Prevention of overweight and obesity: how effective is the current public health approach

Transcutaneous electrical acupoint stimulation combined with core stability training in postpartum women with diastasis rectus abdominis

BACKGROUND

Diastasis rectus abdominis (DRA) women experience discomfort signs, which had a negative impact like an impairment of the quality of life and functional capacities of women. Transcutaneous electrical acupoint stimulation (TEAS) and core muscle training (CMT) have provided increasing evidence as an important strategy for DRA. Here, we aimed to evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with core muscle training (TEAS + CMT) in postpartum women with DRA.

METHODS

A total of 96 postpartum women with DRA were randomly assigned to three groups: control (waiting-list group), treatment group 1 (CMT), and treatment group 2 (TEAS + CMT), with 32 participants in each group. Ultimately, 90 participants completed the study (30 in each group). The control group received conventional postpartum natural recovery. Treatment group 1 underwent CMT once daily, five times per week, for four consecutive weeks (one treatment course). Treatment group 2 received TEAS + CMT following the same schedule. Changes in interrectus distance (IRD), waistline (WL), body mass index (BMI), lumbago (measured by the Short-Form McGill Pain Questionnaire [SF-MPQ]), and quality of life (assessed via SF-36) were evaluated before and after treatment.

RESULTS

At the end of treatment, each group showed notable reductions in IRD, WL, and BMI(P < 0.05), in with the most significant improvements observed in treatment group 2 (P < 0.05). Lumbago scores (SF-MPQ) distinctly decreased each group (P < 0.05), while quality of life scores (SF-36) evidently improved (P < 0.05), with treatment group 2 showing the most pronounced effects (P < 0.05).

CONCLUSION

TEAS + CMT may improve DRA of postpartum women, reduce WL and BMI, alleviate lumbago, and improve quality of life.

Modern-Day Therapeutics and Ongoing Clinical Trials against Type 2 Diabetes Mellitus: A Narrative Review

OBJECTIVES

Diabetes Mellitus (DM) is a global health concern that affects millions of people globally. The present review aims to narrate the clinical guidelines and therapeutic interventions for Type 2 Diabetes Mellitus (T2DM) patients. Furthermore, the present work summarizes the ongoing phase 1/2/3 and clinical trials against T2DM.

METHODS

A meticulous and comprehensive literature review was performed using various databases, such as PubMed, MEDLINE, Clinical trials database (https://clinicaltrials.gov/), and Google Scholar, to include various clinical trials and therapeutic interventions against T2DM.

RESULTS

Based on our findings, we concluded that most T2DM-associated clinical trials are interventional. Anti-diabetic therapeutics, including insulin, metformin, Dipeptidyl Peptidase-4 (DPP-4) inhibitors, Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs), and Sodium- Glucose cotransporter-2 (SGLT-2) inhibitors are frontline therapeutics being clinically investigated. Currently, the therapeutics in phase IV clinical trials are mostly SGLT-2 inhibitors, implicating their critical contribution to the clinical management of T2DM.

CONCLUSION

Despite the success of T2DM treatments, a surge in innovative treatment options to reduce diabetic consequences and improve glycemic control is currently ongoing. More emphasis needs to be on exploring novel targeted drug candidates that can offer more sustained glycemic control.

Black Ginger Extract Suppresses Fat Accumulation by Regulating Lipid Metabolism in High-Fat Diet-Fed Mice

This study investigated the antiobesity effects of black ginger extract (BGE) in high-fat diet (HFD)-induced obese mice. Mice were divided into six groups: normal diet control (NC, AIN-93G normal diet), 60% HFD control (HFD), HFD containing metformin at 250 mg/kg b.w. (Met, positive control), and HFD containing BGE at 5, 10, or 20 mg/kg b.w. for 15 weeks. BGE administration significantly prevented HFD-induced increases in weight gain, organ weight, and adipose tissue mass. Furthermore, it resulted in decreased adipogenesis and lipogenesis-related factors, including phosphorylated mitogen-activated protein kinase, peroxisome proliferator-activated receptor gamma, CCAAT/enhancer-binding proteins, sterol regulatory element-binding protein 1, phosphorylated cAMP response element-binding protein, glucose-6-phosphate dehydrogenase, fatty acid synthase, dephosphorylated ATP-citrate lyase, dephosphorylated acetyl-CoA carboxylase, and lipoprotein lipase, in white adipose tissues. Moreover, BGE administration enhanced lipolysis in white adipose tissue, as evidenced by elevated levels of adipose triglyceride lipase, phosphorylated hormone-sensitive lipase, and protein kinase A, along with reduced levels of perilipin and phosphodiesterase 3B. BGE induced thermogenesis in brown adipose tissues, as reflected by the increased expression of AMP-activated protein kinase, uncoupling protein 1, and carnitine palmitoyltransferase 1 and decreased levels of fatty acid-binding protein 4. In conclusion, this study provides comprehensive evidence supporting the antiobesity effects of BGE, elucidating the underlying molecular mechanisms involved in preventing weight gain, suppressing adipogenesis, promoting lipolysis, and stimulating thermogenesis. These findings suggest the potential therapeutic utility of BGE in combating obesity and associated metabolic disorders (KHGASP-2023-034).

Reducing the incidence of overweight and obesity by a healthy lifestyle intervention program for schoolchildren in Hanoi, Vietnam: a randomized controlled trial

BACKGROUND

The increasing incidence and prevalence of childhood overweight (OW) and obesity (OB) are major global health challenges. This study aimed to evaluate the effectiveness of a 2-year healthy lifestyle intervention program in reducing the incidence of OW and OB among schoolchildren aged 11-12 years in Vietnam.

METHODS

Study design: Randomized controlled trial.

PARTICIPANTS AND INTERVENTIONS

In total, 733 students participated in this study. Participants were included from four schools in Hanoi based on a random cluster sampling method. Students' health outcomes were assessed at baseline and after 2 years.

MAIN OUTCOMES

The primary outcomes were the incidence of OW and OB, and the secondary outcomes were the prevalence and remission of OW and OB. Generalized estimating equations (GEEs) were used to determine the outcomes and risk factors.

RESULTS

After the intervention, the prevalence of OW decreased by 9.24% in the intervention group and 3.01% in the control group. After adjustment for age and sex, the odds of overweight were 36.7% lower in the intervention group than in the control group (OR = 0.633; 95% CI: 0.434-0.925; P = 0.018). The incidence of OW was 1.31% in the intervention group compared with 5.33% in the control group. After adjustment for age and sex, the odds of incident overweight in the intervention group were 77.4% lower than in the control group (OR = 0.226; 95% CI: 0.063-0.813; P = 0.023). The proportion of patients who achieved OW remission was 41.22% in the intervention group and 28.68% in the control group. After adjustment for age and sex, the odds of OW remission of overweight were 2.219 times greater in the intervention group than in the control group (OR = 2.219; 95% CI: 1.220-4.036; P = 0.009). For most OB-related factors, there were no significant differences between the intervention and control groups.

CONCLUSION

A multicomponent healthy lifestyle intervention was effective in reducing the incidence of OW; however, it had no significant effect on OB among children aged 11-12 years in Hanoi, Vietnam.

TRIAL REGISTRATION

Retrospectively registered number: UMIN000014992, 20/08/2023.

The Anti-Obesogenic Effects of Muscadine Grapes through Ciliary Neurotrophic Factor Receptor (Cntfr) and Histamine Receptor H1 (Hrh1) Genes in 3T3-L1 Differentiated Mouse Cells

Obesity and type 2 diabetes are prevalent metabolic diseases that have significant links to several chronic diseases, including cancer, diabetes, hypertension, and cardiovascular disease. Muscadine grape extracts have shown the potential to reduce adiposity and improve insulin sensitivity and glucose control. Thus, this study was designed to determine the potential of muscadine grape berries extract (Pineapple and Southern Home) for its antiobesity properties in 3T3-L1 cells as a model for obesity research. The current study's data indicated the total phenolic content (TPC) and 2,2-diphenyl-1-picrylhydraziyl (DPPH) activity were higher in cultivar (CV) Southern Home, meanwhile, elevated the total flavonoid content (TFC) in Pineapple. Both extracts were safe across the tested range (0-5 mg/mL). A noticeable reduction in lipid accumulation was also found in extract-treated cells. In preadipocytes and adipocytes, the tested extracts showed significant alterations in various genes involved in glucose homeostasis and obesity. The most remarkable findings of the current study are the upregulation of two genes, Cntfr (+712.715-fold) and Hrh1 (+270.11-fold) in CV Pineapple extract-treated adipocytes 3T3-L1 and the high fold increase in Ramp3 induced by both Pineapple and Southern Home in pre-adipose cells. Furthermore, the tested extracts showed a potential to alter the mRNA of various genes, including Zfp91, B2m, Nr3c1, Insr, Atrn, Il6ra, Hsp90ab1, Sort1, and Npy1r. In conclusion, the data generated from the current study suggested that the two extracts under investigation are considered potential candidates for controlling insulin levels and managing obesity.

