The definition of weight maintenance

Poor Activities of Daily Living Predict Future Weight Loss in Older Adults After Hospital Discharge-Secondary Analysis of a Randomized Trial

This study examined whether participants with poor activities of daily living (ADLs) at hospital discharge had increased weight loss after 6 months of follow-up and whether nutrition therapy can prevent this weight loss. This dietary randomized controlled trial (N = 104) examined community-dwelling older adults (66-95 years) discharged from hospital and at risk for malnutrition, receiving either 6 months of nutrition therapy (intervention) or only standard care (control). ADL was assessed using seven questions on self-care based on the Katz et al.'s method. At discharge, 45 (43%), 36 (35%), and 23 (22%) had high, medium, and poor ADL, respectively, with no differences between the control and intervention groups according to chi-square test. Participants in the control group with poor ADL had significantly higher weight loss than participants with high ADL (age- and sex-adjusted analysis of covariance: 3.6 kg; 95% confidence interval [1.0, 6.1] kg, p = .007). No such difference was observed in the intervention group. Participants with poor ADL at hospital discharge develop lower body weight by around 3.5 kg 6 months later when compared with participants with high ADL. Receiving nutrition therapy could help older adults with poor ADL to maintain body weight after hospital discharge.

Fruit and vegetable intake modifies the association between ultra-processed food and metabolic syndrome

BACKGROUND

This prospective cohort study aimed to investigate the association between ultra-processed food (UPF) and the risk of metabolic syndrome (MetS), as well as to assess whether fruit and vegetable intake and weight change modify this association.

METHODS

We included 1915 healthy participants who participated in the Tehran Lipid and Glucose Study (TLGS), all of whom had complete demographic, anthropometric, and dietary measurements. A validated food frequency questionnaire was used to assess UPF consumption based on the NOVA classification system. MetS was defined according to the Joint Interim Statement. Multivariable adjusted Cox regression was used to estimate hazard ratios (HRs) for MetS events across tertiles of UPF. The effect of fruit and vegetable consumption and weight change on this association was assessed using joint classification by Cox regression.

RESULTS

UFP consumption showed no association with MetS risk after adjusting for confounders. However, after adjustment for dietary fiber, fruits, and vegetables, the highest tertile of UPF consumption was positively linked to MetS risk, compared to the lowest tertile. There was a significant interaction between fruit, vegetable, and dietary fiber intake and UPF consumption concerning the risk of MetS (All P values < 0.05). Among individuals consuming less than 248 g/day of fruit, the risk of MetS increased by 54% (confidence interval: 1.13-2.10) in the highest UPF tertile. Consuming vegetables and dietary fiber below the median (258 g/day and 42.2 g/day, respectively) increased the risk of MetS in the third tertile of UPF. However, consuming vegetables and fiber ≥ median intake, reduced the risk of MetS among those with the lowest UPF consumption. Furthermore, the risk of MetS was observed in the third tertile of UPF consumption among individuals with fruit and vegetable consumption < 537 g/day. UPF consumption was not associated with the risk of MetS in different weight change statuses.

CONCLUSIONS

Consuming more fruits and vegetables mitigated the adverse effect of UPF on the risk of developing MetS.

No Effect of Breakfast Consumption Observed for Afternoon Resistance Training Performance in Habitual Breakfast Consumers and Nonconsumers: A Randomized Crossover Trial

BACKGROUND

Pre-exercise meal frequency is commonly believed to impact exercise performance, but little is known about its impact on resistance training.

OBJECTIVE

This study investigated the impact of breakfast consumption on afternoon resistance training performance in habitual breakfast consumers and nonconsumers.

DESIGN

A randomized, crossover study was conducted in Lubbock, TX between November 2021 and May 2022.

PARTICIPANTS

Thirty-nine resistance-trained male (n = 20) and female (n = 19) adults (mean ± SD age 23.0 ± 4.7 years) who habitually consumed (≥5 d/wk; n = 19) or did not consume (≥5 d/wk; n = 20) breakfast completed the study.

INTERVENTION

After the establishment of 1-repetition maximums at the first visit, participants completed 2 additional visits, each of which included 4 sets of barbell back squat, bench press, and deadlift, using 80% of their 1-repetition maximum after either consuming breakfast and lunch or the same food at lunch only.

MAIN OUTCOME MEASURES

Repetitions, along with average and peak average concentric velocity and power, were measured for all repetitions throughout each exercise session. Visual analog scales were used to assess feelings of fatigue, energy, focus, hunger, desire to eat, and fullness throughout each exercise session.

STATISTICAL ANALYSES PERFORMED

Data were analyzed using linear mixed-effects models.

RESULTS

No interactions or main effects involving condition or habitual breakfast consumption were observed for resistance training outcomes, although sex differences were noted. Male participants performed significantly fewer repetitions on sets 2, 3, and 4 (P < .014) for total repetitions, on sets 2 and 4 for barbell back squat (P < .023), and set 4 for deadlift (P = .006), with no observed differences between sexes for bench press repetitions. Male participants displayed reductions in average power across all sets and exercises except deadlift.

CONCLUSIONS

These data suggest that alterations in pre-exercise meal frequency may not influence afternoon resistance training performance provided similar total nutritional intake is consumed.

Long-term effects of a lifestyle modification program for men with obesity delivered in German football clubs

This study examined the long-term effects of a lifestyle modification program delivered at German Bundesliga football clubs. Weekly 90-minute group sessions over 12 weeks combined health education and physical activity and were delivered by coaches affiliated with the football clubs. A total of 371 men (mean age 49.7 years [SD = 7.6]) attended 41 classes at 19 clubs in 2017 and 2018 and participated in the long-term follow-up. Primary outcome was weight-loss at follow-up with a mean observation period of 20.4 months after baseline. Measures were taken partly by research staff and partly by participants themselves. At baseline, the men had a mean weight of 111.3 kg (SD = 16.9). Three months after baseline (posttest), the men had lost a mean of 6.3 kg (95% CI: 5.7-6.9). From posttest to follow-up, growth curve model showed men lost an average of 0.8 kg (95% CI: 0.2-1.4). Weight regain from posttest to follow-up of at least 3% was observed in 75 participants (20.2%) and was associated with less improvement in vegetable consumption in an adjusted logistic regression model. The data suggest that participation in a male-only lifestyle modification program offered by German football clubs may lead to sustained weight loss, but lack of a randomized control group and drop-outs prevent generalization of the results.

Influence of Body Weight Measurement Frequency on the Bone Health of Female Athletes

Purpose: Athletes struggle with bone stress injuries despite the many risk factors reported in previous studies. However, the relationship between body weight measurement frequency and risk of stress fractures has yet to be investigated. Thus, the purpose of this study is to seek the link between body weight measurement frequency and the occurrence of stress fractures. Method: This cross-sectional study included female athletes who were requested to fill out an anonymous online survey regarding their personal background, including the history of amenorrhea and stress fractures. In addition, the frequency at which they measured their body weight and composition and whether they had to report the same to their coaches and seniors were asked. Results: A total of 172 collegiate female athletes for 28 different types of sports participated in this study. Among the included athletes, 35.7% had a history of amenorrhea, whereas 29.7% had a history of stress fractures. A total of 57.0% of the athletes answered that in their team, they measure their body weight on a regular basis, and 33.1% of the athletes answered that they reported the data to their coaches. Logistic regression analysis revealed that those who measured their body weight at least once a day had a higher risk of sustaining stress fractures than did those who measured their body weight less than once a day (OR = 2.36, 95% CI 1.06-5.27, p = .04). Conclusion: Body weight measurement frequency was associated with the risk of stress fractures in female collegiate athletes.

Calorie restriction-induced leptin reduction and T-lymphocyte activation in blood and adipose tissue in men with overweight and obesity

BACKGROUND

T-Lymphocyte activation is modulated by the adipokine leptin and serum concentrations of this hormone can be reduced with short-term calorie restriction. The aim of this study was to understand whether leptin per se is important in determining levels of T-lymphocyte activation in humans, by investigating whether the reduction in leptin concentration following calorie restriction is associated with a decrease in T-Lymphocyte activation in blood and adipose tissue.

METHODS

Twelve men with overweight and obesity (age 35-55 years, waist circumference 95-115 cm) reduced their calorie intake by 50% for 3 consecutive days. Blood and subcutaneous adipose tissue were obtained for isolation of immune cells and cytokine analysis. CD4+ and CD8 + T-Lymphocytes were identified and characterised according to their expression of activation markers CD25 and CD69 by flow cytometry.

RESULTS

Serum leptin was reduced by (mean ± SEM) 31 ± 16% (p < 0.001) following calorie restriction. The percentage of blood CD4 + CD25 + T-lymphocytes and level of CD25 expression on these lymphocytes were significantly reduced by 8 ± 10% (p = 0.016) and 8 ± 4% (p = 0.058), respectively. After calorie restriction, ex vivo leptin secretion from abdominal subcutaneous adipose tissue explants was not changed, and this corresponded with a lack of change in adipose tissue resident T-Lymphocyte activation.

CONCLUSIONS

Serum leptin was reduced after calorie restriction and this was temporally associated with a reduction in activation of blood CD4 + CD25 + T-Lymphocytes. In abdominal subcutaneous adipose tissue, however, leptin secretion was unaltered, and there were no observed changes in adipose resident T-Lymphocyte activation.

Weight change and risk of incident type 2 diabetes: short, medium and long-term follow-up in tehran lipid and glucose study

BACKGROUND

Despite the high burden of obesity and Type 2 diabetes (T2DM) in the Middle East/West Asia region, the effect of weight change on the development of T2DM is poorly addressed. Therefore, we aimed to assess the impact of 3-year body weight change on incident of T2DM over 3-, 6-, and 9-year periods among Iranian adults.

METHODS

A total of 6930 participants (men = 2567) aged ≥ 20 years free of T2DM or cancer at baseline were included. Weight measurements were taken at baseline (2002-2005) and approximately 3 years later. Participants were categorized based on their weight change ratio into  ≥ 5% loss, stable (± 5%), and ≥ 5% gain. Generalized estimating equations (GEE), adjusted with age, sex, education levels, baseline measurements of fasting plasma glucose, weight, waist circumference, triglycerides to high-density lipoprotein cholesterol ratio, family history of diabetes, current smoker, hypertension, and prevalent cardiovascular disease were applied to estimate the Odds ratios (ORs) and 95% confidence intervals (CIs) of weight change categories for incident T2DM, considering stable weight as a reference.

