Obesity and Physical Activity

Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation

BACKGROUND

A plethora of weight management apps are available, but many individuals, especially those living with overweight and obesity, still struggle to achieve adequate weight loss. An emerging area in weight management is the support for one's self-regulation over momentary eating impulses.

OBJECTIVE

This study aims to examine the feasibility and effectiveness of a novel artificial intelligence-assisted weight management app in improving eating behaviors in a Southeast Asian cohort.

METHODS

A single-group pretest-posttest study was conducted. Participants completed the 1-week run-in period of a 12-week app-based weight management program called the Eating Trigger-Response Inhibition Program (eTRIP). This self-monitoring system was built upon 3 main components, namely, (1) chatbot-based check-ins on eating lapse triggers, (2) food-based computer vision image recognition (system built based on local food items), and (3) automated time-based nudges and meal stopwatch. At every mealtime, participants were prompted to take a picture of their food items, which were identified by a computer vision image recognition technology, thereby triggering a set of chatbot-initiated questions on eating triggers such as who the users were eating with. Paired 2-sided t tests were used to compare the differences in the psychobehavioral constructs before and after the 7-day program, including overeating habits, snacking habits, consideration of future consequences, self-regulation of eating behaviors, anxiety, depression, and physical activity. Qualitative feedback were analyzed by content analysis according to 4 steps, namely, decontextualization, recontextualization, categorization, and compilation.

RESULTS

The mean age, self-reported BMI, and waist circumference of the participants were 31.25 (SD 9.98) years, 28.86 (SD 7.02) kg/m2, and 92.60 (SD 18.24) cm, respectively. There were significant improvements in all the 7 psychobehavioral constructs, except for anxiety. After adjusting for multiple comparisons, statistically significant improvements were found for overeating habits (mean -0.32, SD 1.16; P<.001), snacking habits (mean -0.22, SD 1.12; P<.002), self-regulation of eating behavior (mean 0.08, SD 0.49; P=.007), depression (mean -0.12, SD 0.74; P=.007), and physical activity (mean 1288.60, SD 3055.20 metabolic equivalent task-min/day; P<.001). Forty-one participants reported skipping at least 1 meal (ie, breakfast, lunch, or dinner), summing to 578 (67.1%) of the 862 meals skipped. Of the 230 participants, 80 (34.8%) provided textual feedback that indicated satisfactory user experience with eTRIP. Four themes emerged, namely, (1) becoming more mindful of self-monitoring, (2) personalized reminders with prompts and chatbot, (3) food logging with image recognition, and (4) engaging with a simple, easy, and appealing user interface. The attrition rate was 8.4% (21/251).

CONCLUSIONS

eTRIP is a feasible and effective weight management program to be tested in a larger population for its effectiveness and sustainability as a personalized weight management program for people with overweight and obesity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04833803; https://classic.clinicaltrials.gov/ct2/show/NCT04833803.

"The burden of lifestyle diseases and their impact on health service in India"-A narrative review

Basically, non-communicable diseases (NCDs) are lifestyle diseases. They cannot be transmitted from one person to another person. Instead, our lifestyle, genetics, and environment influence our susceptibility to various diseases. In India, non-communicable illnesses and injuries are responsible for 52% of fatalities. The burden of non-communicable diseases and the resultant mortality are predicted to increase if the government does not take significant steps to prevent and control NCDs and related risk factors. According to the currently available research, the top causes of illness, disability, and death in India include hypertension, cardiovascular diseases, cancer, diabetes, lung disease, chronic renal disease, trauma, stroke, and chronic obstructive and mental disorders. Since 1980s, the Government of India has assisted the states through several vertical programs to prevent and control NCDs. However, efforts to prevent and control NCDs significantly increased under the 11th plan. New programs were launched on a small scale in a select few districts. The financial burden of NCDs has mostly stayed the same, though based on past experiences, reducing exposure to risk factors requires focusing on health promotion and preventative actions. The public healthcare system must have the tools and talents needed for effective management, early diagnosis, and screening. Effective monitoring systems, integrated management, and public awareness campaigns are required to successfully implement the program and make services available to all national citizens.

The Double Burden of Obesity and Underweight in Yemeni Adults

INTRODUCTION

 Yemen has a unique low-income population with several sociopolitical challenges and the association between weight disorders and sociodemographic and lifestyle factors is not clearly understood.

AIM

 The aim of this study is to estimate the prevalence of obesity, overweight and underweight among Yemeni adults, and to identify their associated factors.

