Mechanisms linking obesity with cardiovascular disease

Physical stimuli-responsive polymeric patches for healthcare

Many chronic diseases have become severe public health problems with the development of society. A safe and efficient healthcare method is to utilize physical stimulus-responsive polymer patches, which may respond to physical stimuli, including light, electric current, temperature, magnetic field, mechanical force, and ultrasound. Under certain physical stimuli, these patches have been widely used in therapy for diabetes, cancer, wounds, hair loss, obesity, and heart diseases since they could realize controllable treatment and reduce the risks of side effects. This review sketches the design principles of polymer patches, including composition, properties, and performances. Besides, control methods of using different kinds of physical stimuli were introduced. Then, the fabrication methods and characterization of patches were explored. Furthermore, recent applications of these patches in the biomedical field were demonstrated. Finally, we discussed the challenges and prospects for its clinical translation. We anticipate that physical stimulus-responsive polymer patches will open up new avenues for healthcare by acting as a platform with multiple functions.

Coronary artery disease risk prediction by combined stratification of low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol levels across different glucose statuses

AIM

To investigate the association between low-density lipoprotein-cholesterol (LDL-C) levels and coronary artery disease (CAD) incidence based on combining high-density lipoprotein-cholesterol (HDL-C) levels and glucose status.

MATERIALS AND METHODS

In this retrospective cohort study, we used data from a nationwide claims database (1,524,289 individuals without a history of CAD or familial hypercholesterolaemia; 2008-2019). Cox proportional hazards modelling identified the risk of incident CAD by a novel combination of four HDL-C levels, seven LDL-C levels and glucose status.

RESULTS

During the follow-up period (mean: 5.5 years), 8301 (0.99/1000 person-years) events occurred. The risk of CAD increased from lower LDL-C levels accompanied by lower HDL-C levels regardless of the glucose status. Using the most favourable levels of HDL-C and LDL-C (i.e. 60-99 mg/dL and <80 mg/dL, respectively) as references, the hazard ratios (95% confidence interval) for the group with HDL-C levels <40 mg/dL and LDL-C levels <80 mg/dL were 2.74 (1.47-5.11), 2.52 (1.30-4.91) and 2.85 (1.68-4.84) for normoglycaemia, borderline glycaemia and diabetes, respectively. Comparison of the most favourable levels of HDL-C and LDL-C with their least favourable levels (i.e. <40 mg/dL and 180-199 mg/dL, respectively) revealed that the risk of new-onset CAD exhibited a 19-, nine- and seven-fold increase in individuals with normoglycaemia, borderline glycaemia and diabetes, respectively.

CONCLUSIONS

To prevent CAD, LDL-C levels should be strictly controlled in patients with low HDL-C levels regardless of glucose tolerance. Individualized treatment, which involves setting target LDL-C levels based on glucose tolerance and HDL-C values, is required.

Exploring flavonoid intake and all-cause mortality in diverse health conditions: Insights from NHANES 2007-2010 and 2017-2018

OBJECTIVES

Flavonoids exhibit antioxidative, anti-inflammatory, and anticancer properties, yet the relationship between flavonoid intake and all-cause mortality in the obese population remains unclear.

METHODS

This study included NHANES participants from 2007 to 2010 and 2017 to 2018. Cox regression analysis evaluated the impact of total flavonoid intake on all-cause mortality among participants with varying comorbidity profiles. Subgroup analysis was conducted by separately analyzing the six sub-classes of total flavonoids (anthocyanidins, flavan-3-ols, flavanones, flavones, flavonols, and isoflavones). Sensitivity analysis was used to investigate the impact of total flavonoid intake on all-cause mortality among patients with different comorbidities.

RESULTS

During a median follow-up period of 9.92 years (interquartile range (IQR), 5.54-14.29 years), a total of 639 participants died. COX regression analysis revealed a positive impact of flavonoid intake on all-cause mortality among participants with chronic kidney disease, with greater benefits observed in obese participants [hazard ratio (HR): 0.22, 95% CI: 0.11-0.44). In metabolically healthy obese participants (HR: 0.15, 95% CI: 0.07-0.35), obese individuals with diabetes (HR: 0.51, 95% CI: 0.29-0.88), and obese individuals with comorbid cardiovascular disease (HR: 0.37, 95% CI: 0.17-0.83), flavonoid intake was associated with a reduced risk of all-cause mortality. Restricted cubic spline (RCS) analysis indicated a non-linear relationship in obese participants, with optimal intake levels ranging from 319.4978 to 448.6907 mg/day, varying based on different comorbidity profiles. Subgroup analysis revealed varying effects of total flavonoid components in different health conditions, with hazard ratios ranging from 0.06 for higher levels of flavonol to 0.59 for higher levels of anthocyanidins in the Cox model. Sensitivity analyses further indicated that individuals with obesity and comorbid diabetes or CKD see the greatest benefit from flavonoid intake.

CONCLUSIONS

The consumption of flavonoids may be associated with a decreased risk of all-cause mortality. Consumption of flavonoids is particularly beneficial for individuals with obesity and comorbidities.

Microsurgical Breast Reconstruction can be Performed Safely in Patients with Obesity

BACKGROUND

 Numerous studies have shown that obesity is a risk factor for postoperative complications following breast reconstruction. Hence, obesity has traditionally been considered a relative contraindication to microsurgical breast reconstruction. In this study, we investigated the impact of obesity on outcomes following microsurgical breast reconstruction.

METHODS

 A retrospective analysis of 200 consecutive patients who underwent microsurgical breast reconstruction with free abdominal flaps was performed. Subjects were divided into Nonobese (body mass index [BMI] < 30 kg/m2) and Obese (BMI ≥ 30 kg/m2) cohorts. Univariate and multivariate analyses were performed to evaluate differences in patient characteristics, complication rates, and efficiency metrics between the two groups.

RESULTS

 Of the 200 subjects included in the study, 128 were Nonobese, 72 were Obese. The prevalence of diabetes (3.9 vs. 16.9%, p = 0.002) and hypertension (14.7 vs. 39.4%, p < 0.001) were significantly greater in the Obese cohort. Among unilateral reconstructions, postoperative length of stay (LOS) was longer among Obese patients (3.1 vs. 3.6 days, p = 0.016). Seroma occurred more frequently in Obese patients following bilateral reconstruction (5.7 vs. 0.0%, p = 0.047). Otherwise, there were no significant differences in complication rates between the groups. On multivariate analysis, BMI was not independently associated with complications, LOS, or operative time.

CONCLUSION

 The improvements in clinical and patient-reported outcomes that have been associated with postmastectomy breast reconstruction do not exclude obese women. This study indicates that microsurgical breast reconstruction can be performed safely and efficiently in patients with obesity.

Hyperpolarized 13C and 31P MRS detects differences in cardiac energetics, metabolism, and function in obesity, and responses following treatment

Obesity is associated with important changes in cardiac energetics and function, and an increased risk of adverse cardiovascular outcomes. Multi-nuclear MRS and MRI techniques have the potential to provide a comprehensive non-invasive assessment of cardiac metabolic perturbation in obesity. A rat model of obesity was created by high-fat diet feeding. This model was characterized using in vivo hyperpolarized [1-13C]pyruvate and [2-13C]pyruvate MRS, echocardiography and perfused heart 31P MRS. Two groups of obese rats were subsequently treated with either caloric restriction or the glucagon-like peptide-1 analogue/agonist liraglutide, prior to reassessment. The model recapitulated cardiovascular consequences of human obesity, including mild left ventricular hypertrophy, and diastolic, but not systolic, dysfunction. Hyperpolarized 13C and 31P MRS demonstrated that obesity was associated with reduced myocardial pyruvate dehydrogenase flux, altered cardiac tricarboxylic acid (TCA) cycle metabolism, and impaired myocardial energetic status (lower phosphocreatine to adenosine triphosphate ratio and impaired cardiac ΔG~ATP). Both caloric restriction and liraglutide treatment were associated with normalization of metabolic changes, alongside improvement in cardiac diastolic function. In this model of obesity, hyperpolarized 13C and 31P MRS demonstrated abnormalities in cardiac metabolism at multiple levels, including myocardial substrate selection, TCA cycle, and high-energy phosphorus metabolism. Metabolic changes were linked with impairment of diastolic function and were reversed in concert following either caloric restriction or liraglutide treatment. With hyperpolarized 13C and 31P techniques now available for human use, the findings support a role for multi-nuclear MRS in the development of new therapies for obesity.

Association between stroke and relative fat mass: a cross-sectional study based on NHANES

BACKGROUND

This study was aimed at investigating the correlation between the occurrence of stroke and relative fat mass (RFM), a novel metric for determining total body fat.

METHODS

This cross-sectional study employed the National Health and Nutrition Examination Survey (NHANES) dataset, which encompassed the years 2005 to 2018 to assess the independent relationship between RFM and stroke. Moreover, multinomial logistic regression, subgroup analysis, smooth curve fitting, and interaction testing were also used.

RESULTS

This study included 35,842 participants and 1,267 (3.53%) of them were diagnosed with stroke. Fully adjusted Models showed that RFM was positively associated with stroke (odds ratio [OR] = 1.02; 95% confidence interval [CI] = 1.01-1.03). The odds of having a stroke in quartile 4 were significantly elevated by 44%, compared to quartile 1 (OR = 1.44,95%CI:1.09-1.90). In addition, a subgroup analysis also demonstrated that age and BMI significantly impacted the association between RFM and stroke (P for interaction<0.01).

CONCLUSIONS

Elevated RFM is associated with increased odds of stroke, suggesting that RFM may have potential value in the prevention and management of stroke.

Cardio-oncological dialogue: Understanding the mechanistic correlation between heart failure and cancer

AIMS

This review aims to elucidate the bidirectional relationship between heart failure and cancer by identifying their common and reciprocal risk factors. It seeks to provide a comprehensive understanding of the mechanistic interactions between these two conditions, supported by evidence from preclinical and clinical investigations.

