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Osagiede O, Nayar K, Raimondo M, Kumbhari V, Lukens FJ. The Determinants of Inpatient Palliative Care Use in Patients With Pancreatic Cancer. Am J Hosp Palliat Care 2024; 41:1264-1271. [PMID: 37991926 DOI: 10.1177/10499091231218257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Symptom burden management is a major goal of pancreatic cancer care given that most patients are diagnosed late. Early palliative care is recommended in addition to concurrent active treatment; however, disparities exist. We sought to determine the factors associated with inpatient palliative treatment among pancreatic cancer patients and compare treatment outcomes in terms of mortality, discharge disposition and resource utilization. METHODS We conducted a retrospective study of 22,053 pancreatic cancers using the National Inpatient Sample (NIS) database (January - December 2020). Patient and hospital characteristics, mortality, discharge disposition, length of stay (LOS), hospital costs and charges were compared between pancreatic cancer patients based on palliative treatment. Multivariate regression was used to evaluate patient and hospital characteristics and outcomes associated with palliative treatment. RESULTS A total number of 3839 (17.4%) patients received palliative care. Patients who received palliative care were more likely to be older, Medicaid insured, and nonobese. Patients were less likely to receive palliative care if they are males, Medicare insured, had a lower Charlson comorbidity score, or treated in Urban nonteaching hospitals. Patients who received palliative care displayed higher odds of in-hospital mortality and prolonged LOS. The adjusted additional mean hospital cost and charges in patients who received palliative care were lower by $1459, and $4222 respectively. CONCLUSIONS Inpatient palliative treatment in pancreatic cancer patients is associated with an older age, a higher comorbidity burden, non-obesity, insurance status and urban teaching hospitals. Our study suggests that inpatient palliative treatment decreased hospital resource utilization without prolonging survival.
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Affiliation(s)
- Osayande Osagiede
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Kapil Nayar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Massimo Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Frank J Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Biener AI, Meyerhoefer C, Cawley J. Non-classical measurement error in instrumental variables estimation: An application to the medical care costs of obesity. HEALTH ECONOMICS 2024; 33:2558-2574. [PMID: 39030850 DOI: 10.1002/hec.4882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/18/2024] [Accepted: 06/29/2024] [Indexed: 07/22/2024]
Abstract
Estimates of the impact of body mass index and obesity on health and labor market outcomes often use instrumental variables estimation (IV) to mitigate bias due to endogeneity. When these studies rely on survey data that include self- or proxy-reported height and weight, there is non-classical measurement error due to the tendency of individuals to under-report their own weight. Mean reverting errors in weight do not cause IV to be asymptotically biased per se, but may result in bias if instruments are correlated with additive error in weight. We demonstrate the conditions under which IV is biased when there is non-classical measurement error and derive bounds for this bias conditional on instrument strength and the severity of mean-reverting error. We show that improvements in instrument relevance alone cannot eliminate IV bias, but reducing the correlation between weight and reporting error mitigates the bias. A solution we consider is regression calibration (RC) of endogenous variables with external validation data. In simulations, we find IV estimation paired with RC can produce consistent estimates when correctly specified. Even when RC fails to match the covariance structure of reporting error, there is still a reduction in asymptotic bias.
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Affiliation(s)
- Adam I Biener
- Department of Economics, Lafayette College, Easton, Pennsylvania, USA
| | - Chad Meyerhoefer
- Department of Economics, College of Business, Lehigh University, Bethlehem, Pennsylvania, USA
| | - John Cawley
- Brooks School of Public Policy and Department of Economics, Cornell University, Ithaca, New York, USA
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Walker V, Sanderson E, Levin MG, Damraurer SM, Feeney T, Davies NM. Reading and conducting instrumental variable studies: guide, glossary, and checklist. BMJ 2024; 387:e078093. [PMID: 39401839 PMCID: PMC11472180 DOI: 10.1136/bmj-2023-078093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 10/19/2024]
Affiliation(s)
- Venexia Walker
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eleanor Sanderson
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael G Levin
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Surgery and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Scott M Damraurer
- Department of Surgery and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Timothy Feeney
- Department of Epidemiology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Neil M Davies
- Division of Psychiatry, University College London, London W1T 7NF, UK
- Department of Statistical Science, University College London, London, UK
- K G Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Chen F, Jing K, Zhang Z, Liu X. A review on drug repurposing applicable to obesity. Obes Rev 2024:e13848. [PMID: 39384341 DOI: 10.1111/obr.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 05/22/2024] [Accepted: 09/19/2024] [Indexed: 10/11/2024]
Abstract
Obesity is a major public health concern and burden on individuals and healthcare systems. Due to the challenges and limitations of lifestyle adjustments, it is advisable to consider pharmacological treatment for people affected by obesity. However, the side effects and limited efficacy of available drugs make the obesity drug market far from sufficient. Drug repurposing involves identifying new applications for existing drugs and offers some advantages over traditional drug development approaches including lower costs and shorter development timelines. This review aims to provide an overview of drug repurposing for anti-obesity medications, including the rationale for repurposing, the challenges and approaches, and the potential drugs that are being investigated for repurposing. Through advanced computational techniques, researchers can unlock the potential of repurposed drugs to tackle the global obesity epidemic. Further research, clinical trials, and collaborative efforts are essential to fully explore and leverage the potential of drug repurposing in the fight against obesity.
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Affiliation(s)
- Feng Chen
- Department of Clinical Pharmacy, School of Pharmacy, Naval Medical University, Shanghai, China
| | - Kai Jing
- Department of Clinical Pharmacy, School of Pharmacy, Naval Medical University, Shanghai, China
| | - Zhen Zhang
- Department of Clinical Pharmacy, School of Pharmacy, Naval Medical University, Shanghai, China
- Department of Nutrition and Food Hygiene, Faculty of Naval Medicine, Naval Medical University, Shanghai, China
| | - Xia Liu
- Department of Clinical Pharmacy, School of Pharmacy, Naval Medical University, Shanghai, China
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Choo A, Lim E, Eng A, Chan WH, Asokkumar R, Tan J, Tan AS, Chong A, Md Shahrin YB, Wang X, Lee PC, Lim CH. Predictors of early removal of intragastric balloon due to intolerance: Insights from a multiethnic Asian cohort. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:551-561. [PMID: 39373374 DOI: 10.47102/annals-acadmedsg.2023257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
Introduction Intolerance frequently limits the use of intragastric balloons (IGBs) in the treatment of obesity. This includes refractory nausea, vomiting and abdominal discomfort. Our study aims to identify predictors of balloon intolerance and early removal, which will help to guide patient selection for this intervention and peri-procedure care. Method We conducted a retrospective cohort study of 54 consecutive patients who underwent IGB insertion from July 2017 to July 2022 in a single tertiary institution in Singapore. Forty-seven (87.0%) patients completed therapy, while 7 patients (13.0%) had early removal of the balloon due to intolerance. Characteristics of both groups were compared. Results Multivariate analysis revealed significant associations between early balloon removal and both depression (P=0.012) and anxiety (P=0.001) after adjusting for age, sex, ethnicity, height, nulliparity, balloon type and volume. Univariate analysis revealed that anxiety was the main risk factor (P=0.004, odds ratio 9.111, 95% confidence interval 1.624-51.124), while depression was no longer a significant predictor. Conclusion Identifying predictors of balloon intolerance and early removal can enhance patient selection and improve peri-procedural care. In patients with a history of depression or anxiety, it is important to ensure adequate counselling and preparation prior to balloon insertion.
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Affiliation(s)
- Amadora Choo
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Singapore
| | - Eugene Lim
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Singapore
| | - Alvin Eng
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Singapore
| | - Weng Hoong Chan
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Singapore
| | - Ravishankar Asokkumar
- Department of Gastroenterology & Hepatology, Division of Medicine, Singapore General Hospital, Singapore
| | - Jeremy Tan
- Department of Dietetics, Singapore General Hospital, Singapore
| | - Ai Shan Tan
- Department of Dietetics, Singapore General Hospital, Singapore
| | - Agnes Chong
- Department of Dietetics, Singapore General Hospital, Singapore
| | | | - Xuan Wang
- Department of Dietetics, Singapore General Hospital, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Division of Medicine, Singapore General Hospital, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Singapore
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Kim Y, Park HI, Chu H, Jin H, Leem J. Effectiveness and safety of acupuncture modalities for overweight and obesity treatment: a systematic review and network meta-analysis of RCTs. Front Med (Lausanne) 2024; 11:1446515. [PMID: 39234040 PMCID: PMC11372581 DOI: 10.3389/fmed.2024.1446515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/31/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction The effectiveness and safety of acupuncture in the treatment of obesity have not been assessed. This poses a challenge for clinicians who choose to use acupuncture in the treatment of obesity, as they are unable to prioritize this approach based on outcome variables. Methods In May 2024, a literature search of five databases was conducted. Only randomized controlled trials evaluating body weight (BW), body mass index, waist circumference (WC), and adverse events in patients with a body mass index (BMI) of 25 or higher for various acupuncture modalities were included. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials, version 2. Pairwise meta-analysis (PMA) and Bayesian network meta-analysis (NMA) were performed using a random effects model for quantitative synthesis. Results Fourteen studies (n = 868) were included. The included studies evaluated the following acupuncture modalities: electroacupuncture (EA) (N = 6), laser acupuncture (LA) (N = 2), auricular acupuncture (AA) (N = 5), and manual acupuncture (MA) (N = 3). The PMA found that adding EA to usual care (UC), compared to UC alone, reduced BW (MD = 2.46, 95% CI = 1.12 to 3.80, I 2 = 58%, REM, N = 3, n = 157). The NMA of BW showed the following effect sizes for UC alone versus each acupuncture modality combined with UC: LA (MD = 2.09, 95% CI = 0.04 to 3.86), EA (MD = 2.04, 95% CI = 0.88 to 3.50), AA (MD = 1.69, 95% CI = -0.11 to 3.58), and MA (MD = 1.02, 95% CI = -0.82 to 2.94). The probability of each modality being the optimal treatment was evaluated using the surface under the cumulative ranking curve. EA was the most efficacious for BW and BMI, while LA was the most efficacious for WC. Discussion EA and LA can effectively complement clinical obesity management. The number of included studies was limited, and publication bias may have occurred, necessitating a cautious interpretation of the results. Furthermore, most studies lasted between six and 12 weeks. Future clinical studies of acupuncture for obesity should include longer follow-up periods. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387788, identifier CRD42023387788.
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Affiliation(s)
- Youngjin Kim
- Wonkwang University Korean Medicine Hospital, Iksan, Republic of Korea
| | - Ha-Im Park
- Wonkwang University Gwangju Korean Medicine Hospital, Gwangju, Republic of Korea
| | - Hongmin Chu
- Mapo Hongik Korean Medicine Clinic, Seoul, Republic of Korea
| | - Hanbit Jin
- Department of Diagnostics, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Jungtae Leem
- Department of Diagnostics, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea
- Research Center of Traditional Korean Medicine, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea
- Korean Medicine Clinical Research Institute, Wonkwang University Korean Medicine Hospital, Iksan, Republic of Korea
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Monda A, de Stefano MI, Villano I, Allocca S, Casillo M, Messina A, Monda V, Moscatelli F, Dipace A, Limone P, Di Maio G, La Marra M, Di Padova M, Chieffi S, Messina G, Monda M, Polito R. Ultra-Processed Food Intake and Increased Risk of Obesity: A Narrative Review. Foods 2024; 13:2627. [PMID: 39200554 PMCID: PMC11353718 DOI: 10.3390/foods13162627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/15/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
The prevalence of obesity has become a global health concern, with significant impacts on quality of life and mortality rates. Recent research has highlighted the role of ultra-processed foods (UPFs) in driving the obesity epidemic. UPFs undergo extensive processing, often containing high levels of sugars, fats, and additives, while lacking essential nutrients. Studies have linked UPF consumption to obesity and cardiometabolic diseases, underscoring the importance of dietary patterns rich in whole foods. Thus, the aim of this narrative review is to elucidate the correlation between ultra-processed foods and the increased trend of obesity and its related complications. These foods, prevalent in modern diets, contribute to nutritional deficiencies and excessive caloric intake, exacerbating obesity rates. Lifestyle factors such as busy schedules and quick meal management further drive UPF consumption, disrupting hunger regulation and promoting overeating. UPF consumption correlates with adverse health outcomes, including dyslipidemia, hypertension, and insulin resistance. Promoting whole, minimally processed foods and implementing school-based nutrition education programs are crucial steps. Also, numerous challenges exist, including unequal access to healthy foods, the industry's influence, and behavioral barriers to dietary change. Future research should explore innovative approaches, such as nutrigenomics and digital health technologies, to personalize interventions and evaluate policy effectiveness. Collaboration across disciplines and sectors will be vital to develop comprehensive solutions and improve public health outcomes globally.
