The prevalence and increasing trends of overweight, general obesity, and abdominal obesity among Chinese adults: a repeated cross-sectional study

Diastolic dysfunction in adults with uncomplicated obesity evaluated with left atrial and left ventricular tissue tracking and ventricular volume-time curve: a prospective cardiac magnetic resonance study

Background

Obesity is commonly linked with heart failure (HF) with preserved ejection fraction, with diastolic dysfunction playing an important role in this type of HF. However, diastolic function has not been well clarified in obese patients free of overt comorbidities. We aimed to comprehensively assess diastolic function in adults with uncomplicated obesity by combining left atrial (LA) and left ventricular (LV) strain and ventricular volume-time curve based on cardiac magnetic resonance (CMR), and to evaluate its association with body fat distribution.

Methods

A cross-sectional study was conducted with 49 uncomplicated obese participants and 43 healthy controls who were continuously recruited in West China Hospital, Sichuan University from September 2019 to June 2022. LA strain indices [total, passive, and active strains (εs, εe, and εa) and peak positive, early negative, and late negative strain rates (SRs, SRe, and SRa)], LV strain rates [peak diastolic strain rate (PDSR) and peak systolic strain rate (PSSR)], and LV volume-time curve parameters [peak filling rate index (PFRI) and peak ejection rate index (PERI)] were measured. Body fat distribution was assessed by dual-energy X-ray absorptiometry. Correlation between body fat distribution and LA and LV function was evaluated by multiple linear regression.

Results

The obese participants had impaired diastolic function, manifested as lower LV circumferential and longitudinal PDSR (1.3±0.2 vs. 1.5±0.3 s-1, P=0.014; 0.8±0.2 vs. 1.1±0.2 s-1, P<0.001), LV PFRI (3.5±0.6 vs. 3.9±0.7 s-1, P=0.012), and declined LA reservoir function [εs and SRs (46.4%±8.4% vs. 51%±12%, P=0.045; 1.9±0.5 vs. 2.3±0.5 s-1, P<0.001)] and conduit function [εe and SRe (30.8%±8.0% vs. 35.5%±9.8%, P=0.019; -3.1±0.8 vs. -3.5±1.0 s-1, P=0.030)] compared with controls. The LA pumping function (εa and SRa) and LV systolic function [LV ejection fraction (LVEF), PSSR and PERI] were not different between obese and control participants. Multivariable analysis indicated that trunk fat had independent relationships with LA εe (β=-0.520, P<0.001) and LV circumferential PDSR (β=-0.418, P=0.003); visceral fat and peripheral fat were associated with LV longitudinal PDSR (β=-0.342, P=0.038; β=0.376, P=0.024); gynoid fat was associated with LA εs (β=0.384, P=0.014) and PFRI (β=0.286, P=0.047) in obesity.

Conclusions

The obese participants (uncomplicated obese adults with preserved LVEF) had impaired subclinical diastolic function. Central adipose tissue deposits (trunk fat and visceral fat) may exhibit inverse relationships with LV and LA function in obesity. However, peripheral adipose tissue deposits (peripheral fat and gynoid fat) may show positive relationships with LV and LA function.

Prevalence of Abdominal Obesity and Associated Factors in Urban Brazilian Women: A Comparison Between Two Population-Based Cross-Sectional Studies in 2003 and 2015

Background: Abdominal fat accumulation is a known risk factor for cardiometabolic diseases and mortality, particularly in women. This study aimed to compare the prevalence of abdominal obesity and its associated factors in 2003 and 2015. Methods: Two cross-sectional, population-based surveys were conducted, including representative and independent samples of adult women 20-60 years of age residing in the urban area of São Leopoldo/RS municipality in 2003 (n = 981) and 2015 (n = 984). Abdominal obesity was assessed using waist circumference, with a measurement of ≥88 cm indicating its presence. Factors, such as demographics, socioeconomic status, reproductive health, family history, morbidity, and behavioral characteristics, were studied. Poisson regression was used to assess the associations. Results: The mean age of individuals in the samples was 38.5 years (±11.1 years) and 40.3 years (±11.4 years) in 2003 and 2015, respectively. The prevalence of abdominal obesity doubled from 23.3% (95% confidence interval [CI]: 20.7-26.0) in 2003 to 46.9% (95% CI: 43.7-50.0) in 2015. After adjustment, the prevalence of abdominal obesity remained higher in both 2003 and 2015 with increasing age, low family income, higher number of pregnancies, earlier age at menarche, and presence of a family history of obesity in the father and mother and in women with a history of hypertension. Conclusions: This study demonstrates an increase in the prevalence of abdominal obesity in women between 2003 and 2015 and highlights the sociodemographic, reproductive, family history, and comorbidity aspects associated with its occurrence.

Myocardial tissue remodeling in early adult obesity and its association with regional adipose tissue distribution and ectopic fat deposits: a prospective study

OBJECTIVES

To evaluate the left ventricular (LV) myocardial tissue characteristics in early adult obesity and its association with regional adipose tissue and ectopic fat deposition.

METHODS

Forty-nine obese adults (mean body mass index: 29.9 ± 2.0 kg/m2) and 44 healthy controls were prospectively studied. LV native and post-contrast T1 values, extracellular volume fraction (ECV), regional adipose tissue (epicardial, visceral, and subcutaneous adipose tissue (EAT, VAT, and SAT)), and ectopic fat deposition (hepatic and pancreatic proton density fat fractions (H-PDFF and P-PDFF)) based on magnetic resonance imaging were compared. The association was assessed by multivariable linear regression.

RESULTS

The obese participants showed reduced global ECV compared to the healthy controls (p < 0.05), but there was no significant difference in global native or post-contrast T1 values between the two groups. Additionally, the obese individuals exhibited higher EAT, VAT, SAT, H-PDFF, and P-PDFF than the controls (p < 0.05). ECV was associated with insulin resistance, dyslipidemia, and systolic blood pressure (SBP) (p < 0.05). Multiple linear regression demonstrated that H-PDFF and SAT were independently associated with ECV in entire population (β =  - 0.123 and - 0.012; p < 0.05).

CONCLUSIONS

Reduced myocardial ECV in patients with mild-to-moderate obesity and its relationship to SBP may indicate that cardiomyocyte hypertrophy, rather than extracellular matrix expansion, is primarily responsible for myocardial tissue remodeling in early adult obesity. Our findings further imply that H-PDFF and SAT are linked with LV myocardial tissue remodeling in this cohort beyond the growth difference and cardiovascular risk factors.

CLINICAL TRIALS REGISTRATION

Effect of lifestyle intervention on metabolism of obese patients based on smart phone software (ChiCTR1900026476).

CLINICAL RELEVANCE STATEMENT

Myocardial fibrosis in severe obesity predicts poor prognosis. We showed that cardiomyocyte hypertrophy, not myocardial fibrosis, is the main myocardial tissue characteristic of early obesity. This finding raises the possibility that medical interventions, like weight loss, may prevent cardiac fibrosis.

KEY POINTS

• Myocardial tissue characteristics in early adult obesity are unclear. • Myocardial extracellular volume fraction (ECV) can be quantitatively evaluated using T1 mapping based on cardiac magnetic resonance imaging (MRI). • Cardiac MRI-derived ECV may noninvasively evaluate myocardial tissue remodeling in early adult obesity.

Trends in prevalence of obesity and its association with hypertension across socioeconomic gradients in rural Yunnan Province, China

BACKGROUND

This study aimed to uncover the changing prevalence of obesity and its association with hypertension across socioeconomic gradients in rural southwest China.

METHODS

Data were collected from two cross-sectional health interviews and surveys from 2011 to 2021 among individuals aged ≥ 35 years in rural China. Each participant's height, weight, waist circumference, and blood pressure were measured. The overall prevalence of obesity, central obesity, and hypertension was directly standardized by age based on the total population of the two surveys. Multivariate logistic regression was used to analyze the association between obesity and prevalence of hypertension and an individual socioeconomic position (SEP) index was constructed using principal component analysis.

RESULTS

From 2011 to 2021, the prevalence of obesity, central obesity, and hypertension increased substantially, from 5.9%, 50.2%, and 26.1-12.1%, 58.0%, and 40.4% (P < 0.01), respectively. These increasing rates existed in all subcategories, including sex, age, ethnicity, education, annual household income, access to medical services, and SEP (P < 0.05). In both 2011 and 2021, lower education level and poor access to medical services correlated with higher prevalence of central obesity, while higher SEP correlated with higher prevalence of obesity and central obesity (P < 0.01). Prevalence of obesity was higher in the Han ethnicity participants and individuals with poor access to medical services than in their counterparts (P < 0.01). Whereas the prevalence of central obesity was lower in Han participants than in ethnic minority participants in 2011 (P < 0.01), this trend reversed in 2021 (P < 0.01). A positive relationship between annual household income and prevalence of obesity and central obesity was only found in 2021 (P < 0.01). Obese and centrally obese participants were more likely to be hypertensive in both survey years (P < 0.01).

CONCLUSIONS

Future interventions to prevent and manage obesity in rural China should give increased attention to high income, less educated, poor access to medical services, and high SEP individuals. The implementation of these obesity interventions would also help reduce the prevalence of hypertension.

Protocol for the CHINT study: a cross-sectional observational study of risk factors for cancer and other non-communicable diseases in the Chinese community of Milan

INTRODUCTION

The Chinese community in Italy is the largest in Europe. The area of Milan hosts the largest Chinese Italian community-about 41 000 people. Since little is known of the health practices of Chinese persons in Italy, we designed the CHINT study (survey of risk factors for cancer and other non-communicable diseases (NCDs) in the Chinese community of Milan) to investigate lifestyle-related risk factors for these diseases in this community. We expect the study to reveal potentially unhealthy lifestyle behaviours that may be addressed in future prevention programmes.