MATERIALS AND METHODS

A thorough review of peer-reviewed articles was conducted to identify all possible interactions between cancer and heart failure. Multiple search engines were utilized with queries incorporating terms such as cardio-oncology, heart failure, cancer, risk factors, and mechanistic interactions. Selected studies were analysed to identify shared risk factors and to explore the mechanistic junctions that link the two diseases.

KEY FINDINGS

The review identified several common risk factors, including, inflammation, smoking, obesity, clonal haematopoiesis of indeterminate potential, and reduced exercise potential. The pathophysiological mechanisms linking heart failure with cancer include metabolic reprogramming in cancer, cancer-induced thrombosis, cardiac metastasis, paraneoplastic syndrome, cancer-associated cachexia, and anorexia. Additionally, it was found that cancer therapies, such as anthracyclines and radiation, can induce cardiotoxicity, leading to heart failure. The pathophysiological mechanisms that contribute to cancer in heart failure patients were identified as neurohormonal activation, state of hypoxia, secretion of Cardiokines, heart failure medication, innate immune reprograming & cardiac remodelling and coronary atherosclerotic disease.

SIGNIFICANCE

By highlighting the interconnected nature of heart failure and cancer, this review promotes a cardio-oncologic discourse, encouraging cardiologists and oncologists to consider these diseases as interrelated rather than separate entities. This perspective can lead to the development of novel therapeutic strategies and improve patient management by addressing the dual disease burden. Future research should focus on exploring the translational potential of existing drugs and developing new interventions to target the shared characteristics of heart failure and cancer.

Human milk oligosaccharide profiles remain unaffected by maternal pre-pregnancy body mass index in an observational study

Human milk oligosaccharides (HMOs) are important carbohydrates in human milk that infants cannot digest, acting as prebiotics linked to infant health. The risk of childhood obesity increases with maternal obesity, potentially mediated through the gut microbiota affected by the available HMOs. Studies on whether maternal obesity affects HMO abundance, yield conflicting results. This study aimed to investigate the HMO profile and its association with maternal obesity measured by pre-pregnancy body mass index (BMI) and infant anthropometrics. The results were discussed in the context of existing literature. 90 human milk samples were collected at 3 months postpartum from mothers in three BMI-groups: 32 normal weight (BMI: 18.5-24.99 kg/m2), 34 overweight (BMI: 25-30 kg/m2), and 24 obese (BMI > 30 kg/m2). The samples were analyzed using nano liquid chromatography chip quadrupole time-of-flight mass spectrometry yielding 51 HMO structures and isomers. Their peak areas were integrated and normalized to determine relative abundances. Univariate and multivariate analysis showed associations between relative HMO abundance and donors' secretor status and specific infant anthropometric variables, but not with maternal pre-pregnancy BMI. This study does not support the hypothesis that maternal overweight influences the HMO profile and highlights the importance of reporting results despite absence of significant correlations.

Association Between Body Mass Index and Risk of Aortic Stenosis in Women in the Swedish Medical Birth Registry

BACKGROUND

Overweight and obesity are increasing globally with aging, as are life expectancy and aging-associated disorders, including calcific aortic stenosis (AS). Studies investigating the correlation between high body mass index (BMI) and AS are contradictory and inconclusive. This study examines a potential association between BMI and AS in women.

METHODS AND RESULTS

By linking the Swedish Medical Birth Register and the Swedish National Patient Register, we included women aged 18 to 55 years with a first childbirth from 1981 to 2020. Diagnosis of AS and comorbidities were defined according to the International Classification of Diseases (ICD) codes. The women were divided into groups on the basis of BMI. Cox proportional hazards regression models were used to investigate the difference in the risk of being diagnosed with AS, with reference BMI 20 to <22.5 kg/m2. Among the 1 722 625 included women, the mean age was 28 years, and mean BMI was 24 kg/m2, with 21% being overweight (BMI 25 to <30 kg/m2) and 8.5% obese (BMI ≥30 kg/m2). During median follow-up of 19.5 years, 2488 women (0.14%) were diagnosed with AS. The age-adjusted risk of being diagnosed with AS increased with higher BMI to 2.82 (95% CI, 2.44-3.25) times higher in women with BMI 30 to <35 kg/m2, and to 3.72 (95% CI, 2.95-4.70) times higher in those with BMI ≥35 kg/m2. Similar results were found after excluding AS of rheumatic pathogenesis.

CONCLUSIONS

An increase in BMI from its upper normal range was consistently and independently associated with the risk of developing AS in women.

Novel approach for ameliorating high-fat diet-induced syndromes via probiotic-fermented oyster mushroom: from metabolites and microbiota to regulation mechanisms

The potential effects of probiotics on lowering lipid accumulation and alleviating gut microbiota perturbation have been extensively substantiated, but whether Lactobacillus rhamnoses-fermented oyster mushroom (FOM) could more pronouncedly attenuate obesity remains unclear. In this study, the anti-obesity effect of FOM was estimated based on the gut microbiota profile and analysis of hepatic lipid metabolic characteristics. The results revealed that FOM intervention dramatically improved hepatic lipid accumulation, characterized by reduction in fat-related factor metabolism levels and liver lesion enzymatic activities and down-regulation of the expression of genes associated with glycolipid metabolism (Foxo1, Gck, G6pd, Il6r and IL-β). Metabolomics analysis indicated HFD-induced dysglycaemia and disturbed amino acid metabolism, characterized by significant enrichment of pathways (butanoate metabolism, arginine biosynthesis, etc.) and elevated levels of D-mannose, succinate and β-D-fructose, followed by a decreased galactitol content. Furthermore, FOM intervention showed significant enrichment of specific pathways, particularly transcriptional misregulation in cancer and FoxO signaling pathways, while the MAPK signaling pathway demonstrated consistent enrichment across all experimental groups. FOM intervention reshaped the gut microbiota structure by facilitating the proliferation of SCFA producers (Romboutsia, Ruminococcaceae and Allobaculum), together with the depletion of Lachnospiraceae population. The current study strengthened our understanding of FOM prebiotic activities and obesity alleviation mechanisms.

The fattening speed: Understanding the impact of internet speed on obesity, and the mediating role of sedentary behaviour

We examine the impact of access to high-speed internet on obesity. Using 14 waves of longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey and a newly constructed dataset on the rollout and adoption rate of the National Broadband Network (NBN) across Australian postcodes, we find that access to high-speed internet has a positive effect on obesity. Specifically, our preferred instrumental variable estimates, which predict the variation in timing and location of internet access upgrades, suggest that a 1 % increase in the proportion of a postcode that has access to NBN is associated with a 1.573 increase in Body Mass Index and a 6.6 percentage point increase in the probability of being obese. These results are robust to several checks and alternative specifications. We also find that sedentary behaviour and inactivity are mechanisms through which access to high-speed internet transmits to obesity.

GWAShug: a comprehensive platform for decoding the shared genetic basis between complex traits based on summary statistics

The shared genetic basis offers very valuable insights into the etiology, diagnosis and therapy of complex traits. However, a comprehensive resource providing shared genetic basis using the accessible summary statistics is currently lacking. It is challenging to analyze the shared genetic basis due to the difficulty in selecting parameters and the complexity of pipeline implementation. To address these issues, we introduce GWAShug, a platform featuring a standardized best-practice pipeline with four trait level methods and three molecular level methods. Based on stringent quality control, the GWAShug resource module includes 539 high-quality GWAS summary statistics for European and East Asian populations, covering 54 945 pairs between a measurement-based and a disease-based trait and 43 902 pairs between two disease-based traits. Users can easily search for shared genetic basis information by trait name, MeSH term and category, and access detailed gene information across different trait pairs. The platform facilitates interactive visualization and analysis of shared genetic basic results, allowing users to explore data dynamically. Results can be conveniently downloaded via FTP links. Additionally, we offer an online analysis module that allows users to analyze their own summary statistics, providing comprehensive tables, figures and interactive visualization and analysis. GWAShug is freely accessible at http://www.gwashug.com.

Steps to developing a DXA-based risk score for cardiovascular outcomes among older adults: the health, aging, and body composition study

Cardiovascular disease (CVD) is a major chronic disease worldwide and its risk factors have long been investigating in epidemiological studies. Our study aims to develop a body composition-based risk score and integrate it into the Framingham Risk Score (FRS) to improve CVD prediction among well-functioning older adults. We included 1882 older adults from the Health, Aging and Body Composition (Health ABC) study to screen body composition variables obtained from the Dual-energy X-ray absorptiometry (DXA). Three models were developed and compared: the 4-DXA model, the refit FRS, and the refit FRS plus 4-DXA model. C-statistics were 0.62 (95% CI: 0.59, 0.65) for the refit FRS, 0.58 (95% CI: 0.55, 0.61) for the 4-DXA model, and 0.63 (95% CI: 0.60, 0.66) for the refit FRS plus 4-DXA model. Compared to the refit FRS, the refit FRS plus 4-DXA model slightly improved CVD outcome prediction as the discrimination slope, net reclassification index, and the integrated discrimination index were 0.053 (95% CI: 0.041, 0.066), 0.098 (95% CI = - 0.0033, 0.20) and 0.013 (95% CI: 0.0069-0.019). This study provides a model for more accurate risk stratification and draws more attention on DXA-based indices in the clinical setting. It also encourages further research in validating the developed risk score in more diverse population and in investigating a broader range of CVD risk factors.

Body Roundness Index Trajectories and the Incidence of Cardiovascular Disease: Evidence From the China Health and Retirement Longitudinal Study

BACKGROUND

Several previous cross-sectional studies suggested that body roundness index (BRI) may be associated with cardiovascular disease (CVD). However, the association should be further validated. Our study aimed to assess the association of the BRI trajectories with CVD among middle-aged and older Chinese people in a longitudinal cohort.

