Health Effects of Overweight and Obesity in 195 Countries over 25 Years

Next Steps in Efforts to Address the Obesity Epidemic

Obesity prevalence continues to rise globally at alarming rates, with adverse health and economic implications. In this state-of-the-art review, we provide an analysis of selected evidence about the current knowledge in the obesity literature, including a synthesis of current challenges in obesity and its determinants. In addition, we review past and current efforts to combat the obesity epidemic, highlighting both successful efforts and areas for further development. Last, we offer insights into the next steps to address the obesity epidemic and advance the field of obesity through both research and practice by (a) adopting a systems perspective, (b) fostering cross-sector and community collaborations, (c) advancing health equity, (d) narrowing the research-to-practice and research-to-policy gaps with multidisciplinary approaches, and (e) embracing complementary approaches for concurrent obesity prevention and treatment.

Cardioprotective benefits of metabolic surgery and GLP-1 receptor agonist-based therapies

Individuals with excessive adipose tissue and type 2 diabetes mellitus (T2DM) face a heightened risk of cardiovascular morbidity and mortality. Metabolic surgery is an effective therapy for people with severe obesity to achieve significant weight loss. Additionally, metabolic surgery improves blood glucose levels and can lead to T2DM remission, reducing major adverse cardiovascular outcomes (MACE). Glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1RAs) are a class of medication that effectively reduce body weight and MACE in patients with T2DM. This review explores the potential mechanisms underlying the cardioprotective benefits of metabolic surgery and GLP-1RA-based therapies and discusses recent evidence and emerging therapies in this dynamic area of research.

Beans Improve Satiety to an Effect that Is Not Significantly Different from Beef in Older Adults: A Randomized, Crossover Trial

BACKGROUND

Beans are a candidate food for increasing satiety due to their protein and dietary fiber content. Beef is a common animal protein that can increase satiety due to its protein content, which is higher than beans but does not contain dietary fiber. Dietary guidance encourages higher intake of plant-based protein foods and warrants satiety studies that compare plant and animal protein foods, which could particularly benefit the rapidly growing population segment of older adults.

OBJECTIVES

To compare the effects of 2 bean varieties and beef consumed within a breakfast tortilla on satiety, food intake, and 24-h energy intake in older adults.

METHODS

Older adults [n = 35, age 72.4 ± 6.66 y, BMI (in kg/m2) 25.1 ± 3.25] consumed 3 breakfast tortilla test meals containing 1 serving of black beans (135 g), red kidney beans (135 g), or beef (80 g) in a randomized, crossover design. Participants rated their appetite sensations on periodic visual analogue scales, food intake was measured at an ad libitum pizza lunch meal, and 24-h energy intake was measured using weighed food records. Appetite sensation area under the curves (AUCs) were compared between treatments using repeated-measures analysis of covariance, and food intake and 24-h energy intake were compared using repeated-measures analysis of variance.

RESULTS

Fullness and satisfaction were significantly increased, while hunger, desire to eat, and prospective food consumption were significantly decreased, following consumption of the black bean, red kidney bean, and beef test meals. Appetite sensation AUCs, ad libitum pizza intake, and 24-h energy intake did not significantly differ between the test meals.

CONCLUSIONS

These results demonstrate that beans improve satiety to an extent that is not significantly different from beef in older adults, thereby supporting the role of beans as a nutrient-dense source of protein and dietary fiber as part of a satisfying meal for older adults. This trial was registered at clinicaltrials.gov as NCT05499819.

Adapting the Nutrition and Physical Activity Self-Assessment: A Cross-Country Case Study of Improving Early Childhood Health Environments in the United States, Australia, and the United Kingdom

Background: Child overweight and obesity is a critical global health issue with substantial individual and societal impacts necessitating early intervention to establish healthy habits. Health promoting early childhood education (ECE) settings are important as most young children attend ECEs in high- and middle-income countries. Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC) is an evidence-based approach to support improvements to ECE environment for improving child health. While adapting proven child obesity prevention interventions from other countries offers efficiency, the process is frequently underreported and insufficiently documented. Methods: Guided by the ADAPT framework, this article describes the adaptation of NAPSACC in the United States (US), Australia (AU), and the United Kingdom (UK) from 2012 to 2023. Contextual differences in ECE systems in the US, AU, and UK and reflections on the process of adaptation were explored. Results: NAPSACC was successfully adapted, maintaining core theoretical components while allowing for implementation flexibility to meet varying contexts. The iterative adaptation process revealed that a flexible dynamic approach was essential for maintaining the relevance and effectiveness of the NAPSACC intervention in different contexts. Conclusions: Our experience highlights the importance of ongoing iteration, international collaboration, research, and responsiveness to evolving circumstances in adaptation processes. Strong and flexible leadership, such as that demonstrated by NAPSACC's founder, Dr. Dianne S. Ward, facilitates successful adaptation and continuous improvement of public health programs. Trial registration: This paper includes multiple registered trials - NCT02889198, ACTRN12619001158156, ISRCTN16287377, and ISRCTN33134697.

Obesity is associated with progressive brain structural changes

OBJECTIVE

The aim of this study was to investigate the relationship between obesity (OB) progression and brain structural changes.

METHODS

T1-weighted magnetic resonance images were acquired from 258 participants with overweight (OW) or OB and 74 participants with normal weight. Participants with OW or OB were divided into four groups according to BMI grades. Two-sample t tests compared disparities between the four subgroups and the participants with normal weight. We used causal structural covariance networks to examine the progressive impact of OB on brain structure.

RESULTS

With increasing BMI values, reductions in gray matter volume originated in the left caudate nucleus, medial orbitofrontal cortex, and left insula and expanded to the right hippocampus and left lateral orbitofrontal cortex and then to the right parahippocampal gyrus, left precuneus, and left dorsolateral prefrontal cortex (p < 0.05, false discovery rate corrected). The left caudate nucleus and medial orbitofrontal cortex are the primary hubs of the directional network, exhibiting positive causality to the right hippocampus and left dorsolateral prefrontal cortex. Moreover, the right hippocampus is identified as an important transition hub.

CONCLUSIONS

These findings suggest that changes in gray matter volume in individuals with OB may originate from reward/motivation processing regions, subsequently progressing to inhibitory control/learning memory regions, providing a new reference direction for clinical intervention and treatment of OB.

The role of leptin and ghrelin in the regulation of appetite in obesity

Leptin and ghrelin are two key hormones that play opposing roles in the regulation of appetite and energy balance. Ghrelin stimulates appetite and food intake following binding to receptors and the subsequent activation of orexigenic neurons in the arcuate nucleus. Leptin, conversely, has been demonstrated to suppress appetite and reduce food intake. This occurs through the inhibition of ghrelin-activated neurons, while simultaneously activating those that promote satiety and increase energy expenditure. A lack of biological response despite elevated leptin levels, which is known as leptin resistance, is observed in individuals with excess body weight and represents a significant challenge. As the dysregulation of ghrelin and leptin signalling has been linked to the development of obesity and other metabolic disorders, an in-depth understanding of the genetic determinants affecting these two hormones may facilitate a more comprehensive grasp of the intricate interactions that underpin the pathogenesis of obesity.

Rapid indirect detection of N-lactoyl-phenylalanine using dual DNA biosensors based on solution-gated graphene field-effect transistor

As obesity rates continue to rise, there is an increasing focus on reducing obesity through exercise. People are becoming more aware of the importance of weight loss through physical activity. However, the effectiveness of exercise can vary significantly among individuals, making it challenging to evaluate its impact. Therefore, establishing a reliable method for assessing exercise effectiveness is crucial for enhancing exercise quality and reducing obesity risk. It is noteworthy that the relationship between N-lactoyl-phenylalanine (N-Lac-Phe) and energy metabolism has garnered considerable attention. In this study, we developed a N-Lac-Phe biosensor by detecting L-lactic acid (L-Lac) and L-phenylalanine (L-Phe) based on Solution-Gated Graphene Field-Effect Transistors (SGGT). Our findings showed that the L-Lac and L-Phe biosensors exhibited excellent linearity within concentration ranges of 300 pM to 300 nM for L-Lac and 3 nM-1000 nM for L-Phe, with R2 values of 0.9934 and 0.9897, respectively. The detection accuracies for these two types of SGGT biosensors were 91.63 ± 6.97% and 99.39 ± 8.53%, respectively. Using the established N-Lac-Phe, L-Lac, and L-Phe relationship model (NLL model), we could calculate the concentration of N-Lac-Phe in the RAW264.7 culture medium based on the concentrations of L-Lac and L-Phe. The biosensors demonstrated excellent accuracy and selectivity, indicating their potential for rapidly evaluating the effectiveness of exercise.

Unexpected cardiovascular risks of glucagon-like peptide-1 receptor agonist and aspirin co-administration in individuals with obesity, with and without type 2 diabetes: A propensity score matched cohort study

AIMS

To examine the cardiovascular safety of combining glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with aspirin in individuals with obesity, both with and without type 2 diabetes (T2D).

MATERIALS AND METHODS

This propensity score matched cohort study analysed data from 2 946 579 individuals with obesity, with and without T2D, using the TriNetX US and Global dataset. Participants were categorized into four matched groups: those receiving GLP-1 RA plus aspirin versus those receiving GLP-1 RA alone, for both diabetic and non-diabetic individuals. Cardiovascular outcomes and adverse events were evaluated over 5 years using Cox proportional hazards models.

RESULTS

Individuals with obesity treated with GLP-1 RAs plus aspirin showed significantly higher risks of various cardiovascular events compared to those on GLP-1 RAs alone. In non-diabetic obese individuals, the combination therapy increased risks of hypertensive heart diseases (HR 1.40, 95% CI 1.15-1.60), ischaemic heart disease (HR 2.39, 95% CI 1.92-2.97) and heart failure (HR 1.97, 95% CI 1.54-2.53). Similar patterns were observed in individuals with T2D. Atrial fibrillation and cardiac arrhythmias showed increasing hazard ratios over time. The combination therapy also led to more frequent adverse events, including gastrointestinal bleeding.

