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Samuel M, Park RY, Eastwood SV, Eto F, Morton CE, Stow D, Bacon S, Mehrkar A, Morley J, Dillingham I, Inglesby P, Hulme WJ, Khunti K, Mathur R, Valabhji J, MacKenna B, Finer S. Trends in weight gain recorded in English primary care before and during the Coronavirus-19 pandemic: An observational cohort study using the OpenSAFELY platform. PLoS Med 2024; 21:e1004398. [PMID: 38913709 DOI: 10.1371/journal.pmed.1004398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 04/05/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Obesity and rapid weight gain are established risk factors for noncommunicable diseases and have emerged as independent risk factors for severe disease following Coronavirus Disease 2019 (COVID-19) infection. Restrictions imposed to reduce COVID-19 transmission resulted in profound societal changes that impacted many health behaviours, including physical activity and nutrition, associated with rate of weight gain. We investigated which clinical and sociodemographic characteristics were associated with rapid weight gain and the greatest acceleration in rate of weight gain during the pandemic among adults registered with an English National Health Service (NHS) general practitioner (GP) during the COVID-19 pandemic. METHODS AND FINDINGS With the approval of NHS England, we used the OpenSAFELY platform inside TPP to conduct an observational cohort study of routinely collected electronic healthcare records. We investigated changes in body mass index (BMI) values recorded in English primary care between March 2015 and March 2022. We extracted data on 17,742,365 adults aged 18 to 90 years old (50.1% female, 76.1% white British) registered with an English primary care practice. We estimated individual rates of weight gain before (δ-prepandemic) and during (δ-pandemic) the pandemic and identified individuals with rapid weight gain (>0.5 kg/m2/year) in each period. We also estimated the change in rate of weight gain between the prepandemic and pandemic period (δ-change = δ-pandemic-δ-prepandemic) and defined extreme accelerators as the 10% of individuals with the greatest increase in their rate of weight gain (δ-change ≥1.84 kg/m2/year) between these periods. We estimated associations with these outcomes using multivariable logistic regression adjusted for age, sex, index of multiple deprivation (IMD), and ethnicity. P-values were generated in regression models. The median BMI of our study population was 27.8 kg/m2, interquartile range (IQR) [24.3, 32.1] in 2019 (March 2019 to February 2020) and 28.0 kg/m2, IQR [24.4, 32.6] in 2021. Rapid pandemic weight gain was associated with sex, age, and IMD. Male sex (male versus female: adjusted odds ratio (aOR) 0.76, 95% confidence interval (95% CI) [0.76, 0.76], p < 0.001), older age (e.g., 50 to 59 years versus 18 to 29 years: aOR 0.60, 95% CI [0.60, 0.61], p < 0.001]); and living in less deprived areas (least-deprived-IMD-quintile versus most-deprived: aOR 0.77, 95% CI [0.77, 0.78] p < 0.001) reduced the odds of rapid weight gain. Compared to white British individuals, all other ethnicities had lower odds of rapid pandemic weight gain (e.g., Indian versus white British: aOR 0.69, 95% CI [0.68, 0.70], p < 0.001). Long-term conditions (LTCs) increased the odds, with mental health conditions having the greatest effect (e.g., depression (aOR 1.18, 95% CI [1.17, 1.18], p < 0.001)). Similar characteristics increased odds of extreme acceleration in the rate of weight gain between the prepandemic and pandemic periods. However, changes in healthcare activity during the pandemic may have introduced new bias to the data. CONCLUSIONS We found female sex, younger age, deprivation, white British ethnicity, and mental health conditions were associated with rapid pandemic weight gain and extreme acceleration in rate of weight gain between the prepandemic and pandemic periods. Our findings highlight the need to incorporate sociodemographic, physical, and mental health characteristics when formulating research, policies, and interventions targeting BMI in the period of post pandemic service restoration and in future pandemic planning.
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Affiliation(s)
- Miriam Samuel
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Robin Y Park
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sophie V Eastwood
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Fabiola Eto
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Caroline E Morton
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Daniel Stow
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Sebastian Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jessica Morley
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Iain Dillingham
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Peter Inglesby
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - William J Hulme
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, United Kingdom
| | - Rohini Mathur
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Jonathan Valabhji
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Chelsea and Westminster Hospital Campus, Imperial College London, London, United Kingdom
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah Finer
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Ling J, Miller AL, Robbins LB, Zhang N. Elevated parent and child hair cortisol moderated the efficacy of a mindful eating intervention. Stress Health 2024; 40:e3333. [PMID: 37853993 DOI: 10.1002/smi.3333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
To explore whether elevated baseline hair cortisol moderated effects of a mindful eating intervention on anthropometrics, blood pressure (BP), household food insecurity, eating behaviour, and various psychosocial outcomes. The 14-week intervention included a parent Facebook-based programme, 3 parent meetings, preschooler letters connecting school learning to home practices, and a preschool-based mindful eating programme. Among 107 parent-preschooler dyads, mean age was 47.32 months for preschoolers and 30.12 years for parents. Among preschoolers, 54.2% were female, 8.4% were Hispanic, and 19.6% were Black. Among parents, 95.3% were female, 6.5% were Hispanic, 15.0% were Black, 39.4% were single, and 43.4% were unemployed. Preschoolers' elevated hair cortisol was related to a smaller reduction in preschoolers' % body fat (r =.31) and smaller increases in parents' perceived responsibility for child feeding (r = -.37). Parents' elevated hair cortisol was associated with smaller decreases in preschoolers' emotional eating (r = .39) and household food insecurity (r = .44). Relationships between baseline hair cortisol and post-intervention outcomes (BP, emotional eating, fruit/vegetable intake, food insecurity, and coping) varied by baseline values of outcome variables. Given that stress may attenuate intervention effects, a stress management component may be necessary to foster positive behavioural changes. Moreover, interventions should be tailored according to participants' characteristics to achieve optimal effects.