METHODS AND RESULTS

A total of 9935 participants from the CHARLS (China Health and Retirement Longitudinal Study) with repeated BRI measurements from 2011 to 2016 were included. The BRI trajectories were identified by group-based trajectory modeling. The primary outcome was incident CVD (stroke or cardiac events), which occurred in 2017 to 2020. Cox proportional hazards regression models were used to examine the association of BRI trajectories with CVD risk. Participants were divided into 3 BRI trajectories, named the low-stable BRI trajectory, moderate-stable BRI trajectory and high-stable BRI trajectory, accounting for 49.81%, 42.35%, and 7.84% of the study population, respectively. Compared with participants in the low-stable BRI trajectory group, those in the moderate-stable and high-stable BRI trajectory groups had an increased risk of CVD, with multivariable adjusted hazard ratios of 1.22 (95% CI, 1.09-1.37) and 1.55 (95% CI, 1.26-1.90), respectively. Furthermore, simultaneously adding the BRI trajectory to the conventional risk model improved CVD risk reclassification (all P<0.05).

CONCLUSIONS

A higher BRI trajectory was associated with an increased risk of CVD. The BRI can be included as a predictive factor for CVD incidence.

Taraxacum Mongolicum Polysaccharides Reverses Mice Obesity via Activation of AKT/mTOR Pathway

BACKGROUND/OBJECTIVES

The global prevalence of obesity and its associated health complications represent significant public health concerns. Plant polysaccharides have been demonstrated to possess a range of beneficial pharmacological effects. This experiment was designed to elucidate the mechanisms of dietary Taraxacum mongolicum polysaccharides involved in the regulation of obesity and fat browning.

METHODS

Male C57BL/6J mice were randomly divided into three groups: a control group, a high-fat diet (HFD) group, and an HFD group supplemented with 0.3% TMPs. The mice were fed their respective diets for 10 weeks, after which their body weight, food consumption, and serum lipid levels were measured. Histological analysis was performed to assess lipid deposition in adipose tissue and liver. Western blot was used to assess the expression of proteins involved in the AKT/mTOR pathway.

RESULTS

The results show that compared with the HFD group, the TMP supplementation group's body-weight gain (12.17 ± 1.77) significantly decreased. TMPs also reduced serum levels of total cholesterol, triglycerides, and low-density lipoprotein cholesterol. Histological analysis showed that TMPs reduced lipid deposition in both adipose tissue and the liver.

CONCLUSIONS

In addition, TMPs increased the expression of phosphorylated AKT and the mechanistic target of rapamycin (mTOR), indicating that TMPs exert their beneficial effects on lipid metabolism via the AKT/mTOR pathway.

Predicting cardiometabolic disease in medical students using FibroScan and 30-year Framingham risk scores

Introduction

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a major cause of end-stage hepatic disease worldwide requiring liver transplantation, whereas cardiovascular disease (CVD) remains the leading cause of morbidity and mortality globally. Development of MASLD and CVD among young adults is understudied. This study aimed to assess CVD risk in healthy young medical university students using lipid-based and body mass index (BMI)-based 30-year Framingham risk scores (FS30) and to evaluate disease burden for asymptomatic patients with MASLD by performing FibroScan.

Methods

We included medical university students aged 18-30 years without any known medical conditions. All participants underwent physical and anthropometric measurements, and completed a questionnaire. Blood samples were collected for the analysis of glycosylated haemoglobin levels, renal and liver function, biomarker analysis to calculate liver fibrosis risk, and subclinical atherosclerosis biomarkers. Liver stiffness measurements (LSM) and controlled attenuation parameter (CAP) values were measured using FibroScan 430 mini to calculate liver fibrosis and steatosis, respectively. FS30 based on body mass index (FS30-BMI) and lipid levels (FS30-Lipid) were also calculated.

Results

Overall, 138 medical students participated in this study after providing informed consent. Using FS30-Lipid and FS30-BMI, CVD risk was identified in two (1.5%; n = 138) and 23 (17.6%; n = 132) individuals, respectively. MASLD fibrosis was identified based on FibroScan LSMs >7.0 kPa in 12 medical students (9.4%, n = 128; 95% CI, 4.7-14.8%). Consumption of coffee and sugary soft drinks were predictive of liver fibrosis. In total, 36 students (28.6%; n = 128) were found to have hepatic steatosis based on FibroScan CAP values >236 dB, and the predictive factors included increased body fat percentage, male sex, and lack of physical activity. Levels of inflammatory biomarkers, such as C-reactive protein and lipids were not elevated in participants with MASLD.

Discussion

CVD risk was identified in >17% of young medical students. The frequency of liver fibrosis and steatosis was also high among the participants, indicating that liver damage starts at a relatively early age. Early intervention is needed among young adults via health promotion and lifestyle changes.

Potential benefit of Lactobacillus acidophilus supplementation to rats fed with a high-fat diet on serum lipid profile, kidney amyloid protein and tumor necrosis factor-alpha level

AIM

It was aimed to determine the potential effect of Lactobacillus acidophilus supplementation on rats exposed to an experimental high-fat diet on serum lipid profile and kidney total beta amyloid protein (TBAP) and Tumor Necrosis Factor-alpha (TNF-α) levels.

METHODS

24 male Sprague-Dawley rats were used in the study to establish 4 groups. Standard rat food (SD) was provided to Group 1 as the control; Group 2 was fed a high-fat diet (HFD); Group 3 consumed SD and received L. acidophilus probiotics; Group 4 was fed HFD and received L. acidophilus probiotics. Body weights were determined weekly during the 12-week trial period. At the end of the experiment, TBP and TNF-α levels in the serum and kidney tissue of the rats were measured by ELISA method. Serum total cholesterol (TC), triglyceride (TG), HDL, LDL, urea and creatinine levels and paraoxanase, amylase and lipase activities were determined by spectrophotometric method on the analyzer device.

RESULTS

When the control (Group 1) group and Group 2 were compared at the end of the experiment, it was found that Group 2 had gained the most weight and that both the blood and kidney tissue levels of TNF-α and TBAP, as well as the quantities of TG, TK, LDL, and urea, were significantly greater (P<0.05). Serum HDL, PON and amylase levels were found to be significantly low (P>0.05). TG, TK, LDL, urea, and the levels of TNF-α and TBAP in serum and renal tissue were shown to be lower in the groups who received L. acidophilus probiotics (Groups 3, 4) when compared to Group 2 (P>0.05). It was observed that HDL, PON and amylase levels increased and approached the control group (P<0.05).

CONCLUSION

The study's findings showed that probiotic supplementation improved blood levels of TG, TC, HDL, LDL, urea, PON, and amylase as well as serum and kidney tissue levels of TNF-α and TBAP in obese rats fed a high-fat diet.

Effect of Breastfeeding Duration on Coagulation in Women With and Without History of Gestational Diabetes Mellitus

CONTEXT

Breastfeeding is associated with a reduced maternal risk for cardiovascular diseases (CVDs).

OBJECTIVE

Since the underlying mechanisms are still poorly understood, we here examined the effect of breastfeeding on the plasmatic coagulation system in women with and without history of gestational diabetes mellitus (GDM).

METHODS

A total of 76 participants of the German Gestational Diabetes Study (PREG; NCT04270578) were examined 14 months (interquartile range [IQR], 12-26 months) after delivery with a 5-point oral glucose tolerance test. Global coagulation tests, prothrombotic coagulation proteins (FII/FVII/FVIII/FIX), antithrombotic proteins (antithrombin, protein C/S), and endothelial markers (von Willebrand factor and plasminogen activator inhibitor 1) were determined. The Framingham risk score was used to estimate the 10-year CV risk. The effect of breastfeeding duration on coagulation was analyzed using multivariable linear models.

RESULTS

The mean duration of breastfeeding was 11 months (IQR, 7-14 months). Overall, longer duration of breastfeeding was associated with lower CV risk (Framingham risk score; P = .05) and was negatively associated with FIX (P = .018). We detected an interaction between previous GDM and breastfeeding duration for FIX (PInteraction = .017): Only in women with GDM history was the duration of breastfeeding negatively associated with FIX activity (P = .016). This association persisted in statistical models adjusted for age, body mass index, insulin sensitivity, and C-reactive protein. The duration of breastfeeding was not associated with anticoagulant proteins and endothelial markers.

CONCLUSION

Longer duration of breastfeeding is associated with lower CV risk and an improved coagulation profile. Women with GDM history appear to benefit particularly from prolonged breastfeeding.

The association of changes in the Chinese visceral adiposity index and cardiometabolic diseases: a cohort study

OBJECTIVE

The relationship between changes in Chinese visceral adiposity index (CVAI) and cardiometabolic diseases (CMD) in middle-aged and elderly individuals remains unclear. This study aimed to explore whether changes in the CVAI were associated with CMD incidence.

METHODS

This study included 3,243 individuals aged over 45 years from the China Health and Retirement Longitudinal Study. The exposures were changes in the CVAI and cumulative CVAI from 2012 to 2015. Changes in the CVAI were classified using K-means clustering analysis, and the cumulative CVAI was calculated as follows: (CVAI2012 + CVAI2015)/2 × time (2015-2012). Multivariable logistic regression models were used to assess the relationship between different CVAI change classes and CMD incidence. Restricted cubic splines regression was used to assess the dose-response relationship between cumulative CVAI and CMD incidence. To investigate the relationship between combined exposure to each component of CAVI and CMD incidence, a weighted quantile sum regression analysis was employed.

RESULTS

During the 5 years of follow-up, 776 (24%) incident CMD cases were identified. Changes in CVAI and cumulative CVAI were independently and positively associated with CMD. After adjusting for potential confounders, compared with Class 1, the adjusted ORs (95% CIs) for incident CMD were 1.18 (0.90-1.57) for Class 2, 1.40 (1.03-1.92) for Class 3, and 1.56 (1.04-2.34) for Class 4. When cumulative CVAI was categorized into quartiles, compared with Q1, the adjusted ORs (95% CIs) for incident CMD were 1.30 (1.00-1.70) for Q2, 1.34 (1.01-1.79) for Q3, and 1.63 (1.15-2.31) for Q4. In addition, cumulative CVAI in the overall population exhibited a linear association with CMD (Poverall = 0.012, Pnon-linearity = 0.287), diabetes (Poverall = 0.022, Pnon-linearity = 0.188), and stroke (Poverall = 0.002, Pnon-linearity = 0.978), but showed no significant association with heart disease (Poverall = 0.619, Pnon-linearity = 0.442).

