsule: Prespecified and exploratory analysis of the Epitomee capsule RESET study

Background

Management of obesity potentially improves cardiometabolic risk factors in patients with metabolic syndrome (MetS). The Epitomee capsule is a non-pharmacological, biodegradable device treatment for weight reduction in patients with overweight and obesity.

Methods

This secondary analysis of the Randomized Evaluation of Safety and Efficacy of the Epitomee capsule Trial (RESET) (a randomized, 24-week, multicenter, placebo-controlled, double-blind trial that enrolled 279 adults aged ≥18 years with a BMI of 27-40 kg/m2) evaluated changes in cardiometabolic parameters in participants treated with Epitomee or placebo combined with lifestyle counseling among (a) the entire RESET study population, and (b) participants meeting diagnostic criteria for prediabetes. Predefined and exploratory endpoints included changes in waist circumference, glycemic parameters, blood pressure, and lipid blood levels; this analysis also assessed percent weight loss in participants with MetS.

Results

Waist circumference, systolic and diastolic blood pressure and some measures of glycemia and lipids, improved with both Epitomee and placebo with no significant differences. Participants with prediabetes treated with Epitomee showed significantly greater reductions in HOMA-IR (p < 0.007) and insulin levels (p < 0.003) than the placebo group. Participants with MetS at baseline experienced significantly greater percent change in initial weight when treated with the Epitomee capsule (n = 27) compared to placebo (n = 31), -8.3% vs -5.2 %, respectively (p < 0.0004). Similar percentages of participants with MetS in both groups achieved ≥5 % weight reduction (59.3 % and 54.8 %, in Epitomee and placebo groups respectively). Significantly more participants with MetS treated with Epitomee achieved ≥10 % weight reduction compared with those treated with placebo (40.7 % vs. 6.5 %, respectively, p < 0.002).

Conclusion

Treatment with either Epitomee and placebo combined with lifestyle improve cardiometabolic risk factors. Compared to placebo, Epitomee significantly reduced HOMA-IR and insulin levels in participants with prediabetes. Among participants with MetS, Epitomee significantly reduced body weight [ClinicalTrials.gov ID NCT04222322].

Adipose Tissue Biology and Effect of Weight Loss in Women With Lipedema

Lipedema is a lipodystrophic disease that is typically characterized by a marked increase in lower-body subcutaneous adipose tissue that is purported to have increased inflammation and fibrosis, have impaired microvascular/lymphatic circulation, and be resistant to reduction by weight loss therapy. However, these outcomes have not been adequately studied. We evaluated body composition, insulin sensitivity, metabolic health, and adipose tissue biology in women with obesity and lipedema (Obese-LIP) before and after moderate (∼9%) diet-induced weight loss. At baseline, people with Obese-LIP had ∼23% greater leg fat mass, ∼11% lower android-to-gynoid ratio, and ∼48% greater insulin sensitivity (all P < 0.05) than women matched on age, BMI, and whole-body adiposity. In Obese-LIP, macrophage content and expression of genes involved in inflammation and fibrosis were greater, whereas lymph/angiogenesis-related genes were lower in thigh than abdominal subcutaneous adipose tissue. Weight loss improved insulin sensitivity and decreased total fat mass, with similar relative reductions in abdominal and leg fat masses, but without changes in markers of inflammation and fibrosis. These results demonstrate that affected adipose tissue in women with lipedema is characterized by increased inflammation and fibrogenesis, and alterations in lymphatic and vascular biology. Moderate diet-induced weight loss improves metabolic function and decreases lower-body adipose tissue mass.

ARTICLE HIGHLIGHTS

We sought to increase our understanding of the pathophysiology of lipedema and the effects of weight loss. We examined whether there are differences in upper- and lower-body adipose tissue biology in lipedema and whether adipose tissue is affected by weight loss. Women with obesity and lipedema have decreased expression of genes related to lymphatic/vascular function and increased expression of genes related to fibrosis and inflammation in thigh compared with abdominal subcutaneous adipose tissue; weight loss increased insulin sensitivity and decreased leg fat but did not affect adipose tissue inflammation or fibrosis. Weight loss should be the first-line therapy for women with obesity and lipedema.

Efficacy of the PanCareFollowUp eHealth Lifestyle Intervention for Survivors of Childhood, Adolescent and Young Adult Cancer

PURPOSE

A healthy lifestyle may prevent or mitigate late effects in childhood, adolescent and young adult (CAYA) cancer survivors. To support survivors in adopting healthier behaviours, the PanCareFollowUp (PCFU) Lifestyle intervention was developed, encompassing 4 months of online lifestyle coaching aimed at achieving a personal lifestyle goal. The aims of this study were to (1) determine the efficacy of this intervention on lifestyle outcomes over time and (2) identify predictors for goal achievement.

PATIENTS AND METHODS

Fifty-eight survivors were enrolled. Outcomes were assessed at baseline (T0), after 4 months of coaching (T1) and after 4 months of follow-up (T2). The primary outcome included the percentage of survivors successful in achieving and sustaining their goal, whereas secondary outcomes included differences in body mass index (BMI), diet and physical activity. To evaluate the adjusted, longitudinal effects on secondary outcomes, linear mixed models were estimated. Predictors for goal achievement were identified through logistic regression analysis.

RESULTS

At T1 and T2, 68% and 76% of goals were achieved or sustained, respectively. Mean differences between T2 and T0 showed significant improvements in BMI (-0.5 kg/m2), diet (-0.6 points) and physical activity (+7.7 h/week). Estimation of multivariable models also showed positive effects. Participants with a lower BMI and fewer depressive feelings at baseline were more likely to achieve and/or sustain their goals at T2.

CONCLUSION

Findings suggest that the PCFU Lifestyle intervention supports survivors in making lifestyle changes. Results can be used to inform a subsequent randomised intervention study and integrate lifestyle coaching into care.

TRIAL REGISTRATION

International Clinical Trial Registry Platform (ICTRP) number: NL8932 (ICTRP Search Portal [who. int]). Registered on 29 September 2020.

Persistent influence of past obesity on current adiponectin levels and mortality in patients with type 2 diabetes

BACKGROUND/AIMS

Adiponectin, a hormone primarily produced by adipocytes, typically shows an inverse relationship with body mass index (BMI). However, some studies have reported a positive correlation between the two. Thus, this study aimed to examine the relationship between adiponectin level and BMI in diabetic patients, focusing on the impact of past obesity on current adiponectin levels.

METHODS

We conducted an observational study analyzing data from 323 diabetic patients at Kyungpook National University Hospital. Based on past and current BMIs, participants were categorized into never-obese (nn, n = 106), previously obese (on, n = 43), and persistently obese (oo, n = 73) groups based on a BMI threshold of 25 kg/m2. Adiponectin level and BMI were key variables. Kaplan-Meier analysis assessed their impact on all-cause mortality up to August 2023, with survival differences based on adiponectin quartiles and follow-up starting from patient enrollment (2010-2015).

RESULTS

The analysis revealed a significant inverse correlation between adiponectin level and past maximum BMI. The on group exhibited approximately 10% lower adiponectin levels compared to the nn group. This association remained significant after adjusting for current BMI, age, and sex, highlighting the lasting influence of previous obesity on adiponectin levels. Furthermore, survival analysis indicated that patients in the lowest adiponectin quartile had reduced survival, with a statistically significant trend (p = 0.062).

