Obesity as a multisystem disease: Trends in obesity rates and obesity-related complications

Exploring factors influencing late evening eating and barriers and enablers to changing to earlier eating patterns in adults with overweight and obesity

Late evening eating is a potential risk factor for overconsumption and weight gain. However, there is limited qualitative research investigating the complex factors that influence late evening eating in adults living with obesity. Identifying the factors that influence late evening eating can inform interventions to reduce late evening eating and associated health risks. Therefore, this study aimed to: i) explore factors that contribute to eating late, and ii) apply the Capability, Opportunity, and Motivation Behaviour (COM-B) model to understand the barriers and enablers to changing to earlier food intake timings in UK adults who report eating late. Semi-structured interviews with seventeen participants [32.47 ± 6.65 years; 34.68 ± 7.10 kg/m2; 71% female (n = 12); 41% White (n = 7)] investigated reasons for late evening eating and the potential barriers and enablers to changing to earlier eating patterns. Thematic analysis identified four main contributors to late evening eating: 1) internal signals (e.g., feeling hungry in the evening); 2) external and situational factors (e.g., work schedules and the food-rich environment); 3) social factors (e.g., interactions with family) and 4) behavioural and emotional factors (e.g., personal preferences and negative feelings in the evening). Time constraints and work schedules were identified as main barriers to changing to earlier eating patterns. Whereas, having high motivation (e.g., contentment with eating earlier in the evening) and interpersonal support were identified as main enablers to eating earlier. This study provides in-depth insights into the psychological, social, and environmental factors contributing to late evening eating. The findings highlight potential targets for future interventions to facilitate earlier eating times in individuals at risk of overweight and obesity.

Obesity and overweight are common among hospitalized patients and are associated with specific causes of admission to an internal medicine department: a cross-sectional study

PURPOSE

Data on the prevalence of obesity among hospitalized patients are limited. Our objective was to capture the rates of overweight and obesity among people admitted to an internal medicine department and to explore a potential association between body mass index (BMI) and causes of hospitalization.

METHODS

Demographic and anthropometric parameters and cause of admission were recorded in all patients admitted to our department over a 30-day period.

RESULTS

One hundred and eighteen patients with a mean age of 71.84 years and a mean BMI of 26.85 kg/m2 were included in the analysis. Among study participants, 53.25% were living with overweight and obesity. Patients admitted for hepatobiliary disease had a higher BMI compared to those admitted for other diseases of the gastrointestinal tract (P < 0.001).

CONCLUSIONS

More than half of patients admitted to an internal medicine department live with obesity or overweight, the specific reasons for admission being associated with a higher BMI.

Tuberculosis vaccine - A timely analysis of the drawbacks for the development of novel vaccines

The BCG vaccine, Bacille Calmette Guerin, holds the distinction of being the most widely administered vaccine. Remarkably, a century has passed since its discovery; however, puzzlingly, questions persist regarding the effectiveness of the immune response it triggers. After years of diligent observation, it has been deduced that BCG imparts immunity primarily to a specific age group, namely children. This prompts a significant query: the rationale behind BCG's limited efficacy against TB in particular age groups and populations remains elusive. Beyond vaccinations, drug therapy has emerged as an alternative route for TB prevention. Nonetheless, this approach faces challenges in the contemporary landscape, marked by the emergence of new instances of MDR-TB and XDR-TB, compounded by the financial burden of treatment. It's noteworthy that BCG remains the sole WHO-approved vaccine for TB. This comprehensive review delves into several aspects, encompassing the immune response during infection, the shortcomings of BCG in conferring immunity, and the various factors contributing to its limitations. Within this discourse, we explore potential explanations for the observed deficiencies of the BCG vaccine and consider how these insights could catalyze the development of future vaccines. The current landscape of novel vaccine development for TB is illuminated, including a spotlight on the latest vaccine candidates.

Postprandial appetite responses to a pecan enriched meal: A randomized crossover trial

Longer-term pecan consumption has shown appetite-regulating effects as a part of a free-living diet, yet the physiologic appetite responses to a single pecan-containing meal are unclear. The purpose of this study was to compare the acute physiologic, subjective, and direct appetite responses of a pecan-containing meal to an energy- and macronutrient-matched control meal. This was an acute meal challenge study utilizing a double-blinded randomized crossover design with two periods. Participants were young, healthy adults (BMI: 22.9 ± 3.3 kg/m2, age: 22 ± 3 y) who consumed a meal containing either 68 g of pecans (PEC; 795 kcal) or an energy- and macronutrient-matched control meal (CON; 794 kcal) on separate testing days. At both testing visits, five postprandial blood draws, and visual analog scale (VAS) questionnaires (in-lab) were used to determine differences in peptide YY (PYY), ghrelin, and subjective appetite over a 4-h postprandial period. Participants also completed VAS questionnaires (at-home) and food records for the rest of the day after leaving the testing visits. Thirty-one out of thirty-two randomized participants completed the study. There was a greater overall postprandial PYY response (p < 0.001), and a greater suppression of postprandial ghrelin after time point 120 min (p < 0.001), with the PEC vs. CON meal. Further, there was a greater increase in subjective fullness (p = 0.001), and suppression of at-home overall appetite (p = 0.02), from time 240-780 min post-meal with PEC vs. CON meals. There were no differences in self-reported EI between meals or any other VAS measure. In conclusion, a pecan-containing breakfast shake produced more favorable physiologic and subjective improvements in appetite compared to an energy- and macronutrient-matched control meal. This trial is registered at clinicaltrials.gov (NCT05230212).

A comparison of efficacy of erector spinae plane block versus serratus anterior plane block plus subcostal transversus abdominus plane block for bariatric laparoscopic sleeve gastrectomy surgery: study protocol for a randomised clinical trial

BACKGROUND

Obesity is a rapidly growing global health concern. Limited long-term success of diet, behavioural modification and medical therapy have led to the increased performance of bariatric surgery. Laparoscopic sleeve gastrectomy, which permanently reduces the size of the stomach, has been shown to cause considerable weight loss, as well as improving or even eliminating obesity related medical comorbidities such as diabetes, obstructive sleep apnoea and hypertension. Unfortunately, this surgery can also result in significant postoperative pain which, when combined with the dangers of perioperative opioid administration for bariatric patients, can lead to a significantly reduced quality of recovery. Opioid-sparing analgesia has been widely recommended for perioperative bariatric patients, but research into the optimum regional analgesia approach for this surgery is lacking, with no trials to date comparing different regional analgesic techniques. This study protocol describes a randomised clinical trial aimed at answering this question, comparing the quality of recovery after laparoscopic sleeve gastrectomy for patients who receive erector spinae plane block, versus those who receive serratus anterior plane block plus subcostal TAP block.

METHODS

We propose a prospective, randomised, blinded (investigator) clinical trial in a tertiary hospital in Ireland. Seventy patients presenting for laparoscopic sleeve gastrectomy will be randomised to two study groups-group A will receive bilateral erector spinae blockade; group B will receive left sided serratus anterior plane block plus subcostal TAP blocks. Both groups will receive the same dose of the same local anaesthetic and the different regional technique performed will be the only difference in their care. The primary outcome will be QoR-15 scores at 24 h postoperatively, a validated international tool for assessing a patient's overall postoperative recovery.

DISCUSSION

Regional analgesia should be a mainstay of perioperative opioid-sparing analgesia where possible. This is especially important in the bariatric cohort who are particularly susceptible to the complications of perioperative opioid administration. To the best of our knowledge, this trial will be the first to compare efficacy of two different regional analgesia techniques for bariatric patients undergoing laparoscopic sleeve gastrectomy surgery.

TRIAL REGISTRATION

This trial was pre-registered on clinicaltrials.gov, registration number NCT05839704, on March 5, 2023. All items from the World Health Organisation Trial Registration Data Set have been included.

Structure based exploration of mitochondrial alpha carbonic anhydrase inhibitors as potential leads for anti-obesity drug development

BACKGROUND

Obesity has emerged as a major health challenge globally in the last two decades. Dysregulated fatty acid metabolism and de novo lipogenesis are prime causes for obesity development which ultimately trigger other co-morbid pathological conditions thereby risking life longevity. Fatty acid metabolism and de novo lipogenesis involve several biochemical steps both in cytosol and mitochondria. Reportedly, the high catalytically active mitochondrial carbonic anhydrases (CAVA/CAVB) regulate the intercellular depot of bicarbonate ions and catalyze the rapid carboxylation of pyruvate and acetyl-co-A to acetyl-co-A and malonate respectively, which are the precursors of fatty acid synthesis and lipogenesis. Several in vitro and in vivo investigations indicate inhibition of mitochondrial carbonic anhydrase isoforms interfere in the functioning of pyruvate, fatty acid and succinate pathways. Targeting of mitochondrial carbonic anhydrase isoforms (CAVA/CAVB) could thereby modulate gluconeogenetic as well as lipogenetic pathways and pave way for designing of novel leads in the development pipeline of anti-obesity medications.