CONCLUSION

Participants with higher baseline CVAI level and a change of elevating CVAI level may suffer an increased incidence of CMD. Furthermore, our findings elucidate the underlying mechanisms of the CVAI by highlighting TG as the primary contributor to the observed associations. Long-term CVAI monitoring is of significant importance for early identification and prevention of CMD, with significant implications for clinical practice.

The 5:2 Diet Affects Markers of Insulin Secretion and Sensitivity in Subjects with and without Type 2 Diabetes-A Non-Randomized Controlled Trial

This non-randomized controlled trial aimed to compare the effect of the 5:2 diet on insulin levels as a primary outcome and markers of insulin secretion (connecting peptide (C-peptide) and insulin-like growth factor binding protein-1 (IGFBP-1)) and sensitivity (Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)), as well as body composition as secondary outcomes in overweight/obese individuals with and without type 2 diabetes (T2D). Ninety-seven participants (62% women), 35 with T2D and 62 BMI- and waist-matched controls without T2D, followed the 5:2 diet (two days per week of fasting) for six months with a 12-month follow-up. At six months, there was no loss to follow-up in the T2D group, whereas four controls discontinued this study. Overall, 82% attended the 12-month follow-up. After the intervention, insulin levels decreased in the control group and glucose decreased in the T2D group, while C-peptide, HOMA-IR, waist circumference, BMI, trunk, and total fat% decreased in both groups. Furthermore, low IGFBP-1, indicating hyperinsulinemia, improved in the T2D group. The changes in fasting glucose and waist measurement were significantly more improved in the T2D group than in the controls. Persistent positive effects were observed at the 12-month follow-up. The 5:2 diet for six months was feasible and efficient to reduce markers of insulin secretion and resistance and therefore holds promise as management of overweight/obesity in subjects with and without T2D.

Delay Discounting and BMI in Hypertensives: Serial Mediations of Self-Efficacy, Physical Activity and Sedentary Behavior

Objective

Our study aimed to examine the association between delay discounting (DD) and body mass index (BMI) in individuals with hypertension. Additionally, we sought to explore and compare the potential mediating effects of self-efficacy, physical activity and sedentary behavior in this association.

Methods

A cross-sectional survey was conducted in two cities in the Jiangsu province of China, specifically Nanjing and Yangzhou, from March to June 2023. A total of 972 hypertensive patients completed the questionnaire (M age = 64.7 years, SD age = 8.2 years, 54.2% female). Participants engaged in a money choice experiment on computers, provided their height and weight, and completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and General Self-Efficacy Scale (GSES). The experimental program was generated using the programming software E-Prime version 2.0. Multiple hierarchical regression analysis was conducted to identify potential covariates. Two serial mediation models were conducted using PROCESS macro 4.1 in SPSS 27.0. Physical activity and sedentary behavior were designated as M2 to investigate and contrast their respective mediating effects in the association between delay discounting and body mass index.

Results

Self-efficacy, physical activity, and sedentary behavior served as mediators in the relationship between delay discounting and BMI. Self-efficacy accounted for 14.9% and 14.3% of the total effect in Models 1 and 2, respectively, while physical activity and sedentary behavior each accounted for 14.9% and 9.5% of the total effect, respectively. The serial mediation effects of self-efficacy and physical activity, as well as self-efficacy and sedentary behavior, were significant (B = 0.01, 95% CI [0.01, 0.02]; B = 0.01, 95% CI [0.002, 0.01]), collectively contributing 2.1% and 2.4% of the total effect. Sedentary behavior played a smaller mediating role compared to physical activity in this association.

Conclusion

The results indicated that self-efficacy, physical activity and sedentary behavior could act as mediators in the association between delay discounting and BMI, thus potentially mitigating the risk of obesity in hypertensive individuals.

Metabolic dysfunction-associated steatotic liver disease is associated with worse time in ranges in type 1 diabetes

AIM

To investigate the relationship between continuous glucose monitoring (CGM)-derived glucometrics and metabolic dysfunction-associated steatotic liver disease (MASLD) in type 1 diabetes (T1D).

METHODS

A cross-sectional study collecting data on anthropometrics, glucometrics and MASLD in adults with T1D using a CGM device was conducted. MASLD was assessed by abdominal ultrasound and the presence of at least one cardiometabolic criterion. Backward multivariable logistic regression models were applied to define variables independently associated with MASLD.

RESULTS

A total of 302 consecutive participants were included (median age 49 [34-61] years, male sex 58%, median diabetes duration 29 [17-38] years, mean time in range [TIR] 55% ± 16%). MASLD was present in 17% of cases, and 32% had metabolic syndrome (MetS). MetS was significantly more prevalent in the MASLD group (65% vs. 25%, P < .0001). TIR (P = .038) and time below range (TBR) (P = .032) were lower and time above range (TAR) was higher (P = .006), whereas HbA1c did not reach significance (P = .068). No differences were found for the glycaemia risk index. TIR (P = .028), TAR (P = .007), TBR (P = .036), waist circumference (P < .001) and systolic blood pressure (P = .029) were independently associated with MASLD, while sex, age, aspartate aminotransferase/alanine aminotransferase ratio, gamma-glutamyl transferase, high-density lipoprotein cholesterol and triglycerides were not.

CONCLUSIONS

TIR, TAR, TBR, waist circumference and systolic blood pressure were independently associated with MASLD.

Relationship Between Weight Loss, Changes in Serum hs-CRP Levels and apo A-1 Lipoprotein, and High-Density Lipoprotein-Cholesterol Ratios as Predictors for Improved Cardiovascular Risk Factors After Laparoscopic Sleeve Gastrectomy

INTRODUCTION

Obesity, a major global health concern, is a known risk factor for cardiovascular disease (CVD), often due to dyslipidemia and insulin resistance. Laparoscopic sleeve gastrectomy (LSG) is an effective weight reduction surgery that not only alters body metabolism and gastrointestinal physiology but also significantly lowers cardiovascular disease risk.

METHODS

This study explores the impact of weight loss on serum high-sensitivity C-reactive protein (hs-CRP), an established inflammatory marker, and changes in cardiovascular risk factors, particularly high-density lipoprotein-cholesterol (HDL-C) ratios, serum apo A-1, lipid profile, and HOMA-IR in severe obesity undergoing LSG. Anthropometric measurements and blood samples were collected preoperatively and 6 months postoperatively to hs-CRP, HOMA-IR, lipid profile, apo A-1, and low- and high-density lipoprotein-cholesterol (LDL-C/HDL-C) ratios, total cholesterol to HDL-C (TC/HDL-C) ratio, and monocyte to high-density lipoprotein-cholesterol ratio (MHR).

RESULTS

In total, 70 patients were analyzed after 6 months and reached %TWL 27.4 ± 9.5 and %EWL 62.0 ± 15.4. Significant improvements were noted in all measured biomarkers. Analysis showed that each unit reduction in BMI significantly affected hs-CRP and HDL-C. Furthermore, moderate associations between hs-CRP and various cardiovascular disease risk biomarkers, including a negative correlation with apo A-1 and positive correlations with total cholesterol (TC), TC/HDL-C, and LDL-C/HDL-C, along with a mild positive correlation with HOMA-IR.

CONCLUSION

Weight loss following LSG significantly reduced inflammation and improved atheroprotection. Improved inflammation markers were associated with favorable changes in cardiovascular risk factors, including HDL-C ratios particularly TC/HDL-C, LDL-C/HDL-C, and apo A-1.

The genetic architecture of biological age in nine human organ systems

Investigating the genetic underpinnings of human aging is essential for unraveling the etiology of and developing actionable therapies for chronic diseases. Here, we characterize the genetic architecture of the biological age gap (BAG; the difference between machine learning-predicted age and chronological age) across nine human organ systems in 377,028 participants of European ancestry from the UK Biobank. The BAGs were computed using cross-validated support vector machines, incorporating imaging, physical traits and physiological measures. We identify 393 genomic loci-BAG pairs (P < 5 × 10-8) linked to the brain, eye, cardiovascular, hepatic, immune, metabolic, musculoskeletal, pulmonary and renal systems. Genetic variants associated with the nine BAGs are predominantly specific to the respective organ system (organ specificity) while exerting pleiotropic links with other organ systems (interorgan cross-talk). We find that genetic correlation between the nine BAGs mirrors their phenotypic correlation. Further, a multiorgan causal network established from two-sample Mendelian randomization and latent causal variance models revealed potential causality between chronic diseases (for example, Alzheimer's disease and diabetes), modifiable lifestyle factors (for example, sleep duration and body weight) and multiple BAGs. Our results illustrate the potential for improving human organ health via a multiorgan network, including lifestyle interventions and drug repurposing strategies.

Association between short-term pollen exposure and blood pressure in adults: A repeated-measures study

BACKGROUND

Recent studies have related high pollen concentrations to increased cardiovascular morbidity and mortality, yet very little research concerns pre-clinical cardiovascular health, including effects on blood pressure (BP). The EPOCHAL panel study investigated the exposure-response relationship between ambient pollen exposure and systolic and diastolic BP in adults.

METHODS

BP was measured in 302 adults with and in 94 without pollen allergy during the pollen season, on approximately 16 days per person (6253 observations). Average individually-relevant pollen exposure in the 96 h prior to each BP measurement was calculated by summing up the averages of all ambient pollen concentrations to which the individual was found to be sensitized in a skin prick test, and which originated from seven highly allergenic pollen types (hazel, alder, birch, ash, grasses, mugwort and ragweed). Generalized additive mixed models were used to study the association between mean individually-relevant pollen exposure in the last 96 h and BP, adjusting for individual and environmental time-varying covariates. Effect modification by pollen allergy status, sex and BMI was evaluated.

RESULTS

Positive non-linear associations between individually-relevant pollen exposure and both systolic and diastolic BP were found in the allergic but not in the non-allergic group. BP increased sharply for exposures from zero to 60/80 pollen/m3 (diastolic/systolic BP), followed by a tempered further increase at higher concentrations. Increases of 2.00 mmHg [95% confidence interval (CI): 0.80-3.19] in systolic and 1.51 mmHg [95% CI: 0.58-2.45] in diastolic BP were associated with 96-h average pollen exposure of 400 pollen/m3, compared to no exposure. Obesity and female sex were associated with larger BP increases.