Mediterranean Diet Combined with Regular Aerobic Exercise and Hemp Protein Supplementation Modulates Plasma Circulating Amino Acids and Improves the Health Status of Overweight Individuals

Plant protein is considered a sustainable health-promoting strategy to prevent metabolic syndrome. Lifestyle changes (including dietary patterns and exercise) have been demonstrated to exert an effect on human health by modulating the biochemical status in humans. The objective of this study was to assess whether supplementation with hemp protein within a Mediterranean diet context together with exercise could help to ameliorate the metabolic statuses of patients prone to developing metabolic syndrome. For this study, 23 patients followed with Mediterranean diet and engaged in aerobic exercise according to the WHO's recommendations, while also being supplemented with hemp protein, for 12 weeks. A comparison of anthropometric, biochemical, and mineral data as well as amino acid values was made between the start and the end of the study, with the subjects acting as their own control group. Statistical analyses included a paired t-test, Wilcoxon paired test, Pearson correlation coefficient, and Sparse Partial Least Squares Discriminant Analysis to evaluate significant differences and correlations among parameters. There were statistically significant changes in total cholesterol, HDL-C (+52.3%), LDL-C (-54.0%), and TAG levels (-49.8%), but not in glucose plasma levels. Following the intervention, plasma concentrations of some amino acids, including α-aminoadipic acid, phosphoethanolamine, and 1-metylhistidine, increased, whereas those of asparagine and alanine declined. Different correlations between amino acids and the other parameters evaluated were reported and discussed. A Mediterranean diet combined with regular aerobic exercise, together with protein supplementation, can highly improve the metabolic parameters and anthropometric parameters of subjects with obesity and impaired glucose levels, ameliorating their health status and likely delaying the development of metabolic syndrome.

Lemon basil seed-derived peptide: Hydrolysis, purification, and its role as a pancreatic lipase inhibitor that reduces adipogenesis by downregulating SREBP-1c and PPAR-γ in 3T3-L1 adipocytes

The purpose of this study is to assess the bioactive peptides derived from the defatted lemon basil seeds hydrolysate (DLSH) for their ability to inhibit pancreatic lipase, decrease intracellular lipid accumulation, and reduce adipogenesis. Response surface methodology (RSM) was employed to optimize trypsin hydrolysis conditions for maximizing lipase inhibitory activity (LI). A hydrolysis time of 387.06 min, a temperature of 49.03°C, and an enzyme concentration of 1.61% w/v, resulted in the highest LI with an IC50 of 368.07 μg/mL. The ultrafiltration of the protein hydrolysate revealed that the fraction below 0.65kDa exhibited the greatest LI potential. Further purification via RP-HPLC identified the Gly-Arg-Ser-Pro-Asp-Thr-His-Ser-Gly (GRSPDTHSG) peptide in the HPLC fraction F1 using mass spectrometry. The peptide was synthesized and demonstrated LI with an IC50 of 0.255 mM through a non-competitive mechanism, with a constant (Ki) of 0.61 mM. Docking studies revealed its binding site with the pancreatic lipase-colipase complex. Additionally, GRSPDTHSG inhibited lipid accumulation in 3T3-L1 cells in a dose-dependent manner without cytotoxic effects. Western blot analysis indicated downregulation of PPAR-γ and SREBP-1c levels under GRSPDTHSG treatment, while an increase in AMPK-α phosphorylation was observed, suggesting a role in regulating cellular lipid metabolism. Overall, GRSPDTHSG demonstrates potential in attenuating lipid absorption and adipogenesis, suggesting a prospective application in functional foods and nutraceuticals.

Impact of Daikenchuto (TU-100) on the early postoperative period in duodenal-jejunal bypass

INTRODUCTION

We investigated the effect of Daikenchuto (TU-100) on the early postoperative period in duodenal-jejunal bypass (DJB).

METHODS

Study 1:The effect of TU-100 on diabetic rats was investigated. Rats were sacrificed after receiving TU-100 for one week. Study 2:The effect of TU-100 on DJB was investigated. Rats in the DJB and TU-100 treated DJB groups were sacrificed 24 hours postoperation to evaluate blood glucose, cytokine expression, and gut microbiome.

RESULTS

Study 1:TU-100 did not affect glucose or body weight. TU-100 suppressed intestinal inflammation and modified the gut microbiome. Specifically, Bifidobacterium and Blautia were increased, and Turicibacter were decreased in this group. Study 2:Both DJB and TU-100 treated DJB rats showed lower blood glucose at 24 hours postoperation than at preoperation. Cytokine expression in the liver and small intestine of the TU-100 treated DJB group was significantly lower than that of the DJB group. The gut microbiome composition in TU-100 treated DJB rats was altered. In particular, Bifidobacterium and Blautia were increased in this group.

CONCLUSION

DJB suppressed blood glucose during the early postoperative period. TU-100 may enhance the anti-diabetic effect of metabolic surgery by changing the gut microbiome and suppressing inflammation in the early postoperative period. J. Med. Invest. 71 : 210-218, August, 2024.

Degree of association between the body mass index (BMI), waist-hip ratio (WHR), waist-height ratio (WHtR), body adiposity index (BAI) and conicity index (CI) in physically active older adults

BACKGROUND

Aging is the main factor in the eventual development of cardiovascular disease (CVD) the prevalence of which is increasing progressively along with life expectancy. Therefore, it is essential to identify the most effective indicators for predicting the possible development of CVD. Anthropometric indices provide useful information for CVD risk evaluation. These are widely used for the simplicity of their estimates and their high correlation in the positive identification of CVD. The most used in the general population are the body mass index (BMI), the waist to hip ratio (WHR) and waist to height ratio (WHtR), body adiposity index (BAI) and conicity index (CI). However, the behavior and association of such indices in physically active people over 65 years of age is not well established.

PURPOSE

To analyze the behavior and association of the BMI, WHR, WHtR, BAI and CI in a group of active people over 65 years of age.

METHODS

A group of 608 European participants with a mean age of 68.05 ± 5.43yrs, composed of 74.2% female and 28.5% male, was randomly selected and evaluated for anthropometric parameters and body composition by a bio-impedance measuring device with four electrode sensor systems. A descriptive analysis was completed via measures of central tendency (mean and standard deviation) and percentage analysis. As the distribution of the sample was normal (parametric), an association analysis was carried out through the Pearson correlation coefficient (r), in order to determine the relationship between anthropometric and body composition indices. A P value of <0.05 was considered to indicate statistical significance.

RESULTS

The results show that BMI, BAI and WHtR are significantly related to % body fat (Fat %), with BMI reaching the highest correlation (r = 0.612), followed by BAI (r = 0.556) and WHtR (r = 0.521). When the association between indices is considered, the WHtR and BAI and WHtR and BMI are those with the highest significant correlation (r = 0.981 and r = 0,789, respectively). As for the effects of gender, good to strong correlations were found between the BMI and the WHtR (r = 0.731 for female, r = 0.568 for male) and between the WHtR and the BAI (r = 0.989 for female, r = 0.985 for male).

CONCLUSION

The most accurate anthropometric index for indicating the level of body fat present in an active population of 65 years of age or over seems to be the BMI, followed by the BAI and WHtR. However, the degree of association between body fat and anthropometric parameters seems to be conditioned by gender.

The impact of exercise modalities on blood glucose, blood pressure and body composition in patients with type 2 diabetes mellitus

BACKGROUND

Physical activity has been recommended as an important non-pharmacological therapeutic strategy for the management of type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the effects of 12 weeks of strength, aerobic, and a combination of aerobic and resistance training on blood glucose level, blood pressure, and body composition in patients with T2DM.

METHODS

From Debremarkos referral hospital, 40 subjects with T2DM (mean age 42.45 years, 29 men, 11 women) were randomly assigned to one of three intervention groups or the control group. The following variables were measured: body mass index (BMI), fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP), and body fat percentage (BFP). Paired sample T-test and one-way ANCOVA were applied whilst controlling for diet, gender, and age.

RESULTS

All intervention groups showed improvement in a mean difference of FBG - 13.03 (t =-5.55, df = 39, p < 0.001), SBP - 21.63 mmHg - 17.6 mmHg (t =-6.51, df = 39, p < 0.001), DBP - 11.86 mmHg (t = -5.47, df = 39, p < 0.001) and BFP - 9.14 (t = -7.49, df = 39, p < 0.001). There was a significant difference in mean BMI reduction when diet, gender, and age were controlled in a one-way ANCOVA (F (3, 33) = 11.79, p < 0.001), SBP (F (3, 33) = 13.383, p < 0.001), DBP (F (3, 33) = 7.830, p < 0.001), FBG (F (3, 33) = 6.337, p < 0.001), BFP (F (3, 33) = 24.29, p < 0.001) between the exercise intervention groups and control group. Additionally, the estimated marginal means indicate that the combined strength and aerobic exercise intervention group experienced the greatest improvements.

CONCLUSION

Body composition, blood pressure, and fasting blood glucose were significantly lower in the combined (aerobic plus strength) treatment than in the individual treatment, indicating that the combined exercise intervention was more successful in altering these parameters.

Stress during the COVID-19 Pandemic and Emotional Eating Scale Adapted for Children and Adolescents (EES-C) Results in Girls: Polish Adolescents' COVID-19 Experience (PLACE-19) Study

Stress related to the outbreak of the COVID-19 pandemic may have caused substantial changes in eating behaviors, and may have been associated with emotional eating, especially in female individuals. The aim of the present study was to analyze the association between stress perceived during the COVID-19 pandemic and emotional eating in girls, within the third phase of the Polish Adolescents' COVID-19 Experience (PLACE-19) Study. A nationwide sample of 818 Polish female adolescents, aged 15-20, was gathered. The adolescents were recruited to the study based on a random quota sampling procedure. Using a computer-assisted web interview (CAWI) survey, participants filled out the Emotional Eating Scale Adapted for Children and Adolescents (EES-C) to assess the urge to cope with negative emotions by eating, and the Adolescent Stress Questionnaire (ASQ) to assess perceived stress. Additionally, the data concerning body mass, height, as well as body mass change during the COVID-19 pandemic were verified. The groups most susceptible to emotional eating were excessive body mass female adolescents, those who gained weight during the COVID-19 pandemic and those experiencing high stress levels while facing negative emotions. In order to plan effective therapeutic interventions dealing with the issue of emotional eating, both psychological therapy and dietary strategy tailored to the individual should be considered for the indicated susceptible groups.