RESULTS

During median follow-ups of 3-, 6-, and 9-year, 295, 505, and 748 cases of T2DM occurred, respectively. Weight gain of ≥ 5%, as compared to stable weight group (± 5%), was associated with increased T2DM risk, with ORs of 1.58 (95% CI 1.16-2.14), 1.76 (1.41-2.20), and 1.70 (1.40-2.05) for the 3-, 6-, and 9-year follow-ups, respectively, in multivariable analysis; corresponding values for weight loss ≥ 5% were 0.48 (0.29-0.80), 0.57 (0.40-0.81), and 0.51 (0.38-0.68), respectively. This association persisted even after adjusting for attained weight. Subgroup analysis showed consistent associations across age, gender, and body mass index categories.

CONCLUSION

Weight gain and loss of ≥ 5% were associated with increased and decreased risks of incident T2DM, respectively, regardless of attained weight. This association was consistent over various follow-up durations among the Iranian population as recommended by guidelines.

Use of online food retail platforms throughout the COVID-19 pandemic and associated diet-related chronic disease risk factors: A systematic review of emerging evidence

Food accessibility was considerably impacted by restrictions during the coronavirus disease 2019 (COVID-19) pandemic, leading to growth in the online food retail sector, which offered contact-free delivery. This systematic review aimed to assess the change in use of online food retail platforms during COVID-19. The secondary aim was to identify diet-related chronic disease risk factors including dietary intake, eating behaviors, and/or weight status associated with the use of online food retail platforms during the pandemic. The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022320498) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Nine electronic databases were searched between January 2020 and October 2023. Studies that reported the frequency or change in use of online groceries, meal delivery applications, and/or meal-kit delivery services before and during the pandemic were included. A total of 53 studies were identified, including 46 cross-sectional studies, 4 qualitative studies, 2 longitudinal cohort studies, and 1 mixed-methods study. Overall, 96% (43/45) of outcomes showed an increase in the use of online groceries during COVID-19, while 55% (22/40) of outcomes showed a decrease in meal delivery applications. Eight of nine outcomes associated the use of online food retail with weight gain and emotional eating. Further research is needed to investigate the links between online food retail and obesity.

Childhood obesity prevention trials: A systematic review and meta-analysis on trial design and the impact of type 1 error

Effect sizes from previously reported trials are often used to determine the meaningful change in weight in childhood obesity prevention interventions because information on clinically meaningful differences is lacking. Estimates from previous trials may be influenced by statistical significance; therefore, it is important that they have a low risk of type 1 error. A systematic review and meta-analysis were conducted to report on the design of child obesity prevention randomized controlled trials and effectiveness according to risk of type 1 error. Eighty-four randomized controlled trials were identified. A large range of assumptions were applied in the sample size calculations. The most common primary outcome was BMI, with detectable effect size differences used in sample size calculations ranging from 0.25 kg/m2 (followed up at 2 years) to 1.1 kg/m2 (at 9 months) and BMI z-score ranging from 0.1 (at 4 years) to 0.67 (at 3 years). There was no consistent relationship between low risk of type 1 error and reports of higher or lower effectiveness. Further clarity of the size of a meaningful difference in weight in childhood obesity prevention trials is required to support evaluation design and decision-making for intervention and policy. Type 1 error risk does not appear to impact effect sizes in a consistent direction.

Impact of a digital employer-based weight loss program on individuals age 65 or older

Introduction

Older adults are not protected from obesity, which has been linked to frailty, cognitive impairment, and other aging-related factors. Intensive lifestyle interventions have been shown to be effective for weight loss in older adults; however, these have typically been highly intensive and less feasible for dissemination. This analysis describes weight loss in a large-scale, commercially available, digital intervention in a subset of older adults.

Methods

Older adults (N = 20,443, males = 6,238; females = 14,205) between 65 and 85 years of age with overweight (43.3%) or obesity (46.7%) participated in an online, self-directed weight loss program. Behavioral-based content was delivered through weekly video lessons within an online platform that included weight and physical activity tracking, an online community, a reference library, and access to coaching support. Self-reported measures taken at the time of entry into the program were used for this analysis (demographics, height, body weight, and health status). Weight was reported across weeks of engagement in the curriculum.

Results

The average weight loss was -3.15 kg (95% CI: [-3.20, -3.11]) at 15.5 weeks. Weight loss was significantly greater in male individuals (-3.79 kg [95% CI: -3.89, -3.71]) versus female individuals (-2.87 kg [95% CI: -2.94, -2.82]) (p < 0.001), with a similar engagement in curriculum weeks. Percent weight loss was statistically significant for all age categories (p < 0.05) and self-reported health conditions (p < 0.05).

Discussion

Short-term weight loss was observed in older adults exposed to a low-touch, self-guided, and digital behavioral-based weight loss program. Weight loss was also observed even in the presence of various chronic health conditions.

Excess weight, weight gain, and prostate cancer risk and prognosis: the PROCA-life study

BACKGROUND

Studies of excess weight and weight changes throughout adult life for prostate cancer (PCa) risk and prognosis have shown inconsistent results.

METHODS

In a population-based cohort, the Prostate Cancer Study throughout life (PROCA-life), 16,960 healthy men from the prospective cohort Tromsø Study (1994-2016) were included. Body mass index (BMI) and weight were measured at all four attendings, and weight change was calculated as the difference between the first and last of either Tromsø4, Tromsø5 or Tromsø6. Overall, 904 men developed PCa during 16 years of follow-up, and Poisson regression with fractional polynomials was used to investigate trends in incidence. Cox proportional hazard and logistic regression models were used to study associations between measurements of BMI and weight change and PCa risk, severity, and mortality.

RESULTS

At study entry, 46% of the participants (median age 44 years) were overweight, and 14% were obese (BMI > 30 kg/m2). We observed a 127% increase in overall age adjusted PCa incidence in the cohort during 1995 through 2019. No overall associations between BMI or weight change and PCa risk were observed. However, in sub-group analysis, weight gain among obese men was associated with a three-fold higher PCa risk (HR 3.03, 95% CI 1.39-6.58) compared with obese men with stable weight. Overweight was associated with lower risk of metastatic cancer (OR 0.48, 95% CI 0.30-0.75) at diagnosis. Men with obesity had higher risk of PCa-specific death (HR 1.72, 95% CI 1.03-2.88), while nonsmoking obese PCa cases had two times higher PCa-specific mortality compared with normal weighted PCa cases (HR 2.10, 95% CI 1.11-3.70).

INTERPRETATION

In our cohort, weight gain among obese men was associated with higher risk of PCa, and obesity was associated with higher PCa-specific mortality, especially among nonsmokers. The relationship between weight and risk for PCa remains complicated, and future studies are needed to determine clinical implications.

Body weight change during a smoking cessation intervention for individuals with overweight or obesity

INTRODUCTION

A more comprehensive understanding of the factors regarding weight control in individuals with overweight or obesity after quitting smoking is needed. The study aimed to analyze the changes of in-treatment variables during a smoking cessation intervention and examine their impact on weight.

METHODS

A total of 120 individuals who smoke with overweight or obesity (MBMI = 31.75 ± 4.31; 54.16 % female) participated in a cognitive-behavioral therapy for smoking cessation and weight control or the same treatment plus contingency management. Weight, smoking variables (cotinine and continuous abstinence), eating behaviors (appetite, grazing), exercise, and sleep were assessed weekly throughout the treatment.

RESULTS

More participants gained weight over time with reduced nicotine use or abstinence. There was a tendency during treatment to increase appetite and exercise time, while grazing episodes and sleeping hours remained stable. Higher baseline weight (p < .001), greater cotinine reduction (p = .021) and time (p = .009) were associated with greater weight gain, while more hours of exercise (p = .003), no appetite changes (p = .003) and diminished appetite (p < .001) were associated with less gain over the treatment. Both treatment conditions showed similar results in all in-treatment variables.

DISCUSSION

Individuals with overweight and obesity with higher baseline weight and higher baseline cotinine levels during smoking cessation interventions may require special attention to improve weight outcomes. Exercise and appetite regulation may be useful for mitigating weight gain in smoking cessation interventions for individuals with overweight or obesity.

A low-burden, self-weighing intervention to prevent weight gain in adults with obesity who do not enroll in comprehensive treatment

Background

For individuals who are eligible but unlikely to join comprehensive weight loss programs, a low burden self-weighing intervention may be a more acceptable approach to weight management.

Methods

This was a single-arm feasibility trial of a 12-month self-weighing intervention. Participants were healthcare patients with a BMI ≥25 kg/m2 with a weight-related comorbidity or a BMI >30 kg/m2 who reported lack of interest in joining a comprehensive weight loss program, or did not enroll in a comprehensive program after being provided program information. In the self-weighing intervention, participants were asked to weigh themselves daily on a cellular connected scale and were sent text messages every other week with tailored weight change feedback, including messages encouraging use of comprehensive programs if weight gain occurred.

Results

Of 86 eligible patients, 39 enrolled (45.3%) in the self-weighing intervention. Self-weighing occurred on average 4.6 days/week (SD = 1.4). At 12 months, 12 participants (30.8%) lost ≥3% baseline weight, 11 (28.2%) experienced weight stability (±3% baseline), 6 (15.4%) gained ≥3% of baseline weight, and 10 (25.6%) did not have available weight data to evaluate. Three participants reported joining a weight loss program during the intervention (7.7%). Participants reported high intervention satisfaction in quantitative ratings (4.1 of 5), and qualitative interviews identified areas of satisfaction (e.g., timing and content of text messages) and areas for improvement (e.g., increasing personalization of text messages).

Conclusion

A low-burden self-weighing intervention can reach adults with overweight/obesity who would be unlikely to engage in comprehensive weight loss programs; the efficacy of this intervention for preventing weight gain should be further evaluated in a randomized trial.

Glucagon and GLP-1 receptor dual agonist survodutide for obesity: a randomised, double-blind, placebo-controlled, dose-finding phase 2 trial

BACKGROUND

Obesity is a widespread and chronic condition that requires long-term management; research into additional targets to improve treatment outcomes remains a priority. This study aimed to investigate the safety, tolerability, and efficacy of glucagon receptor-GLP-1 receptor dual agonist survodutide (BI 456906) in obesity management.

