Body Mass Index: Obesity, BMI, and Health: A Critical Review

Socioeconomic disparities in the postnatal growth of preterm infants: a systematic review

OBJECTIVE

To determine the effect of parental socioeconomic status (SES) on the postnatal growth of preterm infants.

METHODS

A systematic review (PROSPERO registration CRD42020225714) of original articles from Medline, Embase, CINAHL Plus and Web of Science published 1946-2023 was undertaken. Studies were included if they reported anthropometric growth outcomes for preterm infants according to parental SES. Data extraction and assessments of bias and health equity impact were conducted using custom-designed forms.

RESULTS

A narrative synthesis of twelve included studies was performed. Most infants were moderate to late preterm. The settings, growth outcomes, timings of growth measurement, and SES measures were heterogenous. Six studies demonstrated an adverse effect of low parental SES on the extrauterine growth of preterm infants, five studies showed no effect, and one study showed a potentially beneficial effect. All studies had a high risk of bias, especially confounding and selection bias. The health equity impact of included studies was largely negative.

CONCLUSION

Limited and low-quality evidence suggests that socioeconomic minoritisation may adversely impact the growth of preterm infants, thereby widening existing socioeconomic health inequities. Observational studies informed by theorisation of the mechanistic pathways linking socioeconomic minoritisation to adverse postnatal growth are required to identify targets for intervention.

IMPACT

Limited evidence suggests low parental socioeconomic status (SES) adversely affects the postnatal growth of preterm infants across different settings. Early growth of preterm infants predicts neurodevelopmental outcomes and the risk of cardiovascular and metabolic disease in adulthood. Systematic screening of over 15,000 articles identified only twelve studies which reported postnatal growth outcomes for preterm infants according to parental SES. The health equity impact of the included studies was systematically assessed, and found to be negative overall. This study highlights limitations in existing evidence on the association between parental SES and postnatal growth, and delineates avenues for future research.

Reframing Diabetes Prevention: From Body Shaming to Metabolic Reprogramming

This review integrates new developments in psychology with updated physiological insight on the complex relationships among chronic psychological stress (arising from weight stigmatization and body shaming), food composition, physical activity and metabolic health for the example of diabetes. We address how visual measures of health, such as body mass index (BMI) and waist-to-hip ratio, do not adequately capture metabolic health and can instead contribute to weight stigmatization, chronic stress, and system-wide impairment of metabolic health. We also emphasize the importance of food composition over calorie counting. We summarize how chronic stress interacts with nutritional deficiencies and physical inactivity to disrupt the stress response, immune response, gut microbiome, and function of fat depots. We specifically address how interactions among lifestyle factors and the gut microbiome regulate whether fat stored around the waist has a negative or positive effect on metabolic health. We aim to provide a resource and updated framework for diabetes prevention and health promotion by (i) highlighting metabolic imbalances triggered by lifestyle changes during the transition to industrialized society and (ii) detailing the potential to support metabolic health through access to modest, but comprehensive lifestyle adjustments.

Rehabilitation Management of Neck Pain-Development of a Diagnostic Framework Based on the Pain and Disability Drivers Management Model

RATIONALE

Neck pain is a major cause of disability worldwide, and current rehabilitation strategies show limited effectiveness. Subgrouping patients by their primary pain and disability drivers can help tailor treatments. At this end, the Pain and Disability Drivers Management (PDDM) was developed and has demonstrated preliminary effectiveness in the management of low back pain. Nevertheless, the PDDM model was only validated for this population. Adapting this framework to patients with neck pain would provide a more global view of the patient's experience of pain and support a genuine biopsychosocial intervention.

AIMS AND OBJECTIVES

The aim of this study was to develop and validate the content of the PDDM model for patients living with neck pain.

METHODS

Through a modified DELPHI study design, participants with clinical and research expertize in rehabilitation of neck pain were invited to participate. A questionnaire was developed using literature reviews and endorsed by a steering committee. The relevance of each element of the newly adapted model was evaluated on a 4-point Likert scale. An item reached consensus if it obtained the predefined threshold of > 78% "relevant" and "very relevant." Participants left comments on terminology and recommended items to add in early rounds. Quantitative and qualitative analyses were performed.

RESULTS

An invitation was sent to 1650 potential participants, from which 155 accessed the survey, 64 completed the first round and 55 the second round. A total of 70 elements met consensus and were distributed across six domains: "Nociceptive pain drivers", "nociplastic pain drivers," "drivers associated with neuropathic pain", "comorbidity drivers", "cognitive-emotional drivers" and "environmental or lifestyle drivers, and social determinants of health."

CONCLUSION

Through a modified DELPHI study, the PDDM model was updated and adapted to people with neck pain. Subsequent steps include clinical integration and measures of efficacy when used for assessment/treatment.

In-hospital costs of diabetic foot infection at a national referral hospital in Jakarta, Indonesia

Aims

To determine the in-hospital costs of patients with diabetic foot problems who either require or do not require amputation.

Methods

We conducted a retrospective cross-sectional study of 213 subjects with low, moderate and high ulcer grades from January 2019 to December 2022 at a national referral hospital in Jakarta, Indonesia. Data were taken from the medical admissions record unit, electronic health records (EHR), hospital integrated system (HIS) and the foot registry system in the metabolic endocrine division, in relation to diabetic foot infection (DFI) as the primary or secondary diagnosis. We analysed data referring to patient characteristics, in-hospital costs and length of stay (LOS), with further comparison based on amputation status.

Results

The total DFI costs were estimated at IDR 13.833 billion (median IDR 51.225 [min - max; 10.309-507.281) million]). The total costs were estimated at IDR 64.95 ± 50.89 million per patient. All cost variables were driven by intervention costs estimated at IDR 5.176 billion (median IDR 19.676 [min - max; 1.245-136.348) million per patient). Daily costs were IDR 3.281 million per patient per day. The total treatment costs for amputation and non-amputation were IDR 6.99 billion (median IDR 61.398 (18.785-268.768) million) and IDR 6.842 billion (median IDR 45.016 (10.309-507.282) million, respectively. The average LOS was 19.79 ± 10.77 days per DFI episode, which did not differ significantly between the amputation and non-amputation groups (p > 0.176) but not for total costs (p < 0.003). DFI is associated with high costs and long-term hospital stays.

Conclusions

Our study provides evidence on in-patient hospital costs by capturing the real costs of DFI treatment, with the total treatment costs for amputation being higher than for non-amputation. This information might benefit for health practitioners in clinical practice improvements and policy adjustments, including INA-CBGs tariff for DFI patients.

Breaking the Cycle: Enhancing Cardiovascular Health in the Elderly Through Group Exercise

The global increase in aging populations underscores the urgency of addressing cardio-kidney metabolic health indicators, particularly among sedentary elderly individuals. This study investigates the impact of an 8-month structured group exercise program on cardiovascular health indicators among 320 women aged 60 and older living independently in Rijeka. Participants engaged in biweekly sessions designed to improve mobility, balance, and strength. Key metrics, including blood pressure (BP), body mass index (BMI), waist-to-hip (WHR) and waist-to-height ratio (WHtR), and hand grip strength, were measured before and after the intervention. Results revealed significant reductions in systolic blood pressure (mean -3.4 mmHg) and pulse pressure among hypertensive participants, highlighting improved cardiovascular function. BP control significantly improved (7.2%), and 19% of untreated hypertensive subjects at the start become normotensive at the end of follow-up. Although BMI changes were minimal, WHtR improvements indicated reductions in central obesity and muscle fat redistribution. Hand grip strength increased significantly on both arms, correlating with physical capacity. The results underline the benefits of group training for improving health even in the elderly population through an organized exercise program. While these preliminary results demonstrate promising health improvements, further research with longer follow-up and inclusion of diverse participant groups is recommended to validate these outcomes and refine intervention strategies.

Clinical Data Mega-Collection of Obesity and Obesity-Related Trials: Primary Inclusion Criteria from All Studies and Highlights of Clinical Efficacy Analysis of GLP-1 Drugs

Background/Objectives: Obesity is heterogeneous and considered a chronic epidemic with significant un-met needs for management, treatment, and prevention. Methods: In this study, we used LizAI's software TAITAN (alpha version) for the mega-collection and analysis of clinical data from 10,407 trials addressing obesity and obesity-related diseases and their associated publications, mainly on PubMed. Results: We report an intensive growth of clinical trials until the end of 2024 and highlight the use of the body mass index (BMI) as a critical criterion in clinical participant selection despite its limitations. The significant disparities in races, regions, and the sites of trials across all studies have not been addressed, posing the possibility of research in the far future on the applications of precision medicine in weight management. In the latter parts of this paper, we analyze and discuss the clinical efficacy, mainly focusing on the primary endpoints and benchmarks of the recently FDA-approved once-weekly injectable glucagon-like peptide-1 receptor agonist (GLP-1 RA) drugs, including semaglutide and tirzepatide. Both drugs have functioned comparably when considering the 5% weight loss FDA threshold. Tirzepatide outperforms semaglutide and impacts fewer participants as the weight loss level increases from 5 to 20% and has greater effects in different populations, especially in people with type 2 diabetes (T2D). Conclusions: We would, however, like to highlight that (i) the weight loss level should be dependent on the clinically relevant needs of patients, and faster and greater weight loss might not be a win, and (ii) the clinical benefits, safety, and quality of life of patients should be carefully assessed when the weight loss is significant in a short period. In our search, we found that the specificities and impacts of weight loss therapies on organs like the kidneys and heart, different muscle types, bones, and fat accumulation in different parts of body were not investigated or disclosed during the clinical study period and longer term monitoring. In light of scientific needs and remarkable public interest in weight loss, our report provides findings on the buzz around losing weight in clinical trials, and our TAITAN software continues to collect data in real time and enrich its knowledge for future updates.

