The relation of gender, race and socioeconomic status to obesity and obesity comorbidities in a sample of US adults

Early safety outcomes of laparoscopic one anastomosis gastric bypass in patients with class III, IV, and V obesity

BACKGROUND

The extremely obese patient deserves special consideration: significant comorbidities, technical difficulties, and increased postoperative morbidity and mortality are all expected in this patient population. The study compared early postoperative complications (≤30-day) following one-anastomosis gastric bypass (OAGB) morbidity in patients with morbid obesity class IV obesity, body mass index (BMI) ≥50-59.9 kg/m2, and class V obesity, BMI ≥60 patients.

METHODS

We retrospectively reviewed perioperative OAGB outcomes in three BMI groups. Operative time, length of stay (LOS), and overall early postoperative complication rates were studied. Patient-reported complications were ranked by Clavien-Dindo Classification (CDC).

RESULTS

Between January 2017-December 2021, consecutive patients with obesity class III (n = 2950), IV (n = 256), and V (n = 23) underwent OAGB. BMI groups were comparable in sex, age, and associated comorbidities. Mean operative time was significantly longer in the higher BMI groups: class III (66.5 ± 25.6 min), IV (70.5 ± 28.7 min), and V (80.0 ± 34.7 min), respectively (p = 0.018); no difference in LOS. In respective BMI classes, ≤30-day complication rates were 3.2%, 3.5%, and 4.3% (p = 0.926). The respective number of patients with CDC grades of one to two were 45 (1.5%), 6 (2.3%), and 1 (4.3%), p = 0.500; and in grade ≥3a, 25 (0.8%), 1 (0.4%), 0 (0.0%), p = 0.669. There was 0.06% mortality (n = 2 in 3229), both in BMI class III.

CONCLUSIONS

OAGB is a safe BS procedure in patients with class III, IV, and V obesity in the perioperative term with comparable ≤30-day morbidity in the three BMI groups.

Does neighbourhood deprivation influence low back pain and arthritis: An empirical study using multilevel twin design

OBJECTIVE

Neighbourhood deprivation has been found to be associated with many health conditions, but its association with low back pain (LBP) and arthritis is unclear. This study aimed to examine the association between neighbourhood deprivation with LBP and arthritis, and its potential interaction with individual socioeconomic status (SES) on these outcomes.

METHODS

Monozygotic (MZ) twins from the Washington State Twin Registry were used to control for genetic and common environmental factors that could otherwise confound the purported relationship. Multilevel models were employed to examine the association between neighbourhood deprivation as well as individual-level SES with LBP/arthritis, adjusting for age, sex, body mass index (BMI) and residence rurality.

RESULTS

There were 6,380 individuals in the LBP sample and 2,030 individuals in the arthritis sample. Neighbourhood deprivation was not associated with LBP (P = 0.26) or arthritis (P = 0.61), and neither was its interaction with individual-level SES. People without a bachelor's degree were more likely to report LBP (OR 1.44, 95% CI 1.26-1.65) or both LBP and arthritis (OR 1.67, 95% CI 1.14-2.45) than those with a bachelor's degree, but not for arthritis alone (P = 0.17). Household income was not significantly associated with LBP (P = 0.16) or arthritis (p = 0.23) independent of age, sex, and BMI.

CONCLUSION

Our study did not find significant associations between neighbourhood deprivation and the presence of LBP or arthritis. More research using multilevel modelling to investigate neighbourhood effects on LBP and arthritis is recommended.

Masculinizing Chest Reconstruction in Adolescents and Young Adults: An Analysis of National Surgical Quality Improvement Program Data

BACKGROUND

Masculinizing chest reconstruction (MCR) has been shown to improve quality of life and gender dysphoria in transmasculine adult patients. As nationwide access to gender-affirming care expands, more adolescents are seeking MCR. However, there is a paucity of literature examining patient characteristics, safety, and disparities among this population.

METHODS

Cases of MCR were selected from the pediatric and adult American College of Surgeons and National Surgical Quality Improvement Program. Adolescent (18 years and older) and young adult (aged 19-25 years) transgender patients were analyzed for differences in demographics, comorbidities, surgical characteristics, and postoperative complications.

RESULTS

A total of 1287 cases were identified, with an adolescent cohort of 189 patients. The proportion of White patients to other races was greater among adolescents than young adults (91.2% vs 82.4%, P = 0.007). Of adolescents and young adults, 6.0% and 11.1% identified as Hispanic/Latino, respectively (P = 0.059). Rates of all-cause postoperative complications were similar between adolescents (4.2%) and young adults (4.1%). Multivariate binary logistic regression showed that Black or African American patients experienced more all-cause postoperative complications than other races after controlling for American Society of Anesthesiologists classification, age group, and body mass index (odds ratio, 2.8; 95% confidence interval, 1.3-5.9; P = 0.008).

CONCLUSIONS

Masculinizing chest reconstruction is equally safe for transmasculine adolescent and young adult patients. However, our data point to racial disparities in access to care and postoperative outcomes. An intersectional approach is needed to better understand the unique health care needs and barriers to care of minority transgender youth.

Body-mass index and obesity in infertile couples in southwest China

To investigate body mass index (BMI) of infertile couples and analyze its related influencing factors in Southwest China, so as to prevent and control the obesity. We analyzed the data of a total number of 8877 infertile couples who received treatment in our assisted reproductive center from October 2012 to March 2022. The mean age and BMI of men and women were 33.5 years, 23.9 kg/m2 and 31.6 years, 21.9 kg/m2. The prevalence of overweight (BMI 25-29.9) was 30.9% in men and 14.7% in women, 3.7% of men and 1.6% of women were obese (BMI ≥ 30), while 3.6% of men and 10.8% of women were underweight (BMI<18.5). Multivariable linear regression analysis indicated that the age and educational background of both women and men had an impact on BMI. In our study, the proportion of male obesity and overweight is much higher than that of female. On the other hand, the proportion of females with low weight was higher than that of males. The age and educational background of men and women have a certain correlation with BMI.

Gender-specific determinants of overweight and obesity among older adults in India: evidence from a cross-sectional survey, 2017-18

BACKGROUND

A major societal trend of the twenty-first century is the rapidly ageing population as a consequence of the decline in fertility and increase in life expectancy. Along with the rise in ageing population, the burden of obesity and related non-communicable diseases is also equally rising. In this study, we aimed to investigate the potential gender-specific determinants of overweight and obesity among older adults in India.

SUBJECTS AND METHODS

The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total sample of 25,952 older adults (≥ 60 years) was selected for the study. Descriptive statistics, bivariate chi-square test, and logistic regression estimation were applied to accomplish the study objectives. Body mass index (BMI) has been classified in this study according to the WHO criteria.

RESULTS

The prevalence of overweight was higher among women (18.15% in rural areas and 46.62% in urban areas) compared to men (12.9% in rural areas and 30.61% in urban areas). Similarly, obesity was higher among women than men who were residing in urban areas (17.07% vs. 5.37%), had secondary or above education (32.38% vs. 6.1%) belonged to richest strata (16.37% vs. 4.50%), or had mobility impairment (9.2% vs. 2.8%). Despite adjustment for several confounders, women were more likely to be overweight (OR: 2.18; CI: 1.86, 2.55) and obese (OR: 3.79; CI: 2.86, 5.03) than men. However, among both the elderly men and women, those who were highly educated were 2.29 times (OR: 2.29; CI: 1.80, 4.11) and 2.71 times (OR: 2.71; CI: 1.78, 4.11), respectively more likely to be overweight than their illiterate counterparts. Older adults living in urban areas were more likely to suffer from obesity compared to rural men (OR: 1.47; CI: 1.07, 2.02) and women (OR: 2.58; CI: 1.85, 3.60). Both men and women, who were highly educated were 2.64 times (OR: 2.64; CI: 1.71, 4.09) and 2.94 times (OR: 2.94; CI: 1.40, 6.20), respectively, more likely to be obese than their illiterate counterparts. Older men and women who were richest (OR: 1.60; CI: 1.19, 2.14 & OR: 2.12; CI: 1.63,2.76), or had mobility impairment (OR: 1.33; CI: 1.09,1.61 & OR: 1.72; CI: 1.42,2.08) were more likely to be overweight than their counterparts who were poorest or did not have any mobility limitation, respectively.

CONCLUSIONS

This study found increased vulnerability of overweight and obesity among older women than men irrespective of their socioeconomic, demographic, and health status. The present study suggests that introducing preventative measures such as campaigns to encourage physical activity, and community awareness may help reduce the high burden of overweight and obesity. Finally, the findings are important for better functioning of any public health programme and suitable intervention techniques to maintain a healthy body in order to lower the prevalence and risk factors of non-communicable diseases in later life.

