Obesity: global trends in the prevalence of overweight and obesity

Global burden of chronic kidney disease in adolescents and young adults, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background

The global status of chronic kidney disease (CKD) is underestimated, particularly the burden on adolescents and young adults (early-onset, aged 15-39).

Objective

We aim to investigate the pattern and trend of early-onset CKD from 1990 to 2019.

Methods

We analyzed age-specific rates of early-onset CKD incidence, death, and disability-adjusted life years (DALY) using Global Burden of Disease Study 2019 data. We examined the global, regional, national, gender-based, age group-based, and temporal changes of early-onset CKD burden from 1990 to 2019, as well as proportional DALY attributions of various risk factors.

Results

From 1990 to 2019, the global age-specific incidence rate (per 100,000 population) significantly increased from 25.04 (95% confidence interval 18.51, 31.65) to 32.21 (23.73, 40.81) for early-onset CKD. However, the global age-specific death rate significantly decreased from 2.96 (2.76, 3.15) to 2.86 (2.61, 3.11), and the age-specific DALY rate remained stable. Regarding sociodemographic indexes (SDI), countries with middle SDI had the highest incidence rates and the fastest increasing trends, while those with low and low-middle SDI experienced the highest death and DALY rates. Women had a generally higher age-specific incidence rate than men, whereas men showed higher age-specific death and DALY rates. In addition, the burdens of CKD increased with age among adolescents and young adults. Moreover, the main attributable risk factors for DALY of early-onset CKD were high systolic blood pressure (SBP), fasting plasma glucose (FPG), and body mass index (BMI).

Conclusion

The age-specific incidence rate of early-onset CKD increased significantly from 1990 to 2019, and the age-specific DALY rate remained stable. High SBP, high FPG, and high BMI were the primary risk factors. Targeted prevention and healthcare measures should be developed considering age, gender, and region.

Traditional Japanese medicine Kamikihito ameliorates sucrose preference, chronic inflammation and obesity induced by a high fat diet in middle-aged mice

The high prevalence of obesity has become a pressing global public health problem and there exists a strong association between increased BMI and mortality at a BMI of 25 kg/m2 or higher. The prevalence of obesity is higher among middle-aged adults than among younger groups and the combination of aging and obesity exacerbate systemic inflammation. Increased inflammatory cytokines such as interleukin 6 and tumor necrosis factor alpha (TNFα) are hallmarks of obesity, and promote the secretion of hepatic C-reactive protein (CRP) which further induces systematic inflammation. The neuropeptide oxytocin has been shown to have anti-obesity and anti-inflammation effects, and also suppress sweet-tasting carbohydrate consumption in mammals. Previously, we have shown that the Japanese herbal medicine Kamikihito (KKT), which is used to treat neuropsychological stress disorders in Japan, functions as an oxytocin receptors agonist. In the present study, we further investigated the effect of KKT on body weight (BW), food intake, inflammation, and sweet preferences in middle-aged obese mice. KKT oral administration for 12 days decreased the expression of pro-inflammatory cytokines in the liver, and the plasma CRP and TNFα levels in obese mice. The effect of KKT administration was found to be different between male and female mice. In the absence of sucrose, KKT administration decreased food intake only in male mice. However, while having access to a 30% sucrose solution, both BW and food intake was decreased by KKT administration in male and female mice; but sucrose intake was decreased in female mice alone. In addition, KKT administration decreased sucrose intake in oxytocin deficient lean mice, but not in the WT lean mice. The present study demonstrates that KKT ameliorates chronic inflammation, which is strongly associated with aging and obesity, and decreases food intake in male mice as well as sucrose intake in female mice; in an oxytocin receptor dependent manner.

Restricted cubic spline model analysis of the association between anal fistula and anorectal abscess incidence and body mass index

Objective

The epidemiological profile of anal fistula and anorectal abscess has not been well studied. Based on the results of a retrospective cross-sectional survey, we aimed to investigate the potential influential factors associated with anal fistula and anorectal abscess.

Methods

We conducted a retrospective analysis of outpatients who visited the proctology department at China-Japan Friendship Hospital between January 2017 and May 2022. A comprehensive questionnaire was designed to collect potential influential factors, and according to formal anorectal examination and the corresponding diagnostic criteria, all the participants were divided into patients with anal fistula or perianal abscess and healthy control group. Multiple logistic regression was used to identify factors in significant association with anal fistula and perianal abscess. Additionally, we combined restricted cubic spline regression to examine the dose-response relationship between factors and the risk of developing anal fistula or anorectal abscess.

Results

The present study included 1,223 participants, including 1,018 males and 206 females, with 275 anal fistulas, 184 anorectal abscesses, and 765 healthy controls. We found no statistically significant differences between patients and controls in basic information and preoperative assessment of life factors, except for body mass index. It was indicated that people with overweight or obesity were more prone to anal fistula (OR overweight = 1.35, 95% CI: 1.00-1.82, P = 0.047; OR obesity = 3.44, 95% CI: 2.26-5.26, P < 0.001) or anorectal abscess (OR overweight = 1.41, 95% CI: 1.00-1.99, P = 0.05; OR obesity: 2.24, 95% CI: 1.37-3.67, P = 0.001) than normal-weight individuals. The dose-response research indicated the J-shaped trend between the ascending BMI levels and the higher risk of suffering from anal fistula and anorectal abscess.

Conclusions

Our findings indicate that overweight and obesity are risk factors for anal fistula and anorectal abscess, which plays a role in the prevention of anorectal diseases. This provides some theoretical basis for clinicians to provide health education to their patients.

Endocrine, genetic, and microbiome nexus of obesity and potential role of postbiotics: a narrative review

Obesity is a public health crisis, presenting a huge burden on health care and the economic system in both developed and developing countries. According to the WHO's latest report on obesity, 39% of adults of age 18 and above are obese, with an increase of 18% compared to the last few decades. Metabolic energy imbalance due to contemporary lifestyle, changes in gut microbiota, hormonal imbalance, inherent genetics, and epigenetics is a major contributory factor to this crisis. Multiple studies have shown that probiotics and their metabolites (postbiotics) supplementation have an effect on obesity-related effects in vitro, in vivo, and in human clinical investigations. Postbiotics such as the SCFAs suppress obesity by regulating metabolic hormones such as GLP-1, and PPY thus reducing feed intake and suppressing appetite. Furthermore, muramyl di-peptides, bacteriocins, and LPS have been tested against obesity and yielded promising results in both human and mice studies. These insights provide an overview of targetable pharmacological sites and explore new opportunities for the safer use of postbiotics against obesity in the future.

Association of the gut microbiota with clinical variables in obese and lean Emirati subjects

Background

Growing evidence supports the role of gut microbiota in obesity, yet exact associations remain largely unknown. Specifically, very little is known about this association in the Emirati population.

Methods

We explored differences in gut microbiota composition, particularly the Firmicutes/Bacteroidetes (F/B) ratio, between 43 obese and 31 lean adult Emirate counterparts, and its association with obesity markers, by using V3-V4 regions of 16 S ribosomal RNA gene sequencing data. Furthermore, we collected anthropometric and biochemical data.

Results

The two major phyla in obese and lean groups were Firmicutes and Bacteroidetes. We observed a significantly lower alpha diversity (Shannon index) in obese subjects and a significant difference in beta diversity and phylum and genus levels between the two groups. The obese group had higher abundances of Verrucomicrobia and Saccharibacteira and lower abundances of Lentisphaerae. Acidaminococcus and Lachnospira were more abundant in obese subjects and positively correlated with adiposity markers. No correlations were found between the gut microbiota and biochemical variables, such as fasting blood sugar, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides.