CONCLUSIONS

The combination of GLP-1 RAs with aspirin in individuals with obesity, both with and without T2D, was associated with increased cardiovascular risks compared to GLP-1 RA monotherapy. These findings suggest that there may be risks associated with the combined use of these treatments and highlight the need for further research into this possible complication with regard to treatment.

Ecological impact and metabolic food waste of overweight and obese adults in Northern European and Mediterranean countries

Introduction

Overeating is one of the main drivers of obesity due to the accumulation of excess body fat (EBF). This issue not only impacts human health but also depletes the planet's environmental resources through the production of excess food. Thus, the Metabolic Food Waste (MFW) index was developed to measure the food wasted due to EBF accumulation, associated greenhouse gas (GHG) emissions, and the water and land resources used in its production.

Methods

The present study aims to evaluate and compare the MFW and ecological footprints of some Mediterranean countries (MC) and North European countries (NEC). The MFW for six Mediterranean and North European countries (NEC) was calculated using the following: (i) EBF: This is defined as the difference between ideal and actual body weight in overweight and obese adults, with data sourced from the FAOSTAT and WHO databases; (ii) Food waste: This includes the food wasted due to EBF accumulation and energy intake from major food categories. Data for food waste were obtained from the FAO Food Balance Sheets; and (iii) Environmental Impact: This encompasses GHG emissions, water consumption, and land use associated with EBF by different foods. Data were obtained from the WWF Virtual Shopping Cart and the Barilla Centre for Food and Nutrition. Data were analyzed for the total population and standardized per 100,000 citizens.

Results

The results showed that NEC had the highest rates of obesity, while MC recorded slightly higher rates of individuals classified as overweight. Overall, higher EBF values for 100,000 citizens, including both obese and overweight individuals, were found in NEC compared to MC, with smaller population countries predominantly contributing to these trends. Data on MFW and ecological footprints showed that, regardless of the country, the impact of obesity is two to three times greater than that of being overweight. The highest values of MFW and ecological footprints were found in MC, both in the total and among overweight/obese populations.

Discussion

The present study highlights the harmful role of the overeating as on human health as on the resource exploitations of the Earth. In particular, both MC and NEC showed similar alarming data about overeating and, consequently, negative impact on EBF and ecological footprints, suggesting that residence in countries close or far from Mediterranean basin is not a proxy of adherence to healthy dietary patterns. For this reason, informative campaigns should be developed to improve the knowledge on conscious dietary choices for human and planet healthiness.

Comparison of the effectiveness and safety of GLP-1 receptor agonists for type 2 diabetes mellitus patients with overweight/obesity: A systematic review and network meta-analysis

OBJECTIVE

To evaluate the effectiveness and safety of different Glucagon-like peptide-1 receptor agonists (GLP-1RAs) in treating type 2 diabetes mellitus (T2DM) with overweight/obesity using a systematic review and network meta-analysis.

METHODS

We searched PubMed, Embase, Cochrane Library, and Web of Science up to December 20, 2024, for randomized controlled trials (RCTs) involving T2DM patients with overweight/obesity treated with GLP-1RAs, with the control group receiving either a placebo or another GLP-1RA. We conducted a network meta-analysis assessed evidence using CINeMA.

RESULTS

A total of 4548 articles were retrieved, and 41 RCTs were included, comprising 15,126 patients and 13 different GLP-1RAs. Tirzepatide showed superior effects in lowering blood glucose (Compared with placebo, increased glycated hemoglobin: -1.64 (-1.94, -1.35), increased fasting blood glucose: -2.10 (-2.95, -1.25)) and weight loss (Compared with placebo, increased weight: -9.89 (-11.29, -8.49), rincreased BMI: -3.85 (-4.71, -2.99)). However, clinical efficacy of GLP-1RAs in lipid levels, blood pressure, and pancreatic function was not widely observed. Adverse reactions were significant with GLP-1RAs, but overall acceptable.

CONCLUSION

GLP-1RAs demonstrate efficacy and safety in T2DM patients with overweight/obesity, with certain advantages over other drugs. However, due to limitations in the number and quality of included studies, conclusions should be interpreted with caution.

Human gut microbial aromatic amino acid and related metabolites prevent obesity through intestinal immune control

Obesity affects millions of people in the world. The gut microbiome influences body fat accumulation, but the mechanisms remain to be investigated. Here, we show an association between microbial aromatic amino acid metabolites in serum and body fat accumulation in a large Chinese longitudinal cohort. We next identify that 4-hydroxyphenylacetic acid (4HPAA) and its analogues effectively protect male mice from high-fat-diet-induced obesity. These metabolites act on intestinal mucosa to regulate the immune response and control lipid uptake, which protects against obesity. We further demonstrate that T cells and B cells are not vital for 4HPAA-mediated obesity prevention, and innate lymphoid cells have antagonistic roles. Together, these findings reveal specific microbial metabolites as pivotal molecules to prohibit obesity through immune control, establishing mechanisms of host modulation by gut microbial metabolites.

Association of the time interval between first and last birth with obesity in middle-aged postmenopausal Chinese women: a cross-sectional study in southern China

Background

Birth interval is acknowledged as a significant factor affecting the health of women and their children. This study aimed to investigate the relationship between the time interval from the first to the last birth and the prevalence of general obesity, abdominal obesity, or both, among middle-aged postmenopausal Chinese women.

Methods

This cross-sectional survey examined 4,799 Chinese postmenopausal women, aged 45-59 years, who had at least one live birth. General obesity was assessed using body mass index (BMI), while abdominal obesity was evaluated through waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and waist circumference (WC). Multivariate linear and logistic regression models were employed to analyze the associations between the time interval from the first to the last birth and obesity.

Results

The values of all four obesity measures increased with a longer time interval between the first and last births (P for trend <0.001). After adjusting for potential confounding variables, women with an interval of 10 or more years between their first and last birth exhibited a prevalence of obesity that was 1.49 times (95% confidence interval [CI], 1.12-1.99) higher by BMI, 1.29 times (95% CI, 1.02-1.61) higher by WC, 1.23 times (95% CI, 1.04-1.69) higher by WHtR, and 1.50 times (95% CI, 1.01-2.12) higher by WHR when compared to those with a 0 to 1-year interval.

Conclusion

The time interval between the first and last birth was positively associated with an increased risk of obesity, particularly abdominal obesity, in middle-aged postmenopausal Chinese women. Therefore, healthcare providers should prioritize reproductive health issues among women, actively promote appropriate birth intervals, and advocate for evidence-based pregnancy planning for women of childbearing age. Moreover, these research findings offer valuable scientific insights for policymakers, enabling them to develop more targeted obesity prevention and management strategies specifically tailored to this demographic group.

Personalized Approaches to Diabetic Foot Care: The Impact of Ethnic and Socioeconomic Disparities

Objective: To explore the impact of ethnic and socioeconomic disparities on diabetic foot ulcer (DFU) care and outcomes, emphasizing the need for personalized treatment approaches tailored to diverse patient populations. Methods: This retrospective observational study analyzed 1409 patients hospitalized with DFUs between 2016 and 2023 at a tertiary medical center. Data extracted from electronic medical records included demographics, socioeconomic status (SES), clinical variables, and healthcare utilization. Statistical analyses included descriptive statistics, Chi-Square and Kruskal-Wallis tests, and a regularized logistic regression model to identify predictors of mortality and disparities in treatment access. Results: Arab patients had significantly lower SES (median score: 3.00) compared to Jewish patients (median score: 8.00), resulting in reduced healthcare access and worse clinical outcomes. Arab patients were diagnosed with diabetes at a younger age (57 years vs. 68 years for Jewish patients) and exhibited a higher body mass index (30.36 vs. 28.68, p < 0.05). Despite similar mortality rates between groups (21.52% vs. 22.83%, p = 0.65), differences in healthcare utilization were evident, particularly in younger patients (18-59 years) within the internal medicine department (p = 0.017). Conclusions: Our findings underscore the need for a personalized approach to diabetic foot care, integrating socioeconomic and demographic factors into treatment plans. Ethnic minorities with lower SES, earlier diabetes onset, and higher BMI may require tailored intervention strategies to optimize prevention, access to specialized care, and adherence to treatment. Addressing individualized patient needs through precision medicine and culturally adapted healthcare models can improve outcomes and reduce disparities in DFU management.

Establishing the relationships between obesity and genetically predicted serum micronutrient levels: a multivariable Mendelian randomization analysis

BACKGROUND

Previous observational studies have indicated that circulating micronutrients may influence obesity risk. This study aimed to explore the causal relationship between micronutrient levels and obesity through multivariable Mendelian randomization (MR) analysis.

METHODS

Single nucleotide polymorphisms (SNPs) significantly associated with 15 micronutrients (selenium, zinc, copper, calcium, beta-carotene, folate, iron, magnesium, potassium, and vitamins A, B6, B12, C, D, and E) from published genome-wide association studies (GWAS) were used as instrumental variables (IVs). Three obesity-related datasets were obtained from the GWAS. Inverse variance weighted (IVW) is the main method used for MR analysis. Leave-one-out analysis, MR-Pleiotropy Residual Sum and Outlier method (MR-PRESSO), weighted median, and MR-Egger method were used to assess pleiotropy and heterogeneity.

RESULTS

Genetically predicted levels of circulating selenium and calcium are causally related to the risk of obesity (calcium odds ratio [OR]: 1.478, 95% confidence interval [CI] 1.128-1.935, p = 0.005; selenium OR: 1.478, 95% CI 1.128-1.935, p = 0.005). Multivariate MR analysis suggested a causal relationship between circulating selenium and calcium levels and obesity risk (calcium OR: 1.625, 95% CI 1.260-2.097; selenium OR: 1.080, 95% CI 1.003-1.163, p = 0.041). The p-value obtained in the Cochrane Q test, MR-Egger intercept test, and MR-PRESSO were > 0.05, suggesting no significant evidence of pleiotropy or heterogeneity.

CONCLUSION

Our study revealed, for the first time, a positive correlation between elevated circulating calcium and selenium levels and an increased obesity risk. These findings provide valuable insights into obesity's underlying mechanisms. Nevertheless, further large-scale clinical studies are required to confirm our results.