The effect of nutrition education intervention for caregivers on the nutrition status of the elderly receiving home care: A 1-year follow-up interventional trial

BACKGROUND

The high prevalence of malnutrition among those of older age and the lack of nutrition knowledge among the elderly and their caregivers underscore the need for a nutrition education intervention (NEI) for caregivers.

MATERIALS AND METHODS

Patients enrolled in the "home care program" who were dependent, were >65 years of age, and had caregivers (n = 94) were included in the study. A nutritionist conducted initial NEI sessions for caregivers and subsequently monitored them monthly at home for 12 months. Mini Nutritional Assessment (MNA) and World Health Organization Quality of Life Elderly Module (WHOQOL-OLD) were used to evaluate the nutrition status and quality of life scores of those of older age, respectively. Additional assessments included dietary intake, anthropometric measurements, and biochemical measurements. Other measures included current medical history and Barthel Index for Activities of Daily Living. All measurements were recorded over 12 months.

RESULTS

The mean age of the participants was 84.4 ± 6.9 years, with 61.7% being women. Significant differences were observed postintervention for MNA (Δ = +1.4; P < 0.001) and WHOQOL-OLD (Δ = +3.0; P < 0.001). The NEI was associated with improved nutrition status and quality of life. Post-intervention, significant improvements were noted in body weight (Δ = +0.4 kg; P < 0.001), waist circumference (Δ = +0.3 cm; P < 0.05), BMI (Δ = +0.2 kg/m2; P < 0.05), energy intake (Δ = +77 kcal/day; P < 0.001), protein intake (Δ = +5.4 g/day; P < 0.001), carbohydrate intake (Δ = +16.2 g/day; P < 0.001), and intakes of vitamin B2 (Δ = +0.3 mg/day; P < 0.001), vitamin C (Δ = +24.0 mg/day; P < 0.05), calcium (Δ = +133 mg/day; P < 0.001), and phosphorus (Δ = +116 mg/day; P < 0.001).

CONCLUSIONS

NEI for caregivers may reduce the malnutrition prevalence among those of older age and improve their dietary habits, quality of life, anthropometric measurements, biochemical parameters, and nutritional intake.

The association between body composition and overall survival in patients with advanced non-small cell lung cancer

Nutritional status is associated with prognosis in a variety of cancers. Studies analyzing the association between the measurements of skeletal muscle and adipose tissue obtained from Computerized Tomography (CT) images at the time of diagnosis of advanced non-small cell lung cancer (NSCLC) and overall survival (OS) are relatively few. Data from 425 patients diagnosed with advanced NSCLC between January 2016 and December 2017 were retrospectively analyzed, with an average follow-up of 15.3 months. To outline the patient's chest CT plain image at the time of diagnosis,skeletal muscle and subcutaneous fat at the level of both thoracic vertebrae were quantified in terms of mass and quantity by the pectoral muscle index (PMI), pectoral muscle density (PMD), subcutaneous fat index (SFI), subcutaneous fat density (SFD), paravertebral muscle index (PVMI), and paravertebral muscle density (PVMD). The SFI value in the female survival group is significantly lower than that in the death group (P = 0.049), and the PVMI value in the overall survival group is significantly lower than that in the death group (P < 0.001). After adjusting for clinical variables such as gender, smoking status, clinical staging, degree of differentiation, and radiotherapy history, the multivariable Cox regression analysis showed that an increase in SFI significantly improves the overall survival rate of patients (Hazard Ratio [HR] = 1.410, 95% Confidence Interval [CI]: 1.042-1.908, P = 0.026). Conversely, a decrease in PVMD is significantly associated with improved overall survival and prognosis (HR = 0.762, 95% CI: 0.579-0.982, P = 0.048). No association was found between body mass index (BMI) and chest muscle status indicators and overall survival (P > 0.05). CT-measured body composition parameters provide precise prognostic information and are superior to BMI; an increased OS rate in advanced NSCLC is associated with a greater SFI and a lower PVMD.

Insights into youth nutritional status in Serbia: assessing prevalence and trend in the context of social determinants

BACKGROUND

The study aimed to assess the prevalence and distribution of different levels of nutritional status among young people, to examine its association with social determinants of health, and to analyse its trend over time.

METHOD

The research was a secondary analysis of the data from four national health surveys of the Serbian population. The research sample included 11,243 respondents, aged 15 to 29, both genders. A multivariate logistic regression model was applied to examine the association between socio-demographic characteristics, lifestyle, health status, and the level of respondents' nutritional status. The trend analysis of the levels of nutritional status by the research years was done using multiple linear regression in adjusted models.

RESULTS

A total of 63.3% of respondents had body mass index (BMI) in the normal weight range, 11.7% were underweight, 18.5% were pre-obese, and 6.2% were obese. The average BMI of the study participants was 23.01 ± 6.01. The female respondents were more frequently underweight, and the male respondents were pre-obese and obese. Different factors were associated with different nutritional status levels - for underweight: female gender (OR: 5.29), age 15-19 (OR: 0.06), being married/ in a relationship (OR: 0.69), living in Belgrade region (OR: 1.35), presence of chronic diseases (OR: 0.56), consumption of psychoactive substances (OR:0.56) and non-smoking (OR: 0.70); for pre-obesity: female gender (OR: 0.38), ages 15-19 (OR:0.36) and 20-24 (OR:0.65), being married/ in a relationship (OR: 1.39), having high wealth index (OR:1.30) and non-smoking status (OR:1.32); for obesity: female gender (OR: 0.36), ages 15-19 (OR:0.35) and 20-24 (OR:0.51), being married/ in a relationship (OR:2.31) and primary education level (OR:2.17). The trend analysis of nutritional status level in the research period showed an increase in the average value of the BMI of the respondents in the entire sample, as well as the prevalence of obesity, while the prevalence of underweight and pre-obesity decreased.

CONCLUSION

The research provided insight into the specific factors associated with and trends of levels of nutritional status of the young, leading to the conclusion that preventive and interventional public health programs and strategies must be fully adapted to their specific needs.

How Weight Bias and Stigma Undermine Healthcare Access and Utilization

PURPOSE OF REVIEW

To highlight recent evidence of the impact of weight bias and stigma on healthcare access and utilization.

RECENT FINDINGS

Healthcare access for patients with obesity is limited by weight-discriminatory policies such as body mass index cutoffs and weight loss requirements. These policies are based on flawed justifications without demonstrated medical benefits. Healthcare providers continue to hold negative views of patients with obesity, but recent evidence does not suggest that providers' weight-stigmatizing attitudes affect obesity treatment referrals. With the rise of new anti-obesity medications, more research is needed to understand how weight stigma may or may not affect providers' prescribing behavior and patients' access to this form of treatment. Experienced, anticipated, and internalized weight stigma is associated with patients' avoidance of healthcare and reduced utilization. Weight bias and stigma limit healthcare access and utilization. Structural changes are needed to remove weight-discriminatory barriers to care.

The impact of weight change on suicide mortality: a nationwide population-based cohort study of 2 million Koreans

BACKGROUND

Previous studies have shown that weight change has a reverse J-shape association with all-cause mortality. However, its association with suicide mortality remains undetermined. In this study, we investigated the association between weight change and suicide mortality using a large-scale, population-based cohort from the Korean National Health Insurance Service database.

METHODS

A total of 2,103,525 subjects aged ≥ 20 years who underwent a general health screening program twice in the 2-year interval between 2007 and 2009 were included. Subjects were categorized into five groups according to the percent weight change during this period: severe weight loss (< - 15.0%), moderate weight loss (- 15.0 to < - 5.0%), weight stable (- 5.0 to < 5.0%), moderate weight gain (5.0 to < 15.0%), and severe weight gain (≥ 15.0%).

RESULTS

During a median follow-up of 11.3 years, 6,179 cases (0.3%) of suicide mortality occurred. Weight change was associated with increased suicide mortality in a reverse J-shaped curve, even after adjustment for covariates. In particular, those with severe weight loss or gain showed 1.8-fold or 1.6-fold increased risk of suicide mortality, respectively. This reverse J-shaped association was consistently observed in subgroup analyses considering age, sex, depression, cancer, and BMI category.

CONCLUSIONS

Moderate to severe weight change within a 2-year interval is associated with increased risk of suicide mortality. To better understand the mechanisms through which weight change affects suicide mortality, studies incorporating information on weight change intentions, medications, weight change-related medical conditions are needed.