METHODS

In this randomised, double-blind, placebo-controlled, dose-finding phase 2 trial conducted in 43 centres in 12 countries, we enrolled participants (aged 18-75 years, BMI ≥27 kg/m2, without diabetes) and randomly assigned them by interactive response technology (1:1:1:1:1; stratified by sex) to subcutaneous survodutide (0·6, 2·4, 3·6, or 4·8 mg) or placebo once-weekly for 46 weeks (20 weeks dose escalation; 26 weeks dose maintenance). The primary endpoint was the percentage change in bodyweight from baseline to week 46. Primary analysis included the modified intention-to-treat population (defined as all randomly assigned patients who received at least one dose of trial medication and who had analysable data for at least one efficacy endpoint) and was based on the dose assigned at randomisation (planned treatment), including all data censored for COVID-19-related discontinuations; the sensitivity analysis was based on the actual dose received during maintenance phase (actual treatment) and included on-treatment data. Safety analysis included all participants who received at least one dose of study drug. The trial is registered with ClinicalTrials.gov (NCT04667377) and EudraCT (2020-002479-37).

FINDINGS

Between March 30, 2021, and Nov 11, 2021, we enrolled 387 participants; 386 (100%) participants were treated (0·6 mg, n=77; 2·4 mg, n=78; 3·6 mg, n=77; 4·8 mg, n=77; placebo n=77) and 233 (60·4%) of 386 completed the 46-week treatment period (187 [61%] of 309 receiving survodutide; 46 [60%] of 77 receiving placebo). When analysed according to planned treatment, mean (95% CI) changes in bodyweight from baseline to week 46 were -6·2% (-8·3 to -4·1; 0·6 mg); -12·5% (-14·5 to -10·5; 2·4 mg); -13·2% (-15·3 to -11·2; 3·6 mg); -14·9% (-16·9 to -13·0; 4·8 mg); -2·8% (-4·9 to -0·7; placebo). Adverse events occurred in 281 (91%) of 309 survodutide recipients and 58 (75%) of 77 placebo recipients; these were primarily gastrointestinal in 232 (75%) of 309 survodutide recipients and 32 (42%) of 77 placebo recipients.

INTERPRETATION

All tested survodutide doses were tolerated, and dose-dependently reduced bodyweight.

FUNDING

Boehringer Ingelheim.

To what extent the weight changes impact the risk of hypertension among menopausal women: insights from Tehran lipid and glucose study

BACKGROUND & AIM

The association between weight change and incident hypertension (HTN) in menopausal women has not been well characterized. This study aimed to determine whether weight changes after menopausal years make a difference in incidents of hypertension.

MATERIALS & METHODS

This population-based study was performed using data collected from Tehran Lipid and Glucose Study cohort (1999-2018). Women who had natural and early menopause were followed up every 3 years. Data gathering was performed through the standard protocol of the study. Statistical analysis was performed using multivariable Cox hazard regression analysis. We used the 'survival' package in the R software version 3.6.0 to fit survival models.

RESULTS

A total of 487 menopausal women met the inclusion criteria; 62.6% had natural menopause and remained had early menopause. Among the participants, 65.5% experienced HTN. The highest proportion of participants had > 5% weight gain, while the lowest had 3-5% weight gain. Either losing body weight (lost > 5%: HR: 0.44; CI 95%, 0.32, 0.62; p < 0.001), (lost 3-5%; HR: 0.47; CI 95%, 0.26, 0.84; p = 0.01), and weight gain > 5% (HR: 0.69; CI 95%, 0.51, 0.91; p = 0.01), were associated with decreased risk of HTN after adjustment for confounders. In this study, weight loss and gain have a protective impact on the development of HTN in subjects. For incident HTN, age (HR: 1.04 (1.01, 1.08), p = 0.004), fasting blood glucose (HR: 1.01, CI 95%:1.00, 1.01; p < 0.001), body mass index (1.02 (1.00, 1.05), p = 0.03) and smoking (1.70 (1.11, 2.58), p = 0.01) were positively associated with HTN.

CONCLUSIONS

Our study indicates the significant association of weight change with hypertension risk in later life among menopausal women.

Body composition and cancer survival: a narrative review

Interest in understanding the relationship between body composition and cancer survival has remained strong for decades, with a number of recent systematic reviews on the topic. However, the current state of evidence is based on heterogeneous exposure definitions based on anthropometry, yielding inconsistent findings with regard to this association. Recently the field has taken an exciting direction with the application of radiological assessments to measure specific aspects of body composition, yet reconciliation of findings from these modern assessment tools with those from the historic use of anthropometric data proves challenging. In this paper, I briefly review the biological basis for a link between body composition and cancer survival and summarize the epidemiological evidence with consideration to specific exposure measures. As enthusiasm is building around novel assessments, I conclude with a discussion of issues that researchers should be aware of when interpreting results from these new modalities.

Gastrointestinal: Weight gain increases the risk of metachronous advanced colorectal neoplasm observed in post-polypectomy surveillance colonoscopy

BACKGROUND AND AIM

Although obesity is a known risk factor for colorectal neoplasms, the correlation between weight change and colorectal neoplasm is unclear. Thus, we aim to evaluate the association between weight change and advanced colorectal neoplasm (ACRN) recurrence during post-polypectomy surveillance colonoscopy.

METHODS

This retrospective cohort study included 7473 participants diagnosed with colorectal neoplasms between 2003 and 2010 who subsequently underwent surveillance colonoscopies until 2020. We analyzed the association between the risk of metachronous ACRN and weight change, defining stable weight as a weight change of <3% and weight gain as a weight increase of ≥3% from baseline during the follow-up period.

RESULTS

During a median 8.5 years of follow-up, 619 participants (8.3%) developed ACRN. Weight gain was reported as an independent risk factor for metachronous ACRN in a time-dependent Cox analysis. A weight gain of 3-6% and ≥6% had adjusted hazard ratios (AHRs) of 1.48 (95% confidence interval [CI]: 1.19-1.84) and 2.14 (95% CI: 1.71-2.69), respectively. Participants aged 30-49 and 50-75 years with weight gain of ≥6% showed AHRs of 2.88 (95% CI: 1.96-4.21) and 1.90 (95% CI: 1.43-2.51), respectively. In men and women, weight gain of ≥3% was significantly correlated with metachronous ACRN.

CONCLUSIONS

Weight gain is associated with an increased risk of metachronous ACRN. Furthermore, weight gain is associated with the recurrence of ACRN in both men and women regardless of age.

Cardiovascular disease risk factors in career firefighters: A 6-year follow-up study

This study sought to investigate the evolution of cardiovascular disease (CVD) risk factors in career firefighters. A questionnaire was sent to a cohort of 233 Québec career firefighters in 2015 and 2021 to collect demographic and occupational information and the presence of CVD risk factors. Ninety-six (96) firefighters (1 female) responded to the questionnaire in 2015 and 2021. Body weight (2015: 88.3 ± 10.9, 2021: 89.6 ± 10.7 kg, p = 0.01), body mass index (2015: 27.6 ± 3.2, 2021: 28.0 ± 3.0 kg/m2, p = 0.01), number of CVD risk factors (2015: 1.1 ± 1.0, 2021: 1.3 ± 0.9 CVD risk factors, p = 0.05), and proportion of firefighters with at least 1 CVD risk factor (2015: 71, 2021: 82%, p = 0.02) increased. Overall, our results highlight an aggravation of several CVD risk factors in Québec career firefighters over the years.

Weight loss and risk of dementia in individuals with versus without obesity

INTRODUCTION

Using nationwide cohort data, we aimed to elucidate whether baseline obesity altered the relationship between loss in body mass index (BMI) or waist circumference (WC) and risk of dementia.

METHODS

Among 9689 participants whose BMIs and WCs were repeatedly measured over 1 year, 1:1 propensity score matching was conducted between participants with and without obesity (n = 2976 per group, mean age 70.9). For each group, we explored the association between loss in BMI, or WC, and incidence of dementia during an approximately 4-year follow-up period.

RESULTS

BMI loss was associated with an increased risk of all-cause dementia and Alzheimer's disease in participants without obesity; however, this association was absent in participants with obesity. WC loss was associated with decreased Alzheimer's disease risk only in participants with obesity.

DISCUSSION

Only unfavorable loss (loss from non-obese state) in BMI, not WC, can be a metabolic biomarker of prodromal dementia.

Gut microbiome diversity, variability, and latent community types compared with shifts in body weight during the freshman year of college in dormitory-housed adolescents

Significant human gut microbiome changes during adolescence suggest that microbial community evolution occurs throughout important developmental periods including the transition to college, a typical life phase of weight gain. In this observational longitudinal study of 139 college freshmen living in on-campus dormitories, we tracked changes in the gut microbiome via 16S amplicon sequencing and body weight across a single academic year. Participants were grouped by weight change categories of gain (WG), loss (WL), and maintenance (WM). Upon assessment of the community structure, unweighted and weighted UniFrac metrics revealed significant shifts with substantial variation explained by individual effects within weight change categories. Genera that positively contributed to these associations with weight change included Bacteroides, Blautia, and Bifidobacterium in WG participants and Prevotella and Faecalibacterium in WL and WM participants. Moreover, the Prevotella/Bacteroides ratio was significantly different by weight change category, with WL participants displaying an increased ratio. Importantly, these genera did not display co-dominance nor ease of transition between Prevotella- and Bacteroides-dominated states. We further assessed the overall taxonomic variation, noting the increased stability of the WL compared to the WG microbiome. Finally, we found 30 latent community structures within the microbiome with significant associations with waist circumference, sleep, and dietary factors, with alcohol consumption chief among them. Our findings highlight the high level of individual variation and the importance of initial gut microbiome community structure in college students during a period of major lifestyle changes. Further work is needed to confirm these findings and explore mechanistic relationships between gut microbes and weight change in free-living individuals.

Effect of weight loss on proteinuria in adults with type 2 diabetes: A real-world study

AIMS

To assess the impact of weight loss on proteinuria in patients with type 2 diabetes (T2DM) in real-world settings.

METHODS

A total of 1054 participants were categorized based on weight change from baseline to one-year follow-up: weight gain (≥3%), stable weight, or weight loss (≥3%). Proteinuria outcomes were defined as urinary albumin/creatinine ratio (UACR) progression (≥30 % increase), UACR regression (≥30 % reduction), or UACR stable. Ordered logistic regression analysis evaluated the relationship between weight loss and UACR regression.