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Affiliation(s)
- Antonietta Monda
- Department of Human Science and Promotion of Quality of Life, Telematic University San Raffaele, 00166 Rome, Italy;
| | - Maria Ida de Stefano
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.I.d.S.); (R.P.)
| | - Ines Villano
- Department of Wellness, Nutrition and Sport, Telematic University Pegaso, 80143 Naples, Italy; (I.V.); (F.M.); (A.D.); (P.L.)
| | - Salvatore Allocca
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Maria Casillo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Antonietta Messina
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Vincenzo Monda
- Department of Economics, Law, Cybersecurity, and Sports Sciences, University of Naples “Parthenope”, 80132 Naples, Italy;
| | - Fiorenzo Moscatelli
- Department of Wellness, Nutrition and Sport, Telematic University Pegaso, 80143 Naples, Italy; (I.V.); (F.M.); (A.D.); (P.L.)
| | - Anna Dipace
- Department of Wellness, Nutrition and Sport, Telematic University Pegaso, 80143 Naples, Italy; (I.V.); (F.M.); (A.D.); (P.L.)
| | - Pierpaolo Limone
- Department of Wellness, Nutrition and Sport, Telematic University Pegaso, 80143 Naples, Italy; (I.V.); (F.M.); (A.D.); (P.L.)
| | - Girolamo Di Maio
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Marco La Marra
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Marilena Di Padova
- Department of Humanistic Studies, University of Foggia, 71122 Foggia, Italy;
| | - Sergio Chieffi
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Giovanni Messina
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Marcellino Monda
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.A.); (M.C.); (G.D.M.); (M.L.M.); (S.C.); (G.M.)
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.I.d.S.); (R.P.)
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Maldonado-Devincci AM, Odelade AE, Irby-Shabazz A, Jadhav V, Nepal P, Chang EM, Chang AY, Han J. Longitudinal sex-specific impacts of high-fat diet on dopaminergic dysregulation and behavior from periadolescence to late adulthood. Nutr Neurosci 2024:1-14. [PMID: 39046103 DOI: 10.1080/1028415x.2024.2377471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
OBJECTIVES Obesity is recognized for its adverse impact on brain health and related behaviors; however, the specific longitudinal effects of a high-fat diet (HFD) from juvenile stages of development through late adulthood remain poorly understood, particularly sex-specific outcomes. This study aimed to determine how prolonged exposure to HFD, commencing during periadolescence, would differentially predispose male and female mice to an elevated risk of dopaminergic dysregulation and associated behavioral deficits. METHODS One-month-old C57BL/6J male and female mice were subjected to either a control diet or an HFD for 5 and 9 months. Muscle strength, motor skills, sensorimotor integration, and anxiety-like behaviors were assessed at the end of the 5th and 8th months. Key dopaminergic molecules, including dopamine (DA), dopamine receptor D2 (DRD2), dopamine transporter (DAT), and vesicular monoamine transporter 2 (VMAT2), were quantified at the end of the 5th or 9th months. RESULTS Behaviorally, male mice exposed to HFD exhibited more pronounced alterations in sensorimotor integration, anxiety-like behavior, and muscle strength after the 5th month of dietary exposure. In contrast, female mice displayed most behavioral differences after the 8th month of HFD exposure. Physiologically, there were notable sex-specific variations in the dopaminergic pathway response to HFD. Male mice exposed to HFD exhibited elevated tissue levels of VMAT2 and DRD2, whereas female mice showed reduced levels of DRD2 and DAT compared to control groups. DISCUSSION These findings indicate a general trend of altered time course susceptibility in male mice to chronic HFD consumption compared to their female counterparts, with male mice impacted earlier than females.
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Affiliation(s)
- Antoniette M Maldonado-Devincci
- Department of Psychology, John R. and Kathy R. Hairston College of Health and Human Sciences, North Carolina Agricultural and Technical State University, Greensboro, NC USA
| | - Anuoluwapo E Odelade
- Department of Biology, College of Science and Technology, North Carolina Agricultural and Technical State University, Greensboro, NC USA
| | - Adenike Irby-Shabazz
- Department of Biology, College of Science and Technology, North Carolina Agricultural and Technical State University, Greensboro, NC USA
| | - Vidya Jadhav
- Department of Biology, College of Science and Technology, North Carolina Agricultural and Technical State University, Greensboro, NC USA
| | - Pragya Nepal
- Department of Biology, College of Science and Technology, North Carolina Agricultural and Technical State University, Greensboro, NC USA
| | - Evelyn M Chang
- Program in Liberal Medical Education, Division of Biology and Medicine, Brown University, Providence
| | - Alex Y Chang
- Department of Animal Science, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Jian Han
- Department of Biology, College of Science and Technology, North Carolina Agricultural and Technical State University, Greensboro, NC USA
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Baser O, Samayoa G, Rodchenko K, Isenman L, Baser E, Yapar N. The association between weight loss medications and cardiovascular complications. Obesity (Silver Spring) 2024; 32:1401-1409. [PMID: 38706431 DOI: 10.1002/oby.24037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Obesity and its cardiovascular complications are major causes of morbidity and mortality. Little is known in real-world settings about the effect of newly approved antiobesity medications (AOMs) on cardiovascular complications among patients with obesity. METHODS This retrospective cohort study examined the association between newly approved AOM use and cardiovascular events among Medicare patients with obesity using data from 2020 to 2022. Patient age, gender, comorbidity scores, socioeconomic status, and baseline cardiovascular comorbidities were compared descriptively. Subgroup analysis compared variables by medication type. Relative risk and absolute risk of cardiovascular disease (CVD) events were estimated using Cox and Aalen regression models. RESULTS The analysis included 5926 patients treated with semaglutide and tirzepatide, including Ozempic (5404 patients), Wegovy (375 patients), or Mounjaro (147 patients). Hypertension, type 2 diabetes, and hyperlipidemia were the most common comorbidities. For patients with AOMs, less incidence of heart failure (4.89% vs. 6.13%, p < 0.0001), atrial fibrillation (3.83% vs. 5.17%, p < 0.0001), arrhythmia (3.59% vs. 4.14%, p < 0.0153), and peripheral vascular disease (3.44% vs. 2.94%, p < 0.0395) was found versus patients without AOMs. Patients receiving AOMs showed an 8% risk reduction in any CVD. Protective effect on CVD was apparent over the first 375 days. CONCLUSIONS Results suggest that utilization of AOMs effectively alleviates the high prevalence of CVD.
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Affiliation(s)
- Onur Baser
- Department of Economics, Bogazici University, Istanbul, Turkey
- Graduate School of Public Health, City University of New York, New York, New York, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | | | | | - Erdem Baser
- Columbia Data Analytics, New York, New York, USA
| | - Nehir Yapar
- Columbia Data Analytics, New York, New York, USA
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10
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Goel A, Reddy S, Goel P. Causes, Consequences, and Preventive Strategies for Childhood Obesity: A Narrative Review. Cureus 2024; 16:e64985. [PMID: 39161504 PMCID: PMC11332093 DOI: 10.7759/cureus.64985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
Childhood obesity is a complex public health challenge with profound implications for both physical and psychological well-being. A significant portion of the global population struggles with obesity. Sedentary lifestyles, increased consumption of ultra-processed foods, and socioeconomic disparities are major contributors. The COVID-19 pandemic has further exacerbated these issues, leading to a surge in obesity rates among children. The consequences of childhood obesity extend beyond immediate health issues like type 2 diabetes and cardiovascular diseases; obese children are at higher risk for psychological problems such as depression, anxiety, and low self-esteem, which can persist into adulthood. These health challenges also impose substantial economic burdens due to increased healthcare costs and reduced productivity. This paper synthesizes findings from various articles to provide an overview of the causes, consequences, and preventive strategies related to childhood obesity. It highlights the varied nature of obesity, including genetic, environmental, and lifestyle factors, and discusses the profound impact on physical health, socioemotional skills, and mental health. Additionally, it examines the global challenge of childhood obesity, particularly in developing nations, and emphasizes the importance of preventive measures, family and parental behaviors, and effective policy interventions.
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Affiliation(s)
- Ashish Goel
- Department of Cardiology, Fayth Clinic, Mumbai, IND
| | - Spoorti Reddy
- Department of General Medicine, Jan Sewa Hospital, Tantia University, Sri Ganganagar, IND
| | - Paula Goel
- Department of Pediatrics, Fayth Clinic, Mumbai, IND
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11
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Dawod M, Nagib P, Zaki J, Prevedello LM, Ajam AA, Nguyen XV. CT and MR utilization and morbidity metrics across Body Mass Index. PLoS One 2024; 19:e0306087. [PMID: 38941332 PMCID: PMC11213308 DOI: 10.1371/journal.pone.0306087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 06/11/2024] [Indexed: 06/30/2024] Open
Abstract
OBJECTIVE Obesity is a high-morbidity chronic condition and risk factor for multiple diseases that necessitate imaging. This study assesses the relationship between BMI and same-year utilization of CT and MR imaging in a large healthcare population. METHODS In this retrospective population-based study, all patients aged ≥18 years with a documented BMI in the multi-institutional Cosmos database were included. Cohorts were identified based on ≥1 documented BMI in 2021 within pre-defined ranges. For each cohort, we assessed the percentage of patients undergoing head, neck, chest, spine, or abdomen/pelvis CT and MR during the same year. Disease severity was quantified based on emergency department (ED) visits and mortality. RESULTS In our population of 49.6 million patients, same-year CT and MR utilization was 14.5 ±0.01% and 6.0±0.01%, respectively. The underweight cohort had the highest CT (25.8±0.1%) and MR (8.01 ± 0.05) imaging utilization. At high extremes of BMI (>50 kg/m2), CT utilization mildly increased (18.4±0.1%), but MR utilization decreased (5.3±0.04%). While morbidity differences may explain some BMI-utilization relationships, lower MR utilization in the BMI>50 cohort contrasts with higher age-adjusted mortality (1.8±0.03%) and ED utilization (32.4±0.1%) in this cohort relative to normal weight (1.5±0.01% and 25.7±0.02%, respectively). CONCLUSION Underweight patients had disproportionately high CT/MR utilization, and high extremes of BMI are associated with mildly higher CT and lower MR utilization than the normal weight cohort. The elevated mortality and ED utilization in severely obese patients contrasts with their lower MR imaging utilization. Our findings may assist public health efforts to accommodate obesity trends.
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Affiliation(s)
- Mina Dawod
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Paul Nagib
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - John Zaki
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Luciano M. Prevedello
- Department of Radiology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Amna A. Ajam
- Department of Radiology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Xuan V. Nguyen
- Department of Radiology, The Ohio State University College of Medicine, Columbus, OH, United States of America
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Hansen Edwards C, Håkon Bjørngaard J, Minet Kinge J, Åberge Vie G, Halsteinli V, Ødegård R, Kulseng B, Waaler Bjørnelv G. The healthcare costs of increased body mass index-evidence from The Trøndelag Health Study. HEALTH ECONOMICS REVIEW 2024; 14:36. [PMID: 38822866 PMCID: PMC11143647 DOI: 10.1186/s13561-024-00512-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/13/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Earlier studies have estimated the impact of increased body mass index (BMI) on healthcare costs. Various methods have been used to avoid potential biases and inconsistencies. Each of these methods measure different local effects and have different strengths and weaknesses. METHODS In the current study we estimate the impact of increased BMI on healthcare costs using nine common methods from the literature: multivariable regression analyses (ordinary least squares, generalized linear models, and two-part models), and instrumental variable models (using previously measured BMI, offspring BMI, and three different weighted genetic risk scores as instruments for BMI). We stratified by sex, investigated the implications of confounder adjustment, and modelled both linear and non-linear associations. RESULTS There was a positive effect of increased BMI in both males and females in each approach. The cost of elevated BMI was higher in models that, to a greater extent, account for endogenous relations. CONCLUSION The study provides solid evidence that there is an association between BMI and healthcare costs, and demonstrates the importance of triangulation.