METHODS

The present review unveils a diverse chemical space including synthetic sulphonamides, sulphamates, sulfamides and many natural bioactive molecules which selectively inhibit the mitochondrial isoform CAVA/CAVB with an emphasis on major state-of-art drug design strategies.

RESULTS

More than 60% similarity in the structural framework of the carbonic anhydrase isoforms has converged the drug design methods towards the development of isoform selective chemotypes. While the benzene sulphonamide derivatives selectively inhibit CAVA/CAVB in low nanomolar ranges depending on the substitutions on the phenyl ring, the sulpamates and sulpamides potently inhibit CAVB. The virtual screening and drug repurposing methods have also explored many non-sulphonamide chemical scaffolds which can potently inhibit CAVA.

CONCLUSION

The review could pave way for the development of novel and effective anti-obesity drugs which can modulate the energy metabolism.

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

BACKGROUND

The objective of this study is to evaluate the global burden of ischemic heart disease (IHD) attributable to High body mass index (HBMI) by utilizing data from Global Burden of Disease (GBD) 2019.

METHODS

This study utilized data from the GBD 2019 to examine the impact of HBMI on deaths and disability-adjusted life years (DALYs). The analysis focused on age-standardized rates and considered a 30-year time frame. Trends were assessed using estimated annual percentage changes (EAPCs).

RESULTS

Since 1990, a significant global increase in IHD attributable to HBMI has been observed. This increase is particularly notable among elderly males and in regions with low-middle Socio-Demographic Index (SDI), such as Central Asia and Eastern Europe. In 2019, IHD globally resulted in 1,662,339 deaths and 41,369,773 DALYs. Despite the high age-standardized death rate (20.73 per 100,000) and DALY rate (499.41 per 100,000), a declining trend was noted. This trend is reflected by the EAPCs of -0.35 for DALYs and - 0.67 for deaths. Notably, males and middle SDI countries exhibited higher rates of IHD, whereas high SDI regions such as High-income Asia Pacific and Western Europe showed decreasing trends in IHD.

CONCLUSION

Over the past three decades, there has been a significant increase in IHD caused by HBMI, especially in low-middle and low SDI regions. This highlights the importance of targeted interventions in addressing this issue. Notably, regions including Central Asia, Eastern Europe, North Africa, and the Middle East have been heavily affected.

Screening of Lipid-Reducing Activity and Cytotoxicity of the Exometabolome from Cyanobacteria

Cyanobacteria are rich producers of secondary metabolites, excreting some of these to the culture media. However, the exometabolome of cyanobacteria has been poorly studied, and few studies have dwelled on its characterization and bioactivity assessment. In this work, exometabolomes of 56 cyanobacterial strains were characterized by HR-ESI-LC-MS/MS. Cytotoxicity was assessed on two carcinoma cell lines, HepG2 and HCT116, while the reduction in lipids was tested in zebrafish larvae and in a steatosis model with fatty acid-overloaded human liver cells. The exometabolome analysis using GNPS revealed many complex clusters of unique compounds in several strains, with no identifications in public databases. Three strains reduced viability in HCT116 cells, namely Tolypotrichaceae BACA0428 (30.45%), Aphanizomenonaceae BACA0025 (40.84%), and Microchaetaceae BACA0110 (46.61%). Lipid reduction in zebrafish larvae was only observed by exposure to Dulcicalothrix sp. BACA0344 (60%). The feature-based molecular network shows that this bioactivity was highly correlated with two flavanones, a compound class described in the literature to have lipid reduction activity. The exometabolome characterization of cyanobacteria strains revealed a high chemodiversity, which supports it as a source for novel bioactive compounds, despite most of the time being overlooked.

MRI-derived abdominal adipose tissue is associated with multisite and widespread chronic pain

INTRODUCTION

Musculoskeletal pain typically occurs in multiple sites; however, no study has examined whether excessive visceral and subcutaneous adipose tissue are associated with musculoskeletal pain. This study therefore aimed to describe the associations between MRI-derived abdominal adipose tissue and multisite and widespread chronic musculoskeletal pain.

METHODS

Data from the UK Biobank, a large prospective, population-based cohort study, were used. Abdominal MRI scans were performed at two imaging visits to quantify visceral adipose tissue and subcutaneous adipose tissue. Pain in the neck/shoulder, back, hip, knee or 'all over the body' was assessed at the corresponding visits. Mixed-effects ordinal/multinomial/logistic regression models were used for the analyses.

RESULTS

A total of 32 409 participants were included (50.8% women, mean age 55.0±7.4 years). In multivariable analyses, there was a dose-response association of visceral adipose tissue, subcutaneous adipose tissue and their ratio with the number of chronic pain sites in both women (visceral adipose tissue: OR 2.04 per SD (95% CI 1.85 to 2.26); subcutaneous adipose tissue: OR 1.60 (95% CI 1.50 to 1.70); and their ratio: OR 1.60 (95% CI 1.37 to 1.87)) and men (visceral adipose tissue: OR 1.34 (95% CI 1.26 to 1.42); subcutaneous adipose tissue: OR 1.39 (95% CI 1.29 to 1.49); and their ratio: OR 1.13 (95% CI 1.07 to 1.20)). Higher levels of adipose tissue were also associated with greater odds of reporting chronic pain in both sexes. The effect estimates of these adipose measures were relatively larger in women than in men.

CONCLUSION

Abdominal adipose tissue was associated with chronic musculoskeletal pain, suggesting that excessive and ectopic fat depositions may be involved in the pathogenesis of multisite and widespread chronic musculoskeletal pain. The identified stronger effects in women than men may reflect sex differences in fat distribution and hormones.

The Role of Chemokines in Obesity and Exercise-Induced Weight Loss

Obesity is a global health crisis that is closely interrelated to many chronic diseases, such as cardiovascular disease and diabetes. This review provides an in-depth analysis of specific chemokines involved in the development of obesity, including C-C motif chemokine ligand 2 (CCL2), CCL3, CCL5, CCL7, C-X-C motif chemokine ligand 8 (CXCL8), CXCL9, CXCL10, CXCL14, and XCL1 (lymphotactin). These chemokines exacerbate the symptoms of obesity by either promoting the inflammatory response or by influencing metabolic pathways and recruiting immune cells. Additionally, the research highlights the positive effect of exercise on modulating chemokine expression in the obese state. Notably, it explores the potential effects of both aerobic exercises and combined aerobic and resistance training in lowering levels of inflammatory mediators, reducing insulin resistance, and improving metabolic health. These findings suggest new strategies for obesity intervention through the modulation of chemokine levels by exercise, providing fresh perspectives and directions for the treatment of obesity and future research.

Maternal Dietary Deficiency in Choline Reduced Levels of MMP-2 Levels in Blood and Brain Tissue of Male Offspring Mice

Ischemic stroke is one of the leading causes of disability and death globally, with a rising incidence in younger age groups. It is well known that maternal diet during pregnancy and lactation is vital for the early neurodevelopment of offspring. One-carbon (1C) metabolism, including folic acid and choline, plays a vital role in closure of the neural tube in utero. However, the impact of maternal dietary deficiencies in 1C on offspring neurological function following ischemic stroke later in life remains undefined. The aim of this study was to investigate inflammation in the blood and brain tissue of offspring from mothers deficient in dietary folic acid or choline. Female mice were maintained on either a control or deficient diet prior to and during pregnancy and lactation. When offspring were 3 months of age, ischemic stroke was induced. One and a half months later, blood and brain tissue were collected. We measured levels of matrix metalloproteases (MMP)-2 and 9 in both plasma and brain tissue, and reported reduced levels of MMP-2 in ChDD male offspring in both tissue types. No changes were observed in MMP-9. This observation supports our working hypothesis that maternal dietary deficiencies in folic acid or choline during early neurodevelopment impact the levels of inflammation in offspring after ischemic stroke.