Socio-demographic and behavioral correlates of excess weight and its health consequences among older adults in India: Evidence from a cross-sectional study, 2017-18

BACKGROUND

Rapid population aging is expected to become one of the major demographic transitions in the twenty-first century due to the continued decline in fertility and rise in life expectancy. Such a rise in the aged population is associated with increasing non-communicable diseases. India has suffered from obesity epidemic, with morbid obesity affecting 5% of the population and continuing an upward trend in other developing countries. This study estimates the prevalence of excess weight among older adults in India, and examines the socio-demographic and behavioral factors and its health consequences.

METHODS

The study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total sample of 25,952 older adults (≥ 60 years) was selected for the study. Descriptive statistics, bivariate Chi-Square test, and logistic regression models were applied to accomplish the study objectives. Body mass index (BMI) has been computed for the study according to the classification of the World Health Organization, and "excess weight" refers to a score of BMI ≥ 25.0 kg/m2.

RESULTS

Overall, 23% of older adults (≥ 60 years) were estimated with excess weight in India, which was higher among women irrespective of socioeconomic and health conditions. The higher levels of excess weight (than the national average of ≥22.7%) were observed among older adults in states like Haryana, Tamil Nadu, Telangana, Maharashtra, Gujarat, Manipur, Goa, Kerala, Karnataka, Himachal Pradesh, Punjab, Sikkim and some other states. After adjusting for selected covariates, the odds of excess weight were higher among females than males [OR: 2.21, 95% CI: 1.89, 2.60]. Similarly, the likelihood of excess weight was 2.18 times higher among older adults who were living in urban areas compared to their rural counterparts [OR: 2.18; 95% CI: 1.90, 2.49]. Higher level of education is significantly positively correlated with excess weight. Similarly, higher household wealth index was significantly positively correlated with excess weight [OR: 1.98, CI: 1.62, 2.41]. Having hypertension, diabetes and heart diseases were associated with excess weight among older adults. Regional variations were also observed in the prevalence of excess weight among older adults.

CONCLUSION

The findings suggest that introducing measures that help to reduce the risk of non-communicable diseases, and campaigns to encourage physical activity, and community awareness may help reduce the high burden of excess weight and obesity among older Indians. The findings are important for identifying the at-risk sub-populations and for the better functioning of any public health programme and suitable intervention techniques to lower the prevalence and risk factors for excess weight in later life.

Weight change among patients engaged in medication treatment for opioid use disorder: a scoping review

Background: Medication treatment for opioid use disorder (MOUD) is an instrumental tool in combatting opioid use and overdose. Excess weight gain associated with MOUD initiation is a potential barrier that is not well understood.Objectives: Conduct a scoping review of available studies investigating the effect of MOUD on weight.Methods: Included studies consisted of adults taking any type of MOUD (e.g. methadone, buprenorphine/naloxone, naltrexone) with data on weight or body mass index for at least two time points. Evidence was synthesized using qualitative and descriptive approaches, and predictors of weight gain including demographics, comorbid substance use, and medication dose were examined.Results: Twenty-one unique studies were identified. Most studies were uncontrolled cohort studies or retrospective chart reviews testing the association between methadone and weight gain (n = 16). Studies examining 6 months of methadone treatment reported weight gain ranging from 4.2 to 23.4 pounds. Women appear to gain more weight from methadone than men, while patients using cocaine may gain less. Racial and ethnic disparities were largely unexamined. Only three case reports and two nonrandomized studies examined the effects of either buprenorphine/naloxone or naltrexone, and potential associations with weight gain were not clear.Conclusion: The use of methadone as an MOUD appears to be associated with mild to moderate weight gain. In contrast, there is little data supporting or refuting weight gain with buprenorphine/naloxone or naltrexone. Providers should discuss the potential risk for weight gain with patients as well as prevention and intervention methods for excess weight gain.

Racial Disparities in the 30-Day Outcomes of Gender-affirming Chest Surgeries

OBJECTIVE

To determine if and how race impacts the 30-day outcomes of gender-affirming chest surgeries.

BACKGROUND

Little is currently known about how race may affect the outcomes of gender-affirming surgeries.

METHODS

We analyzed data from the National Surgical Quality Improvement Program (NSQIP) database of 30-day complications of gender-affirming chest surgeries from 2005 to 2019. All participants had a postoperative diagnosis code for gender dysphoria and at least one procedure code for bilateral mastectomy, bilateral breast reduction, or bilateral augmentation mammoplasty. Differences by racial group were analyzed through Pearson χ 2 and multivariate logistic regression.

RESULTS

There were no racial differences in the all-complication rates for both transmasculine and transfeminine individuals undergoing gender-affirming chest surgeries. Black patients undergoing masculinizing procedures were significantly more likely to experience mild systemic [adjusted odds ratio (aOR): 2.17, 95% confidence interval (CI): 1.02-4.65] and severe complications (aOR: 5.63, 95% CI: 1.99-15.98) when compared with White patients. Patients of unknown race had increased odds of experiencing severe complications for masculinizing procedures compared with White patients (aOR: 3.77, 95% CI: 1.39-10.24). Transmasculine individuals whose race was unknown were 1.98 times more likely (95% CI: 1.03-3.81) to experience an unplanned reoperation compared with White individuals. Black transfeminine individuals were 10.50 times more likely to experience an unplanned reoperation (95% CI: 1.15-95.51) than their White peers.

CONCLUSIONS

Although overall complications are uncommon, there is evidence to suggest that there are racial disparities in certain 30-day outcomes of gender-affirming chest surgeries.

Lower mitochondrial respiration does not lead to decreased fat oxidation in young African American women without obesity

OBJECTIVE

The prevalence of type 2 diabetes in African American women (AAW) is nearly twice that of White women. Lower insulin sensitivity and decreased mitochondrial function may be contributing factors. The purpose of this study was to compare fat oxidation in AAW and White women.

METHODS

Participants were 22 AAW and 22 White women, matched for age (18.7-38.3 years) and BMI (< 28 kg/m2). Participants completed two submaximal (50% VO2max) exercise tests with indirect calorimetry and stable isotope tracers to assess total, plasma, and intramyocellular triglyceride fat oxidation.

RESULTS

The respiratory quotient during the exercise test was nearly identical in AAW and White women (0.813 ± 0.008 vs. 0.810 ± 0.008, p = 0.83). Although absolute total and plasma fat oxidation was lower in AAW, adjusting for the lower workload in AAW eliminated these racial differences. There was no racial difference in plasma and intramyocellular triglyceride source of fat for oxidation. No racial differences were observed in rates of ex vivo fat oxidation. Exercise efficiency was lower in AAW when adjusted to leg fat free mass.

CONCLUSIONS

The data suggest that fat oxidation is not lower in AAW compared with White women, but additional studies are needed across exercise intensity, body weight, and age to confirm these results.

Examination of relationship factors between psychological resilience and social support in adolescent obesity

PURPOSE

Childhood obesity is one of the most severe public health problems, and psychiatric conditions have been associated with obesity. In this study, we aimed to investigate psychological resilience and possible related factors in adolescents with obesity.

METHOD

The study included 90 adolescents with obesity and 100 healthy adolescents of similar age. Data were collected using a sociodemographic information form, the Child and Youth Resilience Measure-28 (CYRM-28), and the Multidimensional Scale of Perceived Social Support. Scale scores were compared by Pearson's correlation coefficient test with SPSS-23. Multiple linear regression was performed to describe the relationships between variables.

RESULTS

The adolescents participating in the study were similar in terms of age and gender. Psychological resilience and social support in the obesity group were lower than in the control group (p < 0.05). A negative relationship was found between body mass index (BMI) and resilience levels of adolescents with obesity, and a positive relationship was found between social support and resilience levels (p = 0.027 and p < 0.001, respectively). The perceived family and significant other social support subscale scores of adolescents in the obesity group were significantly lower than in the control group (p = 0.037 and p = 0.023, respectively). The most related variable with the CYRM-28 was the level of perceived social support: standardized β = 0.409; t(151) = 5.626; p < 0.001.

CONCLUSION

A higher BMI has a negative effect on psychological resilience, and family support tends to be lower in these cases. New studies are needed to clarify whether this result is one of the causes of obesity or one of its consequences.

Genetics of sexually dimorphic adipose distribution in humans

Obesity-associated morbidity is exacerbated by abdominal obesity, which can be measured as the waist-to-hip ratio adjusted for the body mass index (WHRadjBMI). Here we identify genes associated with obesity and WHRadjBMI and characterize allele-sensitive enhancers that are predicted to regulate WHRadjBMI genes in women. We found that several waist-to-hip ratio-associated variants map within primate-specific Alu retrotransposons harboring a DNA motif associated with adipocyte differentiation. This suggests that a genetic component of adipose distribution in humans may involve co-option of retrotransposons as adipose enhancers. We evaluated the role of the strongest female WHRadjBMI-associated gene, SNX10, in adipose biology. We determined that it is required for human adipocyte differentiation and function and participates in diet-induced adipose expansion in female mice, but not males. Our data identify genes and regulatory mechanisms that underlie female-specific adipose distribution and mediate metabolic dysfunction in women.