Conclusion

We reveal significant differences in the gut microbiota between obese and lean adult Emiratis and an association between certain microbial genera of the gut microbiota and obesity. A better understanding of the interactions between gut microbes, diet, lifestyle, and health is warranted.

Association between the use of weight management strategies and weight change among Australian adults over 12 months: an observational study

BACKGROUND

Obesity is a growing, global public health issue. This study aimed to describe the weight management strategies used by a sample of Australian adults; examine the socio-demographic characteristics of using each strategy; and examine whether use of each strategy was associated with 12-month weight change.

METHODS

This observational study involved a community-based sample of 375 healthy adults (mean age: 40.1 ± 5.8 years, 56.8% female). Participants wore a Fitbit activity monitor, weighed themselves daily, and completed eight online surveys on socio-demographic characteristics. Participants also recalled their use of weight management strategies over the past month, at 8 timepoints during the 12-month study period.

RESULTS

Most participants (81%) reported using at least one weight management strategy, with exercise/physical activity being the most common strategy at each timepoint (40-54%). Those who accepted their current bodyweight were less likely to use at least one weight management strategy (Odds ratio = 0.38, 95% CI = 0.22-0.64, p < 0.01) and those who reported being physically active for weight maintenance had a greater reduction in bodyweight, than those who did not (between group difference: -1.2 kg, p < 0.01). The use of supplements and fasting were associated with poorer mental health and quality of life outcomes (p < 0.01).

CONCLUSIONS

The use of weight management strategies appears to be common. Being physically active was associated with greater weight loss. Individuals who accepted their current body weight were less likely to use weight management strategies. Fasting and the use of supplements were associated with poorer mental health. Promoting physical activity as a weight management strategy appears important, particularly considering its multiple health benefits.

Trends in deaths and disability-adjusted life-years of stroke attributable to high body-mass index worldwide, 1990-2019

Background

High body mass index (HBMI) is an independent risk factor for stroke. Previous studies on the incremental burden of the rapid growth of stroke attributable to HBMI are incomplete and lag behind. We aim to assess the global burden of stroke attributable to HBMI based on a public database online.

Materials and methods

Study data were taken from the Global Burden of Disease, Injuries, and Risk Factors Study; deaths, the Disability-Adjusted Life-Years (DALYs), and their age-standardized rates were screened. The join point regression was used, wherein age-standardized rates were referred to as temporal trends in disease burden.

Results

Deaths from stroke attributable to HBMI worldwide were on the rise during 1990-2019, with an increase of 88.75%. Age-standardized DALYs were on the rise during 1990-2003 but declined during 2003-2013, with a turning point in 2013 and an increasing trend since then [the Annual Percentage Change (APC) = 0.30%, p < 0.05]. China, India, Indonesia, the Russian Federation, and the United States of America shared in sequence the rate of leading deaths and DALYs in 2019. The Socio-Demographic Index (SDI) was associated with an increasing trend in age-standardized deaths (R = -0.24, p < 0.001) and age-standardized DALYs (R = -0.22, p = 0.0018).

Conclusion

A range of indicators for the global burden of stroke attributable to HBMI have been on the rise for the past three decades. Tremendous efforts worldwide should be in place to control and treat stroke attributable to HBMI, especially in regions with high-middle and middle SDIs and among middle-aged and aged populations.

Fat fighting liraglutide based nano-formulation to reverse obesity: Design, development and animal trials

Obesity is a metabolic disease, which is one of the major causes of morbidity and mortality, where therapeutic options are limited. Treatment of obesity is necessary as it is associated with fatal complications like diabetes mellitus, cardiovascular disease, non-alcoholic fatty liver disease, osteoarthritis, and many more. Liraglutide (Lir), a synthetic analogue of Glucagon-like Peptide-1 (GLP-1), is the FDA approved anti-obesity drug, however, its major limitation is its clinical application which needs frequent parenteral injections. To address the issue of regular injection, we have synthesized a fat fighting oral nano-formulation of liraglutide with a sustained release feature, which was evaluated against high fat diet (HFD) induced obesity in mice. Experimental obesity was induced in mice by feeding HFD for 26 weeks. Lir nanoparticles (NP) were fabricated with chitosan via ion-gelation technique and were coated with Eudragit@S100 to protect the drug in harsh gastric conditions. Physiochemical characterization of Eu-Lir-Cs-NP demonstrated a small particle size of 253.1 ± 1.21 nm with ∼ 9.74 % loading and ∼ 72.11 % encapsulation efficiency of the drug. In-vitro studies showed successful cellular uptake of NP in Caco-2 cells and were stable in various enteric fluid pH conditions. Eudragit@S100 coated chitosan NP were able to protect the drug from harsh gastric pH conditions with more than ∼ 74% of recovery. Treatment of two weeks of liraglutide Eu-Lir-Cs-NP (0.1, 0.2 and 0.4 mg/kg, orally; twice daily) moderately reduces obesity in mice as evidenced by a reduction in the body weight, blood glucose, serum total cholesterol, serum triglyceride, serum resistin and serum insulin level of mice. In addition, significant reduction of liver weight, abdominal white adipose tissue, and hepatic oxidative stress were noted. Our results suggest that chitosan-based NP of liraglutide can be an effective and convenient formulation for the management of obesity.

Olive Oil in the Mediterranean Diet and Its Biochemical and Molecular Effects on Cardiovascular Health through an Analysis of Genetics and Epigenetics

Human nutrition is a relatively new science based on biochemistry and the effects of food constituents. Ancient medicine considered many foods as remedies for physical performance or the treatment of diseases and, since ancient times, especially Greek, Asian and pre-Christian cultures similarly thought that they had beneficial effects on health, while others believed some foods were capable of causing illness. Hippocrates described the food as a form of medicine and stated that a balanced diet could help individuals stay healthy. Understanding molecular nutrition, the interaction between nutrients and DNA, and obtaining specific biomarkers could help formulate a diet in which food is not only a food but also a drug. Therefore, this study aims to analyze the role of the Mediterranean diet and olive oil on cardiovascular risk and to identify their influence from the genetic and epigenetic point of view to understand their possible protective effects.

Correlation between lifestyle patterns and overweight and obesity among Chinese adolescents

Lifestyles such as physical exercise, sedentary behavior, eating habits, and sleep duration are all associated with adolescent overweight and obesity. The purpose of this study was to investigate how Chinese adolescents' lifestyles clustered into different lifestyle patterns, and to analyze the correlation between these patterns and adolescent overweight and obesity. The investigated respondents included 13,670 adolescents aged 13-18 from various administrative regions in China. Latent class analysis was employed to cluster the lifestyles of adolescents, χ2 test and Logistic regression were used to explore the relationship between lifestyle patterns and overweight and obesity in adolescents. The results identified 6 types of Chinese adolescents' lifestyle patterns, as well as the significant differences in gender and age. The adolescents with high exercise-high calorie diet had the lowest risk of overweight and obesity, and the adolescents with low consciousness-low physical activity and low consciousness-unhealthy had the highest risk of overweight and obesity, which were 1.432 times and 1.346 times higher than those with high exercise-high calorie diet, respectively. The studied demonstrated that there was a coexistence of healthy behaviors and health-risk behaviors in the lifestyle clustering of Chinese adolescents. Low physical exercise and high intake of snacks and carbonated beverages were the most common. Physical exercise and health consciousness were the protective factors of overweight and obesity in adolescents.