METHODS

A cross-sectional study was conducted from 11 January to 25 March 2020, including 561 subjects of Yemen's adult population aged 18 and above, from four Yemeni governorates, who answered a questionnaire including demographic, socio-economic, and physical activity items after getting their signed consent. Height and weight were measured, and body mass index (BMI) was computed. The association between obesity or overweight (BMI ≥ 25.0kg/m2) or underweight (BMI < 18.5 kg/m2) and the other variables was analyzed using multinomial logistic regression.

RESULTS

A total of 561 subjects aged ≥ 18 years have participated in this survey. The overall prevalence of obesity and overweight was 10.3%, 95% CI [7.7%; 12.8%] and 20.3%, 95% CI [17%; 23.5%] respectively, while the one for underweight was 21.2%, 95% CI [17.8%; 24.5%]. The risk of overweight-obesity increased with age (OR=1.02, 95% CI (1.01-1.03)), living in urban areas (OR= 1.680, 95% CI (1.105-2.552)) and average-high socioeconomic status (SES) (OR= 1.729, 95% CI (1.156-2.587)) while the risk of underweight decreased with the age (OR= 0.981, 95% CI (0.964-0.998)).

CONCLUSION

These findings provide a special case of high prevalence of obesity, overweight, and underweight in Yemen. Therefore, implementing awareness and prevention programs is highly recommended there.

Personalized Care in Long QT Syndrome: Better Management, More Sports, and Fewer Devices

Long QT Syndrome (LQTS) is a potentially life-threatening yet highly treatable inherited cardiac channelopathy. When evaluating these patients, it is important to consider patient-specific as well as genotype-specific factors in order to adequately encompass the many nuances to care that exist in its management. The tendency to follow a "one-size-fits-all" approach needs to be replaced by treatment strategies that embrace the unique considerations of the individual patient in the context of their genotype. Herein, the authors aim to review the spectrum of LQTS, including the considerations when tailoring a personalized, genotype-tailored treatment program for a patient's LQTS.

Association between Pain and Frequent Physical Exercise among Adults in the United States: A Cross-Sectional Database Study

Pain affects over 20% of United States adults, and less than 50% of United States adults participate in frequent physical exercise. This cross-sectional database study included 13,758 United States adults aged >18 years from the 2020 Medical Expenditure Panel Survey (MEPS) and analyzed the association between severity of pain (independent variable) and frequent physical exercise (dependent variable), adjusting for demographic, economic, limitation, and health variables using multivariable logistic regression. The study showed 50.3% of adults report frequently exercising. Only 37.1% of adults reported experiencing pain of any degree, with a majority of them experiencing little pain. In the adjusted model, extreme pain vs. none, quite a bit of pain vs. none, Hispanic vs. non-Hispanic ethnicity, having a functional limitation vs. no limitation, and being overweight/obese vs. not being obese/overweight were associated with lower odds of reporting doing frequent physical exercise. Meanwhile, being ≥65 or 40-64 vs. 18-39 years of age, male vs. female, white vs. not white race, private or public vs. no health coverage, and good vs. poor general health were associated with greater odds of reporting doing frequent physical exercise. These variables associated with frequent physical exercise should be considered in future work when designing health interventions.

The use of cellulose, chitosan and hyaluronic acid in transdermal therapeutic management of obesity: A review

Obesity is a clinical condition with rising popularity and detrimental impacts on human health. According to the World Health Organization, obesity is the sixth most common cause of death worldwide. It is challenging to combat obesity because medications that are successful in the clinical investigation have harmful side effects when administered orally. The conventional approaches for treating obesity primarily entail synthetic compounds and surgical techniques but possess severe adverse effects and recurrences. As a result, a safe and effective strategy to combat obesity must be initiated. Recent studies have shown that biological macromolecules of the carbohydrate class, such as cellulose, hyaluronic acid, and chitosan, can enhance the release and efficacy of medications for obesity but due to their short biological half-lives and poor oral bioavailability, their distribution rate is affected. This helps to comprehend the need for an effective therapeutic approach via a transdermal drug delivery system. This review focuses on the transdermal administration, utilizing cellulose, chitosan, and hyaluronic acid via microneedles, as it offers a promising solution to overcome existing therapy limitations in managing obesity and it also highlights how microneedles can effectively deliver therapeutic substances through the skin's outer layer, bypassing pain receptors and specifically targeting adipose tissue.