RESULTS

Of the 1054 participants, 44.5 % were overweight, and 24.1 % were obese. Patients with obesity were at higher risk of developing proteinuria (OR, 1.783; 95 %CI, 1.195 to 2.659). Weight loss was associated with an 83.3 % increase in UACR regression compared to weight gain (OR, 1.833; 95 % CI, 1.262 to 2.663; P = 0.001). This association remained consistent across most subgroups and stronger in males (P for interaction = 0.023), with a 6 % UACR regression for every 1 kg weight loss (OR, 1.06; 95 % CI, 1.02 to 1.10; P = 0.003).

CONCLUSIONS

Our real-world study reveals that weight reduction is associated with UACR regression in patients with T2DM, regardless of the approach used for weight management, and the association was much stronger in males.

Effectiveness of a group-based Diabetes Prevention Education Program (DiPEP) in a population with pre-diabetes: a cluster randomised controlled trial in Nepal

Background

Although several lifestyle intervention studies have been conducted in low/middle-income countries, there were no such studies in Nepal. Therefore, a group-based culturally tailored Diabetes Prevention Education Program (DiPEP) was conducted recently. The study aimed to evaluate the effect of DiPEP in glycated haemoglobin (HbA1c), weight, waist circumference, physical activity and diet among population with pre-diabetes.

Method

A two-arm cluster randomised controlled trial was conducted in 12 clusters of two urban areas in Nepal. The DiPEP was a 6 month intervention (four 1-hour weekly educational sessions and 5 months of follow-up by community health workers/volunteers (CHW/Vs)). A postintervention assessment was done after 6 months. Linear mixed model was used to estimate the mean difference in primary outcome (HbA1c) and secondary outcomes (weight, waist circumference, physical activity and diet) between intervention and control arms, adjusted for baseline measure.

Results

In intention-to-treat analysis with a total of 291 participants, the estimated mean difference in HbA1c was found to be 0.015 percentage point (95% CI -0.074 to 0.104) between the intervention arm and the control arm, while it was -0.077 (95% CI -0.152 to -0.002) among those who attended at least 3 out of 4 educational sessions. The estimated mean difference in weight (in participants who attended ≥1 educational session) was -1.6 kg (95% CI -3.1 to -0.1). A significantly lower grain consumption was found in intervention arm (-39 g/day, 95% CI -65 to -14) compared with the control arm at postintervention assessment.

Conclusion

Although compliance was affected by COVID-19, individuals who participated in ≥3 educational sessions had significant reduction in HbA1c and those who attended ≥1 educational session had significant weight reduction. Grain intake was significantly reduced among the intervention arm than the control arm. Hence, group-based lifestyle intervention programmes involving CHW/vs is recommended for diabetes prevention.

Trial registration number

NCT04074148.

Rapid weight change as a predictor of disability among community-dwelling Japanese older adults

AIM

To fill the knowledge gap regarding weight change and the onset of disability in community-dwelling Japanese older adults, we investigated the potential effects of rapid weight change on disability risk as defined by Japan's long-term care insurance (LTCI) system.

METHODS

We analyzed data from a longitudinal study of 10 375 community-dwelling older Japanese adults (≥65 years) who were not LTCI needs certified at baseline and joined the study from 2002 to 2005. Weight change (percentage) was calculated by subtracting participants' weight in the previous year from that measured during a physical examination at study commencement. The five weight-change categories ranged from sizable weight loss (≤ -8.0%) to sizable weight gain (≥ +8.0%). Disability was defined according to LTCI certifications at follow-up. Hazard ratios (HRs) and 95% confidence intervals were calculated for new-onset disability using a Cox proportional hazards model that fitted the proportional subdistribution hazards regression model with weights for competing risks of death.

RESULTS

During the mean 10.5-year follow-up, 2994 participants developed a disability. Sizable weight loss (HR [95% confidence intervals], 1.41 [1.17-1.71]) and weight loss (1.20 [1.05-1.36]) were significant predictors of disability onset. Sizable weight gain (1.45 [1.07-1.97]) corresponded to severe disability. Stratified analyses by lifestyle and initial body mass index categories revealed more pronounced associations between weight change and disability risk in the unhealthy lifestyle and below initial normal body mass index groups.

CONCLUSIONS

Rapid and sizable weight gain could be additional criteria for disability risk in older adults. Geriatr Gerontol Int 2023; 23: 809-816.

Are motivational and self-regulation factors associated with 12 months' weight regain prevention in the NoHoW study? An analysis of European adults

PURPOSE

Preventing weight regain can only be achieved by sustained changes in energy balance-related behaviors that are associated with weight, such as diet and physical activity. Changes in motivation and self-regulatory skills can support long-term behavioral changes in the context of weight loss maintenance. We propose that experiencing a supportive climate care is associated with enhanced satisfaction of basic psychological needs, intrinsic goals, and autonomous motivation. These factors are expected to be associate with the utilization of self-regulation skills, leading to more sustained behavior changes and ultimately preventing weight regain. This hypothesis was tested in this ancillary analysis of the NoHoW trial, where the study arms were pooled and followed for 12 months.

METHODS

The NoHoW was a three-center, large-scale weight regain prevention full factorial trial. In this longitudinal study, data were collected in adults who lost > 5% weight in the past year (N = 870, complete data only, 68.7% female, 44.10 ± 11.86 years, 84.47 ± 17.03 kg) during their participation in a 12-month digital behavior change intervention. Weight and validated measures of motivational- and self-regulatory skills-related variables were collected at baseline, six- and 12 months. Change variables were used in Mplus' path analytical models informed by NoHoW's logic model.

RESULTS

The bivariate correlations confirmed key mediators' potential effect on weight outcomes in the expected causal direction. The primary analysis showed that a quarter of the variance (r2 = 23.5%) of weight regain prevention was achieved via the mechanisms of action predicted in the logic model. Specifically, our results show that supportive climate care is associated with needs satisfaction and intrinsic goal content leading to better weight regain prevention via improvements in self-regulatory skills and exercise-controlled motivation. The secondary analysis showed that more mechanisms of action are significant in participants who regained or maintained their weight.

CONCLUSIONS

These results contribute to a better understanding of the mechanisms of action leading to behavior change in weight regain prevention. The most successful participants used only a few intrinsic motivation-related mechanisms of action, suggesting that habits may have been learned. While developing a digital behavior change intervention, researchers and practitioners should consider creating supportive climate care to improve needs satisfaction and intrinsic goal contents.

TRIAL REGISTRATION

ISRCTN, ISRCTN88405328 , registered 12/22/2016.

Towards precision dosing of aripiprazole in children and adolescents with autism spectrum disorder: Linking blood levels to weight gain and effectiveness

AIMS

Aripiprazole is one of the most commonly prescribed antipsychotic drugs to children and adolescents worldwide, but it is associated with serious side-effects, including weight gain. This study assessed the population pharmacokinetics of aripiprazole and its active metabolite and investigated the relationship between pharmacokinetic parameters and body mass index (BMI) in children and adolescents with autism spectrum disorder (ASD) and behavioural problems. Secondary outcomes were metabolic, endocrine, extrapyramidal and cardiac side-effects and drug effectiveness.

METHODS

Twenty-four children and adolescents (15 males, 9 females) aged 6-18 years were included in a 24-week prospective observational trial. Drug plasma concentrations, side-effects and drug effectiveness were measured at several time points during follow-up. Relevant pharmacokinetic covariates, including CYP2D6, CYP3A4, CYP3A5 and P-glycoprotein (ABCB1) genotypes, were determined. Nonlinear mixed-effects modelling (NONMEM®) was used for a population pharmacokinetic analysis with 92 aripiprazole and 91 dehydro-aripiprazole concentrations. Subsequently, model-based trough concentrations, maximum concentrations and 24-h area under the curves (AUCs) were analysed to predict outcomes using generalized and linear mixed-effects models.

RESULTS

For both aripiprazole and dehydro-aripiprazole, one-compartment models best described the measured concentrations, with albumin and BMI as significant covariates. Of all the pharmacokinetic parameters, higher sum (aripiprazole plus dehydro-aripiprazole) trough concentrations best predicted higher BMI z-scores (P < .001) and higher Hb1Ac levels (P = .03) during follow-up. No significant association was found between sum concentrations and effectiveness.

CONCLUSIONS

Our results indicate a threshold with regard to safety, which suggests that therapeutic drug monitoring of aripiprazole could potentially increase safety in children and adolescents with ASD and behavioural problems.

Exploratory analysis of reflective, reactive, and homeostatic eating behaviour traits on weight change during the 18-month NoHoW weight maintenance trial

Behaviour change interventions for weight management have found varied effect sizes and frequent weight re-gain after weight loss. There is interest in exploring whether differences in eating behaviour can be used to develop tailored weight management programs. This secondary analysis of an 18-month weight maintenance randomised controlled trial (RCT) aimed to investigate the association between individual variability in weight maintenance success and change in eating behaviour traits (EBT). Data was analysed from the NoHoW trial (Scott et al., 2019), which was designed to measure processes of change after weight loss of ≥5% body weight in the previous year. The sample included 1627 participants (mean age = 44.0 years, SD = 11.9, mean body mass index (BMI) = 29.7 kg/m2, SD = 5.4, gender = 68.7% women/31.3% men). Measurements of weight (kg) and 7 EBTs belonging to domains of reflective, reactive, or homeostatic eating were taken at 4 time points up to 18-months. Increases in measures of 'reactive eating' (binge eating, p < .001), decreases in 'reflective eating' (restraint, p < .001) and changes in 'homeostatic eating' (unlimited permission to eat, p < .001 and reliance on hunger and satiety cues, p < .05) were significantly and independently associated with concomitant weight change. Differences in EBT change were observed between participants who lost, maintained, or re-gained weight for all EBTs (p < .001) except for one subscale of intuitive eating (eating for physical reasons, p = .715). Participants who lost weight (n = 322) exhibited lower levels of reactive eating and higher levels of reflective eating than participants who re-gained weight (n = 668). EBT domains can identify individuals who need greater support to progress in weight management interventions. Increasing reflective eating and reducing reactive eating may enhance weight management success.

Impact of a Powdered Meal Replacement on Metabolism and Gut Microbiota (PREMIUM) in individuals with excessive body weight: a study protocol for a randomised controlled trial

INTRODUCTION

Excess body weight is associated with a state of low-grade chronic inflammation and alterations of the gut microbiome. Powdered meal replacements (PMR) have been shown to be an effective strategy for weight management; however, their effect on inflammation and the gut microbiome remains unclear. The aim of this 12-week randomised control clinical trial is to investigate the effects of PMR consumption, here given as a soy-yoghurt-honey formula, on inflammation, gut microbiome and overall metabolism in individuals with excessive body weight.