LEVEL OF EVIDENCE

Level III, Mendelian randomization.

The clinical antiprotozoal drug halofuginone promotes weight loss by elevating GDF15 and FGF21

Obesity is a debilitating global pandemic with a huge cost on health care due to it being a major underlying risk factor for several diseases. Therefore, there is an unmet medical need for pharmacological interventions to curb obesity. Here, we report that halofuginone, a Food and Drug Administration-approved anti-scleroderma and antiprotozoal drug, is a promising anti-obesity agent in preclinical mouse and pig models. Halofuginone suppressed food intake, increased energy expenditure, and resulted in weight loss in diet-induced obese mice while also alleviating insulin resistance and hepatic steatosis. Using molecular and pharmacological tools with transcriptomics, we identified that halofuginone increases fibroblast growth factor 21 (FGF21) and growth differentiation factor 15 (GDF15) levels via activating integrated stress response. Using Gdf15 and Fgf21 knockout mice, we show that both hormones are necessary to elicit anti-obesity changes. Together, our study reports the beneficial metabolic effects of halofuginone and underscores its utility in treating obesity and its associated metabolic complications, which merits clinical assessment.

Diuretics: a review of the pharmacology and effects on glucose homeostasis

Thiazides, thiazide-like and loop diuretics are commonly prescribed to manage hypertension and heart failure. The main mechanism of action of these diuretics involve inhibition of Na+ reabsorption in the kidneys, leading to increased urine production. While effective, diuretics, particularly hydrochlorothiazide, have been linked to altered glucose metabolism and other metabolic issues. These disruptions in fuel homeostasis are not clearly related to their primary action of fluid management, raising concerns for patients with metabolic syndrome, in which high blood pressure coexists with obesity, insulin resistance, glucose intolerance and dyslipidemia. In this review, we conducted an extensive examination of existing literature on these classes of diuretics, covering publications from the late 1950s to the present. Our objective was to investigate the origins, development and current understanding of the widely recognized association between the use of diuretics in general and their potential negative impact on glucose homeostasis. We focused on the clinical and experimental evidence of the most commonly prescribed diuretics: hydrochlorothiazide, chlorthalidone, bumetanide and furosemide. On one hand, the clinical evidence supports the hypothesis that the metabolic effects on glucose homeostasis are primarily linked to hydrochlorothiazide, with little, if any impact observed in other diuretics. In addition, these metabolic effects do not appear to be related to their diuretic action or intended pharmacological targets, raising concerns about the long-term metabolic impact of specific diuretics, particularly in vulnerable populations, including those with metabolic syndrome. On the other hand, the experimental evidence using animal models suggest variable effects of diuretics in insulin secretion and general glucose metabolism. Although the mechanisms involved are not clearly understood, further research is needed to uncover the molecular mechanisms by which certain diuretics disrupt fuel metabolism and contribute to metabolic disturbances.

Body mass index trajectories and all-cause mortality in older Chinese adults: Hong Kong's Elderly Health Service Cohort

BACKGROUND

Weight loss at older ages appears to be associated with higher mortality in Western and some East Asian countries, despite differences in the prevalence of obesity; whether it is relevant to China is unknown. We examined the association of body mass index (BMI) trajectories with all-cause mortality in older Chinese adults by sex and baseline age (65-69 years, 70+ years).

METHODS

54 160 participants aged 65 or above from Hong Kong's Elderly Health Service Cohort with at least five BMI measurements were included. We identified distinct BMI trajectories using group-based trajectory modelling. We assessed the associations of BMI trajectories with mortality risk using a Cox model stratified by sex and age.

RESULTS

Compared with 'normal weight, stable', the 'low-normal weight, decreasing' had higher mortality risk in both sexes and age groups (eg, HR 1.43, 95% CI 1.24 to 1.66 in men aged 65-69 years). The 'overweight, stable' and 'obese, stable' had lower mortality risk, especially in men at older ages. However, the proportion in the 'low-normal weight, decreasing' was greater at 70+ years than at 65-69 years, while the proportion in the 'overweight, stable' and 'obese, stable' was lower in the older group.

CONCLUSIONS

Decreasing BMI is a likely symptom of ill health in older adults. Inconsistency between the risks and the proportion in each BMI trajectory group by age suggests the observed associations could be driven by changes in weight and preferential recruitment of survivors. Maintaining a healthy weight remains relevant at older ages.

Level of overweight and obesity surpassed underweight among women in 40 low and middle-income countries: Findings from a multilevel multinomial analysis of population survey data

BACKGROUND

Despite continued global and local initiatives to address nutritional problems, low- and middle-income countries are facing both malnutrition and non-communicable diseases, with about 80% of non-communicable disease-related deaths. There is a dearth of recent evidence on the extent and determinants of underweight, overweight, and obesity in this region, which is essential for guiding intervention programs. Thus, this study intended to provide insights into the current level of malnutrition among women of reproductive age in low- and middle-income countries.

METHODS

A secondary analysis of Demographic and Health Survey data from 40 low- and middle-income countries was performed using a weighted sample of 1,044,340 women of reproductive age. Forest plots and line graph were used to present the pooled and regional estimates of underweight and overweight and obesity. A multilevel multinomial logistic regression models were fitted to identify determinants of malnutrition and models were compared based on the deviance and log-likelihood values. In the final model, statistical significance was determined using an adjusted relative risk ratio with the corresponding 95% confidence interval.

RESULTS

The overall prevalence of obesity and overweight was 26.8% (95% CI: 26.7%-26.9%), with the highest rate in Jordan (67.2%) and lowest in Burundi (9.5%). Additionally, the level of underweight was found to be 15.6% [95% CI: 15.5%-15.7%], ranging from 1.3% in Jordan to 25.4% in Timor-Leste. Women of families with middle and rich wealth indexes, those aged 25-34 and 35-49, contraceptive users, those with primary and higher education, and urban residents were more likely to be overweight or obese. In contrast, the results showed a lower likelihood of undernutrition among women in the households with middle [ARRR (95% CI): 0.83 (0.80-0.86)] and rich wealth indexes [ARRR (95% CI): 0.73 (0.71-0.76)], those with primary [ARRR (95% CI): 0.70 (0.68-0.73)], secondary [ARRR (95% CI): 0.71 (0.69-0.74)], and higher education [ARRR (95% CI): 0.57 (0.53-0.61))], and women with media access [ARRR (95% CI): 0.79 (0.77-0.82)].

CONCLUSION

Over a quarter of women of reproductive age in LMICs were overweight or obese, with underweight affecting 15.6%. It was also found that the levels of overweight and obesity were higher than the rate for underweight, with wide variations across the countries. Thus, efforts to improve the modifiable risks can have a positive impact on reducing undernutrition and over-nutrition. Given the considerable variations between countries and survey periods, nutrition programs should also be tailored to the specific needs and cultural contexts of different regions within the study settings. Furthermore, the findings suggest the need for regular monitoring and evaluation of the existing nutritional interventions to assess their effectiveness.

Missense variants in FRS3 affect body mass index in populations of diverse ancestries

Obesity is associated with adverse effects on health and quality of life. Improved understanding of its underlying pathophysiology is essential for developing counteractive measures. To search for sequence variants with large effects on BMI, we perform a multi-ancestry meta-analysis of 13 genome-wide association studies on BMI, including data derived from 1,534,555 individuals of European ancestry, 339,657 of Asian ancestry, and 130,968 of African ancestry. We identify an intergenic 262,760 base pair deletion at the MC4R locus that associates with 4.11 kg/m2 higher BMI per allele, likely through downregulation of MC4R. Moreover, a rare FRS3 missense variant, p.Glu115Lys, only found in individuals from Finland, associates with 1.09 kg/m2 lower BMI per allele. We also detect three other low-frequency FRS3 missense variants that associate with BMI with smaller effects and are enriched in different ancestries. We characterize FRS3 as a BMI-associated gene, encoding an adaptor protein known to act downstream of BDNF and TrkB, which regulate appetite, food intake, and energy expenditure through unknown signaling pathways. The work presented here contributes to the biological foundation of obesity by providing a convincing downstream component of the BDNF-TrkB pathway, which could potentially be targeted for obesity treatment.

The Role of Recreational Physical Activity in Adherence to the Mediterranean Diet in the Greek Population: Public Health and Sustainability Implications

The Mediterranean diet (MedDiet) is renowned for its health benefits and cultural significance in Mediterranean populations. The present study investigates the question of whether individuals who participate in recreational activities exhibit higher adherence to the MedDiet than those who do not engage in such activities. A cross-sectional survey was conducted with participants completing questionnaires assessing demographic characteristics, MedDiet adherence, and dietary habits. A total of 1055 participants of both sexes with an average age of 32.2 ± 10.1 years participated in the survey, and they were classified based on their engagement in recreational physical activity. Statistical analyses included independent samples t-tests, chi-squared tests, analysis of variance (ANOVA), and multiple regression analysis. The results demonstrated that physically active individuals exhibited significantly higher adherence to the MedDiet than non-exercisers (p < 0.001), supporting the hypothesis that exercise is associated with healthier dietary choices. Regression analysis further revealed that exercise, olive oil consumption, and family meals were significant predictors of MedDiet adherence. Additionally, group comparisons highlighted differences in BMI (p < 0.001), meal frequency (p < 0.001), and food preparation habits (p < 0.001), indicating that exercisers were more likely to adopt a holistic Mediterranean lifestyle. These findings emphasize the importance of integrating physical activity with dietary education in public health policies. Promoting an active lifestyle alongside MedDiet principles may enhance overall well-being and contribute to sustainable health strategies.