Excessive Weight Gain During Pregnancy Increased Ponoxarase 1 Level in Neonatal Cord Blood

Maternal obesity is increasingly recognized as a risk factor for adverse fetal outcomes, primarily through its association with heightened oxidative stress. This study aimed to evaluate oxidative stress markers in umbilical cord blood of neonates born to obese mothers. Sixty-three pregnant women, who were of normal weight at the start of pregnancy but classified as obese at term, were included. Umbilical cord blood samples were collected immediately post-delivery and analyzed for serum oxidative stress markers (total oxidant status (TOS), total antioxidant status (TAS), paraoxanase (PON), aryl esterase, thiol, and catalase activities). Protein interaction networks were generated using Cytoscape (v3.10.3), and the overlapping proteins were further analyzed for functional annotations with ShinyGO (0.80). The top ten significantly enriched pathways were identified with a false discovery rate (FDR) threshold of <0.05. Significant associations were found between maternal BMI change and paraoxonase 1 (PON1) levels in umbilical cord blood, while no correlation was observed with other oxidative (total oxidant status) and antioxidant markers (total antioxidant status, aryl esterase, thiol, and catalase). Additionally, the correlation analysis showed a significant relationship between BMI change and fetal gestational age, but not with other demographic or clinical features. A total of 24 common protein interactors associated with PON1, obesity, and oxidative stress were identified. Functional annotation analysis revealed significant enrichment in antioxidant and oxidoreductase activities, along with pathways involved in insulin resistance, AGE-RAGE signaling, and atherosclerosis. Maternal obesity may specifically affect PON1 activity, potentially serving as a compensatory response to oxidative stress in neonates, suggesting PON1 as a possible biomarker for oxidative stress-related metabolic disturbances in neonates of obese mothers, with implications for monitoring and managing pregnancy outcomes in obese populations.

Effects of blood flow restriction training on cardiometabolic health and body composition in adults with overweight and obesity: a meta-analysis

Objective

This meta-analysis aims to evaluate the effects of blood flow restriction (BFR) training on cardiometabolic health and body composition in adults with overweight and obesity.

Method

Following PRISMA guidelines, a systematic search of PubMed (MEDLINE), EMBASE, Web of Science, Cochrane, and Scopus databases was conducted on 15 March 2024. Pooled effects for each outcome were summarized using Hedge's g (g) through meta-analysis-based random effects models, and subgroup analyses were used to explore moderators.

Results

A total of 11 studies with 242 participants (Age:32.6 ± 3.6, BMI:27.2 ± 3.5) were included. Regarding cardiometabolic health, BFR training significantly reduced systolic blood pressure (g = 0.62 [0.08, 1.16], p = 0.02), while no significant differences were observed in maximal oxygen uptake (g = 0.48 [-0.21, 1.17], p = 0.17) or diastolic blood pressure (g = 0.31 [-0.22, 0.84], p = 0.25). Regarding body composition, BFR training significantly reduced body fat percentage (g = 0.30 [0.01, 0.58]; p = 0.04), while no significant differences (p > 0.05) were observed in body weight (g = 0.14 [-0.14, 0.42]), body mass index (g = 0.08 [-0.21, 0.38]), waist circumference (g = 0.13 [-0.28, 0.53]), or waist-to-hip ratio (g = 0.48 [-0.19, 1.15]). Subgroup analysis revealed no significant difference in improving systolic blood pressure (g = 0.57 [-0.10, 1.24] vs. g = 0.70 [-0.18, 1.59]) and body fat percentage (g = 0.20 [-0.20, 0.61] vs. g = 0.45 [-0.05, 0.95]) between BFR resistance training and BFR aerobic training. In all selected studies, the overall risk of bias was categorized as "some concern". The certainty of evidence for the BFR outcomes was low.

Conclusion

BFR training shows promise in improving cardiometabolic health and body composition, indicating that it may serve as a beneficial, individualized exercise prescription for improving cardiovascular disease risk and fat loss in adults with excess body weight and obesity.

Systematic Review Registration

https://archive.org/details/osf-registrations-uv6jx-v1.

Association between World Trade Center disaster exposures and body mass index in community members enrolled at World Trade Center Environmental Health Center

Studies suggest that environmental disasters have a big impact on population health conditions including metabolic risk factors, such as obesity and hypertension. The World Trade Center (WTC) destruction from the 9/11 terrorist attack resulted in environmental exposures to community members (Survivors) with potential for metabolic effects. We now examine the impact of WTC exposure on Body Mass Index (BMI) using the data from 7136 adult participants enrolled in the WTC Environmental Health Center (EHC) from August 1, 2005, to December 31, 2022. We characterized WTC-related exposures by multiple approaches including acute dust-cloud exposure, occupational or residential exposures, and latent exposure patterns identified by synthesizing multiplex exposure questions using latent class analysis. Employing multivariable linear and quantile regressions for continuous BMI and ordered logistic regression for BMI categories, we found significant associations of BMI with WTC exposure categories or latent exposure patterns. For example, using exposure categories, compared to the group of local residents, local workers exhibited an average BMI increase of 1.71 kg/m2 with 95% confidence intervals (CI) of (1.33, 2.09), the rescue/recovery group had an increase of 3.13 kg/m2 (95% CI: 2.18, 4.08), the clean-up worker group had an increase of 0.75 kg/m2 (95% CI: 0.09, 1.40), and the other mixer group had an increase of 1.01 kg/m2 (95% CI: 0.43, 1.58). Furthermore, quantile regression analysis demonstrated that WTC exposures adversely affected the entire distribution of BMI in the WTC EHC Survivors, not merely the average. Our analysis also extended to blood pressure and hypertension, demonstrating statistically significant associations with WTC exposures. These outcomes highlight the intricate connection between WTC exposures and metabolic risk factors including BMI and blood pressure in the WTC Survivor population.

Obesity and metabolic syndrome in a diverse pediatric kidney transplant population: which anthropometric measure best predicts arterial stiffness?

BACKGROUND

Obesity and metabolic syndrome (MS) accelerate arterial stiffening, increasing cardiovascular (CV) risk after transplant. BMI is limited by inability to differentiate muscle, fat mass, and fat distribution patterns. The aim of this study was to identify the best anthropometric measure to detect arterial stiffness as assessed by pulse wave velocity (PWV) in a racially diverse pediatric transplant population.

METHODS

Kidney transplant recipients 6-20 years old and ≥ 6 months post-transplant were prospectively enrolled. PWV was measured oscillometrically by Mobil-O-Graph. Skeletal muscle-to-fat mass ratio (SM:FM) and percent body fat (PBF) were evaluated by dual-frequency bioelectrical impedance. BMI and waist-to-height ratio (WHR) were calculated. Associations of arterial stiffness (high PWV) with obesity and MS as defined by WHR, SM:FM, PBF, and BMI were evaluated.

RESULTS

Participants (n = 67) were 15 (IQR 11, 18) years old and 39 (IQR 10, 68) months post-transplant. Participants with SM:FM-obesity (OR 3.2) and WHR-obesity (OR 3.0) had increased odds of high PWV (p = 0.04) while PBF-obesity (OR 2.6, p = 0.09) and BMI-obesity (OR 2.2, p = 0.17) were not significant. Participants with WHR-MS (OR 12.5, p = 0.02), SM:FM-MS (OR 5.2, p = 0.03), and PBF-MS (OR 5.0, p = 0.02) had increased odds of arterial stiffness, while BMI-MS was not significant (OR 3.7, p = 0.08).

CONCLUSIONS

Obesity is associated with arterial stiffness in a racially diverse cohort of pediatric transplant recipients. Anthropometric measures that assess body fat distribution (WHR) and body composition (SM:FM) are more strongly associated with arterial stiffness than BMI. MS has a stronger association with arterial stiffness than obesity alone, particularly when WHR is used.

Obesity alters the fitness of peritumoral adipose tissue, exacerbating tumor invasiveness in renal cancer through the induction of ADAM12 and CYP1B1

Obesity exacerbates the risk and aggressiveness of many types of cancer. Adipose tissue (AT) represents a prevalent component of the tumor microenvironment (TME) and contributes to cancer development and progression. Reciprocal communication between cancer and adipose cells leads to the generation of cancer-associated adipocytes (CAAs), which in turn foster tumor invasiveness by producing paracrine metabolites, adipocytokines, and growth factors. Interfering with the crosstalk between CAAs and cancer cells is of key relevance in the prevention of tumor progression. The present study aimed to analyze the contribution of peritumoral AT in renal cell carcinoma (RCC) progression in lean versus overweight or obese patients. By isolating human adipose-derived stromal/stem cells from the three groups of patients and performing conditioned medium studies with RCC cells along with in vivo xenograft experiments, we found that peritumoral adipocytes from the three groups show a distinct expression profile of genes. In particular, ADAM metallopeptidase domain 12 (ADAM12) and cytochrome P450 family 1 subfamily B member 1 (CYP1B1) were found to be upregulated in obesity and their silencing reduced RCC cell invasiveness. In conclusion, high ADAM12 and CYP1B1 expressions in the peritumoral adipocytes boost tumor invasiveness and may serve as an indicator of poor prognosis in RCC.