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Affiliation(s)
- Christina Hansen Edwards
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Jonas Minet Kinge
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunnhild Åberge Vie
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vidar Halsteinli
- Regional Center for Healthcare Improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Rønnaug Ødegård
- Regional Center for Obesity Research and Innovation, Department of Surgery, St. Olavs Hospital, Trondheim, Norway
- Department of Clinical Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bård Kulseng
- Regional Center for Obesity Research and Innovation, Department of Surgery, St. Olavs Hospital, Trondheim, Norway
- Department of Clinical Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gudrun Waaler Bjørnelv
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
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13
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Toliver J, Schnecke V, Rizkallah L. The Clinical and Economic Burdens of Obesity and the Value of Weight Loss for an EMR-Derived US Cohort: A Modeling Study. Popul Health Manag 2024; 27:300-306. [PMID: 39110141 DOI: 10.1089/pop.2024.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2024] Open
Abstract
Obesity-related comorbidities (ORCs) cause significant economic and clinical burdens for people with obesity and the US health care system. A reduction in weight at the population level may reduce incident ORC diagnoses and associated costs of treatment. The aim of this work is to describe obesity burden in the United States through the prevalence and direct treatment costs of ORCs, as well as the clinical and economic value of 15% weight loss in a population of adults with obesity. The IQVIA Ambulatory US electronic medical record database was used to create a cohort (7,667,023 individuals 20-69 years of age, body mass index of 30-50 kg/m2), utilized to characterize the prevalence of 10 ORCs. Direct treatment costs were collected from literature reports. A risk model was leveraged to estimate the number and cost of additional ORC diagnoses over 5 years from baseline through two scenarios: stable weight and 15% lower body weight at baseline for all members of the population. Prevalence, incidence, and cost data were scaled down to a representative subset of 100,000 individuals. In 2022, the annual treatment costs for all 10 ORCs exceeded $918 million for the representative cohort. In a stable-weight scenario, these costs were estimated to increase to ≈$1.4 billion by 2027. With 15% lower body weight at baseline, $221 million in cumulative savings was estimated, corresponding to $2205 in savings/patient over 5 years. Consequently, weight loss in this population may correspond to significantly reduced numbers of incident ORC complications translating to substantial cost savings.
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14
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Mourchid R, Yassine A, Bellahcen M, Cherrah Y, Serragui S. Chronic kidney disease in America, Africa, and Asia: Overview of treatment cost and options. ANNALES PHARMACEUTIQUES FRANÇAISES 2024; 82:392-400. [PMID: 38218427 DOI: 10.1016/j.pharma.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
Chronic kidney disease (CKD) is one of the non-infectious diseases that threaten patients' lives on a daily basis. Its prevalence is high, but under-reported by patients and those living with the disease, as it is silent and asymptomatic in the early stages. Kidney disease increases the risk of heart and vascular disease. These problems can manifest themselves slowly, over a long period of time. Early detection and treatment can often prevent chronic kidney disease from worsening. As kidney disease progresses, it can lead to kidney failure, requiring dialysis or a kidney transplant to stay alive. In this narrative review, we will mainly discuss different treatment option costs in different countries and how much they cost healthcare systems in countries in three different continents.
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Affiliation(s)
- Rania Mourchid
- Pharmaco-epidemiology and pharmacoeconomics research team, Pharmacology and Toxicology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, 10100 Rabat, Morocco.
| | - Amal Yassine
- National health Insurance agency, 10100 Rabat, Morocco.
| | - Mohammed Bellahcen
- Hemodialysis Center Fondation Amal Hay Nahda Rabat, 10210 Rabat, Morocco.
| | - Yahia Cherrah
- Pharmaco-epidemiology and pharmacoeconomics research team, Pharmacology and Toxicology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, 10100 Rabat, Morocco.
| | - Samira Serragui
- Pharmaco-epidemiology and pharmacoeconomics research team, Pharmacology and Toxicology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, 10100 Rabat, Morocco.
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15
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Sharif FV, Yousefi N, Sharif Z. Economic Evaluations of Anti-obesity Interventions in Obese Adults: An Umbrella Review. Obes Surg 2024; 34:1834-1845. [PMID: 38438668 DOI: 10.1007/s11695-024-07104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/06/2024]
Abstract
This umbrella review amalgamates the outcomes of economic evaluations pertaining to bariatric surgeries, pharmacotherapy, and gastric balloon for adult obesity treatment. Six databases were systematically searched. The inclusion criteria were established following the Patient/population Intervention Comparison and Outcomes (PICO) statement. Fifteen reviews met all the inclusion criteria. Eight studies focused on surgical interventions, four on pharmacotherapy, and three on both interventions. No systematic review of the economic evaluation of gastric balloons was identified. The majority of reviews advocated bariatric surgery as a cost-effective approach; however, there was discordance in the interpretation of pharmacological cost-effectiveness. Most of the economic evaluations were conducted from the payer and the healthcare system perspectives. We propose that future economic evaluations assessing weight loss interventions in adults adopt a societal perspective and longer-term time horizons.
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Affiliation(s)
| | - Nazila Yousefi
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Sharif
- School of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran.
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16
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Kober AKMH, Saha S, Ayyash M, Namai F, Nishiyama K, Yoda K, Villena J, Kitazawa H. Insights into the Anti-Adipogenic and Anti-Inflammatory Potentialities of Probiotics against Obesity. Nutrients 2024; 16:1373. [PMID: 38732619 PMCID: PMC11085650 DOI: 10.3390/nu16091373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Functional foods with probiotics are safe and effective dietary supplements to improve overweight and obesity. Thus, altering the intestinal microflora may be an effective approach for controlling or preventing obesity. This review aims to summarize the experimental method used to study probiotics and obesity, and recent advances in probiotics against obesity. In particular, we focused on studies (in vitro and in vivo) that used probiotics to treat obesity and its associated comorbidities. Several in vitro and in vivo (animal and human clinical) studies conducted with different bacterial species/strains have reported that probiotics promote anti-obesity effects by suppressing the differentiation of pre-adipocytes through immune cell activation, maintaining the Th1/Th2 cytokine balance, altering the intestinal microbiota composition, reducing the lipid profile, and regulating energy metabolism. Most studies on probiotics and obesity have shown that probiotics are responsible for a notable reduction in weight gain and body mass index. It also increases the levels of anti-inflammatory adipokines and decreases those of pro-inflammatory adipokines in the blood, which are responsible for the regulation of glucose and fatty acid breakdown. Furthermore, probiotics effectively increase insulin sensitivity and decrease systemic inflammation. Taken together, the intestinal microbiota profile found in overweight individuals can be modified by probiotic supplementation which can create a promising environment for weight loss along enhancing levels of adiponectin and decreasing leptin, tumor necrosis factor (TNF)-α, interleukin (IL)-6, monocyte chemotactic protein (MCP)-1, and transforming growth factor (TGF)-β on human health.
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Affiliation(s)
- A. K. M. Humayun Kober
- Department of Dairy and Poultry Science, Chittagong Veterinary and Animal Sciences University, Khulshi, Chittagong 4225, Bangladesh;
| | - Sudeb Saha
- Laboratory of Animal Food Function, Graduate School of Agricultural Science, Tohoku University, Sendai 980-8576, Japan; (F.N.); (K.N.)
- Livestock Immunology Unit, International Education and Research Center for Food and Agricultural Immunology (CFAI), Tohoku University, Sendai 980-8576, Japan
- Department of Dairy Science, Faculty of Veterinary, Animal and Biomedical Sciences, Sylhet Agricultural University, Sylhet 3100, Bangladesh
| | - Mutamed Ayyash
- Department of Food Science, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al Ain 15551, United Arab Emirates;
| | - Fu Namai
- Laboratory of Animal Food Function, Graduate School of Agricultural Science, Tohoku University, Sendai 980-8576, Japan; (F.N.); (K.N.)
- Livestock Immunology Unit, International Education and Research Center for Food and Agricultural Immunology (CFAI), Tohoku University, Sendai 980-8576, Japan
| | - Keita Nishiyama
- Laboratory of Animal Food Function, Graduate School of Agricultural Science, Tohoku University, Sendai 980-8576, Japan; (F.N.); (K.N.)
- Livestock Immunology Unit, International Education and Research Center for Food and Agricultural Immunology (CFAI), Tohoku University, Sendai 980-8576, Japan
| | - Kazutoyo Yoda
- Technical Research Laboratory, Takanashi Milk Products Co., Ltd., Yokohama 241-0023, Japan;
| | - Julio Villena
- Laboratory of Animal Food Function, Graduate School of Agricultural Science, Tohoku University, Sendai 980-8576, Japan; (F.N.); (K.N.)
- Laboratory of Immunobiotechnology, Reference Centre for Lactobacilli (CERELA-CONICET), Tucuman 4000, Argentina
| | - Haruki Kitazawa
- Laboratory of Animal Food Function, Graduate School of Agricultural Science, Tohoku University, Sendai 980-8576, Japan; (F.N.); (K.N.)
- Livestock Immunology Unit, International Education and Research Center for Food and Agricultural Immunology (CFAI), Tohoku University, Sendai 980-8576, Japan
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17
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Atella V, Belotti F, Giaccherini M, Medea G, Nicolucci A, Sbraccia P, Mortari AP. Lifetime costs of overweight and obesity in Italy. ECONOMICS AND HUMAN BIOLOGY 2024; 53:101366. [PMID: 38354596 DOI: 10.1016/j.ehb.2024.101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/16/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024]
Abstract
We use longitudinal electronic clinical data on a large representative sample of the Italian population to estimate the lifetime profile costs of different BMI classes - normal weight, overweight, and obese (I, II, and III) - in a primary care setting. Our research reveals that obese patients generate the highest cost differential throughout their lives compared to normal weight patients. Moreover, we show that overweight individuals spend less than those with normal weight, primarily due to reduced expenditures beginning in early middle age. Our estimates could serve as a vital benchmark for policymakers looking to prioritize public interventions that address the obesity pandemic while considering the increasing obesity rates projected by the OECD until 2030.
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Affiliation(s)
- Vincenzo Atella
- Department of Economics and Finance, Tor Vergata University of Rome, Italy; CEIS Tor Vergata, Tor Vergata University of Rome, Italy.
| | - Federico Belotti
- Department of Economics and Finance, Tor Vergata University of Rome, Italy; CEIS Tor Vergata, Tor Vergata University of Rome, Italy
| | | | - Gerardo Medea
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | | | - Paolo Sbraccia
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Andrea Piano Mortari
- Department of Economics and Finance, Tor Vergata University of Rome, Italy; Department Programming, Ministry of Health, Rome, Italy
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18
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Sudat SEK, Huang Q, Szwerinski N, Romanelli RJ, Azar KMJ. Changes in Healthcare Utilization After Lifestyle Intervention for Weight Loss. Am J Prev Med 2024; 66:619-626. [PMID: 37907133 PMCID: PMC10957326 DOI: 10.1016/j.amepre.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION This study evaluates the real-world impact of a lifestyle change program (LCP) on healthcare utilization in a large health system. METHODS Using electronic health record data from a large health system in northern California, U.S., LCP participant and propensity-score-matched nonparticipant outcomes were compared in the second year post-participation: (1) overall healthcare utilization and (2) utilization and medications related to cardiometabolic conditions and obesity. Adult LCP participants between 2010 and 2017 were identified and matched 1:1 with replacement to comparable nonparticipants. Participants without electronic health record activity in the 12-36 months before baseline, or with conditions or procedures associated with substantial weight change, were excluded. Statistical analysis and modeling were performed in 2021-22. RESULTS Compared to matched nonparticipants, LCP participants in the 12-24 months post-baseline were more likely to have specialty-care visits (+4.7%, 95% CI +1.8%, +7.6%), electronic communications (8.6%, 95% CI +5.6%, +11.7%), and urgent-care visits (+6.5%, 95% CI +3.0%, 10.0%). Participants also had more office visits for cardiometabolic conditions and obesity (+1.72 visits/patient, 95% CI +1.05, +2.39). CONCLUSIONS Compared with matched nonparticipants, LCP participation was associated with higher utilization of outpatient services post-participation. Additional research could assess whether this indicates an increase in preventive care that could lead to improved future outcomes.