METHODS AND ANALYSIS

The CHINT study is a cross-sectional study on a sample of around 600 adults recruited from the Chinese community of Milan and surrounding areas. The non-random sample is clustered by age, sex, occupation and socioeconomic characteristics and is being recruited with the active cooperation of stakeholders within the Chinese community. The study employs face-to-face meetings, text messaging and WeChat. At the first recruitment meeting, participants' physical measurements are taken and a lifestyle questionnaire is administered which enquires about physical activity, the consumption of salt, fruit and vegetables, tobacco and alcohol, and the presence of other risk factors for NCDs. A food frequency questionnaire is in preparation. By analysis of physical data and the results of the two questionnaires, the prevalence and distribution of NCD risk factors, and characteristics associated with these factors, will be identified. Factors associated with recruitment and compliance/retention will be investigated to identify predictors of willingness to participate future intervention studies.

ETHICS AND DISSEMINATION

The study has been approved by the ethics committee of the Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy. All participants are required to provide written informed consent. Findings will be disseminated through peer-reviewed scientific publications, conferences and public meetings involving the Chinese community and the lay public.

Treatment of obesity by acupuncture combined with medicine based on pathophysiological mechanism: A review

Obesity is a complex, multifactorial disease. The incidence of overweight and obesity has doubled worldwide since 1980, and nearly one-third of the world population is now classified as overweight or obese. Obesity rates are increasing in all age groups and for both sexes, regardless of geographic region, race, or socioeconomic status, although they are generally higher in older adults and women. Although the absolute prevalence of overweight and obesity varies widely, this trend is similar across different regions and countries. In some developed countries, the prevalence of obesity has levelled off over the past few years. However, obesity has become a health problem that cannot be ignored in low- and middle-income countries. Although the drug treatment model of modern medicine has a significant therapeutic effect in the treatment of obesity, its adverse effects are also obvious. Acupuncture combined with Chinese medicine treatment of obesity has prominent advantages in terms of clinical efficacy, and its clinical safety is higher, with fewer adverse reactions. The combination of acupuncture and medicine in the treatment of obesity is worth exploring.

Non-invasive omics analysis delineates molecular changes in water-only fasting and its sex-discriminating features in metabolic syndrome patients

Fasting has been grown in popularity with multiple potential benefits. However, very few studies dynamically monitor physiological and pathological changes during long-term fasting using noninvasive methods. In the present study, we recruited 37 individuals with metabolic syndrome to engage in a 5-day water-only fasting regimen, and simultaneously captured the molecular alterations through urinary proteomics and metabolomics. Our findings reveal that water-only fasting significantly mitigated metabolic syndrome-related risk markers, such as body weight, body mass index, abdominal circumference, blood pressure, and fasting blood glucose levels in metabolic syndrome patients. Indicators of liver and renal function remained within the normal range, with the exception of uric acid. Notably, inflammatory response was inhibited during the water-only fasting period, as evidenced by a decrease in the human monocyte differentiation antigen CD14. Intriguingly, glycolysis, tricarboxylic acid cycle, and oxidative phosphorylation underwent a sex-dependent reprogramming throughout the fasting period, whereby males exhibited a greater upregulation of carbohydrate metabolism-related enzymes than females. This disparity may be attributed to evolutionary pressures. Collectively, our study sheds light on the beneficial physiological effects and novel dynamic molecular features associated with fasting in individuals with metabolic syndrome using noninvasive methods.

Lifestyle behaviours and associated factors among people with type 2 diabetes attending a diabetes clinic in Ningbo, China: A cross-sectional study

The burden of type 2 diabetes (T2DM) in China is significant and growing, and this is reflected in high rates of T2DM in the city of Ningbo, China. Consequent impacts on morbidity, mortality, healthcare expenditure, and health-related quality of life, make this a problem of the utmost importance to address. One way to improve T2DM outcomes is to address lifestyle behaviours that may affect prognosis and complications, such as physical activity levels, dietary habits, smoking status, and alcohol intake. A cross-sectional survey was undertaken to describe the prevalence of being physically active, having a healthy diet, currently smoking, and currently drinking alcohol among people living with T2DM attending a diabetes clinic in Ningbo, China. Regression analysis was used to determine the factors associated with these lifestyle behaviours. We found a high prevalence of a healthy diet (97.8%, 95% CI 96.5-98.7%). Prevalence of being physically active (83.4%, 95% CI 80.6-85.9%), smoking (21.6%, 95% CI 18.8-24.6%), and alcohol drinking (32.9%. 95% CI 29.6-36.2%) appeared in keeping with those of the general population. Marked associations were demonstrated between male sex and smoking (OR 41.1, 95% CI 16.2-139.0), and male sex and alcohol drinking (OR 4.00, 95% CI 2.62-6.20). Correlation between lifestyle factors was demonstrated including between alcohol drinking and smoking, and between physical activity and reduced smoking. General diabetes self-management education programmes that address multiple lifestyle risk factors simultaneously may be beneficial in this population. Specific interventions targeting smoking cessation and reduction in alcohol drinking may be of benefit to men living with T2DM attending a diabetes clinic in Ningbo.

Prevalence of obesity and associated complications in China: A cross-sectional, real-world study in 15.8 million adults

AIM

To evaluate the prevalence of overweight/obesity and associated complications from a large, cross-sectional, nationwide database in China.

MATERIALS AND METHODS

Data were obtained from 519 Meinian health check-up centres across 243 cities. Eligible participants were aged ≥18 years, with a routine check-up in 2019 (N = 21 771 683) and complete height, weight, sex and region data. The unadjusted prevalence rates of overweight/obesity were calculated by age, sex and region. In addition, the nationwide prevalence rates of overweight and obesity were standardized according to the 2010 China census by age group and sex. The prevalence of obesity-related complications by body mass index (BMI) groups was calculated using logistic regression.

RESULTS

There were 15 770 094 eligible participants (median age 40 years; mean BMI 24.1 kg/m2 ; 52.8% male). By Chinese BMI classification, 34.8% were overweight and 14.1% were obese. Overweight and obesity were more prevalent in male than female participants (standardized: overweight 40.2% vs. 27.4%; obesity 17.6% vs. 9.6%, respectively). The prevalence of assessed complications was higher in participants with overweight/obesity versus those with normal BMI (P < 0.001 for trends). The most prevalent complications in participants with overweight/obesity were fatty liver disease, prediabetes, dyslipidaemia and hypertension. The number of complications increased with higher BMI.

CONCLUSIONS

Overweight/obesity and related complications are highly prevalent in this population. These data may better inform management and prevention public health strategies in China.

Effect of the smartphone application on caesarean section in women with overweight and obesity: a randomized controlled trial in China

BACKGROUND

The rate of caesarean section (CS) is increasing worldwide. While a CS can be life-saving when medically indicated, it can cause adverse health effects for both women and children. This trial aims to evaluate the effect of the smartphone application, which aims to control the gestational weight gain, on the rate of CS in overweight and obese women.

METHODS

Overweight and obese primiparas (BMI ≥ 24 kg/m2) with age between 20 and 40 years old were recruited at Beijing Obstetrics and Gynecology Hospital, and randomly assigned into the intervention group (143 cases) and the control group (138 cases). The intervention group applied the smartphone application (App) to control gestational weight gain in addition to the usual care, and the control group received the usual care. Primary outcome was cesarean section (CS) rate. Secondary outcomes included gestational hypertension, preeclampsia and eclampsia, gestational diabetes mellitus, postpartum hemorrhage, neonatal asphyxia, and macrosomia.

RESULTS

There was a significant difference in CS rate, with 53.3% in the intervention group and 65.4% in the control group (P = 0.044). The difference still exists in the overweight subgroup (32.6% vs. 55.6%, P = 0.04), but disappears in the obesity subgroup (63.0% vs. 69.1%, P = 0.381). The median of gestational weight gain (GWG) of the intervention group is 8.5 kg (IQR 5.5, 11.0), which is significantly less than that of the control group (median 10.0 kg, IQR [6.0, 14.0], P = 0.008). The intervention group has significantly lower rate of postpartum hemorrhage (5.19%) than the control group (12%) (P = 0.045). There were no significant differences between the groups in gestational hypertension, gestational diabetes mellitus, neonatal asphyxia, and macrosomia.

CONCLUSION

The smartphone assisted weight control may help reduce CS rate. The effects of the smartphone application might be via the management of gestational weight gain.

TRAIL REGISTRATION

This trial was registered at Chinese Clinical Trial Registry. Registration number is ChiCTR2300068845 (retrospectively registered, 01/03/2023).

Prevalence of obesity and abdominal obesity and their association with metabolic-related conditions in Vietnamese adults: an analysis of Vietnam STEPS survey 2009 and 2015

Background

The abdominal obesity trends and prevalence are important contributing factors to significant rise of many noncommunicable diseases in Vietnam but have not been well-documented in the literature. This study aimed to describe the prevalence and trends of obesity and abdominal obesity in Vietnam from 2009 to 2015 and evaluate how different definitions of obesity and abdominal obesity are associated with metabolic-related conditions.

Methods

We conducted a secondary analysis based on the Vietnam STEPS (STEPwise approach to Surveillance) cross-sectional Survey 2009 and 2015. Obesity and abdominal obesity were defined using the body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR) cut-offs from the World Health Organization (WHO) and International Diabetes Federation (IDF).

Findings

Depending on the specific cut-offs, from 2009 to 2015, obesity prevalence increased from 0.8%-10% to 1.7%-16.4% in women and from 0.8%-10.3% to 1.7%-15% in men; abdominal obesity prevalence increased from 3%-31.3% to 8%-41.7% in women and from 0.3%-19.3% to 0.4%-25% in men. Abdominal obesity using WC-IDF and WHR-WHO definitions had noticeably higher sensitivity and lower specificity for metabolic-related conditions compared to the other four criteria. All anthropometric measurements were statistically correlated with biomarkers/blood pressure in 2009 and 2015 except for fasting glucose. Only WC-IDF and WHR-WHO definitions showed consistent association with all reported metabolic-related conditions regardless of sex and survey years.

