The Prevalence of Overfat Adults and Children in the US

Cardiometabolic implications of adipose tissue aging

Adipose tissue is a large endocrine organ that serves numerous physiological functions. As we age, adipose tissue remodels and can develop functional changes that alters its phenotype, potentially contributing to metabolic and cardiovascular disorders. Aging adipose tissue is characterized by regional redistribution of fat, accumulation of senescent cells, fibrosis, and decline in adipocyte differentiation capacities, which collectively impact adipose tissue function and whole body health. A notable transformation involves increased accumulation of intra-abdominal visceral adipose tissue and ectopic fat around internal organs such as the heart, blood vessels, liver, and kidneys that alter their functions. Other changes associated with aging include alterations in adipokine secretion and changes in adipocyte size and numbers. Aging adipocytes play a role in mediating chronic inflammation, metabolic dysfunction, and insulin resistance. Visceral adipose tissue, which increases in volume with aging, is in particular associated with inflammation, angiogenic dysfunction, and microvascular abnormalities, and mediators released by visceral fat may have adverse consequences systemically in multiple target organs, including the cardiovascular system. Understanding mechanisms underlying adipose tissue aging and its impact on cardiovascular health are important for developing interventions and treatments to promote healthy aging and reduce cardiometabolic disease risk.

Epigenetic BET reader inhibitor apabetalone (RVX-208) counters proinflammatory aortic gene expression in a diet induced obesity mouse model and in human endothelial cells

BACKGROUND AND AIMS

Obese patients are at risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). A lipid-rich diet promotes arterial changes by inducing hypertension, oxidative stress, and inflammation. Bromodomain and extraterminal (BET) proteins contribute to endothelial and immune cell activation in vitro and in atherosclerosis mouse models. We aim to determine if BET inhibition can reduce lipid-rich diet-induced vascular inflammation in mice.

METHODS

Body weight, serum glucose and lipid levels were measured in mice fed a high-fat diet (HFD) or low-fat diet (LFD) for 6 weeks and at study termination. BET inhibitors apabetalone and JQ1 were co-administered with the HFD for additional 16 weeks. Aortic gene expression was analyzed post necropsy by PCR, Nanostring nCounter® Inflammation Panel and bioinformatics pathway analysis. Transcription changes and BRD4 chromatin occupancy were analyzed in primary human endothelial cells in response to TNFα and apabetalone.

RESULTS

HFD induced weight gain, visceral obesity, high fasting blood glucose, glucose intolerance and insulin resistance compared to LFD controls. HFD upregulated the aortic expression of 47 genes involved in inflammation, innate immunity, cytoskeleton and complement pathways. Apabetalone and JQ1 treatment reduced HFD-induced aortic expression of proinflammatory genes. Congruently, bioinformatics predicted enhanced signaling by TNFα in the HFD versus LFD aorta, which was countered by BETi treatment. TNFα-stimulated human endothelial cells had increased expression of HFD-sensitive genes and higher BRD4 chromatin occupancy, which was countered by apabetalone treatment.

CONCLUSIONS

HFD induces vascular inflammation in mice through TNFα signaling. Apabetalone treatment reduces this proinflammatory phenotype, providing mechanistic insight into how BET inhibitors may reduce CVD risk in obese patients.

Assessing the income-related inequality in obesity among the elderly in China: A decomposition analysis

Background

Obesity among the elderly imposes a significant health and economic burden. The purpose of this study was to measure the obesity prevalence and income-related inequality among older adults in China and to explore the determinants of the inequity.

Methods

Data were obtained from 4,541 older adults (60 years and older) participating in the China Family Panel Study, 2018. Obesity was defined as body mass index (BMI) ≥28 kg/m². Normalized concentration index and concentration curve were calculated to measure the income-related inequality. Decomposition analysis was used to measure the contribution of each factor to the overall unfairness.

Results

The prevalence of obesity among the respondents was 7.99%. The 95% confidence interval for the overall prevalence was 7.20-8.78%. The normalized concentration index of obesity in the elderly was 0.075 (95% confidence interval: 0.047-0.103), indicating that obesity was more concentrated among the rich (p < 0.05). Socioeconomic factors contributed the most to the overall inequality (68.73%). Health behavior factors explained 16.38% of the observed income-related inequality in obesity among the elderly in China.

