Decomposing adult obesity trends in China (1991-2011)

Human exposure characteristics of pharmaceutical and personal care product chemicals and associations with dietary habits

Considering the widespread presence of pharmaceutical and personal care products (PPCPs) in the environment and their adverse health effects, human exposure to PPCPs has caused worldwide concern. However, there remains insufficient information on the exposure assessment of the Chinese population. Based on this, the exposure levels of 13 PPCPs in the urine samples of 986 Chinese adults were measured, aiming to provide information on the prevalence of PPCP occurrence and investigate potential correlations between PPCP exposure and obesity. Results showed that the detection rates of these compounds in urine ranged from 28.12 % to 98.58 %, with median concentrations ranging below the limit of detection to 10.58 ng mL-1. Methyl-paraben (MeP) was the most dominant paraben and had the highest urinary concentration (median = 10.12 ng mL-1), while 4-hydroxy-benzophenone (4-OH-BP) was the dominant benzophenone derivative (median = 0.22 ng mL-1). In antibacterials, the urinary concentration of triclosan (mean = 42.00 ng mL-1) was much higher than that of triclocarban (mean = 0.63 ng mL-1). PPCP concentrations were significantly associated with sex, age, body mass index, education level, and annual household income (p < 0.050). Regression analysis of dietary habits showed that seafood and tea consumption may be significant exposure sources of PPCP exposure (p < 0.050). Furthermore, individual exposure to MeP (odds ratio (OR) < 1, p = 0.002) and 4-OH-BP (OR < 1, p = 0.009) exhibited a significantly negative association with obesity in females. Also, analysis results from quantile g-computation and Bayesian kernel machine regression models demonstrated that an inverse correlation between PPCP mixture exposure and obesity was significant in females. This study reports the extensive prevalence of PPCP exposure among adults from China, and may provide crucial insights into PPCP exposure dynamics. More epidemiological studies are need in the future, with a thorough knowledge of PPCP exposure.

Pharmacoeconomic evaluation of anti-obesity drugs for chronic weight management: a systematic review of literature

Introduction

Pharmacological therapy is recommended as a second-line alternative to reverse obesity. Currently, five anti-obesity drugs (AODs) have been approved by the U.S. Food and Drug Administration (FDA) for chronic weight management. The aim of this paper is to investigate the pharmacoeconomic evaluation of AODs through a systematic review with a special focus on methodological considerations.

Methods

We searched the general and specific databases to identify the primary pharmacoeconomic evaluation of AODs.

Results

A total of 18 full-text articles and three conference abstracts were included in this review. Most of the economic assessments were still about Orlistat. And the observations we could make were consistent with the previous systematic review. A few studies were on the combined therapies (i.e. PHEN/TPM ER and NB ER) compared to different comparators, which could hardly lead to a generalized summary of the cost-effectiveness. Most recently, pharmacoeconomic evidence on the newest GLP 1 RA approved for the indication of obesity or obesity with at least one comorbidity emerged gradually. Modelling-based cost-utility analysis is the major type of assessment method. In the modelling studies, a manageable number of the key health states and the state transitions were structured to capture the disease progression. In particular, the principal structure of the decision model adopted in the three studies on the newly approved drug was nearly the same, which enables more in-depth comparisons and generalizations of the findings.

Conclusion

This study provided an up-to-date overview of the strengths and areas for improvement in the methodological design of the pharmacoeconomic evaluation of the licensed drugs for chronic weight management. Future modelling evaluations would benefit from a better understanding of the long-term weight loss effects of the current therapeutic options and the weight rebound process after the discontinuation of treatment.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022302648, identifier CRD42022302648.

Ferulic acid alleviates high fat diet-induced cognitive impairment by inhibiting oxidative stress and apoptosis

Cognitive impairment has become a major public health problem. Growing evidence suggests that high-fat diet (HFD) can cause cognitive dysfunction and increase the risk of dementia. However, effective treatment for cognitive impairment is not available. Ferulic acid (FA) is a single phenolic compound with anti-inflammatory and antioxidant properties. Nevertheless, its role in regulating learning and memory in HFD-fed mice and the underlying mechanism remains unclear. In this study, we aimed to identify the neuroprotective mechanisms of FA in HFD induced cognitive impairment. We found that FA improved the survival rate of HT22 cells treated with palmitic acid (PA), inhibited cell apoptosis, and reduced oxidative stress via the IRS1/PI3K/AKT/GSK3β signaling pathway; Furthermore, FA treatment for 24 weeks improved the learning and memory of HFD-fed mice and decreased hyperlipidemia. Moreover, the expression of Nrf2 and Gpx4 proteins were decreased in HFD-fed mice. After FA treatment, the decline of these proteins was reversed. Our study showed that the neuroprotective effect of FA on cognitive impairment was related to the inhibition of oxidative stress and apoptosis and regulation of glucose and lipid metabolism. These findings suggested that FA can be developed as a potential agent for the treatment of HFD-induced cognitive impairment.