A New Approach Using BMI and FMI as Predictors of Cardio-Vascular Risk Factors among Mexican Young Adults

The study aimed to identify accurate cut-off points for waist circumference (WC), body fat percentage (BF%), body mass index (BMI), fat mass index (FMI), and fat-free mass index (FFMI), and to determine their effective accuracy to predict cardiovascular risk factors (CVRFs) among Mexican young adults. A cross-sectional study was conducted among 1730 Mexican young adults. Adiposity measures and CVRFs were assessed under fasting conditions. The optimal cut-off points were assessed using the receiver operating characteristic curve (ROC). Age-adjusted odds ratios (OR) were used to assess the associations between anthropometric measurements and CVRFs. The cut-off values found, in females and males, respectively, for high WC (≥72.3 and ≥84.9), high BF% (≥30 and ≥22.6), high BMI (≥23.7 and ≥24.4), high FMI (≥7.1 and ≥5.5), and low FFMI (≤16 and ≤18.9) differ from those set by current guidelines. High BMI in women, and high FMI in men, assessed by the 50th percentile, had the best discriminatory power in detecting CVRFs, especially high triglycerides (OR: 3.07, CI: 2.21-4.27 and OR: 3.05, CI: 2.28-4.08, respectively). Therefore, these results suggest that BMI and FMI measures should be used to improve the screening of CVRFs in Mexican young adults.

Weighing heavy: Heavy serving dishes increase food serving

The current work demonstrates that people serve themselves greater amounts of food when carrying heavier serving dishes. This effect occurs because increases in carried weight lower consumers' sensitivity to the weight of the food served. Decreased sensitivity to weight of food served in turn leads people to continue serving past the point where they would normally stop. The paper demonstrates this effect across two lab studies involving actual food serving (with a third lab study extending the outcomes to unhealthy food choices reported in the S1 Appendix). The studies also demonstrate liking for the food moderates the effect, such that carrying greater weight leads people to serve an increased amount of liked, but not of less well liked, foods. The findings extend prior research regarding the effects of dish weight on food judgment to provide a first demonstration of effects of weight not only on judgment but on behavior. In this, they help expand our understanding of the ways in which elements in the eating environment effects food consumption. In addition, the studies provide initial evidence for the mechanism behind the phenomenon: reduced sensitivity to weight. The research carries important implications for public well being, given that increases in serving sizes may contribute to obesity.

Metabolic and inflammatory profiles, gut microbiota and lifestyle factors in overweight and normal weight young thai adults

Obesity among young adults, especially those living in developing countries is increasing. A high body mass index (BMI) is one of the major causes of several diseases worldwide, constituting an important risk factor for non-communicable diseases (NCDs). Investigations describing the relationship between BMI, clinical and gut microbiota characteristics and lifestyle factors of overweight young adults, especially from Southeast Asian countries are limited. Metabolic and inflammatory biomarkers, fecal microbiota profiles and lifestyle factors were compared between overweight Thai young adults (n = 30, mean age 33 ± 9.48) and those with normal weight (n = 30, mean age 27 ±7.50). This study was registered with the Thai Clinical Trials Registry (TCTR20220204007). Health status including body composition, fasting glucose and insulin, lipid profiles, liver and kidney function, inflammatory biomarkers, blood pressure and fecal microbiota using 16S rRNA gene sequencing data was determined. Dietary intake was assessed using a 3-day dietary record and a food frequency questionnaire (FFQ), with physical activity levels compared using the international physical activity questionnaire (IPAQ). The overweight group had significantly higher BMI, waist-hip ratio, body fat mass, % body fat, skeletal mass, triglyceride level, C-reactive protein, insulin and blood pressure, with lower levels of high-density lipoprotein cholesterol (HDL-C) and blood urea nitrogen compared to the normal weight group. Significant differences in fecal microbiota composition at the family and genus levels were observed between the two groups. In our clinical setting, we also observed that unhealthy diets with high consumption of food rich in fat and sugar, processed meat and alcohol, and physical inactivity were associated with an increased prevalence of overweight in Thai young adults. Results provided the big picture of health and lifestyle characteristics of overweight young Thai people. Young adults should be encouraged to engage in health-promoting activities that maintain healthy bodyweight.

Age-specific effects of weight-based body size on fracture risk in later life: a lifecourse Mendelian randomisation study

Musculoskeletal conditions, including fractures, can have severe and long-lasting consequences. Higher body mass index in adulthood is widely acknowledged to be protective for most fracture sites. However, sources of bias induced by confounding factors may have distorted previous findings. Employing a lifecourse Mendelian randomisation (MR) approach by using genetic instruments to separate effects at different life stages, this investigation aims to explore how prepubertal and adult body size independently influence fracture risk in later life.Using data from a large prospective cohort, univariable and multivariable MR were conducted to simultaneously estimate the effects of age-specific genetic proxies for body size (n = 453,169) on fracture risk (n = 416,795). A two-step MR framework was additionally applied to elucidate potential mediators. Univariable and multivariable MR indicated strong evidence that higher body size in childhood reduced fracture risk (OR, 95% CI: 0.89, 0.82 to 0.96, P = 0.005 and 0.76, 0.69 to 0.85, P = 1 × 10- 6, respectively). Conversely, higher body size in adulthood increased fracture risk (OR, 95% CI: 1.08, 1.01 to 1.16, P = 0.023 and 1.26, 1.14 to 1.38, P = 2 × 10- 6, respectively). Two-step MR analyses suggested that the effect of higher body size in childhood on reduced fracture risk was mediated by its influence on higher estimated bone mineral density (eBMD) in adulthood.This investigation provides novel evidence that higher body size in childhood reduces fracture risk in later life through its influence on increased eBMD. From a public health perspective, this relationship is complex since obesity in adulthood remains a major risk factor for co-morbidities. Results additionally indicate that higher body size in adulthood is a risk factor for fractures. Protective effect estimates previously observed are likely attributed to childhood effects.

Association between walking pace and incident type 2 diabetes by adiposity level: A prospective cohort study from the UK Biobank

AIMS

To investigate the combined association of adiposity and walking pace with incident type 2 diabetes.

METHODS

We undertook a prospective cohort study in 194 304 White-European participants (mean age 56.5 years, 55.9% women). Participants' walking pace was self-reported as brisk, average or slow. Adiposity measures included body mass index (BMI), waist circumference (WC) and body fat percentage (BF%). Associations were investigated using Cox proportional hazard models, with a 2-year landmark analysis. A four-way decomposition analysis was used for mediation and additive interaction.

RESULTS

The median (interquartile range) follow-up was 5.4 (4.8-6.3) years. During the follow-up period, 4564 participants developed type 2 diabetes. Compared to brisk-walking participants with normal BMI, those with obesity who walked briskly were at an approximately 10- to 12-fold higher risk of type 2 diabetes (hazard ratio [HR] 9.64, 95% confidence interval [CI] 7.24-12.84, in women; HR 11.91, 95% CI 8.80-16.12, in men), whereas those with obesity and walked slowly had an approximately 12- to 15-fold higher risk (HR 12.68, 95% CI 9.62-16.71, in women; HR 15.41, 95% CI 11.27-21.06, in men). There was evidence of an additive interaction between WC and BF% and walking pace among women, explaining 17.8% and 47.9% excess risk respectively. Obesity mediated the association in women and men, accounting for 60.1% and 44.9%, respectively.

CONCLUSIONS

Slow walking pace is a risk factor for type 2 diabetes independent of adiposity. Promoting brisk walking as well as weight management might be an effective type 2 diabetes prevention strategy given their synergistic effects.

Multivariate resting-state functional connectomes predict and characterize obesity phenotypes

The univariate obesity-brain associations have been extensively explored, while little is known about the multivariate associations between obesity and resting-state functional connectivity. We therefore utilized machine learning and resting-state functional connectivity to develop and validate predictive models of 4 obesity phenotypes (i.e. body fat percentage, body mass index, waist circumference, and waist-height ratio) in 3 large neuroimaging datasets (n = 2,992). Preliminary evidence suggested that the resting-state functional connectomes effectively predicted obesity/weight status defined by each obesity phenotype with good generalizability to longitudinal and independent datasets. However, the differences between resting-state functional connectivity patterns characterizing different obesity phenotypes indicated that the obesity-brain associations varied according to the type of measure of obesity. The shared structure among resting-state functional connectivity patterns revealed reproducible neuroimaging biomarkers of obesity, primarily comprising the connectomes within the visual cortex and between the visual cortex and inferior parietal lobule, visual cortex and orbital gyrus, and amygdala and orbital gyrus, which further suggested that the dysfunctions in the perception, attention and value encoding of visual information (e.g. visual food cues) and abnormalities in the reward circuit may act as crucial neurobiological bases of obesity. The recruitment of multiple obesity phenotypes is indispensable in future studies seeking reproducible obesity-brain associations.