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Affiliation(s)
- Jiying Ling
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Alison L Miller
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Lorraine B Robbins
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Nanhua Zhang
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Kanamori S, Tomiyama K, Haruyama Y. Comparison of BMI changes in Japanese adults receiving face-to-face versus online counseling for specific health guidance: a noninferiority prospective observational study. J Occup Health 2024; 66:uiae026. [PMID: 38729214 PMCID: PMC11170213 DOI: 10.1093/joccuh/uiae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate the noninferiority of online counseling over face-to-face counseling for specific health guidance (SHG). METHODS This prospective observational study was conducted using specific health checkup (SHC) and SHG data of individuals with health insurance in Japan. We analyzed data from 1431 participants who met the inclusion criteria, including those who underwent online or face-to-face counseling between April 1, 2020 and March 31, 2021, and received an SHC in the following year but no earlier than 90 days after their first counseling session. Assessed variables comprised demographics, counseling methods, and SHC results, including baseline questionnaire findings and body mass index (BMI) at follow-up. We performed inverse probability of treatment weighting (IPTW) using propensity scores, with changes in BMI as the objective variable and the counseling method as the explanatory variable. We set the noninferiority margin to 0.175, based on a previous study. RESULTS The online and face-to-face counseling groups comprised 455 (31.8%) and 976 (68.2%) participants, respectively. The number of men and mean age were 214 (47.0%) and 49.9 years (SD: 6.9 years), respectively, in the online counseling group, and 491 (50.3%) and 51.1 years (SD: 7.6 years), respectively, in the face-to-face counseling group. IPTW using propensity scores revealed a regression coefficient of -0.014 (95% CI: -0.157 to 0.129) for the online group compared with the face-to-face group (P = .847). The CI was within the noninferiority margin. CONCLUSIONS The effects of online counseling on BMI are likely noninferior to those of face-to-face counseling.
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Affiliation(s)
- Satoru Kanamori
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Kiyomi Tomiyama
- Division of Health Support, Department Store Health Insurance Association, Tokyo, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University School of Medicine, Tochigi, Japan
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O'Rourke C, Wood P, Macleod KA, Westwood J, Urquhart DS. Retrospective cohort analysis of weight changes during the COVID-19 pandemic in a pediatric asthma population. J Asthma 2023; 60:2170-2176. [PMID: 37345889 DOI: 10.1080/02770903.2023.2228885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/20/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To investigate the BMI trajectories of children attending a tertiary asthma clinic during the COVID-19 pandemic. METHODS Data were collected retrospectively on children and young people with asthma who attended the Royal Hospital for Children and Young People (RHCYP) before March 2020 (pre-COVID-19) and after August 2021 (the lifting of national restrictions). MAIN OUTCOME MEASURES Changes in weight, height, and BMI Z score measured between 13/03/2019 and 13/03/2020 (timepoint 1) and then again during the period 01/08/2021 to 01/10/2022 (timepoint 2); changes in lung function parameters (FEV1) between the timepoints; proportion of study sample classed as obese and overweight at both timepoints; interaction analyses according to deprivation indices (SIMD decile), the use of high dose inhaled corticosteroid (ICS) therapy, and the presence of atopy. RESULTS Eighty-nine children aged 5-18 years were studied. Weight and height Z scores significantly increased between timepoint 1 and 2 [weight Z score: +0.19 (0.08, +0.30), height Z score: +0.15 (+0.07, +0.23)], such that no significant change was observed in the BMI Z score [+ 0.07 (-0.05, +0.20)] or BMI centile [+0.5 (-3.1, +4.1)]. There was also no change in FEV1%predicted [-0.1 (-3.8, +3.6)] between the timepoints. CONCLUSIONS No changes in BMI were observed in children with asthma before and after COVID-19 lockdowns. Improved linear growth was noted, implying an improvement in the overall physical health of our study cohort. This may suggest improved asthma control, which may reflect avoidance of viral triggers and/or improved adherence to treatment.
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Affiliation(s)
- Cari O'Rourke
- University of Edinburgh Medical School, Edinburgh, UK
| | - Philippa Wood
- Department of General Pediatrics, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Kenneth A Macleod
- Department of Pediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Julie Westwood
- Department of Pediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Don S Urquhart
- Department of Pediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
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Reljic D, Koller A, Herrmann HJ, Ekici AB, Neurath MF, Zopf Y. Differential Effects of Very-Low-Volume Exercise Modalities on Telomere Length, Inflammation, and Cardiometabolic Health in Obese Metabolic Syndrome Patients: A Subanalysis from Two Randomized Controlled Trials. Antioxidants (Basel) 2023; 12:1847. [PMID: 37891926 PMCID: PMC10603979 DOI: 10.3390/antiox12101847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Oxidative stress (OS) and inflammation are features of metabolic syndrome (MetS) that can contribute to the shortening of telomere length (TL), a marker of cellular ageing. Research indicates that exercise can positively influence MetS-associated conditions and TL. However, the effects of low-volume exercise types on TL are still unknown. We investigated the impact of very-low-volume high-intensity interval training (LV-HIIT), one-set resistance training (1-RT), and whole-body electromyostimulation (WB-EMS) on TL, inflammation, and cardiometabolic indices in 167 MetS patients. Data were derived from two randomized controlled trials where patients were allocated to an exercise group (2 sessions/week, for 12 weeks) or a control group. All groups received standard-care nutritional weight loss counselling. TL was determined as the T/S ratio (telomere to single-copy gene amount). All groups significantly reduced body weight (p < 0.05), but the T/S-ratio (p < 0.001) only increased with LV-HIIT. OS-related inflammatory markers (C-reactive protein, interleukin-6, and lipopolysaccharide-binding protein) only decreased (p < 0.05) following LV-HIIT. The MetS severity z-score improved with LV-HIIT (p < 0.001) and 1-RT (p = 0.014) but not with WB-EMS. In conclusion, very-low-volume exercise modalities have differential effects on telomeres, inflammation, and cardiometabolic health. Only LV-HIIT but not strength-based low-volume exercise increased TL in MetS patients, presumably due to superior effects on OS-related inflammatory markers.
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Affiliation(s)
- Dejan Reljic
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.J.H.); (M.F.N.); (Y.Z.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Adriana Koller
- Institute of Genetic Epidemiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Hans J. Herrmann
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.J.H.); (M.F.N.); (Y.Z.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Arif B. Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Markus F. Neurath
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.J.H.); (M.F.N.); (Y.Z.)