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Affiliation(s)
- Sylvia E K Sudat
- Sutter Health, Center for Health Systems Research, Walnut Creek, California.
| | - Qiwen Huang
- Sutter Health, Center for Health Systems Research, Palo Alto, California
| | - Nina Szwerinski
- Sutter Health, Center for Health Systems Research, Palo Alto, California
| | | | - Kristen M J Azar
- Sutter Health, Center for Health Systems Research, Palo Alto, California; Sutter Health, Institute for Advancing Health Equity, Sacramento, California; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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19
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Choi DH, Hong M, Kwon TH, Lee SU. Antioxidant and Anti-Obesity Effects of Juglans mandshurica in 3T3-L1 Cells and High-Fat Diet Obese Rats. J Microbiol Biotechnol 2024; 34:634-643. [PMID: 38111312 PMCID: PMC11016786 DOI: 10.4014/jmb.2311.11032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023]
Abstract
Juglans mandshurica Maxim. walnut (JMW) is well-known for the treatment of dermatosis, cancer, gastritis, diarrhea, and leukorrhea in Korea. However, the molecular mechanism underlying its anti-obesity activity remains unknown. In the current study, we aimed to determine whether JMW can influence adipogenesis in 3T3-L1 preadipocytes and high-fat diet rats and determine the antioxidant activity. The 20% ethanol extract of JMW (JMWE) had a total polyphenol content of 133.33 ± 2.60 mg GAE/g. Considering the antioxidant capacity, the ABTS and DPPH values of 200 μg/ml of JMWE were 95.69 ± 0.94 and 79.38 ± 1.55%, respectively. To assess the anti-obesity activity of JMWE, we analyzed the cell viability, fat accumulation, and adipogenesis-related factors, including CCAAT-enhancer-binding protein alpha (C/EBPα), sterol regulatory element-binding protein-1c (SREBP1c), peroxisome proliferator-activated receptor-gamma (PPARγ), fatty acid synthase (FAS), and acetyl-CoA carboxylase (ACC). We found that total lipid accumulation and triglyceride levels were reduced, and the fat accumulation rate decreased in a dose-dependent manner. Furthermore, JMWE suppressed adipogenesis-related factors C/EBPα, PPARγ, and SREBP1c, as well as FAS and ACC, both related to lipogenesis. Moreover, animal experiments revealed that JMWE could be employed to prevent and treat obesity-related diseases. Hence, JMWE could be developed as a healthy functional food and further explored as an anti-obesity drug.
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Affiliation(s)
- Da-Hye Choi
- Institute of Biological Resources, Chuncheon Bioindustry Foundation, Chuncheon 24232, Republic of Korea
| | - Min Hong
- Institute of Biological Resources, Chuncheon Bioindustry Foundation, Chuncheon 24232, Republic of Korea
| | - Tae-Hyung Kwon
- Institute of Biological Resources, Chuncheon Bioindustry Foundation, Chuncheon 24232, Republic of Korea
| | - Soo-Ung Lee
- Institute of Biological Resources, Chuncheon Bioindustry Foundation, Chuncheon 24232, Republic of Korea
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20
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Han SH, Ockerman K, Furnas H, Mars P, Klenke A, Ching J, Momeni A, Sorice-Virk S. Practice Patterns and Perspectives of the Off-Label Use of GLP-1 Agonists for Cosmetic Weight Loss. Aesthet Surg J 2024; 44:NP279-NP306. [PMID: 38085071 DOI: 10.1093/asj/sjad364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The off-label use of glucagon-like peptide 1 (GLP-1) agonists for cosmetic weight loss has captured the interest of the public. However, there is a paucity of published data on their utilization, implications, and management, particularly in the plastic surgery community. OBJECTIVES This study aims to explore the current practice patterns of aesthetic plastic surgeons regarding the off-label implementation of GLP-1 agonists. METHODS A 35-question survey was sent to the 2600 members of The Aesthetic Society in July 2023. The survey collected physician demographics, practice settings, patient population demographics, and the use and management of GLP-1 agonists in their practice. No identifying variables were collected; all responses were anonymous. RESULTS A total of 368 respondents were included. A quarter of respondents (25.3%) prescribed or utilized GLP-1 agonists in their practice. Nearly a third (29.9%) reported personal use of the medication, of which 71 (70.3%) indicated it was for cosmetic weight loss. Many aspects of the current treatment, counseling, and follow-up practices were similar among prescribing plastic surgeons. However, there were discrepancies in screening, nutrition counseling, and perioperative management. The majority believed that GLP-1 agonists were effective for weight loss (68.9%), profitable for business (57.8%), and would recommend its implementation to other plastic surgeons (68.5%). CONCLUSIONS As leaders in the aesthetic field, it behooves plastic surgeons to take charge of shaping public opinion surrounding the growing off-label use of GLP-1 agonists for cosmetic weight loss. Plastic surgeons' leadership is imperative in establishing safe and ethical guidelines and protocols for proper screening, management, and patient care. LEVEL OF EVIDENCE: 4
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Wong ES, Stechuchak KM, Smith VA, Hung A, Dennis PA, Hoerster KD, Maciejewski ML. Differences in healthcare costs over 10 years following discharge from military service by weight trajectory. Obes Res Clin Pract 2024; 18:88-93. [PMID: 38565463 DOI: 10.1016/j.orcp.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
The prevalence of overweight and obesity among military personnel has increased substantially in the past two decades. Following military discharge many personnel can receive integrated health care from the Veterans Health Administration. Prior research related to the economic impacts of obesity has not examined health care costs following the transition into civilian life following military discharge. To address this evidence gap, this study sought to compare longitudinal costs over 10 years across weight categories among VA enrollees recently discharged from the military.
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Affiliation(s)
- Edwin S Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, MS-152, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA.
| | - Karen M Stechuchak
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA; Division of General Internal Medicine, Department of Medicine, Duke University, 200 Morris St., Durham, NC 27701, USA
| | - Anna Hung
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA
| | - Paul A Dennis
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA
| | - Katherine D Hoerster
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, MS-152, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA; Division of General Internal Medicine, Department of Medicine, Duke University, 200 Morris St., Durham, NC 27701, USA; Duke-Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC 27708, USA
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22
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Zwack CC, Haghani M, de Bekker-Grob EW. Research trends in contemporary health economics: a scientometric analysis on collective content of specialty journals. HEALTH ECONOMICS REVIEW 2024; 14:6. [PMID: 38270771 PMCID: PMC10809694 DOI: 10.1186/s13561-023-00471-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 11/28/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Health economics is a thriving sub-discipline of economics. Applied health economics research is considered essential in the health care sector and is used extensively by public policy makers. For scholars, it is important to understand the history and status of health economics-when it emerged, the rate of research output, trending topics, and its temporal evolution-to ensure clarity and direction when formulating research questions. METHODS Nearly 13,000 articles were analysed, which were found in the collective publications of the ten most specialised health economic journals. We explored this literature using patterns of term co-occurrence and document co-citation. RESULTS The research output in this field is growing exponentially. Five main research divisions were identified: (i) macroeconomic evaluation, (ii) microeconomic evaluation, (iii) measurement and valuation of outcomes, (iv) monitoring mechanisms (evaluation), and (v) guidance and appraisal. Document co-citation analysis revealed eighteen major research streams and identified variation in the magnitude of activities in each of the streams. A recent emergence of research activities in health economics was seen in the Medicaid Expansion stream. Established research streams that continue to show high levels of activity include Child Health, Health-related Quality of Life (HRQoL) and Cost-effectiveness. Conversely, Patient Preference, Health Care Expenditure and Economic Evaluation are now past their peak of activity in specialised health economic journals. Analysis also identified several streams that emerged in the past but are no longer active. CONCLUSIONS Health economics is a growing field, yet there is minimal evidence of creation of new research trends. Over the past 10 years, the average rate of annual increase in internationally collaborated publications is almost double that of domestic collaborations (8.4% vs 4.9%), but most of the top scholarly collaborations remain between six countries only.
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Affiliation(s)
- Clara C Zwack
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.
| | - Milad Haghani
- School of Civil and Environmental Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Marincola G, Procopio PF, Pennestrì F, Gallucci P, Voloudakis N, Ciccoritti L, Greco F, Salvi G, Prioli F, De Crea C, Raffaelli M. Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes. J Robot Surg 2024; 18:34. [PMID: 38231461 PMCID: PMC10794378 DOI: 10.1007/s11701-023-01748-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/28/2023] [Indexed: 01/18/2024]
Abstract
The increased operative time and costs represent the main limitations of robotic technology application to bariatric surgery. Robotic platforms may help the surgeon to overcome the technical difficulties in super-obese (SO, BMI ≥ 50 kg/m2) patients, in which multi-quadrant operations could be challenging. We aimed to evaluate the effect of robot-assisted (R) versus laparoscopic (L) approaches in Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and Roux-en-Y Gastric Bypass (RYGB) in SO and Super-Super Obese (SSO, BMI ≥ 60 kg/m2) patients in terms of outcomes and cost-effectiveness. Bariatric procedures performed from 2012 to 2023 were retrospectively reviewed. The inclusion criteria were BMI ≥ 50 kg/m2, primary SADI-S or RYGB. Operative time (OT), early complications, post-operative stay (POS), overall costs and follow-up data were analyzed. A subgroup analysis for surgical procedures and SSO patients was also performed. Among 4596 patients, 174 RYGB and 91 SADI-S in BMI ≥ 50 kg/m2 patients were selected. After Propensity Score Matching analysis, two groups of patients were identified (laparoscopic and robot-assisted), each one composed of 18 RYGB and 26 SADI-S. Intraoperative and post-operative complication rates and POS were comparable. Mean OT was longer in robotic procedures compared with laparoscopy (199.1 ± 65.7 and 109.5 ± 39.1 min, respectively, p < 0.001). The difference in OT was eliminated after only SSO patients were included in the analysis (172.7 ± 24.1 vs 152.6 ± 26.2 min for R-SADI-S and L-SADI-S, respectively, p = 0.107). Robotic surgeries were associated with higher costs (8134.6 ± 1886.7 and 2386.7 ± 388.2 € in R-RYGB and L-RYGB, respectively; 7996.6 ± 873.1 and 3954.6 ± 631.1 € in R-SADI-S and L-SADI-S). Despite increased costs, robotic approach may represent an added value in more complex cases such as SSO patients.
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Affiliation(s)
- Giuseppe Marincola
- Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Priscilla Francesca Procopio
- Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pennestrì
- Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy.
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Pierpaolo Gallucci
- Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Nikolaos Voloudakis
- Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Ciccoritti
- Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Francesco Greco
- Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Giulia Salvi
- Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Prioli
- Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Carmela De Crea
- Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Raffaelli
- Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
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Shouli MM, Shouli KM, Aqtam I, Ayed A. Effect of Nitro Counseling on Lifestyle of Obese Adolescence. SAGE Open Nurs 2024; 10:23779608241228637. [PMID: 38322623 PMCID: PMC10846033 DOI: 10.1177/23779608241228637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Obesity during adolescence represents a strong predictor of higher mortality in adulthood; thus, lifestyle interventions represent the recommended therapy. Objective To evaluate the effect of nitro counseling on lifestyle of obese adolescence, and develop life changing program. Method Quasi-experimental design was conducted between October 2021 and January 2022. A total of 117 university nursing students participated from two universities in Palestine. A self-reported questionnaire was used for data collection and included the following: socio-demographic characteristics, university students' knowledge, practices adolescent lifestyle, and anthropometric measurement to detect body mass index. The nitro counseling program was performed over three and half months. Percentage, mean value, standard deviation, Chi-square (X2), T paired test, and proportion probability (p-value), when p < 0.05 or < 0.02 it is statistically significant difference. Results The results revealed that 34.1% of students weren't aware of obesity pre-counseling, while it was improved to 93.1% post-nitro counseling implementation with highly statistical significance (p < 0.001). Less than half of adolescence were obesity class1, and more than one-third were obesity class II. There was a highly significant difference between students' knowledge and their practices pre- and post-nitro counseling program implementation. Conclusion This study confirmed that the total effect of obesity on adolescence self-esteem, social distress, and physical health demonstrated a highly significant difference between pre- and post-implementation of nitro counseling program. In addition to, improved adolescence knowledge and practices pre- and post-counseling implementation.