Workplace-based primary prevention intervention reduces incidence of hypertension: a post hoc analysis of cluster randomized controlled study

BACKGROUND

A workplace-based primary prevention intervention be an effective approach to reducing the incidence of hypertension (HTN). However, few studies to date have addressed the effect among the Chinese working population. We assessed the effect of a workplace-based multicomponent prevention interventions program for cardiovascular disease on reducing the occurrence of HTN through encouraging employees to adopt a healthy lifestyle.

METHODS

In this post hoc analysis of cluster randomized controlled study, 60 workplaces across 20 urban regions in China were randomized to either the intervention group (n = 40) or control group (n = 20). All employees in each workplace were asked to complete a baseline survey after randomization for obtaining sociodemographic information, health status, lifestyle, etc. Employees in the intervention group were given a 2-year workplace-based primary prevention intervention program for improving their cardiovascular health, including (1) cardiovascular health education, (2) a reasonable diet, (3) tobacco cessation, (4) physical environment promotion, (5) physical activity, (6) stress management, and (7) health screening. The primary outcome was the incidence of HTN, and the secondary outcomes were improvements of blood pressure (BP) levels and lifestyle factors from baseline to 24 months. A mix effect model was used to assess the intervention effect at the end of the intervention in the two groups.

RESULTS

Overall, 24,396 participants (18,170 in the intervention group and 6,226 in the control group) were included (mean [standard deviation] age, 39.3 [9.1] years; 14,727 men [60.4%]). After 24 months of the intervention, the incidence of HTN was 8.0% in the intervention groups and 9.6% in the control groups [relative risk (RR) = 0.66, 95% CI, 0.58 ~ 0.76, P < 0.001]. The intervention effect was significant on systolic BP (SBP) level (β =  - 0.7 mm Hg, 95% CI, - 1.06 ~  - 0.35; P < 0.001) and on diastolic BP (DBP) level (β =  - 1.0 mm Hg, 95% CI, - 1.31 ~  - 0.76; P < 0.001). Moreover, greater improvements were reported in the rates of regular exercise [odd ratio (OR) = 1.39, 95% CI, 1.28 ~ 1.50; P < 0.001], excessive intake of fatty food (OR = 0.54, 95% CI, 0.50 ~ 0.59; P < 0.001), and restrictive use of salt (OR = 1.22, 95% CI, 1.09 ~ 1.36; P = 0.001) in intervention groups. People with a deteriorating lifestyle had higher rates of developing HTN than those with the same or improved lifestyle. Subgroup analysis showed that the intervention effect of BP on employees with educational attainment of high school above (SBP: β =  - 1.38/ - 0.76 mm Hg, P < 0.05; DBP: β =  - 2.26/ - 0.75 mm Hg, P < 0.001), manual labor workers and administrative worker (SBP: β =  - 1.04/ - 1.66 mm Hg, P < 0.05; DBP: β =  - 1.85/ - 0.40 mm Hg, P < 0.05), and employees from a workplace with an affiliated hospital (SBP: β =  - 2.63 mm Hg, P < 0.001; DBP: β =  - 1.93 mm Hg, P < 0.001) were significantly in the intervention group.

CONCLUSIONS

This post hoc analysis found that workplace-based primary prevention interventions program for cardiovascular disease were effective in promoting healthy lifestyle and reducing the incidence of HTN among employees.

TRIAL REGISTRATION

Chinese Clinical Trial Registry No. ChiCTR-ECS-14004641.

Pharmacologic blockade of the natriuretic peptide clearance receptor promotes weight loss and enhances insulin sensitivity in type 2 diabetes

While natriuretic peptides (NPs) are primarily known for their renal and cardiovascular actions, NPs stimulate lipolysis in adipocytes and induce a thermogenic program in white adipose tissue (WAT) that resembles brown fat. The biologic effects of NPs are negatively regulated by the NP clearance receptor (NPRC), which binds and degrades NPs. Knockout (KO) of NPRC protects against diet induced obesity and improves insulin sensitivity in obese mice. To determine if pharmacologic blockade of NPRC enhanced the beneficial metabolic actions of NPs in type 2 diabetes, we blocked NP clearance in a mouse model of type 2 diabetes using the specific NPRC ligand ANP(4-23). We found that treatment with ANP(4-23) caused a significant decrease in body weight by increasing energy expenditure and reducing fat mass without a change in lean body mass. The decrease in fat mass was associated with a significant improvement in insulin sensitivity and reduced serum insulin levels. These beneficial effects were accompanied by a decrease in infiltrating macrophages in adipose tissue, and reduced expression of inflammatory markers in both serum and WAT. These data suggest that inhibiting NP clearance may be an effective pharmacologic approach to promote weight loss and enhance insulin sensitivity in type 2 diabetes. Optimizing the therapeutic approach may lead to useful therapies for obesity and type 2 diabetes.

Mediating effect of BMI on the relation of dietary patterns and glycemic control inT2DM patients: results from China community-based cross-sectional study

OBJECTIVE

To analyze the effects of different dietary types on in type 2 diabetes mellitus (T2DM) and determine the mediating effects of Body Mass Index (BMI) on dietary type with Fasting Plasma Glucose (FPG), Glycosylated Hemoglobin (HbA1c) on the associations in T2DM.

METHODS

Data of community-based cross-sectional study with 9602 participants including 3623 men and 5979 women were collected from the project 'Comprehensive Research in prevention and Control of Diabetes mellitus (CRPCD)' conducted by Jiangsu Center for Disease Control and Prevention in 2018. The dietary data were collected from a food frequency qualitative questionnaire (FFQ) and dietary patterns were derived through Latent Class Analysis (LCA). Then, Logistics regression analyses were used to evaluate the associations of FPG, HbA1c with different dietary patterns. The BMI (BMI = height/weight²) was used as a moderator to estimate the mediating effect. Mediation analysis was performed using hypothetical variables, the mediation variables, to identify and explain the observed mechanism of association between the independent and dependent variables while the moderation effect was tested with multiple regression analysis with interaction terms.

RESULTS

After completing Latent Class Analysis (LCA), the dietary patterns were divided into three categories: TypeI, TypeII, TypeIII. After adjusting for confounding factors such as gender, age, education level, marital status, family income, smoking, drinking, disease course, HDL-C, LDL-C, TC, TG, oral hypoglycemic drugs, insulin therapy, Hypertension, Coronary heart disease, Stroke, Type III were all significantly associated with HbA1c compared to those with Type I (P < 0.05), and the research showed the patients with Type III had High glycemic control rate. Taking type I as the reference level, the 95% Bootstrap confidence intervals of the relative mediating effect of TypeIII on FPG were (-0.039, -0.005), except 0, indicating that the relative mediating effect was significant (α_III = 0.346*, β_IIIFPG = -0.060*). The mediating effect analysis was performed to demonstrate that BMI was used as a moderator to estimate the moderation effect.

CONCLUSIONS

Our findings demonstrate that consuming Type III dietary patterns associates with good glycemic control in T2DM and the BMI associations would be playing a two-way effect between diet and FPG in Chinese population with T2DM, indicated that Type III could not only directly affect FPG, but also affect FPG through the mediating effect of BMI.

When Students Patronize Fast-Food Restaurants near School: The Effects of Identification with the Student Community, Social Activity Spaces and Social Liability Interventions

US schools have fast-food restaurants nearby, encouraging student patronage, unhealthy consumption, and weight gain. Geographers have developed an activity space framework which suggests this nearby location effect will be moderated by whether people perceive the location as their activity space. Therefore, we study whether students perceive a fast-food restaurant near school as their activity space, and whether social marketing messages can change that perception. We conducted six studies: a secondary data analysis with 5986 students, a field experiment with 188 students, and four lab experiments with 188, 251, 178, and 379 students. We find that students who strongly identify with their student community patronize a fast-food restaurant near school (vs. farther away) because they view it as their activity space, while students who weakly identify do not. For example, in our field experiment, 44% vs. 7% of students who strongly identified with the student community patronized the near versus farther restaurant, while only 28% versus 19% of students who weakly identified patronized the near and farther restaurants comparably. We also find that to deter the strong identifiers, messages should convey that patronage is a social liability, e.g., portray student activism against fast food. We show that standard health messages do not change perceptions of restaurants as social activity spaces. Thus, to combat the problem of fast-food restaurants near schools causing unhealthy consumption, policy and educational interventions should focus on students who strongly identify with their student community and find ways to weaken their perceptions that fast-food restaurants near schools are their activity spaces.

Obesity Stigma: Causes, Consequences, and Potential Solutions

PURPOSE OF REVIEW

This review aims to examine (i) the aetiology of obesity; (ii) how and why a perception of personal responsibility for obesity so dominantly frames this condition and how this mindset leads to stigma; (iii) the consequences of obesity stigma for people living with obesity, and for the public support for interventions to prevent and manage this condition; and (iv) potential strategies to diminish our focus on personal responsibility for the development of obesity, to enable a reduction of obesity stigma, and to move towards effective interventions to prevent and manage obesity within the population.