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Yurdagül Zopf
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.J.H.); (M.F.N.); (Y.Z.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
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Fragala MS, Matsushita F, Chen Z, Bare LA. Cardiometabolic Risk Increased in Working-Aged Adults During the COVID-19 Pandemic. Metab Syndr Relat Disord 2023; 21:426-434. [PMID: 37615613 PMCID: PMC10615087 DOI: 10.1089/met.2023.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Background: Public health measures necessary to mitigate the spread of coronavirus disease 2019 (COVID-19) impacted lifestyles and health practices. This multiyear cohort analysis of U.S. working-aged adults aims to evaluate the impact of the COVID-19 pandemic on metabolic syndrome and explores contributing factors. Methods: This longitudinal study (n = 19,543) evaluated year-to-year changes in metabolic syndrome and cardiometabolic risk factors through employer-sponsored annual health assessment before and during the COVID-19 pandemic using logistic mixed-effects model. Results: From prepandemic to pandemic (2019 to 2020), prevalence of metabolic syndrome increased by 3.5% for men and 3.0% for women, across all ethnic groups. This change was mainly driven by increased fasting glucose (7.3%) and blood pressure (5.2%). The increased risk of metabolic syndrome was more likely to occur in individuals with an elevated body mass index (BMI) combined with insufficient sleep or physical activity. Conclusions: Cardiometabolic risk increased during the COVID-19 pandemic compared with before the pandemic in a working-aged adult population, more so for those with a high BMI, unhealthy sleep, and low physical activity practices. Given this observation, identification of risk and intervention (including lifestyle and medical) is increasingly necessary to reduce the cardiovascular and metabolic risk, and improve working-aged population health.
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Affiliation(s)
| | | | - Zhen Chen
- Quest Diagnostics, Secaucus, New Jersey, USA
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Tholla TS, Sawicki CM, Bhupathiraju SN. The Intersection Between COVID-19, Cardiovascular Disease, and Diet: a Review. Curr Atheroscler Rep 2023; 25:643-652. [PMID: 37646976 DOI: 10.1007/s11883-023-01138-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is one of the top comorbidities associated with COVID-19-both pre- and post-infection. This review examines the relationships between COVID-19 infection and cardiovascular health, with a specific focus on diet as an important modifiable risk factor. RECENT FINDINGS Pandemic era studies of individuals battling and recovering from COVID-19 infection suggest a strong link between metabolic diseases, such as CVD, and SARS-CoV-2 infection susceptibility and severity. Other studies also demonstrate how COVID-19 lockdown policies and quarantine recommendations led to drastic lifestyle changes associated with increased CVD risk, such as reduced physical activity and lower diet quality. At the same time, new research is emerging that plant-based diets, which have previously been associated with lower CVD risk, may lower COVID-19 infection rates and severity of symptoms. Diet, COVID-19, and CVD intersect through complex biological mechanisms and related behavioral factors evidenced by clinical trials and epidemiological studies. Diet may be a critical tool for modifying risk of communicable and non-communicable conditions in the post-pandemic world.
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Affiliation(s)
- Tanusha S Tholla
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Caleigh M Sawicki
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Room 338, 181 Longwood Ave, Boston, MA, 02115, USA
| | - Shilpa N Bhupathiraju
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Room 338, 181 Longwood Ave, Boston, MA, 02115, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Huang AA, Huang SY. Exploring Depression and Nutritional Covariates Amongst US Adults using Shapely Additive Explanations. Health Sci Rep 2023; 6:e1635. [PMID: 37867784 PMCID: PMC10588337 DOI: 10.1002/hsr2.1635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/02/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023] Open
Abstract
Background Depression affects personal and public well-being and identification of natural therapeutics such as nutrition is necessary to help alleviate this public health concern. Objective The study aimed to identify feature importance in a machine learning model using solely nutrition covariates. Methods A retrospective analysis was conducted using a modern, nationally representative cohort, the National Health and Nutrition Examination Surveys (NHANES 2017-2020). Depressive symptoms were evaluated using the validated 9-item Patient Health Questionnaire (PHQ-9), and all adult patients (total of 7929 individuals) who completed the PHQ-9 and total nutritional intake questionnaire were included in the study. Univariable regression was used to identify significant nutritional covariates to be included in a machine learning model and feature importance was reported. The acquisition and analysis of the data were authorized by the National Center for Health Statistics Ethics Review Board. Results 7929 patients met the inclusion criteria in this study. The machine learning model had 24 out of a total of 60 features that were found to be significant on univariate analysis (p < 0.01 used). In the XGBoost model the model had an Area Under the Receiver Operator Characteristic Curve (AUROC) = 0.603, Sensitivity = 0.943, Specificity = 0.163. The top four highest ranked features by gain, a measure of the percentage contribution of the covariate to the overall model prediction, were Potassium Intake (Gain = 6.8%), Vitamin E Intake (Gain = 5.7%), Number of Foods and Beverages Reported (Gain = 5.7%), and Vitamin K Intake (Gain 5.6%). Conclusion Machine learning models with feature importance can be utilized to identify nutritional covariates for further study in patients with clinical symptoms of depression.
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Affiliation(s)
| | - Samuel Y. Huang
- Virginia Commonwealth University School of MedicineRichmondVirginiaUSA
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Harville EW, Kracht CL, Cohen NL, Sutton EF, Kebbe M, Redman LM. Trends in Gestational Weight Gain in Louisiana, March 2019 to March 2022. JAMA Netw Open 2023; 6:e2331277. [PMID: 37642960 PMCID: PMC10466167 DOI: 10.1001/jamanetworkopen.2023.31277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/22/2023] [Indexed: 08/31/2023] Open
Abstract
Importance Average gestational weight gain (GWG) increased during the COVID-19 pandemic, but it is not known whether this trend has continued. Objective To examine patterns of GWG during the COVID-19 pandemic by delivery and conception timing through the second year of the pandemic. Design, Setting, and Participants This cohort study is a retrospective review of birth certificate and delivery records from 2019 to 2022. Electronic health records were from the largest delivery hospital in Louisiana. Participants included all individuals giving birth from March 2019 to March 2022. Data analysis was performed from October 2022 to July 2023. Exposure Delivery date (cross-sectionally) and conception before the pandemic (March 2019 to March 2020) and during the peak pandemic (March 2020 to March 2021) and late pandemic (March 2021 to March 2022). Main Outcomes and Measures The primary outcome was GWG (total GWG and adherence to the 2009 Institute of Medicine recommendations) analyzed using linear and log-linear regression with control for covariates. Results Among 23 012 total deliveries (8763 Black individuals [38.1%]; 11 774 White individuals [51.2%]; mean [SD] maternal age, 28.9 [5.6] years), 3182 individuals (42.0%) exceeded the recommended weight gain in the year proceeding the pandemic, 3400 (45.4%) exceeded recommendations during the peak pandemic, and 3273 (44.0%) exceeded recommendations in the late pandemic. Compared with those who delivered before the pandemic (reference), participants had higher total GWG if they delivered peak or late pandemic (adjusted β [SE], 0.38 [0.12] kg vs 0.19 [0.12] kg; P = .007). When cohorts were defined by conception date, participants who conceived before the pandemic but delivered after the pandemic started had higher GWG compared with those whose entire pregnancy occurred before the pandemic (adjusted β [SE], 0.51 [0.16] kg). GWG was lower in the pregnancies conceived after the pandemic started and the late pandemic (adjusted β [SE], 0.29 [0.12] kg vs 0.003 [0.14] kg; P = .003) but these participants began pregnancy at a slightly higher weight. Examining mean GWG month by month suggested a small decrease for March 2020, followed by increased mean GWG for the following year. Individuals with 2 pregnancies (1289 individuals) were less likely to gain weight above the recommended guidelines compared with their prepandemic pregnancy, but this association was attenuated after adjustment. Conclusions and Relevance In this cohort, individuals with critical time points of their pregnancy during the COVID-19 pandemic gained more weight compared with the previous year. The increased GWG leveled off as the pandemic progressed but individuals were slightly heavier beginning pregnancy.
