General and abdominal adiposity and risk of death in Europe

Body Shapes of Multiple Anthropometric Traits and All-cause and Cause-specific Mortality in the UK Biobank

BACKGROUND

Individual traditional anthropometric measures such as body mass index and waist circumference may not fully capture the relation of adiposity to mortality. Investigating multitrait body shapes could overcome this limitation, deepening insights into adiposity and mortality.

METHODS

Using UK Biobank data from 462,301 adults (40-69 years at baseline: 2006-2010), we derived four body shapes from principal component analysis on body mass index, height, weight, waist and hip circumference, and waist-to-hip ratio. We then used multivariable-adjusted Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between body shapes and mortality for principal component scores of +1 and -1.

RESULTS

During 6,114,399 person-years of follow-up, 28,807 deaths occurred. A generally obese body shape exhibited a U-shaped mortality association. A tall and centrally obese body shape showed increased mortality risk in a dose-response manner (comparing a score of +1 and 0: HR = 1.16, 95% CI = 1.14, 1.18). Conversely, tall and lean or athletic body shapes displayed no increased mortality risks when comparing a score of +1 and 0, with positive relations for the comparison between a score of -1 and 0 in these shapes (short and stout shape: HR = 1.12, 95% CI = 1.10, 1.14; nonathletic shape: HR = 1.15, 95% CI = 1.13, 1.17).

CONCLUSION

Four distinct body shapes, reflecting heterogeneous expressions of obesity, were differentially associated with all-cause and cause-specific mortality. Multitrait body shapes may refine our insights into the associations between different adiposity subtypes and mortality.

American Society for Metabolic and Bariatric Surgery review of the body mass index

The body mass index was first described almost 200 years ago and has since been used as a measure of obesity. This review describes the history, advantages, disadvantages, and alternatives to the body mass index in the care of the metabolic and bariatric surgical patient.

Effects of Exercise Training on Body Composition and Exercise Capacity After Bariatric Surgery: A Systematic Review and Meta-Analysis

PURPOSE

Bariatric surgery is a widely used treatment for obesity; however, it may be associated with certain complications. Effective postoperative management, including lifestyle interventions and exercise training, is essential for optimal outcomes. This study explores the effectiveness of exercise training in postoperative care.

METHODS

We searched PubMed, Web of Science, Cochrane, and Embase up to April 3, 2024. Articles were screened and data extracted based on inclusion/exclusion criteria. Risk of bias was assessed using RoB 2.0, and data were analyzed with Stata 15.0.

RESULTS

Twenty-three articles involving 1940 patients were included; 16 were analyzed quantitatively. Exercise training did not significantly reduce body weight compared to routine care (WMD: -0.26; 95% CI, -2.11 to 1.58; I2 = 54%), but it significantly reduced fat mass (WMD: -2.42; 95% CI, -3.50 to -1.34; I2 = 42.9%) and maintained lean mass (WMD: 1.40; 95% CI, 0.32 to 2.48; I2 = 0.0%). Additionally, it reduced waist circumference (WMD: -2.58; 95% CI, -4.43 to -0.73; I2 = 13.4%) and improved exercise capacity (VO₂ max: WMD: 1.88; 95% CI, 0.64 to 3.13; I2 = 0.0%).

CONCLUSION

While exercise training did not significantly lower body weight post-surgery, it effectively reduced fat mass, maintained lean mass, and improved waist circumference and exercise capacity. Given the limited sample sizes in most studies, further large-scale controlled trials are warranted for more definitive conclusions, along with further consideration of their long-term impact on health metrics.

Preoperative Patient Attrition in Metabolic Bariatric Surgery: A Retrospective Monocentric Study

BACKGROUND

Obesity is a major public health issue. Although metabolic bariatric surgery is recommended for patients with obesity and related comorbidities, several patients drop out after receiving surgical eligibility. This study aims to assess dropout rate and identify predictors of attrition before surgery.

METHODS

This retrospective monocentric study included patients enrolled between June 2007 and December 2019 at a metabolic bariatric surgery center. Sociodemographic, clinical, and psychopathological data were collected. Patients were divided into operated group and attrition group. Univariate analysis and multivariate binary logistic regression were performed to identify independent predictors of attrition.

RESULTS

Of the 447 patients, the dropout rate was 22.25%. Depressed mood, binge eating disorder, and impulsivity traits at the time of psychiatric evaluation were correlated with dropout from the bariatric pathway (p < 0.05), but these variables lost significance at multivariate analyses. Significant predictors of attrition included male gender (OR = 3.723, p = 0.001), active smoking (OR = 2.852, p = 0.009), and ex-smoker status (OR = 2.860, p = 0.044). Protective factors were socio-familial support (OR = 0.194, p = 0.003) and the metabolic syndrome (OR = 0.078, p = 0.047). The average waiting time for surgery was 11.57 ± 9.36 months.

CONCLUSIONS

The study identifies key factors influencing patients' dropout in the surgical pathway, emphasizing the need for targeted interventions to improve retention. Although the presence of depressed mood, binge eating disorder, and impulsivity traits lost statistical significance at the multivariate analyses, their potential clinical relevance should be considered. The findings offer valuable insights for developing strategies to reduce attrition, enhance health care resource to support patients in achieving better health outcomes.

Association Between Weight-Adjusted Waist Index and the Prevalence of Low Back Pain: A Cross-Sectional Observational Study from National Health and Nutrition Examination Survey

BACKGROUND

The weight-adjusted waist index (WWI) is a novel obesity index that is calculated as the waist circumference (WC) divided by the square root of body weight (kg). Previous studies have revealed that higher body mass index (BMI) and WC increase the risk of low back pain (LBP). However, no research explores the relationship between WWI and LBP.

METHODS

Data utilized in this cross-sectional study were drawn from the National Health and Nutrition Examination Survey. Three logistic regression models were used to evaluate the association between WWI and LBP. Stratified analysis was applied to assess the stability of the results. Receiver-operating characteristic (ROC) curves were employed to visually assess and compare the predictive effectiveness of WWI, BMI, WC, and weight on LBP.

RESULTS

A significant positive correlation was observed between WWI and LBP, model 1 (odds ratio [OR] = 1.222, 95% confidence interval (95% CI) [1.164, 1.283], P < 0.0001), model 2 (OR = 1.187, 95% CI [1.118, 1.261], P < 0.0001), and model 3 (OR = 1.129, 95% CI [1.056, 1.207], P < 0.001). Relative to the Q1, Q3 (model 1 (OR = 1.241, 95% CI [1.114, 1.382], P < 0.001), model 2 (OR = 1.192, 95% CI [1.050, 1.353], P = 0.007), model 3 (OR = 1.145, 95% CI [1.002, 1.310], P = 0.047)) and Q4 (model 1 (OR = 1.524, 95% CI [1.341, 1.733], P < 0.0001), model 2 (OR = 1.422, 95% CI [1.233, 1.640], P < 0.0001), model 3 (OR = 1.333, 95% CI [1.149, 1.547], P < 0.001)) all showed a significant positive correlation between them. The area under the receiver-operating characteristic curve (AUC) for WWI is 0.5447536, the AUC for BMI is 0.5466724, and the AUC for WC and weight is 0.5501341 and 0.5376615, respectively.

CONCLUSIONS

This cross-sectional study revealed a significant positive association between WWI and LBP, but WWI did not show better predictive efficacy than BMI and WC.

Obesity-related indices are associated with self-reported infertility in women: findings from the National Health and Nutrition Examination Survey

OBJECTIVE

Obesity can contribute to infertility, but the exact relationship between infertility risk and obesity-related measurements like waist-to-height ratio (WHtR), body roundness index (BRI), conicity index (CoI), and A body shape index (ABSI) in women is uncertain. We investigated the association between these indices and female infertility.

METHODS

In this cross-sectional study, we used National Health and Nutrition Examination Survey data (2013-2018). We used weighted multivariable logistic regression analysis, receiver operating characteristic (ROC) curves, and subgroup analysis, as well as propensity score matching.

RESULTS

Among 3373 participants, 344 (10.2%) reported infertility. A significant link between higher infertility risk and increased WHtR, BRI, CoI, ABSI, and body mass index (BMI) was found. Multivariable logistic regression analysis showed WHtR (odds ratio [OR] = 1.27, 95% confidence interval [CI]: 1.14-1.42), BRI (OR = 1.09, 95% CI: 1.05-1.14), CoI (OR = 1.36, 95% CI: 1.18-1.56), ABSI (OR = 1.22, 95% CI: 1.12-1.33), and BMI (OR = 1.03, 95% CI: 1.02-1.05) were significantly associated with female infertility. CoI had the best diagnostic performance (area under the ROC curve 0.628, 95% CI: 0.597-0.658).

CONCLUSIONS

Obesity-related indices were positively linked to infertility risk among women in the United States. These indices serve as valuable tools for assessing female infertility risk.

Effect of a Culturally Adapted Exercise Program on the Anthropometrics and Body Composition of Postmenopausal Women With Excess Weight Gain: A Randomized Controlled Trial

Background

Physical activity (PA) is recommended as a component of weight management for the prevention of weight gain and weight regain after weight loss. Yet, no study has adapted culturally appropriate PA for postmenopausal women's health.

Aims

The study aimed to investigate the effect of a developed culturally appropriate exercise program for Ghanaian postmenopausal women with excess weight gain on the anthropometrics and body composition.

Material and methods

A single-blind randomized controlled trial in which participants randomly received a culturally-induced exercise program. A total of 226 Ghanaian postmenopausal women were randomized into exercise and control groups for 12 weeks. Anthropometrics (body mass index [BMI], waist-to-hip ratio [WHR], waist-to-height ratio [WHtR] waist circumference [WC], hip circumference [HC], and weight) and body composition (body fat, visceral fat, muscle mass) were determined pre-and post-intervention.

Results

Average of 58.70 ± 6.38 years (p > 0.05) with more than half (52.1%) above 58 years. Except for WHR, there were statistically significant differences in weight, BMI, WHtR, visceral fat, and total body fat in the exercise and control groups. Muscle mass increased significantly (+0.21 kg), whereas HC (-2.46 cm) and WC (-1.39 cm) decreased significantly compared with the control group. Within the exercise group, when stratified by BMI, there were higher reductions in BMI (1.01 kg/m2 vs. 0.46 kg/m2), WC (2.18 cm vs. 0.22 cm), body weight (2.12 kg vs. 1.17 kg) and body fat (1.84% vs. 1.6%) in women with obesity compared with women with overweight.