The Association Between Metabolic Score for Visceral Fat and Cognitive Function Among Older Adults in the United States

BACKGROUND

Although several studies have demonstrated a link between obesity and cognitive function, the majority have primarily utilized body mass index (BMI) and waist circumference, ignoring the distribution of body fat. Evidence regarding the association of metabolic score for visceral fat (METS-VF), a proposed measurement for visceral adipose tissue (VAT), with cognitive function remains limited. We mainly aimed to investigate this association in older adults in the United States.

METHODOLOGY

Data were from the National Health and Nutrition Examination Survey (NHANES) 2011 to 2014. Weighted linear regression models were adopted to examine the association of METS-VF and cognitive function scores, with further exploration of these associations across different obesity subgroups. Smoothing curve analysis, along with threshold and saturation effect analysis, were conducted to explore potential non-linear relationships.

RESULTS

In the multivariable-adjusted model, participants in the highest quartile (Quartile 4) of METS-VF exhibited a β coefficient of -1.52 [95% CI (-2.43, -0.62)] for the CERAD score compared with those in the lowest quartile (Quartile 1). Threshold and saturation effect analysis revealed non-linear associations of METS-VF with DSST score and Z-score.

CONCLUSIONS

The findings of this study indicate that elevated METS-VF scores are inversely related to cognitive function, highlighting the importance of considering visceral fat distribution in cognitive health assessments.

Elevated High Sensitivity C Reactive Protein and Risk of Abdominal Aortic Aneurysm: A Prospective Population Based Study in The Norwegian HUNT Study

OBJECTIVE

Inflammation seems to be crucial in the pathogenesis of abdominal aortic aneurysm (AAA). Previous research links inflammatory biomarkers, such as high sensitivity C reactive protein (hs-CRP), to AAA. Few studies, however, have used a prospective design. The aim of this study was to examine whether individuals with elevated hs-CRP have increased risk of AAA, using a prospective and population based design.

METHODS

This prospective, population based, cohort study included 46 322 participants in the Trøndelag Health Study (HUNT) in Norway (53.7% female). During a median follow up of 12.6 years (range 0 - 26 years), 407 individuals were diagnosed with AAA (22.4% female). Cox proportional hazards regression was applied to examine associations between hs-CRP and risk of AAA. hs-CRP was treated either as a continuous or a categorical variable (dichotomised at 2 mg/L, 1 mg/L, or median [1.2 mg/L], or as quartiles).

RESULTS

The hazard ratio (HR) of developing AAA per 1 mg/L increase in hs-CRP (continuous hs-CRP) was 1.02 (95% confidence interval [CI] 1.01 - 1.03) in the analysis adjusted for smoking, coronary heart disease, hypertension, diabetes, body mass index, and total cholesterol. Individuals with hs-CRP ≥ 2 mg/L had almost twice the risk of AAA compared with individuals with hs-CRP < 2 mg/L (adjusted HR 1.84, 95% CI 1.51 - 2.25). Dichotomising hs-CRP at a clinical cutoff point of 1 mg/L (adjusted HR 2.13, 95% CI 1.64 -2.76) or at the median of 1.2 mg/L (adjusted HR 2.12, 95% CI 1.62 - 2.76) slightly strengthened the HR. The adjusted HR gradually increased through the ordered hs-CRP quartiles, and was almost four times higher (HR 3.87, 95% CI 2.54 - 5.92) in the highest hs-CRP quartile (hs-CRP > 2.7 mg/L) compared with the lowest quartile (hs-CRP ≤ 0.6 mg/L).

CONCLUSION

Individuals with elevated hs-CRP had significantly increased risk of developing AAA.

Limited Changes in Red Blood Cell Parameters After Probiotic Supplementation in Depressive Individuals: Insights from a Secondary Analysis of the PRO-DEMET Randomized Controlled Trial

Background: Depression often coexists with anemia, potentially sharing common pathways, highlighting the need for treatments addressing both conditions simultaneously. This study evaluated the effect of probiotics on red blood cell (RBC) parameters in adults with depressive disorder. We hypothesized that probiotics would positively influence RBC parameters, potentially modulated by baseline inflammation or dietary intake, with improved RBC function correlating with better antidepressant outcomes. Methods: This secondary analysis of a two-arm, randomized, double-blind, controlled trial involved 116 adults with depressive disorder. Participants received a probiotic formulation containing Lactobacillus helveticus Rosell®-52 and Bifidobacterium longum Rosell®-175 or a placebo for 60 days. Data from 97 subjects were analyzed for RBC parameters, including hemoglobin (HGB), RBC count, hematocrit (HCT), mean corpuscular volume (MCV), mean hemoglobin concentration (MCH), mean corpuscular hemoglobin concentration (MCHC), and RBC distribution width (RDW). Results: Probiotic supplementation did not result in significant changes in RBC parameters compared to the placebo. However, probiotics may help stabilize HGB, HCT, MCH, and MCHC levels, potentially preventing fluctuations observed in the placebo group. Conclusions: While probiotics showed potential benefits for depressive symptoms, significant changes in RBC parameters were not observed. Larger studies are needed to clarify the mechanisms and clinical implications.

Evaluation of diagnostic performances of Pro-neurotensin and Heart-type fatty acid binding protein as reliable biomarkers for cardiovascular diseases

AIM

In 2019, cardiovascular diseases accounted for 32% of global deaths. So, early detection of cardiac disorders is crucial. The study aimed to examine the suitability of Pro-neurotensin and Heart-type fatty acid binding protein as dependable biomarkers for cardiac patients with Heart failure as a primary diagnosis.

METHODOLOGY

The prospective study involved 204 Egyptian volunteers (100 cardiac patients and 104 controls) enrolled from El-Sahel Teaching Hospital in Cairo, Egypt, between October 2022 and May 2023. Inclusion criteria included a high risk of cardiovascular events with symptoms like a fast or irregular pulse, shortness of breath, and fatigue. Exclusion criteria included asymptomatic individuals, cognitive disorders, and psychiatric conditions. The Research Ethics Committee approved the protocol. The consultant conducted a clinical examination of all patients and assessed their heart state. Serum ProNT and H-FABP were detected using a kit for the sandwich ELISA technique.

RESULTS

ProNT and H-FABP were significantly elevated in patients compared to controls with p < 0.001. Demonstrated sensitivity of 81% and 84%, with a specificity of 89% and 91%, respectively.

CONCLUSION

Elevated ProNT and H-FABP levels are associated with severe CVDs, suggesting their potential as diagnostic biomarkers for patients, specifically those with heart failure, as a primary characteristic.

Modifiable Risk Factors for Stroke in Syria: A Nationwide Multi-centre Case-Control Study

Stroke is the second-leading cause of death worldwide, including in Syria, and the third-leading cause of death and disability combined. With approximately 90% of strokes worldwide linked to modifiable risk factors, identifying and quantifying these factors within a specific population is essential for effective prevention. This is the first study to investigate primary risk factors for stroke in Syria. This study included the six primary stroke centres across four major cities in Syria. Data was collected through case files and a questionnaire answered by the cases or their proxies through personal interviews, as well as selected controls. A total of 411 cases were recruited, comprising 363 ischemic strokes (IS) and 48 haemorrhagic strokes, and with a matched ratio of 1:1 for age and sex. IS was significantly associated with multiple chronic conditions including atrial fibrillation AF [AOR 5.04 (2.64-9.62)], high body mass index (overweight [AOR 2.09 (1.28-3.40)], obesity [AOR 4.17 (2.32-7.50)]), hypercholesterolemia [AOR 2.10 (1.34-3.28], hypertension HTN [AOR 1.83 (1.23-2.73)], and diabetes mellitus DM [AOR 1.79 (1.18-2.71)]. Moreover, several lifestyle risk factors contributed to IS: Alcohol consumption [AOR 4.80 (1.72-13.41)], a diet lacking fruits and vegetables [AOR 2.04 (1.28-3.23)], and low physical activity PA [AOR 1.75 (1.01-2.86)]. Notably, over 40% of the population exhibited medication nonadherence. IS showed no significant association with cigarette smoking, heart failure (HF), ischemic heart disease (IHD), or a family history of stroke (p > 0.05). In contrast, haemorrhagic stroke was linked to higher BMI, HTN, DM, and AF (p < 0.05), but not to hypercholesterolemia, cigarette smoking, IHD, or HF (p > 0.05). This first nationwide multicentre case-controlled study in Syria identified critical modifiable risk factors for stroke, including hypertension, diabetes, atrial fibrillation, and obesity, with high rates of medication non-adherence, especially among hypertensive patients, complicating stroke risk. These findings underscore the urgent need for targeted health interventions promoting lifestyle modifications, medication adherence, and public health policies tailored to Syria's current resource-limited context to reduce the stroke burden and improve population health.