Polygenic scores of obesity in childhood based on summary statistics from adults versus children

The lack of polygenic scores (PGSs) developed for body mass index (BMI) in children may be problematic because the genetic architecture characterizing BMI changes throughout life. This study aims to describe the genetic susceptibility to obesity in children and to compare two PGSs based on data from adults and children and their association with BMI and discrimination of obesity. The study sample comprises 717 participants aged 4-13 years. Adult- and child-based PGSs were evaluated by examining (1) mean BMI across polygenic score risk categories, (2) the capacity to identify obesity with logistic regression, and (3) the linear association with BMI z-scores using linear regression. Increases in one standardized unit of adult-based PGS were related to a stronger increase in BMI z-score (β = 0.24-0.39) than PGS derived in children (β = 0.21-0.30). The association between obesity and the child score was higher (OR = 1.75-2.33) than that for the adult score (OR = 1.74-2.06) for the age group 4-7 years. The inverse was observed for the age group 8-13 years (ORchild 1.56-1.79 vs. ORadult 1.78-2.54). Both adult- and child-based PGSs show strong associations with BMI and risk of obesity, with the adult-based score standing out from 8 years old.

Obesity among college students in Oman: implications for health and academic performance

This study examines the impact of obesity on the current health and academic performance of college students, with potential long-term implications for their overall well-being. Using survey data from 300 students at a university in the Arab Gulf of Oman, the study finds that over 27% of students are classified as overweight or obese. The analysis reveals a significant negative relationship between obesity and academic performance, with obese students showing a 6.6% decrease in academic grades compared to their peers of healthy weight. The findings suggest that the likelihood of earning lower academic grades is 2.54 times higher among obese students than those with normal weight. Additionally, the study indicates that obese students face an 8.5% higher burden of obesity-related health issues and are 5.77 times more likely to develop such conditions compared to normal-weight students. These results highlight that obesity affects both academic achievement and health, with potential long-term consequences for students' well-being. To address these issues, educational institutions and communities should prioritize promoting healthy lifestyles, including proper nutrition and weight management support.

Integrative proteomic and lipidomic analysis of GNB1 and SCARB2 knockdown in human subcutaneous adipocytes

Obesity, a global public health concern, is influenced by various factors, including genetic predispositions. Although many obesity-associated genes have been identified through genome-wide association studies (GWAS), the molecular mechanisms linking these genes to adipose tissue function remain largely unexplored. This study integrates proteomic data on adipocyte fat accumulation with GWAS data on obesity to unravel the roles of the identified key candidate genes - G protein subunit beta 1 (GNB1) and scavenger receptor class B member 2 (SCARB2) - involved in fat accumulation. We utilized RNA interference to knock down GNB1 and SCARB2 in human subcutaneous adipocytes, followed by lipidome and proteome analyses using mass spectrometry. Knockdown of these genes resulted in a reduction in lipid droplet accumulation, indicating their role in adipocyte lipid storage. Digital PCR confirmed effective gene knockdown, with GNB1 and SCARB2 mRNA levels significantly reduced. In total, the lipidomic analysis identified 96 lipid species with significant alterations. GNB1 knockdown resulted in a decrease in cholesterol esters and an increase in phosphatidylcholines, phosphatidylinositols, and ceramides. SCARB2 knockdown also led to an increase in phosphatidylcholines, with a trend towards decreased triacylglycerols. Proteomic analysis revealed significant changes in proteins involved in lipid metabolism and adipocyte function, including PLPP1 and CDH13, which were upregulated following GNB1 knockdown, and HSPA8, which was downregulated. Conversely, SCARB2 knockdown resulted in the downregulation of PLPP1 and METTL7A, and the upregulation of PLIN2, HSPA8, NPC2, and SQSTM1. Our findings highlight the significant roles of GNB1 and SCARB2 in lipid metabolism and adipocyte function, providing insights that could inform therapeutic strategies targeting these regulatory genes in obesity.

Research Progress on the Protective Effect of Green Tea Polyphenol (-)-Epigallocatechin-3-Gallate (EGCG) on the Liver

The liver, as the primary metabolic organ, is susceptible to an array of factors that can harm liver cells and give rise to different liver diseases. Epigallocatechin gallate (EGCG), a natural compound found in green tea, exerts numerous beneficial effects on the human body. Notably, EGCG displays antioxidative, antibacterial, antiviral, anti-inflammatory, and anti-tumor properties. This review specifically highlights the pivotal role of EGCG in liver-related diseases, focusing on viral hepatitis, autoimmune hepatitis, fatty liver disease, and hepatocellular carcinoma. EGCG not only inhibits the entry and replication of hepatitis B and C viruses within hepatocytes, but also mitigates hepatocytic damage caused by hepatitis-induced inflammation. Furthermore, EGCG exhibits significant therapeutic potential against hepatocellular carcinoma. Combinatorial use of EGCG and anti-hepatocellular carcinoma drugs enhances the sensitivity of drug-resistant cancer cells to chemotherapeutic agents, leading to improved therapeutic outcomes. Thus, the combination of EGCG and anti-hepatocellular carcinoma drugs holds promise as an effective approach for treating drug-resistant hepatocellular carcinoma. In conclusion, EGCG possesses hepatoprotective properties against various forms of liver damage and emerges as a potential drug candidate for liver diseases.

Causal effect of life-course adiposity on the risk of respiratory diseases: a Mendelian randomization study

BACKGROUND

There is limited evidence on the causal associations of life-course adiposity with the risk of respiratory diseases. This study aimed to elucidate these associations.

METHODS

Two-sample Mendelian randomization was conducted using genetic instruments of life-course adiposity (including birth weight, childhood BMI, and adulthood adiposity) to estimate their causal effect on respiratory diseases in participants of European ancestry from the UK Biobank, the FinnGen consortium, and other large consortia.

RESULTS

Genetically predicted higher birth weight was associated with decreased risk of acute upper respiratory infections and increased risk of pulmonary embolism, sleep apnea, and lung cancer. Genetically predicted high childhood BMI was associated with increased risk of asthma, COPD, pulmonary embolism, and sleep apnea. However, most of these observed associations were no longer significant after adjusting for adult BMI. Genetically predicted higher adult BMI and WHR were associated with 10 and 4 respiratory diseases, respectively. High adult body fat percentage and visceral adiposity were genetically associated with increased risk of 9 and 11 respiratory diseases, respectively. Consistently, genetically predicted higher whole-body fat mass was associated with increased risk of 8 respiratory diseases.

CONCLUSIONS

This study provides genetic evidence that greater adiposity in childhood and adulthood has a causal effect in increasing the risk of a wide range of respiratory diseases. Furthermore, the effects of childhood obesity on respiratory outcomes may be mediated by adult obesity.

Comparing clinical outcomes of adults with obesity receiving tirzepatide versus bariatric metabolic surgery: A multi-institutional propensity score-matched study

AIMS

This real-world study compared clinical outcomes between tirzepatide treatment and bariatric metabolic surgery (BMS) in adults with obesity.

METHODS

This retrospective cohort study used the TriNetX network to identify adults with a body mass index (BMI) ≥ 30 kg/m2. Patients initiating tirzepatide treatment were compared with those undergoing BMS. The primary outcome was all-cause mortality, while secondary outcomes included major adverse cardiovascular events (MACEs) and major adverse kidney events (MAKEs). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and stratified analyses were performed based on age, sex and BMI categories.

RESULTS

After exclusions and 1:1 propensity score matching (PSM), 84 884 matched pairs were analysed. The incidence of all-cause mortality was 0.19 per 100 person-years in the tirzepatide group compared with 0.57 in the BMS group. Tirzepatide was associated with a significantly lower risk of all-cause mortality compared with BMS (HR, 0.311; 95% CI, 0.257-0.375; p < 0.0001). The mortality benefits were consistent across age groups, genders and BMI categories. Tirzepatide also reduced the risk of MACEs (HR, 0.743; 95% CI, 0.673-0.821; p < 0.0001) and MAKEs (HR, 0.375; 95% CI, 0.336-0.419; p < 0.0001). Stratified analyses demonstrated significant reductions in primary and secondary outcomes across most categories.

CONCLUSION

Tirzepatide demonstrated superior clinical outcomes compared with BMS in adults with obesity, including significant reductions in all-cause mortality, MACEs and MAKEs. These findings suggest that tirzepatide may serve as an effective non-surgical alternative to BMS, with broad applicability across diverse patient populations.

Abnormal DNA methylation of EBF1 regulates adipogenesis in chicken

BACKGROUND

DNA methylation influences gene expression and is involved in numerous biological processes, including fat production. It is involved in lipid generation in numerous animal species, including poultry. However, the effect of DNA methylation on adipogenesis in chickens remains unclear.

RESULTS

A total of 12 100-day-old chickens were divided into high and low-fat groups based on their abdominal fat ratios. Subsequently, genome-wide bisulfite sequencing (WGBS) was performed on their abdominal fat, and 1877 differentially methylated region (DMR) genes were identified, among which SLC45A3, EBF1, PLA2G15, and ACAD9 were associated with lipid metabolism. Interestingly, EBF1 showed a lower level of DNA methylation and higher mRNA expression in the low-fat group, as determined by comprehensive RNA-seq analysis. Cellular verification showed that EBF1 expression was upregulated by 5-azacytidine (5-Aza) and downregulated by betaine. EBF1 facilitated the differentiation of immortalized chicken preadipocyte 1 (ICP-1) through the PPAR-γ pathway, thereby affecting chicken adipogenesis.

CONCLUSION

A combination of WGBS and RNA-seq analyses revealed 48 DMGs in the abdominal fat tissue of chickens. Notably, the DNA methylation status of EBF1 was inversely related to its mRNA expression. Mechanistically, DNA methylation regulates EBF1 expression, which in turn mediates the differentiation of ICP-1 through the PPARγ pathway. This study provides a theoretical framework for investigating the effects of DNA methylation on adipogenesis in chickens.

Movement behaviours and eating habits in children: a cross-sectional study

OBJECTIVE

It is well-established that adherence to 24-h movement guidelines affects various health outcomes. However, few studies have explored its impacts on eating habits in children comprehensively, with most focusing on small or non-representative samples, and neglecting the combined effects of movement behaviours. Therefore, this study aims to investigate the relationship between adherence to 24-h movement guidelines and eating habits in Chinese children.