Conclusion

The promotion of Indigenous physical activity in postmenopausal women is beneficial. This has implications for health professionals who prescribe physical activity in postmenopausal women's treatment plans.

Trial Registration

PACTR202301779437544.

Influence of waist circumference measurement site on the cardiometabolic risk factors in Korean adults

BACKGROUND

Waist circumference (WC) has been recognized as a simple anthropometric measure of abdominal obesity and associated health risk. We compared WC values at five measurement sites, and examined whether measurement sites influence the relationships between WC and cardiometabolic risk in Korean adults.

METHODS

In this cross-sectional study, participants included 180 men and 176 women (age: 30-60 years, BMI: 18.5-30.0 kg/m2) who underwent a regular health examination between 2021 and 2022. WC was measured at the following sites; lowest rib, superior border of the iliac crest, midpoint between the lowest rib and the iliac crest, umbilicus, and narrowest waist. Fasting glucose and lipids, and resting blood pressure were measured after a 10-hour overnight fast. Cardiometabolic risk factors were defined using the modified National Cholesterol Education Program Adult Treatment Panel-III.

RESULTS

All WC measures at five sites were highly correlated (P < 0.01) with each other in men (r = 0.933-0.995) and women (r = 0.893-0.990). Differences in absolute mean WC values existed in both men and women. The prevalence of abdominal obesity (men: 17.2 %-34.4 %, women: 5.7 %-40.9 %) and metabolic syndrome (men: 30.6 %-38.9 % women: 13.6 %-22.2 %) varied depending on the measurement site. All five WC sites were similarly associated (P < 0.05) with an increased odd ratio for elevated glucose, elevated triglycerides, low HDL cholesterol and cardiometabolic risk clustering in men, and elevated blood pressure and cardiometabolic risk clustering in women.

CONCLUSION

Although the differences in absolute WC values existed, the associations between WC at each site and cardiometabolic risk were similar in Korean adults.

Factors influencing waist circumference among urban bank employees in Northeast Ethiopia: a cross-sectional study

Introduction

A widely recognized public health issue affecting people worldwide is central obesity. Numerous chronic conditions, such as type 2 diabetes mellitus, cardiovascular disease, and malignancies are linked to this syndrome. There is limited information about waist circumference (WC) and its related variables among urban bank workers in Ethiopia. Therefore, the purpose of this study was to evaluate waist circumference and the factors associated with it among bank workers in Northeast Ethiopia.

Methods

An institution-based cross-sectional study was carried out in Dessie, Northeast Ethiopia, between 2 October 2023 and 24 October 2023. A random selection method was employed to select 363 bank workers. STATA version 17 was used for analysis after the data were imported into EpiData version 4.4.2.0. Univariate and multivariate linear regression analyzes were performed to identify factors related to waist circumference. Normality, homoscedasticity, significant outliers, and multicollinearity were assessed, and a p-value of less than 0.05, along with a 95% confidence interval, was considered statistically significant.

Results

A total of 345 participants were included in the final analysis, with a 95% response rate. The overall mean ± standard deviation (SD) of the waist circumference of the employees was 81.7 ± 6.8 cm, with 82.4 ± 6.5 cm for men and 80.7 ± 7.2 cm for women. The overall prevalence of central obesity was 57.7%, with 48.2% for the men and 70.3% for the women. The overall mean ± SD of the waist-to-hip ratio (WHR) was 0.90 ± 0.05, with 0.91 ± 0.04 for men and 0.89 ± 0.05 for women. The average waist circumference was significantly associated with the participants' age (0.2 cm per year (SE: 0.1)) and MET hours (0.2 cm (SE: 0.1)). The mean waist circumference was 2.7 cm (SE:0.8) higher in the married women, 4.6 cm (SE:1.9) higher in the participants with non-communicable diseases (NCDs), and 1.7 cm (SE:0.8) higher in the participants who consumed discretionary calories for 4 days/week.

Conclusion

The mean waist circumference among bank employees was higher, with more than half of the participants having central obesity. Age, marital status, discretionary calorie intake, non-communicable diseases, and metabolic equivalence task hours were the significant factors of waist circumference. Therefore, promoting activities aimed at preventing non-communicable diseases, such as leisure-time physical activity, and reducing discretionary calorie intake are essential for reducing high waist circumference measurements.

Management of obesity

PURPOSE

This review summarizes the comprehensive management of obesity with a focus on the pharmacology, efficacy, and safety of anti-obesity medications.

SUMMARY

Obesity is a highly prevalent chronic disease with significant health risks, requiring a multifaceted approach to treatment. While most approved weight loss medications have modest effects, newer medications such as semaglutide and tirzepatide have shown greater than 15% reduction in baseline weight. Optimal selection of therapy requires taking into consideration patient factors, such as comorbidities and goals, and medication-related factors, including weight loss efficacy, contraindications, and improvements in cardiovascular risk. As the availability of anti-obesity medications increases, multidisciplinary care teams will play an important role in selecting optimal strategies for long-term health benefits in individuals with obesity.

CONCLUSION

The expanding array of anti-obesity medications provides valuable treatment options alongside lifestyle interventions and surgical approaches for managing obesity and reducing weight-related health risks. As this therapeutic area continues to grow, selecting optimal agents and educating patients on administration, monitoring, and potential adverse effects will be critical for improving overall outcomes.

Safety and effects of anti-obesity medications on weight loss, cardiometabolic, and psychological outcomes in people living with overweight or obesity: a systematic review and meta-analysis

Background

Overweight and obesity pose serious health challenges for individuals and societies. This study aims to facilitate personalised treatment of obesity by summarising recent research on weight-loss pharmacotherapies, with a focus on their effects on weight reduction, cardiometabolic health, psychological outcomes, and adverse events.

Methods

This systematic review and meta-analysis included searches of Web of Science, PubMed, and Cochrane Central Register of Controlled Trials from inception to June 8, 2024. Randomised controlled trials evaluating weight-loss pharmacotherapies approved by the Food and Drug Administration (FDA) or European Medicines Agency (EMA) for treating overweight or obesity were included. Primary outcomes included changes in body weight, cardiometabolic indicators, psychological outcomes, and adverse events. Summary data was extracted from published reports. Random-effects meta-analyses were used to calculate weighted mean differences (WMDs), risk ratios (RRs), and 95% confidence intervals (CI). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of evidence for each pooled analysis. PROSPERO registration: CRD42024547905.

Findings

A total of 154 randomised controlled trials (n = 112,515 participants) were included. Tirzepatide had the greatest weight-loss effect (WMD -11.69, 95% CI -19.22 to -4.15; P = 0.0024; I2 = 100.0%; moderate certainty), followed by semaglutide (-8.48, -12.68 to -4.27; P < 0.0001; I2 = 100.0%; moderate certainty). Tirzepatide had the strongest antihypertensive effect on both systolic (WMD -5.74, -9.00 to -2.48; P = 0.0006; I2 = 99.8%; moderate certainty) and diastolic blood pressure (WMD -2.91, -4.97 to -0.85; P = 0.0056; I2 = 99.8%; moderate certainty) and best reduced triglycerides (WMD -0.77, -0.85 to -0.69; P < 0.0001; I2 = 3.2%; high certainty), fasting glucose (WMD -3.06, -5.53 to -0.59; P = 0.015; I2 = 100.0%; moderate certainty), insulin (WMD -4.91, -8.15 to -1.68; P = 0.0029; I2 = 97.0%; moderate certainty), and glycated haemoglobin levels (WMD -1.27, -1.82 to -0.73; P < 0.0001; I2 = 100.0%; moderate certainty). Semaglutide (RR 0.83, 0.74-0.92; P < 0.0001; I2 = 0.0%; high certainty) and liraglutide (0.87, 0.79-0.96; P = 0.0059; I2 = 0.0%; high certainty) reduced the risk of major adverse cardiovascular events (MACEs). However, all three medications were associated with adverse gastrointestinal effects. Naltrexone/bupropion increased the risk of elevated blood pressure (RR 1.72, 1.04-2.85; P = 0.036; I2 = 0.0%; high certainty). Topiramate increased depression risk (RR 1.62, 1.14 to 2.30; P = 0.0077; I2 = 0.0%; high certainty), and phentermine/topiramate raised concerns about anxiety (RR 1.91, 1.09 to 3.35; P = 0.025; I2 = 29.5%; high certainty), sleep disorders (RR 1.55, 1.24-1.93; P < 0.0001; I2 = 0.0%; high certainty), and irritability (RR 3.31, 1.69-6.47; P < 0.0001; I2 = 0.0%; high certainty). No medication increased the risk of serious adverse events.

Interpretation

For weight reduction, tirzepatide is the top choice, followed by semaglutide. Considering cardiometabolic risk factors, tirzepatide shows the best blood pressure- and glucose-lowering benefits, while semaglutide and liraglutide reduce the risk of MACEs. Naltrexone/bupropion carries a risk of increased blood pressure. Phentermine/topiramate should be used with caution due to its higher risk of psychological side effects. Despite limitations related to study heterogeneity, these findings provide valuable insights for weight management strategies across diverse individuals.

Funding

National Natural Science Foundation of China, Leading Talents Program of Hunan Province, and Fundamental Research Funds for the Central Universities of Central South University.

A genetic basis of mitochondrial DNAJA3 in nonalcoholic steatohepatitis-related hepatocellular carcinoma

BACKGROUND AND AIMS

NAFLD is the most common form of liver disease worldwide, but only a subset of individuals with NAFLD may progress to NASH. While NASH is an important etiology of HCC, the underlying mechanisms responsible for the conversion of NAFLD to NASH and then to HCC are poorly understood. We aimed to identify genetic risk genes that drive NASH and NASH-related HCC.