Effects of Irvingia gabonensis Extract on Metabolism, Antioxidants, Adipocytokines, Telomere Length, and Aerobic Capacity in Overweight/Obese Individuals

We investigated the effects of Irvingia gabonensis (IG) kernel extract on the metabolism, adiposity indices, redox status, inflammation, adipocytokines, blood leukocyte relative telomere length (RTL), and aerobic capacity of overweight/obese individuals. All participants used the first 12-week phase to monitor body weight. They were then randomly divided into two groups: (1) 300 mg IG or (2) placebo (PLA). Both groups took one tablet per day for 12 weeks. The variables were measured before supplementation and after 3, 6, and 12 weeks of supplementation. RTL and aerobic capacity were measured before and after 12 weeks. Compared with the PLA, the IG increased plasma vitamin C after supplementation at 6 (p < 0.01) and 12 weeks (p < 0.05) and serum adiponectin after 3 weeks (p < 0.05). Compared with before supplementation, plasma malondialdehyde in the IG and serum leptin in the PLA were decreased after 12-week supplementation, without any differences between the groups. There were no differences between groups with respect to metabolism, inflammation, RTL, and aerobic capacity after the supplementation. We suggest that 12-week daily IG supplementation improved plasma vitamin C and adiponectin. The findings show the possible mechanism contributing to the effect of IG supplementation on a reduction in obesity-related complications.

Obesity Burden and Physical Activity Pattern Among Doctors in South India

Context

A career as a doctor makes him prone to develop health issues like obesity and obesity-related noncommunicable diseases.

Aims

This study aims to find the burden and determinants of obesity among Modern Medicine doctors in Kerala.

Settings and Design

We conducted a cross-sectional study among 240 doctors working in South Kerala from 2018 to 2019.

Methods and Material

The sample size was calculated using a formula and stratified random sampling was done for the selection of study participants. An interviewer-administered structured questionnaire was used for data collection. Physical activity was measured using International Physical Activity Questionnaire.

Statistical Analysis

Data were entered in MS Excel and was analyzed using Statistical Package for Social Sciences version 26.0. The significance of association was tested using the χ2 test. Binary logistic regression was done to predict the factors associated with overweight and obesity.

Results

Out of 240 study participants, 128 (54%) were females and 112 (46%) were males. Among the 240 doctors, 54% (114) were either overweight or obese. A low level of physical activity was reported among 54.5% of doctors. Male gender odds ratio (OR) = 2.8 (95% confidence interval [CI] = 1.29-6.06), nuclear family OR = 2.7 (95% CI = 1.32-5.42), daily hours of sleep <6 hours OR = 4.92 (95% CI = 2.29-10.5), history of obesity among parents OR = 3.54 (95% CI = 1.04-12.02), reported the presence of private practice OR = 3.34 (95% CI = 1.25-8.96), and holding a graduation degree alone were found to be significantly associated with obesity.

Conclusions

The study found that majority of the doctors (55%) were either overweight or obese. Awareness and behavior change communication among doctors on modifiable risk factors like having adequate sleep and reducing the hours spent in private practice is needed to reduce the burden of obesity among doctors.

Advertising of unhealthy foods and beverages around primary and junior high schools in Ghana's most urbanized and populous region

Introduction

The advertising of energy-dense, nutrient-poor foods and beverages is a common feature in obesogenic food environments. Such advertising, within and around settings where children live, learn, and play, negatively affects their food acquisition and consumption. We examined the extent and nature of food and beverage advertising around primary and junior high schools in Ghana's most populous and urbanized region, Greater Accra.

Materials and methods

Outdoor advertisements for foods and beverages within a 250 m road network distance of 200 randomly sampled schools were geocoded. For each food and beverage advertisement, information was collected on the setting, type, size, and number of product types featured in the advertisement. Promotional techniques (promotional characters and premium offers) used in advertisements were documented. Advertised foods and beverages were classified using the INFORMAS and NOVA food classification systems.

Results

A total of 5,887 advertisements were identified around the schools surveyed, 42% of which were for foods and beverages. Advertisements were most prevalent at food outlets (78% of all food advertisements), but also along roads and on non-food structures. Overall, 70% of food advertisements featured non-core/unhealthy products, while 12 and 14% had core/healthy and miscellaneous (including soup cubes, seasonings, and tea) products. About 4% of food advertisements had only a product/brand name or logo displayed. One out of two of the foods and beverages advertised were ultra-processed foods, 30% processed, 3% processed culinary ingredients, and 17% unprocessed or minimally processed foods. Sugar-sweetened beverages were the most advertised food product type (32%). Promotional characters were found on 14% of all food advertisements (most-69% were cartoons or manufacturer's characters), while 8% of all food advertisements had premium offers (including price discounts and gift/collectables).

Conclusions

There is an abundance of unhealthy food advertisements around primary and junior high schools in the Greater Accra Region. Policy actions such as restricting the promotion of unhealthy foods in children's settings are needed to protect pupils from such advertising practices.

Frequency of watching television, owning a mobile phone and risk of being overweight/obese among reproductive-aged women in low- and lower-middle-income countries: A pooled analysis from Demographic and Health Survey data

People who are overweight and obese suffer from significant health impacts that have increased globally. Concurrently, usage of information and communication devices such as television and mobile phones have also been growing, affecting people's weight. This study examined the association between watching television and owning a mobile phone with overweight and obesity among reproductive-aged women in low- and lower-middle-income countries (LLMICs). Data of 21 LLMICs reported between 2015 and 2020 were collected from the Demographic and Health Surveys. Multivariate logistic regression was performed to determine the association into three pooled segments: a group of 21 countries, the World Bank income classification and the regional categorisation of the countries. The all-inclusive prevalence of overweight or obesity was found at 27.1% among 175,370 reproductive-aged women, and this prevalence varied among countries. Overall, the odds of being overweight or obese were 1.20 (adjusted odds ratio [AOR]=1.20, 95% confidence interval [CI]: 1.15-1.24), 1.40 (AOR=1.40, 95% CI: 1.35-1.44) and 1.18 (AOR=1.18, 95% CI: 1.03-1.35) times higher among those who watched television less than once a week, at least once a week and almost every day, respectively, compared with those who did not watch television. Besides, women's mobile phone ownership is more likely to experience overweight or obesity (AOR=1.72, 95% CI: 1.67-1.77). Consistent results were found for the countries categorised according to the World Bank income and regional classification. Focus on sedentary behaviour, such as television watching and mobile phone use, of women and regional or country-specific innovative strategies and programs are of great immediate importance to decrease the prevalence of overweight and obesity.

Trends in Obesity and Obesity-Related Risk Factors among Adolescents in Korea from 2009 to 2019

This study was conducted to identify the trends in obesity prevalence among adolescents and changes in the risk factors related to obesity. The study analyzed secondary data obtained from Korean Youth Risk Behavior Web-based Surveys conducted from 2009 to 2019. The Korean Youth Risk Behavior Web-based Survey is an annual survey of a nationwide representative sample of enrolled students aged 13–18 years in middle and high schools in Korea. Linear and trend analyses showed that the prevalence of obesity increased by 0.47% on average annually; this increase was statistically significant. Healthy food intake decreased significantly, but the prevalence of unhealthy food intake and the prevalence of skipping breakfast increased significantly. Vigorous-intensity physical activity, physical activity for over 60 min a day, and muscle-strengthening exercise for more than 3 days a week increased significantly, but so did the adolescents’ sedentary time. Therefore, health care providers and public policymakers need to actively manage adolescent obesity, which has been continuously increasing since 2009. In addition, long-term trends in obesity-related risk factors such as physical activity and dietary behaviors need to be considered in the development of obesity management strategies.

Autologous Versus Alloplastic Reconstruction for Patients with Obesity: A Systematic Review and Meta-analysis

BACKGROUND

Autologous flaps may have superior outcomes when compared to implant breast reconstruction in patients with obesity. To date, no published review has illustrated the superiority of autologous to implant-based reconstruction in this study group in terms of aesthetics outcomes and surgical complications.