Relationship between BMI and risk of impaired glucose tolerance and impaired fasting glucose in Chinese adults: a prospective study

BACKGROUND

Current studies in most Western countries have largely focused on body mass index (BMI) as an important risk factor for impaired glucose tolerance (IGT) and impaired fasting glucose (IFG), which have different pathophysiological bases. In people with obesity, the prevalence of IGT is higher and the prevalence of IFG is lower. The prevalence of IGT in the Asian population is higher than that in the white population, and the obesity rate in China is still increasing. However, few cohort studies explore the relationship between BMI and the incidence of IGT and IFG in China. We aimed to explore the relationship between BMI and the risk of IGT and IFG in Chinese adults and analyze the differences between them.

METHODS

The baseline data were obtained from the 2010 China Chronic Disease and Risk Factor Surveillance, of which 20 surveillance sites were followed up from 2016 to 2017. Finally, in this study, a total of 5,578 studies were grouped into BMI categories of underweight (BMI < 18.5 kg/m²), normal weight (18.5-23.9 kg/m²), overweight (24.0-27.9 kg/m²), and obesity (≥ 28.0 kg/m²). We used the unconditional logistic regression model to analyze the relationship between BMI and the risk of IGT and IFG.

RESULTS

During an average follow-up of 6.4 years, 562 developed IGT and 257 developed IFG. After age, gender, urban and rural areas, physical activity, family history of diabetes, hypertension, abdominal obesity, dyslipidemia, and other factors were adjusted, overweight increased the risk of IGT by 35% [odds ratio (OR) 1.35, 95% confidence interval (CI) 1.08-1.70], and obesity increased the risk of IGT by 77% (OR 1.77, 95% CI 1.27-1.47). After the factors consistent with the above were adjusted, only obesity increased the risk of IFG by 122% (OR 2.22, 95% CI 1.39-3.54).

CONCLUSIONS

In China, obesity is an important risk factor for IGT and IFG, and the risk of IGT increases during the overweight stage.

Impact of BMI on Long-Term Outcomes in Patients with ST-Segment Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention

AIM

Obesity paradox remains a point of debate in ST-segment elevation myocardial infarction (STEMI) patients. The aim of this study was to examine the relationship between body mass index (BMI) and clinical outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).

METHODS

Outcomes were assessed in 1429 STEMI patients undergoing PPCI between January 2009 and January 2010 in Beijing. Patients were classified into 6 groups according to age (the younger and elderly groups consisting of patients ≤65 and > 65 years old) and baseline BMI (normal weight, BMI < 24 kg/m²; overweight, 24 kg/m² ≤BMI < 28 kg/m²; obese, BMI ≥ 28 kg/m²). The primary outcome was death, acute myocardial infarction (AMI), or revascularization.

RESULTS

On long-term follow-up (mean follow-up of 59 months), 13.9% of patients experienced the adverse event. Multivariate logistic regression analyses showed that low BMI was a significant predictor of the primary outcome only in the younger group. The odds ratio for overweight in comparison with normal weight was 0.741 (95% CI: 0.413-0.979; p = 0.038), the odds radio for obesity in comparison with normal-weight patients was 0.508 (95% CI: 0.344-0.750; p = 0.016) in the younger group. In the elderly group, diabetes, hypertension, triple disease, regular exercise, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blockers (ARBs) use after discharge, and bleeding complication were associated with primary outcome.

CONCLUSION

The obesity paradox was recognized only in the younger age group in STEMI patients undergoing PPCI.

Overweight with HBV infection limited the efficacy of TACE in hepatocellular carcinoma by inhibiting the upregulated HMGB1

Background

Transarterial chemoembolization (TACE) is an effective treatment for patients with hepatocellular carcinoma (HCC). However, the impact of hepatitis B viral (HBV) infection and body mass index (BMI) on TACE is controversial. The present study aimed to compare the influence of HBV and high BMI on TACE outcomes in advanced HCC.

Methods

Based on HBV infection history and BMI, patients were assigned to different subgroups. Blood samples were collected and analyzed by an enzyme-linked immunosorbent assay (ELISA) kit. The primary endpoint was progression-free survival (PFS) and the overall survival (OS) in the population.