APPROACH AND RESULTS

We searched genetic alleles among the 24 most significant alleles associated with body fat distribution from a genome-wide association study of 344,369 individuals and validated the top allele in 3 independent cohorts of American and European patients (N=1380) with NAFLD/NASH/HCC. We identified an rs3747579-TT variant significantly associated with NASH-related HCC and demonstrated that rs3747579 is expression quantitative trait loci of a mitochondrial DnaJ Heat Shock Protein Family (Hsp40) Member A3 ( DNAJA3 ). We also found that rs3747579-TT and a previously identified PNPLA3 as a functional variant of NAFLD to have significant additional interactions with NASH/HCC risk. Patients with HCC with rs3747579-TT had a reduced expression of DNAJA3 and had an unfavorable prognosis. Furthermore, mice with hepatocyte-specific Dnaja3 depletion developed NASH-dependent HCC either spontaneously under a normal diet or enhanced by diethylnitrosamine. Dnaja3 -deficient mice developed NASH/HCC characterized by significant mitochondrial dysfunction, which was accompanied by excessive lipid accumulation and inflammatory responses. The molecular features of NASH/HCC in the Dnaja3 -deficient mice were closely associated with human NASH/HCC.

CONCLUSIONS

We uncovered a genetic basis of DNAJA3 as a key player of NASH-related HCC.

Association of relative fat mass (RFM) index with diabetes-related mortality and heart disease mortality

Although studies have examined the association of the Relative Fat Mass (RFM, a novel anthropometric index used as a surrogate for whole-body fat percentage) with all-cause mortality, the association of RFM with diabetes-related mortality and heart disease mortality has not been thoroughly investigated. In addition, no study has compared the associations of RFM and waist circumference (a surrogate for intra-abdominal fat) with cause-specific mortality and all-cause mortality. In the present study, we addressed these knowledge gaps. We used data from the US National Health and Nutrition Examination Survey (NHANES) 1999-2018. NHANES III was used for validation. Analyses included 46,535 adults (mean age 46.5 years). During a median follow-up time of 9.7 years, 6,101 participants died (743 from diabetes; 1,514 from heart disease). Compared with BMI and WC, RFM was more strongly associated with diabetes-related mortality in both women and men, adjusting for age, ethnicity, education, and smoking status. All anthropometric measures were similarly strongly associated with heart disease mortality and all-cause mortality. RFM showed greater predictive discrimination of mortality. Similar results were found in NHANES III (n = 14,448). In conclusion, RFM is strongly associated with diabetes-related mortality, heart disease mortality, and all-cause mortality, and outperforms conventional adiposity measures for prediction of mortality.

Weight-adjusted waist index predicts metabolic syndrome in Caucasian patients with obesity

Introduction

Background and aims: the usefulness of the weight-adjusted waist index (WWI) among persons with metabolic syndrome (MS) has not been previously evaluated. The objective of this study was to evaluate the ability of WWI to predict MS in a Caucasian population with obesity. Methods: we conducted a cross sectional study in 2162 Caucasian patients with obesity. Anthropometric data (weight, height, body mass index [BMI], waist circumference, [WWI]), bioimpedanciometer parameters (total fat mass [FM], skeletal muscle mass [SMM] and skeletal muscle mass index [SMMi]), blood pressure, presence of MS and biochemical parameters were recorded and compared by tertiles of WWI. Results: a total of 1,176 subjects had MS (54.4 %) and 986 did not show MS (45.6 %). Compared with the lowest WWI category Q1 (< 11.24 cm/√kg), the prevalence of MS increased in the logistic regression model adjusted by sex and age in the Q3 group (OR = 2.53, 95 % CI = 1.71-3.23; p = 0.001). In addition, the prevalence of MS was higher in the Q3 group than in Q2 (OR = 1.65, 95 % CI = 1.25-2.17; p = 0.005). Finally, the prevalence of MS in Q2 was higher than in the Q1 group (OR = 1.21, 95 % CI = 1.06-3.11; p = 0.01). The area under the curve (AUC) to assess the ability of WWI to identify MS showed values of 0.811 (0.687-0.871; p = 0.001). The cut-off point according to the Youden index was 11.59, with sensitivity and specificity of 70 % and 93.4 %, respectively. Conclusion: we described a good accuracy of WWI to identify MS an independent association between WWI in Caucasian patients with obesity.

A systematic review of observational studies on the association between diet quality patterns and visceral adipose tissue

Beyond obesity, visceral adipose tissue (VAT) has emerged as an important predictor of chronic disease, but the role of diet quality patterns (DQP) in VAT development is not well defined. Therefore, we conducted a systematic review of how various DQP are associated with VAT via literature searches in PubMed and EMBASE. We included observational investigations in disease-free adults/adolescents that related DQP to VAT assessed by imaging methods. The studies were evaluated separately for a priori and a posteriori DQP and according to design differences. Study quality was assessed using the Risk of Bias in Non-randomised Studies of Interventions tool. Of the 1807 screened articles, thirty-five studies met the inclusion criteria. The majority of a priori indices, for example, the Healthy Eating Index, showed significant inverse associations with VAT, while only a small proportion of a posteriori patterns were related to VAT. Results did not differ substantially by the method of exposure and outcome assessment or between studies with (n 20) or without (n 15) body-size adjustment, but significant findings were more common in younger v. older individuals, USA v. other populations and investigations with moderate v. serious risk of bias. The heterogeneity of the existing literature limited the ability to quantify the magnitude of the associations across studies. These findings suggest that a high-quality diet, as assessed by a priori DQP, is generally inversely associated with VAT, but results for a posteriori DQP are less consistent. As associations persisted after adjusting for body size, diet quality may beneficially influence VAT beyond its association with obesity.

An explainable predictive model for anxiety symptoms risk among Chinese older adults with abdominal obesity using a machine learning and SHapley Additive exPlanations approach

Background

Early detection of anxiety symptoms can support early intervention and may help reduce the burden of disease in later life in the elderly with abdominal obesity, thereby increasing the chances of healthy aging. The objective of this research is to formulate and validate a predictive model that forecasts the probability of developing anxiety symptoms in elderly Chinese individuals with abdominal obesity.

Method

This research's model development and internal validation encompassed 2,427 participants from the 2017-2018 Study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Forty-six variables were defined based on the Health Ecology Model (HEM) theoretical framework. Key variables were screened using LASSO regression, and the XGBoost (Extreme Gradient Boosting) model was further introduced to forecast the risk of developing anxiety symptoms in the elderly with abdominal obesity. SHapley Additive exPlanations (SHAP) was adopted to further interpret and show how the eigenvalues contributed to the model predictions.

Results

A total of 240 participants (9.89%) with anxiety symptoms out of 2,427 participants were included. LASSO regression identified nine key variables: looking on the bright side, self-reported economic status, self-reported quality of life, self-reported health status, watching TV or listening to the radio, feeling energetic, feeling ashamed/regretful/guilty, feeling angry, and fresh fruits. All the evaluation indicators of the XGBoost model showed good predictive efficacy. Based on the significance of the features identified by SHAP (Model Interpretation Methodology), the feature 'looking on the bright side' was the most important, and the feature 'self-reported quality of life' was the least important. The SHAP beeswarm plot illustrated the impacts of features affected by XGBoost.

Conclusion

Utilizing machine learning techniques, our predictive model can precisely evaluate the risk of anxiety symptoms among elderly individuals with abdominal obesity, facilitating the timely adoption of targeted intervention measures. The integration of XGBoost and SHAP offers transparent interpretations for customized risk forecasts.

Abdominal fat accumulation increases the risk of high blood pressure: evidence of 47,037 participants from Chinese and US national population surveys

AIMS

This study aims to ascertain whether abdominal fat accumulation evaluated by waist circumference increases the risk of hypertension using the nationwide population.

METHODS

We enrolled 47,037 participants from the China Health and Nutrition Survey (CHNS), China Health and Retirement Longitudinal Study (CHARLS), and National Health, and Nutrition Examination Survey (NHANES). The adjusted logistic regression model was used to examine the relationship between waist circumference and prevalent hypertension. 9445 participants without baseline hypertension from the CHNS and CHARLS were followed up to investigate the association between waist circumference and onset hypertension. The association was evaluated using a Cox regression model and restricted cubic spline. Furthermore, Mendelian randomization was employed to explore causal inferences.

RESULTS

In the baseline survey, waist circumference demonstrated a notable correlation with hypertension, presenting an odds ratio (with 95% confidence intervals) of 1.34 (1.28 ~ 1.40). After a mean follow-up of 3.8 years for participants without baseline hypertension, 2,592 (27.5%) developed hypertension. In the pooled analysis, the Cox regression showed that every 10 cm increase in waist circumference was associated with 20% (95% CI: 13% ~ 27%) elevated risk of new-onset hypertension. Restricted cubic splines indicated a pronounced linear dose-response relationship. A subgroup analysis affirmed the persisting association between waist circumference and hypertension onset even in those with normal BMI. The Mendelian randomization method revealed a significant causative association between waist circumference and hypertension.

CONCLUSION

Elevated waist circumference stands as an independent risk factor for hypertension, even in those with normal BMI. Our results provide evidence supporting the routine measure for waist circumference.

An updated study protocol for a real-life digital 12-month weight management program, the Healthy Weight Coaching

Obesity is an important health concern that poses many public health challenges. Evidence-based treatment modalities, capable of cost-effectively reaching large patient groups are needed. In this paper, we present the design and methods of the updated national, 12-month, digital weight management program, the Healthy Weight Coaching (HWC). The major updates, as compared to the previous version, are related to the theoretical background of the obesity management and updated BMI cut-offs. The HWC is available, based on physicians' referrals, to adult Finnish citizens with BMI ≥30 kg/m2 or ≥27 kg/m2 with a comorbidity, who have a health-based need to lose weight. Rooted in the principles of behavioural therapy, the HWC focuses on teaching coping skills, guides to healthy self-reflection, and supports concrete lifestyle changes as part of healthy weight loss. The automated weekly training sessions, supplemented by 3-8 exercises, form the basis of the program. These sessions address topics such as diet, physical activity, stress management, and rest and recovery. Additionally, a personal coach is allocated to each patient to provide tailored support. At baseline, patients record their weight, height, and waist circumference, online, and complete questionnaires on lifestyle, diet, physical activity, sleep, psychological factors, and health. Thereafter weight recording is conducted at least every 4 weeks, while the questionnaires and measuring the weight circumference are repeated at 3, 6, 9, and 12 months. In addition, patients can make use of diaries and peer group chats for additional support. Data collected from the consenting patients will be used for research purposes with the weight change from baseline to 12 months as the main outcome in the real-life observational study. The study will provide invaluable insights into the application of digital modalities in the treatment of obesity.