RECENT FINDINGS

We summarise literature which shows that obesity stems from a complex interplay of genetic and environment factors most of which are outside an individual's control. Despite this, evidence of obesity stigmatisation remains abundant throughout areas of media, entertainment, social media and the internet, advertising, news outlets, and the political and public health landscape. This has damaging consequences including psychological, physical, and socioeconomic harm. Obesity stigma does not prevent obesity. A combined, concerted, and sustained effort from multiple stakeholders and key decision-makers within society is required to dispel myths around personal responsibility for body weight, and to foster more empathy for people living in larger bodies. This also sets the scene for more effective policies and interventions, targeting the social and environmental drivers of health, to ultimately improve population health.

Robust Bioinformatics Approaches Result in the First Polygenic Risk Score for BMI in Greek Adults

Quantifying the role of genetics via construction of polygenic risk scores (PRSs) is deemed a resourceful tool to enable and promote effective obesity prevention strategies. The present paper proposes a novel methodology for PRS extraction and presents the first PRS for body mass index (BMI) in a Greek population. A novel pipeline for PRS derivation was used to analyze genetic data from a unified database of three cohorts of Greek adults. The pipeline spans various steps of the process, from iterative dataset splitting to training and test partitions, calculation of summary statistics and PRS extraction, up to PRS aggregation and stabilization, achieving higher evaluation metrics. Using data from 2185 participants, implementation of the pipeline enabled consecutive repetitions in splitting training and testing samples and resulted in a 343-single nucleotide polymorphism PRS yielding an R² = 0.3241 (beta = 1.011, p-value = 4 × 10^-193) for BMI. PRS-included variants displayed a variety of associations with known traits (i.e., blood cell count, gut microbiome, lifestyle parameters). The proposed methodology led to creation of the first-ever PRS for BMI in Greek adults and aims at promoting a facilitating approach to reliable PRS development and integration in healthcare practice.

Emotional Eating Interventions for Adults Living with Overweight or Obesity: A Systematic Review and Meta-Analysis

BACKGROUND

Emotional eating (EE) may be defined as a tendency to eat in response to negative emotions and energy-dense and palatable foods, and is common amongst adults with overweight or obesity. There is limited evidence regarding the effectiveness of interventions that address EE.

OBJECTIVES

To synthesize evidence on the effectiveness of EE interventions for weight loss and EE in adults living with overweight or obesity.

METHODS

This is a systematic review and meta-analysis. Adhering to the PRISMA guidance, a comprehensive electronic search was completed up to February 2022. Random effects meta-analysis was carried out to determine the percentage change in weight and EE scores.

RESULTS

Thirty-four studies were included. The combined effect size for percentage weight change was -1.08% (95% CI: -1.66 to -0.49, I² = 64.65%, n = 37), once adjusted for publication bias. Similarly, the combined effect size for percentage change in EE was -2.37%, (95% CI: -3.76 to -0.99, I² = 87.77%, n = 46). Cognitive Behavioural Therapy showed the most promise for reducing weight and improving EE.

CONCLUSIONS

Interventions to address EE showed promise in reducing EE and promoted a small amount of weight loss in adults living with overweight or obesity.

The effect of obesity on chronic diseases in USA: a flexible copula approach

We analyze the effect of obesity on the incidence of hypertension, hyperlipidemia and diabetes in USA using a health production theoretical framework along with a bivariate flexible semi-parametric recursive copula model that account for endogeneity. In this approach, the effects of control variables are flexibly determined using additive predictors that allow for a variety of effects. Our findings suggest that there exist a positive and significant effect of obesity on the prevalence of all chronic diseases examined. In particular, after endogeneity is accounted for, the probability of having hypertension, hyperlipidemia and diabetes for obese individuals are, respectively, 35%, 28% and 11% higher than those under the obesity threshold. These findings suggest that lowering obesity rates could lead to significant reductions in the morbidity and mortality associated with these diseases.

Genetically-predicted placental gene expression is associated with birthweight and adult body mass index

The placenta is critical to human growth and development and has been implicated in health outcomes. Understanding the mechanisms through which the placenta influences perinatal and later-life outcomes requires further investigation. We evaluated the relationships between birthweight and adult body mass index (BMI) and genetically-predicted gene expression in human placenta. Birthweight genome-wide association summary statistics were obtained from the Early Growth Genetics Consortium (N = 298,142). Adult BMI summary statistics were obtained from the GIANT consortium (N = 681,275). We used S-PrediXcan to evaluate associations between the outcomes and predicted gene expression in placental tissue and, to identify genes where placental expression was exclusively associated with the outcomes, compared to 48 other tissues (GTEx v7). We identified 24 genes where predicted placental expression was significantly associated with birthweight, 15 of which were not associated with birthweight in any other tissue. One of these genes has been previously linked to birthweight. Analyses identified 182 genes where placental expression was associated with adult BMI, 110 were not associated with BMI in any other tissue. Eleven genes that had placental gene expression levels exclusively associated with BMI have been previously associated with BMI. Expression of a single gene, PAX4, was associated with both outcomes exclusively in the placenta. Inter-individual variation of gene expression in placental tissue may contribute to observed variation in birthweight and adult BMI, supporting developmental origins hypothesis.

Predicting nutritional status for women of childbearing age from their economic, health, and demographic features: A supervised machine learning approach

BACKGROUND

Malnutrition imposes enormous costs resulting from lost investments in human capital and increased healthcare expenditures. There is a dearth of research focusing on the prediction of women's body mass index (BMI) and malnutrition outcomes (underweight, overweight, and obesity) in developing countries. This paper attempts to fill out this knowledge gap by predicting the BMI and the risks of malnutrition outcomes for Bangladeshi women of childbearing age from their economic, health, and demographic features.

METHODS

Data from the 2017-18 Bangladesh Demographic and Health Survey and a series of supervised machine learning (SML) techniques are used. Additionally, this study circumvents the imbalanced distribution problem in obesity classification by utilizing an oversampling approach.

RESULTS

Study findings demonstrate that the support vector machine and k-nearest neighbor are the two best-performing methods in BMI prediction based on the coefficient of determination (R2), root mean square error (RMSE), and mean absolute error (MAE). The combined predictor algorithms consistently yield top specificity, Cohen's kappa, F1-score, and AUC in classifying the malnutrition status, and their performance is robust to alternative standards. The feature importance ranking based on several nonparametric and combined predictors indicates that socioeconomic status, women's age, and breastfeeding status are the most important features in predicting women's nutritional outcomes. Furthermore, the conditional inference trees corroborate that those three features, along with the partner's educational attainment and employment status, significantly predict malnutrition risks.

CONCLUSION

To the best of our knowledge, this is the first study that predicts BMI and one of the pioneer studies to classify all three malnutrition outcomes for women of childbearing age in Bangladesh, let alone in any lower-middle income country, using SML techniques. Moreover, in the context of Bangladesh, this paper is the first to identify and rank features that are critical in predicting nutritional outcomes using several feature selection algorithms. The estimators from this study predict the outcomes of interest most accurately and efficiently compared to other existing studies in the relevant literature. Therefore, study findings can aid policymakers in designing policy and programmatic approaches to address the double burden of malnutrition among Bangladeshi women, thereby reducing the country's economic burden.

Adipose-targeted triiodothyronine therapy counteracts obesity-related metabolic complications and atherosclerosis with negligible side effects

Thyroid hormone (TH) is a thermogenic activator with anti-obesity potential. However, systemic TH administration has no obvious clinical benefits on weight reduction. Herein we selectively delivered triiodothyronine (T3) to adipose tissues by encapsulating T3 in liposomes modified with an adipose homing peptide (PLT3). Systemic T3 administration failed to promote thermogenesis in brown and white adipose tissues (WAT) due to a feedback suppression of sympathetic innervation. PLT3 therapy effectively obviated this feedback suppression on adrenergic inputs, and potently induced browning and thermogenesis of WAT, leading to alleviation of obesity, glucose intolerance, insulin resistance, and fatty liver in obese mice. Furthermore, PLT3 was much more effective than systemic T3 therapy in reducing hypercholesterolemia and atherosclerosis in apoE-deficient mice. These findings uncover WAT as a viable target mediating the therapeutic benefits of TH and provide a safe and efficient therapeutic strategy for obesity and its complications by delivering TH to adipose tissue.

Temporal changes in health-related lifestyle during the COVID-19 epidemic in Finland - a series of cross-sectional surveys

BACKGROUND

Public health recommendations and governmental restrictions during the COVID-19 epidemic have affect everyday life. This study aimed to examine temporal changes in health-related lifestyle and the accumulation of positive and negative changes in the key lifestyle factors (vegetable consumption, leisure-time physical activity, sleeping, alcohol consumption, smoking) in the same individuals among Finnish adults during the epidemic.

METHODS

This study was based on a series of cross-sectional surveys conducted between April 2020 and June 2021 to investigate antibody levels for the new coronavirus in the population. In each survey, a random sample of adults (18 to 69 years) from five university hospital regions were invited. A total of 5655 (response rate 32%) responded to the questionnaire including questions on lifestyle changes during epidemic.

RESULTS

On average one-sixth of respondents (17%) reported at least two negative changes in the key lifestyle factors during the study period. An increase in snacking and sleep problems and decrease in leisure-time physical activity and active commuting to work were the most common of individual negative changes. The proportion of negative changes in physical activity increased as the epidemic drags on. In contrast, on average every seventh of the respondents (14%) reported at least two positive lifestyle changes in the key lifestyle factors. The most common individual positive changes were increased consumption of fruit, berries and vegetables and decreased consumption of alcohol. More negative changes were reported on average, when both negative and positive changes in the key lifestyle factors were summed. The most negative changes were reported in the late 2020.