Modern Management of Cardiometabolic Continuum: From Overweight/Obesity to Prediabetes/Type 2 Diabetes Mellitus. Recommendations from the Eastern and Southern Europe Diabetes and Obesity Expert Group

The increasing global incidence of obesity and type 2 diabetes mellitus (T2D) underscores the urgency of addressing these interconnected health challenges. Obesity enhances genetic and environmental influences on T2D, being not only a primary risk factor but also exacerbating its severity. The complex mechanisms linking obesity and T2D involve adiposity-driven changes in β-cell function, adipose tissue functioning, and multi-organ insulin resistance (IR). Early detection and tailored treatment of T2D and obesity are crucial to mitigate future complications. Moreover, personalized and early intensified therapy considering the presence of comorbidities can delay disease progression and diminish the risk of cardiorenal complications. Employing combination therapies and embracing a disease-modifying strategy are paramount. Clinical trials provide evidence confirming the efficacy and safety of glucagon-like peptide 1 receptor agonists (GLP-1 RAs). Their use is associated with substantial and durable body weight reduction, exceeding 15%, and improved glucose control which further translate into T2D prevention, possible disease remission, and improvement of cardiometabolic risk factors and associated complications. Therefore, on the basis of clinical experience and current evidence, the Eastern and Southern Europe Diabetes and Obesity Expert Group recommends a personalized, polymodal approach (comprising GLP-1 RAs) tailored to individual patient's disease phenotype to optimize diabetes and obesity therapy. We also expect that the increasing availability of dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonists will significantly contribute to the modern management of the cardiometabolic continuum.

Opportunities to optimize lifestyle interventions in combination with glucagon-like peptide-1-based therapy

Obesity is a chronic multi-system disease and major driver of type 2 diabetes and cardiometabolic disease. Nutritional interventions form the cornerstone of obesity and type 2 diabetes management. Some interventions such as Mediterranean diet can reduce incident cardiovascular disease, probably independently of weight loss. Weight loss of 5% or greater can improve many adiposity-related comorbidities. Although this can be achieved with lifestyle intervention, it is often difficult to sustain in the longer term due to adaptive endocrine changes. In recent years glucagon-like-peptide-1 receptor agonists (GLP-1RAs) have emerged as effective treatments for both type 2 diabetes and obesity. Newer GLP-1RAs can achieve average weight loss of 15% or greater and improve cardiometabolic health. There is heterogeneity in the weight loss response to GLP-1RAs, with a substantial number of patients unable to achieve 5% or greater weight. Weight loss, on average, is lower in older adults, male patients and people with type 2 diabetes. Mechanistic studies are needed to understand the aetiology of this variable response. Gastrointestinal side effects leading to medication discontinuation are a concern with GLP-1RA treatment, based on real-world data. With weight loss of 20% or higher with newer GLP-1RAs, nutritional deficiency and sarcopenia are also potential concerns. Lifestyle interventions that may potentially mitigate the side effects of GLP-1RA treatment and enhance weight loss are discussed here. The efficacy of such interventions awaits confirmation with well-designed randomized controlled trials.

Dietary strategies for cardiovascular disease risk factors prevention

Nutrition can play a key role in cardiovascular disease risk reduction, and its risk factors modification. This paper aims to present, compare, and summarize the main dietary concepts for preventing the main cardiovascular disease risk factors - obesity, hypertension, and dyslipidemia. The dietary models and macronutrient intakes were compared between main cardiovascular risk factors prevention recommendations. Dietary recommendations related to selected cardiovascular risk factors share the points, that can be suggested as crucial for overall cardiovascular risk factors reduction. Recommendations suggest limiting saturated fatty acids intake to <10% of total caloric intake in obesity, and <7 % in hypercholesterolemia, along with an increased intake of mono- and polyunsaturated fatty acids. In addition, daily dietary fiber intake should reach a level of 25-40 g. The vegetables and fruits should be consumed at a daily minimum level of 200g (or 4-5 portions) each. Salt intake should not exceed 5g/day. Alcohol should be generally avoided, and moderate intake levels (sex-specific) should not be exceeded. It is also worth noting, that proteins are essential for tissue formation and regeneration. Carbohydrates are the main source of energy, but it is necessary to choose products with a low glycemic index. Dietary antioxidants help combat free radicals and prevent cell damage.

shRNA-mediated down-regulation of Acsl1 reverses skeletal muscle insulin resistance in obese C57BL6/J mice

Prolonged consumption of diet rich in fats is regarded as the major factor leading to the insulin resistance (IR) and type 2 diabetes (T2D). Emerging evidence link excessive accumulation of bioactive lipids such as diacylglycerol (DAG) and ceramide (Cer), with impairment of insulin signaling in skeletal muscle. Until recently, little has been known about the involvement of long-chain acyl-CoAs synthetases in the above mechanism. To examine possible role of long-chain acyl-coenzyme A synthetase 1 (Acsl1) (a major muscular ACSL isoform) in mediating HFD-induced IR we locally silenced Acsl1 in gastrocnemius of high-fat diet (HFD)-fed C57BL/6J mice through electroporation-delivered shRNA and compared it to non-silenced tissue within the same animal. Acsl1 down-regulation decreased the content of muscular long-chain acyl-CoA (LCACoA) and both the Cer (C18:1-Cer and C24:1-Cer) and DAG (C16:0/18:0-DAG, C16:0/18:2-DAG, C18:0/18:0-DAG) and simultaneously improved insulin sensitivity and glucose uptake as compared with non-silenced tissue. Acsl1 down-regulation decreased expression of mitochondrial β-oxidation enzymes, and the content of both the short-chain acylcarnitine (SCA-Car) and short-chain acyl-CoA (SCACoA) in muscle, pointing towards reduction of mitochondrial FA oxidation. The results indicate, that beneficial effects of Acsl1 partial ablation on muscular insulin sensitivity are connected with inhibition of Cer and DAG accumulation, and outweigh detrimental impact of decreased mitochondrial fatty acids metabolism in skeletal muscle of obese HFD-fed mice.

An Interdisciplinary Intervention Based on Prescription of Physical Activity, Diet, and Positive Mental Health to Promote Healthy Lifestyle in Patients with Obesity: A Randomized Control Trial

This study used a multimodal approach to address the issue of obesity among individuals with a Body Mass Index (BMI) between 30 and 40 residing in a rural region of north-east Spain. A pretest-posttest model was employed in a clinical trial design, comparing an intervention group with a control group. The intervention, which lasted for a period of nine months, was based on three main strategies: the prescription of physical activity, the promotion of healthy nutritional habits, and the management of emotional wellbeing through Positive Mental Health (PMH). A variety of assessment tools were employed, including the CLASS-AF scale and a stress test for physical activity levels; advanced anthropometry and blood analysis for metabolic and body composition variables; a Mediterranean diet adherence questionnaire for nutritional habits; and a PMH multifactorial questionnaire for the assessment of emotional management. The results revealed significant improvements in the level of physical activity and adherence to the Mediterranean diet in favor of the intervention group, where 89.4% (n = 17) of the participants went from being not very active/sedentary to being active. Also, adherence to the Mediterranean diet improved with a mean increase of 2.2 points on the scale [mean: 10.5 (CI 95%: 9.90, 11.09)]. In addition, significant reductions in body fat [mean: -2.50 kg (CI 95%: -3.56, -1.44)] and free fat mass [mean: -3.38% (IC 95%: -4.34, -2.41), along with decreased cholesterol levels (196 vs. 182 mg/dL), were observed, suggesting a decrease in cardiovascular and metabolic risk. In conclusion, this multimodal intervention was effective at improving the lifestyle of people with obesity and reducing their cardiovascular and metabolic risk. The combination of interventions focused on physical activity, diet, Positive Mental Health, and metabolic changes and were perceived as a comprehensive and complementary strategy in obesity care. These findings highlight the importance of approaching this condition from multiple perspectives to ensure optimal health outcomes.

Paediatric motor difficulties and internalising problems: an integrative review on the environmental stress hypothesis

The current study aims to provide an in-depth analysis and extension of the Environmental Stress Hypothesis (ESH) framework, focusing on the complex interplay between poor motor skills and internalising problems like anxiety and depression. Using an integrative research review methodology, this study synthesises findings from 38 articles, both empirical and theoretical, building upon previous foundational works. The hypothesis posits that poor motor skills serve as a primary stressor, leading to internalising problems through various secondary stressors. A rigorous comparison of data was conducted, considering study design, findings, and methodologies-while exploring variables such as age, sex, and comorbidities. The study also enhances the ESH framework by including intrapersonal stressors and introducing resource buffers, including optimism and familial support as additional influencing factors. This multi-level approach yields a more nuanced and comprehensive ESH framework, highlighting the need for future studies to consider variables that intersect across multiple domains and how the relationship between poor motor skills and internalising problems may vary across different life stages.