Abdominal obesity and cardiometabolic risk markers: A comparative analysis of waist circumference, dual-energy X-ray absorptiometry, and magnetic resonance imaging techniques

BACKGROUND AND AIMS

This study compares three methods to determine central adiposity (waist circumference -WC - and visceral adipose tissue - VAT - estimated by dual-energy x-ray absorptiometry - DXA, and by magnetic resonance imaging - MRI) in their ability to predict increases in cardiometabolic risk (CMR) markers in young individuals. We examined their associations with CMR in 47 men and women aged 25-40.

METHODS AND RESULTS

VAT mass was assessed using DXA and MRI. Blood samples were analyzed for CMR markers. Associations between central adiposity measurements and CMR factors were analyzed using Spearman's correlation coefficient, and the ability of these three central adiposity measurements to detect increased CMR was compared using receiver operating characteristic (ROC) curves. Similar to what was observed for the MRI-DXA and VAT-DXA, WC showed strong correlations with LDL-c and triglycerides (TG) and an inverse correlation with HDL-c (rho = -0.657 MRI, rho = -0.628 DXA, and rho = -0.604 WC, p < 0.01). On the other hand, only MRI-VAT and WC were associated with insulin and HOMA-IR (rho = 0.341 MRI and rho = 0.421 WC, p < 0.01). Central adiposity measurements were negatively associated with cold-induced 18F-FDG uptake in subcutaneous adipose tissue and positively associated with VAT TG content. No significant differences were observed when comparing the three central adiposity measurements in ROC curve analysis, and all measurements could predict increases in CMR markers and the combined CMR index.

CONCLUSIONS

This study reinforces the importance of using WC to assess increases in CMR markers among young adults. Given its practicality and efficacy, WC should be recommended in health centers to assess CMR risk.

A free-living, walking-based, exercise programme, with exercise timed relative to breakfast, to improve metabolic health in people living with overweight and obesity: A feasibility study

Optimising the timing of food intake relative to exercise may maximise the effectiveness of free-living exercise programmes on improvements in glycaemic control and cardio-metabolic health. This study aimed to assess the feasibility of a free-living, walking-based exercise programme and determine whether undertaking each exercise session before or after breakfast would most benefit longer-term metabolic health. Thirty-four people living with obesity (43±12 y, BMI 35.1±5.1 kg.m-2) undertook a 12-week walking-based programme, consisting of two continuous (30-60 min at 50% HRmax) and two interval exercise sessions per week (30-60 min, alternating 3 min at 85% HRmax and 3 min at 50% HRmax). Participants were allocated to exercise before (FASTED) or after (FED) breakfast (n = 17 per group). Feasibility (acceptability, adherence and compliance) to the exercise intervention were assessed, as well as changes in anthropometric variables, 24-hour continuous glucose monitoring, serum biochemistry including HbA1c, lipid profile and liver transaminases. Exercise adherence (FASTED: 93±4%, FED: 95±5%) and compliance (FASTED: 85±10%, FED: 88±10%) was high in both groups, and participants described exercise monitoring, programme structure and support as facilitators to this. Body mass, BMI, waist-to-hip ratio and HbA1c decreased similarly between groups (all P<0.01). However, serum ALT concentrations decreased after FASTED (-16± -14%; P = 0.001), but not FED training (-2 ± -4%; P = 0.720). We demonstrate that a free-living walking-based exercise programme, with exercise timed relative to breakfast can achieve high adherence and compliance and improve some anthropometric variables and HbA1c. Whether FASTED exercise can elicit greater improvements in liver health requires further investigation.

Development and validation of a risk score for detecting non-alcoholic fatty liver disease

The development of an easy-to-use noninvasive model to screen nonalcoholic fatty liver disease (NAFLD) is warranted. This study aimed to develop and validate a simple noninvasive NAFLD risk score (NARS). We used the National Health and Nutrition Examination Survey 2017 to March 2020 cycle data. The sample size of derivation and validation cohort were 4056 and 2502, separately. The NAFLD was determined by FibroScan® measured controlled attenuation parameter scores of >285 dB/m in the absence of excessive alcohol use, steatogenic medications use, and viral hepatitis. The NARS was derived from a multivariable logistic regression model and variables were selected based on Boruta analysis. The performance of NARS was internally validated and compared with previous models using receiver-operating characteristics curve and C-statistics. The NARS was established using waist circumference, triglycerides, alanine aminotransferase, and fasting glucose, and the total score ranges from 0 to 8, with an increasing risk of NAFLD. NARS demonstrated ideal discrimination in the validation cohort, with C-statistics of 0.832 (95% confidence interval, 0.801-0.824), and was not inferior to any existing models. The optimal cutoff point for predicting NAFLD was obtained at 4 scores with a sensitivity of 82% and specificity of 69%. We reported the derivation and internal validation of a novel and easy-to-use risk score for detecting the presence of NAFLD. NARS demonstrated ideal discrimination performance and was practical in clinical practice for selecting individuals at higher risk of NAFLD for further examination or intervention.

Accuracy of self-reported height, weight, and waist circumference in poor, rural areas of China

Objectives

There are differing opinions and findings about the accuracy of self-reported data. This study sought to assess the accuracy of self-reported height, weight, and waist circumference (WC) data among adult residents in poor, rural areas of China.

Methods

Multi-stage stratified cluster random sampling was used to sample rural adult residents in Jinzhai County. Intraclass correlations (ICCs), Bland-Altman plots with limits of agreements (LOAs), and Cohen's kappa were used to examine the accuracy of self-reported data. Multiple linear regression was used to explore the effect of demographic and socioeconomic variables.

Results

Height was over-reported by an average of 0.67 cm, weight and WC were both under-reported, by an average of 0.004 kg and 1.09 cm, respectively. The ICC for height was 0.92, the ICC for weight was 0.93, and the ICC for WC was 0.93. Bland-Altman plots showed no trend in variability with increasing height, weight, and WC, but 95% of the LOAs were wide, especially for WC. The percentage agreement (kappa) for BMI was 82.10% (0.71), and the percentage agreement for WC was 83.56% (0.66). Overall, obesity, overweight, and increased WC were underestimated by 0.56%, 2.64%, and 6.89%, respectively. Assessments of which demographic and socioeconomic factors were associated with statistically significant differences between self-reported and measured data showed that education (junior school vs. primary or below: β = -0.56, 95% CI [-1.01 to -0.11]) and occupation (others vs. professionals: β = 2.16, 95% CI [0.62-3.70]) were associated with differences between measured and self-reported height; occupation (industrial and commercial service vs. professionals: β = 1.57, 95% CI [0.52-2.61]) was associated with differences between measured and self-reported weight; and gender (women vs. men: β = -1.74, 95% CI [-2.51 to -0.97]) and age (60- vs. 18-44: β = -1.62, 95% CI [-2.88 to -0.36]) were associated with differences between measured and self-reported WC.

Conclusions

Self-reported height and weight were shown to be reliable in poor, rural areas of China, but self-reported WC should be used with caution. To improve the accuracy of self-reported data, certain subgroups should be targeted for educational interventions.

Abdominal obesity: A lethal factor in elderly male osteoporosis patients - insights from NHANES

BACKGROUND AND AIM

This study aims to investigate the relationship between A Body Shape Index (ABSI) Z-score and all-cause mortality among osteoporotic patients using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS AND RESULTS

We analyzed NHANES data from 2005 to 2010, 2013 to 2014, and 2017 to 2018, focusing on individuals aged 50 and above with complete bone mineral density (BMD) data. The ABSI Z-score, calculated by adjusting waist circumference (WC) for height and weight, was used to independently assess abdominal fat beyond Body Mass Index (BMI). Mortality status was confirmed by linking NHANES data with the National Death Index (NDI), with follow-up until December 31, 2019. Weighted Cox proportional hazards models were employed for analysis, adjusting for age, gender, race, fracture history, anti-osteoporosis treatment history, diabetes, and cardiovascular disease (CVD). The study included 1596 participants. Higher ABSI Z-scores were significantly associated with increased all-cause mortality risk, especially among elderly male osteoporotic patients. This association remained robust after adjusting for multiple potential confounders.

CONCLUSION

The ABSI Z-score serves as a valuable non-invasive screening tool that effectively identifies osteoporotic patients at higher risk of mortality. These findings emphasize the importance of body management in health, supporting further research to explore the practical utility of ABSI Z-score in osteoporotic patients and how body management can enhance long-term survival rates.

Renal adaptation in pre-obesity patients with hypertension

BACKGROUND AND HYPOTHESIS

Obesity aggravates the risk to develop chronic kidney disease in hypertensive patients. Whether pre-obesity already impairs renal function, renal perfusion and intraglomerular hemodynamics in hypertensive patients is unknown.

METHODS

Renal hemodynamic profiles were measured using steady state input clearance (infusion of para-amino-hippuric acid and inulin) in 36 patients with primary arterial hypertension stage 1-2 without antihypertensive medication. Intraglomerular pressure (IGP) and resistances of the afferent (RA) and efferent (RE) arterioles were calculated. The study population was divided into two groups based on median of waist circumference (WC) (96 cm) (pre-obesity and non-obesity group1) and median of body mass index (BMI) (26.5 kg/m 2 ) (pre-obesity and non-obesity group2), respectively.

RESULTS

All patients were males, non-smoking, aged 36 ± 10 years, with an office blood pressure of 145 ± 8.6/89 ± 11.8 mmHg. None of the patients had cardiovascular disease. Patients from the pre-obese group 1 showed lower glomerular filtration rate (GFR), lower renal plasma flow (RPF) and lower IGP compared to the non-obese group1. Renal vascular resistance (RVR) and RA were higher in the pre-obese group1 compared to the non-obese group1. Similar differences in the hemodynamic profile were found for patients in the pre-obesity group2 compared to the non-obesity group2.

CONCLUSION

The renal hemodynamic profile in hypertensive patients with pre-obesity, irrespective whether defined by WC or BMI, was characterized by a reduced GFR and RPF and by an increased RVR preferentially at the preglomerular site. Our results suggest that hypofiltration is the first phase of renal adaptation in pre-obesity hypertension.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov : NCT02783456.