The effect of obesity on chronic diseases in USA: a flexible copula approach

We analyze the effect of obesity on the incidence of hypertension, hyperlipidemia and diabetes in USA using a health production theoretical framework along with a bivariate flexible semi-parametric recursive copula model that account for endogeneity. In this approach, the effects of control variables are flexibly determined using additive predictors that allow for a variety of effects. Our findings suggest that there exist a positive and significant effect of obesity on the prevalence of all chronic diseases examined. In particular, after endogeneity is accounted for, the probability of having hypertension, hyperlipidemia and diabetes for obese individuals are, respectively, 35%, 28% and 11% higher than those under the obesity threshold. These findings suggest that lowering obesity rates could lead to significant reductions in the morbidity and mortality associated with these diseases.

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.

BMI and Disordered Eating in Black College Women: The Potential Mediating Role of Body Appreciation and Moderating Role of Ethnic Identity

Multiple studies indicate Black American women have disproportionately higher rates of obesity compared with other groups in United States. Although body image is associated with obesity, this relation is understudied among Black women. The purpose of the current study was to (1) examine the relations among body appreciation, body dissatisfaction and disordered eating; (2) assess body appreciation as a mediator of the relation between body mass index (BMI) and disordered eating, and (3) explore ethnic identity as a moderator in this association. Participants were 191 Black women recruited from a mid-Atlantic university. Participants' mean age was 19.16 years (SD = 1.95). Body appreciation partially mediated the relation between BMI and disordered eating behaviors and attitudes, such that women with higher BMIs reported lower body appreciation, which was associated with greater disordered eating symptoms. Ethnic identity was not a significant moderator of the association between BMI and body appreciation. Results support screening Black women with higher BMIs for disordered eating symptomatology and suggest it might be helpful to include body appreciation in interventions for Black women.

Increasing Access to Healthy Foods through Improving Food Environment: A Review of Mixed Methods Intervention Studies with Residents of Low-Income Communities

Food insecurity is a broad and serious public health issue in the United States, where many people are reporting lack of access to healthy foods. The reduced availability of healthy, affordable foods has led to increased consumption of energy-dense and nutrient-poor foods, resulting in increasing the risk for many chronic diseases such as obesity, cardiovascular diseases, and type 2 diabetes mellitus. Thus, identifying promising approaches to increase access to healthy foods through improving the food environment is of importance. The purpose of this review article is to highlight how the food environment affects directly a person’s food choices, and how to increase access to healthy foods through improving environmental approaches. The literature search was focused on finding different approaches to improve food security, primarily those with an impact on food environment. Overall, potential solutions were gathered through multilevel environmental approaches, including nutrition education and peer education, community-based participatory research, and policy changes in supplemental nutrition programs. A recommendation to reduce food insecurity is learning to create meals with a variety of seasonal fruits and vegetables purchased from affordable farmers’ markets.

Birth cohort, sex and educational disparities in the trajectories of body mass index in Taiwan: a longitudinal study

Background

Taiwan has gone through rapid industrialization, urbanization and economic growth in the 20th and early 21st centuries. Therefore, the population has experienced significant changes in the physical and social environment during the life course, which may affect the overall adiposity. Our aim was to examine the age trajectories of height, weight and body mass index (BMI) in the Taiwanese population and to explore the influences of sex, birth cohort and education.

Methods

The sample comprised 572,358 residents between 20 and 94 years of age in Taiwan who attended at least one health examination during 1996 to 2017 in a cohort study. Repeated measures of body weight and height were collected using an auto-anthropometer. We conducted a series of linear mixed-effects growth curve models to examine the trajectory of height, weight, and BMI across the life course with stratification by sex.

Results

Age-related trajectories of BMI differed between men and women and stronger cohort effects were observed among men, with younger cohorts having higher BMI. After holding cohort and age variables constant, men with junior high or lower education were shorter, thinner and had higher BMI than men with university or higher education (effect sizes: − 3.138 cm, p < 0.001; − 2.277 kg, p < 0.001; 0.121 kg/m², p < 0.001, respectively). Women with junior high or lower education were shorter, heavier and had higher BMI than women with university or higher education (effect sizes: − 2.368 cm, p < 0.001; 2.417 kg, p < 0.001; 1.691 kg/m², p < 0.001, respectively). The educational disparities in BMI were found to be larger among women.

Conclusions

Our findings suggest that younger generations, especially men, and lower educational level individuals, particularly women, have increasing levels of BMI. The influence of age and cohort effects together with sex and educational disparities on adiposity should be highlighted when designing future interventions and policies regarding overweight and obesity.

Sleep regularity and body mass index: findings from a prospective study of first-year college students

Study Objectives

Using data from a large, prospective study of sleep in first-year college students, we examined whether students’ sleep regularity is associated with body mass index (BMI) and BMI change (∆BMI) during their first college semester. In a subset of participants, we also tested whether dim light melatonin onset (DLMO) phase and DLMO-bedtime phase angle are associated with BMI and ∆BMI.

Methods

Analyses included data from 581 students (mean age = 18.7 ± 0.5 years; 58% female; 48% non-white) who had their height and weight assessed at the start of classes (T1) and end of 9 weeks. Participants completed online daily sleep diaries from which total sleep time (TST) and the sleep regularity index (SRI) were calculated. Among participants who completed a DLMO protocol (n = 161), circadian phase was quantified by DLMO and circadian alignment by DLMO-bedtime phase angle. Data were analyzed with linear regressions that controlled for sex and average TST.

Results

Average SRI was 74.1 ± 8.7 (range: 25.7; 91.6). Average BMI at T1 was 22.0 ± 3.5 and participants gained 1.8 ± 2.4 kg (range: −7.2; 11.4); 39% gained 2–5 kg, 8% gained &gt;5 kg. Lower SRI was associated with greater BMI at T1 (B = −0.06 [95% CI: −0.09; −0.02], p = 0.001) but not with ∆BMI (p = 0.062). Average TST was not significantly associated with BMI or ∆BMI, nor were circadian phase and alignment in the subsample (p’s &gt; 0.05).

Conclusions

Sleep regularity is an understudied but relevant sleep dimension associated with BMI during young adulthood. Our findings warrant future work to examine longer-term associations between sleep regularity and weight gain.

Differential Impact of COVID-19 Risk Factors on Ethnicities in the United States

The coronavirus disease (COVID-19) has revealed existing health inequalities in racial and ethnic minority groups in the US. This work investigates and quantifies the non-uniform effects of geographical location and other known risk factors on various ethnic groups during the COVID-19 pandemic at a national level. To quantify the geographical impact on various ethnic groups, we grouped all the states of the US. into four different regions (Northeast, Midwest, South, and West) and considered Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, Non-Hispanic Asian (NHA) as ethnic groups of our interest. Our analysis showed that infection and mortality among NHB and Hispanics are considerably higher than NHW. In particular, the COVID-19 infection rate in the Hispanic community was significantly higher than their population share, a phenomenon we observed across all regions in the US but is most prominent in the West. To gauge the differential impact of comorbidities on different ethnicities, we performed cross-sectional regression analyses of statewide data for COVID-19 infection and mortality for each ethnic group using advanced age, poverty, obesity, hypertension, cardiovascular disease, and diabetes as risk factors. After removing the risk factors causing multicollinearity, poverty emerged as one of the independent risk factors in explaining mortality rates in NHW, NHB, and Hispanic communities. Moreover, for NHW and NHB groups, we found that obesity encapsulated the effect of several other comorbidities such as advanced age, hypertension, and cardiovascular disease. At the same time, advanced age was the most robust predictor of mortality in the Hispanic group. Our study quantifies the unique impact of various risk factors on different ethnic groups, explaining the ethnicity-specific differences observed in the COVID-19 pandemic. The findings could provide insight into focused public health strategies and interventions.