CONCLUSIONS

The finding that short-term pollen concentration is associated with increased systolic and diastolic BP in persons with pollen allergy strengthens the evidence that pollen may cause systemic health effects and trigger cardiovascular events.

Strengths and Limitations of BMI in the Diagnosis of Obesity: What is the Path Forward?

PURPOSE OF REVIEW

This review aims to discuss strengths and limitations of body mass index (BMI) in diagnosing obesity, the use of alternative anthropometric measurements, and potential new technology that may change the future of obesity diagnosis and management.

RECENT FINDINGS

The diagnosis of obesity requires the anthropometric assessment of adiposity. In clinical settings, this should include BMI with confirmation that elevated BMI represents excess adiposity and a measure of fat distribution (i.e., waist circumference (WC), waist to height ratio (WHtR), or WC divided by height0.5 (WHR.5R). Digital anthropometry and bioelectric impedance (BIA) can estimate fat distribution and be feasibly employed in the clinic. In addition, the diagnosis should include a clinical component assessing the presence and severity of weight-related complications. As anthropometric measures used in the diagnosis of obesity, BMI is generally sufficient if confirmed to represent excess adiposity, and there are advantages to the use of WHtR over WC to assess fat distribution. BIA and digital anthropometry have the potential to provide accurate measures of fat mass and distribution in clinical settings. There should also be a clinical evaluation for the presence and severity of obesity complications that can be used to stage the disease.

Association of Obesity With Kidney and Cardiac Outcomes Among Patients With Glomerular Disease: Findings From the Cure Glomerulonephropathy Network

RATIONALE & OBJECTIVE

The influence of obesity on cardiorenal outcomes in individuals with glomerular disease is incompletely known. This study examined the association between obesity and kidney and cardiovascular outcomes in children and adults with glomerular kidney disease.

STUDY DESIGN

Prospective, multicenter, observational study.

SETTING & PARTICIPANTS

Participants in the Cure Glomerulonephropathy Network (CureGN) who were≥5 years of age at enrollment.

EXPOSURE

Adult body mass index (BMI) groups: 20-24 (healthy) versus 25-34 (overweight/class 1 obesity) versus≥35 (class 2-3 obesity); and pediatric BMI percentiles: 5th-84th (healthy) versus 85th-94th (overweight) versus≥95th (obese).

OUTCOME

A composite kidney outcome (40% estimated glomerular filtration rate [eGFR] decline or kidney failure) and a composite cardiovascular outcome (myocardial infarction, stroke, heart failure, or death).

ANALYTICAL APPROACH

Time to composite primary outcomes by BMI strata were estimated using Kaplan-Meier analysis. The adjusted associations between BMI and outcomes were estimated using Cox proportional hazards analysis.

RESULTS

The study included 2,301 participants (1,548 adults and 753 children). The incidence of the primary kidney end point was 90.8 per 1,000 person-years in adults with class 2-3 obesity, compared with 58.0 in normal weight comparators. In the univariable analysis, class 2-3 obesity was associated with the primary kidney outcome only in adults (HR, 1.6 [95% CI, 1.1-2.2], P=0.006) compared with the healthy weight groups. In the multivariable adjusted analysis, class 2-3 obesity did not remain significant among adults when controlling for baseline eGFR and proteinuria. Adults with class 2-3 obesity had an incidence of 19.7 cardiovascular events per 1,000 person-years and greater cardiovascular risk (HR, 3.9 [95% CI, 1.4-10.7], P=0.009) in the fully adjusted model.

LIMITATIONS

BMI is an imperfect indicator of adiposity. Residual confounding may exist from socioeconomic factors.

CONCLUSIONS

Among adult patients in CureGN, class 2-3 obesity is associated with cardiovascular but not kidney outcomes when adjusted for potential confounding factors.

PLAIN-LANGUAGE SUMMARY

Obesity is a risk factor for adverse heart and kidney outcomes in patients with chronic kidney disease, but whether it is associated with these outcomes in patients with glomerulonephropathy is not known. This study used existing data from a large sample of adults and children with glomerular diseases to address this question. The findings suggest that obesity increases the risk of cardiovascular but not kidney disease events in adult patients with glomerular disease.

Impact of bariatric surgery on carotid intima-media thickness and arterial stiffness in metabolically healthy obesity: a prospective study

PURPOSE

Cardiovascular disease is one of the leading causes of mortality in patients with obesity. Metabolically healthy obesity (MHO), in which people do not have metabolic disorders, is a transient state of obesity. However, over the long term, a proportion of individuals with MHO develop metabolic syndrome (MetS). We aimed to investigate the effect of substantial weight loss following bariatric surgery in MHO on carotid intima-media thickness (CIMT) and pulse-wave velocity (PWV), which are independent predictors of subclinical atherosclerosis.

METHODS

This prospective study included 38 patients (34 women, four men) undergoing bariatric surgery who had severe obesity but without comorbidities (hypertension, diabetes, and hyperlipidemia), and 28 control individuals who were matched for age and sex. CIMT and PWV of the left common carotid artery were measured. At 12-month follow-up after bariatric surgery, measurements were repeated in the 38 patients with obesity.

RESULTS

Mean baseline body mass index (BMI) in the MHO group was 40.55 ± 3.59 kg/m2, which decreased by 33.1% after bariatric surgery. Compared with controls, CIMT and PWV were increased in MHO (543.53 ± 55.29 vs. 407.82 ± 53.09 μm, 6.70 ± 1.22 vs. 5.45 ± 0.74 m/s, respectively; all P < 0.001). At 12 months post-bariatric surgery, CIMT in MHO was lower than baseline (466.79 ± 53.74 vs. 543.53 ± 55.29 μm, P = 0.009), but PWV was not significantly different from baseline (6.27 ± 0.86 vs. 6.70 ± 1.22 m/s, P = 0.132). Multivariate regression showed that BMI was an independent predictor of CIMT (β = 0.531, P < 0.001).

CONCLUSION

Carotid artery structure and function were impaired in MHO, and improved carotid artery structure was associated with weight loss in MHO after bariatric surgery.

Emotional Eating in Primary Care: Considerations for Assessment and Management

LEARNING OBJECTIVES

After participating in this CME activity, the psychiatrist should be better able to:• Describe how to identify and address emotional eating in the primary care setting.

ABSTRACT

Emotional eating (i.e., eating in response to negative emotional states and stress) is a highly prevalent concern within primary care settings. It is associated with myriad health issues such as the experience of overweight or obesity, increased difficulty losing weight and sustaining weight loss, various eating disorders, diabetes, and heart disease. Given the effects of emotional eating on patient health goals regarding weight loss or management, it is imperative to incorporate interventions that address emotional underpinnings alongside traditional, behaviorally based weight-loss treatment. Ensuring that primary care providers, who represent pivotal frontline touch points for patients interested in weight-related treatment, can identify emotional eating is an important first step in supporting these patients' goals. The primary purpose of this paper is to provide background information and practical guidance for addressing emotional eating in the primary care setting. We summarize theorized biological and psychological mechanisms that underlie emotional eating, and review traditional (i.e., psychological) interventions, with special consideration for adapting available treatments for use in primary care contexts.

A comprehensive review and meta-analysis comparing robot-assisted and laparoscopic adrenalectomy in individuals with obesity

This meta-analysis aimed to compare the efficacy of robot-assisted vs. laparoscopic adrenalectomy in individuals with obesity. We performed an extensive review of the PubMed, Embase, and Cochrane Library databases for research on adrenalectomy in individuals with obesity up to August 2024. Only studies comparing robot-assisted surgery with laparoscopic surgery were included. Only articles written in English were included. We utilized established criteria for inclusion and exclusion, concentrating on randomized controlled trials and cohort studies. The ROBINS-I instrument was employed to assess the bias risk in non-randomized control studies. Review Manager 5.4.1 was utilized to conduct the meta-analysis. The final analysis incorporated four retrospective cohort studies with a total of 492 individuals with obesity (261 receiving RA and 231 undergoing LA). The results showed that RA was linked to a shorter duration of hospitalization and less estimated blood loss in comparison to LA. Nonetheless, there were no notable distinctions between the two surgical methods in terms of OT, laparotomy conversion rates, overall postoperative complications, or death rates after surgery. In conclusion, RA is a reliable and safe choice for individuals with obesity. It offers notable advantages over LA in terms of LOHS and EBL.

J-shaped relationship between Chinese visceral adiposity index and hyperuricemia: a cross-sectional study

BACKGROUND

Recent years have seen the emergence of numerous novel indicators for visceral obesity. This study investigates the potential correlation between the Chinese visceral adiposity index (CVAI) and hyperuricemia (HUA).

METHODS

This research, derived from a 2011 cross-sectional analysis in Dalian, China, employed restricted cubic spline (RCS) plots to identify inflection points. Subsequently, one-way and multifactorial logistic regression models were utilized, with HUA as the outcome variable. Additionally, subgroup analyses and interaction tests were conducted. Eventually, receiver operating characteristic (ROC) curves were calculated to assess the effectiveness of CVAI and other body composition indices in predicting HUA.

RESULTS

The study included 10,061 individuals, with a HUA prevalence of 14.25%. Significant relationships with HUA were observed for CVAI. RCS analysis revealed a J-shaped relationship between CVAI and HUA. Compared to those in the low CVAI category, HUA was notably associated with individuals in the high CVAI category in multifactorial logistic regression (OR = 2.661, 95% CI: 2.323, 3.047). Subgroup analyses demonstrated stronger relationships in women, participants without hypertension, and participants without diabetes. Additional modeling via ROC curves suggested that the CVAI may offer effective predictive value for HUA.

CONCLUSION

This study confirmed that an elevated CVAI elevates the risk of HUA in middle-aged and elderly populations in the Dalian community. The findings advance obesity prevention strategies that mitigate HUA risk and support healthcare initiatives for China's aging population.