Results

Compared to overweight combined HBV patients who received TACE, people with normal weight or no viral infection had significantly better OS and PFS. Sex, age, portal vein tumor thrombus, BCLC, ECOG, and tumor diameter are the main risk factors affecting PFS and OS. Except for the postoperative fever, no significant difference was detected in adverse reactions. Irrespective of TACE, the average expression of HMGB1 in hepatitis or obesity patients was higher than that in normal individuals and did not show upregulation after TACE. Patients without overweight or HBV infection had a low expression of serum HMGB1 that was substantially upregulated after TACE.

Conclusions

In this study, overweight combined HBV infection patients had shorter PFS and OS than other HCC patients. Thus, HBV and BMI maybe two factors affecting the efficacy of TACE via upregulated HMGB1.

1. High BMI combined with HBV infection has a negative impact on the PFS and OS of HCC patients treated with TACE.

2. Irrespective of TACE, the average HMGB1 in hepatitis and obesity patients was higher than that in normal individuals, which was not upregulated after TACE.

3. Patients without overweight and HBV infection had a low level of serum concentration of HMGB1 before TACE that was upregulated after TACE. Compared to others, these patients have severe changes in HMGB1 in the peripheral blood after treatment, indicating a higher risk of acute liver injury.

4. Upregulated HMGB1 elevated the prognosis after TACE, but obesity and HBV infection resulted in the negative effect by inhibiting HMGB1 expression.

5. For advanced HCC, overweight combined HBV infection, PVTT, multiple lesions, and larger tumor diameter are negative factors for TACE.

Inequality of weight status in urban Cuba: 2001-2010

Background

Although understanding changes in the body weight distribution and trends in obesity inequality plays a key role in assessing the causes and persistence of obesity, limited research on this topic is available for Cuba. This study thus analyzed changes in body mass index (BMI) and waist circumference (WC) distributions and obesity inequality over a 9-year period among urban Cuban adults.

Methods

Kolmogorov-Smirnov tests were first applied to the data from the 2001 and 2010 National Survey on Risk Factors and Chronic Diseases to identify a rightward shift in both the BMI and WC distributions over the 2001–2010 period. A Shapley technique decomposed the increase in obesity prevalence into a mean-growth effect and a (re)distributional component. A univariate assessment of obesity inequality was then derived by calculating both the Gini and generalized entropy (GE) measures. Lastly, a GE-based decomposition partitioned overall obesity inequality into within-group and between-group values.

Results

Despite some relatively pronounced left-skewing, both the BMI and WC distributions exhibited a clear rightward shift to which the increases in general and central obesity can be mostly attributed. According to the Gini coefficients, both general and central obesity inequality increased over the 2001–2010 period, from 0.105 [95% confidence interval (CI) = 0.103–0.106] to 0.110 [95% CI = 0.107–0.112] and from 0.083 [95% CI = 0.082–0.084] to 0.085 [95% CI = 0.084–0.087], respectively. The GE-based decomposition further revealed that both types of inequality were accounted for primarily by within-group inequality (93.3%/89.6% and 87.5%/84.8% in 2001/2010 for general/central obesity, respectively).

Conclusions

Obesity inequality in urban Cuba worsened over the 2001–2010 time period, with within-group inequality in overall obesity dominant over between-group inequality. In general, the results also imply that the rise in obesity inequality is immune to health care system characteristics.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12963-021-00251-6.

DsbA-L deficiency in T cells promotes diet-induced thermogenesis through suppressing IFN-γ production

Adipose tissue-resident T cells have been recognized as a critical regulator of thermogenesis and energy expenditure, yet the underlying mechanisms remain unclear. Here, we show that high-fat diet (HFD) feeding greatly suppresses the expression of disulfide-bond A oxidoreductase-like protein (DsbA-L), a mitochondria-localized chaperone protein, in adipose-resident T cells, which correlates with reduced T cell mitochondrial function. T cell-specific knockout of DsbA-L enhances diet-induced thermogenesis in brown adipose tissue (BAT) and protects mice from HFD-induced obesity, hepatosteatosis, and insulin resistance. Mechanistically, DsbA-L deficiency in T cells reduces IFN-γ production and activates protein kinase A by reducing phosphodiesterase-4D expression, leading to increased BAT thermogenesis. Taken together, our study uncovers a mechanism by which T cells communicate with brown adipocytes to regulate BAT thermogenesis and whole-body energy homeostasis. Our findings highlight a therapeutic potential of targeting T cells for the treatment of over nutrition-induced obesity and its associated metabolic diseases.