METHODS

A systematic search was conducted on PubMed, Cochrane, Google Scholar, and Embase from inception to December 31, 2020. Studies comparing the outcomes (patient satisfaction and complications) of autologous versus implant-based reconstruction in patients with BMI > 30 were selected.

RESULTS

The search yielded 1633 articles, of which 76 were assessed in full text. A total of 12 articles fit inclusion for qualitative review; of them, 7 were meta-analyzed. Autologous reconstruction had a lower incidence of infection (OR 0.74 [95% CI 0.59, 0.92]), hematoma/seroma formation (OR 0.34 [95% CI 0.23, 0.49]), and reconstructive failure (OR 0.47 [95% CI 0.36, 0.62]), but not skin necrosis (OR 0.95 [95% CI 0.73, 1.25]) or wound dehiscence (OR 1.03 [95% CI 0.72, 1.49]) when compared to implant-based reconstruction. Deep vein thrombosis (DVT) and pulmonary embolism occurred more frequently with autologous versus alloplastic reconstruction (OR 2.21 [95% CI 1.09, 4.49] for DVT and OR 2.49 [95% CI 1.13, 5.48] for PE). BREASTQ scores were higher for the autologous breast reconstruction when compared to implant-based group, but failed to reach significance (p value >0.05).

CONCLUSION

The current evidence in the literature suggests that autologous breast reconstruction has lower surgical complication rate when compared to implant-based reconstruction at the expense of higher risk of thrombotic complications for patients with BMI > 30.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Adolescents' Perspectives on the Drivers of Obesity Using a Group Model Building Approach: A South African Perspective

Overweight and obesity increase the risk of a range of poor physiological and psychosocial health outcomes. Previous work with well-defined cohorts has explored the determinants of obesity and employed various methods and measures; however, less is known on the broader societal drivers, beyond individual-level influences, using a systems framework with adolescents. The aim of this study was to explore the drivers of obesity from adolescents' perspectives using a systems approach through group model building in four South African schools. Group model building was used to generate 4 causal loop diagrams with 62 adolescents aged 16-18 years. These maps were merged into one final map, and the main themes were identified: (i) physical activity and social media use; (ii) physical activity, health-related morbidity, and socio-economic status; (iii) accessibility of unhealthy food and energy intake/body weight; (iv) psychological distress, body weight, and weight-related bullying; and (v) parental involvement and unhealthy food intake. Our study identified meaningful policy-relevant insights into the drivers of adolescent obesity, as described by the young people themselves in a South African context. This approach, both the process of construction and the final visualization, provides a basis for taking a novel approach to prevention and intervention recommendations for adolescent obesity.

Pilates and TRX training methods can improve insulin resistance in overweight women by increasing an exercise-hormone, Irisin

AIMS AND BACKGROUND

Physical inactivity is leading to obesity and consequently insulin resistance and diabetes. Feasible and cost efficient strategies like Pilates and total body resistance exercise (TRX) training can impede obesity and its compilation. The aim of this study was to investigate the effects of 8 weeks Pilates and TRX training programs on irisin concentration and insulin resistance in overweight women.

METHOD

Thirty overweight women (Body mass index (BMI): 25-29.9 kg/m2) were divided, based on their BMI, into 3 groups; control, Pilates and TRX. The participants in the training groups were subjected to moderate intensity of Pilates or TRX exercise training 3 times a week for 8 weeks. Blood samples were taken at pre-test and 48 h after the last training session and used for analyzing irisin, insulin and glucose. Data were analyzed by ANCOVA and paired-samples t-test.

RESULTS

The finding showed that the Pilates training decreased body weight and BMI compared to the pre-test (P < 0.05). Also, it has been revealed that irisin concentration in response to Pilates and TRX training programs were increased in comparison with the control group (P < 0.05). However, there was no significant difference in irisin concentrations between training groups (p > 0.05). Moreover, fasting insulin, glucose and insulin resistance were significantly reduced after exercise intervention compared to the pre-test which were significantly lowered compared to the control group as well.

CONCLUSION

The results suggest Pilates and TRX trainings are two efficient model of exercise that by eliciting an exercise-hormone, irisin, can improve insulin resistance in overweight women.

Green tea aqueous extract (GTAE) prevents high-fat diet-induced obesity by activating fat browning

Adipose browning leads to increased energy expenditure and reduced adiposity and has, therefore, become an attractive therapeutic strategy for obesity. In this study, we elucidated the effect of green tea aqueous extract (GTAE) on the browning of inguinal white adipose tissue (Ing-WAT) and brown adipose tissue (BAT) in high-fat diet (HFD)-fed mice. The main phytochemical components identified in GTAE through high-performance liquid chromatography (HPLC) included (-)-gallocatechin, (-)-epigallocatechin, (-)-catechin, (-)-epigallocatechin-3-gallate, caffeine, (-)-epicatechin, (-)-gallocatechin gallate, and (-)-epicatechin-3-gallate. Daily supplementation with 1% GTAE for 12 weeks markedly reduced bodyweight gain, systemic inflammation, oxidative stress, and improved insulin resistance. Additionally, histological analysis revealed that dietary supplementation with 1% GTAE reversed HFD-induced adipocyte size and hepatic steatosis. These effects were associated with activation of browning in the Ing-WAT and BAT, which mediate systemic metabolic dysfunction in HFD-fed mice. Taken together, our data support the use of GTAE, a natural product, for the attenuation of obesity through the activation of fat browning.

Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications

The prevalence of heart failure is on the rise and imposes a major health threat, in part, due to the rapidly increased prevalence of overweight and obesity. To this point, epidemiological, clinical, and experimental evidence supports the existence of a unique disease entity termed “obesity cardiomyopathy,” which develops independent of hypertension, coronary heart disease, and other heart diseases. Our contemporary review evaluates the evidence for this pathological condition, examines putative responsible mechanisms, and discusses therapeutic options for this disorder. Clinical findings have consolidated the presence of left ventricular dysfunction in obesity. Experimental investigations have uncovered pathophysiological changes in myocardial structure and function in genetically predisposed and diet-induced obesity. Indeed, contemporary evidence consolidates a wide array of cellular and molecular mechanisms underlying the etiology of obesity cardiomyopathy including adipose tissue dysfunction, systemic inflammation, metabolic disturbances (insulin resistance, abnormal glucose transport, spillover of free fatty acids, lipotoxicity, and amino acid derangement), altered intracellular especially mitochondrial Ca²⁺ homeostasis, oxidative stress, autophagy/mitophagy defect, myocardial fibrosis, dampened coronary flow reserve, coronary microvascular disease (microangiopathy), and endothelial impairment. Given the important role of obesity in the increased risk of heart failure, especially that with preserved systolic function and the recent rises in COVID-19-associated cardiovascular mortality, this review should provide compelling evidence for the presence of obesity cardiomyopathy, independent of various comorbid conditions, underlying mechanisms, and offer new insights into potential therapeutic approaches (pharmacological and lifestyle modification) for the clinical management of obesity cardiomyopathy.