Snacking behavior differs between evening and morning chronotype individuals but no differences are observed in overall energy intake, diet quality, or food cravings

There is a growing body of literature that links chronotype to certain undesirable eating behaviors. However, the relationship between chronotype and dietary intake is poorly characterized among adults in the United States (U.S.). This cross-sectional study examined the associations among chronotype, snacking habits, dietary intake and quality, and food cravings. One-hundred adults living in the U.S. completed the study. Based on the Horne-Östberg Morningness-Eveningness Questionnaire score, an individual was categorized as having either a morning (M)-type, intermediate (I)-type, or evening (E)-type chronotype. Snack intake was assessed using a previously published specialized food frequency questionnaire. Sugar-sweetened beverage (SSB) intake was assessed using the updated version of the Beverage Intake Questionnaire-15. Alcohol misuse was measured using the Alcohol Use Disorders Identification Test-Consumption. Diet quality was obtained using the Diet History Questionnaire III. The validated General Food Cravings Questionnaire-Trait measured participants' food cravings. E-type individuals reported consuming snacks more often over the course of a week than M-types (p = .002) but not I-types. In terms of timing of snacking, E-type individuals consumed more snacks after dinner than M-types (p < .001). E-type individuals consumed more energy-dense snacks (p = .005), especially candies (p = .005), than M-types. However, there were no significant differences in healthy snack frequency, diet quality, energy and macronutrient intake, SSB consumption, alcohol misuse, or food cravings among chronotypes (p > .05, for all). In conclusion, E-type individuals consumed snacks more frequently and later than M-types; however, chronotype was not associated with an individual's energy intake, diet quality, and food cravings, which suggests that chronotype is negligibly associated with weight gain-related behaviors in this population.

Transitioning to an obese India: Demographic and structural determinants of the rapid rise in overweight incidence

India, which has long suffered from undernutrition, has seen a rapid rise in overweight incidence in the last decade and a half. These changes are characterized by significant within-country differences in overweight incidence that vary by gender and regional development levels. In this paper, we provide an integrative framework, linking the income-gradient hypothesis of obesity with biological, obesogenic, and environmental factors to provide an explanation on the emergence of within-country differences in overweight patterns. We utilize measured body mass index (BMI), along with individual- and household-level data of over 800,000 men and women surveyed in the National Family Health Surveys of 2005-06 and 2015-16 to identify correlates of within-country differences in overweight incidence. A decomposition analysis reveals that among women, in addition to increasing access to obesogenic technologies, biological factors are associated with overweight incidence. Among men, obesogenic factors related to technology use and health behaviors are associated with the rise in overweight incidence, but biological factors are not. At lower levels of regional development, overweight incidence is associated with greater access to obesogenic technology such as motorized transport, which reduces physical activity among men at higher rates than women. At higher levels of economic development, obesogenic behaviors, such as watching more television and reducing smoking, are associated with overweight incidence. Our results corroborate the call by public health experts for group-specific policies to stem the rise of overweight incidence in developing countries.

Impact of underlying malignancy on emergency department utilization and outcomes

PURPOSE

Cancer patients frequently utilize the emergency department (ED) for a variety of diagnoses both related to and unrelated to their cancer, yet ED outcomes for cancer patients are not well documented. This study sought to define risks and identify predictors for inpatient admission and hospital mortality among cancer patients presenting to the ED.

PATIENTS AND METHODS

We utilized the National Emergency Department Sample to identify patients with and without a diagnosis of cancer presenting to the ED between January 2016 and December 2018. We used multivariable mixed-effects logistic regression models to assess the influence of cancer on outcomes of hospital admission after the ED visit and hospital mortality for the whole patient cohort and individual presenting diagnoses.

RESULTS

There were 340 million weighted ED visits, of which 8.3 million (2.3%) were associated with a cancer diagnosis. Compared to non-cancer patients, patients with cancer had an increased risk of inpatient admission (64.7% vs. 14.8%; p < 0.0001) and hospital mortality (4.6% vs. 0.5%; p < 0.0001). For each of the top 15 presenting diagnoses, cancer patients had increased risks of hospitalization (odds ratio [OR] range 2.0-13.2) or death (OR range 2.1-14.4). Although our dataset does not contain reliable estimation of stage, cancer site was the most robust individual predictor associated with the risk of hospitalization or death compared to other clinical or system-related factors.

CONCLUSIONS

Cancer patients in the ED have high risks for hospital admission and death when compared to patients without cancer. Cancer patients represent a distinct population and may benefit from cancer-specific risk stratification or focused interventions to improve outcomes.

Body Image Distress and Its Associations From an International Sample of Men and Women Across the Adult Life Span: Web-Based Survey Study

BACKGROUND

Previous research on body image distress mainly relied on samples that were small, generally homogeneous in age or sex, often limited to one geographical region, and were characterized by a lack of comprehensive analysis of multiple psychosocial domains. The research presented in this paper extends the international literature using the results of the web-based Global Health and Wellbeing Survey 2015. The survey included a large sample of both men and women aged ≥16 years from Australia, Canada, New Zealand, the United Kingdom, or the United States.

OBJECTIVE

The main objectives of this study are to examine body image distress across the adult life span (≥16 years) and sex and assess the association between body image distress and various psychosocial risk and protective factors.

METHODS

Data were extracted from the Global Health and Wellbeing Survey 2015, a web-based international self-report survey with 10,765 respondents, and compared with previous web-based surveys conducted in 2009 and 2012.

RESULTS

The body image distress of young Australians (aged 16-25 years) significantly rose by 33% from 2009 to 2015. In 2015, 75.19% (961/1278) of 16- to 25-year-old adults reported body image distress worldwide, and a decline in body image distress was noted with increasing age. More women reported higher levels of body image distress than men (1953/3338, 58.51% vs 853/2175, 39.22%). Sex, age, current dieting status, perception of weight, psychological distress, alcohol and other substance misuse, and well-being significantly explained 24% of the variance in body image distress in a linear regression (F_15,4966=105.8; P<.001).

CONCLUSIONS

This study demonstrates the significant interplay between body image distress and psychosocial factors across age and sex.

Do intersecting identities structure social contexts to influence life course health? The case of school peer economic disadvantage and obesity

Scholarship linking social contextual measures to health outcomes has grown in recent decades, but the role of individuals' intersecting identities in structuring social contexts to influence health remains unclear. Building on an existing intersectionality framework, we conceptualize how this may occur through social relationships. Then, we apply this framework to analyze whether adolescent peer social contextual disadvantage influences life-course obesity heterogeneously by individual gender, race, and early-life income. We take a life course approach as adolescence is a sensitive period for both social development and adult obesity development. In our analysis, we use cohort data from the National Longitudinal Study of Adolescent to Adult Health and leverage quasi-experimental variation in adolescent peers to addresses common sources of bias in prior observational studies. We find that among Black men from lower-income households in adolescence, there is a strong negative relationship between adolescent peer economic disadvantage and adult obesity that strengthens over time. By contrast, among Black women across adolescent household income levels, we find a strong positive relationship between adolescent peer economic disadvantage and obesity that emerges as women leave high school and endures into mid-adulthood. Among non-Black women, a more modest positive relationship appears between peer disadvantage and obesity. Among non-Black men, we find no relationship. These diverging patterns suggest that the pathways through which adolescent peer economic disadvantage influences health may differ or produce differential effects based on intersecting race, gender, and socioeconomic identities. Such heterogenous effects offer new insights, and future directions, for better understanding social life-course determinants of adult health and addressing inequities.

The association between lunch composition and obesity in Iranian adults

We aimed to assess the dietary composition of lunch meal using a posteriori-derived dietary patterns and to determine the association of lunch composition with obesity in a sample of Iranian adults. This cross-sectional study was conducted on 850 men and women in Tehran (aged 20-59 years). Dietary intakes were assessed using three 24-h dietary recalls, and dietary patterns were identified via principal component factor analysis. For each identified pattern, scores were calculated for each participant and then classified into tertiles. Central obesity was defined WHO criteria. General obesity was defined as a BMI of more than 30 kg/m2. Three major dietary patterns were identified at lunch meal using twelve food groups: 'Bread, grains and fat', 'Western' and 'Potato and eggs'. After adjustment for potential confounders, participants at the top tertile of the 'Bread, grains and fat' dietary pattern had greater odds for a higher waist-to-hip ratio (WHR), compared with those in the lowest tertile (OR: 1·44, 95 % CI 1·01, 2·07). However, we found no association between 'Western' or 'potato and eggs' patterns and WHR (OR: 0·89, 95 % CI 0·62, 1·28 and OR: 1·16, 95 % CI 0·69, 1·42, respectively). None of the identified dietary patterns was associated when defining obesity with waist circumference or BMI. In conclusion, participants had a greater chance of central obesity defined based on WHR following a lunchtime pattern with a higher and positive loading factor for 'Bread, grains and fat'.

Evaluation of body mass index and related lifestyle factors among 14-17-year-old Turkish adolescents

OBJECTIVE:

During adolescence, unhealthy body weight status is considered as a global concern as it may lead to adverse health consequences in adulthood, therefore evaluation of the risk factors is crucial. The aim of the study was to determine the prevalence of adolescents under the risk of being underweight, overweight, and obese among 14–17-year-old Turkish adolescents. In addition, we examined the association between unhealthy body weight categories and lifestyle factors.