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Affiliation(s)
- Emily W. Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Nicole L. Cohen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Maryam Kebbe
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
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Barlow KJ, Fahey PP, Atlantis E. Glycaemic monitoring and control among high-risk patients with type 2 diabetes in Australian general practice during COVID-19. Fam Med Community Health 2023; 11:e002271. [PMID: 37567729 PMCID: PMC10423797 DOI: 10.1136/fmch-2023-002271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted general practice worldwide, primarily due to public health measures that restricted access to care for chronic diseases, such as type 2 diabetes. These measures disproportionately affected higher risk groups with type 2 diabetes, such as older people and those with obesity. This study aims to identify factors that may have influenced the rates of compliance with testing guidelines and target glycaemic control in Australian general practice settings during the COVID-19 pandemic. METHODS We used a serial cross-sectional study design of patient record data from general practices representative of the Nepean Blue Mountains Local Health District between 2020 and 2022. Aggregated patient records were analysed to determine percentages of subgroups with a blood glycaemic testing interval consistent with guidelines (≥1 within 15 months) and achieving target glycaemic control (by glycated haemoglobin of ≤7%). Linear regression models were used to test the association between independent and dependent variables, and to generate regression coefficients and 95% CI, corrected for time trends. RESULTS Of the average 14 356 patient records per month, 55% were male, 53% had a body mass index (BMI) <30 and 55% were aged 55-74 years. Compliance to testing guidelines slightly decreased (75-73%) but was positively associated with male sex (2.5%, 95% CI 1.7%, 3.4%), BMI≥30 (9.6%, 95% CI 8.8%, 10.4%) and 55-74 years (7.5%, 95% CI 6.6%, 8.5%) and 75 years and over age groups (7.1%, 95% CI 6.2%, 7.9%). Mean percentage of patient records achieving target glycaemic control slightly increased and was negatively associated with male sex (-3.7%, 95% CI -5.2%, -2.2%), but positively associated with 55-74 years (4.5%, 95% CI 3.8%, 5.1%) and 75 years and over age groups (12.2%, 95% CI 4.5%, 20.0%). Compliance to testing guidelines increased with each additional general practice per 10 000 persons (8.4%, 95% CI 4.9%, 11.8%). CONCLUSIONS During the COVID-19 pandemic, people with type 2 diabetes in Australia continued to follow glycaemic testing guidelines at the same rate. In fact, there was a slight improvement in glycaemic control among all subgroups of patients, including those at higher risk. These findings are encouraging, but the longer term impact of COVID-19 on type 2 diabetes care is still unclear.
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Affiliation(s)
- Kirrilee Jane Barlow
- School of Health Sciences, Western Sydney University, Kingswood, New South Wales, Australia
| | - Paul P Fahey
- School of Health Sciences, Western Sydney University, Kingswood, New South Wales, Australia
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Kingswood, New South Wales, Australia
- Discipline of Medicine, Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Nepean, New South Wales, Australia
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11
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Fallows E, Ells L, Anand V. Semaglutide and the future of obesity care in the UK. Lancet 2023; 401:2093-2096. [PMID: 37290459 DOI: 10.1016/s0140-6736(23)01083-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Ellen Fallows
- Brackley Medical Centre, Brackley NN13 6QZ, UK; The British Society of Lifestyle Medicine, Haddington, East Lothian, UK.
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Varun Anand
- Diadem Medical Practice and Hull Public Health Team, Hull, UK
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12
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Bolesławska I, Jagielski P, Błaszczyk-Bębenek E, Jagielska A, Przysławski J. Lifestyle Changes during the SARS-CoV-2 Pandemic as Predictors of BMI Changes among Men and Women in Poland. Nutrients 2023; 15:nu15112427. [PMID: 37299391 DOI: 10.3390/nu15112427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Social isolation during the SARS-CoV-2 pandemic affected people's body weight, therefore, this study was designed to evaluate the association between lifestyle elements and the change in BMI during lockdown. METHODS This retrospective observational study involved 290 questionnaires completed by adult participants divided into three groups according to BMI change during isolation. The structured questionnaire included a general description of the study objective and collected data regarding sociodemographics, anthropometrics, physical activity, sedentary behaviour, sleep duration, and food intake pre- and during COVID-19 lockdown. RESULTS A decrease or increase in BMI was found in 23.6% and 47.8% of women and 18.5% and 42.6% of men, respectively. Among those who lost weight, 46.5% of women and 40% of men followed a diet of their own choice, 30.2% of women and 25% of men changed their product mix and reduced their intake, 40% of men stopped eating outside the home. An increase in BMI was associated with increased food intake (32.2% of women and 28.3% of men), increased sleep duration on weekdays (49.2% of women and 43.5% of men) and, in more than 50% of subjects, decreased physical activity. In women, increased BMI was associated with the highest frequency of snacking (p = 0.0003), the highest intake of sweets (p = 0.0021), and in men with the highest intake of alcohol (p = 0.0017). CONCLUSIONS The observed changes in BMI during social isolation were the result of lifestyle modifications including dietary behaviour and differed by gender.