Conclusions

In 2018, obesity was more concentrated among the elderly with higher incomes in China. The pro-poor income-related inequality was mainly due to the higher socioeconomic status of higher-income older adults. Health behaviors and psychosocial factors could also exacerbate the inequality. To prevent the heavy burden of obesity on the health and finances of older adults, more attention should be paid to those who are financially better off, especially those who smoke and are physically inactive, while extroverted older adults also need to be focused on. For developing countries, concern needs to be given to the obesity of the wealthy elderly as a result of economic development.

Very Low-Carbohydrate High-Fat Diet Improves Risk Markers for Cardiometabolic Health More Than Exercise in Men and Women With Overfat Constitution: Secondary Analysis of a Randomized Controlled Clinical Trial

Purpose

This randomized controlled parallel-group study examined the effects of a very low-carbohydrate high-fat (VLCHF) diet and high-intensity interval training (HIIT) program over 12-weeks on cardiometabolic risk factors in individuals with overfat constitution.

Methods

Ninety-one participants out of 109 completed the study. The participants were randomly allocated to the HIIT (N = 22), VLCHF (N = 25), VLCHF+HIIT (N = 25), or control (N = 19) groups for 12 weeks. Fasting plasma samples were collected before the intervention and after 4 and 12 weeks. The analyzed outcomes included complete blood count, glucose, insulin, glycated hemoglobin, triglycerides (TG), cholesterol, high- and low-density lipoprotein (HDL-C and LDL-C), lipoprotein(a), adiponectin (Adpn), leptin (Lep), tumor necrosis factor α (TNF-α), other interleukins (hs-IL-6, IL-1β, and IL-10), and IL-1RA. The homeostasis model assessment of insulin resistance (HOMA-IR), Adpn/Lep ratio, TG/HDL-C ratio, and TyG index were calculated and analyzed. Blood pressure was measured before the intervention, after 4, 8, and 12 weeks (ClinicalTrials.gov: NCT03934476).

Results

Absolute changes in HOMA-IR, Adpn/Lep ratio, LDL-C, and diastolic blood pressure after 12 weeks differed by study groups (p < 0.05). The most pronounced changes were revealed in the VLCHF (ΔM [95% CI]; HOMA-IR: -0.75 [-1.13; -0.55]; Adpn/Lep: 9.34 [6.33; 37.39]; LDL-C: 0.06 [-0.12; 0.50] mmol/l) and VLCHF+HIIT (HOMA-IR: -0.44 [-1.14; 0.12]; Adpn/Lep: 4.26 [2.24; 13.16]; LDL-C: 0.25 [-0.04; 0.50] mmol/l) groups.

Conclusions

A 12-week VLCHF diet intervention in individuals with overfat constitution is effective for favorable changes in HOMA-IR (compared to HIIT), Adpn/Lep ratio, and diastolic blood pressure. HIIT, or HIIT combined with the VLCHF diet, had no additional benefits for the analyzed variables. No adverse side effects were observed.

Rethinking COVID-19 and Beyond: Prevention, Remedies, and Recovery

In a relatively short timeframe, millions of deaths and illnesses associated with COVID-19 have been reported, accompanied by substantial economic losses, and overall, negatively impacting society. This experience should serve as a wakeup call to those in public health and healthcare, along with politicians and citizens: COVID-19 is considered a predictable and preventable disaster. While various reactive responses to address the pandemic were implemented, some with adverse effects, proactive measures in the years before COVID-19 were neglected. Predominately this involved the development of a preventable overfat pandemic, which played a key role in both rising rates of chronic disease, the comorbidities that increase the risk for COVID-19, along with associated inflammation and malnutrition. This increased the risk of infection in billions of people worldwide, which, in essence, primed society for high rates of COVID-19 infection. Excess body fat evolves primarily from poor nutrition, particularly the overconsumption of sugar and other refined carbohydrates, which replace the vital nutrients needed for optimal immune function. Sugar and refined carbohydrates must be considered the new tobacco, as these foods are also devoid of nutrients, and underly inflammatory chronic diseases. A balanced diet of nutrient-dense wholefood must be emphasized to combat infectious and inflammatory diseases. Implementing proactive preventive lifestyle changes must begin now, starting with simple, safe, and inexpensive dietary modifications that can quickly lead to a healthier population.