Evaluation of university students' Mediterranean diet quality and sustainable eating behaviors: a cross-sectional study

The study aimed to evaluate University Students' diet quality and sustainable eating behaviors, with the intention of developing strategies to promote healthy eating habits. We questioned the sociodemographic characteristics and general eating habits of the students. We administered Mediterranean diet quality scale (KIDMED) and Behaviors Scale Towards Sustainable Nutrition (BSTSN) to 300 Turkish students. We found that 163 of the students' diet quality was moderate level. KIDMED score positively correlated with the BSTSN score (r=0.306, p<0.001). When higher night eating habits predicted lower diet quality (β=-0.117, p=0.038), higher main meals and sustainable eating behavior predicted higher diet quality (β=0.145, p=0.009 and β=0.258, p<0.001, respectively). The results indicate that students generally have moderate diet quality, which sustainable eating behaviors can enhance. Night eating habits and dietary patterns impact diet quality, highlighting the importance of meal planning. To promote healthy eating, universities should incorporate sustainability into curricula and provide supportive facilities.

Endoscopic Sleeve Gastroplasty Versus Laparoscopic Sleeve Gastrectomy: A Comparison in Effectiveness and Safety Profile

BACKGROUND AND OBJECTIVES

Current treatment options for obesity typically involve a combination of lifestyle changes, medications, and bariatric surgeries. This study aimed to assess the safety profile of the endoscopic sleeve gastroplasty (ESG), which is a novel non-invasive approach, as compared to laparoscopic sleeve gastrectomy (LSG) and to correlate their weight loss effectiveness and complication risk in Lebanese patients.

SUBJECTS AND METHODS

This is a retrospective study, including 70 patients who underwent ESG at Fouad Khoury Hospital and 70 patients who underwent LSG at Trad Hospital, between September 2021 and March 2023. Data collection targeted the patients' medical records and included their demographic characteristics (age, sex, weight, height, BMI), comorbidities, and post-procedural information. Weight and BMI (pre-op, 6-months post-op, and 1-year post-op) were collected. Total body weight loss was calculated, and analysis was performed using SPSS version 25.

RESULTS

Patients who underwent ESG were distributed between 43 (61.4%) females and 27 (38.6%) males, with an average age of 38.07 ± 10.78 years. Patients who underwent LSG were distributed between 42 (60%) females and 28 (40%) males, with an average age of 33.99 ± 10.55 years. Both ESG and LSG resulted in significant weight loss, but LSG achieved greater total body weight loss at 6 and 12 months. ESG was associated with significantly shorter hospital stays (9.14 h vs. 27.77 h, p < 0.001) and fewer adverse events (8.5% vs. 17.1%, p = 0.111). New-onset GERD was more frequent after LSG (20% vs. 4.3%, p = 0.004).

CONCLUSION

ESG offers a less invasive approach with a potentially more favorable short-term safety profile and faster recovery, while LSG yields greater total body weight loss. ESG may be a suitable alternative for patients with a higher BMI. Further research is needed to assess long-term outcomes and cost-effectiveness.

Impact of Body Mass Index and VO2 Max on Symptoms, Physical Activity, and Physical Function in a Multinational Sample of People with HIV

People with HIV (PWH) are at increased risk for metabolic disorders affecting body mass index (BMI), chronic symptoms, and impaired physical function and capacity. Although physical activity improves health and well-being, PWH often do not meet activity recommendations necessary to achieve these benefits. Despite the known impact of symptoms, physical activity, and physical function on health, little is known about the relationships and interactions between these variables and BMI and maximum oxygen consumption during exercise (VO2 max) in a multinational population of PWH. We examined the relationship of BMI with PROMIS-29 measures, physical activity, strength, flexibility, and VO2 max in a diverse sample of PWH. Additionally, we examined the relationship of VO2 max with PROMIS-29 measures. Data from 810 PWH who participated in a cross-sectional study conducted by the International Nursing Network for HIV Research (Study VII) were analyzed. Participants were recruited from 8 sites across the United States, Thailand, and South Africa. BMI was calculated from collected height and weight data. Physical function and symptoms were assessed using the PROMIS-29 measure. Physical activity was assessed using the 7-day Physical Activity Recall. VO2 max was calculated using sex at birth, age, BMI and the 6-minute Walk Test. Data were analyzed using descriptive, correlational, and regression statistical analyses. Participants had an average age of 49.1 (± 11.1) years, 44% were female, and the average BMI of the sample group was 27 kg/m2 (± 6.7). Increased BMI was associated with decreased 6-minute Walk Test (β=-2.18, p < 0.001), flexibility (β=-0.279, p < 0.001), and VO2 max (β=-0.598, p < 0.001), even after controlling for covariates (age, sex at birth, country, years living with HIV, and antiretroviral therapy status). BMI was not associated with self-reported physical activity. Increased VO2 max was associated with increased physical function (β = 0.069, p < 0.001), and decreased pain (β=-0.047, p < 0.006), even after controlling for covariates (country, years living with HIV, and antiretroviral therapy status). Future research should explore development of effective and sustainable symptom self-management interventions in PWH accounting for the potential impact of BMI and VO2 max.

Resuscitative endovascular balloon occlusion of the aorta in the patient with obesity

BACKGROUND

Palpation of anatomic landmarks is difficult in patients with obesity, which could increase difficulty of achieving femoral access and resuscitative endovascular balloon occlusion of the aorta (REBOA) placement. The primary aim of this study was to examine the association between obesity and successful REBOA placement. We hypothesized that higher body mass index (BMI) would decrease first-attempt success and increase time to successful aortic occlusion (AO).

METHODS

A review of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry was performed on patients who underwent REBOA placement with initiation systolic blood pressure >0 mm Hg from years 2013-2022. Patients were excluded if they received cardiopulmonary resuscitation on arrival, underwent open AO, or missing data entries for variables of interest. Body mass index categorization was as follows: non-obese (<30), class I (30-34.9), class II (35-39.9), and class III (40+) obesity. Patients were also stratified by access technique, including use of palpation or ultrasound guidance.

RESULTS

Inclusion criteria were met by 410 patients. On binary analysis, no primary outcomes of interest, including rate of success, time to placement, or mortality, were significantly impacted by BMI. Among BMI subgroups, there was no statistical difference in injury severity, admission systolic blood pressure (SBP), or augmented SBP. At initiation of aortic occlusion, patients with class II and class III obesity had higher median SBP compared with non- and class I obese patients ( p = 0.03). Body mass index subgroup did not impact likelihood of first-attempt success or conversion to open procedure. When stratified by access technique, there was no difference in success rates, time to success or mortality between groups.

CONCLUSION

Body habitus did not impact success of REBOA placement, time to successful AO, or mortality. Further, ultrasound guidance was not superior to landmark palpation for arterial access. Following traumatic injury without hemodynamic collapse, obesity should not deter providers from considering REBOA placement.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.

ABC Grow Healthy Practices and Obesity-Related Health Behaviours in Family Child Care Homes in South Carolina

BACKGROUND

Many states throughout the United States have introduced Quality Rating and Improvement Systems (QRIS) to address childhood obesity in preschool-age children, but few have examined the impact of these standards in Family Child Care Homes (FCCHs). In South Carolina, the ABC Grow Healthy Practices are specific QRIS items that include diet, physical activity and sleep practices.

METHODS

The purposes of this cross-sectional study are to (1) describe physical activity levels, sleep duration and diet quality of children attending FCCHs in South Carolina and (2) compare physical activity levels, sleep duration and diet quality between children attending FCCHs that were enrolled versus not enrolled in the ABC programme. Means and percentages were used to summarize child- and parent-level descriptive characteristics, physical activity levels, diet quality and sleep behaviours overall and by sex, race/ethnicity and ABC participation. t tests and chi-square analyses were used to compare child- and parent-level demographic characteristics as well as child-level behaviours by ABC status.

RESULTS

Results revealed low physical activity levels (11.2 ± 4.1 min/h of total physical activity and 5.5 ± 2.6 min/h of moderate and vigorous physical activity) and poor diet quality (Healthy Eating Index 56.0 ± 10.3) in all children. There were statistically significant differences in fat and protein consumption between ABC and non-ABC FCCHs, as well as differences in demographic characteristics.

CONCLUSION

Future research is recommended to assess whether strengthening guidelines and improving implementation of obesity prevention standards will improve physical activity levels and diets of children attending FCCHs.

Correlations and consistency of body composition measurement indicators and BMI: a systematic review

OBJECTIVE

It is critical to accurately determine the level of obesity and health status since overweight/obesity has become a main global public health problem. This systematic review attempted to evaluate the consistency and correlation between body composition measurement indicators and body mass index (BMI) in childhood and adolescence.

METHODS

Seven electronic databases (Web of Science, PubMed, Cochrane Library, Embase, CNKI, WANFANG DATA, SinoMed) were searched to collect the literature published since 1999 with the focus on the relationship between body composition measurement indicators and BMI to measure obesity in childhood and adolescence.