METHODS:

This study was designed as cross-sectional study which included body weight status and associated parameters of 1561 adolescents aged between 14 and 17 who were registered 25 different high schools in Istanbul, Uskudar. Height and body weight of participants were measured and related factors were obtained through a questionnaire. Differences in distributions were analyzed using the Chi-square test and to control confounding factors, multivariate logistic regression analysis was performed. As statistical significance limit of p<0.05 was determined.

RESULTS:

Body mass index (BMI) percentile analyses indicated that 3.6% of participants were underweight, 14.3% were overweight, and 13.8% were obese. We demonstrated that age, gender, and school types were statistically very significantly associated with BMI (p<0.001) and daily meal frequency, eating speed, and mealtime regularity were significantly related with BMI (p<0.05). In addition, according to multivariate analysis results, gender and school types were closely related with obesity among 14–17-year old Turkish adolescents.

CONCLUSION:

This study has been demonstrated that frequency of adolescent obesity in Istanbul, Turkey, has increased and obesity closely related to gender and type of school. Further educational and interventional studies should be organized in this region with consideration of relevant risk factors.

Does Physical Activity Predict Obesity-A Machine Learning and Statistical Method-Based Analysis

BACKGROUND

Obesity prevalence has become one of the most prominent issues in global public health. Physical activity has been recognized as a key player in the obesity epidemic.

OBJECTIVES

The objectives of this study are to (1) examine the relationship between physical activity and weight status and (2) assess the performance and predictive power of a set of popular machine learning and traditional statistical methods.

METHODS

National Health and Nutrition Examination Survey (NHANES, 2003 to 2006) data were used. A total of 7162 participants met our inclusion criteria (3682 males and 3480 females), with average age ranging from 48.6 (normal weight) to 52.1 years old (overweight). Eleven classifying algorithms-including logistic regression, naïve Bayes, Radial Basis Function (RBF), local k-nearest neighbors (k-NN), classification via regression (CVR), random subspace, decision table, multiobjective evolutionary fuzzy classifier, random tree, J48, and multilayer perceptron-were implemented and evaluated, and they were compared with traditional logistic regression model estimates.

RESULTS

With physical activity and basic demographic status, of all methods analyzed, the random subspace classifier algorithm achieved the highest overall accuracy and area under the receiver operating characteristic (ROC) curve (AUC). The duration of vigorous-intensity activity in one week and the duration of moderate-intensity activity in one week were important attributes. In general, most algorithms showed similar performance. Logistic regression was middle-ranking in terms of overall accuracy, sensitivity, specificity, and AUC among all methods.

CONCLUSIONS

Physical activity was an important factor in predicting weight status, with gender, age, and race/ethnicity being less but still essential factors associated with weight outcomes. Tailored intervention policies and programs should target the differences rooted in these demographic factors to curb the increase in the prevalence of obesity and reduce disparities among sub-demographic populations.

Evaluation of the Role of Leisure Time Physical Activity and Sedentary Behavior Simultaneously on the Income-Overweight/Obesity Relationship

In the United States, overweight/obesity is more prevalent among those with low-income; higher income is related to greater leisure time physical activity (LTPA) and sedentary behavior (SB), which are inversely related to overweight/obesity. This study aimed to evaluate the role of LTPA and SB simultaneously in the income-overweight/obesity relationship. Cross-sectional data from the National Health and Nutrition Examination Survey (2007–2014) were utilized (n = 10,348 non-older adults (aged 20–59 years)). A multiple mediator structural equation model was conducted to evaluate the indirect effects from income to overweight/obesity (Body Mass Index ≥25 kg/m²) through LTPA and SB simultaneously, controlling for confounding variables, including diet, smoking, and alcohol consumption. As expected, greater income was negatively associated with overweight/obesity. Income indirectly influenced overweight/obesity through LTPA (Indirect effect: B = −0.005; CI = −0.01, −0.003), and through SB (Indirect effect: B = 0.008; CI = 0.005, 0.01), in opposing directions. The direct effect from income to overweight/obesity remained statistically significant. LTPA partially accounted for the negative relationship between income and overweight/obesity; SB reduced the strength of the negative relationship between income and overweight/obesity. Targeted behavior approaches for weight management may be beneficial. Increasing LTPA among adults with lower income and decreasing SB among adults with higher income may provide some overweight/obesity protection.

Trends of risk profile among middle-aged adults hospitalized for acute ischemic stroke in United States 2006-2017

BACKGROUND

Recent studies reported increasing trends in hospitalization of stroke patients aged 35-64 years.

AIM

To examine changes in risk factor profiles among patients aged 35-64 years hospitalized with acute ischemic stroke between 2006 and 2017 in the United States.

METHODS

We used data from the National Inpatient Sample of the Healthcare Cost and Utilization Project from 2006 through 2017. Principal ICD-9-CM/ICD-10-CM codes were used to identify acute ischemic stroke hospitalizations, and secondary codes were used to identify the presence of four major stroke risk factors: hypertension, diabetes, lipid disorders, and tobacco use. We used the relative percent change to assess the changes in the prevalence of risk profile between 2006-2007 and 2016-2017 and linear regression models to obtain the p values for the overall trends across six time periods.

RESULTS

Approximately 1.5 million acute ischemic stroke hospitalizations occurred during 2006-2017. The prevalence of having all four risk factors increased from 4.1% in 2006-2007 to 9.1% in 2016-2017 (relative percent change 122.0%, p < 0.001 for trend), prevalence of any three risk factors increased from 24.5% to 33.8% (relative percent change 38.0%, p < 0.001). Prevalence of only two risk factors decreased from 36.1% to 32.7% (p < 0.001), only one risk factor decreased from 25.2% to 18.1% (p < 0.001), and absence of risk factors decreased from 10.1% to 6.2% (p < 0.001). The most prevalent triad of risk factors was hypertension, diabetes, and lipid disorders (14.3% in 2006-2007 and 19.8% in 2016-2017), and the most common dyad risk factors was hypertension and lipid disorders (12.6% in 2006-2007 and 11.9% in 2016-2017).

CONCLUSIONS

The prevalence of hospitalized acute ischemic stroke patients aged 35-64 years with all four or any three of four major stroke risk factors increased by 122% and 38%, while those with only one risk factor or no risk factor has declined by 28% and 39%, respectively, from 2006 to 2017. Younger adults are increasingly at higher risk for stroke from preventable and treatable risk factors. This growing public health problem will require clinicians, healthcare systems, and public health efforts to implement more effective prevention strategies among this population.

Associations of socioeconomic status and lifestyle factors with dental neglect of elementary school children: the MEXT Super Shokuiku School Project

BACKGROUND

Despite the fact that there are parents who do not take children with untreated dental caries to a dental clinic, few studies have been conducted to identify the responsible underlying social and family factors. The aim of this study was to investigate whether socioeconomic status and lifestyle factors are associated with dental neglect in elementary school children.

METHODS

This study was conducted in 2016 with 1655 children from the Super Shokuiku School Project in Toyama. Using Breslow's seven health behaviors, the survey assessed: the grade, sex, and lifestyle of the children; parental internet and game use and lifestyle; socioeconomic status. The odds ratios (OR) and 95% confidence intervals (CIs) for having untreated dental caries were calculated using logistic regression analysis.

RESULTS

Among the children participating, 152 (3.2%) had untreated dental caries. Among them, 53 (34.9%) had not been taken to a dental clinic despite the school dentist's advice. Dental neglect was significantly associated with children in higher grades (OR, 2.08; 95% CI, 1.14-3.78), father's Internet and game use ≥ 2 h/day (OR, 1.99; 95% CI, 1.02-3.88), not being affluent (OR, 2.78; 95% CI, 1.14-6.81), and non-engagement in afterschool activities (OR, 1.99; 95% CI, 1.10-3.62).

CONCLUSIONS

Socioeconomic status was the strongest factor associated with dental neglect despite the fact that the children's medical expenses are paid in full by the National Health Insurance in Toyama, Japan. Future studies should investigate what factors prevent parents of non-affluent families from taking their children to dental clinics and how they can be socially supported to access adequate medical care.

The Genetic Basis of Obesity and Related Metabolic Diseases in Humans and Companion Animals

Obesity is one of the most prevalent health conditions in humans and companion animals globally. It is associated with premature mortality, metabolic dysfunction, and multiple health conditions across species. Obesity is, therefore, of importance in the fields of medicine and veterinary medicine. The regulation of adiposity is a homeostatic process vulnerable to disruption by a multitude of genetic and environmental factors. It is well established that the heritability of obesity is high in humans and laboratory animals, with ample evidence that the same is true in companion animals. In this review, we provide an overview of how genes link to obesity in humans, drawing on a wealth of information from laboratory animal models, and summarise the mechanisms by which obesity causes related disease. Throughout, we focus on how large-scale human studies and niche investigations of rare mutations in severely affected patients have improved our understanding of obesity biology and can inform our ability to interpret results of animal studies. For dogs, cats, and horses, we compare the similarities in obesity pathophysiology to humans and review the genetic studies that have been previously reported in those species. Finally, we discuss how veterinary genetics may learn from humans about studying precise, nuanced phenotypes and implementing large-scale studies, but also how veterinary studies may be able to look past clinical findings to mechanistic ones and demonstrate translational benefits to human research.