Epigenetic profiles in blood and adipose tissue: identifying strong correlations in morbidly obese and non-obese patients

Epigenetic alterations play a pivotal role in conditions influenced by environmental factors such as overweight and obesity. Many of these changes are tissue-specific, which entails a problem in its study since obtaining human tissue is a complex and invasive practice. While blood is widely used as a surrogate biomarker, it cannot directly extrapolate the evidence found in blood to tissue. Moreover, the intricacies of metabolic diseases add a new layer of complexity, as obesity leads to significant alterations in adipose tissue, potentially causing associated pathologies that can disrupt existing correlations seen in healthy individuals. Here, our objective was to determine which epigenetic markers exhibit correlations between blood and adipose tissue, regardless of the metabolic status. We collected paired blood and adipose tissue samples from 64 patients with morbidity obesity and non-obese and employed the MethylationEPIC 850 K array for analysis. We found that only a small fraction, specifically 4.3% (corresponding to 34,825 CpG sites), of the sites showed statistically significant correlations (R ≥ 0.6) between blood and adipose tissue. Within this subset, 5327 CpG sites exhibited a strong correlation (R ≥ 0.8) between blood and adipose tissue. Our findings suggest that the majority of epigenetic markers in peripheral blood do not reliably reflect changes occurring in visceral adipose tissues. However, it is important to note that there exists a distinct set of epigenetic markers that can indeed mirror changes in adipose tissue within blood samples. KEY MESSAGES: More than 8% of methylation sites exhibit similarity between blood and adipose tissues, regardless of BMI The correlation percentage between blood and adipose tissue is strongly influenced by gender The principal genes implicated in this correlation are related to metabolism or the immunological system.

Association between body roundness index and osteoarthritis: a cross-sectional analysis of NHANES 2011-2018

Objective

The objective of this study was to investigate the potential association between body roundness index (BRI) and the risk of osteoarthritis (OA) in US adults.

Methods

A cross-sectional analysis consisting of 20,232 participants was conducted using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Participants (≥20 years of age) were included and divided into OA and non-OA groups. Then, the demographics and characteristics of the participants were compared between the two groups. The relationship between BRI and OA was assessed using a multivariate logistic regression model with fitted smoothed curve techniques. Additionally, subgroup analyses on the correlation between BRI and OA were performed.

Results

The BRI scores in OA group were significantly higher than in the non-OA group (6.60 ± 2.62 vs. 5.46 ± 2.34, p < 0.001). Multivariate logistic analysis revealed that a significantly positive association between BRI and OA (OR = 1.12, 95% CI: 1.09-1.14, p < 0.001). In the subgroup analysis, only the race subgroup showed a significant difference between BRI and OA (p < 0.001).

Conclusion

Our findings highlight a significantly positive association between BRI and OA prevalence in the general US population.

Effectiveness of 2 Lip Taping Techniques in Infants With Bilateral Cleft Lip and Palate: A Randomized Clinical Trial

OBJECTIVES

This trial was designed to test the efficacy of 2 lip taping methods in modifying the maxillary arch dimensions (MADs) of infants with bilateral cleft lip and palate (BCLP) before lip repair surgery.

DESIGN

Parallel-group randomized clinical trial.

SETTING

The trial was conducted at 3 centers in Baghdad city.

PARTICIPANTS

Thirty-six nonsyndromic infants with BCLP.

INTERVENTION

The eligible infants were randomly assigned to either the first experimental group that received a conventional horizontal tape (3 M Steri strip-1/4 inch) or the second experimental group that received a custom-made tape made of Steri strips and orthodontic extra oral elastics. All of the included infants in both groups had rubber base impressions taken for them at the start of treatment (T1) and right before surgical lip repair (T2). A desktop scanner was used to scan each of the generated models, creating digital models that could be used for outcome evaluation.

MAIN OUTCOMES MEASURES

Virtual MAD measurements were performed by a blinded assessor on the generated digital models both before (T1) and after (T2) treatment.

RESULTS

At T2, both groups showed statistically significant changes in all measured MADs, with a mean difference ranging from 1.36 to 2.95 mm for the conventional taping group and from 1.46 to 7.96 mm for the custom-made one. The comparison of the 2 groups revealed both statistically and clinically significant differences with a P value <.05. The custom-made taping demonstrated more constriction in maxillary arch in terms of changes, which could provide easier surgical manipulation for the cleft parts.

CONCLUSION

Lip taping appears to be an efficient technique for modifying the MADs in infants with BCLP.

Waist circumference as a parameter in school-based interventions to prevent overweight and obesity - a systematic review and meta-analysis

BACKGROUND

Preventing childhood obesity remains an important public health issue worldwide. Since visceral fat in particular is understood as an important risk factor for many chronic diseases, waist circumference is recommended as a measurement parameter for global obesity surveillance. This systematic review and meta-analysis focused on waist circumference as an outcome parameter for studies of school-based interventions to prevent overweight and obesity.

METHODS

A systematic literature search was conducted at the end of 2019 in nine data bases, including Medline and Embase, in order to identify relevant studies evaluating interventions in schools aimed at preventing obesity. Eligibility criteria admitted randomised and non-randomised controlled trials. After screening titles, abstracts and full texts, the data of the identified studies were systematically extracted. Risk of bias was assessed according to study type with the appropriate Cochrane Risk of Bias Tool. The review gives a qualitative overview over all included studies structured by extracted data. Separate meta-analyses were done for the outcome mean difference in change in waist circumference, measured in cm or reported as z-score value, using an inverse variance random-effects model due to study design.

RESULTS

A total of 2421 publications were screened based on titles, abstracts and full texts. Complemented by results of a former systematic literature search 44 studies were identified for inclusion, comprising a total of 39.837 participants (age range: 6 to 18 years). Nearly half of the studies were conducted in Europe, two-thirds combined diet and exercise-based interventions. Likewise two thirds of the studies were conducted as cluster-randomised trials. Most of the reported effects favoured the experimental groups, indicating the basic effectiveness of school-based measures. Based on reported data, only one third of the studies could be included in the meta-analyses. For the difference in mean change of the outcome parameter waist circumference measured in cm (95% CI), we found a pooled effect estimate of -0.95 (-1.87; -0.46). For the difference in mean change of the outcome parameter waist circumference reported as z-score value (95% CI), the pooled effect estimate was -0.10 (-0.15; -0.05). Both effect estimates were in favour of the experimental group. The overall effect sizes were small with a p-value < 0.05.

CONCLUSIONS

Pooled effect estimates were small but in favour of the experimental groups. The same applies to the majority of the effects reported in the included studies. The included cluster of randomised controlled trials demonstrated an especially sound methodological standard. The possibility of achieving larger effects in studies of preventive interventions and health promotion is limited. Schools can only realise their full potential in preventing overweight and obesity in children and adolescents if they are accompanied by measures in other areas of the obesogenic environment.

Obesity-Related Traits Mediate the Effects of Educational Attainment on the Risk of Varicose Veins, Venous Thromboembolism, and Phlebitis

BACKGROUND

 The extent to which educational attainment (EA) influences the risk of varicose veins (VVs), venous thromboembolism (VTE), and phlebitis occurrence, whether this pathway is mediated by obesity-related traits, and the proportion of their mediation is unknown.

METHODS

 A Mendelian randomization (MR) design was used to genetically investigate the causal effects of EA on the risk of VV, VTE, and phlebitis and to assess the mediating effect of obesity-related traits. Causal effects were estimated using primarily the multiplicative random-effects inverse variance-weighted method. This was supplemented by Cochran's Q-statistic, MR-Egger regression, MR funnel plots, and leave-one-out test to evaluate the reliability of the results. For the individual mediation effect, the coefficient product method was mainly utilized to estimate.

RESULTS

 An increase in genetically predicted EA was associated with a lower risk of VV, VTE, and phlebitis, as well as lower body mass index, basal metabolic rate, hip circumference, and waist circumference. As genetically predicted body mass index, basal metabolic rate, hip circumference, and waist circumference increased, the risk of developing VV, VTE, and phlebitis increased, respectively. Body mass index, basal metabolic rate, hip circumference, and waist circumference were identified as mediators of the protective effects of EA on VV, VTE, and phlebitis.

CONCLUSION

 The findings support a causal relationship between higher EA and lower risk of VV, VTE, and phlebitis. Obesity-related traits play a significant mediating role in these pathways, and there are interactions between them, with hip circumference mediating these pathways relatively independently from the other three.

Obesity-related neuropathy: the new epidemic

PURPOSE OF REVIEW

To examine the evidence evaluating the association between obesity and neuropathy as well as potential interventions.

RECENT FINDINGS

Although diabetes has long been associated with neuropathy, additional metabolic syndrome components, including obesity, are increasingly linked to neuropathy development, regardless of glycemic status. Preclinical rodent models as well as clinical studies are shedding light on the mechanisms of obesity-related neuropathy as well as challenges associated with slowing progression. Dietary and surgical weight loss and exercise interventions are promising, but more data is needed.

SUMMARY

High-fat-diet rodent models have shown that obesity-related neuropathy is a product of excess glucose and lipid accumulation leading to inflammation and cell death. Clinical studies consistently demonstrate obesity is independently associated with neuropathy; therefore, likely a causal risk factor. Dietary weight loss improves neuropathy symptoms but not examination scores. Bariatric surgery and exercise are promising interventions, but larger, more rigorous studies are needed. Further research is also needed to determine the utility of weight loss medications and ideal timing for obesity interventions to prevent neuropathy.

The discriminatory capability of anthropometric measures in predicting reproductive outcomes in Chinese women with PCOS

OBJECTIVE

Obesity is a common feature in women with polycystic ovary syndrome (PCOS) and potentially significantly influences reproductive function. However, opinions are divided as to which factor is a more appropriate obesity predictor of reproductive outcomes. The aim of this study was to investigate the discriminatory capability of anthropometric measures in predicting reproductive outcomes in Chinese women with PCOS.

METHODS

A total of 998 women with PCOS from PCOSAct were included. Logistic regression models were used to compute the odds ratios (ORs) and 95% confidence interval (95% CIs) to assess the effect of anthropometric measures, including body mass index (BMI), waist circumference (WC), hip circumference (HC), the waist‒hip ratio (WHR) and the waist‒height ratio (WHtR), on reproductive outcomes. The discrimination abilities of the models were assessed and compared based on the area under the receiver operating characteristic curve (AUC), Akaike's information criterion (AIC) and integrated discrimination improvement (IDI).