A Closer Look into White Adipose Tissue Biology and the Molecular Regulation of Stem Cell Commitment and Differentiation

White adipose tissue (WAT) makes up about 20-25% of total body mass in healthy individuals and is crucial for regulating various metabolic processes, including energy metabolism, endocrine function, immunity, and reproduction. In adipose tissue research, "adipogenesis" is commonly used to refer to the process of adipocyte formation, spanning from stem cell commitment to the development of mature, functional adipocytes. Although, this term should encompass a wide range of processes beyond commitment and differentiation, to also include other stages of adipose tissue development such as hypertrophy, hyperplasia, angiogenesis, macrophage infiltration, polarization, etc.… collectively, referred to herein as the adipogenic cycle. The term "differentiation", conversely, should only be used to refer to the process by which committed stem cells progress through distinct phases of subsequent differentiation. Recognizing this distinction is essential for accurately interpreting research findings on the mechanisms and stages of adipose tissue development and function. In this review, we focus on the molecular regulation of white adipose tissue development, from commitment to terminal differentiation, and examine key functional aspects of WAT that are crucial for normal physiology and systemic metabolic homeostasis.

Executive function, perceived stress and eating behaviours among Chinese young adults

Young adults in a transitional period may experience more stress and, hence, suffer from an increased risk of unhealthy eating. Executive function (EF) involves not only inhibitory control and mental flexibility (the 'cool' facet) to facilitate resistance to immediate temptations, but also affective decision making (the 'hot' facet) that helps to regulate emotional eating. The effects of different facets of EF and their interactions with perceived stress on eating behaviours remained underexplored. In this study, 594 young adults in their graduation year of post-secondary education were included. We used latent profile analysis to identify major patterns of eating behaviours and analysed their associations with perceived stress, and both the 'cool' and 'hot' facets of EF using multinominal logistic regression models. Latent profile analysis identified three clusters of eating patterns: non-approaching moderate eaters (N = 312, 52.5%), approaching eaters (N = 229, 38.6%), and approaching-and-avoidant eaters (N = 53, 8.9%). Logistic regression models found that the approaching-and-avoidant eating pattern was associated with higher perceived stress (OR = 3.16, p value = 0.007) and poorer affective decision-making (OR = 0.97, p value = 0.006). Stratified analysis further revealed that higher perceived stress was significantly associated with approaching-and-avoidant eating only among individuals with poorer affective decision-making. These findings suggest that individuals with poorer emotional regulation may face greater difficulties in regulating eating behaviours when experiencing higher stress. Interventions for people with a mixed pattern of approaching-and-avoidance eating should focus on providing support to regulate emotion-related eating.

Obesity-induced tissue alterations resist weight loss: A mechanistic review

Interventions aimed at weight control often have limited effectiveness in combating obesity. This review explores how obesity-induced dysfunction in white (WAT) and brown adipose tissue (BAT), skeletal muscle, and the brain blunt weight loss, leading to retention of stored fat. In obesity, increased adrenergic stimulation and inflammation downregulate β-adrenoreceptors and impair catecholaminergic signalling in adipocytes. This disrupts adrenergic-mediated lipolysis, diminishing lipid oxidation in both white and brown adipocytes, lowering thermogenesis and blunting fat loss. Emerging evidence suggests that WAT fibrosis is associated with worse weight loss outcomes; indeed, limiting collagen and laminin-α4 deposition mitigates WAT accumulation, enhances browning, and protects against high-fat-diet-induced obesity. Obesity compromises mitochondrial oxidative capacity and lipid oxidation in skeletal muscle, impairing its ability to switch between glucose and lipid metabolism in response to varying nutrient levels and exercise. This dysfunctional phenotype in muscle is exacerbated in the presence of obesity-associated sarcopenia. Additionally, obesity suppresses sarcolipin-induced sarcoplasmic reticulum calcium ATPase (SERCA) activation, resulting in reduced oxidative capacity, diminished energy expenditure, and increased adiposity. In the hypothalamus, obesity and overnutrition impair insulin and leptin signalling. This blunts central satiety signals, favouring a shift in energy balance toward energy conservation and body fat retention. Moreover, both obese animals and humans demonstrate impaired dopaminergic signalling and diminished responses to nutrient intake in the striatum, which tend to persist after weight loss. This may result in enduring inclinations toward overeating and a sedentary lifestyle. Collectively, the tissue adaptations described pose significant challenges to effectively achieving and sustaining weight loss in obesity.

The Interplay Between Cytokines and MicroRNAs to Regulate Metabolic Disorders

Metabolic disorders represent significant public health challenges worldwide. Emerging evidence suggests that cytokines and microRNAs (miRNAs) play crucial roles in the pathogenesis of metabolic disorders by regulating various metabolic processes, including insulin sensitivity, lipid metabolism, and inflammation. This review provides a comprehensive overview of the intricate interplay between cytokines and miRNAs in the context of metabolic disorders, including obesity, type 2 diabetes, and cardiovascular diseases. We discuss how dysregulation of cytokine-miRNA networks contributes to the development and progression of metabolic disorders and explore the therapeutic potential of targeting these interactions for disease management.

Glucagon-like-peptide 1 receptor agonism and attempted suicide: A Mendelian randomisation study to assess a potential causal association

Glucagon-like-peptide 1 receptor agonists (GLP-1RA) have transformed type 2 diabetes (T2D) and obesity management. Multiple regulatory agencies are investigating reported associations between GLP1-RA and increased suicide attempts (SA), but observational data may be prone to confounding. Randomised control trials (RCT) of GLP-1RA were largely undertaken in people at lower risk of SA. Real-world data suggest semaglutide use associates with reduced suicidal ideation and depression but was under-powered to statistically assess risk of SA. Mendelian randomisation (MR) leverages genetic instrument(s) to infer potential causal association between an exposure and an outcome. We undertook MR using missense variants in the gene encoding GLP1R that improve glycemia, lower T2D risk and/or lower BMI, to investigate potential causal association between GLP-1RA and SA. In people of European ancestry, MR did not find evidence genetically proxied GLP1RA increased SA in a general population cohort: (rs10305492, exposure: HbA1c, odds ratio [OR] and 95% confidence interval [CI]: 1.38, 0.41-4.62, p = .60), (rs10305492, exposure: FG, OR 1.27, 0.52-3.13, p = .60) and (rs1042044, exposure BMI, OR 0.30, 0.06-1.48) with concordant results in a multi-ancestry SA case-control cohort. In conclusion, we did not find MR evidence that increased GLP-1RA impacts SA. This awaits confirmation with RCT and real-world data.

Long-term systemic effects of metabolic bariatric surgery: A multidisciplinary perspective

Background

Obesity is a global health crisis with profound implications on various body systems, contributing to a series of comorbidities. Metabolic Bariatric Surgery (MBS) has emerged as an effective treatment option for severe obesity, with significant weight reduction and potential systemic physiological alterations.

Objectives

This narrative review aims to provide a comprehensive analysis of the long-term effects of MBS on a wide array of body systems, including the heart, liver, kidneys, reproductive system, skin, lungs, digestive tract, pancreas, and blood, as well as related cancers of these organs.

Methods

A systematic search was conducted in academic databases (PubMed, ISI Web of Science, and Scopus) for observational studies and reviews published between July 2000 and December 2023, investigating the association between MBS and the subsequent function of different organ systems. High-quality studies were prioritized to ensure reliable evidence synthesis.

Results

MBS has demonstrated favorable outcomes in reducing cardiovascular disease risk, improving cardiac function, and alleviating heart failure symptoms. It has also been associated with improved respiratory function, remission of obstructive sleep apnea, and reduced cancer incidence and mortality. Additionally, MBS has shown benefits in managing gastrointestinal disorders, enhancing glycemic control, and promoting pancreatic beta-cell regeneration in type 2 diabetes mellitus. However, some methods of MBS are associated with a higher risk of cholelithiasis, GERD, and pancreatic exocrine insufficiency.

Conclusion

MBS has far-reaching systemic effects beyond weight loss, offering potential long-term benefits for various organ systems and comorbidities associated with obesity. For many patients with severe obesity, the potential benefits of Metabolic and Bariatric Surgery (MBS) can outweigh the associated risks. However, careful evaluation by a qualified healthcare professional is crucial to determine candidacy and ensure a successful outcome. Further research is needed to fully elucidate the long-term impacts and tailor personalized treatment approaches.

Molecular Morbidity Score-Can MicroRNAs Assess the Burden of Disease?