METHODS AND ANALYSIS

Healthy adults with excess body weight (n=88) are being recruited and randomly assigned to one of the following groups: (1) Control group (CON): maintaining usual diet for 12 weeks, or (2) PMR group: replacing morning and afternoon snacks daily with a PMR for 12 weeks. Participants are asked to maintain body weight throughout the study and fill out a journal with information about PMR consumption, body weight, food intake, appetite sensations and medications. Three study visits are required: baseline, week 6 and week 12. Outcome measures include systemic inflammatory biomarkers, gut microbiome composition, metabolic blood markers, host energy metabolism, body composition, appetite sensations and host gene expression profile.

ETHICS AND DISSEMINATION

This research protocol was approved by the University of Alberta Ethics Board (Pro00070712) and adheres to the Canadian Tri-Council Policy statement on the use of human participants in research. Procedures and potential risks are fully discussed with participants. Study findings will be disseminated in peer-reviewed journals, conference presentations and social media.

TRIAL REGISTRATION NUMBER

NCT03235804.

Effect of weight change on the association between overall and source of carbohydrate intake and risk of metabolic syndrome: Tehran lipid and glucose study

BACKGROUND

In this prospective cohort study, we aimed to evaluate the association between dietary carbohydrates, whole grains, refined grains, and simple sugar with the risk of metabolic syndrome (MetS) and assess the effect of weight change on these associations.

METHODS

This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS). We included 1915 healthy participants with complete demographic, anthropometric and dietary measurements, among whom 591 developed MetS during 8.9 years of follow-up. Intake of dietary carbohydrates, whole grains, refined grains, and simple sugar was assessed with a validated semi-quantitative food frequency questionnaire. Multivariable adjusted Cox regression was used to estimate hazard ratios (HRs) for MetS events across tertiles of dietary variables. Using joint classification, the effect of weight change on the association between dietary variables and risk of MetS was assessed by Cox regression.

RESULTS

Carbohydrate intake was not associated with the risk of MetS in multivariable-adjusted models. Whole grains intake was inversely associated with the risk of MetS (HR: 0.78, CI: 0.63-0.98), while this association disappeared after adjustment for weight change. The risk of MetS increased by 11% (1.11, 1.09-1.14) for each 3% energy increment from simple sugar, and by 5% (1.05, 1.03-1.08) for each 1 serving/day increment in refined grains. Consumption of refined grains increased the risk of MetS; an effect modification of this association was found by weight change. Among subjects with weight loss, intake of refined grains < median intake decreased the risk of MetS (0.59, 0.41-0.87). However, consumption of refined grains ≥ median intake increased the risk of MetS in individuals with weight gain (1.47, 1.08-2.01). Simple sugar was positively associated with an increased risk of MetS, after adjustment for weight change (3.00, 2.37-3.82). In joint classification, intake of simple sugar greater than median intake increased the risk of MetS, independent of weight change.

CONCLUSION

Our findings suggest an effect modification by weight change on the association between carbohydrates, and refined grains intake and the risk of MetS. Weight loss along with lower consumption of carbohydrates, and refined grains reduced the risk of MetS. However, simple sugar intake, regardless of weight change, was associated with an increased risk of MetS.

Relationships between longitudinal changes in body composition and bone mineral density in middle-to-older aged Australians

There are limited longitudinal data regarding relationships between changes in body composition and bone mineral density (BMD). In 3671 participants aged 46-70 years at baseline, ∆lean mass was a stronger determinant than ∆fat mass of ∆BMD over 6 years. Maintained or increased lean mass may slow down age-related bone loss.

PURPOSE

There are limited longitudinal data regarding relationships between changes in body composition and bone mineral density (BMD) with ageing. We examined these in the Busselton Healthy Ageing Study.

METHODS

We studied 3671 participants (2019 females) aged 46-70 years at baseline with body composition and BMD assessments by dual-energy x-ray absorptiometry at baseline and after ~6 years. Relationships between changes in total body mass (∆TM), lean mass (∆LM) and fat mass (∆FM) with ∆BMD at total hip, femoral neck and lumbar spine were evaluated using restricted cubic spline modelling (accounting for baseline covariates) and mid-quartile least square means were compared.

RESULTS

∆TM was positively associated with ∆BMD of total hip and femoral neck in both sexes, and spine in females; in females but not males, associations plateaued at ∆TM above ~5kg for all sites. In females, ∆LM was positively associated with ∆BMD of all three sites with plateauing of the relationship at ∆LM above ~1kg. Women in the highest quartile of ∆LM (Q4, mid-quartile value +1.6 kg) had 0.019-0.028 g/cm2 less reduction in BMD than those in the lowest quartile (Q1, -2.1 kg). In males, ∆LM was positively associated with ∆BMD of total hip and femoral neck; men in Q4 (+1.6 kg) had 0.015 and 0.011 g/cm2 less bone loss, respectively, compared with Q1 (-2.7 kg). ∆FM was positively associated with ∆BMD of total hip only in both sexes.

CONCLUSION

∆LM is a stronger determinant than ∆FM of ∆BMD. Maintained or increased LM is associated with less age-related bone loss.

Association of Eating Behaviors with Variability in Weight Change in Response to Physical Activity Interventions in Adults with Overweight

There is individual variability in weight change in response to physical activity interventions. Secondary analyses explored whether there were differences in physical activity, dietary intake, and the domains of hunger, dietary disinhibition, or dietary restraint in response to different physical activity interventions and by pattern of weight change across 6 months of an intervention. Participants (N = 207; age: 44.8 ± 8.2 years; body mass index: 27.0 ± 1.7 kg/m2) were included in these secondary analyses. Participants were randomly assigned to (1) a self-help physical activity intervention, (2) a prescription to progress to 150 min/week of physical activity, or (3) a prescription to progress to 300 min/week of physical activity and following 6 months were categorized based on weight change (weight gain, stability, or loss). Intervention conditions did not differ for change in weight, physical activity, dietary intake, and measures of hunger, dietary disinhibition, and total dietary restraint. Categories of weight change did not differ for change in physical activity or dietary intake, but the category of weight loss had significantly greater decreases in hunger and increases in flexible dietary restraint compared to the categories of weight stability and weight gain. The findings may provide insight into the variability in weight change in response to physical activity.

The effects of acarbose treatment on cardiovascular risk factors in impaired glucose tolerance and diabetic patients: a systematic review and dose-response meta-analysis of randomized clinical trials

Acarbose (ACB) seems to be an effective drug in the management of cardiovascular risk factors. However, no previous meta-analysis of randomized controlled trials (RCTs) has been done to evaluate the effects of ACB on cardiovascular risk factors on impaired glucose tolerance (IGT), type 2 diabetes mellitus (T2D), and type 1 diabetes mellitus (T1D). We comprehensively searched electronic databases including Scopus, Web of Science, and PubMed for RCTs for related keywords up to September 2022. A random-effects model was used to estimate the weighted mean difference (WMD) and 95% confidence interval (CI). The pooled analysis demonstrated that ACB treatment had a significant effect on fasting blood glucose (FBG) (WMD = -3.55 mg/dL; 95%CI: -6.29, -0.81; p = 0.011), fasting insulin (WMD = -6.73 pmoL/L; 95%CI: -10.37, -3.10; p < 0.001), HbA1c [WMD = -0.32%; 95%CI: -0.45, -0.20; p < 0.001], body weight (WMD = -1.25 kg; 95%CI: -1.79, -0.75; p < 0.001), body mass index (BMI) (WMD = -0.64 kg/m2; 95%CI: -0.92, -0.37; p < 0.001), tumor necrosis factor-alpha (TNF-α) (WMD = -2.70 pg/mL, 95%CI: -5.25, -0.16; p = 0.037), leptin (WMD = -1.58 ng/mL; 95%CI: -2.82, -0.35; p = 0.012), alanine transaminase (ALT) (WMD = 0.71 U/L; 95%CI: -0.31, 1.85; p = 0.164), triglyceride (TG) (WMD = -13.89 mg/dL; 95%CI: -20.69, -7.09; p < 0.001), total cholesterol (TC) (WMD = -2.26 mg/dL; 95%CI: -4.18, -0.34; p = 0.021), systolic blood pressure (SBP) (WMD = -1.29 mmHg; 95%CI: -2.44, -0.15; p = 0.027), and diastolic blood pressure (DBP) (WMD = 0.02 mmHg; 95%CI: -0.41, 0.45; p = 0.925) in an intervention group, compared with a placebo group. The non-linear dose-response analysis showed that ACB reduces the TC in trial duration by >50 weeks, and 180 mg/day is more effective for the decrement of CRP. ACB can improve lipid profiles, glycemic indices, anthropometric indices, and inflammatory markers in T2D, T1D, and IGT patients.

A pilot study of implementation of endoscopic sleeve gastroplasty (ESG) in Norway

BACKGROUND AND AIM

Bariatric surgery is the most effective treatment for obesity but is invasive and associated with serious complications. Endoscopic sleeve gastroplasty (ESG) is a less invasive weight loss procedure to reduce the stomach volume by full-thickness sutures. ESG has been adopted in many countries, but implementation at Scandinavian centres has not yet been documented. We performed a clinical pilot trial at a Norwegian centre with the primary objective to assess the feasibility of the ESG procedure.

PATIENTS AND METHODS

We included the first 10 patients treated with ESG at a Norwegian centre in a single-arm pilot study. The eligibility criteria were either a body mass index (BMI) of 40-49.9 kg/m2, BMI 35-39.9 kg/m2 and at least one obesity-related comorbidity, or BMI 30-34.9 kg/m2 and type 2 diabetes. Patient follow-up resembled the scheme used for bariatric surgery at the center, including dietary plans and outpatient visits.

RESULTS

All procedures were technically successful except for one patient who had adhesions between the stomach and anterior abdominal wall, related to a prior hernia repair, resulting in less-than-intended stomach volume reduction. Mean total body weight loss (TBWL) after 26 and 52 weeks was 12.2% (95% CI 8.1-16.2) and 9.1% (95% CI 3.3 - 15.0). One patient experienced a minor suture-induced diaphragmatic injury, which was successfully managed conservatively.

CONCLUSIONS

This first Scandinavian clinical trial of ESG, documenting the implementation of the procedure at a Norwegian center, demonstrated acceptable feasibility and safety, with large variations in individual weight loss during the 52-week follow-up period.