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Affiliation(s)
- Izabela Bolesławska
- Department of Bromatology, Poznan University of Medical Sciences, 3 Rokietnicka Street, 60-806 Poznan, Poland
| | - Paweł Jagielski
- Department of Nutrition and Drug Research, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawińska Street, 31-066 Kraków, Poland
| | - Ewa Błaszczyk-Bębenek
- Department of Nutrition and Drug Research, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawińska Street, 31-066 Kraków, Poland
| | - Anna Jagielska
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Street, 02-007 Warsaw, Poland
| | - Juliusz Przysławski
- Department of Bromatology, Poznan University of Medical Sciences, 3 Rokietnicka Street, 60-806 Poznan, Poland
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Serbis A, Giapros V, Tsamis K, Balomenou F, Galli-Tsinopoulou A, Siomou E. Beta Cell Dysfunction in Youth- and Adult-Onset Type 2 Diabetes: An Extensive Narrative Review with a Special Focus on the Role of Nutrients. Nutrients 2023; 15:2217. [PMID: 37432389 PMCID: PMC10180650 DOI: 10.3390/nu15092217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 07/12/2023] Open
Abstract
Traditionally a disease of adults, type 2 diabetes (T2D) has been increasingly diagnosed in youth, particularly among adolescents and young adults of minority ethnic groups. Especially, during the recent COVID-19 pandemic, obesity and prediabetes have surged not only in minority ethnic groups but also in the general population, further raising T2D risk. Regarding its pathogenesis, a gradually increasing insulin resistance due to central adiposity combined with a progressively defective β-cell function are the main culprits. Especially in youth-onset T2D, a rapid β-cell activity decline has been observed, leading to higher treatment failure rates, and early complications. In addition, it is well established that both the quantity and quality of food ingested by individuals play a key role in T2D pathogenesis. A chronic imbalance between caloric intake and expenditure together with impaired micronutrient intake can lead to obesity and insulin resistance on one hand, and β-cell failure and defective insulin production on the other. This review summarizes our evolving understanding of the pathophysiological mechanisms involved in defective insulin secretion by the pancreatic islets in youth- and adult-onset T2D and, further, of the role various micronutrients play in these pathomechanisms. This knowledge is essential if we are to curtail the serious long-term complications of T2D both in pediatric and adult populations.
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Affiliation(s)
- Anastasios Serbis
- Department of Pediatrics, School of Medicine, University of Ioannina, St. Niarhcos Avenue, 45500 Ioannina, Greece;
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, St. Νiarhcos Avenue, 45500 Ioannina, Greece (F.B.)
| | - Konstantinos Tsamis
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, St. Niarhcos Avenue, 45500 Ioannina, Greece
| | - Foteini Balomenou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, St. Νiarhcos Avenue, 45500 Ioannina, Greece (F.B.)
| | - Assimina Galli-Tsinopoulou
- Second Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece;
| | - Ekaterini Siomou
- Department of Pediatrics, School of Medicine, University of Ioannina, St. Niarhcos Avenue, 45500 Ioannina, Greece;
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14
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Matthiessen J, Biltoft-Jensen A, Stockmarr A, Fagt S, Christensen T. Changes in Diet and Physical Activity among 18-65-Year-Olds after the First National COVID-19 Lockdown in Denmark. Nutrients 2023; 15:nu15061480. [PMID: 36986210 PMCID: PMC10054679 DOI: 10.3390/nu15061480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
COVID-19 lockdowns affected everyday life significantly and made it challenging to achieve or maintain a healthy lifestyle. The aim of the present study was to examine longitudinal changes in Danish adults' eating habits and physical activity (PA) assessed during and after the first national lockdown in 2020. Furthermore, changes in body weight were examined during the first lockdown period. The whole diet (semi-quantitative Food Frequency Questionnaire), sociodemographic factors, moderate-to-vigorous intensity PA (MVPA), leisure screen time, anthropometrics, change in body weight, and stress level were assessed with a self-administered web-based questionnaire among 839 18-65-year-old Danes during and 5-6 months after the lockdown. Both favorable (decreased intake of saturated fat) and unfavorable (decreased intake of whole grain and fish, and increased intake of red meat) changes were found in the diet after the lockdown, while favorable changes in MVPA (increase in couples) and leisure screen time (decrease with a combined effect of family status and education) were found for PA. More Danish adults reported to gain weight (mean 3.0 kg) than to lose weight (mean 3.5 kg) during the first lockdown period (27% vs. 15%). The study showed favorable changes in PA and mixed results regarding diet among Danish adults after the lockdown. Furthermore, the first lockdown period unfavorably impacted the body weight of many Danes.
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Affiliation(s)
- Jeppe Matthiessen
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Anja Biltoft-Jensen
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Sisse Fagt
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Tue Christensen
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
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15
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Carek SM. From COVID to Couch Potato: The Importance of Physical Activity Promotion and Education. Fam Med 2023; 55:72-74. [PMID: 36787516 PMCID: PMC10614531 DOI: 10.22454/fammed.2023.255834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
For many, the lockdowns of the COVID-19 pandemic resulted in drastic behavior changes. While the immediate uncertainty and fear surrounding the initial lockdown has subsided, there are still significant changes to our daily lives and work that may have lasting impact on our health and well-being. One such change is the increase in physical inactivity and sedentarism, a result of decreased group activities, organized events, work and school from home mandates, and physical distancing. Physical inactivity represents one of the strongest modifiable risk factors for poor health outcomes and a preventable cause of early morbidity and mortality from many common chronic diseases. Overall, health care providers are inconsistent and often ineffective at screening and counseling patients on the benefits of regular physical activity. Additionally, there is very little structured curricula for medical learners to address physical inactivity and other lifestyle factors that contribute to the health of our patients. As we adjust to new social practices and behaviors as a result of the COVID-19 pandemic, it is critical that we emphasize the need for education, screening, evidence-based interventions, advocacy, and effective role modeling on the importance of physical activity for our patients, communities, and our own well-being.
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16
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Alonso-Bernáldez M, Cuevas-Sierra A, Micó V, Higuera-Gómez A, Ramos-Lopez O, Daimiel L, Dávalos A, Martínez-Urbistondo M, Moreno-Torres V, Ramirez de Molina A, Vargas JA, Martinez JA. An Interplay between Oxidative Stress (Lactate Dehydrogenase) and Inflammation (Anisocytosis) Mediates COVID-19 Severity Defined by Routine Clinical Markers. Antioxidants (Basel) 2023; 12:antiox12020234. [PMID: 36829793 PMCID: PMC9951932 DOI: 10.3390/antiox12020234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Viral infections activate the innate immune response and the secretion of inflammatory cytokines. They also alter oxidative stress markers, which potentially can have an involvement in the pathogenesis of the disease. The aim of this research was to study the role of the oxidative stress process assessed through lactate dehydrogenase (LDH) on the severity of COVID-19 measured by oxygen saturation (SaO2) and the putative interaction with inflammation. The investigation enrolled 1808 patients (mean age of 68 and 60% male) with COVID-19 from the HM Hospitals database. To explore interactions, a regression model and mediation analyses were performed. The patients with lower SaO2 presented lymphopenia and higher values of neutrophils-to-lymphocytes ratio and on the anisocytosis coefficient. The regression model showed an interaction between LDH and anisocytosis, suggesting that high levels of LDH (>544 U/L) and an anisocytosis coefficient higher than 10% can impact SaO2 in COVID-19 patients. Moreover, analysis revealed that LDH mediated 41% (p value = 0.001) of the effect of anisocytosis on SaO2 in this cohort. This investigation revealed that the oxidative stress marker LDH and the interaction with anisocytosis have an important role in the severity of COVID-19 infection and should be considered for the management and treatment of the oxidative phenomena concerning this within a precision medicine strategy.