Multimorbidity refers to the presence of two or more chronic diseases and is associated with adverse outcomes for patients. Factors such as an ageing population have contributed to a rise in prevalence of multimorbidity globally; however, multimorbidity is often neglected in clinical guidelines. This is largely because patients with multimorbidity are systematically excluded from clinical trials. Accordingly, there is an urgent need to develop novel biomarkers and methods of prognostication for this cohort of patients. The hallmarks of ageing are now thought to potentiate the pathogenesis of multimorbidity. MicroRNAs are small, regulatory, noncoding RNAs which have been implicated in the pathogenesis and prognostication of numerous chronic diseases; there is a substantial body of evidence now implicating microRNA dysregulation with the different hallmarks of ageing in the aetiology of chronic diseases. This article proposes using the hallmarks of ageing as a framework to develop a panel of microRNAs to assess the prognostic burden of multimorbidity. This putative molecular morbidity score would have many potential applications, including assessing the efficacy of clinical interventions, informing clinical decision making and facilitating wider inclusion of patients with multimorbidity in clinical trials.

Genetic variation in NOTCH1 is associated with overweight and obesity in Brazilian elderly

Excessive weight (overweight and obesity) is a common disorder involving genetic and environmental factors, associated with cardiovascular diseases, type-2 diabetes, and others. NOTCH1 is critical for the maintenance of stem cells and adult tissues, being reported as a key player in metabolism and adipogenesis in animals. Thus, we test the hypothesis that NOTCH1 Single Nucleotide Polymorphisms (SNPs) are associated with excessive weight. Participants from the census-based cohort SABE (Saúde, Bem Estar e Envelhecimento-Health, Well-Being, and Aging), carried out in the city of São Paulo-Brazil, were stratified into cases and controls according to BMI. We filter the SNPs located at the start and end positions of NOTCH1 and 50 Kb on both sides. We selected SNPs with minor allelic frequency (MAF) greater than or equal to 0.01 and Hardy-Weinberg equilibrium (p > 0.05) and r2 ≥ 0.8. We performed an association study with genotypes and haplotypes, as well as in silico functional analysis of the identified SNPs. We observed an association of the SNP rs9411207 with the risk of excessive weight, under log-additive model, and the genotype distribution showed an increased frequency of homozygous TT (OR 1.50, CI 1.20-1.88; p = 0.0002). The haplotype GAT constructed from this and other SNPs in high Linkage Disequilibrium was more frequent in excessive-weight individuals (p = 0.003). In silico analyses suggested that these SNPs are likely to affect the transcription of NOTCH1 and other genes involved in adipogenesis and metabolism. This is the first study reporting association between NOTCH1 SNPs and the risk of excessive weight. Considering the possibility of NOTCH1 modulation, additional population studies are important to replicate these data and confirm the usefulness of risk genotypes for management strategies of excessive weight.

Maternal dietary deficiency in choline reduced levels of MMP-2 levels in blood and brain tissue of male offspring mice

Ischemic stroke is one of the leading causes of disability and death globally, with a rising incidence in younger age groups. It's well known that maternal diet during pregnancy and lactation is vital for the early neurodevelopment of offspring. One-carbon (1C) metabolism, including folic acid and choline, plays a vital role in closure of the neural tube in utero. However, the impact of maternal dietary deficiencies in 1C on offspring neurological function following ischemic stroke later in life remains undefined. The aim of this study was to investigate inflammation in blood and brain tissue of offspring from mothers deficient in dietary folic acid or choline. Female mice were maintained on either a control or deficient diets prior to and during pregnancy and lactation. When offspring were 3-months of age, ischemic stroke was induced. One and half months later blood and brain tissue were collected. We measured levels of matrix-metalloproteases (MMP)-2 and 9 in both plasma and brain tissue, and report reduced levels of MMP-2 in both, with no changes observed in MMP-9. This observation supports our working hypothesis that maternal dietary deficiencies in folic acid or choline during early neurodevelopment impact the levels of inflammation in offspring after ischemic stroke.

Collagen peptides from sturgeon swim bladder prolong the lifespan and healthspan in Caenorhabditis elegans

BACKGROUND

Sturgeon is a popular aquaculture species in many countries. Its swim bladder is rich in collagen but has not yet been exploited scientifically.

RESULTS

Collagen peptides (CPs) prepared from sturgeon swim bladder by trypsinolysis had an average molecular weight of 528.5 Da and consisted of 407 peptides, 16.1% of the content of which was GFPGADGSAGPK. The CPs at 25 mg mL-1 extended the lifespan of Caenorhabditis elegans by 22.6%, which was significantly higher than the extension achieved by other hydrolysis methods and source materials. They also improved fitness-related traits (body size, motor capacity, oxidative stress, cell apoptosis, and epidermal barrier function), indicating prolonged healthspan. Transcriptome analysis showed that the effect was mediated by the mitogen-activated protein kinase pathway, which enhanced stress resistance, the insulin/IGF-1 pathway, which inhibited protein aggregation, and the NHR-80/FAT-6 pathway, which regulated lipid metabolism.

CONCLUSION

Collagen peptides from sturgeon swim bladder by trypsinolysis prolonged the lifespan and healthspan in C. elegans, and might be promising anti-aging agents. © 2024 Society of Chemical Industry.

Bariatric surgery and the diseased kidney: a 5-year assessment of safety and postoperative renal outcomes

BACKGROUND

Obesity and its related medical conditions are well-established contributors to the development of chronic kidney disease (CKD). Metabolic and bariatric surgery (MBS), including procedures such as sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), is a potential intervention for these individuals. However, the heightened risk of postoperative complications casts doubts on the suitability of MBS in this population. Our aim is to evaluate the long-term safety, anthropometric and renal outcomes of MBS in patients with CKD.

METHODS

A retrospective review of patients who underwent primary laparoscopic MBS with a BMI ≥ 35 kg/m2 and a preoperative diagnosis of stage 2 to 5 CKD. Criteria for CKD diagnosis and staging were based on estimated glomerular filtration rate measurements in accordance with established guidelines. Anthropometric and renal outcomes were measured at 3-, 6-, 12-, 24- and 60-months postoperatively.

RESULTS

A total of 302 patients (177 SG, 125 RYGB) were included. RYGB was preferred for patients with stage 3 CKD, while SG was more common in stages 4 and 5. At 5-year follow-up, percentage of total weight loss was higher in the RYGB cohort compared to SG (25.1% vs. 18.6%, p = 0.036). Despite SG patients having more advanced CKD, the incidence of late complications was significantly higher following RYGB, with 11 incidents (8.8%), compared to the SG cohort with only 4 cases (2.3%) (p = 0.014). In those with preoperative CKD stage 3, 76 patients (43.2%) improved to stage 2, with another 9 patients (5.1%) improving further to stage 1. Of all patients, 63 (20.8%) eventually received a successful renal transplant.

CONCLUSIONS

MBS is an effective strategy for sustained weight loss in patients with CKD with acceptable complications rates. RYGB leads to a higher percentage of overall weight loss, albeit with an elevated likelihood of late surgical complications. Future studies are needed to determine the safety of MBS in this demographic.

Theory-based obesity intervention program for women: A randomized controlled study

AIMS

To determine the effect of the education and counseling intervention given to overweight and obese women according to the theory of planned behavior on their health behaviors.

METHODS

The study consisted of 78 overweight and obese women in total, between the ages of 18-49. While the women in the intervention group were given a 6-month training program and 6-month counseling service structured according to the theory of planned behavior, the women in the control group were given standard obesity training and were put on hold for 6 months.

RESULTS

There was a decrease in the post-test anthropometric measurement values of the intervention group compared to the pretest. While there was no statistically significant change in the activity status of the control group over time, the inactivity rate of the intervention group decreased; however, the minimal activity rate increased over time. The post-test healthy life style behaviors scale II health responsibility, physical activity, nutrition, stress management and total scores of the intervention group were higher than those of the control group, and the differences were significant.

CONCLUSION

It has been determined that the education and counseling services applied to overweight and obese women based on the theory of planned behavior are effective in gaining positive health behaviors.

The Application of Cohen's Stress-Buffering Model for Weight Bias Internalization in Prebariatric Patients

INTRODUCTION

Weight bias internalization (WBI) is associated with reduced psychological well-being in individuals with obesity. The aim of this study was to investigate the application of Cohen's stress-buffering model of social support for WBI on well-being in patients presenting for bariatric surgery.

METHODS

In N = 804 adult prebariatric patients, WBI, social support, depression severity, health-related quality of life (HRQOL), and self-esteem were assessed by self-report questionnaires. Structural Equation Modeling was applied to test for direct associations between social support and well-being and for a buffering effect of social support on the relationship between WBI and well-being.