Unraveling the Genotype-Phenotype Relationship in Hypertrophic Cardiomyopathy: Obesity-Related Cardiac Defects as a Major Disease Modifier

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy and is characterized by asymmetric septal thickening and diastolic dysfunction. More than 1500 mutations in genes encoding sarcomere proteins are associated with HCM. However, the genotype‐phenotype relationship in HCM is incompletely understood and involves modification by additional disease hits. Recent cohort studies identify obesity as a major adverse modifier of disease penetrance, severity, and clinical course. In this review, we provide an overview of these clinical findings. Moreover, we explore putative mechanisms underlying obesity‐induced sensitization and aggravation of the HCM phenotype. We hypothesize obesity‐related stressors to impact on cardiomyocyte structure, metabolism, and homeostasis. These may impair cardiac function by directly acting on the primary mutation‐induced myofilament defects and by independently adding to the total cardiac disease burden. Last, we address important clinical and pharmacological implications of the involvement of obesity in HCM disease modification.

Food Security Challenges and Health Opportunities of Companion Animal Ownership for Low-Income Adults

PURPOSE

Do pets provide benefits or risks for low-income individuals in regards to food security?

METHOD

Surveys of food security were administered to 392 low-income adults utilizing food pantries. Data collection included a self-administered questionnaire about demographics, food security, health and well-being, and for those with pets, animal attachment, commitment and animal information. Qualitative interviews were conducted with fifteen pet-owning individuals who completed the questionnaire and agreed to be contacted and interviewed over the phone about food security and their pets.

RESULTS

Bivariate analyzes suggested that those with pets were more food secure and logistic regression found pet ownership associated with greater food security. The interviews suggest that pets assisted in creating a routine, and motivation for obtaining food.

DISCUSSION

It is critical that social workers realize the importance of pets in the lives of humans and include them in psychosocial assessments and as motivators for health interventions.

The effects of obesity on the human body, part I: Skin and musculoskeletal

Obesity is a worldwide issue that many global health authorities consider a growing epidemic. Having a positive correlation between increases in the industrialization of processed foods and sedentary occupations as well as a lack of access to healthcare in poorer socioeconomic areas, obesity is a multifactorial disease affecting several organ systems. The tendency for obesity to cause detrimental changes to the human body is a focal point for healthcare providers to establish more effective clinical treatment and management plans. Implementing comprehensive global educational programs to decrease the prevalence of this unforgiving disease is imperative for a healthier future. Herein, we have provided a comprehensive review of the health effects of obesity upon the human body for the interest of many practicing clinicians managing this health crisis.

A Reversal of the Association between Education Level and Obesity Risk during Ageing: A Gender-Specific Longitudinal Study in South Korea

This study aimed to examine and quantify obesity risk across different education levels during ageing using the dataset of a nationally representative longitudinal survey. A total of 45,391 observations of 9991 individuals aged ≥45 years were included in this study. Obesity was defined as a body mass index of ≥25, according to a guideline for Asians by the World Health Organization, and education level was grouped into three categories. Socio-demographics, lifestyles, and health conditions were used as covariates. Adjusted odds ratios and predicted probabilities of obesity were computed and adjusted for a complex survey design. With respect to gender, education level and age were significantly associated with obesity risk, and the association was stronger in women than in men. Furthermore, education level was negatively associated with obesity risk in the middle age in each gender. However, the association became positive in the old age, specifically among highly educated women. Therefore, policy efforts to reduce obesity risk and the resulting education gradients should be established based on studies considering their old age. Further longitudinal studies are required to examine whether these findings are valid in other socio-cultural or economic settings.

Racial Disparities in Incidence and Outcomes Among Patients With COVID-19

IMPORTANCE

Initial public health data show that Black race may be a risk factor for worse outcomes of coronavirus disease 2019 (COVID-19).

OBJECTIVE

To characterize the association of race with incidence and outcomes of COVID-19, while controlling for age, sex, socioeconomic status, and comorbidities.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study included 2595 consecutive adults tested for COVID-19 from March 12 to March 31, 2020, at Froedtert Health and Medical College of Wisconsin (Milwaukee), the largest academic system in Wisconsin, with 879 inpatient beds (of which 128 are intensive care unit beds).

EXPOSURES

Race (Black vs White, Native Hawaiian or Pacific Islander, Native American or Alaska Native, Asian, or unknown).

MAIN OUTCOMES AND MEASURES

Main outcomes included COVID-19 positivity, hospitalization, intensive care unit admission, mechanical ventilation, and death. Additional independent variables measured and tested included socioeconomic status, sex, and comorbidities. Reverse transcription polymerase chain reaction assay was used to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

RESULTS

A total of 2595 patients were included. The mean (SD) age was 53.8 (17.5) years, 978 (37.7%) were men, and 785 (30.2%) were African American patients. Of the 369 patients (14.2%) who tested positive for COVID-19, 170 (46.1%) were men, 148 (40.1%) were aged 60 years or older, and 218 (59.1%) were African American individuals. Positive tests were associated with Black race (odds ratio [OR], 5.37; 95% CI, 3.94-7.29; P = .001), male sex (OR, 1.55; 95% CI, 1.21-2.00; P = .001), and age 60 years or older (OR, 2.04; 95% CI, 1.53-2.73; P = .001). Zip code of residence explained 79% of the overall variance in COVID-19 positivity in the cohort (ρ = 0.79; 95% CI, 0.58-0.91). Adjusting for zip code of residence, Black race (OR, 1.85; 95% CI, 1.00-3.65; P = .04) and poverty (OR, 3.84; 95% CI, 1.20-12.30; P = .02) were associated with hospitalization. Poverty (OR, 3.58; 95% CI, 1.08-11.80; P = .04) but not Black race (OR, 1.52; 95% CI, 0.75-3.07; P = .24) was associated with intensive care unit admission. Overall, 20 (17.2%) deaths associated with COVID-19 were reported. Shortness of breath at presentation (OR, 10.67; 95% CI, 1.52-25.54; P = .02), higher body mass index (OR per unit of body mass index, 1.19; 95% CI, 1.05-1.35; P = .006), and age 60 years or older (OR, 22.79; 95% CI, 3.38-53.81; P = .001) were associated with an increased likelihood of death.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of adults tested for COVID-19 in a large midwestern academic health system, COVID-19 positivity was associated with Black race. Among patients with COVID-19, both race and poverty were associated with higher risk of hospitalization, but only poverty was associated with higher risk of intensive care unit admission. These findings can be helpful in targeting mitigation strategies for racial disparities in the incidence and outcomes of COVID-19.

Identifying subgroups of age and cohort effects in obesity prevalence

The obesity epidemic represents an important public health issue in the United States. Studying obesity trends across age groups over time helps to identify crucial relationships between the disease and medical treatment allowing for the development of effective prevention policies. We aim to define subgroups of age and cohort effects in obesity prevalence over time by considering an optimization approach applied to the age-period-cohort (APC) model. We consider a heterogeneous regression problem where the regression coefficients are age dependent and belong to subgroups with unknown grouping information. Using the APC model, we apply the alternating direction method of multipliers (ADMM) algorithm to develop a two-step algorithm for (1) subgrouping of cohort effects based on similar characteristics and (2) subgrouping age effects over time. The proposed clustering approach is illustrated for the United States population, aged 18-79, during the period 1990-2017.

Factors contributing to educational differences in obesity among women: evidence from South Korea

Background

Obesity is more prevalent among less-educated women than highly-educated women around the world. However, little is known about the factors which cause this difference in obesity, and almost nothing is known about how the individual factors which explain differences in education among women alone contribute to obesity. In this study, we identified the factors which help explain the relationship between education and obesity in women, and quantified their separate contributions to obesity.

Methods

We analyzed information on 14,577 women aged 25 years or over using datasets from the Korea National Health and Nutrition Examination Survey (2010–2014). We divided the women into two education groups: women who had, at most, finished high school (less-educated women), and women who had college degrees and beyond (highly-educated women). Using an extended Oaxaca-Blinder method, we decomposed the difference in obesity prevalence between the two education groups into the contributions (%) due to two effects: composition effect and association effect.