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Affiliation(s)
- Mustafa Mohammad Shouli
- Community Health Nursing Department, Nablus University for Vocational & Technical Education, Nablus, Palestine
| | - Khaila Mohammad Shouli
- Community Health Nursing Department, Nablus University for Vocational & Technical Education, Nablus, Palestine
| | - Ibrahim Aqtam
- Menatl Health Nursing Department, Nablus University for Vocational & Technical Education, Nablus, Palestine
| | - Ahmad Ayed
- Faculty of Nursing, Arab American University, Jenin, Palestine
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25
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Leinen M, Grandy EF, Gebel LMU, Santana TM, Rodriguez AL, Singh SK, Fernandez MI, Dalugdug JC, Garcia-Colon EM, Lybeshari K, Alexander DR, Maura MI, Gonzalez MDC, De Paula Cunha Almeida C, Anyaso-Samuel S, Datta S, Schiefer MA. Bilateral Subdiaphragmatic Vagal Nerve Stimulation Using a Novel Waveform Decreases Body Weight, Food Consumption, Adiposity, and Activity in Obesity-Prone Rats. Obes Surg 2024; 34:1-14. [PMID: 38040984 PMCID: PMC10781827 DOI: 10.1007/s11695-023-06957-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/05/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Obesity affects millions of Americans. The vagal nerves convey the degree of stomach fullness to the brain via afferent visceral fibers. Studies have found that vagal nerve stimulation (VNS) promotes reduced food intake, causes weight loss, and reduces cravings and appetite. METHODS Here, we evaluate the efficacy of a novel stimulus waveform applied bilaterally to the subdiaphragmatic vagal nerve stimulation (sVNS) for almost 13 weeks. A stimulating cuff electrode was implanted in obesity-prone Sprague Dawley rats maintained on a high-fat diet. Body weight, food consumption, and daily movement were tracked over time and compared against three control groups: sham rats on a high-fat diet that were implanted with non-operational cuffs, rats on a high-fat diet that were not implanted, and rats on a standard diet that were not implanted. RESULTS Results showed that rats on a high-fat diet that received sVNS attained a similar weight to rats on a standard diet due primarily to a reduction in daily caloric intake. Rats on a high-fat diet that received sVNS had significantly less body fat than other high-fat controls. Rats receiving sVNS also began moving a similar amount to rats on the standard diet. CONCLUSION Results from this study suggest that bilateral subdiaphragmatic vagal nerve stimulation can alter the rate of growth of rats maintained on a high-fat diet through a reduction in daily caloric intake, returning their body weight to that which is similar to rats on a standard diet over approximately 13 weeks.
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Affiliation(s)
- Monique Leinen
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Elise F Grandy
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Lourdes M Ubeira Gebel
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Tahimi Machin Santana
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Amanda L Rodriguez
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Sundip K Singh
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Michael I Fernandez
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Justin C Dalugdug
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Elaine M Garcia-Colon
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Kamela Lybeshari
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Daniel R Alexander
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Maria I Maura
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Maria D Cabrera Gonzalez
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA
| | | | - Samuel Anyaso-Samuel
- Department of Biostatistics, University of Florida, 2004 Mowry Rd, 5Th Fl, Gainesville, FL, 32603, USA
| | - Somnath Datta
- Department of Biostatistics, University of Florida, 2004 Mowry Rd, 5Th Fl, Gainesville, FL, 32603, USA
| | - Matthew A Schiefer
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL, 32608, USA.
- Department of Biomedical Engineering, University of Florida, 1275 Center Dr, Gainesville, FL, 32611, USA.
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Butler LR, Chen KA, Hsu J, Kapadia MR, Gomez SM, Farrell TM. Predicting readmission after bariatric surgery using machine learning. Surg Obes Relat Dis 2023; 19:1236-1244. [PMID: 37455158 DOI: 10.1016/j.soard.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND While bariatric surgery is an effective method for achieving long-term weight loss, postoperative readmissions are associated with negative clinical outcomes and significant costs. OBJECTIVES We aimed to use machine learning (ML) algorithms to predict readmissions and compare results to logistic regression. SETTING Hospitals participating in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, United States. METHODS Patients who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch between 2016 and 2020 were selected from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Patient variables reported by the MBSAQIP database were analyzed by ML algorithms random forest (RF), gradient boosting (XGB), and deep neural networks (NN), and the results of the predictive models were compared to logistic regression using area under the receiver operating characteristic curve (AUROC). RESULTS Our study included 863,348 patients, of which 39,068 (4.52%) were readmitted. AUROC scores were XGB .785 (95% CI .784-.786), RF .785 (95% CI .784-.785), and NN .754 (95% CI .753-.754), compared with .62 (95% CI .62-.621) for logistic regression (LR) (P < .001). The sensitivity and specificity for XGB, the best performing model, were 73.81% and 70%, compared with 52.94% and 70% for logistic regression. The most important variables were intervention or reoperation prior to discharge, unplanned ICU admission, initial procedure, and the intraoperative transfusion. CONCLUSIONS ML demonstrates significant advantages over logistic regression when predicting 30-day readmission following bariatric surgery. With external validation, models could identify the best candidates for early discharge or targeted postdischarge resources.
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Affiliation(s)
- Logan R Butler
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Kevin A Chen
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Justin Hsu
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Shawn M Gomez
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Timothy M Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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27
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Parnes N, Scanaliato JP, Dunn JC, Fink WA, Sandler A, Fares AB. Obesity negatively affects outcomes following arthroscopic rotator cuff repair at four-year follow-up. Shoulder Elbow 2023; 15:46-52. [PMID: 37974610 PMCID: PMC10649479 DOI: 10.1177/17585732221095846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 11/19/2023]
Abstract
Introduction The purpose is to evaluate the influence of obesity (BMI 30 to 39.9 kg/m2) on surgical outcomes following arthroscopic rotator cuff repair surgery. Materials and Methods A retrospective review was performed examining the outcomes of arthroscopic rotator cuff repair in both a normal weight (BMI 18.5 to 24.9 kg/m2) and an obese (BMI 30 to 39.9 kg/m2) patient population, specifically looking at functional outcomes and range of motion. Secondary variables analyzed were surgical time, complications, and medical comorbidities. Results 52 normal weight patients (mean BMI 23.7 ± 2.1) and 59 obese patients (mean BMI 34.0 ± 2.4) were included. Both groups demonstrated statistically significant improvements in VAS, SANE and ASES scores (P < 0.0001), however there were significantly better outcomes in the normal weight group in VAS (0.56 ± 0.96 vs 1.42 ± 2.22; P = 0.0108), ASES (96.1 ± 5.8 vs 90.6 ± 15.6; P = 0.0192), and internal rotation (9.2 ± 3.0 vs 10.9 ± 2.3; P = 0.0010). Additionally, the obese cohort had more complications, longer surgical times, and a greater comorbid background. Conclusions Obesity is associated with significantly more comorbid conditions, surgical complications, longer surgical time, and worse patient reported outcomes than normal weight patients undergoing arthroscopic rotator cuff repair.
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Affiliation(s)
- Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital. Carthage, NY, USA
| | - John P Scanaliato
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas, USA
| | - John C Dunn
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas, USA
| | - Walter A Fink
- Department of Orthopaedic Surgery, Carson Tahoe Health, Carson City, Nevada, USA
| | - Alexis Sandler
- Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC, USA
| | - Austin B Fares
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center-El Paso, El Paso, Texas, USA
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Landovská P, Karbanová M. Social costs of obesity in the Czech Republic. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1321-1341. [PMID: 36449132 PMCID: PMC9709763 DOI: 10.1007/s10198-022-01545-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Abstract
Increasing prevalence of obesity (BMI > 30) is a pressing public health issue in the Czech Republic as well as world-wide, affecting up to 2.1 billion people. Increasing trend in the prevalence of obesity in adults and children generates large social costs. The main aim of this study is to estimate both direct and indirect costs of obesity in the Czech Republic. Social costs of obesity are estimated using the cost-of-illness approach. Direct costs (healthcare utilization costs and costs of pharmacotherapy of 20 comorbidities) are estimated using the top-down approach, while indirect costs (absenteeism, presenteeism and premature mortality) are estimated using the human capital approach. In aggregate, the annual costs attributable to obesity in the Czech Republic in 2018 were 40.8 bn CZK (1.6 bn EUR, 0.8% GDP). Direct costs were 14.5 bn CZK (0.6 bn EUR) and accounted for 3.4% of Czech healthcare expenditures. The highest healthcare utilization costs were attributable to type II diabetes (20.6%), ischemic heart disease (18.8%) and osteoarthritis (16.7%). The largest indirect costs were attributable to premature mortality (10 bn CZK/0.39 bn EUR), absenteeism (9.2 bn CZK/0.36 bn EUR) and presenteeism (7.1 bn CZK/0.27 bn EUR). This article demonstrates that obesity is a serious problem with considerable costs. Several preventive interventions should be applied in order to decrease the prevalence of obesity and achieve cost savings.
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Affiliation(s)
- Petra Landovská
- Faculty of Social Sciences, Charles University, Opletalova 26, 110 00, Prague, Czech Republic.
| | - Martina Karbanová
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
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Gao D, Hu J, Bradley CJ, Yang F. Instrumental variable analysis for cost outcome: Application to the effect of primary care visit on medical cost among low-income adults. Stat Med 2023; 42:4349-4376. [PMID: 37828812 PMCID: PMC10644894 DOI: 10.1002/sim.9865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/12/2023] [Accepted: 07/20/2023] [Indexed: 10/14/2023]
Abstract
Medical cost data often consist of zero values as well as extremely right-skewed positive values. A two-part model is a popular choice for analyzing medical cost data, where the first part models the probability of a positive cost using logistic regression and the second part models the positive cost using a lognormal or Gamma distribution. To address the unmeasured confounding in studies on cost outcome under two-part models, two instrumental variable (IV) methods, two-stage residual inclusion (2SRI) and two-stage prediction substitution (2SPS) are widely applied. However, previous literature demonstrated that both the 2SRI and the 2SPS could fail to consistently estimate the causal effect among compliers under standard IV assumptions for binary and survival outcomes. Our simulation studies confirmed that it continued to be the case for a two-part model, which is another nonlinear model. In this article, we develop a model-based IV approach, Instrumental Variable with Two-Part model (IV2P), to obtain a consistent estimate of the causal effect among compliers for cost outcome under standard IV assumptions. In addition, we develop sensitivity analysis approaches to allow the evaluation of the sensitivity of the causal conclusions to potential quantified violations of the exclusion restriction assumption and the randomization of IV assumption. We apply our method to a randomized cash incentive study to evaluate the effect of a primary care visit on medical cost among low-income adults newly covered by a primary care program.
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Affiliation(s)
- Dexiang Gao
- University of Colorado Cancer Center Biostatistics Core, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Junxiao Hu
- University of Colorado Cancer Center Biostatistics Core, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cathy J. Bradley
- Department of Health Systems, Management & Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Fan Yang
- Yau Mathematical Sciences Center, Tsinghua University, Beijing, China
- Yanqi Lake Beijing Institute of Mathmatical Sciences and Applications, Beijing, China
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Ramanujam K, Mergu N, Kondeth H, Reddy GVR, Venkata Prasad U, Sadasivuni R, Geddam JB, Rajkumar H, Reddy NS. Chronic Illness, Nutritional Status, and Factors Associated with Malnutrition among Various Age Groups Residing in Urban Areas of Telangana and Rural Areas of Andhra Pradesh. Nutrients 2023; 15:4470. [PMID: 37892545 PMCID: PMC10610153 DOI: 10.3390/nu15204470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Malnutrition includes both under-nutrition and over-nutrition, which have negative health impacts and social consequences. The present study aims to understand the demographic dynamics, burden of chronic illnesses, and risk factors associated with malnutrition (stunting, thinness, and obesity) among different age groups in urban and rural areas. Data were collected through a cross-sectional study conducted in an urban area in Hyderabad and four rural villages in Andhra Pradesh. A multivariable mixed-effect logistic regression was used to assess the risk factors associated with malnutrition among different age groups. The final analysis included the data of 10,350 individuals, consisting of 8317 (80.4%) from urban areas and 2033 (19.6%) from rural areas. The number of known cases of hypertension in the urban area was 926 (11.1%) and 114 (5.6%) in the rural areas, and that of diabetes was 511 (6.1%) in the urban area and 104 (5.1%) in the rural areas. The burden of stunting among under-five children and obesity among adults was 33.7% (95% CI; 29.7-37.9) and 47.4% (95% CI; 45.8-49.1), respectively. Adults aged 40-59 years (AOR 1.91; 1.59-2.28) and belonging to a clerical/skilled (AOR 1.32; 1.03-1.71) occupation were at higher odds of obesity compared to their counterparts. Policymakers and health practitioners should consider the insights from our findings to tailor effective interventions to address malnutrition.
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Affiliation(s)
- Karthikeyan Ramanujam
- Clinical Epidemiology Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, Telangana, India; (K.R.); (N.M.); (G.V.R.R.); (J.B.G.)
| | - Nagaraju Mergu
- Clinical Epidemiology Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, Telangana, India; (K.R.); (N.M.); (G.V.R.R.); (J.B.G.)
| | - Henna Kondeth
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605 006, Puducherry, India;
| | - Garlapati Venkat Raji Reddy
- Clinical Epidemiology Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, Telangana, India; (K.R.); (N.M.); (G.V.R.R.); (J.B.G.)
| | - Upadrasta Venkata Prasad
- Model Rural Health Research Unit, ICMR-National Institute of Nutrition, Chandragiri 517 101, Andhra Pradesh, India; (U.V.P.); (R.S.)
| | - Renuka Sadasivuni
- Model Rural Health Research Unit, ICMR-National Institute of Nutrition, Chandragiri 517 101, Andhra Pradesh, India; (U.V.P.); (R.S.)
| | - Jagajeevan Babu Geddam
- Clinical Epidemiology Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, Telangana, India; (K.R.); (N.M.); (G.V.R.R.); (J.B.G.)
| | - Hemalatha Rajkumar
- ICMR-National Institute of Nutrition, Hyderabad 500 007, Telangana, India;
| | - Nusi Samarasimha Reddy
- Clinical Epidemiology Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, Telangana, India; (K.R.); (N.M.); (G.V.R.R.); (J.B.G.)