Obesity and the prevention of thyroid cancer: Impact of body mass index and weight change on developing thyroid cancer - Pooled results of 24 million cohorts

BACKGROUND

Body weight may be a modifiable risk factor predisposing to different cancers. To establish a potential impact of weight change on thyroid cancer risk, we conducted a meta-analysis to evaluate the effect of body mass index (BMI) and weight change over time as a risk of developing thyroid cancer (TC).

METHODS

A systematic search was performed up to February 25, 2020. Pooled relative risk (RR) were estimated using fixed and random models. Heterogeneity between articles was examined using Q-test and I² index. Evaluation of publication bias was conducted with Egger's regression test.

RESULTS

A total of 31 studies including 24,489,477 cohorts were eligible. Pooled analysis revealed that normal and underweight cohorts were associated with a decreased risk of TC (RR = 0.68, 95%CI = 0.65-0.71, p < 0.001) and (RR = 0.92, 95%CI = 0.91-0.93, p < 0.001), respectively. In contrast, overweight and obese cohorts were more likely to develop TC (RR = 1.26, 95%CI = 1.24-1.28, p < 0.001 and RR = 1.50, 95%CI = 1.45-1.55, p < 0.001, respectively). Obesity was associated with higher risk of developing TC among women (RR = 1.29, 95%CI = 1.14-1.46, p < 0.001), but not men (RR = 1.25, 95%CI = 0.97-1.62, p = 0.08). Furthermore, weight gain increased the risk of developing TC (RR = 1.18, 95%CI = 1.14-1.22, p < 0.001), while weight loss decreased the risk (RR = 0.89, 95%CI = 0.85-0.93, p < 0.001). Results showed similar trends of weight change effect in both males and females.

CONCLUSIONS

Obesity is associated with higher risk of developing TC in women. However, maintaining a healthy weight is associated with reduced risk of TC in both women and men. Shifting our practice to include weight control strategies will help lead to cancer prevention.

Trends in the prevalence of overweight, obesity, and abdominal obesity among Chinese adults between 1993 and 2015

BACKGROUND

Most previous studies on trends in the prevalence of obesity or abdominal obesity in Chinese adults were based on regional data and/or short time intervals, and recent trends are not available. We aimed to examine the secular trends in the prevalence of overweight, obesity, and abdominal obesity among Chinese adults at the national level from 1993 to 2015.

METHODS

A total of 70,242 Chinese adults aged 18-80 years were from the cross-sectional surveys conducted from 1993 to 2015. According to the World Health Organization criteria, overweight was defined as body mass index (BMI) ≥23.0 kg/m² and <27.5 kg/m², and obesity was defined as BMI ≥27.5 kg/m². According to the International Diabetes Federation criteria, abdominal obesity was defined as waist circumference (WC) ≥90 cm for men and ≥80 cm for women. Mean values and prevalence of adiposity markers were standardized to the age distribution of the China population in 2010.

RESULTS

Between 1993 and 2015, and based on age-standardized values, mean BMI increased from 21.9 kg/m² in 1993 to 23.9 kg/m² (+2.0 kg/m²) in 2015 (P for trend < 0.001), and mean WC increased from 76.0 cm to 83.4 cm (+7.4 cm) (P for trend <0.001). From 1993 to 2015, the prevalence increased from 26.6% to 41.3% (+14.7%) for overweight, from 4.2% to 15.7% (+11.5%) for obesity, and from 20.2% to 46.9% (+26.7%) for abdominal obesity (all P for trends < 0.001). In multivariate linear regression analysis, time (calendar years), older age and urban regions were strongly and independently associated with BMI.

CONCLUSIONS

The prevalence of overweight, obesity, and abdominal obesity increased markedly among Chinese adults during the past two decades. Weight control programs and public health measures to address the societal causes of obesity should be strengthened.