CONCLUSION

Findings of this study suggest that lower adiponectin levels, potentially reflecting past obesity, are associated with decreased survival in diabetic patients, underscoring a critical role of adiponectin in long-term health outcomes.

U.S. weight trends: a longitudinal analysis of an NIH-partnered dataset

BACKGROUND

Obesity is a major public health challenge in the U.S. Existing datasets utilized for calculating obesity prevalence, such as the National Health and Nutrition Examination Survey (NHANES) and Behavioral Risk Factor Surveillance System (BRFSS), have limitations. Our objective was to analyze weight trends in the U.S. using a nationally representative dataset that incorporates longitudinal electronic health record data.

METHODS

Using the National Institutes of Health All of Us Research Program (AoU) dataset, we identified patients aged 18-70 years old who had at least two height and weight measurements within a 5-year period from 2008 to 2021. Baseline and most recent BMI values were used to calculate total body weight (%TBW) changes. %TBW change predictors were determined using multivariable linear regression.

RESULTS

We included 30,862 patients (mean age 48.9 [ ± 12.6] years; 60.5% female). At the 5-year follow-up, the prevalences of obesity and severe obesity were 37.4% and 20.7%, respectively. The frequency of patients with normal weight or overweight BMI who gained ≥5% TBW at follow-up was 37.8% and 33.1%, respectively. Nearly 24% of the cohort lost ≥ 5% TBW, and 6.5% with severe obesity lost weight to achieve a BMI < 30 kg/m2. In adjusted analyses, male sex (-1.10%, 95% CI [-1.36, -0.85]), non-Hispanic Asian race/ethnicity (-1.69% [-2.44, -0.94]), and type 2 diabetes (-1.58% [-1.95, -1.22]) were associated with weight loss, while obstructive sleep apnea (1.80% [1.40, 2.19]) was associated with weight gain.

CONCLUSIONS

This evaluation of an NIH-partnered dataset suggests that patients are continuing to gain weight in the U.S. AoU represents a unique tool for obesity prediction, prevention, and treatment given its longitudinal nature and unique behavioral and genetic data.

Efficacy and Safety of Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss Among Adults Without Diabetes : A Systematic Review of Randomized Controlled Trials

BACKGROUND

Recent randomized controlled trials (RCTs) have investigated glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual or triple co-agonists for weight loss among adults with overweight or obesity and without diabetes.

PURPOSE

To assess the efficacy and safety of GLP-1 RAs and co-agonists for the treatment of obesity among adults without diabetes.

DATA SOURCES

MEDLINE, Embase, and Cochrane CENTRAL from inception to 4 October 2024.

STUDY SELECTION

Placebo-controlled RCTs in otherwise healthy participants with overweight or obesity.

DATA EXTRACTION

The primary outcome was change in relative or absolute body weight from baseline to maximum on-treatment follow-up. Safety outcomes included death, serious adverse events (SAEs), any adverse events (AEs), and gastrointestinal AEs.

DATA SYNTHESIS

A total of 26 RCTs comprising 15 491 participants (72% female; mean body mass index, 30 to 41 kg/m2; mean age, 34 to 57 years) and 12 agents (3 commercially available agents [liraglutide, semaglutide, and tirzepatide] and 9 premarket agents for long-term weight management) were included. Treatment ranged from 16 to 104 weeks (median, 43 weeks). Compared with placebo, tirzepatide (15 mg once weekly) resulted in weight loss of up to 17.8% (95% CI, 16.3% to 19.3%) after 72 weeks of therapy; semaglutide (2.4 mg once weekly), up to 13.9% (CI, 11.0% to 16.7%) after 68 weeks; and liraglutide (3.0 mg once daily), up to 5.8% (CI, 3.6% to 8.0%) after 26 weeks. Retatrutide (12 mg once weekly) produced greater weight loss of up to 22.1% (CI, 19.3% to 24.9%) after 48 weeks; other novel single and combination GLP-1 agents were also efficacious to varying degrees. Although AEs were frequent (GLP-1 RA vs. placebo: 80% to 97% vs. 63% to 100%), the majority were gastrointestinal-related (47% to 84% vs. 13% to 63%, respectively), most commonly nausea, vomiting, diarrhea, and constipation. AEs requiring treatment discontinuation (0% to 26% vs. 0% to 9%, respectively) and SAEs (0% to 10% vs. 0% to 12%, respectively) were rare.

LIMITATIONS

No head-to-head RCTs were available. Heterogeneity prevented meta-analysis.

CONCLUSION

GLP-1 RAs and co-agonists are efficacious for weight loss, with reported safety concerns predominantly gastrointestinal in nature, when used among adults with overweight or obesity and without diabetes.

PRIMARY FUNDING SOURCE

None. (PROSPERO: CRD42024505558).

An Intermittent Fasting Intervention for Black Adults Can Be Feasibly Implemented in Black Churches: A Cluster Randomized Controlled Pilot Study

BACKGROUND

Intensive lifestyle interventions, including modest reductions in daily caloric intake (ie, continuous calorie energy reduction [CER]), are recommended by US national professional health organizations (eg, American Heart Association). However, they are less effective in Black communities. A burgeoning literature has reported the promise of intermittent fasting (IF) as an alternative strategy for weight loss. However, IF studies have been conducted with White participants predominately and provided participant resources not readily available in real-world situations.

OBJECTIVE

Weight-loss and weight-related outcomes of a scalable (ie, able to be widely disseminated and implemented) IF intervention developed with and for Black adults were compared with a CER intervention for the purpose of determining IF's feasibility (ie, initial effectiveness, adherence, and acceptance) in a Black community.

DESIGN

A cluster randomized controlled pilot study was conducted.

PARTICIPANTS/SETTING

A total of 42 Black adults with a body mass index (calculated as kg / m2) ≥25 were recruited from 5 Black churches (3 IF and 2 CER) in Western New York State from September 2021 to May 2022. Participants were free of medical conditions that might have contraindicated participation in a weight-reduction program and other factors that might affect weight loss.

INTERVENTIONS

Community health workers delivered the 6-month, 16-session, faith-based IF and CER interventions.

MAIN OUTCOME MEASURES

The primary outcome was feasibility, consisting of initial effectiveness on body weight (ie, percent body weight lost from baseline to 6-month follow-up), adherence, and acceptability.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics and linear mixed models accounting for within-church clustering were used. A baseline covariate corresponding to the outcome variable was included in the model. Intent-to-treat analysis was used.

RESULTS

There was statistically significant weight loss within both arms (IF: -3.5 kg; 95% CI -6 to -0.9 kg, CER: -2.9 kg; 95% CI -5.1 to -0.8 kg) from baseline to 6-month follow-up. Compared with CER, IF led to significantly lower daily energy intake (414.2 kcal; 95% CI 55.2 to 773.2 kcal) and fat intake (16.1 g; 95% CI 2.4 to 29.8 g). IF may result in lower fruit and vegetable intake (-103.2 g; 95% CI -200.9 to -5.5 g) and fiber intake -5.4 g; 95% CI -8.7 to -2 g) compared with CER. Participants in the IF arm completed a mean (SE) of 3.8 (1.4) more self-monitoring booklets compared with those in the CER arm (P = .02). Participants reported high levels of satisfaction with the program.