CONCLUSION

The results of the present study suggest that the lifestyle changes during the COVID-19 epidemic have been diverse being on average more commonly unfavorable than favorable for health. The deteriorated epidemic situation in the late 2020 and, on the other hand, prolonged epidemic predisposed to negative lifestyle changes. Further studies are important to examine whether these changes are maintained over time and to identify the factors that contribute to changes and their accumulation in the same individuals. Health promotion actions are needed to prevent the long-term effects of the epidemic on health and welfare.

Sustainable or Not? Insights on the Consumption of Animal Products in Poland

Animal products are one of the main constituents of the human diet. They are the main source of energy, proteins, microelements, and bioactive substances. The most popular negative health impacts linked with the consumption of animal products are obesity, atherosclerosis, heart attacks, and cancer. Apart from human health, consuming animal products is also controversial lately, due to farm animals' well-being and environmental protection issues. Thus, within the context of sustainability, the consumption trends of animal products were investigated through our on-line questionnaire surveys. The following animal products were involved in the survey: unprocessed meat (pork, beef, lamb, veal, mutton, chicken, duck, goose, turkey), processed meat (cold-cuts, sausages, pates), fish products, and eggs. Our research concluded that consumption among respondents with higher education was unsustainable for both unprocessed and processed meat, as eating habits in terms of type and quantity of consumed meat indicated respondents' unawareness. The consumption of fish products was also revealed as unsustainable regarding the quantity of fish consumed in terms of its beneficial nutritional values. Egg consumption was revealed as the most sustainable among the investigated animal products. However, insignificant egg consumption among the respondents showed the actual need of social education in terms of the current knowledge regarding the beneficial aspects of eggs.

Narrative-focused Group Counseling Improves Intervention Outcomes in Women With Obesity

OBJECTIVE

To investigate the effects of narrative group counseling combined with diet modification and exercise plans on weight loss in Iranian women with obesity.

DESIGN

Parallel 2-arm clinical trial.

PARTICIPANTS

Fifty-six Iranian women with obesity (aged 18-50 years).

INTERVENTION

The intervention group included weekly diet, exercise, and narrative-focused group counseling, whereas the comparison group included dietary modification and exercise sessions for 8 months (32 sessions).

MAIN OUTCOME MEASURE

Anthropometric and body composition parameters, blood biochemical parameters (high-density lipoproteins, low-density lipoproteins, triglycerides, fasting blood sugar, ghrelin, obestatin), physical activities, and appetite scores.

ANALYSIS

McNemar test was used for the variables that were not normally distributed and for scaling. Furthermore, t tests were used to compare quantitative variables with normal distributions. The original P (0.05) was adjusted to P = 0.0031 using the Bonferroni correction.

RESULTS

Weight, body mass index, body fat proportion, and hip circumference decreased significantly in the intervention vs comparison group. Serum low-density lipoproteins, triglycerides, total cholesterol, fasting blood sugar, appetite score, and ghrelin decreased, whereas obestatin increased significantly in the intervention vs comparison group.

CONCLUSIONS AND IMPLICATIONS

Narrative-focused group counseling combined with traditional strategies was effective in achieving significant changes in weight, body mass index, and appetite. Future studies with a more diverse audience and a longer follow-up are warranted.

Resveratrol Supplementation in Obese Pregnant Rats Improves Maternal Metabolism and Prevents Increased Placental Oxidative Stress

Maternal obesity (MO) causes maternal and fetal oxidative stress (OS) and metabolic dysfunction. We investigated whether supplementing obese mothers with resveratrol improves maternal metabolic alterations and reduces OS in the placenta and maternal and fetal liver. From weaning through pregnancy female Wistar rats ate chow (C) or a high-fat diet (MO). One month before mating until 19 days’ gestation (dG), half the rats received 20 mg resveratrol/kg/d orally (Cres and MOres). At 19dG, maternal body weight, retroperitoneal fat adipocyte size, metabolic parameters, and OS biomarkers in the placenta and liver were determined. MO mothers showed higher body weight, triglycerides and leptin serum concentrations, insulin resistance (IR), decreased small and increased large adipocytes, liver fat accumulation, and hepatic upregulation of genes related to IR and inflammatory processes. Placenta, maternal and fetal liver OS biomarkers were augmented in MO. MOres mothers showed more small and fewer large adipocytes, lower triglycerides serum concentrations, IR and liver fat accumulation, downregulation of genes related to IR and inflammatory processes, and lowered OS in mothers, placentas, and female fetal liver. Maternal resveratrol supplementation in obese rats improves maternal metabolism and reduces placental and liver OS of mothers and fetuses in a sex-dependent manner.

Teaching Second-Year Medical Students How to Counsel Pediatric Patients with Unhealthy Body Mass Index

Obesity affects the health and well-being of children globally. Despite recommendations to routinely screen children for obesity starting at age 6 years, physicians do not consistently address weight or provide effective weight-management counseling. We developed an interactive session for second-year medical students with foundational knowledge and practical communication skills around partnership and discussion of pediatric healthy weight management. Students were administered a pre-/post-Likert survey to self-assess knowledge, comfort, and confidence in counseling patients and caregivers about weight management. Students' related counseling skills were assessed during a standardized patient encounter of a teen with rapid weight gain. The session successfully increased students' self-assessed knowledge, comfort, and confidence, and resulted in successful application of weight management skills in a simulated patient encounter. Utilization of empathy skills requires continued coaching. We propose incorporation of similar sessions into medical school curricula to address the pediatric obesity epidemic.

The potential mechanisms of bergamot-derived dietary fiber alleviating high-fat diet-induced hyperlipidemia and obesity in rats

This study is aimed to investigate the health-associated benefits of bergamot-dietary fibers (DFs) with a special emphasis on weight loss and lipid-lowering effects, as well as the potential mechanisms involved. The feeding experiment of Sprague-Dawley (SD) rats for 6 weeks showed that DFs had dose-dependent regulatory effects against metabolic syndrome and they controlled obesity by slowing down the rate of weight growth, and reduced body mass index (BMI) and Lee's index without affecting appetite. Furthermore, DFs inhibited increment in TG, TC, LDL-C levels and AI index caused by a high-fat diet, and improved the pathological abnormality of the liver. Western blot results showed that DFs significantly up-regulated the protein expression levels of LXRα and CYP7A1, and down-regulated the levels of SREBP-1c, FAS, ACC and SREBP-2 in the liver. QRT-PCR results showed that DFs up-regulated PGC-1α, PRDM16, UCP-1, and PPARγ in brown adipose tissue. These results suggest that DFs played an effective role in reducing weight and lipids levels by promoting the decomposition and transport of lipids in liver, increasing the energy consumption of brown adipose tissue. DFs intervention reduced the difference in the intestinal microflora between rats fed with a normal diet and those fed with a high-fat diet. Soluble dietary fiber (SDF) and total dietary fiber (TDF) showed better weight loss and hypolipidemic potential compared to insoluble dietary fiber (IDF) at the same dose. In conclusion, bergamot-derived DFs demonstrated the potential to lower blood cholesterol and body weight and could be used to develop novel functional foods for the prevention or treatment of obesity and hyperlipidemia.

Anti-obesity Effects of Some Plant Extracts in Rats Fed with High-Fat Diet

Background and Aim:

Obesity has reached epidemic proportions around the world, resulting in severe health effects and financial costs, which have led to prompt actions and the advancement of phytochemistry technologies as new treatment techniques. This study aimed to assess and compare the anti-obesity, antioxidant, and anti-inflammatory effects of some common and safe doses of natural products like bitter orange, flax seeds, and ginger in adult male albino rats fed a high-fat diet.

Methods:

Fifty adult male albino rats were divided into five groups (n=10): a negative control group that received a balanced normal diet, a positive control group that received a high-fat diet (HFD) for eight weeks, and other 3 groups were fed HFD for eight weeks receiving daily 20 mg/kg/day of bitter orange fruit aqueous extract (standardized at 10% p- synephrine) or 250 mg/kg/- day of flax seeds ethanol extract or 200 mg/kg/day of ginger rhizomes ethanol extract for the last 4 weeks. All rats were sacrificed at the end of the study to obtain blood, liver, and kidney samples for biochemical and histopathological analyses.

Results:

The herbal extracts reduced body weight, lipid profile, inflammatory markers alpha-fetoprotein (AFP) and C reactive protein (CRP), malondialdehyde (MDA), and liver enzymes, all of which had been increased by the HFD. Furthermore, treatment with herbal extracts resulted in a significant reduction and improvement of the proliferated inflammatory infiltration, congested veins, and fatty vacuolated vesicles induced by HFD in liver and kidney tissues. Bitter orange exhibited the strongest anti-obesity effects, while flaxseed and ginger showed the strongest antioxidant and anti-inflammatory effects in response to the HFD.

Conclusion:

In obese rats, the use of these herbal extracts displayed a variety of possible protective and therapeutic effects. As a result, they are recommended for obese people, and further research is needed to determine the effects of a combination of various biochemical components found in these plant extracts on obesity and related disorders.

Secular Difference in Body Mass Index From 2014 to 2020 in Chinese Older Adults: A Time-Series Cross-Sectional Study

Background

Body mass index (BMI) is the most widely used parameter to assess the body weight status. Both the increase of BMI (overweight and obesity) and decrease of BMI (underweight) has been associated with high risk of adverse outcome, such as stroke, disability, and even death. However, recent data on secular differences in BMI in the Chinese aged population are limited. The present study provides robust new evidence about the evolving epidemic of obesity among aged adults in China.