Protein tyrosine phosphatase 1B in metabolic and cardiovascular diseases: from mechanisms to therapeutics

Protein Tyrosine Phosphatase 1B (PTP1B) has emerged as a significant regulator of metabolic and cardiovascular disease. It is a non-transmembrane protein tyrosine phosphatase that negatively regulates multiple signaling pathways integral to the regulation of growth, survival, and differentiation of cells, including leptin and insulin signaling, which are critical for development of obesity, insulin resistance, type 2 diabetes, and cardiovascular disease. Given PTP1B's central role in glucose homeostasis, energy balance, and vascular function, targeted inhibition of PTP1B represents a promising strategy for treating these diseases. However, challenges, such as off-target effects, necessitate a focus on tissue-specific approaches, to maximize therapeutic benefits while minimizing adverse outcomes. In this review, we discuss molecular mechanisms by which PTP1B influences metabolic and cardiovascular functions, summarize the latest research on tissue-specific roles of PTP1B, and discuss the potential for PTP1B inhibitors as future therapeutic agents.

Prioritising patients for publicly funded bariatric surgery in Queensland, Australia

OBJECTIVES

This study reports the development and pilot application of the Bariatric Surgery Assessment and Prioritisation Tool (BAPT) for use in a public health system. The BAPT was designed as a patient prioritisation instrument to assess patients with excessive weight and type 2 diabetes suitable for bariatric surgery. We assessed whether the instrument successfully identified those who gained the greatest benefits including weight loss, diabetes remission, reduction in comorbidities, and health-related quality of life (HR-QoL).

METHODS

The BAPT instrument was applied to score 292 patients referred for bariatric surgery in Queensland between 2017 and 2020 based on their, body mass index, diabetes status, surgical risk (e.g. pulmonary embolism) and comorbidities (e.g. non-alcoholic steatohepatitis). These data were collected at referral and at 12-months post-surgery for 130 patients and stratified by BAPT scores. Outcomes included clinical and HR-QoL.

RESULTS

Patients' BAPT scores ranged from 12 to 78 (possible range 2-98). Those with higher scores tended to be younger (p < 0.001), have higher BMI (p < 0.001) or require insulin to manage diabetes (p < 0.01). All patients lost similar percentages of body weight (20-25%, p = 0.73) but higher-scoring patients were more likely to discontinue oral diabetes medications (p < 0.001) and the improvement in glycated haemoglobin was four times greater in patients scoring 70-79 points compared to those scoring 20-29 (p < 0.05). Those who scored ≥ 50 on the BAPT were substantially more likely to obtain diabetes remission (57% vs 31%). BAPT scores of 40 and above tended to have greater improvement in HR-QoL.

CONCLUSIONS

The BAPT prioritised younger patients with higher BMIs who realised greater improvements in their diabetes after bariatric surgery. Higher-scoring BAPT patients should be prioritised for bariatric surgery as they have a greater likelihood of attaining diabetes remission.

Genetic Variants Associated with Body Mass Index Changes in Korean Adults: The Anseong and Ansan Cohorts of the Korean Genome and Epidemiology Study

Although previous studies have examined the relationship between obesity and genetics in response to the growing obesity epidemic, research on the relationship between obesity and long-term changes in body mass index (BMI) is limited. To investigate this relationship, data from 1030 cases in the Anseong and Ansan cohorts were collected from the Korean Genome and Epidemiology Study conducted by the Korea National Institute of Health between 2000 and 2014. Cases lacking participants' BMI data throughout the study were excluded, resulting in a final sample size of 3074. An increase or decrease in BMI was analyzed using PLINK, STRING, and DAVID, with significant differences observed in the AEN, ANKS1B, CSF1, EEF2K, FRAS1, GRIK4, PDGFC, THTPA, and TREH genes. These genes were observed to cluster with pathways related to type 2 diabetes, cardiovascular disease, metabolic processes, and endocytosis-related genes. These results suggest that several genes are involved in BMI changes and that several pathways are associated with obesity risk. Moreover, some genetic variants appear to influence BMI changes in Korean adults.

Decoding the connection between lncRNA and obesity: Perspective from humans and Drosophila

Background

Obesity is a burgeoning global health problem with an escalating prevalence and severe implications for public health. New evidence indicates that long non-coding RNAs (lncRNAs) may play a pivotal role in regulating adipose tissue function and energy homeostasis across various species. However, the molecular mechanisms underlying obesity remain elusive.

Scope of review

This review discusses obesity and fat metabolism in general, highlighting the emerging importance of lncRNAs in modulating adipogenesis. It describes the regulatory networks, latest tools, techniques, and approaches to enhance our understanding of obesity and its lncRNA-mediated epigenetic regulation in humans and Drosophila.

Major conclusions

This review analyses large datasets of human and Drosophila lncRNAs from published databases and literature with experimental evidence supporting lncRNAs role in fat metabolism. It concludes that lncRNAs play a crucial role in obesity-related metabolism. Cross-species comparisons highlight the relevance of Drosophila findings to human obesity, emphasizing their potential role in adipose tissue biology. Furthermore, it discusses how recent technological advancements and multi-omics data integration enhance our capacity to characterize lncRNAs and their function. Additionally, this review briefly touches upon innovative methodologies like experimental evolution and advanced sequencing technologies for identifying novel genes and lncRNA regulators in Drosophila, which can potentially contribute to obesity research.

Anti-obesity effects and underlying molecular mechanisms of the ethanolic extract of figs from Ficus hispida using high fat-fed wister rats

Obesity is a known risk factor for many chronic diseases and a substantial threat to public health. We investigated the effects of figs sourced from Ficus hispida on a high fat-fed experimental rat model. We found that a 500-mg dose of ethanolic extract of figs (EFH) reduced oxidative stress markers nitric oxide (NO), malondialdehyde (MDA), and advanced oxidation protein products (AOPP), which were increased in high fat-fed rats. Antioxidant enzymes superoxide dismutase (SOD), catalase, reduced glutathione (GSH), and myeloperoxidase (MPO), found elevated in high fat-fed rats, were also normalized to nearly regular levels by fig treatment. Administration of EFH further reduced fat deposition and expression of adipogenic genes leptin, fatty acid synthase (FAS), peroxisome proliferator-activated receptor gamma (PPARγ), and sterol regulatory element-binding protein-1c (SERBP-1c). Our results suggest that figs have significant effects on reducing oxidative stress and mitigating obesity-associated liver and adipose tissue abnormalities via suppressing adipogenesis. Thus, we propose that F. hispida has potential benefits in reducing obesity.

Identification and verification of immune-related genes for diagnosing the progression of atherosclerosis and metabolic syndrome

BACKGROUND

Atherosclerosis and metabolic syndrome are the main causes of cardiovascular events, but their underlying mechanisms are not clear. In this study, we focused on identifying genes associated with diagnostic biomarkers and effective therapeutic targets associated with these two diseases.

METHODS

Transcriptional data sets of atherosclerosis and metabolic syndrome were obtained from GEO database. The differentially expressed genes were analyzed by RStudio software, and the function-rich and protein-protein interactions of the common differentially expressed genes were analyzed.Furthermore, the hub gene was screened by Cytoscape software, and the immune infiltration of hub gens was analyzed. Finally, relevant clinical blood samples were collected for qRT-PCR verification of the three most important hub genes.

RESULTS

A total of 1242 differential genes (778 up-regulated genes and 464 down-regulated genes) were screened from GSE28829 data set. A total of 1021 differential genes (492 up-regulated genes and 529 down-regulated genes) were screened from the data set GSE98895. Then 23 up-regulated genes and 11 down-regulated genes were screened by venn diagram. Functional enrichment analysis showed that cytokines and immune activation were involved in the occurrence and development of these two diseases. Through the construction of the Protein-Protein Interaction(PPI) network and Cytoscape software analysis, we finally screened 10 hub genes. The immune infiltration analysis was further improved. The results showed that the infiltration scores of 7 kinds of immune cells in GSE28829 were significantly different among groups (Wilcoxon Test < 0.05), while in GSE98895, the infiltration scores of 4 kinds of immune cells were significantly different between groups (Wilcoxon Test < 0.05). Spearman method was used to analyze the correlation between the expression of 10 key genes and 22 kinds of immune cell infiltration scores in two data sets. The results showed that there were 42 pairs of significant correlations between 10 genes and 22 kinds of immune cells in GSE28829 (|Cor| > 0.3 & P < 0.05). There were 41 pairs of significant correlations between 10 genes and 22 kinds of immune cells in GSE98895 (|Cor| > 0.3 & P < 0.05). Finally, our results identified 10 small molecules with the highest absolute enrichment value, and the three most significant key genes (CX3CR1, TLR5, IL32) were further verified in the data expression matrix and clinical blood samples.

CONCLUSION

We have established a co-expression network between atherosclerotic progression and metabolic syndrome, and identified key genes between the two diseases. Through the method of bioinformatics, we finally obtained 10 hub genes in As and MS, and selected 3 of the most significant genes (CX3CR1, IL32, TLR5) for blood PCR verification. This may be helpful to provide new research ideas for the diagnosis and treatment of AS complicated with MS.

The Associations Between Obesity and Deep Vein Thrombosis in Patients With Cardiovascular Disease: A Narrative Review

This article provides an in-depth review of the relationship between obesity and deep vein thrombosis (DVT) in patients with cardiovascular disease (CVD). Our aim is to enhance understanding of the associations between obesity and DVT, particularly in patients with comorbid cardiovascular conditions. This relationship, although significant, is often underrepresented in discussions about obesity and DVT. Current research frequently lacks clarity on whether studies of obesity and DVT account for the presence of coexisting CVD. We draw on data from systematic reviews, meta-analyses, and other peer-reviewed medical journals that focus on individuals who are overweight or obese and their association with DVT and CVD. The review begins with an introduction to cardiovascular disease, venous thromboembolic disease, and obesity. We then examine potential links between obesity and DVT, emphasizing the roles of gender, venous stasis, chronic inflammation, and decreased fibrinolytic activity. Key findings suggest that while obesity may contribute to the development of DVT, this association is not significantly affected by adjustments for cardiovascular risk factors. The review highlights the need for further research, specifically targeting studies that investigate cardiovascular disease as an underlying risk factor in obese individuals who develop DVT.