Changes in body weight and cardiovascular risk factors in a Chinese population with type 2 diabetes mellitus: a longitudinal study

Introduction

The primary care management of blood glucose, blood pressure, lipid profiles, and body weight is important among patients with type 2 diabetes mellitus (T2DM) to prevent disease progression. Information on how weight changes would improve or deteriorate cardiovascular (CV) risk factors is warranted for making primary care recommendations. We aimed to investigate the changes in body weight and CV risk factors and to analyse their association in a Chinese population with T2DM.

Methods

We retrieved longitudinal data between 2020 and 2021 from 1,758 adult primary care patients enrolled in a diabetic retinopathy (DR) screening programme. Linear associations of changes in body weight with CV risk factors were explored. Multivariable logistic regression analysis was performed to examine associations between different weight change categories and the worsening of CV risk factors.

Results

The mean age of all the participants was 63.71 years, and over half of participants were females. During a one-year follow-up period, 24.7% of patients had a weight loss of ≥3%, while 22.2% of patients had a weight gain of ≥3%. Patients who had a weight loss of ≥3% were more likely to prevent the worsening of haemoglobin A1c (HbA1c) and triglycerides, while those who had a weight gain of ≥3% tended to have worsened HbA1c, lipid profiles, and blood pressure.

Conclusion

Results from this real-world investigation suggested the concurrent need for weight loss intervention among patients who are overweight or obese and weight gain prevention among patients whose body weight falls within the normal range in the context of community-based diabetes management.

Phase I studies of the safety, tolerability, pharmacokinetics and pharmacodynamics of the dual glucagon receptor/glucagon-like peptide-1 receptor agonist BI 456906

AIM

To report two phase I studies of the novel subcutaneous glucagon-like peptide-1 receptor/glucagon receptor (GLP-1R/GCGR) dual agonist BI 456906 versus placebo in healthy volunteers and people with overweight/obesity.

MATERIALS AND METHODS

A phase Ia study (NCT03175211) investigated single rising doses (SRDs) of BI 456906 in 24 males with a body mass index (BMI) of 20-<30 kg/m² . A phase Ib study (NCT03591718) investigated multiple rising doses (MRDs) of BI 456906 (escalated over 6 [Part A] or 16 [Part B] weeks) in 125 adults with a BMI of 27-40 kg/m² .

RESULTS

In the SRD study (N = 24), mean body weight decreased with increasing BI 456906 dose. In the MRD study, the maximum decreases in placebo-corrected mean body weight were at week 6 (-5.79%, dosage schedule [DS] 1; Part A) and week 16 (-13.8%, DS7; Part B). BI 456906 reduced plasma amino acids and glucagon, indicating target engagement at GCGRs and GLP-1Rs. Drug-related adverse events (AEs) increased with BI 456906 dose. The most frequent drug-related AE with SRDs was decreased appetite (n = 9, 50.0%), and two subjects (8.3%) did not complete the trial because of AEs (nausea and vomiting). During MRD Part A (N = 80), 10 subjects (12.5%) discontinued BI 456906, most commonly because of a cardiac or vascular AE (n = 6, 7.5%); during Part B (N = 45), eight subjects (17.8%) discontinued BI 456906, mainly because of AEs (n = 6, 13.3%), most commonly gastrointestinal disorders.

CONCLUSIONS

BI 456906 produced a placebo-corrected body weight loss of 13.8% (week 16), highlighting its potential to promote clinically meaningful body weight loss in people with overweight/obesity.

Effect of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Fat Loss and Cardiorespiratory Fitness in the Young and Middle-Aged a Systematic Review and Meta-Analysis

OBJECTIVES

This systematic review is conducted to evaluate the effect of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on body composition and cardiorespiratory fitness (CRF) in the young and middle-aged.

METHODS

Seven databases were searched from their inception to 22 October 2022 for studies (randomized controlled trials only) with HIIT and MICT intervention. Meta-analysis was carried out for within-group (pre-intervention vs. post-intervention) and between-group (HIIT vs. MICT) comparisons for change in body mass (BM), body mass index (BMI), waist circumference (WC), percent fat mass (PFM), fat mass (FM), fat-free mass (FFM), and CRF.

RESULTS

A total of 1738 studies were retrieved from the database, and 29 studies were included in the meta-analysis. Within-group analyses indicated that both HIIT and MICT can bring significant improvement in body composition and CRF, except for FFM. Between-group analyses found that compared to MICT, HIIT brings significant benefits to WC, PFM, and VO_2peak.

CONCLUSIONS

The effect of HIIT on fat loss and CRF in the young and middle-aged is similar to or better than MICT, which might be influenced by age (18-45 years), complications (obesity), duration (>6 weeks), frequency, and HIIT interval. Despite the clinical significance of the improvement being limited, HIIT appears to be more time-saving and enjoyable than MICT.

Restricting sugar or carbohydrate intake does not impact physical activity level or energy intake over 24 h despite changes in substrate use: a randomised crossover study in healthy men and women

PURPOSE

To determine the effects of dietary sugar or carbohydrate restriction on physical activity energy expenditure, energy intake, and physiological outcomes across 24 h.

METHODS

In a randomized, open-label crossover design, twenty-five healthy men (n = 10) and women (n = 15) consumed three diets over a 24-h period: moderate carbohydrate and sugar content (MODSUG = 50% carbohydrate [20% sugars], 15% protein, 35% fat); low sugar content (LOWSUG = 50% carbohydrate [< 5% sugars], 15% protein, 35% fat); and low carbohydrate content (LOWCHO = 8% carbohydrate [< 5% sugars], 15% protein, 77% fat). Postprandial metabolic responses to a prescribed breakfast (20% EI) were monitored under laboratory conditions before an ad libitum test lunch, with subsequent diet and physical activity monitoring under free-living conditions until blood sample collection the following morning.

RESULTS

The MODSUG, LOWSUG and LOWCHO diets resulted in similar mean [95%CI] rates of both physical activity energy expenditure (771 [624, 919] vs. 677 [565, 789] vs. 802 [614, 991] kcal·d-1; p = 0.29] and energy intake (2071 [1794, 2347] vs. 2195 [1918, 2473] vs. 2194 [1890, 2498] kcal·d-1; P = 0.34), respectively. The LOWCHO condition elicited the lowest glycaemic and insulinaemic responses to breakfast (P < 0.01) but the highest 24-h increase in LDL-cholesterol concentrations (P < 0.001), with no differences between the MODSUG and LOWSUG treatments. Leptin concentrations decreased over 24-h of consuming LOWCHO relative to LOWSUG (p < 0.01).

CONCLUSION

When energy density is controlled for, restricting either sugar or total dietary carbohydrate does not modulate physical activity level or energy intake over a 24-h period (~ 19-h free-living) despite substantial metabolic changes.

CLINICAL TRIALS REGISTRATION ID

NCT03509610, https://clinicaltrials.gov/show/NCT03509610.

Lifestyle strategies after intentional weight loss: results from the MAINTAIN-pc randomized trial

Introduction/Purpose

Weight maintenance following intentional weight loss is challenging and often unsuccessful. Physical activity and self-monitoring are strategies associated with successful weight loss maintenance. However, less is known about the type and number of lifestyle strategies used following intentional weight loss. The purpose of this study was to determine the types and amounts of strategies associated with successful long-term weight loss maintenance.

Methods

Data from the 24-month Maintaining Activity and Nutrition Through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) trial were analyzed. MAINTAIN-pc recruited adults (n=194; 53.4±12.2 years of age, body mass index (BMI): 30.4±5.9 kg/m2, 74% female) with recent intentional weight loss of ≥5%, randomized to tracking tools plus coaching (i.e., coaching group) or tracking tools without coaching (i.e., tracking-only group). At baseline, 6, 12, and 24 months, participants reported lifestyle strategies used in the past 6 months, including self-monitoring, group support, behavioral skills, and professional support. General linear models evaluated changes in the number of strategies over time between groups and the consistency of strategies used over the 24-month intervention.

Results

At baseline, 100% used behavioral skills, 73% used group support, 69% used self-monitoring, and 68% used professional support in the past 6 months; at 24 months, these rates were 98%, 60%, 75%, and 61%, respectively. While the number of participants utilizing individual strategies did not change significantly over time, the overall number of strategies participants reported decreased. More strategies were used at baseline and 6 months compared to 12- and 24-month follow-ups. The coaching group used more strategies at months 6 and 12 than the tracking-only group. Consistent use of professional support strategies over the 24-month study period was associated with less weight regain.

Conclusion

Weight loss maintenance interventions that incorporate continued follow-up and support from healthcare professionals are likely to prevent weight regain after intentional weight loss.

Obesity and weight change during the COVID-19 pandemic in children and adults: A systematic review and meta-analysis

Many obesity risk factors have increased during the COVID-19 pandemic, including physical inactivity, poor diet, stress, and poverty. The aim of this systematic review was to evaluate the impact of the COVID-19 pandemic, as well as associated lockdowns or restrictions, on weight change in children and adults. We searched five databases from January 2020 to November 2021. We included only longitudinal studies with measures from before and during the pandemic that evaluated the change in weight, body mass index (BMI) (or BMI z-scores for children), waist circumference, or the prevalence of obesity. Random effects meta-analyses were conducted to obtain pooled estimates of the mean difference in outcomes. Subgroups were evaluated for age groups and diabetes or obesity at baseline. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale, and the certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A total of 74 studies were included (3,213,776 total participants): 31 studies of children, 41 studies of adults, and 2 studies of children and adults. In children, the pooled mean difference was 1.65 kg (95% confidence interval [CI]: 0.40, 2.90; 9 studies) for weight and 0.13 (95% CI 0.10, 0.17; 20 studies) for BMI z-scores, and the prevalence of obesity increased by 2% (95% CI 1%, 3%; 12 studies). In adults, the pooled mean difference was 0.93 kg (95% CI 0.54, 1.33; 27 studies) for weight and 0.38 kg/m² (95% CI 0.21, 0.55; 25 studies) for BMI, and the prevalence of obesity increased by 1% (95% CI 0%, 3%; 11 studies). In children and adults, the pooled mean difference for waist circumference was 1.03 cm (95% CI -0.08, 2.15; 4 studies). There was considerable heterogeneity observed for all outcomes in both children and adults, and the certainty of evidence assessed using GRADE was very low for all outcomes. During the first year of the COVID-19 pandemic, small but potentially clinically significant increases in weight gain, BMI, and increased prevalence of obesity in both children and adults were observed. Increases were greater in children, and targeted prevention interventions may be warranted.