Social Capital as a Mediator through the Effect of Education on Depression and Obesity among the Elderly in China

Objectives: Global aging is an increasingly serious problem. The health problems faced by the elderly, such as depression and obesity, require serious consideration. Education, depression and obesity are inextricably linked; for the elderly, education is constant, and the factors which can mediate the relationship between education, depression and obesity are still being discussed by scholars. The mediating effect of social capital is rarely studied. The objective of this study was to assess the mediating role of cognitive social capital and structural social capital, as well as the effect of education on depression and obesity among the elderly using China Family Panel Studies (CFPS) data. Methods: In total, 4919 respondents were included in the final analysis. Education was measured by years of schooling. Trust and participation were used as measures of cognitive social capital and structural social capital. Depression symptoms and BMI were used as outcomes. Structural equation models were developed to examine the direct and indirect effect of social capital and education on health outcomes. Results: Education was negatively correlated with depression symptom (r = −0.15, p < 0.001), while education was positively correlated with BMI (r = 0.08, p < 0.001). Older adults with a higher education level have higher cognitive social capital (r = 0.11, p < 0.001) and structural social capital (r = 0.20, p < 0.001). Social capital plays a mediatory role. Older adults with higher social capital have a lower risk of depression (cognitive: r = −0.23, p < 0.001; structural: r = −0.03, p < 0.01) but a higher risk of obesity (cognitive: r = 0.06, p < 0.01; structural: r = 0.03, p < 0.01). For depression, the mediating function of cognitive social capital (a1b1= −0.025) is stronger than that of structural social capital (a2b2 = −0.006). While, for obesity, the effects of both cognitive and structural social capital are the same (a1c1 = a2c2 = 0.005). Conclusions: Social capital as a mediator through the effect of education on depression and obesity among the elderly in China. Meanwhile, using the positive effects of social capital to avoid negative effects should also be seriously considered.

Dynamics of Chinese Diet Divergence from Chinese Food Pagoda and Its Association with Adiposity and Influential Factors: 2004-2011

Nutrition transition in China has a strong impact on dietary quality and health of Chinese consumers. This study developed the diet quality divergence Index (DQD), the divergence between real food consumption and the Chinese food pagoda 2016 (CFP), to measure the quality of diet in China. Using four waves of data (2004, 2006, 2009, and 2011) from China Health and Nutrition Survey (CHNS), this study shed light on the transition of diet quality for Chinese residents. Results indicate that the DQD generally decreased and Chinese diet quality improved during 2004-2011. The divergence was mainly caused by over-consumption of legumes and nuts, and under-consumption of milk and milk products. Rising income and urbanization were positively correlated with diet quality for the people with low DQD. However, both of them had negative impacts on diet quality for those with high DQD. Females and rural residents held a lower DQD than their counterparts. The results also revealed that healthy food preference, education, dining at home, household size, proportions of teens (6-17) and elders (over 64) in the families are positively correlated with Chinese diet quality. However, labor intensity, frequency of drinking alcohol, and smoking have negative impacts on diet quality. Moreover, higher DQD was found to be associated with increasing risks of overweight/obesity. Therefore, we suggest national healthy policies should pay more attention to nutrition education. It is also necessary to focus on populations with poor diet quality and to adopt measures to control drinking alcohol and smoking.

Soy Products Ameliorate Obesity-Related Anthropometric Indicators in Overweight or Obese Asian and Non-Menopausal Women: A Meta-Analysis of Randomized Controlled Trials

Background: The effect of soy products on the weight of overweight or obese people is controversial, so we aimed to conduct a systematic review and a meta-analysis of published randomized controlled trials to analyze whether supplementation with soy products can help them to lose weight. Methods: The relevant data before January 2019 in PubMed, Embase and Cochrane Library were searched. A random-effect model was adopted to calculate the weighted average difference of net changes of body weight, body mass index (BMI), body fat percentage, fat mass, waist circumference, etc. Results: A total of 22 trials (870 overweight or obese participants) were reflected in the present meta-analysis. Analysis showed that soy products significantly reduced body weight, BMI, body fat percent and waist circumference in overweight or obese Asian populations (−0.37 kg, P = 0.010; −0.27 kg/m², P = 0.042; −0.36%, P = 0.032; −0.35 cm, P = 0.049) and more significant effects were observed in non-menopausal women reduced body weight (−0.59 kg, P = 0.041), BMI (−0.59, P = 0.041) and waist circumference (−0.59 cm, P = 0.041) in overweight or obese populations. Conclusion: This meta-analysis showed that soy products have weight loss effects, mainly due to soy protein, isoflavone and soy fiber.

Further Development of P4 Approach to Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a heterogeneous disorder. Cluster analysis has identified different physiologic subtypes with respect to symptoms. A difference exists in cardiovascular risk from OSA between the 7 subtypes identified. There are 3 basic subtypes replicated in multiple studies: (a) a group where insomnia is the main symptom; (b) an asymptomatic group; (c) a group with marked excessive sleepiness. The symptomatic benefit from treatment with nasal CPAP varies between these 3 subtypes. Data from the Sleep Heart Health Study reveal that the increased risk of cardiovascular disease from OSA occurs only in the excessively sleepy group.