Epicardial and pericoronary adipose tissue and coronary plaque burden in patients with Cushing's syndrome: a propensity score-matched study

PURPOSE

To assess coronary inflammation by measuring the volume and density of the epicardial adipose tissue (EAT), perivascular fat attenuation index (FAI) and coronary plaque burden in patients with Cushing's syndrome (CS) based on coronary computed tomography angiography (CCTA).

METHODS

This study included 29 patients with CS and 58 matched patients without CS who underwent CCTA. The EAT volume, EAT density, FAI and coronary plaque burden were measured. The high-risk plaque (HRP) was also evaluated. CS duration from diagnosis, 24-h urinary free cortisol (UFC), and abdominal visceral adipose tissue volume (VAT) of CS patients were recorded.

RESULTS

The CS group had higher EAT volume (146.9 [115.4, 184.2] vs. 119.6 [69.0, 147.1] mL, P = 0.006), lower EAT density (- 78.79 ± 5.89 vs. - 75.98 ± 6.03 HU, P = 0.042), lower FAI (- 84.0 ± 8.92 vs. - 79.40 ± 10.04 HU, P = 0.038), higher total plaque volume (88.81 [36.26, 522.5] vs. 44.45 [0, 198.16] mL, P = 0.010) and more HRP plaques (7.3% vs. 1.8%, P = 0.026) than the controls. The multivariate analysis suggested that CS itself (β [95% CI], 29.233 [10.436, 48.03], P = 0.014), CS duration (β [95% CI], 0.176 [0.185, 4.242], P = 0.033), and UFC (β [95% CI], 0.197 [1.803, 19.719], P = 0.019) were strongly associated with EAT volume but not EAT density, and EAT volume (β [95% CI] - 0.037[- 0.058, - 0.016], P = 0.001) not CS was strongly associated with EAT density. EAT volume, FAI and plaque burden increased (all P < 0.05) in 6 CS patients with follow-up CCTA. The EAT volume had a moderate correlation with abdominal VAT volume (r = 0.526, P = 0.008) in CS patients.

CONCLUSIONS

Patients with CS have higher EAT volume and coronary plaque burden but less inflammation as detected by EAT density and FAI. The EAT density is associated with EAT volume but not CS itself.

Association Between Diet, Physical Activity, Smoking, and Ultra-Processed Food and Cardiovascular Health, Depression, and Sleep Quality

BACKGROUND

This study evaluated cardiovascular health, dietary habits, physical activity, depression, and sleep quality in young university adults.

MATERIALS AND METHODS

A cross-sectional design was used to assess anthropometric, biochemical, and cardiovascular health behaviors. The study included 158 university students aged 18 to 30 years (65% women, 35% men, average age: 20.3 ± 2.4 years), selected through non-probabilistic sampling. Measurements included BMI, waist circumference, blood pressure, glucose, triglycerides, HDL and LDL cholesterol, and visceral fat using bioelectrical impedance. Health behaviors were evaluated via questionnaires on physical activity, fruit and vegetable consumption, smoking, ultra-processed food consumption, and sleep quality using the Pittsburgh Sleep Quality Index. The cardiovascular health index was assessed with the "Life's Essential 8" questionnaire and depression was assessed with Beck Depression Inventory. Statistical analyses included ANOVA, Fisher's F test, Student's t-test, and simple linear regression, conducted using SPSS Statistics version 25.0 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp), with significance set at p<0.05.

RESULTS

Women showed better adherence to healthy behaviors. Higher fruit and vegetable consumption and physical activity were associated with lower visceral fat. Higher visceral fat is correlated with increased blood pressure and decreased HDL cholesterol. Smoking and frequent ultra-processed food consumption were linked to higher depression scores, which were associated with poorer sleep quality.

CONCLUSION

Healthy lifestyle habits are crucial for physical and mental health, providing a basis for public health interventions.

Body Composition, Sarcopenic Obesity, and Cognitive Function in Older Adults: Findings From the National Health and Nutrition Examination Survey (NHANES) 1999-2002 and 2011-2014

OBJECTIVE

Sarcopenic-obesity (SO) is characterized by the concomitant presence of low muscle mass and high adiposity. This study explores the association of body composition and SO phenotypes with cognitive function in older adults.

METHODS

Cross-sectional data in older adults (≥60 years) from NHANES 1999-2002 and 2011-2014 were used. In the 1999-2002 cohort, phenotypes were derived from body mass index (BMI) and dual-X-ray-absorptiometry, and cognition was assessed the by Digit-Symbol-Substitution-Test (DSST). In the 2011-2014 cohort, phenotypes were derived from BMI, waist-circumference (WC), and hand-grip-strength (HGS). Cognition was assessed using four tests: DSST, Animal Fluency, the Consortium-to-Establish-a-Registry-for-Alzheimer's-Disease-Delayed-Recall, and Word Learning. Mediation analysis was conducted to evaluate the contribution of inflammation (C-reactive-protein, CRP) and insulin resistance (Homeostatic-Model-Assessment-for-Insulin-Resistance, HOMA-IR) to the association between body composition and cognitive outcomes.

RESULTS

The SO phenotype had the lowest DSST mean scores (p < 0.05) and was associated with a significant risk of cognitive impairment [Odds Ratio (OR) = 1.9; 95%CI 1.0-3.7, p = 0.027] in the 1999-2002 cohort. A higher ratio of fat mass and fat free mass (FM/FFM) also showed a greater risk of cognitive impairment (OR = 2.0; 95%CI 1.3-3.1, p = 0.004). In the 2011-2014 cohort, the high WC-Low HGS group showed significantly lower scores on all four cognitive tests (p < 0.05) and a higher risk of cognitive impairment. CRP and HOMA-IR were significant partial mediators of the association between FM/FFM and DSST in the 1999-2002 cohort.

CONCLUSIONS

The SO phenotype was associated with a higher risk of cognitive impairment in older adults. Insulin resistance and inflammation may represent key mechanisms linking SO to the development of cognitive impairment.

High Obesity Indices Are Associated with Gastroesophageal Reflux Disease, but Low Obesity Indices Are Associated with Peptic Ulcer Disease in a Large Taiwanese Population Study

INTRODUCTION

Gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD) are prevalent in Taiwan. Few studies have investigated the associations between obesity indices with GERD and PUD simultaneously. This study aimed to investigate the correlations among obesity indices with GERD and PUD in a large cohort of participants, around 120,000, in the Taiwan Biobank (TWB).

METHODS

A total of 121,583 participants (male: 43,698; female: 77,885; mean age 49.9 ± 11.0 years) were included to analyze the associations among obesity indices, including body mass index (BMI), waist-hip ratio (WHR), waist-to-height ratio (WHtR), body roundness index (BRI), abdominal volume index (AVI), lipid accumulation product (LAP), visceral adiposity index (VAI), and triglyceride-glucose index (TyG index), with GERD and PUD. Self-reported GERD and PUD were obtained by questionnaires. Multivariate logistic regression analysis was employed to analyze the relationship between obesity indices with GERD and PUD.

RESULTS

The prevalence of GERD and PUD was 13.7% and 14.6%, respectively. After multivariable analysis, high WHR (odds ratio [OR] = 1.009, p < 0.001), WHtR (OR = 1.005, p = 0.003), BRI (OR = 1.022, p = 0.005), AVI (OR = 1.013, p < 0.001), LAP (OR = 1.001, p < 0.001), TyG index (OR = 1.068, p < 0.001), and VAI (OR = 1.013, p = 0.002) were significantly associated with GERD, except BMI (p = 0.384). On the other hand, low BMI (OR = 0.984; p < 0.001) and AVI (OR = 0.994; p = 0.036) were significantly associated with PUD. However, the values of WHR (p = 0.151), WHtR (p = 0.304), BRI (p = 0.452), LAP (p = 0.799), VAI (p = 0.347), and TyG index (p = 0.642) were not.

CONCLUSION

This study found that high obesity indices are associated with GERD, but low obesity indices are associated with PUD in a large Taiwanese population study. Our findings may alert physicians to notice that different obesity index may be associated with different gastrointestinal disorder.

Association of Visceral Adiposity Index and Handgrip Strength with Cardiometabolic Multimorbidity among Middle-Aged and Older Adults: Findings from Charls 2011-2020

The visceral adiposity index (VAI) and handgrip strength (HGS) are identified as important objectives for the prevention of illness. Nevertheless, there is limited understanding regarding the impact of the VAI and HGS on cardiometabolic multimorbidity (CMM). We aimed to ascertain the impact of the VAI and HGS on CMM among middle-aged and older people. Data spanning from 2011 to 2020 were derived from the China Health and Retirement Longitudinal Study (CHARLS). In total, 7909 individuals aged 45 years and older were included. Cox proportional hazard regression was utilized to examine the correlation among the VAI, HGS, and CMM. Throughout the 10-year follow-up, we determined that both the VAI (HR = 1.330; 95%CI = 1.179-1.500) and HGS (HR = 0.745, 95%CI = 0.645-0.861) exhibited significant associations with CMM risk. Individuals exposed to both a high VAI and low HGS were found to have higher hazards of CMM (HR = 1.377, 95%CI = 1.120-1.694) in contrast to participants exposed to one or none of these conditions. The older (HR = 1.414; 95%CI = 1.053-1.899) and male (HR = 1.586; 95%CI = 1.114-2.256) groups are more likely to experience CMM risk. Our findings suggest that both the VAI and HGS have significant effects on CMM risk. Appropriate interventions focused on vulnerable groups are recommended to prevent the incidence of CMM.

Rise in fasting and dynamic glucagon levels in children and adolescents with obesity is moderate in subjects with impaired fasting glucose but accentuated in subjects with impaired glucose tolerance or type 2 diabetes

Background

Fasting levels of glucagon are known to be elevated in youth and adults with type 2 diabetes mellitus (T2D). Children and adolescents with obesity were previously reported to show increasing fasting and post-glucose-challenge hyperglucagonemia across the spectrum of glucose tolerance, while no data are available in those with impaired fasting glucose (IFG).