RESULTS

Among PCOS women, there was a graded association between anthropometric measures and predicted reproductive outcomes across quintiles of anthropometric measures, including a linear association among WHR, BMI and reproductive outcomes and among waist circumference, WHtR and live birth, pregnancy, and ovulation. However, only a linear association was noted between the hip and ovulation. C-statistic comparisons and IDI analyses revealed a trend towards a significant superiority of BMI for ovulation and WHR for live birth, pregnancy and conception in the models. Combining obesity variables improved discrimination in the multivariable models for reproductive outcomes.

CONCLUSIONS

Our findings support that BMI is a better predictor of ovulation and that the WHR is a better predictor of live birth, pregnancy and conception, whereas the combination of obesity variables contributes to the discrimination of reproduction.

Visceral fat mass dynamics in a 2-year randomized STrength versus ENdurance training trial in people with obesity

AIM

To compare the effectiveness of strength versus endurance training on reducing visceral fat in individuals with obesity.

MATERIALS AND METHODS

For the STrength versus ENdurance (STEN) 24-month randomized clinical trial, we assigned 239 participants with abdominal obesity to either strength or endurance training (two to three times a week, 60 min/training session) in addition to standard nutritional counselling to promote a healthy diet. Changes in abdominal visceral adipose tissue (VAT) area quantified by magnetic resonance imaging after 12 months were defined as a primary endpoint.

RESULTS

Participants (aged 44 years, 74% women, body mass index: 37 kg/m2, mean VAT volume: 4050 cm3) had an approximately 50% retention rate and a 30% good training programme adherence at 12 months. There was no difference between strength and endurance training in VAT volume dynamics after 12 and 24 months (p = .13). Only in the good adherence group did we find a trend for reduced VAT volume in both training regimens. Independently of the exercise programme, there was a continuous trend for moderate loss of abdominal subcutaneous AT volume, body fat mass, body mass index and improved parameters of insulin sensitivity. Although parameters of physical fitness improved upon both exercise interventions, the dynamics of resting energy expenditure, glucose and lipid metabolism parameters were not different between the intervention groups and did not significantly improve during the 2-year trial (p > .05).

CONCLUSIONS

Despite heterogeneous individual training responses, strength and endurance training neither affected VAT volume nor key secondary endpoints differently.

Clinical Implications of Low Body Mass Index on Endovascular Lower Extremity Revascularization

BACKGROUND

The epidemic of obesity and associated cardiovascular morbidity continues to grow, attracting public attention and healthcare resources. However, the impact of malnutrition and being underweight continues to be overshadowed by obesity, especially in patients with peripheral arterial disease (PAD). This study assesses the characteristics and outcomes of patients with low body mass index (BMI ≤ 18.5) compared to patients with nonobese BMI undergoing peripheral vascular interventions (PVI).

METHODS

A retrospective analysis of patients undergoing PVI due to PAD registered in the Vascular Quality Initiative database. Patients were categorized into underweight (BMI ≤ 18.5) and nonobese BMI (BMI = 18.5-30). Patients in both groups were matched 3:1 for baseline demographic characteristics, comorbidities, medications, and indications. Kaplan-Meier analysis was done for long-term outcomes.

RESULTS

A total of 337,926 patients underwent PVI, of whom 12,935 (4%) were underweight, 215,728 (64%) were nonobese, and 109,263 (32%) were obese. Underweight patients were more likely to be older, female, smokers, with chronic obstructive pulmonary disorder, and more likely to present with chronic limb-threatening ischemia than nonobese patients. After propensity matching, there were 18,047 nonobese patients and 6,031 underweight patients. There were no significant differences in matched characteristics. Perioperatively, underweight patients were more likely to require a longer hospital length of stay. Underweight patients had statistically significantly higher 30-day mortality compared to patients with nonobese BMI (3% vs. 1.6%, P < 0.001) and a higher rate of thrombotic complications. As for long-term outcomes, underweight patients had a higher rate of reintervention (20% vs. 18%, P < 0.001) and major adverse limb events (27% vs. 22%, P < 0.001). The 4-year rate of amputation-free survival was significantly lower in underweight patients (70% vs. 82%, P < 0.001), and the 2-year freedom from major amputation (90% vs. 94%, P < 0.001) showed similar trends with worse outcomes in patients who were underweight.

CONCLUSIONS

Underweight patients with PAD are disproportionally more likely to be African American, females, and smokers and suffer worse outcomes after PVI than PAD patients with nonobese BMI. When possible, increased scrutiny and optimization of nutrition and other factors contributing to low BMI should be addressed prior to PVI.

Centrally Distributed Adiposity as a Modifiable Risk Factor for Fecal Incontinence: United States Population-based Analysis

BACKGROUND AND AIMS

Fecal incontinence (FI) is highly prevalent with substantial impacts on quality of life and health care utilization. The impact of obesity on FI remains unclear, with differing conclusions using body mass index (BMI) as a risk factor. We aimed to determine the association between obesity and FI, and whether this relationship is dependent on the distribution of adiposity (waist circumference-to-height ratio [WHtR]).

METHODS

This was a population-based analysis of the National Health and Nutrition Examination Survey, including participants who responded to the bowel health survey in 2005 to 2010. FI was defined by the accidental bowel leakage of solid stool, liquid, or mucus at least once in the past month. Stepwise multivariable logistic regression models were constructed to assess risk factors for FI.

RESULTS

A total of 7606 participants were included, with an overall FI prevalence of 9.2%. When stratified by quartiles of body measurements, FI was increasingly prevalent from the 1st to the 4th quartile for both WHtR (range, 5.3%-12.5%) and BMI (range, 7.1%-10.5%). WHtR was associated with FI and was a stronger predictor than BMI in all quartiles of body measurement. On multivariable analysis, WHtR remained a significant predictor of FI comparing the 4th with the 1st quartile of body measurements (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.11-2.80; P = .017), whereas BMI was not. A WHtR cutoff of >0.592 optimized the Youden index in prediction of FI in the overall sample.

CONCLUSION

WHtR was independently associated with increased odds of FI in this nationally representative sample of United States adults, whereas BMI was not consistently correlated. This suggests bowel continence may depend more on how body mass is distributed.

Loneliness and its cross-sectional associations with health, health behaviours, and perceptions in Finnish patients with overweight or obesity taking part in the Healthy Weight Coaching

OBJECTIVE

To investigate cross-sectional associations between loneliness and health, health behaviours, and perceptions in Finnish individuals with overweight or obesity (BMI ≥25 kg/m2).

METHODS

We used baseline data from patients participating, in 2016-2022, in a real-life digital 12-month weight management program known as Healthy Weight Coaching. Patients completed several questionnaires such as those related to loneliness, healthcare resource utilization, physical activity, and life satisfaction. BMI was computed based on self-reported weight and height. In addition to investigating individual health variables, we studied the association between loneliness and factor-analysis-derived health and wellbeing clusters.

RESULTS

Data were available from 2000 individuals (16.7% men, median age 48 years, median BMI 39.2 kg/m2). Altogether, 11.6%, 42.4%, and 46.0% reported feeling lonely, somewhat lonely, and not lonely, respectively. Feeling lonely was associated with higher BMI, greater healthcare resource utilization, lower life satisfaction, burdensomeness of life, more negative perceptions related to obesity and to the upcoming coaching, lower daytime energy, and reduced 20-min brisk walk results, a measure of functional capacity. Of the five factor-analysis-derived clusters, loneliness was adversely associated with "Life satisfaction" [lonely, 0.337 (0.270-0.421), p < 0.001; somewhat lonely, 0.545 (0.475-0.625), p < 0.001]. Moreover, loneliness associated with "Negative perceptions of obesity/daytime fatigue" [lonely, 4.627 (3.391-6.314), p < 0.001; somewhat lonely 2.021 (1.694-2.412), p < 0.001], and "Obesity/low physical activity" [lonely, 1.474 (1.105-1.966), p = 0.008; somewhat lonely, 1.220 (1.019-1.460), p = 0.030].

CONCLUSIONS

Loneliness had several untoward associations with health, health behaviours, and perceptions. Further research should explore the intricate relationship between obesity, loneliness, and physical and psychosocial health.

TRIAL REGISTRATION

The trial is registered at clinicaltrials.cov (Clinical Trials Identifier NCT04019249).

Explaining adverse cholesterol levels and distinct gender patterns in an Indonesian population compared with the U.S

Cardiovascular disease is among the most common causes of death around the world. As rising incomes in low and middle-income countries are accompanied by increased obesity, the burden of disease shifts towards non-communicable diseases, and lower-income settings make up a growing share of cardiovascular disease deaths. Comparative investigation of the roles of body composition, behavioral and socioeconomic factors across countries can shed light on both the biological and social drivers of cardiovascular disease more broadly. Comparing rigorously-validated measures of HDL and non-HDL cholesterol among adults in the United States and in Aceh, Indonesia, we show that Indonesians present with adverse cholesterol biomarkers relative to Americans, despite being younger and having lower body mass index. Adjusting for age, the gaps increase. Body composition, behaviors, demographic and socioeconomic characteristics that affect cholesterol do not explain between-country HDL differences, but do explain non-HDL differences, after accounting for medication use. On average, gender differences are inconsistent across the two countries and persist after controlling observed characteristics. Leveraging the richness of the Indonesian data to draw comparisons of males and females within the same household, the gender gaps among Indonesians are not explained for HDL cholesterol but attenuated substantially for non-HDL cholesterol. This finding suggests that unmeasured household resources play an important role in determining non-HDL cholesterol. More generally, they appear to be affected by social and biological forces in complex ways that differ across countries and potentially operate differently for HDL and non-HDL biomarkers. These results point to the value of rigorous comparative studies to advance understanding of cardiovascular risks across the globe.