Effects of physical activity interventions on anthropometric indicators and health indices in Chilean children and adolescents: A protocol for systematic review and/or meta-analysis

INTRODUCTION

Physical activity interventions have been a proven effective means of preventing or treating overweight and obesity in children and adolescents. The results of these interventions in many cases are based on the determination of the effect they produce on anthropometric evaluations, which allow the calculation of health indices. However, the effects of physical activity interventions on anthropometric assessments in Chilean children and adolescents have not been systematized. The objective of this study is to provide a detailed protocol for a systematic review with meta-analysis that synthesizes the available evidence on the effect of physical activity interventions on anthropometric indicators and health indices in Chilean children and adolescents and identifies the field-based methods and health indices most used for body composition estimation.

METHODS

This protocol was performed according to the PRISMA declaration. MEDLINE (PubMed), Web of Science, Scopus, and Scielo databases will be systematically searched. Eligible studies will include randomized controlled trials (RCTs), non-RCTs and pre-post studies.

CONCLUSION

This systematic review and meta-analysis protocol is designed to provide up-to-date evidence that could significantly assist public health policy makers and implementers of physical activity interventions through evidence-based guidance and recommendations.

The effect of calorie restriction on the anthropometric parameters, HOMA-IR index, and lipid profile of female office workers with overweight and obesity: a preliminary study

OBJECTIVES

This study evaluates the effect of a 3-month calorie restriction (CR) without snacking on the anthropometric parameters, Homeostatic Model Assesment of Insulin Resistance (HOMA-IR), and lipid profiles of female office workers with overweight or obesity, whose physical activity was limited during the COVID-19 pandemic lockdown.

MATERIAL AND METHODS

Forty-eight women aged 20-38 years (28.9±5.24) with low physical activity levels were divided into a non-snacking (NS) group (N = 21) and a snacking (S) group (N = 27) prior to the dietary intervention. Their daily energy intake during the intervention was lowered by 30% compared with the baseline level, and the proportion of polyunsaturated fatty acids and fiber in their diet was increased (to >30 g/day). The proportion of saturated fatty acids and simple carbohydrates was also reduced. The study participants were assessed at the baseline and post-intervention for anthropometric variables (body weight, body fat percentage BMI, waist circumference, hip circumference, waist-to-hip ratio) and the concentrations of insulin, total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Moreover, the values for HOMA-IR, the atherogenic index of plasma (AIP), and the ratios of TC/HDL-C, TG/HDL-C, and LDL-C/HDL-C were calculated.

RESULTS

All anthropometric parameter values obtained post-intervention were lower than the baseline in both groups. The serum insulin concentration and HOMA-IR decreased respectively by an average of 6% and 25% in the NS group and 37% and 45% in the S group. The lipid profiles of all participants improved significantly, with the LDL-C concentration showing a more promising trend in the S group (decrease by 27%) than in the NS group (17%).

CONCLUSIONS

The study showed that CR improved the anthropometric parameters, HOMA-IR index, and lipid profiles of all participants. Int J Occup Med Environ Health. 2022;35(6):693-706.

Outcomes of Athletes With Genetic Heart Diseases and Implantable Cardioverter-Defibrillators Who Chose to Return to Play

OBJECTIVE

To evaluate outcomes for athletes with a genetic heart disease (GHD) and an implantable cardioverter-defibrillator (ICD) after return-to-play (RTP) approval.

PATIENTS AND METHODS

We conducted a retrospective review of athletes with GHD and an ICD who were evaluated and treated in Mayo Clinic's Genetic Heart Rhythm Clinic between July 2000 and July 2020. Data on frequency of GHD-associated breakthrough cardiac events (BCEs), inappropriate shocks, and ICD-related complications were collected and analyzed.

RESULTS

There were 125 (57 [45.6%] female) GHD-positive athletes with an ICD (mean age at RTP was 19.8±11.6 years); 56 of 125 (44.8%) had long QT syndrome. Overall, 42 ventricular fibrillation-terminating ICD therapies were given to 23 athletes (18.4%) over an average follow-up of 3.6±3.5 years. Athletes with an ICD were more likely to experience a BCE during athletic follow-up (n=28 of 125, 22.4%) compared with those without an ICD (n=4 of 533, 0.8%; P<.0001). The BCE rate for athletes with ICDs was 6.3 events per 100 athlete-years of follow-up; this included 5.1 ventricular fibrillation-terminating events per 100 athlete-years compared with 0.3 BCEs per 100 patient-years for athletes without ICDs. In total, 6 (4.8%) athletes experienced at least one inappropriate shock (1.34 per 100 athlete-years) and 28 (29.6%) athletes had at least one other device-related complication (5.02 per 100 patient-years). However, none of these other complications occurred during sports.

CONCLUSION

This 20-year single-center study provides the longest spanning retrospective review of outcomes for athletes with ICDs given RTP approval. For athletes with GHD and an ICD, no sports-associated deaths or reports of sports-related ICD damage occurred.