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Ibele AR, Nau PN, Galvani C, Roth JS, Goldberg RF, Kurian MS, Khaitan L, Gould J, Pandya YK. Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD. Surg Endosc 2023; 37:7642-7648. [PMID: 37491660 DOI: 10.1007/s00464-023-10212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/11/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Obesity is an increasingly prevalent public health problem often associated with poorly controlled gastroesophageal reflux disease. Fundoplication has been shown to have limited long-term efficacy in patients with morbid obesity and does not address additional weight-related co-morbidities. Roux-en-Y gastric bypass (RYGB) is the gold standard operation for durable resolution of GERD in patients with obesity, and is also used as a salvage operation for GERD after prior foregut surgery. Surgeons report access to RYGB as surgical treatment for GERD is often limited by RYGB-specific benefit exclusions embedded within insurance policies, but the magnitude and scope of this problem is unknown. METHODS A 9-item survey evaluating surgeon practice and experience with insurance coverage for RYGB for GERD was developed and piloted by a SAGES Foregut Taskforce working group. This survey was then administered to surgeon members of the SAGES Foregut Taskforce and to surgeons participating in the SAGES Bariatrics and/or Foregut Facebook groups. RESULTS 187 surgeons completed the survey. 89% reported using the RYGB as an anti-reflux procedure. 44% and 26% used a BMI of 35 kg/m2 and 30 kg/m2 respectively as cutoff for the RYGB. 89% viewed RYGB as the procedure of choice for GERD after bariatric surgery. 69% reported using RYGB to address recurrent reflux secondary to failed fundoplication. 74% of responders experienced trouble with insurance coverage at least half the time RYGB was offered for GERD, and 8% reported they were never able to get approval for RYGB for GERD indications in their patient populations. CONCLUSION For many patients, GERD and obesity are related diseases that are best addressed with RYGB. However, insurance coverage for RYGB for GERD is often limited by policies which run contrary to evidence-based medicine. Advocacy is critical to improve access to appropriate surgical care for GERD in patients with obesity.
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Affiliation(s)
- Anna R Ibele
- Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City Utah, 84132, USA.
| | - Peter N Nau
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Carlos Galvani
- Tulane University School of Medicine, New Orleans, LA, USA
| | - J Scott Roth
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Leena Khaitan
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jon Gould
- Medical College of Wisconsin, Milwaukee, WI, USA
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Albalawi WF, Albaraki J, Alharbi S, Ababtain N, Aloteibi RE, Alsudais AS, Jamjoom J, Alaqeel M. Distribution of perceived weight stigma and its psychological impact on obese people in Saudi Arabia. Saudi Pharm J 2023; 31:101763. [PMID: 37791034 PMCID: PMC10542636 DOI: 10.1016/j.jsps.2023.101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023] Open
Abstract
Background Worldwide, obesity prevalence has nearly tripled since 1975, with about 13% of adults being obese and about 39% overweight. Overweight and obese persons are vulnerable to frequent stigmatization and discrimination because of their weight, an issue that is barely discussed in the medical literature. In Saudi Arabia, the prevalence of obesity is 36%. However, there is no available data on the prevalence of perceived weight stigma among obese people. Therefore, this study aims to (a) determine the Distribution of perceived weight stigma among obese people, (b) identify the major sources of stigma, and (c) determine the psychological impact of perceived weight-based stigma on obese people in Saudi Arabia. Methods This is a cross-sectional study conducted in Saudi Arabia using an online questionnaire that includes Stigmatizing Situations Inventory Scale (SSI) and Perceived Stress Scale (PSS). Results 1341 people participated in the study, of which 819 (61%) were females and 522 (39%) were male. Of all, 62 (5%) were underweight, 357 (27%) were normal weight, and 922 (69%) were overweight or obese. Participants in the overweight/obese category scored higher on average in every SSI item than did their counterparts in the underweight and normal weight categories, indicating higher levels of stigma among overweight and obese participants. The major sources of stigma for overweight and obese participants were identified based on the mean of participant responses to each item. These were: assumption about overeating or binge eating (mean response ± SD 2.80 ± 3.01), children's comments (2.22 ± 2.58), being stared at in public (2.18 ± 2.83) and being singled out as a child (2.05 ± 2.67). Conclusion Parallel with the literature, our findings indicate a high prevalence of weight stigma in Saudi Arabia which can have negative psychological implications on obese people.
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Affiliation(s)
- Wafi F Albalawi
- Department of Community Health Sciences, College of Applied Medical Sciences - King Saud University, Saudi Arabia
| | - Joud Albaraki
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sereen Alharbi
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nouf Ababtain
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Reema Enad Aloteibi
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ali Saleh Alsudais
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jafar Jamjoom
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Meshal Alaqeel
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- Department of Mental Health, Ministry of The National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Costa DL. Overweight grandsons and grandfathers' starvation exposure. JOURNAL OF HEALTH ECONOMICS 2023; 91:102796. [PMID: 37541079 PMCID: PMC10593129 DOI: 10.1016/j.jhealeco.2023.102796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 08/06/2023]
Abstract
Much of the increase in the prevalence of overweight and obesity has been in developing countries with a history of famines and malnutrition. This paper is the first to examine overweight among adult grandsons of grandfathers exposed to starvation during developmental ages. I study grandsons born to grandfathers who served in the Union Army during the US Civil War (1861-5) where some grandfathers experienced severe net malnutrition because they suffered a harsh POW experience. I find that male-line but not female-line grandsons of grandfathers who survived a severe captivity during their growing years faced a 21% increase in mean overweight and a 2% increase in mean BMI compared to grandsons of non-POWs. Male-line grandsons descended from grandfathers who experienced a harsh captivity faced a 22%-28% greater risk of dying every year after age 45 relative to grandsons descended from non-POWs, with overweight accounting for 9%-14% of the excess risk.
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Affiliation(s)
- Dora L Costa
- University of California, Los Angeles, United States of America; National Bureau of Economic Research, United States of America.
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Khamseh ME, Emami Z, Iranpour A, Mahmoodian R, Amouei E, Tizmaghz A, Moradi Y, Baradaran HR. Attitude and Belief of Healthcare Professionals Towards Effective Obesity Care and Perception of Barriers; An Updated Systematic Review and Meta-analysis. ARCHIVES OF IRANIAN MEDICINE 2023; 26:529-541. [PMID: 38310408 PMCID: PMC10862058 DOI: 10.34172/aim.2023.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/03/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Obesity is a serious chronic disease that adversely affects health and quality of life. However, a significant percentage of people do not participate in or adhere to weight loss programs. Therefore, a multidisciplinary approach is needed to identify critical barriers to effective obesity management and to examine health practitioners' attitudes and behaviors towards effective obesity treatment. METHODS This systematic review was conducted in accordance with PRISMA 2020. Eligible studies were identified through a systematic review of the literature using Medline, Scopus, Cochrane, Google Scholar, Web of Science, and Embase databases from January 1, 2011 to March 2, 2021. RESULTS A total of 57 articles were included. Data on 12663 physicians were extracted from a total of 35 quantitative articles. Some of the most commonly perceived attitude issues included "obesity has a huge impact on overall health", "obesity is a disease" and "HCPs are to blame". Health professionals were more inclined to believe in "using BMI to assess obesity," "advice to increase physical activity," and "diet/calorie reduction advice." The major obstacles to optimal treatment of obesity were "lack of motivation", "lack of time" and "lack of success". CONCLUSION Although the majority of health care professionals consider obesity as a serious disease which has a large impact on overall health, counseling for lifestyle modification, pharmacologic or surgical intervention occur in almost half of the visits. Increasing the length of physician visits as well as tailoring appropriate training programs could improve health care for obesity.
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Affiliation(s)
- Mohammad E. Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Emami
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Aida Iranpour
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Mahmoodian
- Department of Internal Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Erfan Amouei
- Department of Internal Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Adnan Tizmaghz
- Department of Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Moradi
- Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hamid R Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
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Subramanian T, Shinn D, Shahi P, Akosman I, Amen T, Maayan O, Zhao E, Araghi K, Song J, Dalal S, Dowdell J, Iyer S, Qureshi S. Severe Obesity Is an Independent Risk Factor of Early Readmission and Nonhome Discharge After Cervical Disc Replacement. Neurospine 2023; 20:890-898. [PMID: 37798984 PMCID: PMC10562223 DOI: 10.14245/ns.2346442.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Despite growing interest in cervical disc replacement (CDR) for conditions such as cervical radiculopathy, limited data exists describing the impact of obesity on early postoperative outcomes and complications. These data are especially important as nearly half of the adult population in the United States is expected to become obese (body mass index [BMI] ≥ 30 kg/m2) by 2030. The goal of this study was to compare the demographics, perioperative variables, and complication rates following CDR. METHODS The 2005-2020 American College of Surgeons National Surgical Quality Improvement Program datasets were queried for patients who underwent primary 1- or 2-level CDR. Patients were divided into 3 cohorts: Nonobese (BMI: 18.5-29.9 kg/m2), Obese class-I (BMI: 30-34.9 kg/m2), Obese class-II/III (BMI ≥ 35 kg/m2). Morbidity was defined as the presence of any complication within 30 days postoperatively. Rates of 30-day readmission, reoperation, morbidity, individual complications, length of stay, frequency of nonhome discharge disposition were collected. RESULTS A total of 5,397 patients were included for analysis: 3,130 were nonobese, 1,348 were obese class I, and 919 were obese class II/III. There were more 2-level CDRs performed in the class II/III cohort compared to the nonobese group (25.7% vs. 21.5%, respectively; p < 0.05). Class-II/III had more nonhome discharges than class I and nonobese (2.1% vs. 0.5% vs. 0.7%, respectively; p < 0.001). Readmission rates differed as well (nonobese: 0.5%, class I: 1.1%, class II/III: 2.1%; p < 0.001) with pairwise significance between class II/II and nonobese. Class II/III obesity was an independent risk factor for both readmission (odds ratio [OR], 3.32; p = 0.002) and nonhome discharge (OR, 2.51; p = 0.02). Neither 30-day reoperation nor morbidity rates demonstrated significance. No mortalities were reported. CONCLUSION Although obese class-II/III were risk factors for 30-day readmission and nonhome discharge, there was no significant difference in reoperation rates or morbidity. CDR procedures can continue to be safely preformed independent of obesity status.
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Affiliation(s)
- Tejas Subramanian
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Daniel Shinn
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | | | - Izzet Akosman
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Troy Amen
- Hospital for Special Surgery, New York, NY, USA
| | - Omri Maayan
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Eric Zhao
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | | | - Junho Song
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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Affiliation(s)
- Frank B Hu
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.
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Beitz JM, Kennedy-Evans KL. Good Things Don't Always Come in Small Packages: Comprehensive Care of Patients With Class 3 Obesity: An Integrative Review. J Wound Ostomy Continence Nurs 2023; 50:365-374. [PMID: 37713346 DOI: 10.1097/won.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
The epidemic of obesity and morbid obesity is straining the American health care system's ability to provide quality patient care. Patients with Class 3 (also referred to as morbid or severe) obesity require specialized equipment, unique approaches in the delivery of care, and understanding of the biopsychosocial pathophysiologic mechanisms underlying their condition. This article defines Class 3 obesity, its pathophysiology, and discusses issues that arise when providing quality care of these individuals including safe patient handling, right-sized equipment, and empathetic interpersonal care. We also discuss skin and wound care issues associated with Class 3 obesity.