METHODS

School-aged students were included for analysis. Physical activity and screen time were assessed using items from the Health Behaviour in School-aged Children questionnaire (the Chinese version). Sleep duration was assessed using the items from the Pittsburgh Sleep Quality Index (PSQI). Multivariable ordinal logistic regression models were used to explore the relationship between adherence to 24-h movement guidelines and eating habits.

RESULTS

Overall, only 1.4 % of children adhered to 24-h movement guidelines. Regression analysis showed that children adhering to one (OR = 1.35, CI: 1.05-1.73) or two recommendations (OR = 1.52, CI = 1.17-1.97) were more inclined to consume fruits compared to those who did not adhere to any recommendations. Those who adhered to two recommendations exhibited reduced likelihoods of consuming soft drinks (OR = 0.62, CI: 0.46-0.81) and junk food (OR = 0.48, CI: 0.35-0.66), whereas adherence to one recommendation displayed a diminished likelihood of consuming junk food.

CONCLUSION

Although no significant association between adherence to all 24-hour movement guidelines and better eating habits was discerned, it was worth noting that adherence to both the recommendations for moderate-to-vigorous physical activity and screen time may have positive effects of improving eating habits.

Oral microbiome changes in subjects with obesity following bariatric surgery compared to lean counterparts

Introduction

This study aimed to compare oral microbiome profiles between obese and lean individuals without clinical periodontitis, and to assess changes in the oral microbiome of obese subjects following bariatric surgery.

Methods

Individuals with a body mass index (BMI) > 30 were enrolled in the obese group, whereas those with a BMI < 23 served as controls. The obese surgery group, which consented to bariatric surgery, was followed up at 1, 3, and 6 months with clinical examinations. Oral examinations were conducted and periodontal disease was classified based on probing results. Saliva, buccal and subgingival microbiome samples were analyzed for community diversity, relative bacterial abundance, and differential abundance between control (n = 24) and obese group (n = 31). To evaluate effect size and statistical power, we used micropower, a simulation-based method for Permutational Multivariate Analysis of Variance-based β-diversity comparisons.

Results

The obese group exhibited distinct alpha diversity (buccal: Chao1 p = 0.0002, Shannon p = 0.0003, supragingival: Shannon p < 0.0001) compared with the control group. Bray-Curtis distance analysis indicated significant disparities in microbiome composition distribution in saliva (p = 0.003), buccal (p = 0.002), and subgingival plaque samples (p = 0.001). Although the obese and normal weight groups exhibited no significant periodontal differences, the obese group showed distinct species associated with periodontal disease, especially in subgingival plaque including Filifactor alocis, Peptostreptococcaceae spp., Prevotella spp., and Treponema maltophilum. Cluster analysis of the obese surgery group indicated the emergence of microbiomes associated with a healthy state that increased over time including Streptococcus salivarious and various Veillonella spp., whereas clusters containing periodontal pathogens including Porphyromonas spp., tended to diminish.

Discussion

The oral microbiome at 6 months post-bariatric surgery indicates a potential shift toward a healthy periodontal state, suggesting that weight loss interventions may positively impact oral microbial communities even in the absence of clinical periodontitis.

Global, regional, and national burden of kidney cancer and attributable risk factors in adults aged 65 years and older from 1990 to 2021 and projections to 2040

BACKGROUND

Identifying the past and future burden of kidney cancer (KC) and its temporal trends among older adults (≥ 65 years) at global, regional, and national levels is critical for effective prevention strategies.

METHODS

The age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were calculated using data from the Global Burden of Disease (GBD) study from 1990 to 2021. These indicators were stratified by sex, age, and socio-demographic index (SDI). The correlation between these indicators and SDI was assessed. Temporal trends were quantified using the annual average percentage change (AAPC), and future trends from 2022 to 2040 were predicted using the Bayesian age-period-cohort (BAPC) model.

RESULTS

The global age-standardized incidence rate (ASIR) of KC among older adults increased from 21.73 per 100,000 people in 1990 to 26.74 per 100,000 people in 2021, with an AAPC of 0.67%. Age-standardized DALYs rate (ASDR) remained stable, while significant increases were observed in age-standardized prevalence (AAPC = 1.24%, 95%CI: 1.14-1.34%) and mortality rate (AAPC = 0.13%, 95%CI: 0.05-0.22%). From 1990 to 2021, males consistently exhibited a higher disease burden than females, additionally, the ASIR of KC increased significantly in all age subgroups. Regions with higher SDI levels also showed a greater disease burden, while Oceania had the lowest burden of KC in 2021. The ASIR increased in almost all countries and territories. Czechia showed the highest ASIR (92.25 per 100,000 people) and ASDR (819.88 per 100,000 people). Smoking and high body mass index (BMI) remained significant risk factors for DALYs and mortality in the older population, and their effects were greatest in high SDI region. Furthermore, the burden of KC is expected to continue to decline through 2040.

CONCLUSIONS

The global burden of KC among older adults increased from 1990 to 2021, with notable regional and national variations. However, it is projected to continue to decline through 2040. The management of smoking and high BMI remain major challenges for people with KC, necessitating targeted clinical guidelines, particularly focusing on males and the older adults.

Body weight changes in people with HIV starting dolutegravir versus efavirenz-based regimens in a large cohort in rural Tanzania

OBJECTIVES

To analyze weight changes associated with dolutegravir- versus efavirenz-based antiretroviral therapy (ART) in people with HIV (PWH) in rural Tanzania, where undernutrition is prevalent.

DESIGN

Longitudinal, observational study of the prospective Kilombero and Ulanga Antiretroviral Cohort (KIULARCO).

METHODS

We included adult, ART-naïve, nonpregnant PWH initiating efavirenz-based ART 12/2016-02/2019 or dolutegravir-based ART 03/2019-12/2022. We used multivariable linear mixed-effects models to assess adjusted weight changes during 18 months after ART start and Cox regression models to assess factors associated with incident obesity, weight gain ≥10% and hypertension.

RESULTS

Of 1205 PWH at ART start [median age 40 years (interquartile range (IQR) 32-48); 719 (59.7%) females], 166 (13.8%) individuals were underweight and 317 (26.3%) overweight/obese; 621 (51.5%) initiated efavirenz-based and 584 (48.5%) dolutegravir-based ART. After 18 months, estimated weight gain was 5.1 kg [95% confidence interval (CI) 4.7-5.5] in the dolutegravir versus 4.0 kg (95% CI 3.7-4.4) in the efavirenz group. The weight gain difference between treatment groups was high in men (1.7 kg (95% CI 0.8-2.6; P  < 0.001)), in those aged 30-49 years (1.5 kg (0.8-2.1); P  < 0.001) and those with CD4 + cell count ≥500/ul (2.5 kg (1.4-3.7), P  < 0.001)). Cumulative obesity incidence at 18 months was 10.9% (95% CI 8.3-14.0) in the dolutegravir and 5.1% (95% CI 3.6-7.1) in the efavirenz group. Associated factors were dolutegravir and a pre-ART body mass index (BMI) of 25-29 kg/m 2 . Dolutegravir and age, but not weight gain were associated with incident of hypertension.

CONCLUSIONS

Dolutegravir-based ART was associated with more weight gain, higher obesity and hypertension - especially in those with a higher pre-ART BMI compared to efavirenz-based regimens.

Causal Effects of 25-Hydroxyvitamin D on Metabolic Syndrome and Metabolic Risk Traits: A Bidirectional Two-Sample Mendelian Randomization Study

Background/Objectives: Individuals with metabolic syndrome (MetS) present reduced 25(OH)D levels. We performed a two-sample Mendelian randomization (MR) study to investigate whether causal relationships exist between 25(OH)D levels and MetS/MetS risk traits, including waist circumference, body mass index (BMI), hypertension (systolic/diastolic blood pressure), triglyceride, high-density lipoprotein cholesterol, and glucose levels. Methods: We employed genetic variants related to 25(OH)D levels from the SUNLIGHT Consortium and a European genome-wide association study meta-analysis, including UK Biobank (UKB) data, as well as variants for MetS and MetS risk traits from UKB and multiple European consortia. Several MR methods were used, i.e., inverse-variance weighted, weighted median, and MR-Egger regression. Heterogeneity and horizontal pleiotropy analyses were performed to ensure the stability of candidate single-nucleotide polymorphisms (SNPs) as the instrumental variable. We first conducted univariable MR to investigate the relationship between 25(OH)D levels and MetS, including its related risk traits, and subsequently performed multivariable MR to adjust for potential confounders. Results: This study did not provide evidence of a causal relationship between 25(OH)D levels and MetS/MetS risk traits. However, we found that several risk traits of MetS, such as waist circumference, BMI, and TG, had an inverse-causal relationship with 25(OH)D levels, suggesting that 25(OH)D levels could be secondary consequences of metabolic illnesses. Conclusions: We identified no causal relationship between 25(OH)D levels and MetS/MetS risk factors. However, 25(OH)D levels may result from MetS traits.

ENERGY expenditure of COmmuting to school (ENERGYCO): protocol for a cluster randomized controlled trial

Introduction

This article outlines the rationale and methodology of the ENERGY expenditure of COmmuting to school study (the ENERGYCO study), a cluster-randomized controlled trial. The ENERGYCO study is divided into two phases: Phase I will aim; to assess the physical activity energy expenditure (PAEE) of different modes of commuting to school (i.e., walking, cycling, and motorized-vehicle) using indirect calorimetry in Spanish adolescents; and Phase II will aim to assess the effect of a school-based cycling intervention on resting metabolic rate and PAEE, as well as on other physiological, physical, and psychosocial outcomes on Spanish adolescents.

Method

For Phase I, a convenience sample of ~50 adolescents will be recruited. These participants will have their PAEE assessed in three different modes of commuting. Regarding phase II, a total of 300 adolescents from different schools in three Spanish cities will participate in this cluster randomized controlled trial. As many schools as necessary to meet the target sample will be included. In addition, each school will be randomized as either an intervention or control group. Participants from intervention schools will be asked to complete a school-based cycling intervention, while participants from control schools will be asked to continue their same habits for 8 weeks. The school-based cycling intervention will last for 8 weeks and will include Bikeability sessions, along with encouragement strategies to increase adherence to cycling to and from school.