Interpretation

The prevalence of obesity and abdominal obesity in Vietnam is increasing rapidly, especially abdominal obesity in women regardless of the criteria used. More studies are needed to investigate how using different diagnostic criteria for obesity and abdominal obesity could better identify metabolic-related conditions.

Funding

Authors received no funding for this study.

Association of dietary patterns with general and central obesity among Chinese adults: a longitudinal population-based study

BACKGROUND

Limited evidence exists for the association between dietary patterns and later obesity phenotypes among Chinese adults. This longitudinal study aimed to evaluate associations of dietary patterns with general and central obesity in Chinese adults.

METHODS

Based on the China Health and Nutrition Survey (CHNS) waves 2004 and 2015, the study was conducted on 4207 adult men and women (age range: 18-65 years). Dietary intakes were assessed by three consecutive 24-h dietary recalls, and dietary patterns were identified using exploratory factor analysis. Longitudinal associations of dietary patterns with general and central obesity were evaluated using logistic regression analyses.

RESULTS

The prevalence rates of general and central obesity were 14.2% and 42.1%, respectively. Factor analysis extracted three major dietary patterns: "traditional southern," "modern," and "traditional northern." After adjustment for potential confounders, adults in the highest quartile of the traditional southern dietary group were less likely to develop over 10 years general (odds ratio [OR] = 0.50, 95% confidence interval [95%CI]: 0.39, 0.65) and central (OR = 0.52, 95%CI: 0.43, 0.63) obesity compared to those in the lowest quartile group. The modern dietary pattern was not significantly associated with general and central obesity. Adherence to the traditional northern dietary pattern increased the chance of both general and central obesity (OR = 1.61, 95%CI: 1.23, 2.10; OR = 1.64, 95%CI: 1.36, 1.98) after 10 years.

CONCLUSIONS

Our study provides longitudinal evidence for associations between dietary patterns and later obesity phenotypes among Chinese adults. Our findings may guide the development of evidence-based preventive nutrition interventions to control the obesity epidemic.

Plasma vaspin levels and clinical outcome in incident peritoneal dialysis patients

BACKGROUND

Vaspin is an adipokine that regulates glucose and lipid metabolism. Plasma vaspin level is increased in chronic kidney disease but decreased in hemodialysis patients. However, plasma vaspin level in peritoneal dialysis (PD) patients, as well as its prognostic role, has not been studied.

METHODS

We recruited 146 incident PD patients. Their baseline plasma vaspin levels, body anthropometry, the profile of insulin resistance, bioimpedance spectroscopy parameters, dialysis adequacy, and nutritional indices were measured. They were followed for up to 5 years for survival analysis.

RESULTS

The average age was 58.4 ± 11.8 years; 96 patients (65.8%) were men, and 90 (61.6%) had diabetes. The median vaspin level was 0.18 ng/dL (interquartile range [IQR] 0.11 to 0.30 ng/dL). Plasma vaspin level did not have a significant correlation with adipose tissue mass or baseline insulin level. However, plasma vaspin level had a modest correlation with the change in insulin resistance, as represented by the HOMA-IR index, in non-diabetic patients (r = -0.358, p = 0.048). Although the plasma vaspin level quartile did not have a significant association with patient survival in the entire cohort, it had a significant interaction with diabetic status (p < 0.001). In nondiabetic patients, plasma vaspin level quartile was an independent predictor of patient survival after adjusting for confounding clinical factors (adjusted hazard ratio 2.038, 95% confidence interval 1.191-3.487, p = 0.009), while the result for diabetic patients was not significant.

CONCLUSIONS

Plasma vaspin level quartile had a significant association with patient survival in non-diabetic PD patients. Baseline plasma vaspin level also had a modest inverse correlation with the subsequent change in the severity of insulin resistance, but the exact biological role of vaspin deserves further studies.

Modifiable determinants of central obesity among the rural black population in the DIMAMO HDSS, Limpopo, South Africa

Background

Central obesity is a leading risk factor for cardiometabolic diseases, in which body fat accumulates to a particular extent, and may negatively impact on health. The prevalence of abdominal obesity has increased over the last 10 years and currently surpasses that of overall obesity. There is a scarcity of data on the determinants of central obesity, especially among populations residing in rural Africa. The aim of the present study was thus to determine sociodemographic and lifestyle factors that are associated with central obesity.

Methods

This was a cross-sectional, retrospective study. The present study used secondary data from the AWI-Gen phase 1 study. The study comprised 791 participants, of which 242 were men and 549 were women aged 40 years and above. The participants were selected by convenient sampling. Data were analyzed using the Statistical Package for Social Sciences version 27. A comparison of proportions was performed using the chi-square test, while a comparison of means was performed using an unpaired Student t-test. The association between sociodemographic and lifestyle factors with central obesity was analyzed using bivariate correlation, partial correlation, and binary regression analysis, and the statistical significance was set at a p-value of <0.05.

Results

The proportion of central obesity in the total population was 59.9%, and significantly more women were centrally obese (79.6 vs. 15.3%, p = <0.001) as compared to men. Married status correlated positively and significantly with central obesity in both bivariate and partial correlations. Moreover, binary logistic regression further confirmed the positive association between married status and central obesity. Single status correlated negatively and significantly with central obesity. The correlation remained unchanged even after controlling for age and gender. Binary logistic regression showed that unemployment correlated significantly with central obesity. The proportion of smokers was also significantly higher in participants without central obesity than in those with central obesity (87.2 vs. 34.0%, p = <0.001). Smoking correlated negatively and significantly with central obesity in bivariate and partial correlations. In addition, binary logistic regression further confirmed the negative association between smoking and central obesity.

Conclusion

The present study shows that in this population, central obesity is determined by gender, unemployment, and marital status.

Smartphone-Based Cancer and Obesity Prevention Education Program for Chinese Women (SCOPE): A Pilot RCT

Breast cancer prevalence has increased globally, with 12.2% of breast cancer cases identified in China. Obesity and unhealthy lifestyles are major risk factors for breast cancer. We conducted a randomized control trial to assess the feasibility and evaluate the preliminary effect of the Smartphone-Based Cancer and Obesity Prevention Education (SCOPE) program among adult biological women with a waist circumference greater than 80 cm. The SCOPE program includes tailored and culturally appropriate educational information for obesity and breast cancer prevention delivered by the research team via WeChat. The control group received non-tailored general health information via WeChat. A total of 102 women (52 intervention, 50 control) participated, and 87 (85%) completed 6-month follow-up assessments. For the primary study outcome at 6 months, women using SCOPE significantly reduced waist circumference (Cohen's d = -0.39, p < 0.001). For secondary outcomes at 6 months, women using SCOPE significantly reduced BMI (d = -0.18, p = 0.001) and increased breast cancer-related knowledge (d = 0.48, p = 0.001) and attitude (d = 1.39, p < 0.01). No significant findings were found regarding diet self-efficacy, physical self-efficacy, or breast cancer screening barriers. The results suggest the intervention has great potential to promote the health and wellness of women.

Dietary diversity indices v. dietary guideline-based indices and their associations with non-communicable diseases, overweight and energy intake: evidence from China

OBJECTIVES

To evaluate various diet quality indices and to estimate their associations with major non-communicable diseases (NCD) (i.e. diabetes mellitus (DM) and myocardial infarction (MI)) and risk for overweight (OW).

DESIGN

Four dietary diversity indices (namely, count index (Count), dietary diversity score index, berry index (BI) and entropy index (EI)) and three Chinese dietary guideline-based indices (namely, China healthy diet index, Chinese food pagoda score and diet quality divergence index) were employed to evaluate Chinese diet quality. DM, MI and OW were used as diet-related health indicators. Logit regressions were employed to unveil the associations between diet quality indices and NCD and risk for OW. The relationships between diet quality indices and daily energy intakes were checked with ordinary least squares linear regressions.

SETTING

Four recent waves (2004, 2006, 2009, 2011) of longitudinal individual data from China Health and Nutrition Survey.

PARTICIPANTS

Chinese adults (aged 18-64 years) from twelve provinces were included in the analysis (n 30 350).

RESULTS

Count, BI, and EI were positively associated with higher OW risk and daily energy intakes. As dietary guideline-based indices got better, people were exposed to lower DM and OW risks and got lower daily energy intakes. Finally, dietary guideline-based indices properly revealed the expected relationships that high-quality diets would reduce NCD and risk for OW, while high diversity indices were usually correlated with over-nutrition and high risks.

CONCLUSIONS

Increasing diversity of the diet does not necessarily improve the nutrition and health. Dietary guideline-based indices are more robust than dietary diversity indices; thus, they should be highly recommended when evaluating diet quality.

Effects of different weight loss dietary interventions on body mass index and glucose and lipid metabolism in obese patients

To investigate the effects of different weight loss interventions on body mass index (BMI) and glucose and lipid metabolism in obese patients. Obese patients (n = 135) admitted to our hospital between December 2020 and August 2022 were divided into 3 groups, according to their diet patterns: calorie-restricted diet (CRD) group (n = 39), high-protein diet (HPD) group (n = 28), and 5 + 2 intermittent fasting (IF) group (n = 68). Body weight, body fat rate, BMI, hip circumference, and waist circumference were measured before and 60 days after implementation of the respective diet plan. Glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), 2h postprandial blood glucose (2hPG), triglyceride (TG), total cholesterol, low-density lipoprotein, high-density lipoprotein, and adverse events were evaluated. Following the dietary intervention, the weight (P = .005 for CRD, P < .001 for HPD, and P = .001 for IF), body fat rate (P = .027 for CRD, P = .002 for HPD, and P = .011 for IF group), BMI (P = .017 for CRD, P < .001 for HPD, and P = .002 for IF group), hip circumference (P < .001 for CRD, P = .013 for HPD, and P = .032 for IF group), waist circumference (P = .005 for CRD, P < .001 for HPD, and P = .028 for IF group), HbA1c (P = .014 for CRD, P = .002 for HPD, and P = .029 for IF group), FBG (P = .017 for CRD, P < .001 for HPD, and P = .033 for IF group), and 2hPG (P = .009 for CRD, P = .001 for HPD, and P = .012 for IF group), were significantly decreased. TG (P = .007 for CRD, P < .001 for HPD, and P = .018 for IF group), TC (P = .029 for CRD, P = .013 for HPD, and P = .041 for IF group), LDL-C (P = .033 for CRD, P = .021 for HPD, and P = .042 for IF group), and LDL-C (P = .011 for CRD, P < .001 for HPD, and P = .027 for IF group) improved significantly in the 3 groups, when compared to that before treatment. The HPD had the best effect on reducing blood lipids, followed by the CRD; the effect of IF was slightly lesser. Short-term HPD, CRD, and IF can reduce the weight and body fat of overweight/obese individuals and improve blood lipid and blood sugar levels. The effect of HPD on weight loss, body fat, and blood lipid levels was greater than that of CRD or IF.