Disease burden of liver cancer attributable to specific etiologies in China from 1990 to 2019: An age-period-cohort analysis

Temporal trends of total liver cancer have been well reported in China, especially the trends caused by hepatitis B (HBV); however, the trends of liver cancer attributable to specific etiologies have rarely been reported in China. Thus, this study aims to describe the temporal trends in the incidence, mortality and DALYs of total and etiology-specific liver cancer in China from 1990 to 2019. We extracted the incidence, mortality and disability-adjusted life years (DALYs) of total and etiology-specific liver cancer in China from 1990 to 2019 from global disease burden (GBD) 2019. We plotted the trends in the age-standardized rates for incidence, mortality, and DALYs using locally weighted regression (LOESS)-smoothed data from 1990 to 2019. The age-standardized rate for the incidence of liver cancer was analyzed with an age-period-cohort method. The age-standardized rates for incidence, death, and DALYs decreased by -58.8%, -63.8%, and -65.6%, respectively, between 1990 and 2019. The age-standardized rates of incidence, mortality, and DALYs of total liver cancer showed similar temporal patterns, presenting an overall decline, with the average annual percentage change (AAPC) ranging from -3.3% to -3.8%. People in the period before 2007 had a higher risk, and people after 2007 had a lower risk. The cohort risk ratios (RRs) showed decreasing patterns, with the most rapid decline observed in the 1910 to 1960 cohorts. Our study generally revealed favorable decreasing trends for total and etiology-specific liver cancer in China from 1990 to 2019. Despite the overall decline in liver cancer due to heavy alcohol use and obesity from 1990 to 2019, there have been apparent upward trends since 2006. Planned population-wide interventions targeting heavy alcohol use and obesity may mitigate the increasing trends in liver cancer attributable to alcohol use and NASH.

Pilates for Overweight or Obesity: A Meta-Analysis

Background: Evidence for the efficacy of Pilates for the modulation of body weight and body composition is unclear. Objective: This meta-analysis aimed to evaluate the effects of Pilates on body weight and body composition in adults with overweight or obesity. Data Sources: The PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and EMBASE databases were systematically searched from the inception dates to 12 November 2020 for relevant randomized controlled trials (RCTs). Study Selection: Randomized controlled trials comparing Pilates with other physical exercises or without any intervention were included. Data Extraction and Synthesis: Three reviewers independently performed the data extraction and assessed study quality. The mean differences (MDs) and 95% confidence intervals (CIs) for pooled data were calculated. Main Outcomes and Measures: Outcome measures were body weight, body mass index (BMI), body fat percentage, lean body mass, and waist circumference. Results: Eleven RCTs with 393 subjects were included. This study revealed that Pilates dramatically reduces body weight (MD = -2.40, 95% CI: [-4.04, -0.77], P = 0.004, I 2 = 51%), BMI (MD = -1.17, 95% CI: [-1.85, -0.50], P = 0.0006, I 2 = 61%), and body fat percentage (MD = -4.22, 95% CI: [-6.44, -2.01], P = 0.0002, I 2 = 88%) in adults with overweight or obesity. The reduction in body weight and body fat percentage appears to be more pronounced in studies including participants with obesity only, and the efficacy of Pilates for the improvement of body weight and BMI appears to be more evident in longer intervention duration. However, Pilates has no significant effect on waist circumference (MD = -2.65, 95% CI: [-6.84, 1.55], P = 0.22, I 2 = 0%) and lean body mass (MD = -0.00, 95% CI: [-1.40, 1.40], P = 1.00, I 2 = 23%). Conclusions: Pilates dramatically reduces body weight, BMI, and body fat percentage in adults with overweight or obesity. Large-scale and well-designed RCTs with improved methodology and reporting are urgently needed to further confirm these results.

Modulation of the Gut Microbiota by Shen-Yan-Fang-Shuai Formula Improves Obesity Induced by High-Fat Diets

Obesity and related metabolic disorders are associated with intestinal microbiota dysbiosis, disrupted intestinal barrier and chronic inflammation. Shen-Yan-Fang-Shuai formula (SYFSF) is a traditional Chinese herbal formula composed of Astragali Radix, Radix Angelicae Sinensis, Rheum Officinale Baill, and four other herbs. In this study, we identified that SYFSF treatment prevented weight gain, low-grade inflammation and insulin resistance in high-fat diet (HFD)-fed mice. SYFSF also substantially improved gut barrier function, reduced metabolic endotoxemia, as well as systemic inflammation. Sequencing of 16S rRNA genes obtained from fecal samples demonstrated that SYFSF attenuated HFD-induced gut dysbiosis, seen an decreased Firmicutes to Bacteroidetes ratios. Microbial richness and diversity were also higher in the SYFSF-treated HFD group. Furthermore, similar therapeutic effects and changes in gut microbiota profile caused by SYFSF could be replicated by fecal microbiota transfer (FMT). Taken together, our study highlights the efficacy of SYFSF in preventing obesity and related metabolic disorders. Its therapeutic effect is associated with the modulation of gut microbiota, as a prebiotic.

Dietary polyphenols in lipid metabolism: A role of gut microbiome

Polyphenols are a class of non-essential phytonutrients, which are abundant in fruits and vegetables. Dietary polyphenols or foods rich in polyphenols are widely recommended for metabolic health. Indeed, polyphenols (i.e., catechins, resveratrol, and curcumin) are increasingly recognized as a regulator of lipid metabolism in host. The mechanisms, at least in part, may be highly associated with gut microbiome. This review mainly discussed the beneficial effects of dietary polyphenols on lipid metabolism. The potential mechanisms of gut microbiome are focused on the effect of dietary polyphenols on gut microbiota compositions and how gut microbiota affect polyphenol metabolism. Together, dietary polyphenols may be a useful nutritional strategy for manipulation of lipid metabolism or obesity care.

Low-dose Bisphenol-A Promotes Epigenetic Changes at Pparγ Promoter in Adipose Precursor Cells

Exposure to endocrine-disrupting chemicals such as Bisphenol-A (BPA) is associated with an increase in obesity prevalence. Diet is the primary cause of human exposure to this contaminant. BPA promotes obesity by inducing adipocyte dysfunction and altering adipogenesis. Contradictory evidence and unanswered questions are reported in the literature concerning the BPA effects on adipogenesis. To clarify this issue, we tested the effects of prolonged low-dose BPA exposure on different phases of adipogenesis in committed 3T3L1 and uncommitted NIH3T3 preadipocytes. Our findings show that BPA effects on the adipogenesis are mediated by epigenetic mechanisms by reducing peroxisome proliferator-activated receptor gamma (Pparγ) promoter methylation in preadipocytes. Nevertheless, in BPA-exposed 3T3L1, Pparγ expression only transiently increases as lipid accumulation at day 4 of differentiation, without altering the adipogenic potential of the precursor cells. In the absence of differentiation mix, BPA does not make the 3T3L1 an in vitro model of spontaneous adipogenesis and the effects on the Pparγ expression are still limited at day 4 of differentiation. Furthermore, BPA exposure does not commit the NIH3T3 to the adipocyte lineage, although Pparγ overexpression is more evident both in preadipocytes and during the adipocyte differentiation. Interestingly, termination of the BPA exposure restores the Pparγ promoter methylation and inflammatory profile of the 3T3L1 cells. This study shows that BPA induces epigenetic changes in a key adipogenic gene. These modifications are reversible and do not affect preadipocyte commitment and/or differentiation. We identify an alternative transcriptional mechanism by which BPA affects gene expression and demonstrate how the challenge of preventing exposure is fundamental for human health.

Prevalence of overweight/obesity among the adult population in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Overweight and obesity are emerging public health problems in Ethiopia. However, primary study findings on the prevalence of overweight and obesity in Ethiopia are inconsistent. Therefore, this study aimed to estimate the pooled prevalence of overweight and obesity among adults in Ethiopia.

METHODS

Studies that looked at overweight and obesity among adults were searched from four international databases. The search involved articles published from 1 January 2010 to 10 March 2020. The Cochran's Q χ2 and the I2 test statistics were used to check heterogeneity among the studies. The funnel plot and Egger's regression tests were also used to assess the presence of publication bias. Subgroup analysis was performed by residence, study setting, sample size and year of study. Sensitivity analysis was also done to assess the effect of a single study on the pooled estimates. Data analysis was done using STATA V.14 software program.