CONCLUSIONS

An IF intervention developed with and for Black adults can be feasibly implemented in Black churches. Larger studies need to be conducted to ascertain the extent IF can serve as a viable weight-loss alternative to CER interventions in Black communities.

Assessment of the Potential Clinical and Economic Impact of Weight Loss in the Adult Population with Obesity and Associated Comorbidities in Spain

INTRODUCTION

Obesity and its complications are associated with high morbidity/mortality and a significant healthcare cost burden in Spain. It is therefore essential to know the potential clinical and economic benefits of reducing obesity. The objective of this study is to predict the decrease in rates of onset of potential complications associated with obesity and the cost savings after a weight loss of 15% over 10 years in Spain.

METHODS

Data were combined in an adapted version of a weight loss benefit simulation model. Sources with demographic information on the Spanish population and the distribution of obesity and type 2 diabetes mellitus (T2DM) were used to obtain the data for the model. In addition, use was made of prevalence data on obesity-associated complications from a cohort of patients with obesity in the United Kingdom (UK). These data were combined by age and sex to create a Spanish synthetic cohort.

RESULTS

The simulation showed that, for a cohort of 100,000 individuals with a body mass index (BMI) of 30-50 kg/m2, a weight loss of 15% is estimated to lead to relevant relative risk reductions in obstructive sleep apnoea (OSA) (- 56.4%), T2DM (- 39.2%), asthma (- 20.2%) and arterial hypertension (- 18.7%). The estimated overall savings were €105 million for a cohort of 100,000 individuals, mainly resulting from the decrease in T2DM and arterial hypertension (23% and 22% of the total savings at year 10, respectively), as well as osteoarthritis and chronic kidney disease (CKD) (16% and 13%, respectively).

CONCLUSIONS

Sustained weight loss could significantly reduce the burden derived from future complications associated to obesity in Spain, as well as the excess economic cost associated with its treatment.

A legume-enriched diet improves metabolic health in prediabetes mediated through gut microbiome: a randomized controlled trial

Healthy dietary patterns rich in legumes can improve metabolic health, although their additional benefits in conjunction with calorie restriction have not been well-established. We investigated effects of a calorie-restricted, legume-enriched, multicomponent intervention diet compared with a calorie-restricted control diet in 127 Chinese prediabetes participants, living in Singapore. The study was a 16-week, single-blind, parallel-design, randomized controlled trial (n = 63 intervention group (IG), n = 64 control group (CG); mean ± SD age 62.2 ± 6.3 years, BMI 23.8 ± 2.6 kg/m2). Primary outcomes were markers of glycemia and all measurements were taken at 2 or 4-weekly intervals. At the end of 16 weeks, both groups had significantly lower BMI (q(Time) = 1.92 ×10-42, β  = -0.02) compared with baseline, with minimal difference between groups. The IG had significantly greater reductions in LDL cholesterol (q(Treatment×Time) = 0.01, β  = -0.16), total cholesterol (q(Treatment×Time) = 0.02, β  = -0.3) and HbA1c (q(Treatment×Time) = 0.04, β  = -0.004) compared with CG, alongside increases in fiber degrading species in IG, mediated through metabolites such as bile acids and amino acids. A legume-enriched, multicomponent intervention diet can improve metabolic health in a prediabetes population, in addition to benefits obtained from calorie restriction alone, partially mediated through changes in gut microbial composition and function. Trial registration: Clinical Trials NCT04745702.

Evaluation of Intermittent Restricted Eating Using the Interval Weight Loss Online Platform in an Everyday Setting

Background/Objectives: Obesity remains a global health challenge. Many commercial online weight loss programs are available, and they have advantages in terms of scalability and access. Few of these programs have been evaluated for effectiveness in a real-world context. This study reports on the weight loss achieved, platform engagement, and characteristics of successful weight loss predictions in subscribers to the Interval Weight Loss (IWL) program. The Interval Weight Loss program promotes intermittent restricted eating in addition to lifestyle changes in diet composition, exercise, and sleep. Methods: Data for 1705 adults subscribing to the program for >30 days between 2019 and 2024 were included in the analysis. A linear mixed model with polynomial terms was used to model weight loss over time with interaction terms for gender and age. Survival analysis was used to model the proportions and time frame of those meeting 2%, 5%, and 10% weight loss targets and the proportion meeting their goal weight. The focus of the analysis was on the effect at 365 days. Descriptive data from a subset of participants (n = 205) who completed a questionnaire about change in lifestyle habits and mood are also presented. Results: Of those who stayed in the program for at least 365 days, 25.4% achieved their goal weight, 17.6% achieved a 10% weight loss, and 62% achieved a 5% weight loss. By 49 days, 50% had lost 2% of their weight. Significant interactions indicated that males and females in their 60s and 70s were the most responsive to the program. Conclusions: The online commercial Interval Weight Loss platform based on intermittent restricted eating resulted in significant weight loss in a cohort of subscribers in a real-world setting.

Effects of Cirsium japonicum var. maackii on avelliation of metabolic disease by improving insulin resistance

BACKGROUND

Metabolic syndrome (MetS) refers to a group of risk factors that cause health problems, such as obesity, diabetes, dyslipidemia, and hyperglycemia. MetS is characterized by insulin resistance, which leads to abnormal insulin sensitivity. Cirsium japonicum var. maackii (CJ) is perennial herbaceous species found in Asia that exhibits antioxidant, antidiabetic, antitumor, antifungal, and anti-inflammatory activities. In this study, we aimed to measure the effects of CJ on MetS by improving insulin resistance in a db/db type 2 diabetes mouse model. After administrating CJ extract (CJE) for db/db mouse for 6 weeks, we measured with the evaluation of Insulin resistance, lipid profiles, histological analysis of liver, damage of liver and kideny.

RESULTS

The results showed that CJE was effective in reducing body weight and fat mas and showed a positive effect on lowering blood glucose and improving insulin sensitivity. CJE improved dyslipidemia by increasing serum-HDL levels and decreasing serum-LDL levels. In addition, CJE reduced liver and kidney damage in histological analysis.

CONCLUSIONS

These results demonstrate the anti-diabetic effects of CJE and suggest its potential for improving MetS. Therefore, CJE may have potential values as a functional food material for managing MetS.

Factors associated with weight loss response to GLP-1 analogues for obesity treatment: a retrospective cohort analysis

OBJECTIVES

The response to glucagon-like peptide-1 (GLP-1) analogues for weight loss varies significantly. We investigated the anthropometric, demographic and clinical characteristics associated with total body weight loss (TBWL) from subcutaneous GLP-1 analogue therapy in patients with obesity in a real-world setting.

DESIGN

Retrospective cohort analysis.

SETTING

An urban, multidisciplinary obesity community clinic in Vancouver, Canada, from November 2018 to April 2021.

PARTICIPANTS

483 adults with a body mass index (BMI) of ≧30 kg/m2 who had filled a new prescription for subcutaneous semaglutide or liraglutide, with at least 6-month follow-up, were included (mean follow-up: 17.3 months). Individuals with prior bariatric surgery were excluded.

OUTCOMES

The primary outcome was the %TBWL over a mean follow-up period of 520 days. Participant's TWBL was categorised as non-response (<5% TBWL), moderate response (5%-15% TBWL) or hyper-response (>15% TBWL).