Efficacy of traditional Chinese exercises in improving anthropometric and biochemical indicators in overweight and obese subjects: A systematic review and meta-analysis

BACKGROUND

The efficacy of traditional Chinese exercise (TCE)-based intervention in the improvement of anthropometric and biochemical indicators in overweight and obese patients is controversial. In this regard, the aim of this review was to summarize the evidence of TCE interventions to evaluate their effectiveness on the anthropometric and biochemical indicators of overweight and obese patients.

METHOD

Five databases were systematically searched for relevant articles published from inception to October 2022. Randomized controlled trials examining TCE intervention in overweight and obese patients The treatment effects were estimated using a random-effect meta-analysis model with standardized mean differences (Hedges' g). The categorical and continuous variables were used to conduct moderator analyses. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42022377632).

RESULT

Nine studies involving a total of 1297 participants were included in the final analysis. In the anthropometric indicators outcomes, the meta-analytic findings revealed large and significant improvements in body mass index (g = 1.44, 95% confidence interval [CI] = 1.27-1.61, P = .000, I2 = 99%), weight (g = 1.47, 95% CI = 1.25-1.68, P = .000, I2 = 95%), fat percentage (g = 1.22, 95% CI = 0.52-1.93, P = .000, I2 = 93%), and small and significant improvements in waist circumference (g = 0.38, 95% CI = 0.21-0.54, P = .000, I2 = 99%). In the biochemical indicators outcomes, the findings revealed large and significant improvements in low density lipoprotein (g = 2.08, 95% CI = 1.80-2.37, P = .000, I2 = 98%), moderate and significant improvements in triglyceride (g = 0.69, 95% CI = 0.56-0.81, P = .000, I2 = 96%), small and significant improvements in total cholesterol (g = 0.37, 95% CI = 0.19-0.54, P = .000, I2 = 77%), and high-density lipoprotein (g = -0.71, 95% CI = -0.86 to 0.57, P = .000, I2 = 99%). The moderator shows that the effects of TCE on anthropometric and biochemical indicators were moderated by frequency of exercise, exercise duration, and type of control group.

CONCLUSION

TCE intervention is a beneficial non-pharmacological approach to improving anthropometric and biochemical indicators in overweight and obese subjects, especially in body mass index, weight, fat percentage, triglyceride, and low-density lipoprotein. The clinical relevance of our findings is pending more extensive trials and more rigorous study designs to strengthen the evidence.

Excess body weight: Novel insights into its roles in obesity comorbidities

Excess body weight is a global health problem due to sedentary lifestyle and unhealthy diet, affecting 2 billion population worldwide. Obesity is a major risk factor for metabolic diseases. Notably, the metabolic risk of obesity largely depends on body weight distribution, of which visceral adipose tissues but not subcutaneous fats are closely associated with obesity comorbidities, including type 2 diabetes, non-alcoholic fatty liver disease, cardiovascular disease and certain types of cancer. Latest multi-omics and mechanistical studies reported the crucial involvement of genetic and epigenetic alterations, adipokines dysregulation, immunity changes, imbalance of white and brown adipose tissues, and gut microbial dysbiosis in mediating the pathogenic association between visceral adipose tissues and comorbidities. In this review, we explore the epidemiology of excess body weight and the up-to-date mechanism of how excess body weight and obesity lead to chronic complications. We also examine the utilization of visceral fat measurement as an accurate clinical parameter for risk assessment in healthy individuals and clinical outcome prediction in obese subjects. In addition, current approaches for the prevention and treatment of excess body weight and its related metabolic comorbidities are further discussed. DATA AVAILABILITY: No data was used for the research described in the article.

The intervention effects of konjac glucomannan with different molecular weights on high-fat and high-fructose diet-fed obese mice based on the regulation of gut microbiota

Konjac is a high-quality dietary fiber rich in β-glucomannan, which has been reported to possess anti-obesity effects. To explore the effective components and the structure-activity relationships of konjac glucomannan (KGM), three different molecular weight components (KGM-1 (90 kDa), KGM-2 (5 kDa), KGM-3 (1 kDa)) were obtained, and systematical comparisons of their effects on high-fat and high-fructose diet (HFFD)-induced obese mice were investigated in the present study. Our results indicated that KGM-1, with its larger molecular weight, reduced mouse body weight and improved their insulin resistance status. KGM-1 markedly inhibited lipid accumulation in mouse livers induced by HFFD by downregulating Pparg expression and upregulating Hsl and Cpt1 expressions. Further investigation revealed that dietary supplementation with konjac glucomannan at different molecular weights caused β-diversity changes in gut microbes. The potential weight loss effect of KGM-1 maybe attributed to the abundance of changes in Coprobacter, Streptococcus, Clostridium IV, and Parasutterella. The results provide a scientific basis for the in-depth development and utilization of konjac resources.

Omentin-1 Levels and Outcomes in Incident Peritoneal Dialysis Patients

Rationale & Objective

Omentin-1 is an adipokine with anti-inflammatory and cardioprotective properties. The objective of this study was to determine the prognostic role of plasma omentin-1 levels in incident peritoneal dialysis (PD) patients.

Study Design

Retrospective analysis of prospective cohort.

Setting & Participants

152 incident PD patients.

Predictors

Plasma omentin-1 level, adipose tissue omentin-1 messenger RNA (mRNA) expression.

Outcomes

Patient survival, technique survival, hospital admission, and duration of stay.

Analytical Approach

Time-to-event survival analyses; linear regression for hospitalization.

Results

The mean age was 58.4 ± 11.7 years; 102 were men, and 92 had diabetes. There was no significant correlation between plasma omentin-1 level and its adipose tissue mRNA expression. A higher plasma omentin-1 level quartile was not associated with patient survival (P = 0.92) or technique survival (P = 0.83) but had a modest correlation with a lower number of hospital admissions (P = 0.07) and shorter duration of hospital stay (P = 0.04). In adjusted models using multivariable linear regression, a higher plasma omentin-1 level quartile remained significantly associated with fewer hospital admissions (β, -0.13; 95% CI, -0.26 to -0.002; P = 0.05) and shorter hospitalization duration (β, -0.20; 95% CI, -0.38 to -0.02; P = 0.03).

Limitations

Observational study with baseline measures only.

Conclusions

Plasma omentin-1 level was not associated with patient survival, technique survival, or peritonitis, but higher plasma omentin-1 levels were associated with fewer hospital admissions and shorter duration of hospitalization among incident PD patients.

Laparoscopic vs. Robotic Gastrectomy in Patients with Situs Inversus Totalis: A Systematic Review

Background

Situs inversus totalis (SIT) is a rare genetic anomaly involving the mirror-image transposition of organs. This transposition can potentially make surgical treatments difficult because of the reversed anatomy and intraoperative confusion. The aim of this systematic review is to compare the perioperative outcomes and safety of robotic and laparoscopic gastrectomy in patients with SIT.

Methods

We included full-text case reports with brief reviews and standalone case studies on SIT patients age ≥21, undergoing laparoscopic or robotic gastrectomy. We excluded case studies focusing on procedures other than laparoscopic and robotic gastrectomy, namely, open gastrectomy, gastric banding, and gastric bypass. English was selected as the language and articles published in the last 10 years were selected with a date range from Jan, 2011, to Aug, 2021. We focused on intraoperative and postoperative outcomes including blood loss, vascular aberrancy, operation duration, mortality, operative complications, duration of hospitalization, and follow-up interval. Online databases included Clinical Key, Embase, ScienceDirect, Ovid, and Google Scholar. The last search was conducted on Aug 15, 2021. For all eligible articles, risk of bias assessment was carried out using JBI critical appraisal checklist (Table 1). Continuous data were analyzed using t-test with p value of 0.05.

Results

From our search, we retained 29 case reports which reported information from 30 cases. The results reported in each study were summarized (Table 2). The laparoscopic procedure was used in 21 cases and robot-assisted surgery was used in 9 cases. Operative time was mentioned in 24 out of the 30 cases and the average operative time was 205.67 min. Blood loss was reported in 16 out of the 30 cases, with an average blood loss of 51.9 mL. Hospital stay information was provided in 26 out of the 30 cases, with an average length of stay of 8.5 days. A statistically significant difference was not found for the operative time, length of hospitalization, or age of the patient. However, intraoperative blood loss in robot-assisted gastrectomy was lower compared to laparoscopic gastrectomy, with a p value of 0.0293. Perioperative death was not reported in any of the cases. Only three cases of postoperative complications were reported in laparoscopic surgery. Only one of the three cases suggested that the complication was due to an anomaly, whereas the other two of them reported complications due to procedural errors.

Conclusion

Laparoscopic and robotic gastrectomy can be safely used for SIT patients if performed cautiously. Some precautions include thoroughly assessing anatomical aberrations using preoperative imaging, adjusting the operative set up, and having experienced surgeons. The robotic approach may have a few advantages over laparoscopic procedures that may enhance the surgical safety for SIT patients and need to be further explored in future research. Advantages of the robotic approach may include improved surgical safety with better visualization of the surgical field, promoting the stability of surgical instruments and perhaps allowing ease of surgical orientation and positioning when operating on patients with SIT. Further research in this field is merited.