Risks and Benefits of Intermittent Fasting for the Aging Cardiovascular System

Population aging and the associated increase in cardiovascular disease rates pose serious threats to global public health. Different forms of fasting have become an increasingly attractive strategy to directly address aging and potentially limit or delay the onset of cardiovascular diseases. A growing number of experimental studies and clinical trials indicate that the amount and timing of food intake as well as the daily time window during which food is consumed, are crucial determinants of cardiovascular health. Indeed, intermittent fasting counteracts the molecular hallmarks of cardiovascular aging and promotes different aspects of cardiometabolic health, including blood pressure and glycemic control, as well as body weight reduction. In this report, we summarize current evidence from randomized clinical trials of intermittent fasting on body weight and composition as well as cardiovascular and metabolic risk factors. Moreover, we critically discuss the preventive and therapeutic potential of intermittent fasting, but also possible detrimental effects in the context of cardiovascular aging and related disease. We delve into the physiological mechanisms through which intermittent fasting might improve cardiovascular health, and raise important factors to consider in the design of clinical trials on the efficacy of intermittent fasting to reduce major adverse cardiovascular events among aged individuals at high risk of cardiovascular disease. We conclude that despite growing evidence and interest among the lay and scientific communities in the cardiovascular health-improving effects of intermittent fasting, further research efforts and appropriate caution are warranted before broadly implementing intermittent fasting regimens, especially in elderly persons.

Obesity-related cancer and bariatric surgery: A comprehensive systematic review and meta-analysis protocol

INTRODUCTION

Obesity is a silent pandemic affecting all ages and is a component of metabolic syndrome. Its treatment is conducted by lifestyle and behavioral changes, pharmacological therapy, and when correctly indicated, bariatric surgery. In recent years, the procedures for weight loss have been investigated due to their relationship with the development of many types of cancer. Although many studies have shown that bariatric surgery decreases cancer risk, other researchers observed an increase in this association. Carcinogenesis is affected by many factors, such as age, sex, type of cancer, and the bariatric surgery performed on each patient. This systematic review and meta-analysis protocol aims to clarify the association between the different modalities of bariatric surgery and the risk of cancer development in adult patients with metabolic syndrome.

METHOD AND ANALYSIS

The proposed systematic review and meta-analysis will be reported conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guidelines. This research will include observational studies (case-control and cohort studies) about patients who undergo bariatric surgery due to metabolic syndrome. Will be accepted in any language and any year. Publications without peer review will be excluded from this review. Data will be entered into the Review Manager software (RevMan5.2.3). We extracted or calculated the OR and 95% CI for dichotomous outcomes for each study. In case of heterogeneity (I2>50%), the random-effects model will combine the studies to calculate the OR and 95% CI.

ETHICS AND DISSEMINATION

This study will review the published data; Thus, obtaining ethical approval is unnecessary. The findings of this systematic review will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023432079.

Association of a body shape index with femur bone mineral density among older adults: NHANES 2007-2018

This study investigated the relationship between A body shape index (ABSI) and bone mineral density (BMD) in older Americans and found a negative linear association, which was particularly pronounced in diabetic population. An early focus on ABSI in the elderly population will help in the prevention of osteoporosis.

OBJECTIVE

A body shape index (ABSI) is an abdominal obesity index developed based on epidemiological statistics and high ABSI indicates that waist circumference (WC) is higher than expected for a given height and weight and corresponds to a more central concentration of body volume. The objective of this study was to determine whether there is a linear or nonlinear relationship between ABSI and total femur bone mineral density (BMD) in older Americans and whether the relationship between the ABSI and total femur BMD varies across populations.

METHODS

This cross-sectional study was based on data from the 2007-2018 National Health and Nutrition Examination Survey (NHANES). Weighted multiple linear regression, restricted cubic spline (RCS) curves, subgroup analysis, and interaction tests were used to examine the association between ABSI and total femur BMD.

RESULTS

This study included 2505 older adults. This study found a negative linear correlation between ABSI and total femur BMD (β = -3.2, 95%CI: -5.0, -1.4, p < 0.001). When participants were grouped according to quartiles of ABSI, those in the upper quartile had lower total femur BMD compared to those in the bottom quartile of ABSI. This negative association remained consistent across gender, age, education level, smoking, physical activity and BMI subgroups. However, in the diabetes subgroup, ABSI showed a stronger negative association with total femur BMD.

CONCLUSIONS

The study shows a negative linear association between ABSI and total femur BMD in older Americans, with this negative association being stronger in the diabetic population.

Novel anthropometric indices are superior adiposity indexes to portend visual impairment in middle-aged and older Chinese population

OBJECTIVE

To investigate differential associations of traditional and novel adiposity indices with visual impairment (VI) in the middle-aged and older Chinese population.

METHODS AND ANALYSIS

Based on the China Health and Retirement Longitudinal Study, 7750 Chinese older adults aged over 45 were included at baseline 2011, and 4133 participants who accomplished all three interviews from 2011 to 2015 were adapted for longitudinal analyses. We enrolled six adiposity indices, including the body mass index (BMI), waist-to-height ratio (WHtR), weight-adjusted-waist index (WWI), a body shape index (ABSI), body roundness index (BRI) and conicity index (ConI). Visual status and other covariates included sociodemographic characteristics, medical supports and lifestyle-related factors. Cross-sectional correlations were assessed using univariate and multivariate logistic regression analyses. For longitudinal analysis, generalised linear models with generalised estimating equations were used to determine the association between time-varying adiposity and visual status.

RESULTS

Higher levels of WHtR/WWI/ABSI/BRI/ConI were significantly associated with an increased prevalence of VI, whereas a higher BMI was associated with a decreased prevalence of VI. Only WWI was significantly related to the prevalence of VI after adjustment for multiple confounders in both cross-sectional and longitudinal analyses (all p values <0.05). The multivariable-adjusted OR (95% CI) of VI associated with the highest (vs lowest) quintile of WWI was 1.900 (1.407 to 2.565).

CONCLUSION

WWI is a reliable alternative adiposity index that exhibits a dose-response association with the prevalence of VI in the Chinese population. The WWI-VI correlation may eliminate the obesity paradox in the ophthalmic epidemiological area and indicate the detrimental impact of changes in body composition on VI.

Regulation of Keap1-Nrf2 signaling in health and diseases

Nuclear factor erythroid 2-related factor 2 (Nrf2) functions as a central regulator in modulating the activities of diverse antioxidant enzymes, maintaining cellular redox balance, and responding to oxidative stress (OS). Kelch-like ECH-associated protein 1 (Keap1) serves as a principal negative modulator in controlling the expression of detoxification and antioxidant genes. It is widely accepted that OS plays a pivotal role in the pathogenesis of various diseases. When OS occurs, leading to inflammatory infiltration of neutrophils, increased secretion of proteases, and the generation of large quantities of reactive oxygen radicals (ROS). These ROS can oxidize or disrupt DNA, lipids, and proteins either directly or indirectly. They also cause gene mutations, lipid peroxidation, and protein denaturation, all of which can result in disease. The Keap1-Nrf2 signaling pathway regulates the balance between oxidants and antioxidants in vivo, maintains the stability of the intracellular environment, and promotes cell growth and repair. However, the antioxidant properties of the Keap1-Nrf2 signaling pathway are reduced in disease. This review overviews the mechanisms of OS generation, the biological properties of Keap1-Nrf2, and the regulatory role of its pathway in health and disease, to explore therapeutic strategies for the Keap1-Nrf2 signaling pathway in different diseases.

Prediction of visceral adipose tissue magnitude using a new model based on simple clinical measurements

Aims

Waist circumference (WC) is a reliable obesity surrogate but may not distinguish between visceral and subcutaneous adipose tissue. Our aim was to develop a novel sex-specific model to estimate the magnitude of visceral adipose tissue measured by computed tomography (CT-VAT).

Methods

The model was initially formulated through the integration of anthropometric measurements, laboratory data, and CT-VAT within a study group (n=185), utilizing the Multivariate Adaptive Regression Splines (MARS) methodology. Subsequently, its correlation with CT-VAT was examined in an external validation group (n=50). The accuracy of the new model in estimating increased CT-VAT (>130 cm2) was compared with WC, body mass index (BMI), waist-hip ratio (WHR), visceral adiposity index (VAI), a body shape index (ABSI), lipid accumulation product (LAP), body roundness index (BRI), and metabolic score for visceral fat (METS-VF) in the study group. Additionally, the new model's accuracy in identifying metabolic syndrome was evaluated in our Metabolic Healthiness Discovery Cohort (n=430).

Results

The new model comprised WC, gender, BMI, and hip circumference, providing the highest predictive accuracy in estimating increased CT-VAT in men (AUC of 0.96 ± 0.02), outperforming other indices. In women, the AUC was 0.94 ± 0.03, which was significantly higher than that of VAI, WHR, and ABSI but similar to WC, BMI, LAP, BRI, and METS-VF. It's demonstrated high ability for identifying metabolic syndrome with an AUC of 0.76 ± 0.03 (p<0.001).

Conclusion

The new model is a valuable indicator of CT-VAT, especially in men, and it exhibits a strong predictive capability for identifying metabolic syndrome.

Age-appropriate BMI cut-offs for malnutrition among older adults in India

With the increasing prevalence of obesity in India, body mass index (BMI) has garnered importance as a disease predictor. The current World Health Organization (WHO) body mass index (BMI) cut-offs may not accurately portray these health risks in older adults aged 60 years and above. This study aims to define age-appropriate cut-offs for older adults (60-74 years and 75 years and above) and compare the performance of these cut-offs with the WHO BMI cut-offs using cardio-metabolic conditions as outcomes. Using baseline data from the Longitudinal Ageing Study in India (LASI), classification and regression tree (CART) cross-sectional analysis was conducted to obtain age-appropriate BMI cut-offs based on cardio-metabolic conditions as outcomes. Logistic regression models were estimated to compare the association of the two sets of cut-offs with cardio-metabolic outcomes. The area under the receiver operating characteristic curve (AUC), sensitivity and specificity were estimated. Agreement with waist circumference, an alternate measure of adiposity, was conducted. For older adults aged 60-74 years and 75 years and above, the cut-off for underweight reduced from < 18.5 to < 17.4 and < 13.3 respectively. The thresholds for overweight and obese increased for older adults aged 60-74 years old from >  = 25 to > 28.8 and >  = 30 to > 33.7 respectively. For older adults aged 75 years and above, the thresholds decreased for both categories. The largest improvement in AUC was observed in older adults aged 75 years and above. The newly derived cut-offs also demonstrated higher sensitivity and specificity among all age-sex stratifications. There is a need to adopt greater rigidity in defining overweight/obesity among older adults aged 75 years and above, as opposed to older adults aged 60-74 years old among whom the thresholds need to be less conservative. Further stratification in the low risk category could also improve BMI classification among older adults. These age-specific thresholds may act as improved alternatives of the current WHO BMI thresholds and improve classification among older adults in India.