RESULTS

The average %TBWL in the cohort was 12.2%. Among the participants, 17.8% had a non-response, 48.4% had a moderate response and 33.8% had a hyper-response. In the multivariable regression analysis, being a woman was associated with hyper-response (adjusted OR 1.92, CI 1.01 to 3.65, p=0.048). Age, diabetes status, baseline BMI, being sedentary, anxiety and depression were not independently associated with TBWL in response to GLP-1 analogue therapy.

CONCLUSIONS

In a real-world setting, female sex was found to be associated with a hyper-response to GLP-1 analogue therapy for obesity management. Other clinical factors evaluated, including diabetes status, were not associated with the response. Future research should assess additional variables and support the development of novel biomarkers that are associated with weight loss response.

Nicotinamide Adenine Dinucleotide Phosphate Oxidases and Metabolic Dysfunction-Associated Steatotic Liver Disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by lipid accumulation in the liver due to an excess in their supplies or an impairment in their management. While some patients remain stable for years, a proportion of them progress up to steatohepatitis (MASH). MASLD links with systemic pathways being associated with metabolic and non-metabolic diseases. Although liver lipid accumulation represents the first hit for MASLD, the pathophysiology of its development and progression to MASH remains not completely understood. Oxidative stress has received particular attention in recent years, as most of the oxidative process occurs in the liver, which is also the target of oxidative stress-induced damage. Growing evidence linked the activity of nicotinamide adenine dinucleotide phosphate (NADPH) oxidases (NOX) to the increased liver production of reactive oxygen species up to liver damage and fibrosis. NOX acts both in hepatocytes and in non-parenchymal hepatic cells, contributing to hepatocyte lipotoxicity, impaired hepatic microcirculation, hepatic stellate, and mesenchymal stem cells activation and proliferation. This review aims to summarize the current knowledge on the involvement of oxidative stress in the MASLD-MASH transition, focusing on the role of NOX isoforms, and to suggest targeting NOX as a therapeutic approach in MASLD.

Nutritional Strategies for Battling Obesity-Linked Liver Disease: the Role of Medical Nutritional Therapy in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Management

PURPOSE OF REVIEW

This narrative review explores the role of Medical Nutritional Therapy (MNT) in managing Metabolic-Associated Steatotic Liver Disease (MASLD), previously known as nonalcoholic fatty liver disease. It aims to examine the effectiveness of specific nutritional strategies in preventing and treating this obesity-linked liver disease.

RECENT FINDINGS

Emerging evidence underscores the benefits of the Mediterranean diet, low-carbohydrate diets, and intermittent fasting in reducing liver fat, improving insulin sensitivity, and mitigating inflammation. Supplementing with vitamin E, omega-3 fatty acids, and silymarin can potentially reduce liver fibrosis and promote liver health. MNT is a key intervention for MASLD management, emphasizing dietary patterns, caloric restriction, and nutraceutical supplementation. Integrating these strategies with lifestyle modifications, including regular physical activity, offers a comprehensive approach to improving metabolic and liver outcomes in patients with MASLD. Further research is needed to refine and personalize these therapeutic interventions.

Weight cycling exacerbates glucose intolerance and hepatic triglyceride storage in mice with a history of chronic high fat diet exposure

BACKGROUND

Obese subjects undergoing weight loss often fear the Yoyo dieting effect, which involves regaining or even surpassing their initial weight. To date, our understanding of such long-term obesity and weight cycling effects is still limited and often based on only short-term murine weight gain and loss studies. This study aimed to investigate the long-term impacts of weight cycling on glycemic control and metabolic health, focusing on adipose tissue, liver, and hypothalamus.

METHODS

Chow-fed mice and mice subjected to prolonged high-fat diet (HFD) consumption for 20 weeks, followed by 24 weeks of dietary interventions to either induce weight gain, weight loss, or weight cycling were monitored for perturbations in feeding efficiency and glucose homeostasis. Post-mortem analyses included qPCR, Western Blotting, biochemical and microscopical assessments for hepatic steatosis and insulin resistance, hypothalamic and adipose tissue inflammation, and circulating lipid, leptin and IL-6 levels.

RESULTS

Weight cycling led to hyperphagia and rapid weight regain, matching the weights of mice continuously on HFD. Despite weight loss, adipose tissue inflammation persisted with elevated pro-inflammatory markers, macrophage infiltration, and impaired Glut4 expression. HFD-induced dysregulation in hypothalamic expression of orexigenic peptides and synaptic plasticity markers persisted also after weight normalization suggesting long-lasting neural alterations. Weight-cycled mice exhibited higher circulating IL-6 and leptin levels, increased hepatic lipid storage, and dysregulated glucose metabolism compared to those with consistent diets, indicating worsened metabolic effects by Yoyo dieting.

CONCLUSION

In sum, our study highlights significant metabolic risks associated with weight cycling, particularly following prolonged obesity. Persistent adipose tissue inflammation, perturbed neural peptide and plasticity markers and impaired glucose tolerance emphasize the need for effective and sustainable weight loss strategies to mitigate the adverse outcomes of weight regain and improve long-term metabolic health.

8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Emerging Biomarkers and Determinants of Lipoprotein Profiles to Predict CVD Risk: Implications for Precision Nutrition

Biomarkers constitute a valuable tool to diagnose both the incidence and the prevalence of chronic diseases and may help to inform the design and effectiveness of precision nutrition interventions. Cardiovascular disease (CVD) continues to be the foremost cause of death all over the world. While the reasons that lead to increased risk for CVD are multifactorial, dyslipidemias, plasma concentrations of specific lipoproteins, and dynamic measures of lipoprotein function are strong biomarkers to predict and document coronary heart disease incidence. The aim of this review is to provide a comprehensive evaluation of the biomarkers and emerging approaches that can be utilized to characterize lipoprotein profiles as predictive tools for assessing CVD risk, including the assessment of traditional clinical lipid panels, measures of lipoprotein efflux capacity and inflammatory and antioxidant activity, and omics-based characterization of lipoprotein composition and regulators of lipoprotein metabolism. In addition, we discuss demographic, genetic, metagenomic, and lifestyle determinants of lipoprotein profiles-such as age, sex, gene variants and single-nucleotide polymorphisms, gut microbiome profiles, dietary patterns, physical inactivity, obesity status, smoking and alcohol intake, and stress-which are likely to be essential factors to explain interindividual responses to precision nutrition recommendations to mitigate CVD risk.

Spotlight on the Mechanism of Action of Semaglutide

Initially intended to control blood glucose levels in patients with type 2 diabetes, semaglutide, a potent glucagon-like peptide 1 analogue, has been established as an effective weight loss treatment by controlling appetite. Integrating the latest clinical trials, semaglutide in patients with or without diabetes presents significant therapeutic efficacy in ameliorating cardiometabolic risk factors and physical functioning, independent of body weight reduction. Semaglutide may modulate adipose tissue browning, which enhances human metabolism and exhibits possible benefits in skeletal muscle degeneration, accelerated by obesity and ageing. This may be attributed to anti-inflammatory, mitochondrial biogenesis, antioxidant and autophagy-regulating effects. However, most of the supporting evidence on the mechanistic actions of semaglutide is preclinical, demonstrated in rodents and not actually confirmed in humans, therefore warranting caution in the interpretation. This article aims to explore potential innovative molecular mechanisms of semaglutide action in restoring the balance of several interlinking aspects of metabolism, pointing to distinct functions in inflammation and oxidative stress in insulin-sensitive musculoskeletal and adipose tissues. Moreover, possible applications in protection from infections and anti-aging properties are discussed. Semaglutide enhancement of the core molecular mechanisms involved in the progress of obesity and diabetes, although mostly preclinical, may provide a framework for future research applications in human diseases overall.