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Affiliation(s)
- Marta Alonso-Bernáldez
- Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
- Correspondence: (M.A.-B.); (A.C.-S.)
| | - Amanda Cuevas-Sierra
- Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
- Correspondence: (M.A.-B.); (A.C.-S.)
| | - Víctor Micó
- Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28049 Madrid, Spain
| | - Andrea Higuera-Gómez
- Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
| | - Omar Ramos-Lopez
- Medicine and Psychology School, Autonomous University of Baja California, Tijuana 22390, Mexico
| | - Lidia Daimiel
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28049 Madrid, Spain
- Nutritional Control of the Epigenome Group, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Spain
| | - Alberto Dávalos
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28049 Madrid, Spain
- Epigenetics of Lipid Metabolism Group, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
| | | | - Víctor Moreno-Torres
- Puerta de Hierro Research Institute, University Hospital, Majadahonda, 28222 Madrid, Spain
- UNIR Health Sciences School Medical Center, Pozuelo de Alarcón, 28040 Madrid, Spain
| | - Ana Ramirez de Molina
- Molecular Oncology and Nutritional Genomics of Cancer Group, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
| | - Juan Antonio Vargas
- Puerta de Hierro Research Institute, University Hospital, Majadahonda, 28222 Madrid, Spain
| | - J. Alfredo Martinez
- Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28049 Madrid, Spain
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17
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Mueller J, Richards R, Jones RA, Whittle F, Woolston J, Stubbings M, Sharp SJ, Griffin SJ, Bostock J, Hughes CA, Hill AJ, Boothby CE, Ahern AL. Supporting Weight Management during COVID-19 (SWiM-C): twelve-month follow-up of a randomised controlled trial of a web-based, ACT-based, guided self-help intervention. Int J Obes (Lond) 2023; 47:51-59. [PMID: 36369513 PMCID: PMC9651901 DOI: 10.1038/s41366-022-01232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We developed a guided self-help intervention (Supporting Weight Management during COVID-19, "SWiM-C") to support adults with overweight or obesity in their weight management during the COVID-19 pandemic. This parallel, two-group trial (ISRCTN12107048) evaluated the effect of SWiM-C on weight and determinants of weight management over twelve months. METHODS Participants (≥18 years, body-mass-index ≥25 kg/m2) were randomised to the SWiM-C intervention or to a standard advice group (unblinded). Participants completed online questionnaires at baseline, four months, and twelve months. The primary outcome was change in self-reported weight from baseline to twelve months; secondary outcomes were eating behaviour (uncontrolled eating, emotional eating, cognitive restraint of food intake), experiential avoidance, depression, anxiety, stress, wellbeing and physical activity. INTERVENTIONS SWiM-C is based on acceptance and commitment therapy (ACT). Participants had access to an online web platform with 12 weekly modules and email and telephone contact with a trained, non-specialist coach. Standard advice was a leaflet on managing weight and mood during the COVID-19 pandemic. RESULTS 388 participants were randomised (SWiM-C: n = 192, standard advice: n = 196). The baseline-adjusted difference in weight change between SWiM-C (n = 119) and standard advice (n = 147) was -0.81 kg (95% CI: -2.24 to 0.61 kg). SWiM-C participants reported a reduction in experiential avoidance (-2.45 [scale:10-70], 95% CI: -4.75 to -0.15), uncontrolled eating (-3.36 [scale: 0-100], 95% CI: -5.66 to -1.06), and emotional eating (-4.14 [scale:0-100], 95% CI: -7.25 to -1.02) and an increase in physical activity (8.96 [MET-min/week], 95% CI: 0.29 to 17.62) compared to standard advice participants. We found no evidence of an effect on remaining outcomes. No adverse events/side effects were reported. CONCLUSIONS Whilst we were unable to conclude that the intervention had an effect on weight, SWiM-C improved eating behaviours, experiential avoidance and physical activity. Further refinement of the intervention is necessary to ensure meaningful effects on weight prior to implementation in practice. TRIAL REGISTRATION NUMBER ISRCTN 12107048.
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Affiliation(s)
- Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | - Rebecca Richards
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Rebecca A. Jones
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Fiona Whittle
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jennifer Woolston
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Marie Stubbings
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen J. Sharp
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Simon J. Griffin
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK ,grid.5335.00000000121885934Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Carly A. Hughes
- Fakenham Medical Practice, Fakenham, UK ,grid.8273.e0000 0001 1092 7967Medical School, University of East Anglia, Norwich, UK
| | - Andrew J. Hill
- grid.9909.90000 0004 1936 8403Division of Psychological and Social Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Clare E. Boothby
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Amy L. Ahern
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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18
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Anderson LN, Smith BT, Birken CS. Reimagining a population strategy for obesity control. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 114:156-157. [PMID: 36400907 PMCID: PMC9676760 DOI: 10.17269/s41997-022-00713-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Laura N. Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada ,Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario Canada ,Health Promotion, Chronic Disease and Injury Prevention Program, Public Health Ontario, Toronto, Ontario Canada
| | - Brendan T. Smith
- Health Promotion, Chronic Disease and Injury Prevention Program, Public Health Ontario, Toronto, Ontario Canada ,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Catherine S. Birken
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario Canada ,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
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19
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Belchior-Bezerra M, Lima RS, Medeiros NI, Gomes JAS. COVID-19, obesity, and immune response 2 years after the pandemic: A timeline of scientific advances. Obes Rev 2022; 23:e13496. [PMID: 35837843 PMCID: PMC9349458 DOI: 10.1111/obr.13496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 02/06/2023]
Abstract
In the 2 years since the COVID-19 pandemic was officially declared, science has made considerable strides in understanding the disease's pathophysiology, pharmacological treatments, immune response, and vaccination, but there is still much room for further advances, especially in comprehending its relationship with obesity. Science has not yet described the mechanisms that explain how obesity is directly associated with a poor prognosis. This paper gathers all published studies over the past 2 years that have described immune response, obesity, and COVID-19, a historical and chronological record for researchers and the general public alike. In summary, these studies describe how the cytokine/adipokine levels and inflammatory markers, such as the C-reactive protein, are associated with a higher body mass index in COVID-19-positive patients, suggesting that the inflammatory background and immune dysregulation in individuals with obesity may be expressed in the results and that adiposity may influence the immune response. The timeline presented here is a compilation of the results of 2 years of scientific inquiry, describing how the science has progressed, the principal findings, and the challenges ahead regarding SARS-CoV-2, COVID-19, and emerging variants, especially in patients with obesity.