Effect of Fluid Resuscitation Strategies for Obese Patients with Sepsis and Septic Shock: A Systematic Review

Purpose

As the Surviving Sepsis Campaign (2021) recommended, patients with sepsis should be given a liquid infusion of 30 ml/kg (ideal body weight). However, the strategy may result in insufficient resuscitation for obese patients with sepsis. Therefore, we conducted a systematic evaluation of the effectiveness of the initial resuscitation strategy in obese sepsis patients.

Materials and methods

A computer search of PubMed, Embase, Cochrane library, and other databases collected cohort studies from the beginning of the survey to December 2021 to include articles evaluating initial resuscitation strategies for sepsis-obese patients.

Results

Of the six studies included, five used ideal body weight infusion strategies, and three used actual body weight infusion strategies. Differences in fluid volume were observed between the two strategies, but no significant difference was observed in the mortality of obese sepsis patients. In addition, there may be an infusion strategy other than the above two infusion methods, and the safety and efficacy of the new infusion strategy are unclear. The obesity paradox has been observed in most infusion strategies.

Conclusion

The association between obesity and infusion strategy has rarely been investigated in patients with sepsis and septic shock, and the existing results are conflicting. The risk of bias in all included studies was moderate or high. Before providing broad recommendations on the optimal first resuscitation approach to lower the chance of mortality, further clinical trials, and prospective research need to be done.

Circulating and Adipose Tissue Adiponectin Level and Outcomes in Incident Peritoneal Dialysis Patients

Rationale & Objective

Cardiovascular disease is the major cause of mortality and morbidity in peritoneal dialysis (PD) patients. Adiponectin, a key adipokine, is related to obesity and insulin resistance. We determined the clinical and prognostic value of plasma adiponectin level and its adipose tissue messenger RNA (mRNA) expression in new PD patients.

Study Design

Retrospective analysis of a prospective observational study.

Setting & Participants

152 new PD patients from a single center; 6 adults undergoing abdominal surgeries without kidney disease served as controls.

Predictors

Plasma adiponectin level and its adipose tissue mRNA expression.

Outcomes

Body build and composition, patient and technique survival.

Analytical Approach

Adiponectin level and mRNA expression were grouped in quartiles for correlation analysis for body build and Cox regression for survival analysis.

Results

The median plasma adiponectin level was 31.98 μg/mL (IQR, 16.81-49.49 μg/mL), and adiponectin mRNA expression in adipose tissue was 1.65 times higher than in controls (IQR, 0.98-2.63). There was a modest but statistically significant correlation between plasma adiponectin and its adipose tissue mRNA expression (r = 0.40, P < 0.001). Plasma adiponectin level inversely correlated with body mass index, waist-hip ratio, mid-arm circumference, adipose tissue mass, plasma triglyceride (r = -0.39, -0.38, -0.41, -0.38, and -0.30, respectively; P < 0.001 for all), as well as serum insulin level (r = -0.24, P = 0.005). Similar correlations were present but less marked with adipose tissue adiponectin mRNA level. Neither plasma adiponectin level nor adipose tissue adiponectin mRNA level predicted patient or technique survival.

Limitations

Observational study, single center, single baseline measurement.

Conclusions

Plasma adiponectin level correlated with the degree of adiposity in new PD patients. However, neither plasma adiponectin level nor its adipose tissue mRNA expression was an independent prognostic indicator in kidney failure patients newly started on PD.

Exposure to Polybrominated Diphenyl Ethers and Phthalates in China: A Disease Burden and Cost Analysis

Increasing evidence indicates that endocrine-disrupting chemicals (EDCs) cause a variety of adverse health outcomes and contribute to substantial disease burden. This study summarized the exposure status of polybrominated diphenyl ethers (PBDEs) and phthalates (PAEs) in China and evaluated the disease burden attributable to PBDEs and PAEs in 2015. The results showed that PBDE and PAE concentrations were higher in coastal areas. The disease burden attributable to PBDEs was 0.77 million cases, and the economic costs were CNY 18.92 billion. Meanwhile, 3.02 million individuals suffered from diseases attributable to PAEs, and the economic costs were CNY 49.20 billion. The economic burden caused by PBDEs and PAEs accounted for 0.28% and 0.72% of China's Gross Domestic Product (GDP) in 2015, respectively. When comparing China's results from 2010, it was determined that the GDP ratio of economic costs caused by PAEs in 2015 (0.72%) was lower than in 2010 (1.42%). Finally, compared with the results of the European Union and North America, the GDP ratios of economic costs caused by PAEs in 2015 were 0.19% in Canada (lower than China), 0.29% in the United States (lower than China), and 1.44% in the European Union (higher than China). This study provides important reference values for China's health governance, and further research should be conducted in the future.

Effects of an Intermittent Fasting 5:2 Plus Program on Body Weight in Chinese Adults with Overweight or Obesity: A Pilot Study

To retrospectively review the efficacy of intermittent fasting 5:2 plus program (30% of energy requirements on fast days and 70% of energy requirements on nonfasting days) in Chinese patients with overweight or obesity. This retrospective cohort study evaluated weight loss outcomes of patients treated with 12 weeks weight loss program in clinic. Adults with overweight or obesity participated in intermittent fasting 5:2 plus, daily calorie restriction (70% of energy requirements every day) or daily calorie restriction with meal replacement (70% of energy requirements every day, partly provided with high-protein meal replacement) programs for 12 weeks. The primary objective was to compare the weight loss of three groups. The primary outcome measure was the change in the % total weight loss. A total of 131 patients (35.3 ± 10.1 years; 81.7% female) were included, and the mean weight loss was 7.8 ± 4.4% after 12 weeks. The intermittent fasting 5:2 plus group (n = 42) achieved 9.0 ± 5.3% weight loss, compared with 5.7 ± 3.7% in the daily calorie restriction group (n = 41) (p < 0.001) and 8.6 ± 3.5% in the meal replacement group (n = 48) (p = 0.650). A total of 85.7% of patients in the intermittent fasting 5:2 plus group lost more than 5% body weight, vs. 58.5% in the daily calorie restriction group (p = 0.008), and 45.2% lost more than 10% body weight, vs. 14.6% in the daily calorie restriction group (p = 0.005). No serious adverse events were reported in the three groups. The intermittent fasting 5:2 plus program more effectively led to weight loss than daily calorie restriction in the short-term in Chinese patients with overweight or obesity. A longer-term prospective randomized controlled trial is needed.

Trends of Urolithiasis in China: A National Study Based on Hospitalized Patients from 2013 to 2018

Introduction

The aim of this study was to explore the chronological trends in clinical features and utilization of healthcare resources for hospitalized patients with urolithiasis in China.

Methods

Patients with urolithiasis were extracted from the Hospital Quality Monitoring System, a national database of hospitalized patients in China, based on the International Classification of Diseases, Tenth Revision, codes. Variables including demographic characteristics, comorbidities, treatment modalities for urolithiasis, length of hospital stay, and expenditures were collected and analyzed.

Results

Among 79.8 million hospitalized patients, 3.5 million were diagnosed with urolithiasis with an increasing trend (from 3.0% in 2013 to 4.0% in 2018). Most of these patients had upper urinary tract calculi (76.6% in 2013 and 81.7% in 2018). Middle-aged patients (46-65 years) constituted the largest proportion with a stable trend (from 46.9% in 2013 to 48.8% in 2018), while the proportion of older patients (>65 years) showed an increasing trend (from 23.7% in 2013 to 27.4% in 2018). The percentages of gout/hyperuricemia, hypertension, diabetes, and cardiovascular disease among the hospitalized patients with urolithiasis increased steadily, with the sharpest increases in patients from rural areas. Overall, 656,952 patients (18.9%) received surgical interventions for urolithiasis. The proportions of ureteroscopy and extracorporeal shockwave lithotripsy increased steadily during the 6-year study period, with simultaneous decreases in open surgery and percutaneous nephrolithotomy. The median length of hospital stay decreased from 10 days to 8 days. The cost of urolithiasis intervention accounted for 2.0% of the total hospitalization fee in 2013 and increased to 2.7% in 2018.

Conclusions

The analysis showed an increasing trend in the percentage of hospitalized patients with urolithiasis, accompanied by an increased percentage of the total hospitalization fee for urolithiasis intervention during the 6-year study period. Based on the increasing trends in the proportion of older patients (>65 years) and percentages of metabolic comorbidities among patients with urolithiasis, an increased burden of urolithiasis on the healthcare system in China is anticipated.

Spicy food consumption is associated with abdominal obesity among Chinese Han population aged 30-79 years in the Sichuan Basin: a population-based cross-sectional study

BACKGROUND

Few animal experiments and volunteer-based intervention studies have showed a controversial effect of spicy foods on abdominal obesity. We aimed to examine the association between spicy food frequency, spicy flavor, and abdominal obesity among Chinese Han population in the Sichuan Basin which area eating spicy foods relatively often.

METHODS

A cross-sectional analysis was conducted using the Sichuan Basin baseline data from the China Multi-Ethnic Cohort (CMEC) study, including data from electronic questionnaires, anthropometric measurements and blood sample collection. A total of 40,877 adults (22,503 females) aged 30-79 years were included in the final analysis. Multivariable logistic regression yielded adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for abdominal obesity associated with the strength of spicy flavor and frequency of spicy food intake.