Effects of Sodium-Glucose Cotransporter-2 Inhibitors on Body Composition and Fluid Status in Cardiovascular Rehabilitation Patients with Coronary Artery Disease and Heart Failure

Background and Objectives: Sodium glucose cotransporter-2 (SGLT-2) inhibitors have emerged as integral therapeutic tools in the management of patients with cardiovascular-kidney-metabolic (CKM) syndrome. In addition to their well-documented effects on lowering glucose levels and cardiovascular- and reno-protective actions, SGLT-2 inhibitors, through a reduction in body weight (BW), generate changes in the body composition and volume status that have not been clearly studied. Materials and Methods: This retrospective, observational longitudinal cohort, single-center study analyzed and compared body composition and fluid status measured by bioelectrical impedance analysis (BIA) from weeks 0 to 12 after the initiation of the cardiac rehabilitation (CR) program for coronary artery disease and heart failure in 59 patients who started treatment with SGLT-2 inhibitors (SGLT-2iG) and 112 patients without SGLT-2 inhibitors (non-SGLT-2iG). Results: Changes between the baseline and week 12 in the SGLT-2iG and non-SGLT-2iG were -0.3 L (p = 0.003) and -0.03 L (p = 0.82) in extracellular water (ECW) (p = 0.05), -0.39 L (p < 0.001) and -0.14 L (p = 0.33) in intracellular water (ICW) (p = 0.12), -0.69 (p < 0.001) and -0.16 (p = 0.52) in total body water (TBW) (p = 0.08), and -0.01 (p = 0.37) and -0.001 (p = 0.25) in the ECW/TBW ratio, respectively. After 3 months of exercise therapy in the CR program, patients in the SGLT-2iG showed a greater decrease than the non-SGLT-2iG in weight (-1.34 kg, p < 0.001 vs. -0.99, p = 0.02), body mass index (BMI) (-0.45 kg/m2, p < 0.001 vs. -0.38, p = 0.004), arm circumference (-0.57 cm, p = 0.008 vs. -0.12 cm, p = 0.21), waist circumference (-1.5 cm, p = 0.04 vs. -0.11 cm, p = 0.83), systolic blood pressure (SBP) (-8.9 mmHg, p = 0.049 vs. -4.19, p = 0.08), and diastolic blood pressure (DBP) (-5.15, p = 0.03 vs. -2.85, p = 0.01). The bioelectrical impedance analysis (BIA) revealed a significant decrease in body fat mass (BFM) and visceral fat area, without a loss of lean body mass (LBM) or skeletal muscle mass in the SGLT-2iG. Conclusions: SGLT-2 inhibitors exert beneficial effects on body compartments and volume status. Although they induce modest weight loss, this appears to be mainly directed at ECW, BFM, and visceral fat, without a loss of LBM nor skeletal muscle mass, which could contribute to the observed CKM benefits.

Prepregnancy and Gestational Interventions to Prevent Childhood Obesity

Childhood obesity is a significant global health issue with complex and multifactorial origins, often beginning before conception and influenced by both maternal and paternal health. The increased prevalence of prepregnancy obesity and gestational diabetes mellitus in women of reproductive age contributes to a heightened risk of metabolic dysfunction in offspring. Current clinical practices often implement lifestyle interventions after the first trimester and have limited success, implying that they miss a critical window for effective metabolic adjustments. This review examines the limitations of lifestyle interventions during pregnancy in improving perinatal outcomes and highlights the importance of initiating such interventions before conception to positively impact parental health and fetal development. A re-evaluation of strategies is needed to enhance the metabolic health of prospective parents as a preventive measure against childhood obesity.

Treatment with bariatric surgery in patients with osteogenesis imperfecta and severe obesity

•Skeletal fragility and immobility in osteogenesis imperfecta may lead to obesity.•Bariatric surgery is an efficient treatment for severe obesity.•Bone turnover and BMD should be monitored closely during periods of rapid weight loss.•Bone protective treatment minimizes bone deterioration before weight loss.•Bariatric surgery may be considered in mild osteogenesis imperfecta.

The vices and virtues of medical models of obesity

Despite numerous public health organizations supporting the pathologization of obesity and considering recent obesity rates a health crisis, many researchers in the humanities, social sciences, and even in the health sciences remain unconvinced. In this paper, we address a set of arguments coming from these academic fields that criticize medical models of obesity for their supposedly flawed diagnostic categories that shift focus onto individuals and support moralizing judgements. Clarifying some key claims in these models and explicating the view of obesity in terms of energy dysregulation, we aim to tease apart misunderstandings and argue that not only do these models not say what they are often accused of saying, but their apparent vices may actually be virtues in helping to combat stigma. Building on the social psychology of stigma and disease labeling, we then suggest that current medical models are largely supportive of many moral and political aims promoted by critics of these models.

The early transition to cold-induced browning in mouse subcutaneous white adipose tissue (scWAT) involves proteins related to nerve remodeling, cytoskeleton, mitochondria, and immune cells

White adipose tissue (WAT) is a dynamic organ capable of remodelling in response to metabolic state. For example, in response to stimuli such as cold exposure, WAT can develop inducible brown adipocytes ('browning') capable of non-shivering thermogenesis, through concurrent changes to mitochondrial content and function. This is aided by increased neurite outgrowth and angiogenesis across the tissue, providing the needed neurovascular supply for uncoupling protein 1 activation. While several RNA-sequencing studies have been performed in WAT, including newer single cell and single nuclei studies, little work has been done to investigate changes to the adipose proteome, particularly during dynamic periods of tissue remodelling such as cold stimulation. Here, we conducted a comprehensive proteomic analysis of inguinal subcutaneous (sc) WAT during the initial 'browning' period of 24 or 72hrs of cold exposure in mice. We identified four significant pathways impacted by cold stimulation that are involved in tissue remodelling, which included mitochondrial function and metabolism, cytoskeletal remodelling, the immune response, and the nervous system. Taken together, we found that early changes in the proteome of WAT with cold stimulation predicted later structural and functional changes in the tissue that are important for tissue and whole-body remodelling to meet energetic and metabolic needs.

Effect of Weight Loss on Skeletal Muscle Bioactive Lipids in People With Obesity and Type 2 Diabetes

Muscle sn-1,2-diacylglycerol (DAG) and C18:0 ceramide accumulation in sarcolemmal and mitochondrial compartments have been proposed to regulate muscle insulin sensitivity. Here, we evaluated whether weight loss-induced improvements in insulin sensitivity were associated with changes in muscle sn-1,2-DAG and ceramide content in people with obesity and type 2 diabetes. We measured skeletal muscle insulin sensitivity, assessed by using the hyperinsulinemic-euglycemic clamp procedure in conjunction with stable isotopically labeled glucose tracer infusion, and skeletal muscle sn-1,2-DAG and ceramide contents by using liquid chromatography-tandem mass spectrometry after subcellular fractionation and DAG isomer separation in 14 adults with obesity and type 2 diabetes before and after marked (18.6 ± 2.1%) weight loss. Whole-body insulin sensitivity doubled after weight loss. Sarcolemmal sn-1,2-DAG and C18:0 ceramide contents after weight loss were not different from values before weight loss. In contrast, mitochondrial-endoplasmic reticulum (ER) C18:0 ceramide content decreased by ∼20% after weight loss (from 2.16 ± 0.08 to 1.71 ± 0.13 nmol/g, P < 0.005). These results suggest a decrease in muscle mitochondrial-ER C18:0 ceramide content could contribute to the beneficial effect of weight loss on skeletal muscle insulin sensitivity.