The prevalence of aberrations in body composition in pediatric cystic fibrosis patients and relationships with pulmonary function, bone mineral density, and hospitalizations

BACKGROUND

Body mass index (BMI) correlates with clinical outcomes in cystic fibrosis but has limitations.  Body composition aberrations in CF are multifactorial. We sought to evaluate body composition and relationships with pulmonary function, bone health, and hospital admissions. Other aims included defining body composition indices in a cohort of children with CF.

METHODS

We conducted a retrospective review of patients with CF, age 8-18 years, seen at Nationwide Children's Hospital (2015-2020). Indices of body composition measured by dual-energy x-ray absorptiometry(DXA) scans.  Data included fat mass, fat-free mass (FFM), forced expiratory volume in one second (FEV1%), bone mineral density (BMD), and hospital admissions. NWA was defined as BMI 5^th-85^th percentile, body fat percentage >85^th percentile. FFMD defined as FFMI <10^th percentile.

STATISTICS

T-tests compared NWA, FFMD and clinical measurements. Pearson correlations analyzed fat-free mass index (FFMI), fat mass index (FMI), BMI and clinical measurements.

RESULTS

This study included 114 patients.  Mean age 12 years, 72 female. A high prevalence of FFMD existed (n=66, 38.6%).  FMI and FFMI correlated with FEV1% (r: 0.23, p:0.01, r: 0.36, p<0.001, respectively) and BMD (r: 0.29, p:0.002). FMI and hospital admissions were related (r:-0.23,p:0.01). FFMD was associated with 9.5% lower FEV1% (p=0.001) and lower BMD Z-score by 1.1 (p<0.001) when compared to no FFMD.

CONCLUSION

This cohort of children with CF had a high prevalence of FFMD and low prevalence of NWA.  FFMD was associated with worsened clinical measurements. Patients with FFMD need additional exercise or nutritional intervention. Heterogeneity of body composition definitions creates need for more research.

Treatment strategies for anterior cutaneous nerve entrapment syndrome in children: A systematic review

BACKGROUND

Anterior cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked cause of chronic abdominal pain in children. Currently, both nonsurgical and surgical treatment options are available to treat this disease. The objective was to give insight into the success rate of different treatment strategies for children with ACNES, and provide treatment recommendations for physicians based on the published evidence.

METHOD

A literature search of PubMed, Embase.com and the Wiley/Cochrane Library was conducted for studies published up to 25 February 2020. Randomized controlled trials, prospective or retrospective cohort studies, meta-analyses and literature reviews describing the outcome of different treatment strategies for children (<18 years old) with ACNES with a follow-up duration of at least four weeks were included.

RESULTS

Six studies, involving 224 patients, were included with an overall quality reported to be between fair and poor. Treatment success of local injections with an anesthetic agent into the trigger point ranged from 38% to 87% with a follow-up ranging from 4 weeks to 39 months. In addition, treatment success of anterior neurectomy ranged from 86% to 100%, with a follow-up duration ranging from 4 weeks to 36 months.

CONCLUSION

A step-up treatment strategy should be applied when treating pediatric patients with ACNES. This strategy starts with an injection with a local anesthetic agent, reserving surgery (anterior neurectomy) as a viable option in case of persistent pain.

LEVEL OF EVIDENCE

II.

Curse or Blessing? Obesity and Income-Related Inequality in the Chinese Labor Force

China owns a huge labor force of around half billion workers in 2018. However, little is known about the prevalence of obesity and the association between obesity and economic status in this special population. By employing the concentration index (CI) and decomposition analysis, this paper addresses this knowledge gap by using the most recent nationally representative dataset. In specific, this study examines the prevalence of obesity and the socioeconomic gradient in the probability of obesity among Chinese workers between 16 and 65. Our results show that the prevalence of obesity is completely different by using a different measure: the overall prevalence of being general obesity (measured by body mass index, BMI ≥ 28) varies by gender and residency from a minimum of 5.88% to a maximum of 9.46%, whereas abdominal obesity (measured by waist circumference, WCmale ≥ 85 cm & WCfemale ≥ 80 cm) prevalence presents a socking level from 64.53% to 67.69%. Moreover, the results show a pro-rich distribution of obesity (general and abdominal) among male workers (CI_BMI = 0.112; CI_WC = 0.057) and a pro-poor distribution among female workers (CI_BMI = −0.141; CI_WC = −0.166). We also find that the direction of the contribution of socioeconomic factors to income-related inequalities in obesity differs by gender. These results have substantial implications for the measurement of socioeconomic inequality in adiposity and for improving health-related policies targeting the Chinese labor force.