Conclusion

The ENERGYCO study will provide novel insights into the PAEE associated with different modes of commuting to school using indirect calorimetry, as well as a comprehensive overview of how an 8-week school-based cycling intervention impacts resting energy expenditure, daily energy expenditure, and the physical and psychosocial health of adolescents.

Diabetes, obesity, and cardiovascular disease-what is the impact of lifestyle modification?

Diabetes, obesity, and cardiovascular disease (CVD) represent an escalating global health challenge, contributing significantly to morbidity, mortality, and healthcare costs. Evidence from large cohort studies and clinical trials underscores the impact of diabetes and obesity as major risk factors for CVD, causing systemic inflammation, insulin resistance, and neurohormonal activation. Frequently, a sedentary lifestyle and unbalanced dietary habits are associated with these risk factors. Physical activity and exercise training interventions, a Mediterranean and plant-based diet, smoking cessation, and reduction of alcohol have shown promise in mitigating these risks. The implementation of lifestyle and pharmacotherapy have emerged as new pillars of preventive medicine. This review discusses the evidence of lifestyle interventions to reduce the burden of diabetes, obesity, and CVD. It is highlighted that only a multifaceted, sustained approach integrating lifestyle interventions and pharmacological strategies can reduce the burden of disease and improve long-term outcomes.

Combining evidence from human genetic and functional screens to identify pathways altering obesity and fat distribution

Overall adiposity and body fat distribution are heritable traits associated with altered risk of cardiometabolic disease and mortality. Performing rare variant (minor allele frequency<1%) association testing using exome-sequencing data from 402,375 participants in the UK Biobank (UKB) for nine overall and tissue-specific fat distribution traits, we identified 19 genes where putatively damaging rare variation associated with at least one trait (Bonferroni-adjusted P <1.58×10 -7 ) and 50 additional genes at FDR≤1% ( P ≤4.37×10 -5 ). These 69 genes exhibited significantly higher (one-sided t -test P =3.58×10 -18 ) common variant prioritisation scores than genes not significantly enriched for rare putatively damaging variation, with evidence of monotonic allelic series (dose-response relationships) among ultra-rare variants (minor allele count≤10) in 22 genes. Combining rare and common variation evidence, allelic series and longitudinal analysis, we selected 14 genes for CRISPR knockdown in human white adipose tissue cell lines. In three previously uncharacterised target genes, knockdown increased (two-sided t -test P <0.05) lipid accumulation, a cellular phenotype relevant for fat mass traits, compared to Cas9-empty negative controls: COL5A3 (fold change [FC]=1.72, P =0.0028), EXOC7 (FC=1.35, P =0.0096), and TRIP10 (FC=1.39, P =0.0157); furthermore, knockdown of PPARG (FC=0.25, P =5.52×10 -7 ) and SLTM (FC=0.51, P =1.91×10 -4 ) resulted in reduced lipid accumulation. Integrating across population-based genetic and in vitro functional evidence, we highlight therapeutic avenues for altering obesity and body fat distribution by modulating lipid accumulation.

Nutrition literacy is associated with general obesity, abdominal obesity, and body fat percentage obesity

Background

Obesity is associated with unhealthy eating behavior among adults. Nutrition literacy (NL) is an important determinant of eating behavior. This study investigated the association of NL with general obesity, abdominal obesity, and body fat percentage (BFP) obesity among adults.

Methods

This study was a cross-sectional survey on the Nutrition Literacy and Obesity, conducted in Bengbu City, China (May to July 2023). The Short-Form Nutrition Literacy scale was used to evaluate the NL of adults. General obesity was defined as a body mass index of ≥28 kg/m2. Abdominal obesity was defined as a waist circumference of ≥90 cm in men and ≥85 cm in women. BFP obesity was defined as a BFP of ≥30% in men and ≥42% in women. Binary logistic regression analysis was performed to identify the correlations of NL with general obesity, abdominal obesity, and BFP obesity in adults. Subgroup analyses and interaction tests were also performed.

Results

Participants with a high level of NL had low odds of general obesity (odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.43-0.99), abdominal obesity (OR: 0.63; 95% CI: 0.46-0.87), and BFP obesity (OR: 0.55; 95% CI: 0.35-0.87). In subgroup analyses and interaction tests, age significantly influenced the negative correlations of NL with abdominal obesity and BFP obesity (p for interaction <0.05), but not general obesity (p for interaction >0.05). Moreover, sex and smoking status significantly influenced the negative correlations of NL with general obesity and abdominal obesity (p for interaction <0.05), but not BFP obesity (p for interaction >0.05), and drinking status significantly influenced the negative correlations of NL with abdominal obesity (p for interaction <0.05), but not general obesity and BFP obesity (p for interaction >0.05). However, marital status did not significantly influence the correlation of NL with obesity (p for interaction >0.05).

Conclusion

Our findings highlight that adults with high levels of NL have low odds of general obesity, abdominal obesity, and BFP obesity. Age, sex, smoking status, and drinking status influence the correlation between NL and obesity. The results indicate the importance of NL in the prevention and management of obesity in adults. To effectively address the challenges of adult obesity management, public health practitioners should tailor nutrition education and skill training programs to specific demographic profiles.

Semaglutide as a GLP-1 Agonist: A Breakthrough in Obesity Treatment

This review addresses the role of semaglutide (SMG), a GLP-1 receptor agonist, in the treatment of obesity and its related comorbidities. Originally developed for type 2 diabetes (DM2), SMG has shown significant efficacy in weight reduction, with superior results compared to other treatments in the same class. Its effects include appetite suppression, increased satiety, and improvements in cardiovascular, renal, and metabolic parameters. Studies such as SUSTAIN, PIONEER, and STEP highlight its superiority compared to other GLP-1 receptor agonists and anti-obesity drugs. The oral formulation showed promising initial results, with higher doses (50 mg) showing weight losses comparable to those of subcutaneous administration. Despite its benefits, there are challenges, such as weight regain after cessation of treatment, gastrointestinal adverse effects, and variability of response. Future studies should explore strategies to mitigate these effects, identify predictive factors of efficacy, and expand therapeutic indications to other conditions related to obesity and insulin resistance. The constant innovation in this class of drugs reinforces the potential of SMG to transform treatment protocols for chronic weight-related diseases.

Effects of water aerobics on body composition in obesity and overweight people: a systematic review and meta-analysis

OBJECTIVES

Obesity and overweight significantly impact public health. The benefits of water aerobics (WAs) have been shown in obesity and overweight people, but the effects of WAs on body composition improvement are still unclear.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

A systematic literature search was conducted on 16 November 2024, across the PubMed MEDLINE, Ovid MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Only randomised controlled trials (RCTs) were included, which were independently screened by two researchers. All RCTs on WAs that evaluated the anthropometric and body composition parameters of overweight and obesity subjects were included. Eligible studies were reported following the Reporting Items for Systematic Reviews and Meta-Analysis statement.

DATA EXTRACTION AND SYNTHESIS

All process were independently screened by two researchers (ZD, HZ). A fixed-effects or random-effects model was chosen based on the heterogeneity of the studies. The risk of bias in the included studies was assessed using the Risk of Bias V.2.0 tool, and sensitivity and subgroup analyses were conducted for outcome indicators. The quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

RESULTS

A total of 10 studies involving 286 participants were included. Sensitivity analyses were performed for percent body fat (PBF) with high heterogeneity, and the results were robust. WAs were able to reduce body weight (BW) (weighted mean differences (WMD)=-2.69, 95% CI -4.10 to -1.27, p<0.05, I2=0.0%) and waist circumference (WC) (WMD=-2.75, 95% CI -4.41 to -1.09, p<0.05, I2=27.0%), but the effect on other body indicators was not significant. The GRADE assessment revealed that the certainty of evidence was low for body mass index, lean mass, fat mass, waist-hip ratio and hip circumference and very low for PBF. In contrast, the certainty of evidence for BW and WC was moderate.

CONCLUSION

For the obesity and overweight people, WAs interventions over 10 weeks (ie, 12 weeks) reduced BW and WC, with more significant effects in women and greater improvements in body composition in middle-aged and older adults (average age ≥45 years). The moderate certainty of evidence for BW and WC, as assessed using the GRADE framework, indicates that these findings are robust.

PROSPERO REGISTRATION NUMBER

CRD42023466969.

Does income have a non-linear impact on residents' BMI? Re-examining the obesity Kuznets curve

BACKGROUND

After more than 40 years of growth, the income of Chinese residents has greatly increased; however, the problems of overweight and obesity among residents have become increasingly prominent.

METHODS

We used data from the China Family Panel Studies (CFPS) to study the relationship between residents' income and obesity using the instrumental variable (IV) method.

RESULTS

The impact of income on residents' body mass index (BMI) is an inverted U-shape; that is, when income is low, BMI significantly rises with income, and when per capita income exceeds 57,066 yuan in 2023 prices (equivalent to 8,098 dollars), further increases in income will lead to a decrease in BMI.

CONCLUSIONS

The results suggest that the impact of income on resident obesity may be related to dietary behaviour and health investment. Although income increases the likelihood of health expenditure and exercise, it has an inverted U-shaped effect on whether residents consume fish, meat, fried or pickled foods, and dine out. That is, in the low-income stage, income mainly increases consumption of unhealthy foods such as fish, meat, and fried and pickled foods, leading to a significant increase in BMI. In the high-income stage, residents reduce consumption of large amounts of fish and meat, pay more attention to healthy diet and healthcare, and increase exercise, which leads to a decline in BMI and an overall inverted U-shaped impact of income on obesity. Further heterogeneous analysis showed that income has a greater impact on obesity among rural residents, those aged 50 years and older, and those with low education levels. Finally, this study provides relevant suggestions for the prevention and control (P&C) of obesity among urban and rural residents.