RESULTS

A total of 16 studies with 19 527 study participants were included in this systematic review and meta-analysis. The estimated pooled prevalence of overweight among adults in Ethiopia was 20.4%, and after adjustment for publication bias with the trim-and-fill analysis, the estimated prevalence rate was changed to 19%. Besides, the estimated pooled prevalence of obesity was 5.4%. The prevalence of overweight was higher, 22.6% in studies published since 2015, 22.4% in studies conducted only in urban settings and 24.4% in studies with small sample size (≤384 participants). Similarly, the prevalence of obesity was 6.9% in studies published since 2015, 6.2% in studies conducted only in urban settings, 6.4% in institution-based settings and 9.6% in studies with small sample size.

CONCLUSION

The prevalence of overweight and obesity is high in Ethiopia compared with previous studies. This needs large scale awareness creation campaigns and situation-based and context-specific prevention strategies.

Physical activity interventions promoted in the Arabic-speaking region: A review of the current literature

The Arabic-speaking region suffers from insufficient levels of physical activity (PA). Assessing the effectiveness of PA interventions presents a scientifically evaluated method to reduce and prevent the current high burden of noncommunicable diseases affecting this region. This review examined implemented PA interventions and corresponding measured health outcomes in this region. The review was limited to studies prior to January 2020 using nine electronic academic databases. Only intervention-focused articles incorporating PA as the primary intervention or as a component of a multibehavioural intervention were included. Thirty-nine PA intervention studies were identified. Published PA interventions were implemented among 50% of the countries in the region. Seventy percent of the studies were conducted in the Gulf region and 25% in North Africa. A third of the studies was designed for children and adolescents. Accordingly, 40% of interventions were for patients living with comorbidities. Seventy percent of the studies included PA as part of a multidisciplinary intervention. Most studies included body mass index as an outcome parameter. Significant improvement (P < .05) in measured health outcomes was seen in 97% of studies. Thorough analysis includes social and culturally congruent aspects of the PA interventions and discussion of resultant health outcomes. This information furthers the understanding of effective PA interventions that can be adapted to target sedentary lifestyle behaviours in this region.

Education and prevalence of overweight and obesity among reproductive age group women in Ethiopia: analysis of the 2016 Ethiopian demographic and health survey data

Background

Globally, the prevalence of overweight and obesity is escalating, particularly among women and wealthier people. In many developed countries, overweight and obesity are more prevalent in persons with lower socioeconomic status. In contrast, studies in developing countries have reported a higher prevalence rate of overweight and obesity among women with higher educational status. Hence, this study aimed to assess the association between education and the prevalence of overweight and obesity among reproductive age group women in Ethiopia.

Methods

This cross-sectional study was done based on the 2016 Ethiopian demographic and health survey (EDHS) data. From the total 15,683 women participants of the 2016 EDHS, 2848 reproductive age group women aged 15–49 years old who had a complete response to all variables of interest were selected and retained for analysis. Data were analyzed using SPSS version 20 software program. Both descriptive and logistic regression models were used for analysis.

Results

The prevalence of overweight and obesity among the study participants was 11.5 and 3.4% respectively. The combined prevalence of overweight and obesity was 14.9%. From the total participants who are overweight and, or obese, majority, 83.3% were urban dwellers and the remaining 16.7% were rural dwellers. Education was positively associated with overweight and obesity among women. Besides, increased age, region, living in urban areas, being in rich quintile, increased frequency of watching television, and frequency of using internet were significantly associated with the odds of being overweight and obese among reproductive age group women in Ethiopia.

Conclusions

The prevalence of overweight and obesity among reproductive age group women in Ethiopia is increasing compared to previous studies. Education was found to be a risk factor for overweight and obesity among women. Hence, context based interventions on the prevention and control methods of overweight and obesity are required.

Polysaccharide extracted from WuGuChong reduces high-fat diet-induced obesity in mice by regulating the composition of intestinal microbiota

Background

Obesity is a severe public health threat worldwide. Emerging evidence suggests that gut microbiota dysbiosis is closely associated with obesity and its related metabolic complications. The aim of the present study is to investigate the effects of polysaccharide extracted from WuGuChong (PEW) on high-fat diet (HFD)-induced obesity, and the potential mechanisms involving modulation of the gut microbiota composition.

Methods

Mice were fed a normal chow diet and a high-fat diet with or without PEW (300 mg/kg/day) by oral gavage for 8 weeks. Body weight, obesity-related metabolic disorders, and gut microbiota were examined at the end of the experiment.

Results

PEW supplementation reduces body weight, adipose hypertrophy, liver steatosis, insulin resistance and systemic inflammation in HFD-fed mice, as well as maintains intestinal epithelium integrity. High-throughput 16S rRNA analysis demonstrates that PEW supplementation alters the composition of gut microbiota. The Firmicutes to Bacteroidetes ratio and the relative abundance of Proteobacteria are increased in HFD-fed mice, which are reversed by PEW supplementation to approximately the control levels.

Conclusions

Our results suggest that PEW may be used as a bioactive ingredient to prevent obesity and its related metabolic disorders by modulating the composition of gut microbiota.

Oxygenic metabolism in nutritional obesity induced by olive oil. The influence of vitamin C

Obesity is a medical and sociological problem of great importance due to the high percentage of people affected and the important health consequences that it involves. Most cases of obesity are related to an inadequate diet, rich in fats, which could lead to changes in the patient's oxygenic metabolism. That is why this study has been proposed to evaluate how some aspects of oxygenic metabolism are affected in a nutritional experimental model, with a controlled hyperlipidic liquid diet based on olive oil, and the effect of the antioxidant vitamin C on these conditions. Wistar rats were divided into four groups which received a control and hyperlipidic liquid diet for 30 days, with or without a vitamin C supplement (CO, COC, HO and HOC). First of all the body and fat tissue development was measured in the four groups. Our results showed that the excessive intake of nutritional and healthy fat such as olive oil did not prevent the appearance of obesity and the supplementation with vitamin C did not have a protective effect on body and fat development. The study of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) in total liver, liver cytosol, abdominal white fat, brown fat and blood cells showed that vitamin C could have different selectivities and affinities for different enzymes and compartments/tissues of the body. Finally, the effect of vitamin C on various metabolic parameters (glucose, pyruvate, lactate, LDH, ATP, acetoacetate and beta-hydroxybutyrate) provided positive protection against oxidative stress especially under hyperlipidic conditions. All things considered, the present study concludes that vitamin C treatment could protect Wistar rats from the oxidative stress impairment induced by obesity generated by an excessive intake of fats.

Becoming obese in young adulthood: the role of career-family pathways in the transition to adulthood for men and women

BACKGROUND

During the transition to adulthood many young adults become obese for the first time in their lives, yet relatively little research has examined why people in this life phase become obese. This study examines what career and family life-course pathways during the transition to adulthood are related to developing obesity in young adulthood.

METHODS

We use data from the NLSY97, a U.S. nationally representative panel survey conducted by the Bureau of Labor Statistics between 1997 to 2013 (N = 4688), and apply multichannel sequence analysis in order to identify clusters of typical career-family pathways during the transition to adulthood (age 17 to 27), and subsequently investigate whether these pathways are associated with becoming obese at the end of young adulthood (age 28), using logistic regression. We control for obesity at age 17 and family background factors (race, parental education, parental income, and family structure). To take into account the fact that the transition to adulthood has a different meaning for men and for women, we also interact career-family clusters with gender.

RESULTS

For women, pathways characterized by college education, early home leaving, and postponement of family formation decrease the probability of becoming obese. For men, pathways characterized by early marriage increase the probability of becoming obese.

CONCLUSIONS

The results highlight the importance of gender differences in how career and family pathways are related to becoming obese in young adulthood.