RESULTS

After controlling for age, sex, and body mass index, greater social support was directly associated with reduced depression severity and increased self-esteem, but not with increased HRQOL. Contrary to Cohen's stress-buffering model, social support showed no moderating effects on the association between WBI and depression severity, HRQOL, and self-esteem.

CONCLUSION

These cross-sectional results may indicate that greater social support is associated with improved well-being, supporting it as a potential coping resource in bariatric surgery. Given the absence of supporting evidence for the buffering effect in the present study, future prospective research may reevaluate the existence of a moderating effect of social support and investigate whether support-focused interventions improve psychological well-being.

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.

Microalgae as future food: Rich nutrients, safety, production costs and environmental effects

The improvement of food security and nutrition has attracted wide attention, and microalgae as the most promising food source are being further explored. This paper comprehensively introduces basic and functional nutrients rich in microalgae by elaborated tables incorporating a wide variety of studies and summarizes factors influencing their accumulation effects. Subsequently, multiple comparisons of nutrients were conducted, indicating that microalgae have a high protein content. Moreover, controllable production costs and environmental friendliness prompt microalgae into the list that contains more promising and reliable future food. However, microalgae and -based foods approved and sold are limited strictly, showing that safety is a key factor affecting dietary consideration. Notably, sensory profiles and ingredient clarity play an important role in improving the acceptance of microalgae-based foods. Finally, based on the bottleneck in the microalgae food industry, suggestions for its future development were discussed.

Is Propolis a Potential Anti-Obesogenic Agent for Obesity?

PURPOSE OF REVIEW

Propolis is a bee product that has been used for thousands of years. The chemical composition and biological activity of propolis, which has been investigated in the twentieth century, may vary according to location. Propolis polyphenols can induce thermogenesis in brown and beige fat tissue via the uncoupled protein-1 and creatinine kinase metabolic pathways. This review provides a comprehensive investigation of the structural and biological properties of propolis and provides insights into their promising potential strategies in body weight management.

RECENT FINDINGS

By raising overall energy expenditure, it might lead to body weight management. Furthermore, the phenolic components artepillin C, quercetin, catechin, and chlorogenic acid found in its composition may have anti-obesogenic effect by stimulating the sympathetic nervous system, enhancing browning in white adipose tissue, and triggering AMP-activated protein kinase activation and mitochondrial biogenesis. Propolis, a natural product, is effective in preventing obesity which is a contemporary pandemic.

Putting More Weight on Obesity Trials in Heart Failure

PURPOSE OF REVIEW

To review ongoing and planned clinical trials of weight loss among individuals with or at high risk of heart failure.

RECENT FINDINGS

Intentional weight loss via semaglutide among persons with heart failure and preserved ejection fraction and obesity significantly improves weight loss and health status as assessed by the KCCQ-CSS score and is associated with improvements in 6-min walk test. Ongoing and planned trials will explore the role of intentional weight loss with treatments such as semaglutide or tirzepatide for individuals with heart failure across the entire ejection fraction spectrum.

Efficacy of Probiotic Strains Lactobacillus sakei Probio65 and Lactobacillus plantarum Probio-093 in Management of Obesity: An In Vitro and In Vivo Analysis

The prevalence of obesity, characterized by an excessive accumulation of adipose tissue and adipocyte hypertrophy, presents a major public health challenge. This study investigates the therapeutic potential of two probiotic strains, Lactobacillus sakei Probio65 and Lactobacillus plantarum Probio-093, in the context of obesity. Utilizing 3T3-L1 cell-derived human adipocytes, we assessed Probio65's and Probio-093's capacity to mitigate triglyceride accumulation and influence adipocytokine production in vitro. Subsequently, an in vivo trial with male C57BL/6J mice examined the effects of both probiotic strains on adipose tissue characteristics, body weight, fat mass, and obesity-related gene expression. This study employed both live and ethanol-extracted bacterial cells. The results demonstrated significant reductions in the triglyceride deposition, body weight, and adipose tissue mass in the treated groups (p < 0.05). Furthermore, both strains modulated adipokine profiles by downregulating proinflammatory markers such as PAI-1, leptin, TNF-α, STAMP2, F4/80, resistin, and MCP-1, and upregulating the insulin-sensitive transporter GLUT4 and the anti-inflammatory adiponectin (p < 0.05). Our findings suggest that Lactobacillus sakei Probio65 and Lactobacillus plantarum Probio-093 are promising agents for microbiome-targeted anti-obesity therapies, offering the effective mitigation of obesity and improvement in adipocyte function in a murine model.

Identification of ligand and receptor interactions in CKD and MASH through the integration of single cell and spatial transcriptomics

BACKGROUND

Chronic Kidney Disease (CKD) and Metabolic dysfunction-associated steatohepatitis (MASH) are metabolic fibroinflammatory diseases. Combining single-cell (scRNAseq) and spatial transcriptomics (ST) could give unprecedented molecular disease understanding at single-cell resolution. A more comprehensive analysis of the cell-specific ligand-receptor (L-R) interactions could provide pivotal information about signaling pathways in CKD and MASH. To achieve this, we created an integrative analysis framework in CKD and MASH from two available human cohorts.

RESULTS

The analytical framework identified L-R pairs involved in cellular crosstalk in CKD and MASH. Interactions between cell types identified using scRNAseq data were validated by checking the spatial co-presence using the ST data and the co-expression of the communicating targets. Multiple L-R protein pairs identified are known key players in CKD and MASH, while others are novel potential targets previously observed only in animal models.

CONCLUSION

Our study highlights the importance of integrating different modalities of transcriptomic data for a better understanding of the molecular mechanisms. The combination of single-cell resolution from scRNAseq data, combined with tissue slide investigations and visualization of cell-cell interactions obtained through ST, paves the way for the identification of future potential therapeutic targets and developing effective therapies.

Obesity Prevalence and Its Impact on Maternal and Neonatal Outcomes among Pregnant Women: A Retrospective Cross-Sectional Study Design

BACKGROUND

The escalating prevalence of obesity in women of reproductive age raises concerns about its impact on maternal and fetal health during pregnancy. This study aimed to thoroughly assess how obesity affects pregnancy and neonatal outcomes among Saudi pregnant women.

METHODS

In a retrospective cross-sectional study, we analyzed 8426 pregnant women who delivered at King Fahad National Guard Hospital in Riyadh in 2021. Of these, 3416 had obesity, and 341 of them, meeting the inclusion criteria, were selected. Maternal and neonatal outcomes were compiled using a structured questionnaire and extracted from the hospital's "Best Care" data-based registration system.

RESULTS

The findings highlighted that 40.5% of pregnant women were classified as obese, with almost half falling into obesity class II based on BMI. Obesity correlated significantly with adverse maternal outcomes like gestational diabetes and increased rates of cesarean deliveries. Additionally, maternal obesity was linked to unfavorable fetal outcomes, including higher rates of newborn intensive care unit admissions, lower APGAR scores at 1 min, and a greater likelihood of macrosomia.

CONCLUSIONS

This study underscores the important impact of maternal obesity on both maternal and fetal health during pregnancy. Addressing this high-risk condition demands targeted educational programs for women of reproductive age focusing on BMI control, dietary adjustments, and lifestyle modifications to mitigate obesity-related complications during pregnancy.

Understanding health behaviors that modify the risk for obesity in ADHD

OBJECTIVE

Research provides support for the associated risk of inadequate sleep duration, limited physical activity, and excessive media use in attention-deficit/hyperactivity disorder (ADHD) and obesity. The present study aims to (1) examine the association between ADHD and overweight or obese status (OW/OB); (2) comprehensively examine sleep duration, physical activity, and media use as potential moderators of OW/OB; and (3) examine the moderating effects of these health behaviors cross-sectionally by comparing medicated youth with ADHD, unmedicated youth with ADHD, and youth without ADHD.

METHODS

Data were acquired from the 2018 and 2019 National Survey of Children's Health, a nationally representative survey of caregivers conducted across the United States. The current study used data for youth 11-17 years old with a final sample size of 26,644. Hours of sleep, physical activity, and media use per day were dichotomized based on national recommendation guidelines for each health behavior (i.e., either meeting or not meeting guidelines).

RESULTS

The OW/OB prevalence rate was 7% greater among unmedicated youth with ADHD than among medicated youth with ADHD. Medicated youth with ADHD and peers without ADHD had similar OW/OB rates. Among medicated youth with ADHD, physical activity, sleep duration, and media use did not contribute to OW/OB risk after controlling for family poverty level. However, among unmedicated youth with ADHD, meeting sleep duration guidelines was linked to a lower OW/OB risk.