Osteoarthritis burden and inequality from 1990 to 2021: a systematic analysis for the global burden of disease Study 2021

Osteoarthritis (OA) is a major global health burden, affecting millions and causing significant disability. Understanding its trends and determinants is crucial for effective management and prevention. We analyzed data from the Global Burden of Diseases (GBD) study 2021 to assess OA incidence, Years Lived with Disability (YLDs), and age-standardized rates (ASIR/ASYR) from 1990 to 2021. We explored trends and determinants across gender, region, and Socio-Demographic Index (SDI) quintiles using Joinpoint regression, Age-Period-Cohort (APC) modeling, decomposition, and inequality analyses. The global incidence of OA surged from 20.9 million in 1990 to 46.6 million cases in 2021, with an AAPC of 0.29%. Correspondingly, YLDs escalated from 8.92 million to 21.30 million, reflecting an AAPC of 0.30%. Disparities exist across SDI quintiles, with higher rates observed in high SDI countries. Women consistently experience a higher burden compared to men. Asian regions demonstrate the fastest rise in ASYR. High BMI contributes significantly to OA burden, particularly in high SDI countries. The rising burden of OA necessitates urgent attention. Interventions targeting modifiable risk factors, such as obesity, and early detection and management strategies are crucial. Addressing gender disparities and health inequalities, particularly in high SDI countries, is essential for effective OA prevention and control.

Association of childhood obesity on retinal microvasculature and the role of biochemical markers for its early detection

BACKGROUND

Childhood obesity is a growing public health concern, associated with several systemic disorders including changes in retinal microvasculature. This study aims to assess the relationship between body composition, biochemical markers, and retinal microvascular changes in obese children.

METHODS

In this cross-sectional study, 45 overweight and obese children and 46 age- and sex-matched healthy individuals were evaluated. In addition to physical examination, anthropometric measurements were obtained using a body composition analyzer. A comprehensive ophthalmic assessment was conducted for all participants, which included advanced optical biometry, autorefractometry, visual acuity testing, and slit-lamp examination. Retinal microvasculature was assessed using optical coherence tomography angiography (OCT-A). Biochemical markers, including lipid profile, liver function tests, and CRP (as marker of inflammation), were also analyzed.

RESULTS

The mean ages were 10.18 and 9.40 years in the obese/overweight and normal weight groups, respectively. Increased foveal thickness (p = 0.04) and foveal vessel density (p = 0.01) in the superficial capillary plexus, and decreased vessel density in the inferior parafoveal region of the deep capillary plexus (p = 0.03) were observed in obese/overweight children. Adjusted and crude regression analysis showed significant associations between body mass index, percent body fat, fasting blood glucose, and serum alanine transaminase levels with foveal vessel density, as well as between body mass index and serum triglycerides levels with foveal thickness.

CONCLUSIONS

Our findings suggest that childhood obesity is associated with significant alterations in retinal microvasculature. We propose that retinal health assessments and biochemical evaluations be considered in the clinical management of obese children.

Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

BACKGROUND

Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050.

METHODS

Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends.

FINDINGS

Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989-1·01) adult males and 1·11 billion (1·10-1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397-407] individuals), followed by India (180 million [167-194]) and the USA (172 million [169-174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8-160·3) in males and 104·9% (95% UI 100·9-108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39-4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4-269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121-162) by 2050, making it the country with the fourth-largest population with overweight and obesity.

INTERPRETATION

No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels.

FUNDING

Bill & Melinda Gates Foundation.

Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

BACKGROUND

Despite the well documented consequences of obesity during childhood and adolescence and future risks of excess body mass on non-communicable diseases in adulthood, coordinated global action on excess body mass in early life is still insufficient. Inconsistent measurement and reporting are a barrier to specific targets, resource allocation, and interventions. In this Article we report current estimates of overweight and obesity across childhood and adolescence, progress over time, and forecasts to inform specific actions.

METHODS

Using established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we modelled overweight and obesity across childhood and adolescence from 1990 to 2021, and then forecasted to 2050. Primary data for our models included 1321 unique measured and self-reported anthropometric data sources from 180 countries and territories from survey microdata, reports, and published literature. These data were used to estimate age-standardised global, regional, and national overweight prevalence and obesity prevalence (separately) for children and young adolescents (aged 5-14 years, typically in school and cared for by child health services) and older adolescents (aged 15-24 years, increasingly out of school and cared for by adult services) by sex for 204 countries and territories from 1990 to 2021. Prevalence estimates from 1990 to 2021 were generated using spatiotemporal Gaussian process regression models, which leveraged temporal and spatial correlation in epidemiological trends to ensure comparability of results across time and geography. Prevalence forecasts from 2022 to 2050 were generated using a generalised ensemble modelling approach assuming continuation of current trends. For every age-sex-location population across time (1990-2050), we estimated obesity (vs overweight) predominance using the log ratio of obesity percentage to overweight percentage.

FINDINGS

Between 1990 and 2021, the combined prevalence of overweight and obesity in children and adolescents doubled, and that of obesity alone tripled. By 2021, 93·1 million (95% uncertainty interval 89·6-96·6) individuals aged 5-14 years and 80·6 million (78·2-83·3) aged 15-24 years had obesity. At the super-region level in 2021, the prevalence of overweight and of obesity was highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and the greatest increase from 1990 to 2021 was seen in southeast Asia, east Asia, and Oceania (eg, Taiwan [province of China], Maldives, and China). By 2021, for females in both age groups, many countries in Australasia (eg, Australia) and in high-income North America (eg, Canada) had already transitioned to obesity predominance, as had males and females in a number of countries in north Africa and the Middle East (eg, United Arab Emirates and Qatar) and Oceania (eg, Cook Islands and American Samoa). From 2022 to 2050, global increases in overweight (not obesity) prevalence are forecasted to stabilise, yet the increase in the absolute proportion of the global population with obesity is forecasted to be greater than between 1990 and 2021, with substantial increases forecast between 2022 and 2030, which continue between 2031 and 2050. By 2050, super-region obesity prevalence is forecasted to remain highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and forecasted increases in obesity are still expected to be largest across southeast Asia, east Asia, and Oceania (eg, Timor-Leste and North Korea), but also in south Asia (eg, Nepal and Bangladesh). Compared with those aged 15-24 years, in most super-regions (except Latin America and the Caribbean and the high-income super-region) a greater proportion of those aged 5-14 years are forecasted to have obesity than overweight by 2050. Globally, 15·6% (12·7-17·2) of those aged 5-14 years are forecasted to have obesity by 2050 (186 million [141-221]), compared with 14·2% (11·4-15·7) of those aged 15-24 years (175 million [136-203]). We forecasted that by 2050, there will be more young males (aged 5-14 years) living with obesity (16·5% [13·3-18·3]) than overweight (12·9% [12·2-13·6]); while for females (aged 5-24 years) and older males (aged 15-24 years), overweight will remain more prevalent than obesity. At a regional level, the following populations are forecast to have transitioned to obesity (vs overweight) predominance before 2041-50: children and adolescents (males and females aged 5-24 years) in north Africa and the Middle East and Tropical Latin America; males aged 5-14 years in east Asia, central and southern sub-Saharan Africa, and central Latin America; females aged 5-14 years in Australasia; females aged 15-24 years in Australasia, high-income North America, and southern sub-Saharan Africa; and males aged 15-24 years in high-income North America.

INTERPRETATION

Both overweight and obesity increased substantially in every world region between 1990 and 2021, suggesting that current approaches to curbing increases in overweight and obesity have failed a generation of children and adolescents. Beyond 2021, overweight during childhood and adolescence is forecast to stabilise due to further increases in the population who have obesity. Increases in obesity are expected to continue for all populations in all world regions. Because substantial change is forecasted to occur between 2022 and 2030, immediate actions are needed to address this public health crisis.

FUNDING

Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.

Personalizing product sets to individual health priorities increases the healthfulness of hypothetical food choices in US adults

Recently, the potential for dietary personalization based on genetic/phenotypic characteristics to improve health has been studied. While promising, inputs into this biology-focused personalization process are intensive and may not align with an individual's own health priorities, which drive health behaviors. Here, we examine how personalizing food suggestions based on individuals' health priorities affects the healthiness of their food choices. We conducted a pre-registered experiment examining hypothetical food choices from three food categories in six conditions: (1) control, (2) health priority prime, (3) healthy product subset, (4) health priority prime + healthy product subset, (5) health priority prime + priority subset, and (6) health priority-based personalized product suggestions. Participants in conditions 2, 4, 5, and 6 first encountered a question asking them to select their top health priority from a list of options. In conditions 5, the subset of healthy items was described as foods beneficial for the selected health priority, while in condition 6, participants immediately saw the set of foods beneficial for the selected health priority, but had the option to see all foods instead. After making food choices, participants completed a survey with questions about the choice process, health priorities, and demographic variables. We used logistic regression to analyze the impact of condition on healthiness of food choices, and ordered logistic regression to examine the impact of condition on satisfaction with choices made. The experiment and survey were completed by 4171 adults (≥ 19 years) in the US, with the sample closely matching US distribution of age, sex, education, and income characteristics. There were no significant differences in the distribution of demographic characteristics among conditions. All intervention conditions significantly increased the likelihood that an individual chose a healthy food. However, interventions that combined priming with healthy subsets were significantly more effective than single interventions. Conditions that connected the healthy subsets to individuals' health priorities were particularly effective. The adjusted odds ratio (aOR) of selecting a healthy food was 4.77 (95% CI 4.12, 5.52) relative to the control condition when participants could view a subset described as helpful for their health priority. When people immediately viewed the personalized product set, the aOR increased to 11.67 (95% CI 0.1, 13,5). Likewise, analysis of nutrient content from food choices revealed that personalization decreased saturated fat, added sugar, and sodium and increased dietary fiber, potassium, iron, and calcium. However, product choice satisfaction was significantly lower in the personalized product set, which appears to be partially due to a tendency in this condition to forego choosing a product rather than selecting an unhealthy product. Personalization of product options based on individual health priorities should be tested in real-choice environments.

Influence of Obesity on Invasive Hemodynamics and Prognosis in Patients With Heart Failure

BACKGROUND

Previous studies have suggested that obesity may cause heart failure with preserved left ventricular ejection and report strong association between body mass index (BMI) and invasive hemodynamics. However, sparse information exists in patients who have heart failure with reduced ejection fraction (HFrEF).