Fatty acids, epigenetic mechanisms and chronic diseases: a systematic review

BACKGROUND

Chronic illnesses like obesity, type 2 diabetes (T2D) and cardiovascular diseases, are worldwide major causes of morbidity and mortality. These pathological conditions involve interactions between environmental, genetic, and epigenetic factors. Recent advances in nutriepigenomics are contributing to clarify the role of some nutritional factors, including dietary fatty acids in gene expression regulation. This systematic review assesses currently available information concerning the role of the different fatty acids on epigenetic mechanisms that affect the development of chronic diseases or induce protective effects on metabolic alterations.

METHODS

A targeted search was conducted in the PubMed/Medline databases using the keywords "fatty acids and epigenetic". The data were analyzed according to the PRISMA-P guidelines.

RESULTS

Consumption fatty acids like n-3 PUFA: EPA and DHA, and MUFA: oleic and palmitoleic acid was associated with an improvement of metabolic alterations. On the other hand, fatty acids that have been associated with the presence or development of obesity, T2D, pro-inflammatory profile, atherosclerosis and IR were n-6 PUFA, saturated fatty acids (stearic and palmitic), and trans fatty acids (elaidic), have been also linked with epigenetic changes.

CONCLUSIONS

Fatty acids can regulate gene expression by modifying epigenetic mechanisms and consequently result in positive or negative impacts on metabolic outcomes.

A multidimensional understanding of prosperity and well-being at country level: Data-driven explorations

Social scientists have been interested in measuring the prosperity, well-being, and quality of life of nations, which has resulted in a multiplicity of country-level indicators. However, little is known about the factor structure of these indicators. We explored the structure of quality of life, using country-level data on tens of subjective and objective indicators. Applying factor analysis, we identified three distinct factors that exhibited both overlap and complementarity. This structure was replicated in data from previous years and with a partially different set of variables. The first factor, 'socio-economic progress', is dominated by socio-political and economic indicators but also includes life satisfaction, which thus appears to reflect objective living conditions. The second factor, 'psycho-social functioning', consists of subjective indicators, such as eudaimonic well-being and positive affective states. The third, 'negative affectivity', comprises negatively-valenced affective states. The three macro-factors of societal quality of life demonstrated moderate intercorrelations and differential associations with cultural and ecological variables, providing support for their discriminant validity. Finally, country and regional rankings based on the three societal factors revealed a complex picture that cautions against over-reliance on any single indicator such as life satisfaction. The results underline the need for a broadly-based approach to the measurement of societal quality of life, and provide an empirically-derived multidimensional framework for conceptualizing and measuring quality of life and well-being at country level. This study is thus an initial empirical step towards systematizing the multiple approaches to societal quality of life.

A multidimensional understanding of prosperity and well-being at country level: Data-driven explorations

Social scientists have been interested in measuring the prosperity, well-being, and quality of life of nations, which has resulted in a multiplicity of country-level indicators. However, little is known about the factor structure of these indicators. We explored the structure of quality of life, using country-level data on tens of subjective and objective indicators. Applying factor analysis, we identified three distinct factors that exhibited both overlap and complementarity. This structure was replicated in data from previous years and with a partially different set of variables. The first factor, 'socio-economic progress', is dominated by socio-political and economic indicators but also includes life satisfaction, which thus appears to reflect objective living conditions. The second factor, 'psycho-social functioning', consists of subjective indicators, such as eudaimonic well-being and positive affective states. The third, 'negative affectivity', comprises negatively-valenced affective states. The three macro-factors of societal quality of life demonstrated moderate intercorrelations and differential associations with cultural and ecological variables, providing support for their discriminant validity. Finally, country and regional rankings based on the three societal factors revealed a complex picture that cautions against over-reliance on any single indicator such as life satisfaction. The results underline the need for a broadly-based approach to the measurement of societal quality of life, and provide an empirically-derived multidimensional framework for conceptualizing and measuring quality of life and well-being at country level. This study is thus an initial empirical step towards systematizing the multiple approaches to societal quality of life.

Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes

It is the position of the Academy of Nutrition and Dietetics that for adults with prediabetes or type 2 diabetes, medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs) is effective in improving medical outcomes and quality of life, and is cost-effective. MNT provided by RDNs is also successful and essential to preventing progression of prediabetes and obesity to type 2 diabetes. It is essential that MNT provided by RDNs be integrated into health care systems and public health programs and be adequately reimbursed. The Academy's evidence-based nutrition practice guidelines for the prevention of diabetes and the management of diabetes document strong evidence supporting the clinical effectiveness of MNT provided by RDNs. Cost-effectiveness has also been documented. The nutrition practice guidelines recommend that as part of evidence-based health care, providers caring for individuals with prediabetes or type 2 diabetes should be referred to an RDN for individualized MNT upon diagnosis and at regular intervals throughout the lifespan as part of their treatment regimen. Standards of care for three levels of diabetes practice have been published by the Diabetes Care and Education Practice Group. RDNs are also qualified to provide additional services beyond MNT in diabetes care and management. Unfortunately, barriers to accessing RDN services exist. Reimbursement for services is essential. Major medical and health organizations have provided support for the essential role of MNT and RDNs for the prevention and treatment of type 2 diabetes.

Anti-diabetic effect of oligosaccharides from seaweed Sargassum confusum via JNK-IRS1/PI3K signalling pathways and regulation of gut microbiota

Brown seaweed Sargassum confusum (C. Agardh) has been used in traditional Chinese medicine to treat a variety of diseases. The aim of the present study was to evaluate the anti-diabetic effect of oligosaccharides from brown seaweed S. confusum (SCO). The anti-diabetic effect of SCO was evaluated in vivo using high-fat/high-sucrose fed hamsters. Molecular mechanisms of modulating gene expression of specific members of insulin signaling pathways were determined. The components of the intestinal microflora in diabetic animals were also analyzed by high-throughput 16S rRNA gene sequencing. And it was found that SCO had a sequence of sulfated anhydrogalactose and methyl sulfated galactoside units. Fasting blood glucose levels were significantly decreased after SCO administration. Histology showed that SCO could protect the cellular architecture of the liver. SCO could also significantly increase the relative abundance of Lactobacillus and Clostridium XIVa and decrease that of Allobaculum, Bacteroides and Clostridium IV. The active role of SCO in anti-diabetic effect was revealed by its regulation of insulin receptor substrate 1/phosphatidylinositol 3-kinase and c-Jun N-terminal kinase pathways. These results suggested that SCO might be used as a functional material to regulate gut microbiota in obese and diabetic individuals.

Perspective: Public Health Nutrition Policies Should Focus on Healthy Eating, Not on Calorie Counting, Even to Decrease Obesity

Calorie-focused policies, such as calorie menu labeling, seem to result in minor shifts toward healthier choices and public health improvement. This paper discusses the (lack of) relations between energy intake and healthy eating and the rationale for shifting the focus of public health nutrition policies to healthier foods and meals. We argue that the benefits of reducing caloric intake from low-quality foods might not result from the calorie reduction but rather from the reduced consumption of low-quality foods. It is better to consume a given number of calories from high-quality foods than a smaller number of calories from low-quality foods. It is not possible to choose a healthy diet solely based on the caloric value of foods because calories are not equal; they differ in nutritional quality according to their source. Foods are more than just a collection of calories and nutrients, and nutrients interact differently when presented as foods. Different subtypes of a macronutrient, although they have the same caloric value, are metabolized and influence health in different ways. For instance, industrial trans fats increase lipogenesis and the risk of heart diseases, whereas monounsaturated fats have the opposite effect. Food processing and cooking methods also influence the nutritional value of foods. Thus, public health nutrition policies should stop encouraging people to focus mainly on calorie counting to fight noncommunicable diseases. Instead, policies should focus on ingredients, dietary sources, and food processing and cooking methods.