Results

Obesity was more than twice as prevalent among the less-educated women (34.3%) than it was among the highly-educated women (16.0%). The composition effect—contribution of differences in the distribution of observed characteristics compared to that of the difference in obesity prevalence between the two education groups—was 38.2%. The association effect—contributions of differences in the estimated coefficients of characteristics compared to that of the difference in obesity prevalence between the two education groups—was 55.8%, of which lifestyle factors were the most important contributor (43.6%). Of the separate contributions of each factor, the association effect of the factor related to women’s stress exhibited the largest contribution (23.0%).

Conclusion

We suggest that to effectively mitigate the high prevalence of obesity among less-educated women, it may be necessary to help low-educated women who do not feel stressful develop strategies to combat their higher risk of obesity. We also suggest the need to conduct decomposition studies in countries which show significant relationships between education and obesity among women, and to create targeted policies to reduce this population’s overall risk of obesity.

Enrollment Challenges: Recruiting Men to Weight Loss Interventions

Obese men are at an increased risk of chronic disease and are far less likely than women to attempt weight loss. There is a need to successfully recruit men to weight loss clinical trials. Overweight and obese men were recruited to a 6-month, randomized, controlled weight loss trial. Initial recruitment efforts were aimed at men in the workplace with less than or equal to 2 years of college education. After unsatisfactory interest from men and businesses alike, recruitment strategy shifted to enroll men outside the workplace with any educational background. Recruitment methods included word of mouth, email and website advertisements, printed posters in local businesses and doctors’ offices, Facebook ads, and a 1-week newspaper ad campaign. Initial interest and enrollment was negligible with only 35 men enrolled in the first 7 months. The launch of a 1-week newspaper advertisement was the most useful recruitment technique and 102 overweight/obese men were successfully enrolled. Study retention remained high throughout the Gutbusters program, indicating targeted, effective recruitment, and not weight loss interest, may be the largest barrier to trial participation for overweight and obese men.

Decreased Mitochondrial Dynamics Is Associated with Insulin Resistance, Metabolic Rate, and Fitness in African Americans

CONTEXT

African American women (AAW) have a higher incidence of insulin resistance and are at a greater risk for the development of obesity and type 2 diabetes than Caucasian women (CW). Although several factors have been proposed to mediate these racial disparities, the mechanisms remain poorly defined. We previously demonstrated that sedentary lean AAW have lower peripheral insulin sensitivity, reduced maximal aerobic fitness (VO2max), and lower resting metabolic rate (RMR) than CW. We have also demonstrated that skeletal muscle mitochondrial respiration is lower in AAW and appears to play a role in these racial differences.

OBJECTIVE

The goal of this study was to assess mitochondrial pathways and dynamics to examine the potential mechanisms of lower insulin sensitivity, RMR, VO2max, and mitochondrial capacity in AAW.

DESIGN

To achieve this goal, we assessed several mitochondrial pathways in skeletal muscle using gene array technology and semiquantitative protein analysis.

RESULTS

We report alterations in mitochondrial pathways associated with inner membrane small molecule transport genes, fusion-fission, and autophagy in lean AAW. These differences were associated with lower insulin sensitivity, RMR, and VO2max.

CONCLUSIONS

Together these data suggest that the metabolic racial disparity of insulin resistance, RMR, VO2max, and mitochondrial capacity may be mediated by perturbations in mitochondrial pathways associated with membrane transport, fission-fusion, and autophagy. The mechanisms contributing to these differences remain unknown.

Mechanical adaptations of skinned cardiac muscle in response to dietary-induced obesity during adolescence in rats

Childhood obesity is a major risk factor for heart disease during adulthood, independent of adulthood behaviours. Therefore, it seems that childhood obesity leads to partly irreversible decrements in cardiac function. Little is known about how obesity during maturation affects the mechanical properties of the heart. The purpose of this study was to evaluate contractile properties in developing hearts from animals with dietary-induced obesity (high-fat high-sucrose diet). We hypothesized that obesity induced during adolescence results in decrements in cardiac contractile function. Three-week-old rats (n = 16) were randomized into control (chow) or dietary-induced obesity (high-fat high-sucrose diet) groups. Following 14 weeks on the diet, skinned cardiac trabeculae fibre bundle testing was performed to evaluate active and passive force, maximum shortening velocity, and calcium sensitivity. Rats in the high-fat high-sucrose diet group had significantly larger body mass and total body fat percentage. There were no differences in maximal active or passive properties of hearts between groups. Hearts from the high-fat high-sucrose diet rats had significantly slower maximum shortening velocities and lower calcium sensitivity than controls. Decreased shortening velocity and calcium sensitivity in hearts of obese animals may constitute increased risk of cardiac disease in adulthood. Novelty Cardiac muscle from animals exposed to an obesogenic diet during development had lower shortening velocity and calcium sensitivity than those from animals fed a chow diet. These alterations in mechanical function may be a mechanism for the increased risk of cardiac disease observed in adulthood.

It's the fiber, not the fat: significant effects of dietary challenge on the gut microbiome

BACKGROUND

Dietary effects on the gut microbiome play key roles in the pathophysiology of inflammatory disorders, metabolic syndrome, obesity, and behavioral dysregulation. Often overlooked in such studies is the consideration that experimental diets vary significantly in the proportion and source of their dietary fiber. Commonly, treatment comparisons are made between animals fed a purchased refined diet that lacks soluble fiber and animals fed a standard vivarium-provided chow diet that contains a rich source of soluble fiber. Despite the well-established critical role of soluble fiber as the source of short chain fatty acid production via the gut microbiome, the extent to which measured outcomes are driven by differences in dietary fiber is unclear. Further, the interaction between sex and age in response to dietary transition is likely important and should also be considered.

RESULTS

We compared the impact of transitioning young adult and 1-year aged male and female mice from their standard chow diet to a refined low soluble fiber diet on gut microbiota community composition. Then, to determine the contribution of dietary fat, we also examined the impact of transitioning a subset of animals from refined low-fat to refined high-fat diet. We used a serial sampling strategy coupled with 16S rRNA marker gene sequencing to examine consequences of recurrent dietary switching on gut microbiota community dynamics. Analysis revealed that the transition from a chow diet to a refined diet that lacks soluble fiber accounted for most of the variance in community structure, diversity, and composition across all groups. This dietary transition was characterized by a loss of taxa within the phylum Bacteroidetes and expansion of Clostridia and Proteobacteria in a sex- and age-specific manner. Most notably, no changes to gut microbiota community structure and composition were observed between mice consuming either refined low- or high-fat diet, suggesting that transition to the refined diet that lacks soluble fiber is the primary driver of gut microbiota alterations, with limited additional impact of dietary fat on gut microbiota.

CONCLUSION

Collectively, our results show that the choice of control diet has a significant impact on outcomes and interpretation related to diet effects on gut microbiota. As the reduction of soluble fiber may influence synthesis of microbial metabolites that are important for regulating metabolic, immune, behavioral, and neurobiological outcomes, additional studies are now needed to fully delineate the contribution of fat and fiber on the gut microbiome. Video Abtract.

Longitudinal Study of Maternal BMI in Successive Pregnancies

OBJECTIVE

This longitudinal observational study examined BMI changes between successive pregnancies.

METHODS

The computerized medical records of women who attended a large maternity hospital between 2009 and 2017 for their first and second singleton deliveries were analyzed. Women who had their weight first measured after 15 weeks of gestation in either pregnancy were excluded.

RESULTS

Of the 9,724 women, the incidence of obesity increased from 11.6% in the first pregnancy to 16.0% in the second. The mean interpregnancy interval was 32.5 ± 15.7 months, and median BMI change was +0.6 kg/m² (interquartile range 2.2; P < 0.001). Overall, 10.3% (1,006/9,724) developed overweight and 5.9% (571/9,724) developed obesity by the second pregnancy. Of the nulliparas in the overweight category, 20.6% (526/2,558) entered the obesity category. The development of obesity by the second pregnancy was independently associated with a longer interpregnancy interval, formula feeding at hospital discharge, taking antidepressants or anxiolytics, and postnatal depression. Professional/managerial employment was associated with a lower odds ratio of developing obesity.

CONCLUSIONS

Maternal obesity increased between the first and second pregnancy, with one-fifth of nulliparas in the overweight category developing obesity. Pregnancy-related factors were identified as predictors of developing obesity. Further research is needed to assess whether interventions targeting these related factors could optimize maternal weight management between pregnancies.