CONCLUSION

Overall, findings suggest that clinical providers and parents may wish to prioritize improved sleep duration in the management of OW/OB risk in youth with ADHD.

Alternative models to support weight loss in chronic musculoskeletal conditions: effectiveness of a physiotherapist-delivered intensive diet programme for knee osteoarthritis, the POWER randomised controlled trial

OBJECTIVES

To determine if physiotherapists can deliver a clinically effective very low energy diet (VLED) supplementary to exercise in people with knee osteoarthritis (OA) and overweight or obesity.

METHODS

88 participants with knee OA and body mass index (BMI) >27 kg/m2 were randomised to either intervention (n=42: VLED including two daily meal replacement products supplementary to control) or control (n=46: exercise). Both interventions were delivered by unblinded physiotherapists via six videoconference sessions over 6 months. The primary outcome was the percentage change in body weight at 6 months, measured by a blinded assessor. Secondary outcomes included BMI, waist circumference, waist-to-hip ratio, self-reported measures of pain, function, satisfaction and perceived global change, and physical performance tests.

RESULTS

The intervention group lost a mean (SD) of 8.1% (5.2) body weight compared with 1.0% (3.2) in the control group (mean (95% CI) between-group difference 7.2% (95% CI 5.1 to 9.3), p<0.001), with significantly lower BMI and waist circumference compared with control group at follow-up. 76% of participants in the intervention group achieved ≥5% body weight loss and 37% acheived ≥10%, compared with 12% and 0%, respectively, in the control group. More participants in the intervention group (27/38 (71.1%)) reported global knee improvement than in the control group (20/42 (47.6%)) (p=0.02). There were no between-group differences in any other secondary outcomes. No serious adverse events were reported.

CONCLUSION

A VLED delivered by physiotherapists achieved clinically relevant weight loss and was safe for people with knee OA who were overweight or obese. The results have potential implications for future service models of care for OA and obesity.

TRIAL REGISTRATION NUMBER

NIH, US National Library of Medicine, Clinicaltrials.gov NCT04733053 (1 February 2021).

An Updated Review on Nelumbo Nucifera Gaertn: Chemical Composition, Nutritional Value and Pharmacological Activities

Nelumbo nucifera Gaertn is a recognised herbal plant in ancient medical sciences. Each portion of the plant leaf, flower, seed and rhizome is utilised for nutritional and medicinal purposes. The chemical compositions like phenol, alkaloids, glycoside, terpenoids and steroids have been isolated. The plant contains various nutritional values like lipids, proteins, amino acids, minerals, carbohydrates, and fatty acids. Traditional medicine confirms that the phytochemicals of plants give significant benefits to the treatment of various diseases such as leukoderma, smallpox, dysentery, haematemesis, coughing, haemorrhage, metrorrhagia, haematuria, fever, hyperlipidaemia, cholera, hepatopathy and hyperdipsia. To verify the traditional claims, researchers have conducted scientific biological in vivo and in vitro screenings, which have exhibited that the plant keeps various notable pharmacological activities such as anticancer, hepatoprotective, antioxidant, antiviral, hypolipidemic, anti-obesity, antipyretic, hypoglycaemic, antifungal, anti-inflammatory and antibacterial activities. This review, summaries the nutritional composition, chemical constituents and biological activities substantiated by the researchers done in vivo and in vitro.

Revealing Molecular Mechanisms of the Bioactive Saponins from Edible Root of Platycodon grandiflorum in Combating Obesity

Obesity has emerged as a significant health concern, as it is a disease linked to metabolic disorders in the body and is characterized by the excessive accumulation of lipids. As a plant-derived food, Platycodon grandiflorum (PG) was reported by many studies, indicating that the saponins from PG can improve obesity effectively. However, the anti-obesity saponins from PG and its anti-obesity mechanisms have not been fully identified. This study identified the active saponins and their molecular targets for treating obesity. The TCMSP database was used to obtain information on 18 saponins in PG. The anti-obesity target of the PG saponins was 115 targets and 44 core targets. GO and KEGG analyses using 44 core anti-obesity genes and targets of PG-active saponins screened from GeneCards, OMIM, Drugbank, and DisGeNet showed that the PI3K-Akt pathway, the JAK-STAT pathway, and the MAPK pathway were the major pathways involved in the anti-obesity effects of PG saponins. BIOVIA Discovery Studio Visualizer and AutoDock Vina were used to perform molecular docking and process the molecular docking results. The molecular docking results showed that the active saponins of PG could bind to the major therapeutic obesity targets to play an obesity-inhibitory role. The results of this study laid the foundation for further research on the anti-obesity saponins in PG and their anti-obesity mechanism and provided a new direction for the development of functional plant-derived food. This research studied the molecular mechanism of PG saponins combating obesity through various signaling pathways, and prosapogenin D can be used to develop as a new potential anti-obesity drug.

The impact of body mass index on operative time in transoral endoscopic thyroidectomy vestibular approach for thyroid cancer

BACKGROUND

The impact of body mass index (BMI) on operative time in transoral endoscopic thyroidectomy vestibular approach (TOETVA) for thyroid cancer is still a subject of debate. This study assessed the impact of BMI on operative time and postoperative complications in patients undergoing TOETVA.

METHODS

The study has been conducted to compare the outcomes of TOETVA in patients with high BMI (≥25) and those with normal BMI (<25). Postoperative outcomes, including operative time, blood lost, recurrent laryngeal nerve (RLN) palsy, hypocalcemia and postoperative pain score, were evaluated.

RESULTS

A total of 62 patients who underwent TOETVA were included in the study. The high BMI group consisted of 39 patients, while the normal BMI group included 23 patients. No significant differences were observed between the two groups regarding operative time, blood loss, postoperative pain score, and postoperative complications such as recurrent laryngeal nerve (RLN) palsy and hypocalcemia.

CONCLUSIONS

BMI was not significantly associated with operative time and postoperative complications in patients undergoing TOETVA, indicating its safety and feasibility for elevated BMI patients.

Self-Assembled Oligopeptoplex-Loaded Dissolving Microneedles for Adipocyte-Targeted Anti-Obesity Gene Therapy

Advancements in gene delivery systems are pivotal for gene-based therapeutics in oncological, inflammatory, and infectious diseases. This study delineates the design of a self-assembled oligopeptoplex (SA-OP) optimized for shRNA delivery to adipocytes, targeting obesity and associated metabolic syndromes. Conventional systems face challenges, including instability due to electrostatic interactions between genetic materials and cationic oligopeptides. Additionally, repeated injections induce discomfort and compromise patient well-being. To circumvent these issues, a dissolvable hyaluronic acid-based, self-locking microneedle (LMN) patch is developed, with improved micro-dose efficiency, for precise SA-OP delivery. This platform offers pain-free administration and improved SA-OP storage stability. In vitro studies in 3T3-L1 cells demonstrated improvements in SA-OP preservation and gene silencing efficacy. In vivo evaluation in a mice model of diet-induced type 2 diabetes yielded significant gene silencing in adipose tissue and a 21.92 ± 2.51% reduction in body weight with minimum relapse risk at 6-weeks post-treatment, representing a superior therapeutic efficacy in a truncated timeframe relative to the GLP-1 analogues currently available on the market. Additionally, SA-OP (LMN) mitigated insulin resistance, inflammation, and hepatic steatosis. These findings establish SA-OP (LMN) as a robust, minimally invasive transdermal gene delivery platform with prolonged storage stability for treating obesity and its metabolic comorbidities.

Integrated spatial metabolomics and transcriptomics decipher the hepatoprotection mechanisms of wedelolactone and demethylwedelolactone on non-alcoholic fatty liver disease

Eclipta prostrata L. has been used in traditional medicine and known for its liver-protective properties for centuries. Wedelolactone (WEL) and demethylwedelolactone (DWEL) are the major coumarins found in E. prostrata L. However, the comprehensive characterization of these two compounds on non-alcoholic fatty liver disease (NAFLD) still remains to be explored. Utilizing a well-established zebrafish model of thioacetamide (TAA)-induced liver injury, the present study sought to investigate the impacts and mechanisms of WEL and DWEL on NAFLD through integrative spatial metabolomics with liver-specific transcriptomics analysis. Our results showed that WEL and DWEL significantly improved liver function and reduced the accumulation of fat in the liver. The biodistributions and metabolism of these two compounds in whole-body zebrafish were successfully mapped, and the discriminatory endogenous metabolites reversely regulated by WEL and DWEL treatments were also characterized. Based on spatial metabolomics and transcriptomics, we identified that steroid biosynthesis and fatty acid metabolism are mainly involved in the hepatoprotective effects of WEL instead of DWEL. Our study unveils the distinct mechanism of WEL and DWEL in ameliorating NAFLD, and presents a "multi-omics" platform of spatial metabolomics and liver-specific transcriptomics to develop highly effective compounds for further improved therapy.