HORMONAL REGULATION OF CARBOHYDRATE AND FAT METABOLISM IN WOMEN WITH DIFFERENT OBESITY TYPES IN THE FOOD DEPRIVATION TEST

CONTEXT

The dominant type of adipose tissue accumulation in the body is associated with the peculiarities of using key substrates in energy metabolism and their hormonal regulation. Hormonal and metabolic parameters were investigated in women with android and gynoid obesity before and after the short-term food deprivation test.

RESULTS

At baseline, at gynoid obesity as compared to android obesity, the women's blood contained lower glucose and insulin levels and higher FFA levels. The reaction to food deprivation manifested by a decrease in glucose level and an increase in FFA level in the blood is less pronounced in women with gynoid obesity than in those with android obesity. At the same time, a similar (though varying in expression) decrease in insulin level and elevated levels of glucagon, growth hormone and thyroxine were revealed in women's blood in both groups. Blood cortisol level increased in women with gynoid obesity and remained unchanged in those with android obesity.

CONCLUSIONS

More pronounced activation of hormonal mechanisms for maintaining blood glucose levels at gynoid obesity as compared to android one suggests that glucose is the preferable substrate for energy metabolism at gynoid obesity in women.

Biomarkers of Oxidative Stress in Metabolic Syndrome and Associated Diseases

Metabolic syndrome (MS) represents worldwide public health issue characterized by a set of cardiovascular risk factors including obesity, diabetes, dyslipidemia, hypertension, and impaired glucose tolerance. The link between the MS and the associated diseases is represented by oxidative stress (OS) and by the intracellular redox imbalance, both caused by the persistence of chronic inflammatory conditions that characterize MS. The increase in oxidizing species formation in MS has been accepted as a major underlying mechanism for mitochondrial dysfunction, accumulation of protein and lipid oxidation products, and impairment of the antioxidant systems. These oxidative modifications are recognized as relevant OS biomarkers potentially able to (i) clarify the role of reactive oxygen and nitrogen species in the etiology of the MS, (ii) contribute to the diagnosis/evaluation of the disease's severity, and (iii) evaluate the utility of possible therapeutic strategies based on natural antioxidants. The antioxidant therapies indeed could be able to (i) counteract systemic as well as mitochondrial-derived OS, (ii) enhance the endogenous antioxidant defenses, (iii) alleviate MS symptoms, and (iv) prevent the complications linked to MS-derived cardiovascular diseases. The focus of this review is to summarize the current knowledge about the role of OS in the development of metabolic alterations characterizing MS, with particular regard to the occurrence of OS-correlated biomarkers, as well as to the use of therapeutic strategies based on natural antioxidants.

A dual-process psychobiological model of temperament predicts liking and wanting for food and trait disinhibition

A dual-process model of temperament, incorporating the Behavioural Inhibition System (BIS), Behavioural Activation System (BAS) and effortful control (EC), may help to predict hedonic responses to palatable food and trait disinhibition.

PURPOSE

This study aimed to determine if the BIS, BAS and EC predicted liking and wanting for high-fat, sweet foods in adults with overweight and obesity, and if collectively, these variables predicted the eating behaviour trait of Disinhibition.

METHODS

168 adults (104 females, mean BMI = 33.3 kg/m²) completed the Three Factor Eating Questionnaire, the Carver and White BIS/BAS scales, the Adult Temperament Questionnaire-Effortful Control Scale - Short Form and the Leeds Food Preference Questionnaire. The strength of the BIS, BAS and EC in predicting wanting and liking for high-fat sweet foods, and trait Disinhibition was assessed using hierarchical multiple regression.

RESULTS

Both the BIS and EC predicted liking, F (6, 161) = 5.05, p < .001, R² = 0.16, and EC inversely predicted wanting, F (6, 161) = 3.28, p = .005, R² = 0.11. The BIS, EC and liking predicted, F (8, 159) = 11.0, p < .001, R² = 0.36, and explained 36% of Disinhibition. The BAS did not predict wanting, liking or Disinhibition.

CONCLUSIONS

These results demonstrate that a sensitive BIS and a lower level of effortful control predicts food reward and Disinhibition in overweight and obese adults. Consequently, interventions that aim to increase effortful control and reduce BIS reactivity may be beneficial for reducing hedonically motivated, disinhibited eating behaviour.

Impact of Obesity on Employment and Wages among Young Adults: Observational Study with Panel Data

This paper assesses the relationship between obesity and the job market by focusing on young adults early on in their careers, while considering the factor of gender and the individuals’ job qualifications. This study extracted data on high school students for four years from the Korean Education and Employment Panel (from 2010 to 2013), a nationally representative dataset comprising of 2000 middle school students and 4000 high school seniors. The individual-level fixed effects were controlled using conditional logistic regression models and an ordinary least squares model. Obese and overweight men were 1.46 times more likely to be placed in professional jobs and had 13.9% higher monthly wages than their normal-weight counterparts. However, obese and overweight women were 0.33 times less likely to have service jobs, earned 9.0% lower monthly wages, and half as likely to have jobs with bonuses than that of their normal-weight counterparts. However, such penalty among women was found only when they had none of the assessed job market qualifications. Given that initial jobs and job conditions have lingering impacts in long-term job performance, the cumulative penalty for overweight or obesity could be more substantial for young adults in particular.

Subjective health in relation to hedonic and eudaimonic wellbeing: Evidence from the Gallup World Poll

This study investigated the relationships between subjective health, hedonic wellbeing (i.e. positive affect, negative affect, and life satisfaction), and eudaimonic wellbeing (i.e. psycho-social functioning). The sample was drawn from the Gallup World Poll and included a total of 1,567,295 individuals in 165 countries. We found that both hedonic and eudaimonic wellbeing were uniquely associated with subjective health. However, the relative contributions of each dimension to subjective health varied, with negative affect demonstrating the strongest relationship with subjective health and life satisfaction demonstrating the weakest association. The moderating effects of some national-level variables were also explored.

Prevalence and associated factors of pre-hypertension and hypertension in Nepal: Analysis of the Nepal Demographic and Health Survey 2016

OBJECTIVES

Hypertension is the leading risk factor for cardiovascular diseases and develops faster among pre-hypertensive individuals. However, there is a lack of nationally representative studies that investigate the prevalence and determinants of these two conditions in many developing countries, including Nepal. This study investigates the prevalence and determinants of pre-hypertension and hypertension in Nepal.

METHODS

The present cross-sectional analysis used data from the 2016 Nepal Demographic and Health Survey, collected from June 2016 to January 2017. After calculating the weighted prevalence (with 95% confidence interval [CI]), simple and multivariable analyses were performed to estimate odds ratios.

RESULTS

A total of 14 857 individuals (6247 males and 8610 females) aged ≥15 years who had their blood pressure measured during the survey were included in this study. The prevalence for pre-hypertension and hypertension were 26.0% (95% CI: 25.3-26.3, n = 3856) and 19.5% (95% CI: 18.8-20.2, n = 2899), respectively. The prevalence of both conditions was greater among males. In multivariable analyses, older age, male sex, higher body mass index, and residents of Provinces 4 and 5 had significantly increased odds of pre-hypertension and hypertension (P < .05). Additionally, higher education level was found to be positively associated with hypertension.

CONCLUSIONS

The combined higher prevalence of pre-hypertension and hypertension indicates that nearly half (45.5%) of the respondents are at a greater risk of cardiovascular and other non-communicable diseases due to these two conditions. Older people, males, obese people, and individuals living in Provinces 4 and 5 require more awareness to control blood pressure levels.