Association of Early Weight Change With Cognitive Decline in Patients With Parkinson Disease

BACKGROUND AND OBJECTIVE

To examine whether early weight change is associated with subsequent deterioration in cognitive function, including overall performance and specific domains, in Parkinson disease (PD).

METHODS

This observational study used data from the Parkinson Progression Markers Initiative cohort. The patients underwent annual nonmotor assessments covering neuropsychiatric, sleep-related, and autonomic symptoms for up to 8 years of follow-up. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) and detailed neuropsychological testing. Linear mixed-effects models were applied to investigate the association of early weight change with longitudinal evolution of cognitive and other nonmotor symptoms.

RESULTS

A total of 358 patients with early PD were classified into weight loss (decrease of >3% body weight during the first year; n = 98), weight maintenance (within ±3%; n = 201), and weight gain (increase of >3%; n = 59) groups. The weight loss group showed a significantly faster decline in MoCA scores than the weight maintenance group (β = -0.19, 95% CI -0.28 to -0.10). With respect to specific cognitive domains, the weight loss group showed a steeper decline in sematic fluency test scores (β = -0.37, 95% CI -0.66 to -0.08) and MoCA phonemic fluency scores (β = -0.18, 95% CI -0.31 to -0.05) and, to a lesser extent, Letter-Number Sequencing scores (β = -0.07, 95% CI -0.14 to 0.01) compared with the weight maintenance group. Conversely, the weight gain group showed a slower decline in the Symbol Digit Modalities Test scores (β = 0.34, 95% CI 0.05 to 0.63), although no association was found with longitudinal changes in MoCA scores. We did not find any significant effects of weight change on the progression of other nonmotor symptoms.

DISCUSSION

Early weight loss was associated with a faster progression of decline in global cognitive function and executive function in patients with PD, whereas early weight gain was associated with a slower progression of decline in processing speed and attention. The impact of early weight change on nonmotor symptoms seemed to be specific to cognition.

A Cluster Randomized Controlled Trial Comparing Diabetes Prevention Program Interventions for Overweight/Obese Marshallese Adults

This study compared the effectiveness of two Diabetes Prevention Program (DPP) interventions on weight loss among overweight and obese Marshallese adults. The study was a two-arm cluster randomized controlled trial conducted in 30 churches in Arkansas and Oklahoma. Marshallese adults with a body mass index ≥25 kg/m2 were eligible for the study. The study sample included 380 participants. Participants received either a faith-based adaptation of the DPP or a family-focused adaptation of the DPP, each delivered over 24 weeks. The primary outcome was weight change from baseline. Secondary outcomes included changes in Hemoglobin A1c, blood pressure, dietary intake, family support for healthy behaviors, and physical activity. Outcomes were examined longitudinally using general linear mixed effects regression models, adjusting for baseline outcomes, sociodemographic covariates, and clustering of participants within churches. Reductions in weight were small for both groups. Overall, only 7.1% of all participants lost 5% or more of their baseline body weight. There were no significant differences in weight loss between the 2 arms at 6 months (P = .3599) or at 12 months (P = .3207). Significant differences in systolic and diastolic blood pressure were found between the 2 arms at 6 months (P = .0293; P = .0068, respectively). Significant within-arm changes were found for sugar-sweetened beverage consumption and family support for both arms at both follow-ups. Both interventions achieved a modest weight loss. While even modest weight loss can be clinically significant, future research is needed to identify chronic disease prevention interventions that can successfully reduce weight for this at-risk population.

Contrasts of Initial and Gain Scores in Obesity Treatment-Targeted Psychosocial Variables by Women Participants' Weight Change Patterns Over 2 Years

The typical pattern of weight change associated with behavioral obesity treatments has been some loss in weight through approximately 6 months, followed by near complete regain. However, patterns vary widely across individuals. The objectives are to determine whether recent prediction model-based indications of relations among changes in psychosocial correlates of the weight loss behaviors of physical activity and controlled eating vary by patterns of weight change. Women with obesity enrolled in a community-based behavioral obesity treatment who failed to lose at least 5% of their baseline weight (Minimal Effect group, n = 44), lost 5% or greater and then regained most during months 6 to 24 (Loss/Regain group, n = 42), or lost 5% or greater and then maintained/continued loss (Loss/Loss group n = 42) were evaluated. Improvements in physical activity- and eating-related self-regulation and self-efficacy, mood, and emotional eating over 6 months were significant overall and generally most favorable in the Loss/Loss group and least favorable in the Minimal Effect group. Expected model-based relationships between 6-month changes in the aforementioned psychosocial variables were significant and generally not significantly affected by weight change group. However, group substantially affected the prediction of self-regulation of eating at month 24-a key correlate of long-term weight loss. Findings suggested community-based obesity treatment targets and emphases.

Relation of dietary insulin index and dietary insulin load to metabolic syndrome depending on the lifestyle factors: Tehran lipid and glucose study

AIM

The hypothesis of the effect of the insulinogenic effects of diet on the development of cardiovascular diseases has been proposed, but the findings of previous studies are very contradictory. We investigated the association between dietary insulin index (DII) and dietary insulin load (DIL), and metabolic syndrome (MetS) risk. Another objective was to examine the extent to which lifestyle (physical activity, smoking status, and weight change) and sex influence the relationship between DII, DIL, and MetS risk.

MATERIALS AND METHODS

We followed 1915 participants in the Tehran Lipid and Glucose Study. DIL and DII were calculated based on a validated food frequency questionnaire. Weight change was measured, and participants were categorized into > 3% weight loss, weight stable (± 3%), and > 3% weight gain. By joint classification, the association between DII and DIL (< median and ≥ median) and risk of MetS was assessed according to weight change, sex, physical activity levels, and smoking status. Cox proportional hazards models were used to estimate the HRs (95% CI), adjusting for potential confounders.

RESULTS

During 8.9 years of follow-up, among 1915 participants, we documented 591 new cases of MetS. DII and DIL were not associated with MetS risk in the crude and adjusted models. However, DIL and DII were associated with weight gain (≥ 3%). In the crude model, DIL and DII were associated with a higher risk of weight gain [HR: 1.74: 95% CI 1.50-2.03, and 1.70 (1.46-1.98), respectively]. These associations remained significant after further adjustment for confounders. The HRs were 1.61 (1.35-1.92) for DIL and 1.64 (1.39-1.93) for DII. Among men, women, participants with low physical activity levels, and smokers, the risk of MetS, independent of DIL and DII, only increased in a participant with weight gain. In women with weight stability, DIL and DII, higher than the median, were positively associated with MetS risk.

CONCLUSION

Our findings suggest that the association between MetS risk and a hyperinsulinemic diet depended on weight change.

The effect of therapeutic drug monitoring of risperidone and aripiprazole on weight gain in children and adolescents: the SPACe 2: STAR (trial) protocol of an international multicentre randomised controlled trial

BACKGROUND

Antipsychotic drugs are an important part of the treatment of irritability and aggression in children with an autism spectrum disorder (ASD). However, significant weight gain and metabolic disturbances are clinically relevant side effects of antipsychotic use in children. In the SPACe study, we showed positive correlations between both risperidone and aripiprazole plasma trough concentrations and weight gain over a 6-month period. The trial SPACe 2: STAR is designed as a follow-up study, in which we aim to research whether therapeutic drug monitoring in clinical practice can prevent severe weight gain, while retaining clinical effectiveness.

METHODS

SPACe 2: STAR is an international, multicentre, randomised controlled trial (RCT). One hundred forty children aged 6 to 18 who are about to start risperidone or aripiprazole treatment for ASD related behavioural problems will be randomised into one of two groups: a therapeutic drug monitoring (TDM) group, and a care as usual (CAU) group. Participants will be assessed at baseline and 4, 10, 24, and 52 weeks follow-up. In the TDM group, physicians will receive dosing advice based on plasma levels of risperidone and aripiprazole and its metabolites at 4 and 10 weeks. Plasma levels will be measured in dried blood spots (DBS). The primary outcome will be BMI z-score at 24 weeks after start of antipsychotic treatment. Among the secondary outcomes are effectiveness, metabolic laboratory measurements, levels of prolactin, leptin and ghrelin, extrapyramidal side effects, and quality of life.

DISCUSSION

This will be the first RCT evaluating the effect of TDM of antipsychotic drugs in children and adolescents. Thus, findings from SPACe 2: STAR will be of great value in optimising treatment in this vulnerable population.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05146245. EudraCT number: 2020-005450-18. Sponsor protocol name: SPACe2STAR. Registered 8 June 2021. Protocol Version 6, Protocol date: 18 august 2022.

Recovery from weight regain among long-term weight loss maintainers in WW

OBJECTIVE

This study sought to understand the process and strategies to recover from regain among weight loss maintainers.

METHODS

Participants in WeightWatchers (WW; n = 2457) had lost ≥9 kg for ≥1 year and were grouped based on self-reported weight change after maximum loss: sustained maintenance ("Stable"), ups and downs ("Gain-Lose"), and regain ("Gain"). The groups were compared on weight control strategies, and the Gain-Lose and Gain groups reported on attempts to reverse weight regain.

RESULTS

Mean weight loss was 28.5 kg and duration of ≥9 kg loss was 3.5 years. During this time, 48% reported weight stability, and the remaining reported some regain (Gain-Lose, 29% or Gain, 23%). Among Gain and Gain-Lose, action to lose regained weight occurred after gaining >4 kg. Compared with Gain, Gain-Lose sustained reengagement efforts longer (16 vs. 10 weeks) and had better dietary choices (3.4 vs. 3.2), self-monitoring (2.9 vs. 2.7), and psychological coping (2.5 vs. 2.4) scores. Among Gain-Lose, the most successful (< 2.3 kg vs. >2.3 kg regain) initiated weight loss efforts after less regain (2.3 vs. 4.5 kg).

CONCLUSIONS

Reengaging with weight loss after regains may be most successful if focused on diet, self-monitoring, and psychological coping and initiated with less regain.

Assessing service provision and outcomes at the Canberra Obesity Management Service: A retrospective chart review

OBJECTIVE

This study aimed to evaluate the multidisciplinary care model of the Canberra Obesity Management Service (COMS) with regard to patient demographics and clinical outcomes, particularly in comparison with previous COMS outcome reviews.