RESULTS

The prevalence of daily spicy food eating was 47.3% in males and 52.7% in females, the percentages of abdominal obesity were 52.3%, 48.8%, 51.6% and 55.5% in the spicy food intake subgroups of never, 1-2 days/week, 3-5 days/week and 6-7 days/week, respectively. Compared with males who never consumed spicy food, the adjusted ORs (95% CIs) in the 1-2 days/week, 3-5 days/week and 6-7 days/week subgroups were 1.21 (1.09, 1.34), 1.35 (1.21, 1.51), and 1.35 (1.25, 1.47), respectively (P_trend < 0.001). The corresponding odds ratios for females were 0.95 (0.87, 1.05), 1.14 (1.03, 1.26), and 1.25 (1.16, 1.35), respectively (P_trend < 0.001). Similarly, compared with no spicy flavor, the adjusted ORs (95% CIs) of mild, middle, and strong spicy strength for abdominal obesity in males were 1.27 (1.17, 1.38), 1.51 (1.37, 1.67), and 1.36 (1.11, 1.67) respectively (P_trend < 0.001). The corresponding odds ratios for females were 1.14 (1.06, 1.23), 1.27 (1.15, 1.40), and 1.32 (1.06, 1.65), respectively (P_trend < 0.001).

CONCLUSIONS

The data indicated that spicy food consumption was a risk factor for abdominal obesity among Chinese adult population in the Sichuan Basin. The results need to be approved by large cohort studies.

Does the Association of Sedentary Time or Fruit/Vegetable Intake with Central Obesity Depend on Menopausal Status among Women?

(1) Background: The prevalence of central obesity is growing rapidly among women, and the prevalence differs by menopausal status. Longer sedentary time and less fruit/vegetable (F/V) intake increased the risk of central obesity. Among women of different menopausal statuses, controversy surrounds the association between sedentary time or F/V intake and central obesity. This study aimed to explore whether the independent and joint associations between sedentary time or F/V intake and menopausal status are correlated with central obesity, respectively. (2) Methods: This cross-sectional study was conducted in Hunan, China. Self-reported questionnaires were used to gather information on demographic characteristics, menopausal status, sedentary time, and F/V intake. Waist circumference was measured at the study site. Binary logistic regression and multiple interaction models were used to explore the independent and joint associations of menopausal status and the above two lifestyle variables with central obesity. (3) Results: A total of 387 women with a mean age of 47.7 ± 6.6 years old participated in the study. The prevalence of central obesity was 52.8%. Peri- and post-menopause statuses and not taking five servings of F/V per day were risk factors of central obesity (p < 0.05), whereas no significant association was found between sedentary time and central obesity (p > 0.05). Among peri-menopausal (mutual odds ratio (OR): 2.466, 95% confidence interval [CI]: 0.984−6.182; p < 0.05) and post-menopausal women (mutual OR: 2.274, 95% CI: 1.046−4.943; p < 0.05), more than 4 h of sedentary time per day was associated with a high risk of central obesity. Among pre-menopausal women, the consumption of five servings of F/V per day was associated with a low risk of central obesity (mutual OR: 0.444, 95%CI: 0.236−0.837, p < 0.05). (4) Conclusions: More than half of women in the central south of China presented with central obesity, spent >4 h of sedentary time per day, or did not engage in recommended F/V intake. Healthier lifestyle intervention is warranted to prevent central obesity development, including reducing the sedentary time to <4 h per day for peri- and post-menopausal women, while increasing taking five servings of F/V per day for pre-menopausal women.

Anti-obesity weight loss medications: Short-term and long-term use

As obesity prevalence increases, more and more drugs that assist with weight loss have been developed. Numerous weight loss drugs had been approved, but many have also been withdrawn based on their lack of efficacy as well as safety concerns. Initial approaches in developing weight loss drugs was by increasing physiological energy expenditure and suppressing the appetite. Subsequently, as more physiological mechanisms for weight gain has been unearthed, drugs targeting newly discovered receptors and/or enzymes have been introduced with improved safety profiles and fewer psychological adverse events. Additionally, drugs targeting hunger or satiety signaling have been actively studied, and have shown increased adoption by physicians. Studies have also evaluated drugs that target metabolic tissues-such as adipose tissue or muscle-to promote weight loss, however to-date nothing has carried on into clinical practice. Starting with a brief history of early obesity treatments, this review evaluates current weight loss pharmaceutical options based on their duration of therapy status.

Waist Circumference of the Elderly over 65 Years Old in China Increased Gradually from 1993 to 2015: A Cohort Study

Objective

This study aimed to analyze the temporal trends and characteristics associated with waist circumference (WC) among elderly Chinese people.

Methods

We used data from 3,096 adults ≥ 65 years who participated in the China Health and Nutrition Survey (CHNS), an ongoing cohort study, between 1993 and 2015. We used longitudinal quantile regression models to explore the temporal trends and characteristics associated with WC.

Results

WC increased gradually among the elderly Chinese population during the survey. The WC curves shifted to the right with wider distributions and lower peaks in men and women. All WC percentile curves shifted upward with similar growth rates in the 25th, 50th, and 75th percentiles. The WC means increased from 78 cm to 86 cm during the 22 years of our study. WC significantly increased with age and body mass index and decreased with physical activity (PA). These associations were stronger in the higher percentiles than in the lower percentiles.

Conclusions

WC is rising among Chinese adults ≥ 65 years. Factors affecting WC in elderly people may have different effects on different percentiles of the WC distribution, and PA was the most important protective factor in the higher percentiles of the WC distribution. Thus, different interventional strategies are needed.

Health-related quality of life of people with type 2 diabetes and its associated factors at a tertiary care clinic in Ningbo, China: A cross-sectional study

INTRODUCTION

The burden of type 2 diabetes (T2DM) in China is increasing, with potential impacts on the health-related quality of life (HRQoL) of those who develop the disease. Context-specific assessment of HRQoL and its associated factors informs the development of contextually appropriate interventions to improve HRQoL. This study aimed to determine the HRQoL and its associated factors in people with T2DM at a tertiary care clinic in Ningbo, China.

METHODS

A cross-sectional survey was undertaken among 406 people with T2DM in 2020-21. The primary outcome was HRQoL measured using EQ VAS and EQ-5D index from the EQ-5D-3L questionnaire. Multivariable regression analysis was used to determine the factors associated with HRQoL scores.

RESULTS

The mean (± standard deviation) EQ VAS score was 68.7 (13.8). Median (interquartile range) EQ-5D index was 1 (0.027). Prevalence of problems in HRQoL domains was as follows: pain/discomfort (15.7%), anxiety/depression (13.3%), mobility (5.4%), self-care (3.5%) and managing usual activities (5.2%). The ≥60 years age group had a mean EQ VAS score 8.7 points higher (95% CI 3.4, 13.9; p < .001) than the 18-39 years age group. Those with T2DM >10 years had a mean EQ VAS score 8.6 points lower than those with a duration <1 year (-12.8, -4.4; p = .001). A T2DM duration >10 years was associated with a reduction in the EQ-5D index of 0.029 (-0.041, -0.016; p < .001) compared with a duration <1 year.

CONCLUSIONS

Depression/anxiety and pain/discomfort are important domains of reduced HRQoL for this population. A longer duration of T2DM is associated with reduced HRQoL scores, including both EQ VAS and EQ-5D index. Increasing age may be counterintuitively associated with an increase in EQ VAS score in this population, potentially reflecting a 'paradox of aging' process. Future work should focus on developing, evaluating and implementing interventions to improve HRQoL in T2DM, such as strategies to manage pain and mental health conditions.

Obesity Impact on SARS-CoV-2 Infection: Pros and Cons “Obesity Paradox”—A Systematic Review

Background: During the last years, the COVID-19 pandemic meets the pandemic generated by obesity, raising many questions regarding the outcomes of those with severe forms of infection. Methods: The present systematic review summarises and analyses the data providing evidence for or against the “obesity-paradox” in COVID-19 patients. After applying the inclusion and exclusion criteria, 23 studies were included. We also analysed the presumably underlying basic mechanisms. Results: The patients with a body mass index (BMI) of 30–40 kg/m² presented severe symptoms that led to intensive care unit (ICU) admission but not increased death rate. Those with a higher degree of obesity, with a BMI higher than 40 kg/m², led to a rise in the death rate, particularly in young patients. Obesity was associated with a higher rate of ICU admission but was not determined as an independent predictor of increased mortality. In contrast, some studies suggest a strong association between obesity or morbid obesity and the risk of death. Conclusions: The existence of “obesity-paradox” cannot be stated; our study presents obesity as a critical risk factor in the evolution of COVID-19.

Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis

Obesity is a global epidemic that has a complicated pathogenesis as well as impact on the outcome of peritoneal dialysis (PD) patients. In this review, the prevalence of obesity in incident PD patients as well as the phenomenon of new-onset glucose intolerance after PD will be reviewed. Published literature on the effect of obesity on the survival and incidence of cardiovascular disease in PD patients will be discussed. Particular emphasis would be put on literature that compared the impact of obesity on the outcome of hemodialysis and PD, and the confounding effect of dialysis adequacy. Next, the complex concept of obesity and its relevance for PD will be explored. The focus would be put on the methods of assessment and clinical relevance of central versus general obesity, as well as visceral versus subcutaneous adipose tissue. The relation between obesity and systemic inflammation, as well as the biological role of several selected adipokines will be reviewed. The confounding effects of metabolic syndrome and insulin resistance will be discussed, followed by the prevalence and prognostic impact of weight gain during the first few years of PD. The differences between weight gain due to fluid overload and accumulation of adipose tissue will be discussed, followed by the current literature on the change in body composition after patients are put on chronic PD. The methods of body composition will be reviewed, and the clinical relevance of individual body component (fluid, fat, muscle, and bone) will be discussed. The review will conclude by highlighting current gaps of knowledge and further research directions in this area.

Body Composition in Preschool Children and the Association With Prepregnancy Weight and Gestational Weight Gain: An Ambispective Cohort Study

Objective

To describe the body composition in preschool children and to evaluate the association with prepregnancy BMI and gestational weight gain (GWG).

Methods

Children were recruited in their first year in kindergarten (3 years old) and followed up for the next 2 years. Information during pregnancy and birth was retrieved from medical records. Height, weight, fat mass, fat-free mass, and percentage of body fat (FM%) were measured through a bioelectrical impedance analysis for each child visit, and BMI, fat mass index (FMI), and fat-free mass index (FFMI) were calculated. Generalized linear mixed models (GLMMs) were used to evaluate the associations between prepregnancy weight, GWG, and adiposity indicators.