OBJECTIVES

This study aimed to investigate associations between BMI and invasive hemodynamics in patients with HFrEF and the influence of obesity on clinical outcomes.

METHODS

Referred patients with HFrEF evaluated for advanced heart failure were studied. All patients had right heart catheterization performed. Obesity was defined as BMI ≥30 kg/m2. Clinical events included death, heart transplantation, and durable left ventricular assist device implantation.

RESULTS

The study population comprises 578 patients with a mean age of 52 ± 13 years and BMI of 26 ± 5 kg/m2. Patients with obesity (BMI range: 30-45 kg/m2) counted 126 (22%) and had significantly higher cardiac output and slightly higher central venous pressure compared to patients without obesity. Cardiac output increased by 89 mL/min per 1-U increase in BMI. Vascular resistances were significantly inversely related to BMI. Pulmonary arterial pressure and pulmonary capillary wedge pressure were not associated with BMI. In patients with obesity, symptoms seem to be dissociated from filling pressures and cardiac index, whereas a clear association is observed in patients without. Obesity did not predict survival over a median follow-up of 5.9 years (Q1-Q3: 2.0-10.1 years).

CONCLUSIONS

In patients with HFrEF, BMI and CO correlate significantly. Symptoms and hemodynamics appear dissociated in patients with obesity. Finally, survival in patients with obesity did not differ from those without.

Global burden of osteoarthritis among postmenopausal women in 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021

OBJECTIVES

Our study aimed to provide global burden and temporal trends in the incidence, prevalence, and disability-adjusted life-years (DALYs) of osteoarthritis (OA) among postmenopausal women from 1990 to 2021.

METHODS

The study employed data from the Global Burden of Disease (GBD) Study 2021. Four subtypes of OA affecting the hip, knee, hand, and other joints among postmenopausal women were included. Age-standardised rates (ASRs) were derived with reference to the global age standard, and temporal patterns were scrutinised through estimated annual percentage change (EAPC) assessments. The impact of age, body mass index (BMI), and Socio-demographic Index (SDI) were all considered.

RESULTS

From 1990 to 2021, there were more than 1.3-fold increases in OA incidence, prevalence, and DALYs among postmenopausal women globally, with EAPCs of 0.211, 0.356, and 0.395, respectively. Knee OA carried the heaviest burden, while hip OA bore the least. Higher SDI regions had higher burden, and inequalities linked to SDI among countries had intensified over time. East Asia and high-income Asia Pacific experienced the most substantial increments in OA burden. High BMI significantly influences the burden of OA, especially in countries within high, high-middle, and middle SDI, where DALYs attributed to high BMI exceed 20%.

CONCLUSIONS

The burden of OA among postmenopausal women continues to escalate, highlighting its significant impact on the global health of postmenopausal women. Necessarily, effective monitoring and management of risk factors, targeted lifestyle adjustments for BMI, and policy interventions accounting for demographic disparities are required to ease OA in postmenopausal women.

Gamma-aminobutyric acid fermentation and its fermented extracts on α-glucosidase inhibition and anti-obesity effect

Levilactobacillus brevis KCL010 was fermented in a simple medium containing 8% (w/v) of rice bran extract. We modified the carbon, nitrogen, and initial pH conditions using 10 g/L of sucrose, 10 g/L of yeast extract, and 5.0 of pH, respectively. To minimize the pH increase due to decarboxylation, we fermented 100 mL of modified synthetic medium containing citrate-phosphate buffer (CPB, pH 5.0) of 25-200 mM in 250 mL Erlenmeyer flasks. After 72 h of fermentation with 50 mM CPB, the maximum GABA concentration and conversion efficiency were 3.42 g/L and 22.39%. Furthermore, the potential α-glucosidase inhibitory activity, MTT assay, and oil red O staining were determined by fermented extracts of L. brevis KCL010. At the highest concentration of 500 μg/mL, the α-glucosidase inhibition percentages for non-fermented rice bran (NFRB), rice bran fermented by L. brevis (RBFL), and GABA (analytical standard) extracts were 55.03%, 58.37%, and 59.48%, respectively. All extracts exceeded 80% viability, suggesting that there was no cytotoxic to 3T3-L1 adipocytes. The rice bran fermented by L. brevis (RBFL) extract shows a high inhibition of lipid accumulation by 29.33% compared to those of extracts.

Association of long-term weight management pharmacotherapy with multiple health outcomes: an umbrella review and evidence map

BACKGROUND

Multiple meta-analyses (MAs) have demonstrated that six pharmacotherapies, including orlistat, liraglutide, phentermine/topiramate, naltrexone/bupropion, semaglutide, and tirzepatide, improve weight loss and weight maintenance. However, few studies have synthesized and evaluated the quality of this evidence.

OBJECTIVE

To identify the relevant MAs of randomized clinical trials (RCTs) that explored the association between the six pharmacotherapies and obesity-related health outcomes and adverse events (AEs).

METHODS

A comprehensive search was conducted across PubMed, Embase, Cochrane Library, and Web of Science from database inception up to January 2024. We calculated the effect size as the mean difference and risk ratio using the random-effects model. The quality of MAs was evaluated using "A Measurement Tool to Assess Systematic Reviews 2".

RESULTS

Sixteen MAs comprising 235 RCTs that described 115 unique associations between the six pharmacotherapies and various health outcomes were included. Overall, 101 statistically significant associations (88%) had beneficial outcomes on body weight, weight loss, waist circumference, body mass index, total cholesterol, triglycerides, both low-density and high-density lipoprotein cholesterol, blood pressure, and glycemic profile. The pharmacotherapies were associated with significant weight loss and partial improvements in the lipid profile, blood pressure, and glycemic control among individuals with overweight or obesity. Notable AEs were associated with liraglutide, naltrexone/bupropion, semaglutide, and orlistat. The methodological quality of the included MAs requires improvement.

CONCLUSIONS

This umbrella review identified significant beneficial associations between pharmacotherapies and anthropometric measures, lipid profile, blood pressure, glycemic profile, and quality-of-life outcomes in individuals with overweight or obesity. In addition, the umbrella review highlighted safety considerations. The findings affirm the efficacy of the six pharmacotherapies in promoting weight loss in this demographic. Further clinical trials with long-term follow-up are essential to evaluate the effects of these pharmacotherapies on clinical outcomes, including cancer, cardiovascular events, and mortality.

Impact of Obesity on GVHD in Patients Undergoing Allogeneic Hematopoietic Cell Transplant for Hematologic Malignancies

BACKGROUND

The relationship between obesity and graft-versus-host disease (GVHD) has been studied in both preclinical and clinical studies with varying results.

OBJECTIVES

We aimed to investigate the impact of obesity, as measured by body mass index (BMI), on the incidence, severity, and response to therapy of GVHD in a contemporary cohort.

STUDY DESIGN

We conducted a retrospective study of patients undergoing allogeneic hematopoietic cell transplant (HCT) for acute myelogenous leukemia and myelodysplastic syndrome between January 2010 and December 2021 at the Cleveland Clinic. Incidence, grade, organ involvement, and response to therapy of acute and chronic GVHD were compared between patients with obesity (BMI ≥30) and without obesity. Secondary outcomes included relapse, nonrelapse mortality (NRM), and overall survival (OS).

RESULTS

531 patients were identified, with a median follow-up of 19 months (range, 7-49). Mean (SD) BMI at time of HCT was 29.1 (6.3) kg/m2. There was no significant difference in demographic and HCT characteristics between patients with obesity (N = 199) and without obesity (N = 332). Development of any acute (42% versus 43%) or chronic (29% versus 30%) GVHD was similar in patients with and without obesity. Patients with obesity were less likely to have gastrointestinal involvement from chronic GVHD (28% versus 48%, P = .01). Skin (64% versus 56%), mouth (45% versus 35%) and eye (35% versus 27%) involvements were higher in patients with obesity, although statistically not significant. There were no significant differences in OS, NRM, or relapse.

CONCLUSION

There were no significant differences in incidence of GVHD among patients with and without obesity. Additional studies are needed to further understand potential differences in organ involvement.

Elucidating the Linkage Between Obesity-Related Body Fat Indicators and Atrial Fibrillation: Supported by Evidence From Mendelian Randomization and Mediation Analyses

OBJECTIVES

To elucidating the linkage between obesity-associated body fat indicators and atrial fibrillation (AF) using Mendelian Randomization (MR) and mediation analysis.

METHODS

The study utilized three independent genome-wide association study (GWAS) datasets, with containing over 450 000 individuals each, to represent body fat indicators as the exposure variable. Additionally, two summary genetic datasets of AF were utilized as the clinical outcome. Single nucleotide polymorphisms (SNPs) with p-values less than 5 × 10-10 were identified as instrumental variables (IVs) for MR analysis. The primary analysis method employed was the inverse-variance weighting (IVW) model, supplemented by three additional models: MR-Egger regression, weighted median, and maximum likelihood. Sensitivity analysis was conducted, encompassing tests for heterogeneity and horizontal pleiotropy, utilizing Cochran's Q, MR-Egger intercept, and MR-PRESSO tests to validate the reliability of the findings. Furthermore, a mediation analysis was conducted to explore potential mediators involved in the pathogenesis of AF.

RESULTS

The IVW model demonstrated that per 1-SD increase in body fat indicators (body fat percentage, whole body fat mass, and trunk fat mass) is associated with an elevated risk of AF, with values of 63.1%, 55.0%, and 55.8% respectively. All three supplementary models arrived comparable conclusions with IVW model. The sensitivity analysis confirmed the absence of horizontal pleiotropy, thereby validating the reliability of the findings. Additionally, the mediation study indicates that hypertension and sleep apnea syndrome are identified as significant mediators during the pathogenesis of AF.

CONCLUSIONS

The study reveals that individuals with a higher body fat percentage tend to exhibit a heightened genetic predisposition for susceptibility to AF. Meanwhile, hypertension and sleep apnea syndrome have been identified as key mediators contributing to the pathogenesis of AF.