Differential Associations Between Changes in Food Environment and Changes in BMI Among Adults Living in Urban, Low-Income Communities

BACKGROUND

Food environments can contribute to excess weight gain among adults, but the evidence is mixed.

OBJECTIVES

This longitudinal study investigated the associations between changes in the food environment and changes in BMI in adults and whether changes in the food environment differentially impact various subgroups.

METHODS

At 2 time points, BMI was calculated using self-reported height and weight data from 517 adults (mean age, 41 years) living in 4 New Jersey cities. The counts of different types of food outlets within 0.4, 0.8, and 1.6 km of respondents' residences were collected at baseline and tracked until follow-up. A binary measure of social standing (social-advantage group, n = 219; social-disadvantage group, n = 298) was created through a latent class analysis using social, economic, and demographic variables. Multivariable linear regression modeled the associations between changes in BMI with measures of the food environment; additionally, interaction terms between the measures of food environment and social standing were examined.

RESULTS

Overall, over 18 months, an increase in the number of small grocery stores within 0.4 km of a respondent's residence was associated with a decrease in BMI (β = -1.0; 95% CI: -1.9, -0.1; P = 0.024), while an increase in the number of fast-food restaurants within 1.6 km was associated with an increase in BMI (β = 0.1; 95% CI: 0.01, 0.2; P = 0.027). These overall findings, however, masked some group-specific associations. Interaction analyses suggested that associations between changes in the food environment and changes in BMI varied by social standing. For instance, the association between changes in fast-food restaurants and changes in BMI was only observed in the social-disadvantage group (β = 0.1; 95% CI: 0.02, 0.2; P = 0.021).

CONCLUSIONS

In a sample of adults living in New Jersey, changes in the food environment had differential effects on individuals' BMIs, based on their social standing.

Physical activity for health

Physical activity plays a substantial role in maintaining people's good health and mental wellbeing, but that is not all: not only it positively affects the individuals' mental and physical health, but a lack of physical exercise exerts a negative impact also on the overall economy of a nation. In addition, physical inactivity not only increases the risk of non-communicable diseases (NCD), but also contributes significantly to the increased morbidity and mortality in patients suffering from these diseases. On the contrary, physical activity reduces the risk of NCDs - such as cardiovascular diseases, type 2 diabetes, and cancer - in a dose-dependent manner; regular exercise is also associated with many health benefits and delayed mortality. However, understanding the role of physical activity in modern society and creating an awareness in the general population is one of the most important tasks of health and recreation promoters. Correspondingly, there is a dire need to enhance our knowledge, perception, and awareness of physical activity and its impacts on an individual's health, ultimately contributing to developing a healthy society. The current review will focus on the health benefits of the two most widely studied modifiable lifestyle risk factors, physical activity and diet, focusing particularly on the Mediterranean diet.

Determining the effective factors in predicting diet adherence using an intelligent model

Adhering to a healthy diet plays an essential role in preventing many nutrition-related diseases, such as obesity, diabetes, high blood pressure, and other cardiovascular diseases. This study aimed to predict adherence to the prescribed diets using a hybrid model of artificial neural networks (ANNs) and the genetic algorithm (GA). In this study, 26 factors affecting diet adherence were modeled using ANN and GA(ANGA). A dataset of 1528 patients, including 1116 females and 412 males, referred to a private clinic was applied. SPSS Ver.25 and MATLAB toolbox 2017 were employed to make the model and analyze the data. The results showed that the accuracy of the proposed ANN and ANGA models for predicting diet adherence was 93.22% and 93.51%, respectively. Also, the Pearson coefficient showed a significant relationship among the factors. The developed model showed the proper performance for predicting adherence to the diet. Moreover, the most effective factors were selected using GA. Some important factors that affect diet adherence include the duration of the marriage, the reason for referring to the clinic, weight, body mass index (BMI), weight satisfaction, lunch and dinner times, and sleep time. Therefore, applying the proposed model can help dietitians identify people who need more support to adhere to the diet.

Effects of Yoga on Blood Glucose and Lipid Profile of Type 2 Diabetes Patients Without Complications: A Systematic Review and Meta-Analysis

Background

Type II diabetes mellitus (T2DM) has become a worldwide public health problem. Although it has been empirically established that physical activity is a promising therapeutical approach to the prevention and management of T2DM, the effectiveness of yoga on T2DM has not yet reached an agreement across studies and also needs an updated synthetic examination.

Purpose

The purpose of this study was to examine the effect of yoga training on diabetes-related indicators compared with usual care.