METHODS

A retrospective chart review was carried out on all patients attending an initial assessment at COMS between July 2018 and June 2019. Existing patients attending follow-up reviews were excluded so as to avoid repeating analyses of data from previous COMS reviews. Patient data were recorded and deidentified and underwent descriptive analyses.

RESULTS

A total of 234 patients with a mean age of 45.6 (SD = 13.9) years, mean BMI of 50.1 kg/m² (SD = 8.5), and a female majority (72.2%) were analyzed. Of the 165 patients who attended follow-up appointments, 27.9% experienced ≥10% weight loss (46/165). Sleeve gastrectomy was associated with the largest mean weight reduction (15.6% at 6 months [n = 18]).

CONCLUSIONS

Compared with previous COMS studies, both the throughput and proportion of participants achieving clinically meaningful weight reduction were observed to have increased. Further studies assessing service cost-effectiveness, the development of standardized treatment pathways, and the use of a systematic data collection system would be valuable in allowing comparison between outcomes with similar obesity services in Australia and internationally.

Three-year weight change and risk of all-cause, cardiovascular, and cancer mortality among Iranian adults: over a decade of follow-up in the Tehran Lipid and Glucose Study

Background

We investigated the impact of weight change on mortality in a population-based cohort setting.

Methods

We conducted two weight measurements for 5436 participants aged ≥ 30 years with an approximate 3-year interval. Based on their weight change, we categorized participants to: > 5% weight loss, 3–5% weight loss, stable weight (± < 3%), 3–5% weight gain, > 5% weight gain. We followed participants for mortality annually up to March 20th 2018. We applied the multivariable Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of weight change categories for all-cause, cardiovascular (CV), and cancer mortality, considering stable weight as reference. The Cox models was adjusted for age, sex, educational level, body mass index, smoking status, hypertension, hypercholesterolemia, diabetes, and cardiovascular disease (CVD) at baseline.

Results

During a median follow-up of 14.4 years, 629 deaths (247 CV and 126 cancer deaths) have occurred. Over 5% weight loss and gain were associated with increased risk of all-cause mortality in multivariable analysis with HRs of 1.47 [95% CI: 1.17–1.85] and 1.27 [1.02–1.57], respectively; however, a 3–5% loss or gain did not alter the risk of all-cause mortality significantly. These significant risks for wight change > 5% were not modified by the presence of diabetes, obesity, and smoking status; however, the unfavorable impact of weight change on mortality events was more prominent in those older than > 65 years (P-value for interaction: 0.042). After excluding those with history of CVD, diabetes, and cancer during the weight measurements period, these associations significantly attenuated (HR: 1.29 [0.89–1.87] for > 5% weight loss and 1.12 [0.84–1.50] for > 5% weight gain). Additionally, a > 5% weight loss was also associated with about 60% higher risk for CV mortality (HR: 1.62 [1.15–2.28]), and a 3–5% weight loss was associated with about 95% higher risk of cancer mortality (HR: 1.95 [1.13–3.38]).

Conclusions

Our findings showed a U-shaped association across weight change categories for all-cause mortality risk with over 5% weight gain and loss causing higher risk. Moreover, weight loss can have adverse impact on CV and cancer mortality events.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14126-4.

Association between non-alcoholic fatty liver disease and metabolically healthy deterioration across different body shape phenotypes at baseline and change patterns

Non-alcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome (MetS), and the relationship between NAFLD and metabolic deterioration remains unclear. This study aimed to investigate dynamic changes in metabolically healthy phenotypes and to assess the impact of non-alcoholic fatty liver disease (NAFLD) on the conversion from metabolically healthy (MH) to metabolically unhealthy (MU) phenotypes across body shape phenotypes and phenotypic change patterns. We defined body shape phenotypes using both the body mass index (BMI) and waist circumference (WC) and defined metabolic health as individuals scoring ≤ 1 on the NCEP-ATP III criteria, excluding WC. A total of 12,910 Chinese participants who were MH at baseline were enrolled in 2013 and followed-up in 2019 or 2020. During a median follow-up of 6.9 years, 27.0% (n = 3,486) of the MH individuals developed an MU phenotype. According to the multivariate Cox analyses, NAFLD was a significant predictor of conversion from the MH to MU phenotype, independent of potential confounders (HR: 1.12; 95% confidence interval: 1.02–1.22). For the MH-normal weight group, the relative risk of NAFLD in phenotypic conversion was 1.21 (95% CI 1.03–1.41, P = 0.017), which was relatively higher than that of MH-overweight/obesity group (HR: 1.14, 95% CI 1.02–1.26, P = 0.013). Interestingly, the effect of NAFLD at baseline on MH deterioration was stronger in the “lean” phenotype group than in the “non-lean” phenotype group at baseline and in the “fluctuating non-lean” phenotype change pattern group than in the “stable non-lean” phenotype change pattern group during follow-up. In conclusion, lean NAFLD is not as benign as currently considered and requires more attention during metabolic status screening.

Exploring the clinical and genetic associations of adult weight trajectories using electronic health records in a racially diverse biobank: a phenome-wide and polygenic risk study

BACKGROUND

Weight trajectories might reflect individual health status. In this study, we aimed to examine the clinical and genetic associations of adult weight trajectories using electronic health records (EHRs) in the BioMe Biobank.

METHODS

We constructed four weight trajectories based on a-priori definitions of weight changes (5% or 10%) using annual weight in EHRs (stable weight, weight gain, weight loss, and weight cycle); the final weight dataset included 21 487 participants with 162 783 annual weight measures. To confirm accurate assignment of weight trajectories, we manually reviewed weight trajectory plots for 100 random individuals. We then did a hypothesis-free phenome-wide association study (PheWAS) to identify diseases associated with each weight trajectory. Next, we estimated the single-nucleotide polymorphism-based heritability (hSNP2) of weight trajectories using GCTA-GREML, and we did a hypothesis-driven analysis of anorexia nervosa and depression polygenic risk scores (PRS) on these weight trajectories, given both diseases are associated with weight changes. We extended our analyses to the UK Biobank to replicate findings from a patient population to a generally healthy population.

FINDINGS

We found high concordance between manually assigned weight trajectories and those assigned by the algorithm (accuracy ≥98%). Stable weight was consistently associated with lower disease risks among those passing Bonferroni-corrected p value in our PheWAS (p≤4·4 × 10-5). Additionally, we identified an association between depression and weight cycle (odds ratio [OR] 1·42, 95% CI 1·31-1·55, p≤7·7 × 10-16). The adult weight trajectories were heritable (using 5% weight change as the cutoff: hSNP2 of 2·1%, 95% CI 0·9-3·3, for stable weight; 4·1%, 1·4-6·8, for weight gain; 5·5%, 2·8-8·2, for weight loss; and 4·7%, 2·3-7·1%, for weight cycle). Anorexia nervosa PRS was positively associated with weight loss trajectory among individuals without eating disorder diagnoses (OR1SD 1·16, 95% CI 1·07-1·26, per 1 SD higher PRS, p=0·011), and the association was not attenuated by obesity PRS. No association was found between depression PRS and weight trajectories after permutation tests. All main findings were replicated in the UK Biobank (p<0·05).

INTERPRETATION

Our findings suggest the importance of considering weight from a longitudinal aspect for its association with health and highlight a crucial role of weight management during disease development and progression.

FUNDING

Klarman Family Foundation, US National Institute of Mental Health (NIMH).

The Outcomes of App-Based Health Coaching to Improve Dietary Behavior Among Nurses in a Tertiary Hospital: Pilot Intervention Study

Background

At the workplace, health care workers face multiple challenges in maintaining healthy dietary behaviors, which is the major factor behind obesity. A hospital-wide mass health screening exercise showed an increasing trend in the prevalence of obesity and median BMI from 2004 to 2019, as well as a higher crude obesity rate among shift workers.

Objective

We aimed to evaluate the effectiveness of mobile app–based health coaching and incentives for achieving weight loss from better dietary choices among hospital nurses.

Methods

We conducted a pilot study from June 2019 to March 2020, involving the use of a health-coaching app by 145 hospital nurses over 6 months. Weight and BMI were self-reported, and food scores were calculated. Data among overweight nurses, shift work nurses, and incentive groups were analyzed.

Results

A total of 61 nurses were included in the final analysis. Of these 61 nurses, 38 (62%) lost weight. The median percentage weight loss was 1.2% (IQR 0%-2.9%; P<.001), and the median decrease in BMI was 0.35 (IQR −0.15 to 0.82; P<.001), but they were not clinically significant. The median improvement in the food score was 0.4 (IQR 0-0.8). There was no difference between the incentive and nonincentive groups. A total of 49 (34%) participants engaged for ≥8 weeks.

Conclusions

The study demonstrated an association between the use of app-based health coaching and the attainment of some weight loss in nurses, without a significant improvement in the food score. Incentives may nudge on-boarding, but do not sustain engagement.

Multilevel Factors for Adiposity Change in a Population-Based Prospective Study of Black Breast Cancer Survivors

PURPOSE

Unfavorable weight change after breast cancer diagnosis increases the risk of mortality, but individual and neighborhood risk factors affecting postdiagnosis weight and body fat changes are unclear among Black women, who have higher rates of obesity and mortality than any other racial/ethnic group.

METHODS

Adiposity changes during the period approximately 10 months-24 months after diagnosis were evaluated among 785 women diagnosed between 2012 and 2018 and enrolled in the Women's Circle of Health Follow-Up Study, a population-based prospective cohort of Black breast cancer survivors in New Jersey. Multilevel factors for weight and fat mass change (with gain or loss defined as a relative difference of 3% or more, and considering whether changes were intentional or unintentional) were estimated using multivariable polytomous logistic regressions and multilevel models.

RESULTS

Adiposity gain was prevalent: 28% and 47% gained weight and body fat, respectively, despite a high baseline prevalence of overweight or obesity (86%). Risk factors for fat mass gain included receiving chemotherapy (relative risk ratio: 1.59, 95% CI, 1.08 to 2.33) and residing in neighborhoods with a greater density of fast-food restaurants (relative risk ratio comparing highest with lowest tertile: 2.18, 95% CI, 1.38 to 3.46); findings were similar for weight gain. Only 9% of women had intentional weight loss, and multilevel risk factors differed vastly from unintentional loss.

CONCLUSION

Both individual and neighborhood factors were associated with adiposity change among Black breast cancer survivors. Residential environment characteristics may offer clinically meaningful information to identify cancer survivors at higher risk for unfavorable weight change and to address barriers to postdiagnosis weight management.