RESULTS

Among the 28 articles included, 13 articles reported a moderate to very strong correlation between %BF and BMI in obesity measurement (range: 0.49-0.907), while two articles reported a strong to very strong correlation between FM and BMI (range: 0.60-0.86). Six articles reported good to excellent obesity measurement consistency between %BF and BMI (range: 0.441-0.876), one article reported WC (0.58) and WHtR (0.46) in the moderate consistency with BMI, and one article reported a relatively poor to fair consistency between FM and BMI (range: 0.167-0.409). WC, WHtR, and BMI showed the moderate consistency in pre-adolescent children. In pre-adolescence and adolescence, the measurement consistency between %BF and BMI was higher than that between FM and BMI. Gender difference existed in the consistency between %BF and BMI during adolescence.

CONCLUSION

A range of body composition indicators such as %BF, WC, WHtR, and FM could provide valuable body composition measurements, complement BMI for obesity assessment in children and adolescents, and facilitate efficient and comprehensive surveillance of childhood obesity.

REGISTRATION

PROSPERO CRD42024506932.

A two-sample Mendelian randomization study on the relationship of body weight, body mass index, and waist circumference with cardiac arrest

BACKGROUND

This study aims to explore the causal relationship of body weight, body mass index (BMI), and waist circumference (WC) with the risk of cardiac arrest (CA) using two-sample Mendelian randomization (MR).

METHODS

Data were summarized using genome-wide association studies (GWAS). Two-sample MR analyses were performed using the inverse variance weighting (IVW) method, the weighted median method, and the MR-Egger analysis. Heterogeneity test and sensitivity analysis were performed using Cochran's Q test and the leave-one-out method, respectively. The Steiger test was used to detect reverse causality. Bayesian model-averaged MR was used to identify the most influential risk factors.

RESULTS

A total of 13 GWAS data were collected for BMI, body weight and WC. IVW analyses showed a positive correlation of body weight, BMI, and WC with CA (all OR>1 and P<0.05), with MR-Egger and weighted median methods confirming the IVW findings. No horizontal pleiotropy or heterogeneity was observed. Sensitivity analysis indicated that no single nucleotide polymorphism (SNP) caused significant changes in overall causality. Bayesian model-averaged MR was also used to rank causality based on marginal inclusion probability (MIP), and the corresponding model-averaged causal estimate (MACE) were confirmed, which indicated that WC (GWAS ID: ukb-b-9405) was the highest-ranked risk factor (MIP=0.119, MACE=0.011); its posterior probability was 0.057. A total of 14 sex-specific GWAS data on weight, BMI, and WC were analyzed in relationship with CA, and the MR results showed no significant effects of sex-specific factors.

CONCLUSION

Body weight, BMI, and WC are causally associated with an increased risk of CA, with WC identified as the most important risk factor.

The Impact of Body Mass Index (BMI) on Clinical Outcomes for Patients Receiving Systemic Anti-Cancer Therapies for Advanced Clear Cell Renal Carcinoma

IntroductionObesity is a risk factor for the development of renal cell carcinoma (RCC), however observational studies have suggested patients with RCC receiving systemic anti-cancer therapy (SACT) and BMI ≥25 kg/m2 may have a better prognosis than patients with a normal or low BMI, a phenomenon often referred to as the obesity paradox.MethodsThe impact of BMI on survival outcomes in patients with advanced clear cell RCC receiving SACT within the National Health Service (NHS) in England between 2010 and 2018 was investigated. A retrospective analysis was performed using the SACT dataset from NHS-England.ResultsA total of 1034 patients were included. The majority of patients commenced treatment with oral SACT, pazopanib (53.3%) and sunitinib (43.7%). Median overall survival for patients with BMI ≤25 kg/m2 was 12.6 months (95% CI; 10.1-14.4) and 17.9 months (15.4-20.0) for patients with BMI ≥25 kg/m2 (P < .001). The association between BMI and improved survival was greatest in the first year of commencing SACT with the adjusted mortality rate of 68.9% for patients with BMI less than 25 kg/m2 compared to 48.6% for patients with BMI greater than 25 kg/m2 (rate ratio .77, .63 to .93).ConclusionA high BMI compared to a normal or low BMI was associated with improved survival in patients with metastatic RCC who were predominantly treated with oral SACT. Improved survival in obese patients with advanced RCC may be associated with improved response to systemic targeted therapies.

Assessing body composition through anthropometry: Implications for diagnosing and managing polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a multifaceted endocrine disorder with profound implications for the reproductive and metabolic health of women. The utilization of anthropometric measures in the diagnosis and management of PCOS has gained increasing attention due to their practicality and predictive capacity for associated conditions such as obesity and insulin resistance. This review rigorously explores the application of various anthropometric indices, including body mass index, waist-to-hip ratio, and advanced metrics such as the body shape index and body roundness index, wrist circumference, neck circumference. These indices offer critical insights into body fat distribution and its association with the metabolic and hormonal perturbations characteristic of PCOS. The review underscores the necessity of addressing obesity, a prevalent comorbidity in PCOS, through lifestyle modifications and personalized therapeutic approaches. By incorporating anthropometric evaluations into routine clinical practice, healthcare professionals can enhance diagnostic precision, optimize treatment strategies, and ultimately improve patient outcomes. This integrative approach not only facilitates the management of the metabolic challenges inherent in PCOS but also contributes to the development of more individualized therapeutic interventions, thereby enhancing the overall quality of life for women affected by PCOS.

Food Insecurity Prevalence and Risk Factors among Persons with HIV in a Southeastern US Clinical Care Setting

Food insecurity (FI) is associated with adverse health outcomes for persons with HIV (PWH). Little is known about FI among PWH in southern or non-urban settings. We examined FI prevalence, risk factors, and access to services in a southeastern HIV clinic. Among PWH in the UNC CFAR HIV Clinical Cohort who were screened for FI as part of HIV care between 2021 and 2022, we estimated unadjusted prevalence ratios (PRs) comparing the probability of reporting FI by demographic and clinical characteristics. The 479 PWH screened for FI were 65% cisgender men, 62% non-Hispanic Black PWH, a median of 54 years old (IQR 41-62), and 93% with an HIV viral load (VL) < 200 copies/mL. FI prevalence was 36.3% (95% CI 32.3%-40.9%). Cisgender women and transgender adults were more likely to report FI than cisgender men (PRs 1.24 [95% CI 0.97-1.59] and 2.03 [1.32-3.12], respectively). Compared with White PWH, the PR was 1.71 (1.20-2.42) for Black and 2.44 (1.56-3.82) for Hispanic PWH. The PR was 1.42 (0.98-2.05) for PWH with VL ≥ 200 versus < 200 copies/mL. Having no or public versus private health insurance was also associated with FI. PWH with FI had a high prevalence of comorbidities including hypercholesterolemia (49%) and hypertension (48%), though these were not associated with FI. Almost half of PWH with FI were not accessing a food pantry or nutrition assistance program. Identifying FI in PWH is critical as FI is common and may contribute to viral non-suppression, poor comorbidity control, and gender and racial/ethnic health disparities in PWH.

The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana

Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.

Vancomycin administration and AUC/MIC in patients with acute kidney injury on hemodialysis (HD): randomized clinical trial

The pharmacokinetics and pharmacodynamics (PK/PD) of vancomycin change during HD, increasing the risk of subtherapeutic concentrations. The aim of this study was to evaluate during and after the conventional and prolonged hemodialysis sessions to identify the possible risk of the patient remaining without adequate antimicrobial coverage during therapy. Randomized, non-blind clinical trial, including critically ill adults with septic AKI on conventional (4 h) and prolonged HD (6 and 10 h) and using vancomycin for at least 72 h. Sessions were analyzed and randomized into three groups (G): control (C), dose of 15 mg/kg after session), intervention (I) 2 h (dose of 7.5 mg/kg in the second hour and 7.5 mg/kg after) and IG continuous infusion (dose of 30 mg/kg in 24 h). Of the 316 patients recruited, 87 were randomized, and 174 HD sessions were monitored. For the analysis, 28 sessions belonged to the CG, 47 to the 2-hour IG, and 31 to the continuous IG. The groups were similar in age, weight, severity scores, use of nephrotoxins, sérum albumin, Kt/V, HD modality, ultrafiltration, and intradialytic intercurrences. The intervention groups showed a higher therapeutic concentration frequency than the control group (p < 0.002). The initial concentration was identified as a risk factor (OR 1.16, p = 0.001) for a non-therapeutic vancomycin concentration in the logistic regression. In contrast, the 2-hour IG was identified as a protective factor (OR 0.24, p = 0.04). Administration of vancomycin during dialysis proved to be a protective factor against concentrations outside the therapeutic target. Further studies are needed to suggest more appropriate doses of vancomycin for patients with AKI on dialysis therapy and to assess the impact of these results on clinical outcomes.