Methods

The review protocol of this study has been registered in the PROSPERO with a registration number CRD42021267868. A systematic literature search through electronic databases was conducted to identify yoga-based intervention (i.e., randomized controlled trial [RCT]; e.g., yogic postures, movements, breathing, and meditation) studies reporting outcomes on glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial blood glucose (PPBG), total cholesterol (TC), triglycerides (TG), and body mass index (BMI). A number of two researchers manually reviewed and assessed each article using the Cochrane Risk of Bias Tool 2.0. The literature search identified 296 eligible entries, of which 13 were finalized after screening using predefined inclusion and exclusion criteria. The extracted data (group mean and standard deviation at posttest) were synthesized using random-effects meta-analyses. Finally, potential moderators were explored using subgroup analysis and sensitivity analysis.

Results

The standardized mean difference for the effects of yoga was significant on HbA1c (MD = -0.47; 95%CI: -0.77, -0.16; Z = 3.02, p = 0.003), FBG (SMD = -0.92; 95%CI: -1.55, -0.29; Z = 2.87, p = 0.004), PPBG (SMD = -0.53; 95%CI: -0.86, -0.21; Z = 3.20, p = 0.001), and TG (SMD = -0.32; 95%CI: -0.54, -0.10; Z = 2.86, p = 0.004). However, yoga effect was not observed on TC (SMD = -0.84; 95%CI: -1.71, 0.04; Z = 1.87, p = 0.06) and BMI (MD = -0.63; 95%CI: -1.42, 0.16; Z = 1.57, p = 0.12).

Conclusion

The findings suggest that yoga can improve the biochemical indices of blood glucose and the lipid profile of patients with T2DM. Therefore, yoga can be prescribed as an effective and active complementary treatment for T2DM. However, this study only tested yoga as a short-term treatment. In the future, rigorous RCTs with a larger sample size may be carried out to examine the long-term effect of yoga on T2DM.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=267868, identifier: CRD42021267868.

Effects of physical activity intensity on adulthood obesity as a function of long-term exposure to ambient PM2.5: Observations from a Chinese nationwide representative sample

Long-term exposure to PM_2.5 has been associated with increased obesity risk, while physical activity (PA) is a suggested protective factor. This raises a dilemma whether the increased dose of PM_2.5 due to PA-intensified ventilation would offset the benefits of PA. Using a national representative sample, we aim to (1) ascertain inclusive findings of the association between PA and obesity, and (2) examine whether PM_2.5 exposure modifies the PA-obesity relationship. We recruited 91,121 Chinese adults from 31 provinces using a multi-stage stratified-clustering random sampling method. PM_2.5 was estimated using a validated machine learning method with a spatial resolution of 0.1° × 0.1°. PA intensity was calculated as metabolic equivalent (MET)-hour/week by summing all activities. Body weight, height, and waist circumference (WC) were measured after overnight fasting. Obesity-related traits included continuous outcomes (Body mass index [BMI], WC, and waist-to-height ratio (WHtR)) and binomial outcomes (general obesity, abdominal obesity, and WHtR obesity). Generalized linear regression models were used to estimate the interaction effects between PM_2.5 and PA on obesity, controlling for covariates. The results indicated that each IQR increase in PA was associated with 0.078 (95% CI: -0.096 to -0.061) kg/m², 0.342 (-0.389 to -0.294) cm, and 0.0022 (-0.0025 to -0.0019) decrease in BMI, WC, and WHtR, respectively. The joint association showed that benefits of PA on obesity were attenuated as PM_2.5 increased. Risk of abdominal obesity decreased 11.3% (OR = 0.887, 95% CI: 0.866, 0.908) per IQR increase in PA among the low-PM_2.5 (≤55.9 μg/m³) exposure group, but only 5.5% (OR = 0.945, 95% CI: 0.930, 0.960) among the high-PM_2.5 (>55.9 μg/m³) exposure group. We concluded the increase in PA intensity was significantly associated with lower risk of obesity in adults living across mainland China, where annual level of PM_2.5 were mostly exceeding the standard. Reducing PM_2.5 exposure would enhance the PA benefits as a risk reduction strategy.

Experiences of exercise in patients with asthma: qualitative analysis of discussions in a UK asthma online community

BACKGROUND

Engagement with exercise in adults with asthma is suboptimal. Limited information is available regarding factors affecting engagement with exercise.

AIM

To explore experiences of exercise and linked unmet needs in adults with asthma.

DESIGN & SETTING

Qualitative thematic analysis of posts in a UK asthma online community, written between 2015 and 2020.

METHOD

Posts were identified using keywords searches. Posts in the 'Exercise' topic section were additionally included. Thematic analysis of posts was undertaken.