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Affiliation(s)
- Janice M Beitz
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, MAPWCA, ANEF, WOCNF, FNAP, FAAN, School of Nursing-Camden, Rutgers University, Camden, New Jersey
- Karen Lou Kennedy-Evans, RN, APRN-BC, FNP, University of Arizona College of Nursing, Tucson, and K.L. Kennedy LLC, Tucson, Arizona
| | - Karen Lou Kennedy-Evans
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, MAPWCA, ANEF, WOCNF, FNAP, FAAN, School of Nursing-Camden, Rutgers University, Camden, New Jersey
- Karen Lou Kennedy-Evans, RN, APRN-BC, FNP, University of Arizona College of Nursing, Tucson, and K.L. Kennedy LLC, Tucson, Arizona
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Mejias C, Hoegger M, Snyder J, Raptis C, Mellnick V. Subcutaneous and visceral fat are associated with worse outcomes in gunshot injuries but not stab injuries to the torso. Trauma Surg Acute Care Open 2023; 8:e001072. [PMID: 37609504 PMCID: PMC10441081 DOI: 10.1136/tsaco-2022-001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/28/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose The effect of obesity in penetrating trauma outcomes is poorly understood. The purpose of this study was to determine if there is a protective effect of subcutaneous or visceral fat from stab and gunshot wounds. Methods 443 patients admitted after penetrating traumatic injury of the torso were retrospectively identified from our institution's trauma registry. CT scans performed at presentation were used to determine cross-sectional area of visceral and subcutaneous fat at the level of the umbilicus via manual segmentation. Obesity-associated parameters including body mass index, visceral and subcutaneous fat were compared with injury severity score, length of hospital/intesive care unit (ICU) stay, and number of operating room (OR) visits. Parameters were compared between patients who sustained stab wounds versus gunshot injuries. Results Comparing all patients with gunshot injuries with those with stab injuries, gunshots resulted in increased hospital and ICU length of stay, and injury severity score (ISS). For patients with gunshot wounds, all obesity-related parameters correlated with increased length of stay and total ICU stay; subcutaneous fat and visceral fat were correlated with increased OR visits, but there was no significant correlation between obesity-related parameters and ISS. In contrast, with stab wounds there were no statistically significant associations between obesity parameters and any of the outcome measures. Conclusion For penetrating trauma in the torso, obesity is correlated with worse outcomes with gunshot injuries but not in stab injuries. Level of evidence Level III, prognostic and epidemiological.
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Affiliation(s)
- Christopher Mejias
- Diagnostic Radiology, Washington University in St Louis School of Medicine Mallinckrodt Institute of Radiology, Saint Louis, Missouri, USA
| | - Mark Hoegger
- Diagnostic Radiology, Washington University in St Louis School of Medicine Mallinckrodt Institute of Radiology, Saint Louis, Missouri, USA
| | - Jason Snyder
- Department of Surgery, Washington University in St Louis, Saint Louis, Missouri, USA
| | - Constantine Raptis
- Diagnostic Radiology, Washington University in St Louis School of Medicine Mallinckrodt Institute of Radiology, Saint Louis, Missouri, USA
| | - Vincent Mellnick
- Diagnostic Radiology, Washington University in St Louis School of Medicine Mallinckrodt Institute of Radiology, Saint Louis, Missouri, USA
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Lenart-Lipińska M, Łuniewski M, Szydełko J, Matyjaszek-Matuszek B. Clinical and Therapeutic Implications of Male Obesity. J Clin Med 2023; 12:5354. [PMID: 37629396 PMCID: PMC10455727 DOI: 10.3390/jcm12165354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/29/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
The prevalence of obesity, a disorder linked to numerous comorbidities and metabolic complications, has recently increased dramatically worldwide and is highly prevalent in men, even at a young age. Compared to female patients, men with obesity more frequently have delayed diagnosis, higher severity of obesity, increased mortality rate, and only a minority of obese male patients are successfully treated, including with bariatric surgery. The aim of this review was to present the current state of knowledge about the clinical and therapeutic implications of obesity diagnosed in males.
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Affiliation(s)
- Monika Lenart-Lipińska
- Department of Endocrinology, Diabetology, and Metabolic Diseases, Medical University of Lublin, 20-954 Lublin, Poland; (M.Ł.); (J.S.); (B.M.-M.)
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Marshall C, Estes SJ. Reproductive Surgery in Females with Obesity: Reproductive Consequences of Obesity and Applications for Surgical Care. Semin Reprod Med 2023; 41:97-107. [PMID: 37967852 DOI: 10.1055/s-0043-1776915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Obesity is the most common medical problem in women of reproductive age. The surgical applications for this population, many of who are interested in current or future fertility, are critical to safe and effective evaluation and management of issues that impact the reproductive system. As rates of obesity continue to rise worldwide, it is projected that one in two individuals will have obesity by 2030 leading to increasing numbers of individuals affected by a disease process that has implications for their gynecologic surgical care, fertility-related assessment, and infertility treatment. Offering patients with obesity access to safe reproductive surgery is a cornerstone of reproductive autonomy. This review will summarize current recommendations regarding surgical concepts for the operating room, office hysteroscopy, oocyte retrieval, and embryo transfer in female patients with obesity.
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Affiliation(s)
- Ciara Marshall
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Stephanie J Estes
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Division of Reproductive Endocrinology and Infertility, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Seamon E, Megheib M, Williams CJ, Murphy CF, Brown HF. Estimating County Level Health Indicators Using Spatial Microsimulation. POPULATION, SPACE AND PLACE 2023; 29:e2647. [PMID: 37822803 PMCID: PMC10564386 DOI: 10.1002/psp.2647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 01/19/2023] [Indexed: 10/13/2023]
Abstract
Given the importance of understanding health outcomes at fine spatial scales, iterative proportional fitting (IPF), a form of small area estimation, was applied to a fixed number of health-related variables (obesity, overweight, diabetes) taken from regionalized 2019 survey responses (n = 5474) from the Idaho Behavioral Risk Factor Surveillance System (BRFSS). Using associated county-level American Community Survey (ACS) census data, a set of constraints, which included age categorization, race, sex, and education level, were used to create county-level weighting matrices for each variable, for each of the seven (7) Idaho public health districts. Using an optimized modeling construction technique, we identified significant constraints and grouping splits for each variable/region, resulting in estimates that were internally and externally validated. Externally validated model results for the most populated counties showed correlations ranging from .79 to .85, with p values all below .05. Estimates indicated higher levels of obesity and overweight individuals for midsouth and southwestern Idaho counties, with a cluster of higher diabetes estimates in the center of the state (Gooding, Lincoln, Minidoka, and Jerome counties). Alternative external sources for health outcomes aligned extremely well with our estimates, with wider confidence intervals in more rural counties with sparse populations.
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Affiliation(s)
- Erich Seamon
- Institute for Modeling, Collaboration, and Innovation (IMCI), University of Idaho, Moscow, Idaho, United States
| | - Mohamed Megheib
- Institute for Modeling, Collaboration, and Innovation (IMCI), University of Idaho, Moscow, Idaho, United States
| | - Christopher J. Williams
- Department of Mathematics and Statistical Sciences, University of Idaho, Moscow, Idaho, United States
| | - Christopher F. Murphy
- Department of Health and Welfare (IDHW), State of Idaho, Boise, Idaho, United States
| | - Helen F. Brown
- Department of Movement Sciences, University of Idaho, Moscow, Idaho, United States
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Poudel B, Ekperikpe US, Mandal S, Wilson GE, Shields CA, Cornelius DC, Williams JM. Chronic treatment with IL-25 increases renal M2 macrophages and reduces renal injury in obese Dahl salt-sensitive rats during the prepubescent stage. Am J Physiol Renal Physiol 2023; 325:F87-F98. [PMID: 37167270 PMCID: PMC10292980 DOI: 10.1152/ajprenal.00209.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023] Open
Abstract
Recently, we have reported that the early progression of proteinuria in the obese Dahl salt-sensitive (SS) leptin receptor mutant (SSLepRmutant) strain was associated with increased renal macrophage infiltration before puberty. Macrophages can be divided into two distinct phenotypes: M1 (proinflammatory) and M2 (anti-inflammatory). Moreover, previous studies have demonstrated that interleukin (IL)-25 converts resting macrophages and M1 into M2. Therefore, the present study examined whether treatment with IL-25 would reduce the early progression of renal injury in SSLepRmutant rats by increasing renal M2. We also investigated the impact of IL-25 on M2 subtypes: M2a (wound healing/anti-inflammatory), M2b (immune mediated/proinflammatory), M2c (regulatory/anti-inflammatory), and M2d (tumor associated/proangiogenic). Four-wk-old SS and SSLepRmutant rats were treated with either control (IgG) or IL-25 (1 µg/day ip every other day) for 4 wk. The kidneys from SSLepRmutant rats displayed progressive proteinuria and renal histopathology versus SS rats. IL-25 treatment had no effect on these parameters in SS rats. However, in the SSLepRmutant strain, proteinuria was markedly reduced after IL-25 treatment. Chronic treatment with IL-25 significantly decreased glomerular and tubular injury and renal fibrosis in the SSLepRmutant strain. Although the administration of IL-25 did not change total renal macrophage infiltration in both SS and SSLepRmutant rats, IL-25 increased M2a by >50% and reduced M1 by 60% in the kidneys of SSLepRmutant rats. Overall, these data indicate that IL-25 reduces the early progression of renal injury in SSLepRmutant rats by inducing M2a and suppressing M1 and suggest that IL-25 may be a therapeutic target for renal disease associated with obesity. NEW & NOTEWORTHY For the past few decades, immune cells and inflammatory cytokines have been demonstrated to play an important role in the development of renal disease. The present study provides strong evidence that interleukin-25 slows the early progression of renal injury in obese Dahl salt-sensitive rats before puberty by increasing systemic anti-inflammatory cytokines and renal M2a macrophages.
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Affiliation(s)
- Bibek Poudel
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Ubong S Ekperikpe
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Sautan Mandal
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Gregory E Wilson
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Corbin A Shields
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Denise C Cornelius
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, United States
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Jan M Williams
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, United States
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Liu S, Cao W, Li Z, Wang S, Yang S, Lu M, Li H, Song Y, Chen S, Li X, Li R, Wang J, Yang J, Liu M, He Y. Association between different adiposity measures and all-cause mortality risk among centenarians: A prospective cohort study. Clin Nutr 2023; 42:1219-1226. [PMID: 37236872 DOI: 10.1016/j.clnu.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
IMPORTANCE Little evidence on the association between adiposity measures and all-cause mortality was observed among centenarians, and no targeted development of optimal weight recommendations for them. OBJECTIVE To comprehensively assess the association between adiposity indices and all-cause mortality among centenarians. DESIGN SETTING, AND PARTICIPANTS This prospective population-based cohort study included 1002 centenarians registered in 18 counties and cities in Hainan Province from June 2014 to May 2021. The age of participants at baseline was provided by the civil affairs bureau and verified before enrollment. MAIN OUTCOMES AND MEASURES All-cause mortality was rigorously confirmed as the primary outcome. BMI was calculated by height and weight. BRI was calculated by height and waist circumference. RESULTS At baseline, the mean (SD) age was 102.8 ± 2.7 years, and 180 participants (18.0%) were men. The median follow-up time was 5.0 (4.8-5.5) years, with 522 deaths. In BMI categories, compared with the lowest group (mean BMI = 14.2 kg/m2), the highest group (mean BMI = 22.2 kg/m2) had lower mortality (hazard ratio [HR], 0.61; 95%CI, 0.47-0.79) (P for trend = 0.001). In BRI categories, compared with the lowest group (mean BRI = 2.3), the highest group (mean BRI = 5.7) had lower mortality (hazard ratio [HR], 0.66; 95%CI, 0.51-0.85) (P for trend = 0.002), and the risk did not decrease after BRI exceeded 3.9 in women. Higher BRI was associated with lower HRs after adjusting for interaction with comorbidities status. E-values analysis suggested robustness to unmeasured confounding. CONCLUSIONS AND RELEVANCE BMI and BRI were inverse linear associated with mortality risk in the whole population, while BRI was observed to be J-shaped in women. The interaction of lower multiple complication incidence and BRI had a significant effect on the reduced risk of all-cause mortality.
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Affiliation(s)
- Shaohua Liu
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, PLA Medical School, Beijing, China
| | - Wenzhe Cao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, China
| | - Zhiqiang Li
- School of Public Health, China Medical University, Shenyang, 110122, China; Center for Disease Control and Prevention of Chinese People's Liberation Army, Beijing, 100071, China
| | - Shengshu Wang
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, PLA Medical School, Beijing, China
| | - Shanshan Yang
- Department of Disease Prevention and Control, The 1st Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mingming Lu
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, PLA Medical School, Beijing, China
| | - Haowei Li
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, PLA Medical School, Beijing, China
| | - Yang Song
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, PLA Medical School, Beijing, China
| | - Shimin Chen
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, PLA Medical School, Beijing, China
| | - Xuehang Li
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, PLA Medical School, Beijing, China
| | - Rongrong Li
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, PLA Medical School, Beijing, China
| | - Jianhua Wang
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, PLA Medical School, Beijing, China
| | - Junhan Yang
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, PLA Medical School, Beijing, China
| | - Miao Liu
- Department of Statistics and Epidemiology, Graduate School of Chinese PLA General Hospital & Chinese PLA Medical Academy, Beijing 100853, China.
| | - Yao He
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army (PLA) General Hospital, PLA Medical School, Beijing, China.