Expression of immune related genes and possible regulatory mechanisms in different stages of non-alcoholic fatty liver disease

Background

Non-alcoholic fatty liver disease (NAFLD), which includes simple steatosis (SS) and non-alcoholic steatohepatitis (NASH), is a significant contributor to liver disease on a global scale. The change of immunity-related genes (IRGs) expression level leads to different immune infiltrations. However, the expression of IRGs and possible regulatory mechanisms involved in NAFLD remain unclear. The objective of our research is to investigate crucial genes linked to the development of NAFLD and the transition from SS to NASH.

Methods

Dataset GSE89632, which includes healthy controls, SS patients, and NASH patients, was obtained using the GEO database. To examine the correlation between sets of genes and clinical characteristics, we employed weighted gene co-expression network analysis (WGCNA) and differential expression analysis. Hub genes were extracted using a network of protein-protein interactions (PPI) and three different machine learning algorithms. To validate the findings, another dataset that is publicly accessible and mice that were subjected to a high-fat diet (HFD) or MCD diet were utilized. Furthermore, the ESTIMATE algorithm and ssGSEA were employed to investigate the immune landscape in the normal versus SS group and SS versus NASH group, additionally, the relationship between immune infiltration and the expression of hub genes was also examined.

Results

A total of 28 immune related key genes were selected. Most of these genes expressed reverse patterns in the initial and progressive stages of NAFLD. GO and KEGG analyses showed that they were focused on the cytokine related pathways and immune cell activation and chemotaxis. After screening by various algorithms, we obtained two hub genes, including JUN and CCL20. Validation of these findings was confirmed by analyzing gene expression patterns in both the validation dataset and the mouse model. Ultimately, two hub genes were discovered to have a significant correlation with the infiltration of immune cells.

Conclusion

We proposed that there were dynamic changes in the expression levels of IRGs in different stages of NAFLD disease, which led to different immune landscapes in SS and NASH. The findings of our research could serve as a guide for the accurate management of various phases of NAFLD.

Imagine chocolate: The craving experience questionnaire in the food domain

Measurement of food craving has gained relevance in the current obesity epidemic. The Craving Experience Questionnaire (CEQ) considers not only craving intensity but also cognitive intrusiveness and imagery vividness as separate craving factors and could thus refine food craving assessment. It is available in two versions with ten items each. The CEQ-F assesses craving frequency across specific time periods and the CEQ-S time-point specific craving strength. Across three independent studies, N = 533 participants completed the German chocolate CEQ-F referenced at the past year to operationalise trait-like craving. Among them, N = 402 also completed the German chocolate CEQ-S referenced at the current moment to operationalise state-like craving. Four-week test-retest reliability was measured. For external validity, we assessed self-reported chocolate consumption, body-mass-index, trait approach motivation, general imagery vividness, and the most widely used food craving questionnaire, namely the Food Cravings Questionnaires in a trait (FCQ-T-r) and state version (FCQ-S), as well as behavioural approach bias (reaction time-based measurement). The three-factor structure was replicated with excellent internal consistency for both CEQ-F and CEQ-S. Test-retest reliability was moderate for both CEQ versions. CEQ-F scores were related to higher levels of chocolate consumption, approach motivation, and FCQ-T-r scores, but not to body-mass-index, imagery vividness, or approach bias. CEQ-S scores were associated with FCQ-S scores and partly with approach bias, but not with approach motivation and imagery vividness. The current results support the factor structure, validity and reliability of the German chocolate CEQ-S and CEQ-F with questions remaining regarding the ability of the CEQ-S to measure state craving. Thus, CEQ-F and CEQ-S usefully contribute to food craving assessment.

PGC-1α-Coordinated Hypothalamic Antioxidant Defense Is Linked to SP1-LanCL1 Axis during High-Fat-Diet-Induced Obesity in Male Mice

High-fat-diet (HFD)-induced obesity parallels hypothalamic inflammation and oxidative stress, but the correlations between them are not well-defined. Here, with mouse models targeting the antioxidant gene LanCL1 in the hypothalamus, we demonstrate that impaired hypothalamic antioxidant defense aggravates HFD-induced hypothalamic inflammation and obesity progress, and these could be improved in mice with elevated hypothalamic antioxidant defense. We also show that peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α), a critical transcriptional coactivator, is implicated in regulating hypothalamic LanCL1 transcription, in collaboration with SP1 through a direct interaction, in response to HFD-induced palmitic acid (PA) accumulation. According to our results, when exposed to HFD, mice undergo a process of overwhelming hypothalamic antioxidant defense; short-time HFD exposure induces ROS production to activate PGC-1α and elevate LanCL1-mediated antioxidant defense, while long-time exposure promotes ubiquitin-mediated PGC-1α degradation and suppresses LanCL1 expression. Our findings show the critical importance of the hypothalamic PGC-1α-SP1-LanCL1 axis in regulating HFD-induced obesity, and provide new insights describing the correlations of hypothalamic inflammation and oxidative stress during this process.

Credibility of ChatGPT in the assessment of obesity in type 2 diabetes according to the guidelines

BACKGROUND

The Chat Generative Pre-trained Transformer (ChatGPT) allows students, researchers, and patients in the medical field to access information easily and has gained attention nowadays. We aimed to evaluate the credibility of ChatGPT according to the guidelines for the assessment of obesity in type 2 diabetes (T2D), which is one of the major concerns of this century.

MATERIALS AND METHOD

In this cross-sectional non-human subject study, experienced endocrinologists posed 20 questions to ChatGPT in subsections, which were assessments and different treatment options for obesity according to the American Diabetes Association and American Association of Clinical Endocrinology guidelines. The responses of ChatGPT were classified into four categories: compatible, compatible but insufficient, partially incompatible and incompatible with the guidelines.

RESULTS

ChatGPT demonstrated a systematic approach to answering questions and recommended consulting a healthcare provider to receive personalized advice based on the specific health needs and circumstances of patients. The compatibility of ChatGPT with the guidelines was 100% in the assessment of obesity in type 2 diabetes; however, it was lower in the therapy sections, which included nutritional, medical, and surgical approaches to weight loss. Furthermore, ChatGPT required additional prompts for responses that were evaluated as "compatible but insufficient" to provide all the information in the guidelines.

CONCLUSION

The assessment and management of obesity in T2D are highly individualized. Despite ChatGPT's comprehensive and understandable responses, it should not be used as a substitute for healthcare professionals' patient-centered approach.

Do Small Scars Lead to Better Results? Analysis of Long-term Outcomes and Satisfaction of Patients Undergoing Anchor-line Abdominoplasty Following Massive Weight Loss

INTRODUCTION

Do smaller scars lead to higher patient satisfaction? The aim of this study is to analyze long-term satisfaction of patients who underwent abdominoplasty after massive weight loss.

METHODS

Patients inclusion criteria: no previous abdominal remodeling procedures, previous bariatric surgery followed by a weight loss of at least 30 kg, weight stability for at least one year, good understanding of the Italian language and standardized pre- and postoperative photographs. We divided the population in 2 groups based on the surgical procedure: group 1, conventional abdominoplasty, and group 2, anchor-line abdominoplasty. All patients presented scars in the epigastric and mesogastric region resulting from previous laparoscopic or laparotomic bariatric surgery and/or other laparoscopic or laparotomic procedures. At least 2 years after surgery, we administered the Italian version of the post-operative BODY-Q module and the SCAR-Q questionnaire.

RESULTS

We enrolled 20 males and 69 females aged between 25 and 55 years, with a mean follow-up of 2 years. Analyzing the questionnaires, it resulted that patients undergoing anchor-line abdominoplasty were significantly more satisfied in the body perception of the result (p = 0.035) and in the satisfaction with abdomen domain (p = 0.0015) compared to the conventional abdominoplasty group. Scars assessment with the SCAR-Q did not show any significant differences between the groups.

CONCLUSION

Despite its long scars, the anchor-line pattern shows an overall higher satisfaction, due to the possibility of reducing the abdomen both cranio-caudally and circumferentially. These findings might be an important guide when approaching abdominoplasty in post-bariatric patients, debunking the myth "shorter is better".

LEVEL OF EVIDENCE V

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