Breakfast Food Advertisements in Mediterranean Countries: Products' Sugar Content in the Adverts from 2015 to 2019

Although Spain was considered to be the healthiest country in the world in 2019, some studies reported that Mediterranean diet (MD) adherence, especially for breakfast, is low among children in Mediterranean countries, where child obesity is increasing alarmingly. This study correlated longitudinally the sugar content of breakfast products with advertising strategies. The research design applied quantitative analysis to compile the advertising data from 2015 to 2019 for all media, qualitative analysis of the content, and the use of popular characters to promote the food purchase. Additionally, a nutritional analysis was used to determine the products’ sugar content. The results were analyzed according to the target they were aimed at (adults or children). Results showed that the Spanish food industry promoted unhealthy products for breakfast, especially those targeted to children, with very high sugar content. To improve the childhood obesity rate in Spain, greater involvement from the food industry is needed. The reformulation of breakfast products must be a priority along with additional sugar reduction strategies so as not to lose adherence to MD in younger generations. More nutrition education is necessary among children, especially on balanced breakfast consumption, a basic meal that helps children to concentrate better in class during the morning.

COVID-19 and non-alcoholic fatty liver disease: Two intersecting pandemics

BACKGROUND

Initial evidence from China suggests that most vulnerable subjects to COVID-19 infection suffer from pre-existing illness, including metabolic abnormalities. The pandemic characteristics and high-lethality rate of COVID-19 infection have raised concerns about interactions between virus pathobiology and components of the metabolic syndrome.

METHODS

We harmonized the information from the recent existing literature on COVID-19 acute pandemic and mechanisms of damage in non-alcoholic fatty liver disease (NAFLD), as an example of chronic (non-communicable) metabolic pandemic.

RESULTS

COVID-19-infected patients are more fragile with underlying metabolic illness, including hypertension, cardiovascular disease, type 2 diabetes, chronic lung diseases (e.g. asthma, chronic obstructive pulmonary disease and emphysema) and metabolic syndrome. During metabolic abnormalities, expansion of metabolically active fat ('overfat condition') parallels chronic inflammatory changes, development of insulin resistance and accumulation of fat in configuring NAFLD. The deleterious interplay of inflammatory pathways chronically active in NAFLD and acutely in COVID-19-infected patients, can explain liver damage in a subgroup of patients and might condition a worse outcome in metabolically compromised NAFLD patients. In a subgroup of patients with NAFLD, the underlying liver fibrosis might represent an additional and independent risk factor for severe COVID-19 illness, irrespective of metabolic comorbidities.

CONCLUSIONS

NAFLD can play a role in the outcome of COVID-19 illness due to frequent association with comorbidities. Initial evidences suggest that increased liver fibrosis in NAFLD might affect COVID-19 outcome. In addition, long-term monitoring of post-COVID-19 NAFLD patients is advisable, to document further deterioration of liver damage. Further studies are required in this field.

Revisiting the Global Overfat Pandemic

The previously described overfat pandemic, estimated to be 62-76% worldwide, is comprised of individuals with excess body fat sufficient to impair health. The overfat condition is common in those who are overweight and obese, and can also occur in significant numbers of normal-weight non-obese individuals. Being overfat increases the risk for a wide spectrum of common cardiovascular and metabolic (cardiometabolic) abnormalities, chronic diseases and physical impairment. In some ethnicities, up to 40% or more of those who are normal-weight and non-obese may be overfat, a figure twice that used in the original global overfat estimates. In addition to the rates of overfat outpacing overweight and obesity, non-White populations outnumber Whites 6:1, with the recently estimated overfat prevalence being low when considering ethnicities such as Asians, Chinese, Africans and Latin Americans, including these individuals living among predominantly White populations. An awareness of the extent of the overfat pandemic is important because excess body fat can precede cardiometabolic risk factors, chronic diseases, and physical disabilities, and can reduce quality of life and increase healthcare expenditure. The purpose of this Perspective is to demonstrate that the global overfat prevalence of 62-76% may be considerably underestimated.

Socioeconomic and behavioural determinants of overweight/obesity among adults in Botswana: a cross-sectional study

OBJECTIVE

To undertake a comprehensive assessment of socioeconomic and behavioural determinants of overweight/obesity among adult population in Botswana.