Objective

Evaluating secular difference in BMI in a group of Chinese older adults.

Materials and Methods

We analyzed 7 continuous survey years (2014–2020), including 50,192 Chinese aged participants (25,505 men and 24,687 women, aged 71.9 ± 6.1 years, age range: 65–99 years). Information on sex, age, height, and body weight, was collected based on medical history. Participants were classified into four groups: underweight (BMI &lt; 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI &lt; 25 kg/m2), overweight (25 kg/m2 ≤ BMI &lt; 30 kg/m2), and obesity (BMI ≥ 30 kg/m2). Linear regressions were used to assess the secular difference in BMI. Sex and age differences were also evaluated by stratified analyses.

Results

From 2014 to 2020, age-adjusted mean BMI increased by 0.3 kg/m2 (95% CI: 0.1, 0.5 kg/m2) in men, and 0.5 kg/m2 (95% CI: 0.2, 0.7 kg/m2) in women. Age-standardized prevalence of underweight decreased from 3.0 to 2.3% in men, and from 3.0 to 2.1% in women. Age-standardized prevalence of overweight increased in both men (from 40.1 to 41.7%) and women (from 37.8 to 39.8%), and so as obesity (men: from 4.1 to 6.1%; women: from 5.8 to 8.7%).

Conclusion

Our results confirmed that BMI gradually increased from 2014 to 2020. The age-adjusted mean BMI increased by 0.3 kg/m2 in older men, and 0.5 kg/m2 in older women. The age- and sex-standardized prevalence of overweight and obesity significantly increased, especially in 70–79-year age group, while the prevalence of underweight decreased. The combination of a balanced-diet and physical exercise is needed to maintain optimal BMI range for the aged population.

Maternal Obesity as a Risk Factor for Caesarean Delivery in Sub-Saharan Africa: A Systematic Review

Background: Maternal obesity is associated with several adverse reproductive outcomes. It is a growing public health burden in sub-Saharan Africa, a region with low resources and capacity to care for the large, affected population. Objectives: To assess the evidence of maternal obesity as a risk factor for caesarean delivery in women in sub-Saharan Africa. Methods: A systematic review of relevant original articles using PubMed, MEDLINE, and CINAHL was performed. Google Scholar and the reference lists of relevant systematic reviews and meta-analyses were also searched for other eligible studies. Observational studies assessing maternal body mass index (BMI) ≥ 30 kg/m2 before or during gestation and caesarean delivery as birth outcome were included. Results: All 17 studies were published between 2009 and 2021 and included 227,675 (236−153,102) participants. The prevalence of maternal obesity ranged from 3.9 to 44%. All except two studies (88%) indicated an association of obesity and risk of caesarean delivery in pregnant women in sub-Saharan Africa. Overweight/obese women had up to 4-fold increased risk of caesarean delivery compared to normal weight women. Three studies also reported a direct relationship between morbid obesity and prevalence of caesarean delivery in the sub-region. The risk of caesarean delivery appears to increase with increasing BMI e.g., >5 times in women with BMI ≥ 40 kg/m2 than in normal weight women. Conclusions: In sub-Saharan Africa, increased BMI in pregnancy is a risk factor for subsequent caesarean delivery. The risk of caesarean delivery appears to increase with increasing BMI. A robust meta-analysis and other patho-mechanistic studies can be conducted to confirm causal association. Culturally appropriate weight management and nutritional interventions should be implemented to reduce the incidence of obesity-induced caesarean delivery in sub-Saharan Africa.

A nonrandomized controlled trial of individualized exercise prescription combined with remote exercise management in patients who are overweight or obese

Background

Between 2012 and 2020, the obesity rate increased among Chinese people aged 18 years and above, along with blood pressure, fasting blood glucose, serum total cholesterol, and triglycerides.

Purpose

Our objective was to compare the effects of a combined intervention, including individualized exercise prescription plus remote management versus individualized exercise prescription only, on cardiovascular risk factors in patients who are overweight or obese, with the aim of establishing a more effective remote model of health management than self-management.

Methods

This nonrandomized controlled trial (ChiCTR2100046307) studied patients who are overweight or obese at model labor health management centers from January 2019 to December 2019, including 55 people in the experimental group and 34 in the control group. The relevant indexes of all the research objects from both experimental group and control group were examined. Participants in the experimental group were given individualized exercise prescription combined with remote exercise management over a period of 3 months. The control group was prescribed exercise only at time of enrollment and taught about exercise once, followed by voluntary exercise and self-management for 3 months.

Result

After adjusting for baseline differences, the changes in weight (−2.72 ± 4.03 kg versus 0.32 ± 2.50 kg, P < 0.0001), body mass index (−0.99 ± 1.44 kg/m² versus 0.11 ± 0.92 kg/m², P < 0.0001), waist circumference (−2.98 ± 6.29 cm versus 0.60 ± 5.33 cm, P < 0.0001), visceral fat area (−9.75 ± 19.68 cm² versus −1.31 ± 12.37 cm², P = 0.028), body fat (− 2.65 ± 3.52 kg versus 0.54 ± 2.67 kg, P < 0.0001), body fat rate (−2.50 ± 3.32% versus 0.21 ± 3.30%, P < 0.0001), uric acid (−9.75 ± 19.68 µmol/L versus −1.31 ± 12.37 µmol/L, P = 0.028), serum total cholesterol (−0.11 ± 0.40 mmol/L versus −0.11 ± 0.59 mmol/L, P = 0.004), fasting insulin (− 2.36 ± 5.20 μU/mL versus 1.22 ± 7.34 μU/mL, P = 0.009), and homeostatic model assessment of insulin resistance (−0.62 ± 1.25 versus 0.14 ± 1.83, P = 0.022) were significantly better in the experimental group than in the control group after intervention.

Conclusion

Individualized exercise prescription combined with remote management in patients who are obese or overweight facilitated weight and fat loss, lowered blood pressure and serum total cholesterol, improved glucose metabolism and insulin resistance, and reduced cardiovascular risk factors. The intervention was superior to conventional education in terms of weight loss, fat reduction, total cholesterol reduction, fasting insulin reduction, and amelioration of insulin resistance.

Sensitivity, specificity of biochemical markers for early prediction of endothelial dysfunction in atherosclerotic obese subjects

BACKGROUND

The obesity increased incidence of diabetes, hypertension and atherosclerosis and rate of morbidity and mortality. The main cause of atherosclerosis is endothelial dysfunction and formation of foam cells and macrophage that lead to unfavorable complications. This study evaluated specific biomarkers for endothelial dysfunction as sensitive indices for early predication of atherosclerosis in obese subjects.

STUDY DESIGN

One hundred fifty male age and sex matching were included in the current study divided into three groups according to body mass index (BMI): Control (BMI ≤ 22), obese (BMI> 28) and obese with atherosclerosis (BMI> 28). Fasting serum was subjected for determination of adhesion molecules, sICAM-1, sVCAM-1, E-selectin, oxo-LDL and 8-iso-PGF2α by ELISA technique.

RESULTS

Data obtained showed that, a significant elevation of serum inflammatory markers CRP, IL-6 and TNF-α and adhesion molecules sICAM-1 (p<0.001) with sensitivity 96%, sVCAM-1 (p <0.01) with sensitivity 92%, E-selectin (p<0.001) with sensitivity 94%, oxo-LDL (p <0.05) and 8-iso-PGF2α (p < 0.001) with sensitivity 97% in obese with atherosclerosis compared with obese and control.

CONCLUSION

The levels of serum adhesion molecules contributed in the pathogenesis of endothelial dysfunction can be used as sensitive biomarkers for early prediction of atherosclerosis in obese subjects.

Exposure to Food Marketing via Social Media and Obesity among University Students in Saudi Arabia

This study investigated the associations between obesity and unhealthy food/drink intake with both the frequency of social media platform usage and food/drink marketing exposure on social media. Data were obtained from 316 university students aged 18−29 years at two universities in Jeddah, Saudi Arabia. These participants completed online questionnaires with sections on demographics, anthropometric measurements, social media platform usage, food marketing exposure via social media, and unhealthy food consumption. All of the participants, 20.3% and 13.6% were overweight and obese, respectively. Snapchat was the most popular application (85.8%), followed by Instagram (75%), YouTube (61%), Twitter (51%), and TikTok (50%). The obese participants were more likely to purchase foods/drinks after watching relevant social media advertisements than their non-obese counterparts (p < 0.04). Moreover, those who purchased foods/drinks more frequently after watching such advertisements consumed higher amounts of potato chips (p < 0.01) and fast foods (p < 0.03). Finally, those who used Snapchat, TikTok, and Instagram tended to have higher consumption rates for potato chips (p < 0.02), fast foods (p < 0.01), sweets (p < 0.02), and sugary drinks (p < 0.04). Public health policymakers in Saudi Arabia should consider regulating unhealthy food and drink advertisements on social media platforms, especially those targeted at younger generations.