ARTICLE HIGHLIGHTS

Therapeutic landscape of metabolic dysfunction-associated steatohepatitis (MASH)

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its severe subgroup metabolic dysfunction-associated steatohepatitis (MASH) have become a global epidemic and are driven by chronic overnutrition and multiple genetic susceptibility factors. The physiological outcomes include hepatocyte death, liver inflammation and cirrhosis. The first therapeutic for MASLD and MASH, resmetirom, has recently been approved for clinical use and has energized this therapeutic space. However, there is still much to learn in clinical studies of MASH, such as the scale of placebo responses, optimal trial end points, the time required for fibrosis reversal and side effect profiles. This Review introduces aspects of disease pathogenesis related to drug development and discusses two main therapeutic approaches. Thyroid hormone receptor-β agonists, such as resmetirom, as well as fatty acid synthase inhibitors, target the liver and enable it to function within a toxic metabolic environment. In parallel, incretin analogues such as semaglutide improve metabolism, allowing the liver to self-regulate and reversing many aspects of MASH. We also discuss how combinations of therapeutics could potentially be used to treat patients.

Next-visit prediction and prevention of hypertension using large-scale routine health checkup data

This paper proposes the use of machine learning models to predict one's risk of having hypertension in the future using their routine health checkup data of their current and past visits to a health checkup center. The large-scale and high-dimensional dataset used in this study comes from MJ Health Research Foundation in Taiwan. The training data for models is separated into 5 folds and used to train 5 models in a 5-fold cross validation manner. While predicting the results for the test set, the voted result of 5 models is used as the final prediction. Experimental results show that our models achieve 69.59% of precision, 77.90% of recall, and 73.51% of F1-score, which outperforms a baseline using only the blood pressure of visitors' last visits. Experiments also show that a visitor who performs a health checkup more often can be predicted better, and models trained with selected important factors achieve better results than those trained with Framingham risk score. We also demonstrate the possibility of using our models to suggest visitors for weight control by adding virtual visits that assume their body weight can be reduced in the near future to model input. Experimental results show that around 5.48% of the people who are with high Body Mass Index of the true positive cases are rejudged as negative, and a rising trend appears when adding more virtual visits, which may be used to suggest visitors that controlling their body weight for a longer time lead to lower probability of having hypertension in the future.

Visceral Adipocyte-Derived Extracellular Vesicle miR-27a-5p Elicits Glucose Intolerance by Inhibiting Pancreatic β-Cell Insulin Secretion

Pancreatic β-cell dysfunction caused by obesity can be associated with alterations in the levels of miRNAs. However, the role of miRNAs in such processes remains elusive. Here, we show that pancreatic islet miR-27a-5p, which is markedly increased in obese mice and impairs insulin secretion, is mainly delivered by visceral adipocyte-derived extracellular vesicles (EVs). Depleting miR-27a-5p significantly improved insulin secretion and glucose intolerance in db/db mice. Supporting the function of EV miR-27a-5p as a key pathogenic factor, intravenous injection of miR-27a-5p-containing EVs showed their distribution in mouse pancreatic islets. Tracing the injected adeno-associated virus (AAV)-miR-27a-5p (AAV-miR-27a) or AAV-FABP4-miR-27a-5p (AAV-FABP4-miR-27a) in visceral fat resulted in upregulating miR-27a-5p in EVs and serum and elicited mouse pancreatic β-cell dysfunction. Mechanistically, miR-27a-5p directly targeted L-type Ca2+ channel subtype CaV1.2 (Cacna1c) and reduced insulin secretion in β-cells. Overexpressing mouse CaV1.2 largely abolished the insulin secretion injury induced by miR-27a-5p. These findings reveal a causative role of EV miR-27a-5p in visceral adipocyte-mediated pancreatic β-cell dysfunction in obesity-associated type 2 diabetes mellitus.

ARTICLE HIGHLIGHTS

Efficacy and safety of semaglutide: real-world tertiary care experience from Saudi Arabia

BACKGROUND

Semaglutide, a glucagon-like peptide-1, is an effective antidiabetic drug promoting weight loss and providing cardiovascular protection. The original trials did not include participants from Saudi Arabia; hence, the study's findings are expected to be useful.

OBJECTIVES

Explore the efficacy, safety, and favorable effects of once-weekly subcutaneous semaglutide (1 mg) in patients with type 2 diabetes and those who received it as an off-license prescription without having diabetes.

DESIGN

Retrospective review of medical records.

SETTING

Department of medicine at our institution.

PATIENTS AND METHODS

This retrospective observational study evaluated patients receiving the glucagon-like peptide-1 analog semaglutide, with the trade name Ozempic. The weight, height, body mass index, blood pressure, and laboratory data, including serum creatinine and hemoglobin A1c (HbA1c) levels and urine albumin/creatinine ratio, were recorded. Moreover, any history of medical comorbidities, such as cardiovascular diseases, cerebrovascular diseases, and heart failure, was documented before and after drug administration.

MAIN OUTCOME MEASURES

Glycemic and weight loss efficacy.

SAMPLE SIZE

1007 patients.

RESULTS

The median age of the patients was 57.0 years, comprising 60.28% females. Among them, 955 and 442 patients received the medication for at least 3 and 6 months, respectively. Our results show a 4.4% weight loss and 0.4% improvement in HBA1c in patients with diabetes. Similar results were observed in the patients without diabetes in terms of weight along with a significant decrease in diastolic blood pressure. Our results also show stability in the serum creatinine and urine albumin creatinine ratio. The drug was equally effective in males and females.

CONCLUSION

Treatment with once-weekly subcutaneous semaglutide (1 mg) led to clinically significant weight loss and improved HbA1c level and cardiometabolic risk factors such as blood pressure.

LIMITATIONS

Retrospective design.

Prediction of individual weight loss using supervised learning: findings from the CALERIETM 2 study

BACKGROUND

Predicting individual weight loss (WL) responses to lifestyle interventions is challenging but might help practitioners and clinicians select the most promising approach for each individual.

OBJECTIVE

The primary aim of this study was to develop machine learning (ML) models to predict individual WL responses using only variables known before starting the intervention. In addition, we used ML to identify pre-intervention variables influencing the individual WL response.

METHODS

We used 12-mo data from the comprehensive assessment of long-term effects of reducing intake of energy (CALERIETM) phase 2 study, which aimed to analyze the long-term effects of caloric restriction on human longevity. On the basis of the data from 130 subjects in the intervention group, we developed classification models to predict binary ("Success" and "No/low success") or multiclass ("High success," "Medium success," and "Low/no success") WL outcomes. Additionally, regression models were developed to predict individual weight change (percent). Models were evaluated on the basis of accuracy, sensitivity, specificity (classification models), and root mean squared error (RMSE; regression models).