Flavonoids intake and weight-adjusted waist index: insights from a cross-sectional study of NHANES

This study conducted data on 15,446 adults to explore the impact of flavonoids on weight-adjusted waist index (WWI). This was a nationwide cross-sectional study among US adults aged 20 years or older. Dietary intake of flavonoids was assessed through 24-h recall questionnaire. WWI was calculated by dividing waist circumference (WC) by the square root of weight. We utilized weighted generalized linear regression to evaluate the association between flavonoids intake and WWI, and restricted cubic splines (RCS) to explore potential non-linear relationships. Our findings indicated that individuals with lower WWI experienced a notable increase in their consumption of total flavonoids, flavanones, flavones, flavan-3-ols, and anthocyanidins intake (β (95% CI); -0.05(-0.09, -0.01); -0.07(-0.13, 0.00); -0.07(-0.11, -0.02); -0.06(-0.11, 0.00); -0.13(-0.18, -0.08), respectively), with the exception of flavonols and isoflavones. Additionally, consumption of total flavonoids, flavonols, flavanones, isoflavones, and flavan-3-ols had a non-linear relationship with WWI (all P for non-linearity < 0.05). Furthermore, the effect of total flavonoids on WWI varied in race (P for interaction = 0.011), gender (P for interaction = 0.038), and poverty status (P for interaction = 0.002). These findings suggested that increase the intake of flavonoids might prevent abdominal obesity, but further prospective studies are requested before dietary recommendation.

Associations between waist-to-height ratio and abdominal aortic calcification: A cross-sectional study

Waist-to-height ratio (WtHR) is a validated biomarker of central obesity that appears to be preferable to other body composition measurements in the evaluation of cardiovascular disease. The goal of this research was to explore the connection between WtHR and abdominal aortic calcification (AAC) among adults. On the basis of data from the 2013 to 2014 National Health and Nutrition Examination Survey, multivariate logistic regression, sensitivity analysis, as well as smoothed curve fitting were used to evaluate the connection between WtHR and AAC. Subgroup analyses along with interaction tests were done to see if this link was consistent across populations. Among 3079 participants aged >40 years, there was a negative association between WtHR and ACC. Each 1-unit emergence of WtHR was related to a 2% reduction in the probability of severe AAC in the entirely adjusted model (odds ratio = 0.02, 95% confidence interval: [0.00-0.12]). Participants in the highest WtHR quartile were 39% less likely to acquire severe AAC compared with those in the lowest quartile. (odds ratio = 0.61, 95% confidence interval: [0.37-1.00]). This negative association was more pronounced in the diabetes subgroup. We discovered a reversed U-shaped association between WtHR as well as AAC score utilizing a 2-stage linear regression model, with an intersection point of 0.56. WtHR was negatively associated with AAC among US adults.

Association of weight-adjusted waist index with all-cause mortality among non-Asian individuals: a national population-based cohort study

INTRODUCTION

The Weight-Adjusted Waist Index (WWI) is a new indicator of obesity that is associated with all-cause mortality in Asian populations. Our study aimed to investigate the linear and non-linear associations between WWI and all-cause mortality in non-Asian populations in the United States, and whether WWI was superior to traditional obesity indicators as a predictor of all-cause mortality.

METHODS

We conducted a cohort study using data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES), involving 18,592 participants. We utilized Cox proportional hazard models to assess the association between WWI, BMI, WC, and the risk of all-cause mortality, and performed subgroup analyses and interaction tests. We also employed a receiver operating characteristics (ROC) curve study to evaluate the effectiveness of WWI, BMI, and WC in predicting all-cause mortality.

RESULTS

After adjusting for confounders, WWI, BMI, and WC were positively associated with all-cause mortality. The performance of WWI, BMI, and WC in predicting all-cause mortality yielded AUCs of 0.697, 0.524, and 0.562, respectively. The data also revealed a U-shaped relationship between WWI and all-cause mortality. Race and cancer modified the relationship between WWI and all-cause mortality, with the relationship being negatively correlated in African Americans and cancer patients.

CONCLUSIONS

In non-Asian populations in the United States, there is a U-shaped relationship between WWI and all-cause mortality, and WWI outperforms BMI and WC as a predictor of all-cause mortality. These findings may contribute to a better understanding and prediction of the relationship between obesity and mortality, and provide support for effective obesity management strategies.

Comprehensive Strategies for Metabolic Syndrome: How Nutrition, Dietary Polyphenols, Physical Activity, and Lifestyle Modifications Address Diabesity, Cardiovascular Diseases, and Neurodegenerative Conditions

Several hallmarks of metabolic syndrome, such as dysregulation in the glucose and lipid metabolism, endothelial dysfunction, insulin resistance, low-to-medium systemic inflammation, and intestinal microbiota dysbiosis, represent a pathological bridge between metabolic syndrome and diabesity, cardiovascular, and neurodegenerative disorders. This review aims to highlight some therapeutic strategies against metabolic syndrome involving integrative approaches to improve lifestyle and daily diet. The beneficial effects of foods containing antioxidant polyphenols, intestinal microbiota control, and physical activity were also considered. We comprehensively examined a large body of published articles involving basic, animal, and human studie, as well as recent guidelines. As a result, dietary polyphenols from natural plant-based antioxidants and adherence to the Mediterranean diet, along with physical exercise, are promising complementary therapies to delay or prevent the onset of metabolic syndrome and counteract diabesity and cardiovascular diseases, as well as to protect against neurodegenerative disorders and cognitive decline. Modulation of the intestinal microbiota reduces the risks associated with MS, improves diabetes and cardiovascular diseases (CVD), and exerts neuroprotective action. Despite several studies, the estimation of dietary polyphenol intake is inconclusive and requires further evidence. Lifestyle interventions involving physical activity and reduced calorie intake can improve metabolic outcomes.

ER stress inhibition enhances formation of triacylglcerols and protects endothelial cells from lipotoxicity

Elevated concentrations of palmitate in serum of obese individuals can impair endothelial function, contributing to development of cardiovascular disease. Although several molecular mechanisms of palmitate-induced endothelial dysfunction have been proposed, there is no consensus on what signaling event is the initial trigger of detrimental palmitate effects. Here we report that inhibitors of ER stress or ceramid synthesis can rescue palmitate-induced autophagy impairment in macro- and microvascular endothelial cells. Furthermore, palmitate-induced cholesterol synthesis was reverted using these inhibitors. Similar to cell culture data, autophagy markers were increased in serum of obese individuals. Subsequent lipidomic analysis revealed that palmitate changed the composition of membrane phospholipids in endothelial cells and that these effects were not reverted upon application of above-mentioned inhibitors. However, ER stress inhibition in palmitate-treated cells enhanced the synthesis of trilglycerides and restored ceramide levels to control condition. Our results suggest that palmitate induces ER-stress presumably by shift in membrane architecture, leading to impaired synthesis of triglycerides and enhanced production of ceramides and cholesterol, which altogether enhances lipotoxicity of palmitate in endothelial cells.

Cardiometabolic risk stratification using a novel obesity phenotyping system based on body adiposity and waist circumference

BACKGROUND

The estimation of obesity-associated cardiometabolic risk does not usually take into account body composition or the distribution of adiposity. The aim of the present study was to assess the clinical usefulness of a novel obesity phenotyping system based on the combination of actual body fat percentage (BF%) and waist circumference (WC) according to the cardiometabolic risk estimation.

METHODS

A classification matrix combining BF% and WC as measures of both amount and distribution of adiposity establishing nine body phenotypes (3 BF% x 3 WC) was developed. Individuals were grouped in five different cardiometabolic risk phenotypes. We conducted a validation study in a large cohort of White subjects from both genders representing a wide range of ages and adiposity (n = 12,754; 65 % females, aged 18-88 years).

RESULTS

The five risk groups using the matrix combination of BF% and WC exhibited a robust linear distribution regarding cardiometabolic risk, estimated by the Metabolic Syndrome Severity Score, showing a continuous increase between groups with significant differences (P < 0.001) among them, as well as in other cardiometabolic risk factors. An additional 24 % of patients at very high risk was detected with the new classification system proposed (P < 0.001) as compared to an equivalent matrix using BMI and WC instead of BF% and WC.

CONCLUSIONS

A more detailed phenotyping should be a priority in the diagnosis and management of patients with obesity. Our classification system allows to gradually estimate the cardiometabolic risk according to BF% and WC, thus representing a novel and useful tool for both research and clinical practice.

Neck Computed Tomography Measurements Associated With Cardiovascular Risk Factors

Introduction Neck adiposity has been related to cardiovascular risk in healthy and nonhealthy individuals. Our objective was to evaluate the utility of anatomic neck measurements extracted from computed tomography (CT) examinations as a predictor of cardiovascular disease and its risk factors. Methods We investigated patients who had a CT neck examination with intravenous contrast performed at two hospitals between 2013 and 2020. Patients with a neck malignancy, prior neck surgery, age <18 years, incomplete demographic information, and inadequate image quality were excluded. We performed 18 separate measurements of neck anatomy which were correlated with cardiovascular risk factors and disease, as well as relevant lab values and medications. All multivariable linear regressions were controlled for gender and BMI. Associations with p<0.05 were considered statistically significant. The measurements were then used to predict hypertension using random forest, a non-linear prediction algorithm. Results Approximately 20,000 neck CT examinations with contrast were performed between 2013-2020. After applying the inclusion criteria, 458 patients remained in the study population. Eight measurements (all of which include a component of neck adiposity) showed a statistically significant association between anatomic measurements and cardiovascular risk factors. The risk factor most often associated with increases in CT measurements was type 2 diabetes. Accordingly, patients on insulin treatment had a significantly higher average for all eight measurements. Significant measurement increases were also found in those previously diagnosed with hyperlipidemia and in those being treated with hypertension medications. The area under the receiver operating characteristic (AUROC) value of the random forest prediction algorithm was 0.68, meaning our measurements were a good predictor of hypertensive disease status. Conclusion Adipose tissue measurements extracted from CT examinations of the neck are associated with cardiovascular risk factors including hypertension, diabetes, and hyperlipidemia. Machine learning models of anatomic neck measurements can potentially identify patients at risk for cardiovascular disease.