A brief review of vitamin D as a potential target for the regulation of blood glucose and inflammation in diabetes-associated periodontitis

Diabetes is a metabolic disorder associated with various complications, including periodontitis. The risk of periodontitis is increased in patients with diabetes, while vitamin D deficiency is associated with both diabetes and periodontitis. Thus, there is a need to identify the molecular effects of vitamin D on the regulation of inflammation and glucose in diabetes-associated periodontitis. The Web of Science, Scopus, and PubMed databases were searched for studies of the molecular effects of vitamin D. Molecular effects were reportedly mediated by salivary secretions, interactions of advanced glycation end products (AGEs) with receptors of AGEs (RAGEs), cytokines, and oxidative stress pathways linking diabetes with periodontitis. Vitamin D supplementation attenuates inflammation in diabetes-associated periodontitis by reducing the levels of inflammatory cytokines and numbers of immune cells; it also has antibacterial effects. Vitamin D reduces cytokine levels through regulation of the extracellular signal-related kinase 1/2 and Toll-like receptor 1/2 pathways, along with the suppression of interleukin expression. Glucose homeostasis is altered in diabetes either because of reduced insulin production or decreased insulin sensitivity. These vitamin D-related alterations of glucoregulatory factors may contribute to hyperglycaemia; hyperglycaemia may also lead to alterations of glucoregulatory factors. This review discusses the pathways involved in glucose regulation and effects of vitamin D supplementation on glucose regulation. Further studies are needed to characterise the effects of vitamin D on diabetes-associated periodontitis.

Perception of School Committee Members (SCMs) on Factors Contributing to Overweight and Obesity Among High School Students in Kiribati: A Qualitative Study

Background

Schools are vital settings for overweight and obesity prevention among children and adolescents. School Committee Members (SCMs) are crucial assets to engaging students with overweight and obesity prevention programs. This study aimed to determine factors contributing to overweight and obesity among high school students in Kiribati through the perception of SCMs.

Methods

This prospective qualitative study was conducted in four randomly selected senior high schools in South Tarawa, Kiribati, from August to November 2020. With a purposive selection of 20 SCMs employed at the four high schools, both male and female participants consented to participate in the study. A semi-structured open-ended questionnaire was used for data collection using focus group discussions (FGDs). Data were transcribed and analyzed using the thematic analysis method.

Results

Twenty participants were involved in FGDs with equal number of SCMs (n = 5) who attended FGDs for each school and 45% of them were female participants. Six themes were identified, namely, knowledge, behaviors, perceived status toward overweight and obesity, perceived action benefits, perceived barriers to practices, and proposed strategies to overweight and obesity prevention. These themes reveal that SCMs have a broad understanding and skill set for overweight and obesity causes and effects. However, the aptitude alone is not enough to prevent the occurrence, and thus, proposed feasible plans were voiced for responsible stakeholders to include in policy developments for overweight and obesity prevention.

Conclusion

This study recognized that the knowledge-behavior gap is the main reason behind the failure in preventative strategic approaches among adolescents. As role models to students, SCMs and their schools should team up in implementing the public health policies and building mutual awareness and understanding with students and other specialist stakeholders for a more momentous and viable impact.

Gut peptide regulation of food intake - evidence for the modulation of hedonic feeding

The number of people living with obesity has tripled worldwide since 1975 with serious implications for public health, as obesity is linked to a significantly higher chance of early death from associated comorbidities (metabolic syndrome, type 2 diabetes, cardiovascular disease and cancer). As obesity is a consequence of food intake exceeding the demands of energy expenditure, efforts are being made to better understand the homeostatic and hedonic mechanisms governing food intake. Gastrointestinal peptides are secreted from enteroendocrine cells in response to nutrient and energy intake, and modulate food intake either via afferent nerves, including the vagus nerve, or directly within the central nervous system, predominantly gaining access at circumventricular organs. Enteroendocrine hormones modulate homeostatic control centres at hypothalamic nuclei and the dorso-vagal complex. Additional roles of these peptides in modulating hedonic food intake and/or preference via the neural systems of reward are starting to be elucidated, with both peripheral and central peptide sources potentially contributing to central receptor activation. Pharmacological interventions and gastric bypass surgery for the treatment of type 2 diabetes and obesity elevate enteroendocrine hormone levels and also alter food preference. Hence, understanding of the hedonic mechanisms mediated by gut peptide action could advance development of potential therapeutic strategies for the treatment of obesity and its comorbidities.

Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing

PURPOSE

To determine whether Hispanic residents receiving the Healthy Fit intervention enhanced with Motivational Interviewing (MI) experienced greater improvements in body composition, relative to participants receiving the initial intervention.

DESIGN

Quasi-experimental evaluation.

SETTING

El Paso, Texas.

SAMPLE

Among 656 baseline participants, 374 (54%) completed the 12-month assessment.

INTERVENTION

In Healthy Fit, community health workers (CHWs) promote nutrition and exercise. To strengthen intrinsic motivation and help participants overcome barriers to change, we incorporated a 30-minute motivational interview into the baseline assessment. Follow-up phone calls at 1, 3, and 6 months were identical across conditions.

MEASURES

CHWs assessed body mass index (BMI) and body fat percentage (BFP) using a bioelectrical impedance scale.

ANALYSIS

Regression models estimated differences between intervention conditions on change in BMI and BFP from baseline to the 12-month assessment.

RESULTS

Participants receiving MI had 2.13 times higher odds of losing weight (OR = 2.14, 95% CI [1.30, 3.53], P = .003) and 2.59 times higher odds of reduced BFP (OR = 2.59, 95% CI [1.51, 4.41], P < .001), relative to initial intervention participants. MI participants lost an average of 1.23 kg (2.71 lbs.) and their BFP declined 2% over 12 months.

CONCLUSION

Findings suggest CHW use of MI is a promising approach for promoting incremental changes in diet and exercise, which Healthy Fit integrates into a low-cost intervention.

Exploring New Drug Targets for Type 2 Diabetes: Success, Challenges and Opportunities

There are substantial shortcomings in the drugs currently available for treatment of type 2 diabetes mellitus. The global diabetic crisis has not abated despite the introduction of new types of drugs and targets. Persistent unaddressed patient needs remain a significant factor in the quest for new leads in routine studies. Drug discovery methods in this area have followed developments in the market, contributing to a recent rise in the number of molecules. Nevertheless, troubling developments and fresh challenges are still evident. Recently, metformin, the most widely used first-line drug for diabetes, was found to contain a carcinogenic contaminant known as N-nitroso dimethylamine (NDMA). Therefore, purity and toxicity are also a big challenge for drug discovery and development. Moreover, newer drug classes against SGLT-2 illustrate both progress and difficulties. The same was true previously in the case of glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors. Furthermore, researchers must study the importance of mechanistic characteristics of novel compounds, as well as exposure-related hazardous aspects of current and newly identified protein targets, in order to identify new pharmacological molecules with improved selectivity and specificity.

Perception of students on factors contributing to overweight and obesity among high school students in Kiribati: A qualitative study

BACKGROUND

Overweight and obesity among high school students is a growing distress not only to the individual wellbeing of a person but also to the productivity of communities and economic expense of both developed and developing nations. This study aimed to determine factors contributing to overweight and obesity among high school students in Kiribati through the perception of students.

METHODS

This qualitative study was conducted in four (4) randomly selected senior high schools on South Tarawa, Kiribati from August to November, 2020. A purposive sampling was used to select thirty-two (32) students enrolled into form levels 4-7. A semi-structured open-ended questionnaire was used for data collection using face-to-face in-depth interviews. Data was transcribed and analyzed using thematic analysis method.

RESULTS

This research revealed that the participants were 21 (65.6%) were females and 11 (34.4%) males from form levels four with 9 (28.1%) participants, five with 9 (28.1%) participants, and form seven with 14 (43.8%) participants. Five themes identified including determinants and prevention of overweight and obesity, education and health system factors, stigma, and being fat comes with high risk. These themes collectively elaborate on the essentials of overweight and obesity that are obtained from perspectives of students.

CONCLUSION

A strong cultural belief and practice has caused misperception of overweight and obesity among students with knowledge-behavior gap recognized as the main reason behind the failure in lifestyle changes among adolescents. Strengthen healthy behavioral lifestyle, improve awareness, and support feasible preventative strategies is recommended to all students.

Parents' perception of health promotion: What do parents think of a healthy lifestyle in parenting and the impact of the school environment? A qualitative research in the Netherlands

PURPOSE

This study aimed at gaining insight into parents' perceptions towards health behaviour in parenting and the impact of the school environment. Healthcare professionals experience barriers to discuss health behaviour in families where levels of overweight and obesity are elevated. There is a need to understand parents' perception and perceived significance of health behaviour.

DESIGN AND METHODS

Sixty-three semi-structured interviews were conducted with parents of children from three primary schools located in two different neighbourhoods in Zwolle, the Netherlands. Parents were asked to formulate their top three priority goals in parenting, additionally supplemented with 15 predetermined goals, including a health behaviour related goal. Parents ranked the goals in order of importance and gave an explanation. Finally, parents shared their opinions regarding the school environment in promoting health behaviour, according to the EnrG framework.

RESULTS

In 8 out of 63 interviews, health was reported in the top three self-formulated goals. Other goals considered important were happiness and being respectful to others. When health was ranked as less important in parenting, routine of health behaviour, own beliefs and religion were given as explanations. The physical school environment and teachers were mentioned as important factors in promoting health behaviour.

CONCLUSIONS

Parents indicate health behaviour as a key-element in parenting, even when health behaviour is not considered as the most important priority.

PRACTICE IMPLICATIONS

Since school is perceived as a logical and powerful environment, healthcare professionals should collaborate with school staff to empower their own, teachers' and parents' roles to address health promotion.