RESULTS

Best classification models used 20-40 predictors and achieved 89%-97% accuracy, 91%-100% sensitivity, and 56%-86% specificity for binary classification. For multiclass classification, accuracy (69%) and sensitivity (50%) tended to be lower. The best regression performance was obtained with 36 variables with an RMSE of 2.84%. Among the 21 variables predicting individual weight change most consistently, we identified 2 novel predictors, namely orgasm satisfaction and sexual behavior/experience. Other common predictors have previously been associated with WL (16) or are already used in traditional prediction models (3).

CONCLUSIONS

The prediction models could be implemented by practitioners and clinicians to support the decision of whether lifestyle interventions are sufficient or more aggressive interventions are needed for a given individual, thereby supporting better, faster, data-driven, and unbiased decisions. The CALERIETM phase 2 study was registered at clinicaltrials.gov as NCT00427193.

Lead-in calorie restriction enhances the weight-lowering efficacy of incretin hormone-based pharmacotherapies in mice

OBJECTIVES

The potential benefits of combining lifestyle changes with weight loss pharmacotherapies for obesity treatment are underexplored. Building on recent clinical observations, this study aimed to determine whether "lead-in" calorie restriction before administering clinically approved weight loss medications enhances the maximum achievable weight loss in preclinical models.

METHODS

Diet-induced obese mice (DIO) were exposed to 7 or 14 days of calorie restriction before initiating treatment with semaglutide (a glucagon-like peptide-1 receptor (GLP-1R) agonist), tirzepatide (a GLP-1R/glucose insulinotropic peptide receptor (GIPR) co-agonist), or setmelanotide (a melanocortin-4 receptor (MC4R) agonist). Follow-up assessments using indirect calorimetry determined the contributions of energy intake and expenditure linked to consecutive exposure to dieting followed by pharmacotherapy.

RESULTS

Calorie restriction prior to treatment with semaglutide or tirzepatide enhanced the weight loss magnitude of both incretin-based therapies in DIO mice, reflected by a reduction in fat mass and linked to reduced energy intake and a less pronounced adaptive drop in energy expenditure. These benefits were not observed with the MC4R agonist, setmelanotide.

CONCLUSIONS

Our findings provide compelling evidence that calorie restriction prior to incretin-based therapy enhances the achievable extent of weight loss, as reflected in a weight loss plateau at a lower level compared to that of treatment without prior calorie reduction. This work suggests that more intensive lifestyle interventions should be considered prior to pharmacological treatment, encouraging further exploration and discussion of the current standard of care.

Effects of caloric restriction with different doses of exercise on fat loss in people living with type 2 diabetes: A secondary analysis of the DOSE-EX randomized clinical trial

BACKGROUND

Fat loss mainly conveys the benefits of caloric restriction for people living with type 2 diabetes. The literature is equivocal regarding whether exercise facilitates fat loss during caloric restriction. This analysis aimed to assess the dose-response effects of exercise in combination with a caloric restriction on fat mass (FM) and FM percentage (FM%) in persons with diagnosed type 2 diabetes.

METHODS

In this secondary analysis of a 4-armed randomized trial, 82 persons living with type 2 diabetes were randomly allocated to the control group (CON) (n = 21), diet control (DCON) (25% caloric restriction; n = 20), diet control and exercise 3 times per week (MED) (n = 20), or diet control and exercise 6 times per week (HED) (n = 21) for 16 weeks. The primary analysis was the change in FM% points. Secondary analyses included fat-free mass and visceral adipose tissue (VAT) volume (cm3).

RESULTS

FM% decreased compared to CON by a mean difference of -3.5% (95% confidence interval (95%CI): -5.6% to -1.4%), -6.3% (95%CI: -8.4% to -4.1%), and -8.0% (95%CI: -10.2% to -5.8%) for DCON, MED, and HED, respectively. Compared to DCON, MED, and HED decreased FM% by -2.8% (95%CI: -4.9% to -0.7%) and -4.5% (95%CI: -6.6% to -2.4%), respectively. The difference in FM% between HED and MED was -1.8% (95%CI: -3.9% to 0.4%). DCON and MED decreased fat-free mass compared to CON, whereas HED preserved fat-free mass (-0.2%; 95%CI: -2.0% to 1.7%). Compared to CON, VAT volume decreased by -666.0 cm3 (95%CI: -912.8 cm3 to -385.1 cm3), -1264.0 cm3 (95%CI: -1679.6 cm3 to -655.9 cm3), and -1786.4 cm3 (95%CI: -2264.6 cm3 to -1321.2 cm3) more for DCON, MED, and HED, respectively. HED decreased VAT volume more than DCON (-1120.4 cm3; 95%CI: -1746.6 cm3 to -639.4 cm3) while the remaining comparisons did not reveal any differences.

CONCLUSION

All interventions were superior in reducing FM% compared to standard care. Adding exercise to a caloric restriction was superior in reducing FM% compared to a caloric restriction alone.

Effects of Specially Designed Energy-Restricted Diet on Anthropometric Parameters and Cardiometabolic Risk in Overweight and Obese Adults: Pilot Study

BACKGROUND/AIMS

This study examined the effects of a specially designed energy-restricted diet with alternate carbohydrate intake on body composition and cardiometabolic risk factors in overweight and obese adults. The aim was to assess whether the intervention could lead to significant weight loss, improve body composition, and reduce cardiometabolic risks.

METHODS

Sixty-five participants (34 women, 31 men) with an average BMI of 31.8 ± 9.1 kg/m2 (women) and 34.1 ± 6.4 kg/m2 (men) participated in a 14-week intervention. The diet included different days of carbohydrate intake and a 20% reduction in total daily energy consumption. Anthropometric measurements and biochemical parameters, including predictive indices of cardiometabolic risk, were determined at baseline and after the intervention.

RESULTS

The intervention resulted in a significant reduction in body weight (mean weight loss of 17%, p < 0.001), with 64.6% of participants achieving a weight loss of at least 10%. Muscle mass as a percentage of total body weight increased. Cardiometabolic improvements were observed in fasting blood glucose (from 5.4 to 4.9 mmol/L, p < 0.001) and LDL cholesterol (from 3.38 to 2.81 mmol/L, p < 0.001). Gender-specific differences were found, particularly in HDL-C, which decreased significantly in women (p = 0.013), while there was a non-significant increase in men. Cardiometabolic indices, including the Visceral Adiposity Index (VAI) and the Cardiometabolic Index (CMI), also improved significantly.

CONCLUSIONS

The alternate carbohydrate diet improved body composition, cardiometabolic health, and treatment adherence through metabolic flexibility. However, the short duration of this study and the lack of a control group suggest that further research is needed to assess long-term sustainability.

Optimizing muscle preservation during weight loss in patients with cirrhosis: A pilot study comparing continuous energy restriction to alternate-day modified fasting for weight loss in patients with obesity and non-alcoholic cirrhosis of the liver

Introduction

Obesity is associated with increased morbidity in patients with advanced liver disease, but it is particularly challenging for these patients to preserve skeletal muscle mass during weight loss and accelerating sarcopenia is a concern. Alternate-day modified fasting (ADMF) may be particularly effective for weight loss in patients with concomitant cirrhosis and obesity due to preservation of fat-free mass (FFM).

Methods

A weight loss program featuring either ADMF or a continuous low-calorie diet (LCD) was evaluated in a 24-week randomized clinical trial in 20 adult patients with Child-Pugh Class A cirrhosis and obesity. Participants were randomized to either ADMF (n = 11) or LCD (n = 9). Both groups received a remotely delivered exercise program. Body composition, sarcopenia measures, and functional outcomes were assessed pre-post.