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44
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Doukas SG, Doukas PG, Vageli DP, Broder A. Gastric cancer after Bariatric Bypass Surgery. Do they relate? (A Systematic Review). Obes Surg 2023; 33:1876-1888. [PMID: 37041375 DOI: 10.1007/s11695-023-06567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
Bariatric bypass surgery has been an effective treatment for morbid obesity. However, there is an increasing number of reported cases of gastric cancer after bypass surgery. Our systematic review showed an increasing trend of gastric cancer cases after bariatric bypass surgery in the last decade, mostly located in the excluded stomach (77%) and diagnosed in an advanced stage. In addition to known risk factors such as tobacco smoking (17%), H. pylori infection (6%), and family history of gastric cancer (3%), bile reflux, a recently proposed cancer-promoting factor, was also estimated in 18% of the cases. Our data suggest that gastric cancer risk assessment should be considered before gastric bypass surgery, and further investigations are needed to determine the value of post-operative gastric cancer surveillance.
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Affiliation(s)
- Sotirios G Doukas
- Department of Medicine, Division of Gastroenterology and Hepatology, Saint Peter's University Hospital/Rutgers-RWJ Medical School, 254 Easton Avenue, New Brunswick, NJ, 08901, USA.
| | - Panagiotis G Doukas
- Departmengt of Surgery, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Dimitra P Vageli
- Departmengt of Surgery, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Arkady Broder
- Department of Medicine, Division of Gastroenterology and Hepatology, Saint Peter's University Hospital/Rutgers-RWJ Medical School, 254 Easton Avenue, New Brunswick, NJ, 08901, USA
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45
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Pacifico A. Obesity and labour market outcomes in Italy: a dynamic panel data evidence with correlated random effects. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:557-574. [PMID: 35867310 PMCID: PMC9304812 DOI: 10.1007/s10198-022-01493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/21/2022] [Indexed: 05/12/2023]
Abstract
This paper investigates the effects of obesity, socio-economic variables, and individual-specific factors on work productivity across Italian regions. A dynamic panel data with correlated random effects is used to jointly deal with incidental parameters, endogeneity issues, and functional forms of misspecification. Methodologically, a hierarchical semiparametric Bayesian approach is involved in shrinking high dimensional model classes, and then obtaining a subset of potential predictors affecting outcomes. Monte Carlo designs are addressed to construct exact posterior distributions and then perform accurate forecasts. Cross-sectional Heterogeneity is modelled nonparametrically allowing for correlation between heterogeneous parameters and initial conditions as well as individual-specific regressors. Prevention policies and strategies to handle health and labour market prospects are also discussed.
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Affiliation(s)
- Antonio Pacifico
- Applied Statistics and Econometrics, University of Macerata, Macerata, Italy.
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Abstract
The prevalence of preobesity and obesity is rising globally, multiple epidemiologic studies have identified preobesity and obesity as predisposing factors to a number of noncommunicable diseases including type 2 diabetes (T2DM), cardiovascular disease (CVD), and cancer. In this review, we discuss the epidemiology of obesity in both children and adults in different regions of the world. We also explore the impact of obesity as a disease not only on physical and mental health but also its economic impact.
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Affiliation(s)
- Nasreen Alfaris
- King Fahad Medical City, 3895 Susah, Alwurud, Riyadh 12252-7111, Saudi Arabia.
| | | | - Naji Alamuddin
- RCSI Bahrain, King Hamad University Hospital, Alsayh, Sheikh Eisa Bin Salman Bridge, 7J62+X92, Bahrain
| | - Georgia Rigas
- St George Private Hospital, 1 South Street, Kogarah, New South Wales 2217, Australia
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47
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Skrypnik D, Skrypnik K, Suliburska J, Bogdański P. Leptin-VEGF crosstalk in excess body mass and related disorders: A systematic review. Obes Rev 2023:e13575. [PMID: 37230803 DOI: 10.1111/obr.13575] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/17/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023]
Abstract
By 2030, it is expected that a billion people will have suffer from obesity. Adipose tissue synthesizes leptin, an adipokine that affects cardiovascular risk. Leptin intensifies the synthesis of vascular endothelial growth factor (VEGF). Our study reviews recent reports on leptin-VEGF crosstalk in obesity and related disorders. PubMed, Web of Science, Scopus, and Google Scholar were searched. One hundred and one articles involving human, animal, and in vitro research were included. In vitro studies show the crucial role of interaction between endothelial cells and adipocytes and hypoxia as a factor that intensifies leptin's effects on VEGF. Leptin-VEGF crosstalk promotes the progression of cancer. The animal research reveal that a high-fat diet enhances leptin and VEGF crosstalk. Genetic and epigenetic mechanisms and procreator-offspring programming may be involved in leptin-VEGF crosstalk. Some female-specific characteristics of leptin-VEGF relation in obesity were observed. The human studies have shown that increased leptin and VEGF synthesis and leptin-VEGF crosstalk are factors linking obesity with elevated cardiovascular risk. The studies of the last 10 years documented a range of significant aspects of leptin-VEGF crosstalk specific for obesity and related disorders, shedding new light on the link between obesity and increased cardiovascular risk.
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Affiliation(s)
- Damian Skrypnik
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznań University of Medical Sciences, Poznań, Poland
| | - Katarzyna Skrypnik
- Department of Human Nutrition and Dietetics, Poznań University of Life Sciences, Poznań, Poland
| | - Joanna Suliburska
- Department of Human Nutrition and Dietetics, Poznań University of Life Sciences, Poznań, Poland
| | - Paweł Bogdański
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznań University of Medical Sciences, Poznań, Poland
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48
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Reddy TP, Glynn SA, Billiar TR, Wink DA, Chang JC. Targeting Nitric Oxide: Say NO to Metastasis. Clin Cancer Res 2023; 29:1855-1868. [PMID: 36520504 PMCID: PMC10183809 DOI: 10.1158/1078-0432.ccr-22-2791] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/24/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
Utilizing targeted therapies capable of reducing cancer metastasis, targeting chemoresistant and self-renewing cancer stem cells, and augmenting the efficacy of systemic chemo/radiotherapies is vital to minimize cancer-associated mortality. Targeting nitric oxide synthase (NOS), a protein within the tumor microenvironment, has gained interest as a promising therapeutic strategy to reduce metastatic capacity and augment the efficacy of chemo/radiotherapies in various solid malignancies. Our review highlights the influence of nitric oxide (NO) in tumor progression and cancer metastasis, as well as promising preclinical studies that evaluated NOS inhibitors as anticancer therapies. Lastly, we highlight the prospects and outstanding challenges of using NOS inhibitors in the clinical setting.
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Affiliation(s)
- Tejaswini P. Reddy
- Texas A&M University Health Science Center, Bryan, Texas
- Houston Methodist Research Institute, Houston, Texas
- Houston Methodist Neal Cancer Center, Houston, Texas
| | - Sharon A. Glynn
- Prostate Cancer Institute, National University of Ireland Galway, Galway, Ireland
| | - Timothy R. Billiar
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David A. Wink
- Cancer Innovation Laboratory, Center for Cancer Research, National Cancer Institute, National Institute of Health, Frederick, Maryland
| | - Jenny C. Chang
- Houston Methodist Research Institute, Houston, Texas
- Houston Methodist Neal Cancer Center, Houston, Texas
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49
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Naomi R, Teoh SH, Embong H, Balan SS, Othman F, Bahari H, Yazid MD. The Role of Oxidative Stress and Inflammation in Obesity and Its Impact on Cognitive Impairments-A Narrative Review. Antioxidants (Basel) 2023; 12:antiox12051071. [PMID: 37237937 DOI: 10.3390/antiox12051071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Obesity is a chronic low-grade inflammatory condition that induces the generation of oxidative stress and inflammation. This oxidative stress and inflammation stimulate brain atrophy and some morphological changes in the brain that eventually result in cognitive impairments. However, there is no exact study that has summarized the role of oxidative stress and inflammation in obesity and its impact on cognitive impairments. Thus, the objective of this review is to recapitulate the current role of oxidative stress and inflammation in cognitive decline based on in vivo evidence. A comprehensive search was performed in Nature, Medline and Ovid, ScienceDirect, and PubMed, and the search was limited to the past 10 years of publication. From the search, we identified 27 articles to be further reviewed. The outcome of this study indicates that a greater amount of fat stored in individual adipocytes in obesity induces the formation of reactive oxygen species and inflammation. This will lead to the generation of oxidative stress, which may cause morphological changes in the brain, suppress the endogenous antioxidant system, and promote neuroinflammation and, eventually, neuronal apoptosis. This will impair the normal function of the brain and specific regions that are involved in learning, as well as memory. This shows that obesity has a strong positive correlation with cognitive impairments. Hence, this review summarizes the mechanism of oxidative stress and inflammation that induce memory loss based on animal model evidence. In conclusion, this review may serve as an insight into therapeutic development focusing on oxidative stress and inflammatory pathways to manage an obesity-induced cognitive decline in the future.
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Affiliation(s)
- Ruth Naomi
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Soo Huat Teoh
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas 13200, Malaysia
| | - Hashim Embong
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Santhra Segaran Balan
- Department of Diagnostic and Allied Health Sciences, Faculty of Health and Life Sciences, Management and Science University, Shah Alam 40100, Malaysia
| | - Fezah Othman
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Hasnah Bahari
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Muhammad Dain Yazid
- Centre for Tissue Engineering and Regenerative Medicine (CTERM), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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50
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Strain MM, Espinoza L, Fedorchak S, Littlejohn EL, Andrade MA, Toney GM, Boychuk CR. Early central cardiovagal dysfunction after high fat diet in a murine model. Sci Rep 2023; 13:6550. [PMID: 37085567 PMCID: PMC10121716 DOI: 10.1038/s41598-023-32492-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/28/2023] [Indexed: 04/23/2023] Open
Abstract
High fat diet (HFD) promotes cardiovascular disease and blunted cardiac vagal regulation. Temporal onset of loss of cardiac vagal control and its underlying mechanism are presently unclear. We tested our hypothesis that reduced central vagal regulation occurs early after HFD and contributes to poor cardiac regulation using cardiovascular testing paired with pharmacology in mice, molecular biology, and a novel bi-transgenic mouse line. Results show HFD, compared to normal fat diet (NFD), significantly blunted cardio/pulmonary chemoreflex bradycardic responses after 15 days, extending as far as tested (> 30 days). HFD produced resting tachycardia by day 3, reflected significant loss of parasympathetic tone. No differences in bradycardic responses to graded electrical stimulation of the distal cut end of the cervical vagus indicated diet-induced differences in vagal activity were centrally mediated. In nucleus ambiguus (NA), surface expression of δ-subunit containing type A gamma-aminobutyric acid receptors (GABAA(δ)R) increased at day 15 of HFD. Novel mice lacking δ-subunit expression in vagal motor neurons (ChAT-δnull) failed to exhibit blunted reflex bradycardia or resting tachycardia after two weeks of HFD. Thus, reduced parasympathetic output contributes to early HFD-induced HR dysregulation, likely through increased GABAA(δ)Rs. Results underscore need for research on mechanisms of early onset increases in GABAA(δ)R expression and parasympathetic dysfunction after HFD.
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Affiliation(s)
- Misty M Strain
- Department of Cellular and Integrative Physiology, Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7746, San Antonio, TX, 78229-3901, USA
| | - Liliana Espinoza
- Department of Cellular and Integrative Physiology, Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7746, San Antonio, TX, 78229-3901, USA
| | - Stephanie Fedorchak
- Department of Cellular and Integrative Physiology, Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7746, San Antonio, TX, 78229-3901, USA
| | - Erica L Littlejohn
- Department of Cellular and Integrative Physiology, Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7746, San Antonio, TX, 78229-3901, USA
| | - Mary Ann Andrade
- Department of Cellular and Integrative Physiology, Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7746, San Antonio, TX, 78229-3901, USA
| | - Glenn M Toney
- Department of Cellular and Integrative Physiology, Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7746, San Antonio, TX, 78229-3901, USA
| | - Carie R Boychuk
- Department of Cellular and Integrative Physiology, Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7746, San Antonio, TX, 78229-3901, USA.
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