RESULTS

143 relevant posts were analysed. 92 participants were identified through posts (11M, 33F, 48 gender not stated, aged 26-73 years). Emerging themes included: fear of experiencing asthma symptoms during exercise, lack of information about how to deal with symptoms, external barriers, emotional response, and involvement of healthcare providers. Environmental factors, concomitant life stressors, distrust of healthcare professionals and embarrassment of displaying asthma symptoms during exercise were barriers to engagement. Facilitators included experiencing positive health outcomes following exercise and positive discussions regarding exercise with healthcare professionals. Strategies participants developed to enable exercise were warming up, increasing reliever and preventer inhalers when exercising and finding exercises felt as enjoyable.

CONCLUSION

Future interventions to address fears of exercise-induced physical symptoms, and clear instructions on the use of inhalers when exercising are needed. Exploring patients' attitudes to exercise in clinical consultations, especially in primary care, may be beneficial.

Elevating Subjective Well-Being Through Physical Exercises: An Intervention Study

Background: Physical activity is associated with higher levels of subjective well-being. However, little research has been conducted in naturalistic conditions with a longitudinal design. In the current study, we aimed to examine whether regular activity initiation can impact happiness, life satisfaction, and self-esteem 4 weeks later. Methods: The sample (N = 217, 124 women) was divided into three groups based on level of physical activity (active people, beginners, and inactive people). The participants completed measures of happiness, satisfaction with life, self-esteem, and a survey on physical activity. Ninety-five of participants who completed the same set of measures sent by email after 4 weeks were included in the analyses. Results: The study showed a strong relationship between subjective well-being and physical activity. Active people showed higher levels of happiness and self-esteem compared to beginners and inactive people and a higher level of life satisfaction than inactive people. Furthermore, after 4 weeks of exercising, beginners revealed greater life satisfaction and happiness compared to the baseline. Conclusion: These findings confirm that regular physical activity leads to higher levels of well-being. It seems that even a short engagement in physical activity (4 weeks) may contribute to an increase in subjective well-being.

Diet Therapeutics Interventions for Obesity: A Systematic Review and Network Meta-Analysis

BACKGROUND

Up to now, different diet therapeutics interventions have been introduced for the treatment of obesity. The present study aimed to compare the diet therapeutics interventions for obesity simultaneously.

STUDY DESIGN

Systematic review and network meta-analysis METHODS: The major international databases, including Medline (via PubMed), Web of Science, Scopus, Cochrane Library, and Embase, were searched using a predesigned search strategy. Randomized controlled trials (RCTs) that had compared the diet therapy interventions were included. The mean difference with a 95% confidence interval was used to summarize the effect size in the network meta-analysis. The frequentist approach was used for data analysis.

RESULTS

In total, 36 RCTs out of 9335 retrieved references met the inclusion criteria in this review. The included RCTs formed nine independent networks. Based on the results, Hypocaloricdiet+Monoselect Camellia (MonCam, P=0.99), energy restriction, behavior modification+exercise (LED) (P=0.99), sweetener at 20% of total calories (HFCS20)+Ex (P=0.67), catechin-richgreentea(650)+inulin (P=0.68), very low calorie diet (VLCD) (P=1.00), normal protein diet+resistance exercise (NPD+RT) (P=0.80), low-calorie diets+exercise (Hyc+Ex) (P=0.85), high-soy-protein low-fat diet (SD) (P=0.75), calorie restriction+behavioral weight loss (Hyc+BWL) (P=0.99) were the better treatments for weight loss in the networks one to nine, respectively.

CONCLUSION

Based on the results of network meta-analysis, it seems that Hypocaloricdiet+MonCam, LED, HFCS20+Ex, catechin-rich green tea +inulin, VLCD, NPD+RT, Hyc+Ex, SD, Hyc+BWL, are the better treatments for weight loss in patients with overweight and obesity.

Return-to-Play for Athletes With Long QT Syndrome or Genetic Heart Diseases Predisposing to Sudden Death

BACKGROUND

Within the last 5 years, cardiac society guidelines have begun to acknowledge shared decision making (SDM) for the athlete with sudden cardiac death-predisposing genetic heart diseases (GHDs), such as long QT syndrome (LQTS), and the possibility for that athlete's return to play. Previously, international guidelines embraced a de facto disqualification for all such athletes including athletes with solely a positive genetic test in Europe.

OBJECTIVES

This study sought to examine the prevalence and outcomes of athletes with sudden cardiac death-predisposing GHDs, particularly LQTS, after their return to play.