Results

A total of 3,329 single-birth 3-year-old children were recruited as the baseline population and were followed at 4 and 5 years old. During the 3 years of follow-up, the mean (±SD) values of BMI, FMI, FFMI, and FM% of the children were 15.6 (±1.6) kg/m², 2.8 (±1.3) kg/m², 12.8 (±0.7) kg/m², and 17.2% (±5.8%), respectively. The prevalence rates of overweight and obesity in mothers before pregnancy were 16.6 and 3.2%, respectively. Mothers were divided into three groups based on GWG: appropriate (1,233, 37.0%), excessive (767, 23.0%), and insufficient (1,329, 39.9%). GLMMs analyses showed that the preschool children’s BMI, FMI, FFMI, and FM% were all significantly positively related to maternal prepregnancy BMI and GWG (all P < 0.001); the children of mothers who were overweight/obese before pregnancy were more likely to be overweight/obese, high FMI, high FFMI, and high FM% at preschool age (all P < 0.001); although maternal excessive GWG was not correlated with offspring’s overweight/obese (P = 0.156), the children of mothers with excessive GWG are more likely to have higher FMI, but not to be with a higher FFMI status than the children of mothers with appropriate GWG. For prepregnancy overweight/obese women, compared with the GWG-appropriate group, maternal excessive GWG was related to the risk of high FMI (coefficient = 0.388, 95% CI: 0.129–0.647) and high FM% (coefficient = 0.352, 95% CI: 0.097–0.607), but was not related to the risk of overweight/obese or high FFMI of the offspring at preschool age.

Conclusion

Fat mass index decreased with age, while FFMI increased with age among 3- to 5-year-old children. It is necessary to optimize maternal weight prior to conception and GWG management to improve the health outcomes of the offspring.

Investigation of psychometric properties of the Mindful Eating Questionnaire in Chinese adolescents and young adults using mixed methods

Overweight and obesity are major public health challenges in China, and increasingly among young people. Valid measures are needed to examine the relationship between eating styles and weight to advance understanding and intervention. Mindful approaches show promise in weight management. This study aimed to investigate the psychometric properties of a Chinese version of Mindful Eating Questionnaire (C-MEQ). Study 1 used a think aloud methodology to examine Chinese young adults' (n = 7) and adolescents' (n = 10) comprehension of C-MEQ items. Findings informed revision of problematic items before a full validation study (Study 2) of the revised C-MEQ (C-MEQ-R) in a sample of 430 Chinese young adults. In Study 1, both groups misinterpreted ten items as asking about noticing about whether behaviour ever occurred rather than noticing experience, indicating the lack of content validity of the C-MEQ. Ten items were rephrased to emphasise mindful (intentional) noticing in the moment. In Study 2, confirmatory factor analysis revealed an inadequate fit to the original MEQ structure. Exploratory Structural Equation Model of the C-MEQ-R revealed five distinct domains. The C-MEQ-R showed better psychometric properties than the C-MEQ, and significant associations with mindfulness, emotional eating, external eating and BMI in expected directions. However, psychometric limitations including low internal reliability, inadequate coherence of the subscales and limited construct validity were identified. These findings contribute to the progress in the measurement of mindful eating by highlighting the weaknesses of the MEQ. Further research is called to adopt and validate alternative mindful eating measurements to assess mindful eating in Chinese adolescents and young adults.

Longitudinal Association of Dietary Energy Density with Abdominal Obesity among Chinese Adults from CHNS 1993–2018

Few studies have explored the longitudinal association between dietary energy density and waist circumference and abdominal obesity in adults in China. This study aimed to analyze the relationship between dietary energy density and waist circumference and abdominal obesity in Chinese residents aged 18–64. Using data from the CHNS from 1993 to 2018, 25,817 adult residents aged 18 to 64 were selected for the study. Three consecutive 24-h dietary recalls and home-weighed seasonings were used to assess food intake. A multilevel model was used to analyze the relationship between dietary energy density and waist circumference and abdominal obesity. The results showed that compared with the lowest dietary energy density group, females had an increased risk of abdominal obesity (OR = 1.16, 95% CI: 1.05, 1.29), and females’ waist circumference increased significantly by 0.24 cm (95% CI: 0.39–1.09) in the highest dietary energy density group. No association between dietary energy density and waist circumference and abdominal obesity was observed in males. This study shows that higher dietary energy density is significantly associated with females’ waist circumference and abdominal obesity. Further research on high dietary energy density and abdominal obesity will provide scientific basis for the effective control of abdominal obesity.

Dietary patterns, skeletal muscle mass loss, and cardiovascular risk among elderly men: A preliminary cross-sectional study in Sichuan province

The present study investigated the correlation between dietary patterns (DPs) with skeletal muscle mass (SMM) and cardiovascular risks in Sichuan males aged ≥65-years-old. Three major DPs were extracted by principal component analysis: animal-based and processed food, traditional food, and ovo-lacto vegetarian food, which accounted for 14.83%, 14.36%, and 11.86% of the variance, respectively. Adjusted logistic regression analysis showed that animal-based and processed food DP was positively associated with overweight/obesity(OR: 3.25, 95% CI: 1.94-5.46) and dyslipidemia(OR: 3.53, 95% CI: 2.00-6.22). Traditional DP was negatively associated with overweight/obesity(OR: 0.51, 95% CI: 0.36-0.72), dyslipidemia(OR: 0.50, 95% CI: 0.35-0.75), and high blood pressure(OR: 0.54, 95% CI: 0.38-0.77), but positively associated with decreased SMM (OR: 2.21, 95% CI: 1.36-3.16). Ovo-lacto vegetarian DP was negatively associated with dyslipidemia (OR: 0.56, 95% CI: 0.39-0.81) and hyperuricemia (OR: 0.56, 95% CI: 0.39-0.79), but positively associated with decreased SMM (OR: 1.57, 95% CI: 0.74-2.32). How to choose the best DP to control the cardiovascular risks and fight skeletal muscle loss needs further investigation in the future.

Regional Fat Distributions Are Associated With Subclinical Right Ventricular Dysfunction in Adults With Uncomplicated Obesity

Objective

Obesity is a prominent public health problem that has increased cardiovascular mortality risks. However, the specific effects of obesity, independent of comorbidities, on cardiac structure and function have not been well clarified, especially those effects on the right ventricle (RV). Cardiovascular magnetic resonance (CMR) tissue tracking can assess detailed RV mechanical features. This study aimed to evaluate RV strain using CMR in uncomplicated obese adults and assess its association with fat distributions.

Methods

A total of 49 obese patients and 30 healthy controls were included. The RV global systolic function and strain parameters based on CMR were assessed. Body fat distributions were measured with dual X-ray absorptiometry. RV function indices of obese patients were compared with those of healthy controls. Correlations among related body fat distribution parameters and RV function indices were conducted with multivariable linear regression.

Results

Compared with healthy controls, the obese group had impaired RV strain with lower global longitudinal peak strain (PS), longitudinal peak systolic strain rate (PSSR), circumferential and longitudinal peak diastolic strain rates (PDSR) (all P < 0.05), while LV and RV ejection fractions were not significantly different between the two groups (P > 0.05). Multivariable linear regression analysis demonstrated that android fat% was independently associated with longitudinal PS (β = −0.468, model R² = 0.219), longitudinal PDSR (β = −0.487, model R² = 0.237), and circumferential PSSR (β = −0.293, model R² = 0.086). Trunk fat% was independently associated with longitudinal PSSR (β = −0.457, model R² = 0.209). In addition, the strongest correlations of circumferential PDSR were BMI and gynoid fat% (β = −0.278, β = 0.369, model R² = 0.324).

Conclusions

Extensive subclinical RV dysfunction is found in uncomplicated obese adults. BMI, as an index of overall obesity, is independently associated with subclinical RV dysfunction. In addition, central obesity (android fat and trunk fat distributions) has a negative effect on subclinical RV function, while peripheral obesity (gynoid fat distribution) may have a positive effect on it.

Clinical Trials Registration

Effect of lifestyle intervention on metabolism of obese patients based on smart phone software (ChiCTR1900026476).

Dietary Supplementation of Auricularia auricula-judae Polysaccharides Alleviate Nutritional Obesity in Mice via Regulating Inflammatory Response and Lipid Metabolism

The incidence of lipid metabolism disorder and obesity that is caused by high-calorie diets is increasing year by year, which has become an urgent global health problem. This study was performed to explore the intervention effects of polysaccharides that were extracted from Auricularia auricula-judae resources in the Qinba Mountain area on nutritional obesity in C57BL/6J mice that was induced by high fat and high fructose diets (HFFD) and to investigate their underlying molecular mechanisms. The results showed that dietary supplementation of Auricularia auricula-judae polysaccharides (AAP) significantly improved mice’s insulin resistance state, altered serum lipid metabolites, and slowed down body weight gain that was induced by HFFD. In addition, AAP supplementation decreased inflammatory factor levels and alleviated liver histomorphology changes. Furthermore, AAP down-regulated liver adipogenic-related gene expressions, suppressed cholesterol synthesis-related gene levels, up-regulated fatty acid β-oxidation-related gene expressions, and promoted cholesterol efflux-related gene expressions, thus improving mice hepatic lipid metabolism homeostasis. Moreover, the intervention effects were closely related to mitochondrial function. These results provide a scientific basis for the further development and utilization of Auricularia auricula-judae resources in the Qinba Mountain area.

Prevalence and diagnostic agreement of sarcopenic obesity with different definitions among Chinese community-dwelling older adults

OBJECTIVE

this retrospective study aims to compare the prevalence and diagnostic agreement of sarcopenic obesity (SO) using different obesity diagnostic methods among Chinese community-dwelling older adults.

METHODS

SO was diagnosed with sarcopenia and obesity diagnostic methods. Sarcopenia was defined using the Asian Working Group for Sarcopenia criteria 2019 (AWGS2019). Four widely used indicators were used to define obesity: body mass index (BMI), waist circumference (WC), percent of body fat (PBF) and visceral fat area (VFA). Cohen's kappa was used to analyse the diagnosis agreement of SO between different diagnostic methods.