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Affiliation(s)
- Mayara Belchior-Bezerra
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rafael Silva Lima
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Nayara I Medeiros
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Imunologia Celular e Molecular, Instituto René Rachou, Fundação Oswaldo Cruz - FIOCRUZ, Belo Horizonte, Brazil
| | - Juliana A S Gomes
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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20
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Relationship between Mental Health and Emotional Eating during the COVID-19 Pandemic: A Systematic Review. Nutrients 2022; 14:nu14193989. [PMID: 36235642 PMCID: PMC9573278 DOI: 10.3390/nu14193989] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Obesity is one of the most dangerous epidemics of the 21st century. In 2019, the COVID-19 pandemic began and caused many deaths among patients with obesity with and without complications. Simultaneously, the lockdown related to the COVID-19 pandemic caused a host of emotional problems including anxiety, depression, and sleep disturbances. Many people began to cope with their emotions by increasing food (emotional eating) and alcohol consumption and in combination with decreased physical activity, promoted the development of overweight and obesity. Emotional eating, also known as stress eating, is defined as the propensity to eat in response to positive and negative emotions and not physical need. It should be noted that emotional eating may be the first step in the development of binge eating disorder and its extreme subtypes such as food addiction. Interestingly in some post-bariatric surgery patients, an increased frequency of addictive disorders has been observed, for example food addiction replaced by alcohol addiction called: “cross addiction” or “addiction transfer”. This data indicates that obesity should be treated as a psychosomatic disease, in the development of which external factors causing the formation of negative emotions may play a significant role. Currently, one of these factors is the COVID-19 pandemic. This manuscript discusses the relationships between the COVID-19 pandemic and development of emotional eating as well as potential implications of the viral pandemic on the obesity pandemic, and the need to change the approach to the treatment of obesity in the future.
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Nguyen MH, Do TX, Nguyen TT, Pham MD, Pham TTM, Pham KM, Kim GB, Do BN, Nguyen HT, Nguyen NM, Dam HTB, Nguyen YH, Nguyen KT, Nguyen TTP, Nguyen TT, Duong TV. Fear of COVID-19, healthy eating behaviors, and health-related behavior changes as associated with anxiety and depression among medical students: An online survey. Front Nutr 2022; 9:938769. [PMID: 36211498 PMCID: PMC9538633 DOI: 10.3389/fnut.2022.938769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Medical students' health and wellbeing are highly concerned during the COVID-19 pandemic. This study examined the impacts of fear of COVID-19 (FCoV-19S), healthy eating behavior, and health-related behavior changes on anxiety and depression. Methods We conducted an online survey at 8 medical universities in Vietnam from 7th April to 31st May 2020. Data of 5,765 medical students were collected regarding demographic characteristics, FCoV-19S, health-related behaviors, healthy eating score (HES), anxiety, and depression. Logistic regression analyses were used to explore associations. Results A lower likelihood of anxiety and depression were found in students with a higher HES score (OR = 0.98; 95%CI = 0.96, 0.99; p = 0.042; OR = 0.98; 95%CI = 0.96, 0.99; p = 0.021), and in those unchanged or more physical activities during the pandemic (OR = 0.54; 95%CI = 0.44, 0.66; p < 0.001; OR = 0.44; 95%CI = 0.37, 0.52; p < 0.001) as compared to those with none/less physical activity, respectively. A higher likelihood of anxiety and depression were reported in students with a higher FCoV-19S score (OR = 1.09; 95%CI = 1.07, 1.12; p < 0.001; OR = 1.06; 95%CI = 1.04, 1.08; p < 0.001), and those smoked unchanged/more during the pandemic (OR = 6.67; 95%CI = 4.71, 9.43; p < 0.001; OR = 6.77; 95%CI = 4.89, 9.38; p < 0.001) as compared to those stopped/less smoke, respectively. In addition, male students had a lower likelihood of anxiety (OR = 0.79; 95%CI = 0.65, 0.98; p = 0.029) compared to female ones. Conclusions During the pandemic, FCoV-19S and cigarette smoking had adverse impacts on medical students' psychological health. Conversely, staying physically active and having healthy eating behaviors could potentially prevent medical students from anxiety and depressive symptoms.
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Affiliation(s)
- Minh H. Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tinh X. Do
- Department of Psychiatry, Military Hospital 103, Hanoi, Vietnam
| | - Tham T. Nguyen
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Minh D. Pham
- Department of Clinical Nutrition, Military Hospital 103, Hanoi, Vietnam
- Department of Nutrition, Vietnam Military Medical University, Hanoi, Vietnam
| | - Thu T. M. Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Khue M. Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
- President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Giang B. Kim
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Center for Assessment and Quality Assurance, Hanoi Medical University, Hanoi, Vietnam
| | - Binh N. Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam
- Division of Military Science, Military Hospital 103, Hanoi, Vietnam
| | - Hiep T. Nguyen
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam
- Pham Ngoc Thach Clinic, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam
- President Office, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam
| | - Ngoc-Minh Nguyen
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam
| | - Hoa T. B. Dam
- Department of Psychiatry, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Yen H. Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Department of Pharmacy, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam
| | - Kien T. Nguyen
- President Office, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Department of Physiology, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Thao T. P. Nguyen
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Trung T. Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Tuyen Van Duong
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22
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Hassan MA, Liu W, McDonough DJ, Su X, Gao Z. Comparative Effectiveness of Physical Activity Intervention Programs on Motor Skills in Children and Adolescents: A Systematic Review and Network Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11914. [PMID: 36231213 PMCID: PMC9565026 DOI: 10.3390/ijerph191911914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Objective: To evaluate how different physical activity (PA) interventions (traditional, exergaming, and teacher/parent education) impacted children's motor skills (object control, locomotor, and gross motor). Design: Systematic review and network meta-analysis. Data sources: PubMed, Medline, Scopus, Web of Science, EMBASE, and PsycINFO. Eligibility criteria: (1) Participants comprised 1708 children 3-12 years; (2) PA or exercise-based interventions were investigated; (3) only studies using a Test of Gross Motor Skills assessment were included; (4) RCT were chosen as the study design to assess the impact of PA interventions on children's motor skills; and (5) culture-based PA studies with English language only were included. Data were analyzed using a Bayesian network meta-analysis. Results: The results were reported as standardized mean differences (SMDs) with associated 95% credible intervals (CrIs). For object control, aerobic intervention (SMD 6.90, 95% Crl 1.39 to 13.50); for locomotor, exergaming intervention (SMD 12.50, 95% Crl 0.28 to 24.50); and for gross motor, aerobic intervention (SMD 7.49, 95% Crl 0.11 to 15.70) were the most effective treatments. Conclusion: Children's FMSs have been improved through different PA interventions. Among them, aerobic interventions seem to be the most effective intervention in enhancing object control skills and overall gross motor skills.