METHODS

A retrospective review of the electronic medical record was performed on all athletes with GHD, with a primary analysis for those with LQTS, who were evaluated, risk stratified, and treated in Mayo Clinic's Windland Smith Rice Genetic Heart Rhythm Clinic by a single genetic cardiologist between July 1, 2000, and July 31, 2020.

RESULTS

There were 672 athletes with GHD overall including 494 athletes with LQTS (231 female athletes [46.8%]; mean age at diagnosis 14.8 ± 10.5 years; mean follow-up 4.2 ± 4.8 years) who were given return-to-play approval. Overall, 79 of 494 athletes with LQTS (16.0%) were symptomatic before diagnosis, and 58 (11.7%) had an implantable cardioverter-defibrillator. In 2,056 combined years of follow-up, there was no GHD-sports associated mortality. Instead, 29 patients (5.9%) had ≥1 nonlethal, LQTS-associated breakthrough cardiac event. Of those, 15 (3.0%) were athletes at the time of the breakthrough cardiac event, with 3 (0.6%) experiencing a sports-related breakthrough cardiac event, and 12 (2.4%) a non-sports-related event. Overall, the event rate was 1.16 nonlethal events per 100 athlete-years of follow-up.

CONCLUSIONS

This 20-year single center experience challenges the status quo of disqualification for all athletes with LQTS and provides additional observational evidence, albeit from a single center, in support of the more contemporary SDM approaches to this complex issue.

Risk factors for overweight and obesity among women of reproductive age in Dar es Salaam, Tanzania

Background

Overweight and obesity have increased considerably in low- and middle-income countries over the past few decades, particularly among women of reproductive age. This study assessed the role of physical activity, nutrient intake and risk factors for overweight and obesity among women in Dar es Salaam, Tanzania.

Methods

We conducted a cross-sectional survey among 1004 women aged 15–49 years in the Dar es Salaam Urban Cohort Study (DUCS) from September 2018 to January 2019. Dietary intake was assessed using a food frequency questionnaire (FFQ). Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) using metabolic equivalent tasks (MET). Modified poison regression models were used to evaluate associations between physical activity and nutrient intake with overweight/obesity in women, controlling for energy and other factors.

Results

The mean (±SD) age of study women was 30.2 (±8.1) years. Prevalence of overweight and obesity was high (50.4%), and underweight was 8.6%. The risk of overweight/obesity was higher among older women (35–49 vs 15–24 years: PR 1.59; 95% CI: 1.30–1.95); women of higher wealth status (PR 1.24; 95% CI: 1.07–1.43); and informally employed and married women. Attaining moderate to high physical activity (≥600 MET) was inversely associated with overweight/obesity (PR 0.79; 95% CI: 0.63–0.99). Dietary sugar intake (PR 1.27; 95% CI: 1.03–1.58) was associated with increased risk, and fish and poultry consumption (PR 0.78; 95% CI: 0.61–0.99) with lower risk of overweight/obesity.

Conclusion

Lifestyle (low physical activity and high sugar intake), age, wealth status, informal employment and marital status were associated with increased risk of overweight/obesity, while consumption of fish and poultry protein was associated with lower risk. The study findings underscore the need to design feasible and high-impact interventions to address physical activity and healthy diets among women in Tanzania.

Physical Activity and Cumulative Long-Term Care Cost among Older Japanese Adults: A Prospective Study in JAGES

This study aimed to determine the impact of physical activity on the cumulative cost of long-term care insurance (LTCI) services in a cohort of community-dwelling people (65 years and older) in Japan. Using cohort data from the Japan Gerontological Evaluation Study (JAGES) on those who were functionally independent as of 2010/11, we examined differences in the cumulative cost of LTCI services by physical activity. We followed 38,875 participants with LTCI service costs for 59 months. Physical activity was assessed by the frequency of going out and time spent walking. We adopted a generalized linear model with gamma distribution and log-link function, and a classical linear regression with multiple imputation. The cumulative LTCI costs significantly decreased with the frequency of going out and the time spent walking after adjustment for baseline covariates. LTCI's cumulative cost for those who went out once a week or less was USD 600 higher than those who went out almost daily. Furthermore, costs for those who walked for less than 30 min were USD 900 higher than those who walked for more than 60 min. Physical activity among older individuals can reduce LTCI costs, which could provide a rationale for expenditure intervention programs that promote physical activity.

Validation of the Chinese version of the low physical activity questionnaire (LoPAQ) with ActiGraph accelerometer in hemodialysis patients

Background

Valid instruments for measuring physical activity at the low end of the physical activity range and producing quantitative results are required among dialysis patients who are extremely inactive. This study aimed to translate and adapt a Chinese version of the low physical activity questionnaire (LoPAQ) and to examine its reliability and validity among hemodialysis patients.