RESULTS

a total of 1,050 participants were included, including 347 men (71.3 ± 7.4 years) and 703 women (69.9 ± 7.5 years). The prevalence of sarcopenia was 25% in total participants, there was no difference between men (24.2%) and women (25.5%), (P = 0.705). With different obesity diagnostic methods, the obesity prevalence ranged from 4.1 to 42.2%, the SO prevalence was 0.1-7.9%. The diagnosis agreement of SO was poor-to-moderate (κ ranged from -0.002 to 0.682). Among the four diagnostic methods, AWGS combined with BMI had the poorest agreement (κ = -0.002 with other methods), AWGS combined with VFA had the best agreement (κ = 0.641 and 0.682 with AWGS combined with PBF and with AWGS combined with WC, respectively).

CONCLUSION

the prevalence of SO vary considerably and the diagnostic agreement is poor-to-moderate with non-uniform diagnostic methods. BMI has the lowest sensitivity, whereas VFA has the highest sensitivity in diagnosis of SO, and VFA has a relatively good diagnostic agreement with other diagnostic methods.

Cardiorenal Risk Profiles Among Data-Driven Type 2 Diabetes Sub-Phenotypes: A Post-Hoc Analysis of the China Health and Nutrition Survey

BACKGROUND AND AIM

Evidence about recently proposed data-driven clusters of type 2 diabetes (T2D) is mainly about its prognostic effects and Western populations. We tested the applicability of this clustering approach among the Chinese population. We further investigated the cardiorenal risk profiles among different T2D sub-phenotypes cross-sectionally and before diabetes diagnosis.

METHODS

With the use of data from the China Health and Nutrition Survey (1989-2009), 6,728 participants with available fasting blood samples and completed questionnaires in the 2009 survey were included. Glycemic statuses (normoglycemia, prediabetes, and new-onset T2D) were defined according to the 2020 American Diabetes Association criteria. Data-driven cluster analysis was conducted among new-onset T2D based on five variables: age at onset, body mass index (BMI), hemoglobin A1c, homeostasis model estimates of β-cell function, and insulin resistance. Linear regression models were used to cross-sectionally examine the differences of cardiorenal risk factors (body fat distribution, blood pressure, lipid profiles, and kidney function) between glycemic statuses. Mixed-effects models were used to explore a maximum of 20-year trajectories of cardiovascular risk factors (body fat distribution and blood pressure) before diabetes diagnosis.

RESULTS

Among 557 (8.3%) new-onset T2D, four sub-phenotypes were found, with 57 (10.2%) assigned to the severe insulin-resistant diabetes (SIRD), 72 (12.9%) to the severe insulin-deficient diabetes (SIDD), 167 (30.0%) to the mild obesity-related diabetes (MOD), and 261 (46.9%) to the mild age-related diabetes (MARD). People clustered within different T2D sub-phenotypes had different cardiorenal risk profiles. Three T2D sub-phenotypes (SIRD, SIDD, and MOD) had worse cardiorenal abnormalities, while the risk burden in the MARD sub-phenotype was similar to that in prediabetes. Compared with people with other T2D sub-phenotypes, people in the MOD sub-phenotype had a faster increment in BMI, waist, upper arm circumference, and triceps skinfold up to 10 years before diagnosis. Blood pressure was less distinct in different T2D sub-phenotypes; however, SIDD and MOD clusters had higher blood pressure levels before diabetes diagnosis.

CONCLUSIONS

Data-driven T2D sub-phenotyping is applicable in the Chinese population. Certain sub-phenotypes such as MARD only have a minor cardiorenal risk burden, and distinct cardiovascular risk development occurs long before diabetes diagnosis. Our findings can help improve early prevention and targeted treatment for diabetes.

The change in the prevalence of obesity and new-onset diabetes in Chinese peritoneal dialysis patients over 25 years

Background

The global prevalence of both obesity and end-stage kidney diseases (ESKDs) has increased in recent decades. Given the complicated interaction between obesity and ESKD, we examined the change in the prevalence of obesity in incident Chinese peritoneal dialysis (PD) patients over the past 25 years.

Methods

We reviewed the anthropometric measures of incident PD patients in a single Hong Kong center from 1995 to 2019. The results are reported in five 5-year periods. Patients with and without diabetes were analyzed separately, and the incidence of new-onset diabetes after PD was explored.

Results

We reviewed 1681 patients. Their mean age was 58.4 ± 12.5 years; 931 patients (55.4%) had pre-existing diabetes. From 1995–99 to 2015–19, the prevalence of obesity or overweight at the initiation of PD increased progressively for every 5-year period (from 21.9% to 26.2, 37.9, 42.7 and 47.3%, P < 0.001 for linearity). The increase in the prevalence of obesity or overweight was more pronounced in diabetic patients (from 33.7% to 59.6%) than non-diabetic ones (from 13.2% to 32.3%). Among nondiabetics patients, the incidence of new-onset diabetes after started on PD showed an insignificant rising trend during that period (from 18.0, 19.7, 17.8 and 22.4% to 23.3%, P = 0.106). The incidence of new-onset impaired fasting glucose or diabetes was significantly higher in obese or overweight patients than the others (56.9% versus 51.4%, P < 0.001).

Conclusions

The prevalence of obesity has increased substantially in both diabetic and nondiabetic new PD patients in Hong Kong over the past 25 years. The incidence of new-onset diabetes was significantly higher in new PD patients with pre-existing obesity or overweight than those without obesity. The prognostic implication and impacts on the healthcare system deserve further studies.

Projecting National-Level Prevalence of General Obesity and Abdominal Obesity Among Chinese Adults With Aging Effects

OBJECTIVES

To explore the impact of population aging on the projected prevalence of obesity among Chinese adults in 2030.

METHODS

In total, 71450 observations were extracted from the China Health and Nutrition Survey between 1991 and 2015.Population was projected to 2030 using a Bayesian hierarchical modeling method. Two different approaches were adopted to estimate and project the national prevalence of overweight/obesity from 1991 to 2030. One method assumed a constant population at the base year, while the other allowed the age and gender distributions vary in each year.

RESULTS

Our projection indicated that approximately two-thirds of Chinese adults would be affected by overweight/general obesity in 2030, and more than 60% of Chinese adults will suffer from abdominal obesity in 2030. Ignoring population aging led to an underestimation of overweight, general obesity and abdominal obesity for women by 3.81, 0.06, and 3.16 percentage points (pp), and overweight and abdominal obesity among men by 1.67 and 0.53 pp, respectively; but the prevalence of general obesity among men will be overestimated by 2.11 pp. Similar underestimations were detected in the estimation from 1991 to 2015.

CONCLUSIONS

Estimating and projecting the national prevalence of obesity using a constant population structure at the base line would cause significant underestimation if countries are undergoing rapid population aging.

Early-life exposure to famine and the risk of general and abdominal obesity in adulthood: a 22-year cohort study

OBJECTIVES

The aim of this study was to investigate how early-life exposure to famine affected the development of overweight, general obesity and abdominal obesity in Chinese adults.

STUDY DESIGN

This study was a 22-year cohort study.

METHODS

Data were derived from the China Health and Nutrition Survey, which is a national prospective cohort study. All participants born between 1949 and 1966 were potentially eligible. Height, weight and waist circumference (WC) were measured by trained healthcare workers. Height and weight were used to calculate body mass index, which was used to define general obesity and WC was used to define abdominal obesity. Exposure to famine was defined using the birth date as follows: no exposure (participants born between 1962 and 1966); fetal exposure (participants born between 1959 and 1961); early childhood exposure (participants born between 1956 and 1958); mid-childhood exposure (participants born between 1953 and 1955); and late childhood exposure (participants born between 1949 and 1952).

RESULTS

In total, 6957 participants were included in this study. Results indicate that exposure to famine was linked to a lower risk of being overweight. Exposure to famine in mid-childhood decreased the risk of general obesity in both males (hazard ratio [HR] 0.485, 95% confidence interval [CI] 0.292-0.807 [P = 0.005]) and females (HR 0.426, 95% CI 0.256-0.709 [P = 0.001]). Exposure to famine during any period of childhood decreased the risk of abdominal obesity (P < 0.001).

CONCLUSIONS

Exposure to famine in early childhood decreased the risk of overweight and abdominal obesity in adulthood; however, exposure to famine only had a weak role in the development of general obesity.

Is it chicken or the egg: Obesity, anxiety and depression in hospital workers

BACKGROUND: Healthcare workers are susceptible to obesity, anxiety and depression. OBJECTIVE: To determine the prevalence and association of obesity, anxiety and depression symptoms in individuals working in a hospital. METHODS: In this cross-sectional study all of the employees of a hospital were invited to participate (n = 150). Anxiety (via Beck Anxiety Scale) and depression symptoms (via Beck Depression Scale) and obesity were dependent and independent variables. Obesity was determined both with body mass index (BMI) and abdominal obesity (Waist circumference-WC). Data were collected with face-to-face interviews and anthropometric measurements were done. Data were analyzed using SPSS version 25.0 with student t-test, chi-square and correlation tests. Significance was set at a p-value <  0.05. RESULTS: Among the participants who agreed to participate (n = 131, 64.1% females), 35.1% were obese and 50.4% were abdominally obese. The 35.9% had moderate-severe anxiety symptoms, 19.1% had moderate-severe depression symptoms. Both BMI and WC had positive, moderate and significant correlation with anxiety and depression scores. After adjusting for socio-demographic variables obesity (both with BMI and WC) was an independent factor for anxiety and depression symptom presence, whereas after adjusted for these variables anxiety and depression symptom presence was an independent factor for obesity and abdominal obesity (p = 0.001 for all). CONCLUSIONS: There is a correlation between anxiety, depression and obesity. In addition to nutrition interventions in combating obesity, services that will improve mental health should be provided together as teamwork.