Materials and methods

Individuals from the Beta-JUDO study population (Uppsala and Salzburg 2010-2016) (n=101, age 13.3 ± 2.8, m/f =50/51) were included (90 with overweight or obesity, 11 with normal weight). Standardized OGTT were performed and plasma glucose, glucagon and insulin concentrations assessed at baseline, 5, 10, 15, 30, 60, 90 and 120 minutes. Patients were grouped according to their glycemic state in six groups with normal glucose metabolism (NGM) and normal weight (NG-NW), NGM with obesity or overweight (NG-O), impaired glucose tolerance (IGT), impaired fasting glucose (IFG), IGT+IFG and T2D, and in two groups with NGM and impaired glucose metabolism (IGM), for statistical analysis.

Results and conclusion

Glucagon concentrations were elevated in young normoglycemic individuals with overweight or obesity (NG-O) compared to normoglycemic individuals with normal weight. Glucagon levels, fasting and dynamic, increased with progressing glycemic deterioration, except in IFG, where levels were comparable to those in NG-O. All glycemic groups showed an overall suppression of glucagon during OGTT. An initial increase of glucagon could be observed in T2D. In T2D, glucagon showed a strong direct linear correlation with plasma glucose levels during OGTT. Glucagon in adolescents, as in adults, may play a role in the disease progression of T2D.

Current research status and future prospects of NLRP3 inflammasome in cardiovascular diseases: a bibliometric and visualization analysis

Background

Cardiovascular disease (CVD) is a leading cause of global mortality, with atherosclerosis (AS) contributing to its pathological basis. Inflammation plays a critical role in the pathophysiological process of AS, and the NOD-like receptor protein 3 (NLRP3) inflammasome has been extensively studied in this context. This study aimed to analyze the research status of the NLRP3 inflammasome in cardiovascular disease and provide research directions for further exploration in this field.

Methods

Using the "Bibliometrix" and "CiteSpace" software, a total of 516 articles were retrieved from the Web of Science (WoS) database published between 2012 and 2023. The search query used the keywords "["CVD" OR "cardiovascular disease"] AND ["NLRP3 inflammasome "OR "NLRP3"]". Visual analysis was performed on authors, countries, institutions, journal sources, keywords, references, and future trends.

Results

A total of 516 English articles were retrieved, showing an overall upward trend in annual publication volume with slight fluctuations. China, the United States, and Europe were the countries and regions with the highest number of published articles. Among them, China had the highest article count (170), while the United States had the highest citation count (18,664), centrality score (0.43), and h-index (90), indicating its influential role in this research area. These countries also possessed elite institutions, professional researchers, and high-impact journals, making them leading contributors in this field. The main pathogenic mechanisms of the NLRP3 inflammasome in CVD were identified as "oxidative stress", "pyroptosis", and "inflammation". The most frequently studied signaling pathways included "NF-κB", "IL-1", and "C-reactive protein". The most studied disease types were coronary heart disease, atherosclerosis, metabolic syndrome, and myocardial infarction. Additionally, research on the correlation between cholesterol markers and inflammatory indicators associated with NLRP3 inflammasome in CVD risk assessment has gained significant momentum, with the main mechanism being NLRP3/IL-6/hs-CRP and cholesterol lipoproteins emerging as a major keyword in this context.

Conclusion

This study provides valuable insights into the research hotspots and emerging trends of the NLRP3 inflammasome in cardiovascular disease. The findings offer guidance for researchers and scholars in this field and facilitate the exploration of new research directions.

Cardiovascular disease risk scores in patients with optimal vs suboptimal weight loss after bariatric surgery: Translating improvements into clinical practice

INTRODUCTION

The aim of this study was to evaluate cardiovascular disease (CVD) risk modification in patients with optimal weight loss (OWL) versus suboptimal weight loss SWL following MBS.

METHODS

This was a retrospective analysis. The 10-year risk CVD was estimated before and after one year of surgery using the "Framingham Score".

RESULTS

191 patients were included in our study. Mean baseline Framingham score was 7.2 ​± ​6.9%. According to the score, 54% of patients were classified as low risk (n ​= ​104), 23% as moderate (n ​= ​43), 20% moderately high (n ​= ​39) and 3% as high risk (n ​= ​5). One year after surgery, 91% of the patients showed reduction of their Framingham score. Mean CVD risk score decreased significantly to 4.1 ​± ​3.7% when compared to baseline (p-value is ​< ​0.001); 80% of patients classified as low risk (n ​= ​153), 13% as moderate (n ​= ​25), 7% moderately high (n ​= ​13) and 0% as high risk (n ​= ​0).

CONCLUSION

Weight loss after bariatric surgery reduces CVD risk scores and the magnitude of effect correlates with the degree of weight loss.

Sex-specific impact of inflammation on traditional cardiovascular risk factors and atherosclerosis in axial spondyloarthritis. A multicentre study of 913 patients

INTRODUCTION

The nature of the relationship between inflammation, cardiovascular (CV) risk factors and atherosclerosis in axial spondyloarthritis (axSpA) remains largely unknown and sex differences in this regard are yet to be assessed.

METHODS

Study including 611 men and 302 women from the Spanish multicentre AtheSpAin cohort to assess CV disease in axSpA. Data on CV disease risk factors were collected both at disease diagnosis and at enrolment, and data on disease activity, functional indices and carotid ultrasonography only at enrolment.

RESULTS

After a median disease duration of 9 years, patients of both sexes who at disease diagnosis had elevated acute phase reactants (APRs), more frequently had hypertension and obesity. The same occurred with dyslipidaemia in men and with diabetes mellitus in women. At enrolment, CV risk factors were independently associated with APR and with activity and functional indices, with various sex differences. C reactive protein (CRP) values were inversely associated with HDL-cholesterol in men (β coefficient: -1.2 (95% CI: -0.3 to -0.07) mg/dL, p=0.001), while erythrocyte sedimentation rate values were positively associated with triglycerides in women (β coefficient: 0.6 (95% CI: 0.04 to 1) mg/dL, p=0.035). Furthermore, only women showed an independent relationship between insulin resistance parameters and APR or disease activity. Both men and women with high-very high CV risk according to the Systematic Assessment of Coronary Risk Evaluation 2 and CRP levels higher than 3 mg/L at diagnosis of the disease presented carotid plaques significantly more frequently than those with normal CRP levels at disease diagnosis.

CONCLUSION

Inflammation is associated with atherosclerosis and CV disease in axSpA. A gender-driven effect is observed in this relationship.

Association of triglyceride-glucose index and its related parameters with atherosclerotic cardiovascular disease: evidence from a 15-year follow-up of Kailuan cohort

BACKGROUND

Triglyceride glucose (TyG) index and its related parameters have been introduced as cost-effective surrogate indicators of insulin resistance, while prospective evidence of their effects on atherosclerotic cardiovascular disease (ASCVD) remained scattered and inconsistent. We aimed to evaluate the association of TyG and its related parameters with new-onset ASCVD, and the predictive capacity were further compared.

METHOD

A total of 95,342 ASCVD-free participants were enrolled from the Kailuan study. TyG and its related parameters were defined by fasting blood glucose, triglyceride, body mass index (BMI), waist circumstance (WC) and waist-to-height ratio (WHtR). The primary outcome was incident ASCVD, comprising myocardial infarction (MI) and ischemic stroke (IS). Cox proportional hazard models and restricted cubic spline (RCS) analyses were adopted to investigate the association between each index and ASCVD. The C-index, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were used for comparison of their predictive value for ASCVD.

RESULTS

During a median follow-up of 15.0 years, 8,031 new cases of ASCVD were identified. The incidence rate of ASCVD increased along with elevated levels of each index, and the relationships were found to be nonlinear in the RCS analyses. The hazard ratio (HR) and 95% confidence interval (95% CI) for ASCVD was 1.39 (1.35, 1.43), 1.46 (1.41, 1.50), 1.50 (1.46, 1.55), and 1.52 (1.48, 1.57) per 1 IQR increase of baseline TyG, TyG-BMI, TyG-WC, and TyG-WHtR, respectively, and the association were more pronounced for females and younger individuals aged < 60 years (Pfor interaction<0.05). Using the updated mean or time-varying measurements instead of baseline indicators did not significantly alter the primary findings. Additionally, TyG-WC and TyG-WHtR showed better performance in predicting risk of ASCVD than TyG, with the IDI (95% CI) of 0.004 (0.001, 0.004) and 0.004 (0.001, 0.004) and the category-free NRI (95% CI) of 0.120 (0.025, 0.138) and 0.143 (0.032, 0.166), respectively. Similar findings were observed for MI and IS.

CONCLUSIONS

Both the TyG index and its related parameters were significantly and positively associated with ASCVD. TyG-WC and TyG-WHtR had better performance in predicting incident ASCVD than TyG, which might be more suitable indices for risk stratification and enhance the primary prevention of ASCVD.

Extracellular Vesicles Secreted by Adipose Tissue during Obesity and Type 2 Diabetes Mellitus Influence Reverse Cholesterol Transport-Related Gene Expression in Human Macrophages

Obesity is a risk factor for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Adipose tissue (AT) extracellular vesicles (EVs) could play a role in obesity and T2DM associated CVD progression via the influence of their specific cargo on gene expression in recipient cells. The aim of this work was to evaluate the effects of AT EVs of patients with obesity with/without T2DM on reverse cholesterol transport (RCT)-related gene expression in human monocyte-derived macrophages (MDMs) from healthy donors. AT EVs were obtained after ex vivo cultivation of visceral and subcutaneous AT (VAT and SAT, respectively). ABCA1, ABCG1, PPARG, LXRβ (NR1H2), and LXRα (NR1H3) mRNA levels in MDMs as well as in origine AT were determined by a real-time PCR. T2DM VAT and SAT EVs induced ABCG1 gene expression whereas LXRα and PPARG mRNA levels were simultaneously downregulated. PPARG mRNA levels also decreased in the presence of VAT EVs of obese patients without T2DM. In contrast ABCA1 and LXRβ mRNA levels tended to increase with the addition of obese AT EVs. Thus, AT EVs can influence RCT gene expression in MDMs during obesity, and the effects are dependent on T2DM status.