Methods

This was a cross-sectional study. The LoPAQ was translated into Chinese and culturally adapted following the standardized questionnaire adaptation process. Participants wore an ActiGraph for seven consecutive days and were asked to complete the Chinese version of the LoPAQ (C-LoPAQ) following the ActiGraph monitoring period. The criterion validity of the C-LoPAQ was examined with accelerometers using Spearman’s correlation coefficients. Bland-Altman plots were adopted to determine the absolute agreement between methods. The test-retest reliability was analyzed using the intraclass correlation coefficient (ICC).

Results

Eighty-five hemodialysis patients had valid accelerometers and C-LoPAQ data. The total walking time reported on LoPAQ was correlated with step counts by ActiGraph (rho = 0.47, p < 0.01). A moderate correlation was also observed between the C-LoPAQ and the ActiGraph-measured physical activity for total calories (rho = 0.44, p < 0.01). There was a fair correlation between ActiGraph-measured sedentary time and C-LoPAQ-measured inactive time (rho = 0.22, p < 0.05). The test-retest reliability coefficients of C-LoPAQ ranged from 0.30 to 0.66.

Conclusions

The C-LoPAQ demonstrated moderate validity for measuring low levels of physical activity, especially walking, and total kilocalories of physical activity among hemodialysis patients in China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-021-02230-3.

Influence of dietary and activity patterns on weight status of Ukrainian school aged children

Objectives Dietary patterns and physical activity have significant influence on weight status. Despite numerous studies related to this topic, there is no existing research which provides complete population-based studies that identify the most significant predictors of pediatric obesity. Therefore, it has become the major goal of our study. Subjects and methods Three hundred school students between 10 and 17 years of age were participating in our study. All of them are currently attending various schools in city of Ternopil, Ukraine. Anthropometric measurements were performed for all participants. Information about food consumption and physical activity was obtained from distributed questionnaire. Logistic regression was used to identify the significant predictors of obesity. Results Lack of physical activity during week (OR=2.59 [95% CI 1.10-6.08]), long screen time in weekdays (OR=2.94 [95% CI 1.13-7.69]) and weekends (OR=3.63 [95% CI 1.55-8.50]), frequent consumption (OR=2.60 [95% CI 1.30-5.19]) and high amounts (OR=2.52 [95% CI 1.26-5.05]) of sweet beverages, fast-food consumption (OR=30.97 [95% CI 1.46-657.60]) and overeating (OR=3.99 [95% CI 1.26-5.05]) have increased chance to be overweight in children 10-17 years of age (p<0.05). Conclusion Decreased frequency in moderate physical activity per week, increased amount of sugar-sweetened beverages, fast-food consumption per day and food consumption without hunger, appear to be the most significant predictors of overweight and obesity among Ukrainian school-aged children.

Association between long-term exposure to ambient air pollution and obesity in a Chinese rural population: The Henan Rural Cohort Study

Association between long-term exposure to ambient air pollution and obesity remains inconclusive, and the evidence from rural areas was limited. Thus, this study aimed to assess the association between ambient air pollution and obesity based on different anthropometric indices in Chinese rural adults, and further to compare the effect sizes of different air pollution types. A total of 38,824 participants (aged 18-79 years) were recruited from the Henan Rural Cohort Study. Logistic and multivariable linear regression model were used to examine the association between ambient air pollution exposure (including particulate matter with aerodynamic diameters ≤ 1.0 μm (PM₁), ≤2.5 μm (PM_2.5), and ≤10 μm (PM₁₀), and nitrogen dioxide (NO₂)) and obesity as well as obese anthropometric indices (including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BFP), and visceral fat index (VFI)). The potential effect modifications were also examined. Positive associations were found between long-term exposure to PM₁, PM_2.5, PM₁₀ and NO₂ and obesity regardless of how obesity was defined (false discovery rate (FDR) < 0.05). Moreover, BMI, WC, WHR, WHtR, BFP, and VFI displayed increased trends with PM₁, PM_2.5, PM₁₀ and NO₂ concentrations increasing (all FDR<0.05). PM₁₀ had the largest effects on obesity among the four types of air pollution. The elderly, women, individuals with low level of education and income, and those who had high fat diet were more vulnerable to the adverse effects of air pollution. In addition, the results of the sensitivity analysis showed that those associations between ambient air pollution and obesity remained robust. These findings suggest that long-term exposure to ambient air pollutant (particularly PM₁₀) may be positively associated with obesity in Chinese rural adults, especially among the elderly, women, individuals with low education and income, as well as unhealthy lifestyles.