Prevalence of healthy and unhealthy food and beverage price promotions and their potential influence on shopper purchasing behaviour: A systematic review of the literature

Policies to restrict unhealthy food and beverage price promotions have been recommended, as part of a broader strategy to reduce obesity, but little evidence underpins such recommendations. We aimed to synthesize the literature on the prevalence of healthy and unhealthy food and beverage price promotions and their potential influence on purchasing behaviour. Eight scientific databases (covering health, business, and marketing) and grey literature were systematically searched using search terms related to "food and beverage price promotions" up until July 2019. Articles were included if they examined prevalence of, and/or consumer response to, food and non-alcoholic beverage price promotions, from a nutritional perspective. Of the 16 included studies, eight examined the prevalence of price promotions and eight examined the potential influence of price promotions on purchasing behaviour. Seven of the "prevalence" studies found that price promotions were more common for unhealthy foods and beverages. Seven "influence" studies found a greater proportion of price-promoted purchases were for unhealthy compared with healthy products. Policies that reduce the prevalence and/or influence of price promotions on unhealthy foods and beverages may shift consumer purchasing away from unhealthy foods and beverages. Empirical studies are required to better understand how consumers and industry may respond to such policies.

Relationship between psychological stress and metabolism in morbidly obese individuals

BACKGROUND

Despite evidence for a bidirectional relationship between obesity and stress-related mental disorders, the general relationship between psychological stress and metabolism is still controversial. Only few studies have addressed this relationship in morbidly obese individuals.

METHODS

The present study investigated the relationship between psychological distress, health-related quality of life (HRQL), eating behavior, negative emotions and body mass index (BMI), body composition and biomedical parameters of metabolism in an adult sample of 123 (94 females) morbidly obese individuals.

RESULTS

No significant relationship was found between psychological distress and BMI, body composition or any of the parameters of metabolism; however, there was a strong and robust association between HRQL in the physical domain and BMI, body composition and several biomedical parameters of sugar and fat metabolism. The results also showed an interesting dissociation in the relationship between BMI and HRQL in the physical and psychology domains. Only little evidence was found for a relationship between eating behavior (e.g. restraint) or negative emotions (e.g. anger) and BMI, body composition and parameters of metabolism. There was, however, a significant gender difference in restraint eating. Other commonly reported gender differences in BMI, body composition, fat metabolism and liver values were also observed in this sample of morbidly obese individuals.

CONCLUSION

Results from the present study highlight the relationship between HRQL in the physical domain and metabolism. Implications of these findings for weight loss treatment are discussed, emphasizing HRQL as an important treatment goal and the need for long-term psychological monitoring.

A scoping review and systematic mapping of health promotion interventions associated with obesity in Islamic religious settings in the UK

Islamic religious settings (IRS) may be useful places to implement obesity interventions for Muslims. However, little is known about the level and nature of such activity in these settings. We searched bibliographic databases and grey literature, and requested grey information from Muslim organizations, local councils, and mosques in 13 selected areas in the United Kingdom. Thirty-five interventions were identified; most were poorly described and not evaluated. Twenty-seven interventions focused on physical activity behaviours, four on diet behaviours, one on both behaviours, and seven addressed long-term conditions associated with obesity. Most interventions were led by volunteers from the congregation/faith leaders and were funded through donations from congregants or charity organizations. The evidence suggests that health promotion interventions in IRS have a relatively high reach. Obesity interventions are commonly delivered in UK IRS. Most target physical activity behaviours, are instigated and led by volunteers from the congregation or faith leaders, receive no public funding, and are only recorded in people's memories. High-quality evaluations of well-specified interventions in this context are needed. We suggest that the methods used in this review, including the learning around positionality of researchers, could be adopted by other researchers as a way to locate opportunities for effective community-level interventions.

Parent-directed intervention in promoting knowledge of pediatric nutrition and healthy lifestyle among low-SES families with toddlers: A randomized controlled trial

OBJECTIVE

The objective of this study is to determine the efficacy of an interactive, home visiting curriculum tailored to low socio-economic status families in improving parental knowledge of paediatric nutrition and healthy lifestyle.

METHODS

Parents of toddlers aged 13-16 months living with a household income below 200% of the federal poverty line were randomized into healthy lifestyle intervention and control home visiting curriculum groups. Each curriculum consisted of 12 one-on-one educational sessions with parents facilitated by a trained home-visitor that were administered over a 6-month intervention period. Knowledge assessments were administered before and after the intervention period.

RESULTS

Results of a one-way analysis of covariance (ANCOVA) analysis showed that parents in the intervention group (M = 26.05, SD = 4.24) scored significantly higher than control parents (M = 23.84, SD = 4.26) post-intervention, controlling for parent education level, F(1, 102) = 7.494 (95% confidence interval [-3.68, -0.59]). One-way ANCOVA analysis showed no significant mean difference between the parents in the intervention group (M = 24.13, SD = 4.37) and the control group (M = 23.93, SD = 4.16) at baseline, controlling for parent education level, F(1, 163) = 0.002 (95% confidence interval [-1.28, 1.22]).

CONCLUSIONS

An interactive healthy lifestyle intervention focused on low-SES families significantly improved parental knowledge of paediatric healthy lifestyle. Changes in parental knowledge is a key preliminary step in behaviour change to ultimately affect behaviour. Informing and encouraging parents of toddlers to guide healthy lifestyle development early remains a promising point of intervention for prevention, rather than remediation, of childhood obesity.

Differential Influence of Weight Status on Chronic Diseases by Reported Sexual Orientation Identity in Men

PURPOSE

This study examined whether the association between weight status and four chronic diseases (heart disease, hypertension, lifetime asthma, and type 2 diabetes) varied according to sexual orientation identity among adult men, controlling for demographic, socioeconomic, and other factors.

METHODS

Pooled data from male adult participants (n = 72,214) in the 2003-2012 California Health Interview Survey were used along with logistic regression models to estimate whether the associations between weight status and chronic diseases varied by sexual orientation identity.

RESULTS

Weight status was positively associated with each of the chronic diseases (hypertension, heart disease, asthma, and diabetes) among both gay and bisexual men and heterosexual men; however, the associations varied significantly by sexual orientation identity. Among gay and bisexual men, the associations were stronger and statistically significant-with the exception of lifetime asthma-particularly for men in the obese classifications, before and after controlling for age, marital status, race/ethnicity, education, income, health insurance status, food security level, smoking, and nativity.

CONCLUSIONS

Weight status had stronger detrimental associations with chronic disease among gay and bisexual men despite these men having greater socioeconomic advantage and lower body mass index than heterosexual men. Future research should examine mechanisms, including stress related to minority status, which may lead to greater risks for chronic diseases among sexual minority men.

Role of astroglia in diet-induced central neuroplasticity

Obesity, characterized by increased adiposity that develops when energy intake outweighs expenditure, is rapidly becoming a serious health crisis that affects millions of people worldwide and is associated with severe comorbid disorders including hypertension, cardiovascular disease, and type II diabetes. Obesity is also associated with the dysregulation of central neurocircuits involved in the control of autonomic, metabolic, and cognitive functions. Systemic inflammation associated with diet-induced obesity (DIO) has been proposed to be responsible for the development of these comorbidities as well as the dysregulation of central neurocircuits. A growing body of evidence suggests, however, that exposure to a high-fat diet (HFD) may cause neuroinflammation and astroglial activation even before systemic inflammation develops, which may be sufficient to cause dysregulation of central neurocircuits involved in energy homeostasis before the development of obesity. The purpose of this review is to summarize the current literature exploring astroglial-dependent modulation of central circuits following exposure to HFD and DIO, including not only dysregulation of neurocircuits involved in energy homeostasis and feeding behavior, but also the dysregulation of learning, memory, mood, and reward pathways.

Application of the Marginal Beta-Binomial Model in Estimation the Overall Odds of Obesity Among Iranian Adults: Meta-Analysis Method

CONTEXT

To obtain accurate and reliable estimation of overall obesity odds ratio (OR) a statistical method is needed to be designed to account for heterogeneity among studies. The marginal beta-binomial model is a new method with attractive features that make it robust for meta-analysis.

OBJECTIVES

The aim of this study is the estimation of overall obesity OR among Iranian adults with particularly attention to age, sex, place of residence, and smoking status.

DATA SOURCES

We systematically reviewed all studies regarding obesity in Iranian adults in national and international journals that are published between 1990 and 2017, including PubMed, Scopus, SID, Google Scholar, Magiran, and IranMedex. The R software was used for data analysis and obtaining overall obesity OR using the marginal beta-binomial model.

RESULTS

A total of 18 studies, with a sample size of 258283, were included in our analysis. Results showed that increasing age, female sex, and residence in urban areas increases the odds of obesity. Using the age group 20 - 30 years as the reference, the overall obesity ORs for 30 - 40, 40 - 50, 50 - 60, and 60+ years were 2.13, 3.33, 3.15, and 2.33, respectively. The overall obesity OR for women was 2.35, compared with men. The estimated odds of obesity were 53% higher for urban adults. Smoking has a negative effect on obesity; the OR of obesity for smokers was 0.48 compared with non-smokers.

CONCLUSION

Consistent results in our research can be used as a basis to reinforce health programs for prevention and treatment of obesity in Iran.