Analysis of Nutrition Knowledge After One Year of Intervention in a National Extracurricular Athletics Program: A Cross-Sectional Study with Pair-Matched Controls of Polish Adolescents

Background: Nutrition knowledge may be translated into adequate dietary intake and proper eating habits, so adolescent education programs focusing on improving eating habits and nutrition knowledge are needed. The aim of the cross-sectional study with pair-matched controls was to assess the Consumer Nutrition Knowledge Scale (CoNKS) results and its determinants after one year of intervention in a national extracurricular athletics program within a pair-matched sample of Polish adolescents. Methods: The #goathletics Study evaluated a Polish national extracurricular athletics program, 'Athletics for all', being a voluntary and free-of-charge physical activity program organized by the Polish Athletics Association. The study allowed comparing the intervention group of adolescents aged 10-14 years, participating in the program for at least 9 months (a school year) and a pair-matched group not participating in it, while the matching was based on city, gender, and age (each group: n = 506 adolescents, n = 281 females and n = 225 males). The nutrition knowledge was assessed using a Consumer Nutrition Knowledge Scale (CoNKS), and during the analysis, the following factors were taken into account: body weight, height, Body Mass Index (BMI), waist circumference, and waist-to-height ratio (WHtR). Results: The 'Athletics for all' program participation influenced not only the total CoNKS score (p < 0.0001) but also the scores in all studied areas-within procedural nutrition knowledge (p = 0.0002), declarative nutrition knowledge on nutrients (p = 0.0001), and declarative nutrition knowledge on calories (p < 0.0001), and program participants revealed a stronger understanding of all the studied areas compared to non-participating individuals. Gender, BMI, and central obesity tendency were not associated with the total CoNKS score (p > 0.05), or any of the studied areas (p > 0.05). The statistically significant differences in the number of correct answers were observed for four items within procedural nutrition knowledge, for four items within declarative nutrition knowledge on nutrients, and for four items within declarative nutrition knowledge on calories (p < 0.05), while for all of them, 'Athletics for all' program participants revealed a stronger understanding. Conclusions: One year of intervention in a national extracurricular athletics program significantly influenced the nutrition knowledge of the studied group of adolescents aged 10-14 years. While compared with the pair-matched control group of Polish adolescents, they were characterized by a stronger understanding of all areas of nutrition knowledge.

Correlation Between Spinopelvic Parameters, Body Mass Index, Waist Circumference, and Chronic Non-Specific Low Back Pain

STUDY DESIGN

This is an observational study.

OBJECTIVES

In general practice, it is noted that some people can deal more easily with a prominent belly than others. Recent use of spinopelvic parameters in the analysis of the spine might explain this observation. This study aimed to determine the correlation between pelvic incidence (PI), waist circumference (WC), and body mass index (BMI) in patients with non-specific chronic low back pain. We hypothesized that people with a low PI (non-pronounced lumbar lordosis) have significantly lower WC values than those with a high PI (pronounced lumbar lordosis).

METHODS

Adult patients presenting to the outpatient neurosurgery clinic with non-specific chronic low back pain who had undergone full spine radiography were included. The PI, BMI, and WC were measured in all cases.

RESULTS

We included 272 patients (male-female ratio, 1.08) with a mean age of 54 years. There was a statistically significant difference (p < 0.05) in the mean PI according to BMI group. The mean PI in our population was 57.8° (range 28.4-97.2°, SD 12.1°). A significant correlation coefficient of 0.271 (p < 0.001; 95%CI 0.157-0.377) was found between BMI and PI and 0.410 (p-value < 0.001; 95%CI 0.262-0.539).

CONCLUSIONS

We found a significant correlation between PI, BMI, and WC. This finding is the first step in confirming our hypothesis that a patient with a high PI might be able to tolerate being overweight and a high WC better than patients with a low PI, possibly because of their ability to retrovert the pelvis to a greater extent. Further research is warranted to investigate whether people with a high pelvic PI can better cope with obesity, especially those with a higher waist circumference and abdominal weight.

The interplay of factors in metabolic syndrome: understanding its roots and complexity

Metabolic syndrome (MetS) is an indicator and diverse endocrine syndrome that combines different metabolic defects with clinical, physiological, biochemical, and metabolic factors. Obesity, visceral adiposity and abdominal obesity, dyslipidemia, insulin resistance (IR), elevated blood pressure, endothelial dysfunction, and acute or chronic inflammation are the risk factors associated with MetS. Abdominal obesity, a hallmark of MetS, highlights dysfunctional fat tissue and increased risk for cardiovascular disease and diabetes. Insulin, a vital peptide hormone, regulates glucose metabolism throughout the body. When cells become resistant to insulin's effects, it disrupts various molecular pathways, leading to IR. This condition is linked to a range of disorders, including obesity, diabetes, fatty liver disease, cardiovascular disease, and polycystic ovary syndrome. Atherogenic dyslipidemia is characterized by three key factors: high levels of small, low-dense lipoprotein (LDL) particles and triglycerides, alongside low levels of high-density lipoprotein (HDL), the "good" cholesterol. Such a combination is a major player in MetS, where IR is a driving force. Atherogenic dyslipidemia contributes significantly to the development of atherosclerosis, which can lead to cardiovascular disease. On top of that, genetic alteration and lifestyle factors such as diet and exercise influence the complexity and progression of MetS. To enhance our understanding and consciousness, it is essential to understand the fundamental pathogenesis of MetS. This review highlights current advancements in MetS research including the involvement of gut microbiome, epigenetic regulation, and metabolomic profiling for early detection of Mets. In addition, this review emphasized the epidemiology and fundamental pathogenesis of MetS, various risk factors, and their preventive measures. The goal of this effort is to deepen understanding of MetS and encourage further research to develop effective strategies for preventing and managing complex metabolic diseases.

Towards a Thriving Workplace: A Feasibility Study on Mindfulness and the Mediterranean Lifestyle for Corporate Wellness

Background/Objectives: This study explores the potential of integrating mindfulness and the Mediterranean lifestyle into corporate wellness programs to enhance workplace well-being. Methods: A survey of 485 employees from Greece and Cyprus examined how mindfulness, resilience, adherence to the Mediterranean lifestyle, and work ability are connected. Results: Pearson correlation analysis showed statistically significant positive relationships between mindfulness, resilience, and work ability (p < 0.001 and p < 0.001, respectively). Mindfulness was associated with higher job satisfaction (p < 0.001) and was a significant predictor of good (OR = 1.112, 95% CI: 1.043-1.186, p = 0.001) and excellent (OR = 1.163, 95% CI: 1.087-1.245, p < 0.001) work ability, while adherence to the Mediterranean lifestyle had a lower yet significant positive correlation with resilience (p < 0.01) and work ability (p < 0.05). Differences in wellness across job sectors were observed: employees in health and retail sectors had lower resilience, work ability, and mindfulness compared to those in manufacturing, technology, education, and services. Notably, 78% of participants expressed interest in future wellness programs, favoring a combination of online and onsite formats. Conclusions: These findings suggest that mindfulness and the Mediterranean lifestyle can enhance employee well-being and productivity, but sector-specific strategies may be necessary to address unique challenges. Practical applications include tailoring interventions to meet the needs of employees in sectors with lower wellness scores. Future research should investigate the long-term benefits of such programs across diverse industries and employee groups.

Heuristic evaluation of body mass index with bioimpedance data in the Mexican population

Introduction

Introduction: given the problematic battle against cardio-metabolic diseases and the increase in computational power, different applications are being developed to help estimate overweight and obesity in the population. Objectives: to evaluate the body mass index (BMI) formula (kg/m2), taking body fat measured by bioimpedance as a reference and comparing it with variations of the same form obtained by applying algebraic transformation rules using an artificial intelligence heuristic search method. Material and methods: an artificial intelligence heuristic method was applied to search for the formula that most accurately calculates people's body fat percentage. The formula was generated from body mass and stature, variables used to estimate BMI. Thousands of formulas involving body mass and stature were generated from BMI using transformation rules with algebraic variations and increased and decreased constants. Results: body mass, stature, and body fat percentage data set from 142 female and 150 male participants were used. Body mass and stature were used to classify participants into two classes based on body fat percentage (excessive or adequate, with cutoff points of 30 % for women and 15 % for men). The Youden index guided the search algorithm by evaluating candidate formulas to generate new ones. Among the formulas with the maximum value of the Youden index, Body mass1.1 / Stature2.9, is proposed as the best candidate as an alternative formula to apply instead of the BMI conventional formula. Conclusions: although BMI showed a high Youden index, the AI algorithm found that the W1.1 / H2.9 formula is even more efficient in assessing body fat in men and women.

Single-Cell Analysis of Subcutaneous Fat Reveals Profibrotic Cells That Correlate With Visceral Adiposity in HIV

CONTEXT

Cardiometabolic diseases are common in persons with HIV (PWH) on antiretroviral therapy (ART), which has been attributed to preferential lipid storage in visceral adipose tissue (VAT) compared with subcutaneous adipose tissue (SAT). However, the relationship of SAT-specific cellular and molecular programs with VAT volume is poorly understood in PWH.

OBJECTIVE

We characterized SAT cell-type specific composition and transcriptional programs that are associated with greater VAT volume in PWH on contemporary ART.