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Affiliation(s)
- Mohamed A. Hassan
- School of Kinesiology, University of Minnesota-Twin Cities, 208 Cooke Hall, 1900 University Ave. SE, Minneapolis, MN 55455, USA
- Department of Methods and Curriculum, Physical Education College for Men, Helwan University, Cairo 12552, Egypt
| | - Wenxi Liu
- Department of Physical Education, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Daniel J. McDonough
- School of Public Health, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA
| | - Xiwen Su
- School of Rehabilitation Science, Boston University, Boston, MA 02215, USA
| | - Zan Gao
- School of Kinesiology, University of Minnesota-Twin Cities, 208 Cooke Hall, 1900 University Ave. SE, Minneapolis, MN 55455, USA
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23
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Parental Perspectives of the Impact of COVID-19 Lockdown on Food-Related Behaviors: Systematic Review. Foods 2022; 11:foods11182851. [PMID: 36140979 PMCID: PMC9498514 DOI: 10.3390/foods11182851] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 12/15/2022] Open
Abstract
Home confinement during the COVID-19 pandemic has been accompanied by dramatic changes in household food dynamics that can significantly influence health. This systematic literature review presents parental perspectives of the impact of COVID-19 lockdown (up to 30 June 2022) on food preparation and meal routines, as well as other food-related behaviors, capturing both favorable and unfavorable changes in the household food environment. Themes and trends are identified and associations with other lifestyle factors are assessed. Overall, families enjoyed more time together around food, including planning meals, cooking, and eating together. Eating more diverse foods and balanced home-cooked meals (e.g., fresh fruit and vegetables) was combined with overeating and increased snacking (e.g., high-calorie snacks, desserts, and sweets), as parents became more permissive towards food; however, food insecurity increased among families with the lowest income. Adoption of meal planning skills and online shopping behavior emerged alongside behaviors aimed at self-sufficiency, such as bulk purchasing and stockpiling of non-perishable processed foods. These results are an important first step in recognizing how this pandemic may be affecting the family food environment, including low-income families. Future obesity prevention and treatment initiatives, but also ongoing efforts to address food management, parental feeding practices, and food insecurity, can account for these changes moving forward.
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24
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Hamidzadeh K, Westcott J, Wourms N, Shay AE, Panigrahy A, Martin MJ, Nshimiyimana R, Serhan CN. A newly synthesized 17-epi-NeuroProtectin D1/17-epi-Protectin D1: Authentication and functional regulation of Inflammation-Resolution. Biochem Pharmacol 2022; 203:115181. [PMID: 35850309 PMCID: PMC9398963 DOI: 10.1016/j.bcp.2022.115181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 12/15/2022]
Abstract
The production of specialized pro-resolving mediators (SPMs) during the resolution phase in the inflammatory milieu is key to orchestrating the resolution of the acute inflammatory response. 17-epi-neuroprotectin D1/17-epi-protectin D1 (17-epi-NPD1/17-epi-PD1: 10R,17R-dihydroxy-4Z,7Z,11E,13E,15Z,19Z-docosahexaenoic acid) is an SPM of the protectin family, biosynthesized from docosahexaenoic acid (DHA), that exhibits both potent anti-inflammatory and neuroprotective functions. Here, we carried out a new commercial-scale synthesis of 17-epi-NPD1/17-epi-PD1 that enabled the authentication and confirmation of its potent bioactions in vivo and determination of its ability to activate human leukocyte phagocytosis. We provide evidence that this new synthetic 17-epi-NPD1/17-epi-PD1 statistically significantly increases human macrophage uptake of E. coli in vitro and confirm that it limits neutrophilic infiltration in vivo in a murine model of peritonitis. The physical properties of the new synthetic 17-epi-NPD1/17-epi-PD1, namely its ultra-violet absorbance, chromatography, and tandem mass spectrometry fragmentation pattern, matched those of the originally synthesized 17-epi-NPD1/17-epi-PD1. In addition, we verified the structure and complete stereochemical assignment of this new synthetic 17-epi-NPD1/17-epi-PD1 using nuclear magnetic resonance (NMR) spectroscopy. Together, these results authenticate this 17-epi-NPD1/17-epi-PD1 for its structure and potent pro-resolving functions.
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Affiliation(s)
- Kajal Hamidzadeh
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | | | | | - Ashley E Shay
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Anand Panigrahy
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | | | - Robert Nshimiyimana
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Charles N Serhan
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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25
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The Related Metabolic Diseases and Treatments of Obesity. Healthcare (Basel) 2022; 10:healthcare10091616. [PMID: 36141228 PMCID: PMC9498506 DOI: 10.3390/healthcare10091616] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Obesity is a chronic disease characterized by the abnormal or excessive accumulation of body fat, affecting more than 1 billion people worldwide. Obesity is commonly associated with other metabolic disorders, such as type 2 diabetes, non-alcoholic fatty liver disease, cardiovascular diseases, chronic kidney disease, and cancers. Factors such as a sedentary lifestyle, overnutrition, socioeconomic status, and other environmental and genetic conditions can cause obesity. Many molecules and signaling pathways are involved in the pathogenesis of obesity, such as nuclear factor (NF)-κB, Toll-like receptors (TLRs), adhesion molecules, G protein-coupled receptors (GPCRs), programmed cell death 1 (PD-1)/programmed death-ligand 1 (PD-L1), and sirtuin 1 (SIRT1). Commonly used strategies of obesity management and treatment include exercise and dietary change or restriction for the early stage of obesity, bariatric surgery for server obesity, and Food and Drug Administration (FDA)-approved medicines such as semaglutide and liraglutide that can be used as monotherapy or as a synergistic treatment. In addition, psychological management, especially for patients with obesity and distress, is a good option. Gut microbiota plays an important role in obesity and its comorbidities, and gut microbial reprogramming by fecal microbiota transplantation (FMT), probiotics, prebiotics, or synbiotics shows promising potential in obesity and metabolic syndrome. Many clinical trials are ongoing to evaluate the therapeutic effects of different treatments. Currently, prevention and early treatment of obesity are the best options to prevent its progression to many comorbidities.
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