Results

Thirteen participants completed the intervention (Age = 57 ± 10; BMI = 37.7 ± 5.8 kg/m2). The median body weight lost in ADMF was 13.7 ± 4.8 kg (13.9% of initial body weight), while LCD lost 9.9 ± 6.9 kg (10.7% of initial body weight). Total body fat percentage decreased in both groups (ADMF: -4.1 ± 4.0%; LCD = -2.8 ± 1.4%). Fat-free mass accounted for 34 ± 20% of total weight loss in ADMF and 38 ± 10% in LCD. Functional measures, such as timed chair stands, improved in both groups.

Conclusion

This pilot study demonstrates the feasibility of the ADMF and LCD interventions to produce significant weight loss while improving body composition in patients with cirrhosis and obesity. Further research is needed to validate these findings in larger cohorts and to assess changes in muscle quality and visceral fat.

Trial Registration

ClinicalTrials.gov Identifier: NCT05367596.

Incretin-Based Weight Loss Pharmacotherapy: Can Resistance Exercise Optimize Changes in Body Composition?

This narrative review highlights the degree to which new antiobesity medications based on gut-derived nutrient-stimulated hormones (incretins) cause loss of lean mass, and the importance of resistance exercise to preserve muscle. Glucagon-like peptide 1 receptor agonists (GLP-1RA) induce substantial weight loss in randomized trials, effects that may be enhanced in combination with glucose-dependent insulinotropic polypeptide (GIP) receptor agonists. Liraglutide and semaglutide (GLP-1RA), tirzepatide (GLP-1 and GIP receptor dual agonist), and retatrutide (GLP-1, GIP, and glucagon receptor triple agonist) are peptides with incretin agonist activity that induce ∼15-24% weight loss in adults with overweight and obesity, alongside beneficial impacts on blood pressure, cholesterol, blood glucose, and insulin. However, these agents also cause rapid and significant loss of lean mass (∼10% or ∼6 kg), comparable to a decade or more of aging. Maintaining muscle mass and function as humans age is crucial to avoiding sarcopenia and frailty, which are strongly linked to morbidity and mortality. Studies indicate that supervised resistance exercise training interventions with a duration >10 weeks can elicit large increases in lean mass (∼3 kg) and strength (∼25%) in men and women. After a low-calorie diet, combining aerobic exercise with liraglutide improved weight loss maintenance compared with either alone. Retaining lean mass during incretin therapy could blunt body weight (and fat) regain on cessation of weight loss pharmacotherapy. We propose that tailored resistance exercise training be recommended as an adjunct to incretin therapy to optimize changes in body composition by preserving lean mass while achieving fat loss.

Enhanced protein intake on maintaining muscle mass, strength, and physical function in adults with overweight/obesity: A systematic review and meta-analysis

BACKGROUND & AIMS

Weight loss in individuals with obesity and overweight leads to metabolic and health benefits but also poses the risk of muscle mass reduction. This systematic review and meta-analysis of randomized controlled trials aims to determine the initial protein amount necessary for achieving weight loss while maintaining muscle mass, strength, and physical function in adults with overweight and obesity.

METHODS

Relevant literature databases, including Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica (Embase), the Cumulative Index to Nursing and Allied Health Literature (CINHAL), and Web of Science, were electronically searched up to 15 March 2023. We examined the effect of additional protein intake on muscle mass, strength, and physical function in adults with overweight or obesity targeting weight loss. The risk of bias was assessed using the Cochrane RoB 2.0 tool. Results were synthesized using standardized mean differences (SMD) and 95% confidence intervals (CI) via a random-effects model.

RESULTS

Forty-seven studies (n = 3218) were included. In the muscle mass analysis, twenty-eight trials with 1989 participants were encompassed. Results indicated that increased protein intake significantly prevents muscle mass decline in adults with overweight or obesity aiming for weight loss (SMD 0.75; 95% CI 0.41 to 1.10; p < 0.001). Enhanced protein intake did not significantly prevent decreases in muscle strength and physical function. An intake exceeding 1.3 g/kg/day is anticipated to increase muscle mass, while an intake below 1.0 g/kg/day is associated with a higher risk of muscle mass decline. The risk of bias in studies regarding muscle mass ranged from low to high.

CONCLUSIONS

Adults with overweight or obesity and aim for weight loss can more effectively retain muscle mass through higher protein intake, as opposed to no protein intake enhancement.

Trem2 deficiency attenuates breast cancer tumor growth in lean, but not obese or weight loss, mice and is associated with alterations of clonal T cell populations

Obesity is an established risk factor for breast cancer development and worsened prognosis; however, the mechanisms for this association - and the potential benefits of weight loss - have not been fully explored. The adipose environment surrounding breast tumors, which is inflamed in obesity, has been implicated in tumor progression. An emerging therapeutic target for cancer is TREM2, a transmembrane receptor of the immunoglobulin superfamily that is expressed on macrophages in adipose tissue and tumors. We utilized genetic loss of function (Trem2 +,+ and Trem2 -/-) models and dietary (lean, obese, and weight loss) intervention approaches to examine impacts on postmenopausal breast cancer. Remarkably, Trem2 deficiency ameliorated tumor growth in lean, but not obese or weight loss mice. Single-cell RNA sequencing, in conjunction with VDJ sequencing of tumor and tumor-adjacent mammary adipose tissue (mATTum-adj) immune cells, revealed that tumors of lean Trem2 -/- mice exhibited a shift in clonal CD8+ T cells from an exhausted to an effector memory state, accompanied with increased clonality of CD4+ Th1 cells, that was not observed in any other diet-genotype group. Notably, identical T cell clonotypes were identified in the tumor and mATTum-adj of the same mouse. Finally, an immune checkpoint study demonstrated that αPD-1 therapy restricted tumor growth in lean and weight loss, but not obese mice. We conclude that weight history is relevant when considering potential efficacy of TREM2 inhibition in postmenopausal breast cancer. This work reveals immunological interactions between tumors and surrounding adipose tissue, highlighting significant differences under obese and weight loss conditions.

An optimized pipeline for high-throughput bulk RNA-Seq deconvolution illustrates the impact of obesity and weight loss on cell composition of human adipose tissue

Cellular heterogeneity of human adipose tissue, is linked to the pathophysiology of obesity and may impact the response to energy restriction and changes in fat mass. Here, we provide an optimized pipeline to estimate cellular composition in human abdominal subcutaneous adipose tissue (ASAT) from publicly available bulk RNA-Seq using signature profiles from our previously published full-length single nuclei (sn)RNA-Seq of the same depot. Individuals with obesity had greater proportions of macrophages and lower proportions of adipocyte sub-populations and vascular cells compared with lean individuals. Two months of diet-induced weight loss (DIWL) increased the estimated proportions of macrophages; however, two years of DIWL reduced the estimated proportions of macrophages, thereby suggesting a bi-phasic nature of cellular remodeling of ASAT during weight loss. Our optimized high-throughput pipeline facilitates the assessment of composition changes of highly characterized cell types in large numbers of ASAT samples using low-cost bulk RNA-Seq. Our data reveal novel changes in cellular heterogeneity and its association with cardiometabolic health in humans with obesity and following weight loss.