DESIGN

The study adopted a cross-sectional design by selecting adult respondents in 3 cities and towns, 15 urban villages and 15 rural areas across Botswana using a multistage probability sampling technique.

SETTING

The study was conducted in selected rural and urban areas of Botswana.

PARTICIPANTS

The study sample consisted of 1178 adult males and females aged 15 years and above.

PRIMARY OUTCOME MEASURES

Objectively measured overweight/obesity.

RESULTS

Prevalence of overweight/obesity in the study population was estimated at 41%. The adjusted OR (AOR) of overweight/obesity were highest among women (AOR=2.74, 95% CI 1.92 to 3.90), in ages 55-64 years (AOR=5.53, 95% CI 2.62 to 11.6), among individuals with secondary (AOR=1.70, 95% CI 1.11 to 2.61) and tertiary education (AOR=1.99, 95% CI 1.16 to 3.38), smokers (AOR=2.16, 95% CI 1.22 to 3.83) and people with poor physically activity (AOR=1.46, 95% CI 1.03 to 3.24). These were statistically significant at 5% level.

CONCLUSION

Women, older adults, people with high education level, smokers and people who reported poor physical activity were found to have higher odds of being overweight/obesity. These findings suggest the need for broad based strategies encouraging physical activity among different socioeconomic groups.

General and abdominal obesity prevelances and their relations with metabolic syndrome components

Objective

To evaluate the frequency of obesity and its relation of metabolic syndrome.

Methods

The data from the records of the consecutive adult residents of Bursa province in Turkey who were admitted to the family health centers from the 1^st January to the 31^st December 2016 were evaluated retrospectively. The population size was 2901396 (N) and the sample size was at least n=17729. A total of 17812 participants (10939 females, 6873 males) were included in this retrospective observational study. Sociodemographic characteristics, diseases, used medication and smoking, height, weight, waist and hip circumferences (WaC and HC) were recorded from the files.

Results

The mean age of all subjects was 46.1 years, the mean BMI was 28.1 kg/m² with a mean WaC of 91.3 cm, HC of 104.7 cm, WHR of 0.87. The prevalence of obesity in Bursa was found to be 32.2% (37.8% in females and 23.3% in males) according to BMI, 63.2% (69.7% in females, 52.9% in males) according to waist and hip circumferences.

Conclusions

Preventive measures should be taken by health authorities to prevent the rapid increase in general and abdominal obesity that may lead to serious comorbidities.

Gastric cancer after gastric bypass with fundectomy: The possibility for early diagnosis

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RYGB is the most important bariatric procedure worldwide.

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The RYGB mayor limitation is the difficult exploration of the excluded stomach and duodenum.

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The gastric bypass with fundectomy allowed for an easly endoscopic evaluation.

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The possibility to easly perform OGD guaranteed the detection of gastric carcinoma at an early stage.

Introduction: Roux-an-Y gastric bypass (RYGP) is one of the most important bariatric procedures and its results are well known in terms of weight loss and comorbid improvement. The major limitation of this technique is the difficult exploration of the excluded stomach and duodenum. Some Authors are performing the gastric bypass with fundectomy and, according to Literature, it is feasible and effective, with major advantage of explorable gastric pouch.

Presentation of case: We report the case of a 54-year-old woman affected by obesity (BMI 49 kg/m²). After a pre-operative multidisciplinary evaluation and gastroscopy, she underwent a laparoscopic RYGB with fundectomy in October 2016.

One year after surgery she contacted the department for vomiting, pyrosis and weakness.

Thanks to the characteristics of the surgical technique it was possible to easily perform an OGD that detected an antral ulcer. The byopsy revealed a gastric adenocarcinoma.

A degastroresection was performed and the istological finding was a gastric adenocarcinoma pT1b N0 G3.

Discussion: Early diagnosis is essential in gastric tumors to ensure a good prognosis and the gold standard is performing gastroscopy with biopsies.

With the standard technique is very challenging to perform an OGD and the cancer stage is likely to be advanced at diagnosis, with a bad prognosis for the patient.

Conclusion: From the clinical case described and the analysis of the Literature, the advantages of this technique are clear, allowing for an easy endoscopic evaluation of gastric walls with the possibility of diagnosing early stage tumors with a better outcome for patients.