METHODS

We enrolled PWH on long-term ART with a spectrum of metabolic health. Ninety-two participants underwent SAT biopsy for bulk RNA sequencing and 43 had single-cell RNA sequencing. Computed tomography quantified VAT volume and insulin resistance was calculated using the Homeostasis Model Assessment 2 Insulin Resistance (HOMA2-IR).

RESULTS

VAT volume was associated with HOMA2-IR (P < .001). Higher proportions of SAT intermediate macrophages (IMs), myofibroblasts, and MYOC+ fibroblasts were associated with greater VAT volume using partial Spearman's correlation adjusting for age, sex, and body mass index (r = 0.34-0.49, P < .05 for all). Whole SAT transcriptomics showed PWH with greater VAT volume have increased expression of extracellular matrix (ECM)- and inflammation-associated genes, and reduced expression of lipolysis- and fatty acid metabolism-associated genes.

CONCLUSION

In PWH, greater VAT volume is associated with a higher proportion of SAT IMs and fibroblasts, and a SAT ECM and inflammatory transcriptome, which is similar to findings in HIV-negative persons with obesity. These data identify SAT cell-type specific changes associated with VAT volume in PWH that could underlie the high rates of cardiometabolic diseases in PWH, though additional longitudinal studies are needed to define directionality and mechanisms.

Synergistic Effect of Lactobacillus Mixtures and Lagerstroemia speciosa Leaf Extract in Reducing Obesity in High-Fat Diet-Fed Mice

In this study, we describe the anti-obesity effects of a novel combination of Lactobacillus mixture (Lactobacillus curvatus HY7601 and Lactobacillus plantarum KY1032) and leaf extract of Lagerstroemia speciosa (L. speciosa) in mice. The administration of the probiotic mixture of HY7601 and KY1032 in combination with the leaf extract of L. speciosa significantly attenuated fat tissue formation and body weight gain in mice fed a high-fat diet. The white adipose fat mass, comprising the inguinal and epididymal fat pads, was most effectively reduced when the probiotic mixture and L. speciosa leaf extract was orally administered to the mice in combination. This combination also reduced the mRNA expression of adipogenic genes (those encoding CCAAT/enhancer-binding protein alpha, peroxisome proliferator-activated receptor gamma, and fatty acid-binding protein 4) in inguinal and epididymal white adipose tissue depots and the liver. Finally, the combination of reduced blood glucose concentrations regulated the insulin resistance of high-fat diet-fed obese mice. These findings provide insight into the mechanisms underlying the effect of this combination and suggest that using Lactobacillus mixture (HY7601 and KY1032) is as safe as microbial monotherapy, but more effective at preventing obesity.

The prevalence and prognostic significance of Sarcopenia and Adipopenia in Pleural Mesothelioma

INTRODUCTION

Altered body composition is associated with adverse survival in multiple cancers. We determined the prevalence, prognostic significance and clinicopathological correlates of sarcopenia and adipopenia in Pleural Mesothelioma (PM) patients receiving chemotherapy.

METHODS

We performed a multi-centre retrospective cohort study. Clinical data and CT images were retrieved for 111 patients from 4 UK centres. Skeletal muscle (at L3 and T4) and fat tissue areas (at L3 only) were measured on pre- and post-chemotherapy CT scans (ImageJ software) and normalised for height. Pre-chemotherapy sarcopenia and adipopenia were defined using validated thresholds, where available or indices <25th percentile. Muscle/fat loss were defined by < 0 % change (%∆) between CT scans. Extreme muscle/fat loss were defined by <25th percentile of %∆. Overall survival associations were evaluated using Kaplan-Meier methodology ± Cox proportional hazards models.

RESULTS

T4 and L3 measurements were possible in 111/111 and 91/111 (82 %). L3 sarcopenia was observed at baseline in 35 % (32/91); all other features were observed in 25 % at baseline, as defined a priori. Body composition changes during chemotherapy were heterogeneous. Overall, 61.5 % and 53.1 % patients lost muscle at L3 and T4. 60.4 % lost fat (at L3 only). Extreme T4 muscle loss and total fat loss were independently prognostic (HR 2.99, p < 0.001; HR 1.92, p = 0.014). Pre-chemotherapy T4 muscle indices were inversely associated with age. No associations were observed with tumour volume, histology, weight, inflammatory markers.

CONCLUSION

T4 muscle indices were feasible in all cases and outperformed L3 values in prognostication. Extreme T4 muscle and total fat loss were independently prognostic.

Paradoxıcal effect of body mass index ranges on pedobarographic evaluatıon

Although there is evidence suggesting that obesity alters plantar pressure distribution, the specific effects of certain body mass index (BMI) ranges on pedobarographic measures in healty individuals has been poorly investigated. A cross-sectional study with 167 healthy participants was conducted to assess plantar pressure changes across 4 BMI ranges: Under/normal weight (NW), overweight (OW), obese (OB), severe obese (SO). Subjects walked on the Footscan® pressure plate at a self-selected speed, and peak plantar pressure (PPP), load rate, and contact area values were recorded. The foot was divided into 10 zones: hallux (T1), toes 2-5 (T2-5), metatarsals 1-5 (M1-M5), midfoot (MF), medial hindfoot (MH) and lateral hindfoot (LH). PPP underneath M2-M4 was lowest in the NW group (p = 0.011), and although PPP values for the SO group were lower than those for the OW and OB groups, these differences were not statistically significant. Load rate values of M2-M3 were lower in both the NW and SO groups (p = 0.008) compared to the OW and OB groups. In addition, the metatarsal load rate values for the SO group were generally lower than those for the NW group. The total metatarsal contact area of both the NW and SO groups was lower (p = 0.019) than that of the OW and OB groups in both feet. These findings suggest that as BMI increases, PPP, load rate, and contact area in the middle metatarsal region initially increase, stabilize early in obesity, and then decrease at advanced stages, indicating a shift of the load to the midfoot.

Understanding the potential mechanisms of disease modifying effects of physical activity and exercise in people with schizophrenia

Schizophrenia is a serious chronic mental health problem that usually starts during adolescence and early childhood. It is characterized by positive symptoms (delusions, hallucinations and grossly disorganized speech and behaviour), negative symptoms (apathy, isolation and diminished affect), and cognitive impairment that negatively affect quality of life. Its treatments include the use of pharmacological interventions, exercise, non-invasive brain stimulation and cognitive remediation training. Exercise is a very simple and cost-effective intervention. However, it is important the mechanisms of its effects are understood so that it can be trusted in clinical practice. In addition, understanding the mechanisms is important for its modification and safe use. Similarly, it may help provide the basis for invention of safe and cost-effective pharmacological or alternative therapies. From the literature, the mechanisms of diseases modifying effects of exercise seem to include increased cardiorespiratory fitness, biochemical changes (increased level of BDNF, increased N-acetylaspartate (NAA)/cr (creatine) ratio, decreased level of triglycerides, increased high density lipoprotein (HDL) and decreased salivary cortisol), structural changes (increase in cerebral volume, increased white matter integrity and increased cortical thickness) and anthropometric changes (reduced body weight and body mass index (BMI), increased muscular strength and decreased waist-hip ratio or waist circumference or hip circumference).

Comparative outcomes of proximal fibular osteotomy versus high tibial osteotomy in patients with medial knee osteoarthritis: A retrospective analysis

High tibial osteotomy (HTO) is a widely used procedure for delaying knee arthroplasty, correcting alignment, and relieving symptoms in patients with knee osteoarthritis. Recently, proximal fibular osteotomy (PFO) has emerged as a less invasive and more cost-effective alternative. This study compares the outcomes of HTO and PFO to evaluate whether PFO can deliver results comparable to HTO in similar patient populations. A total of 96 patients treated between 2018 and 2022 were analyzed, with 54 patients undergoing HTO and 42 undergoing PFO. Subgroups were also created based on body mass index (BMI): non-obese HTO, obese HTO, non-obese PFO, and obese PFO. For each patient, we recorded demographic data, preoperative and 1-year postoperative Oxford Knee Scores (OKS), visual analog scale (VAS) scores, medial joint space (MJS) measurements, mechanical axis deviations (MAD), Kellgren- Lawrence grade (KL), medial proximal tibial angle (MPTA), and any complications. Both HTO and PFO led to significant improvements in OKS, VAS, MJS width, and MAD. Age, KL grade distribution, BMI, and MPTA values were comparable across the groups. Overall, HTO showed superior clinical (OKS, VAS) and radiological (MJS, MAD) outcomes, particularly in non-obese patients. Among obese patients, HTO and PFO achieved similar clinical improvements, although HTO maintained a radiological advantage. Importantly, a lower preoperative MPTA was associated with poorer clinical outcomes in the PFO group. In conclusion, while PFO can produce meaningful clinical and radiological improvements, HTO remains the more effective option in terms of both clinical and radiological outcomes in patients with a BMI below 30. For patients with a BMI over 30, HTO preserves its radiological superiority, although its clinical benefits are comparable to those of PFO. Additionally, a low preoperative MPTA is significantly linked to worse OKS scores in patients undergoing PFO.

Adolescents' Diabetes Self-Management Regimens and Outcomes During the COVID-19 Pandemic: A Scoping Review

Adolescents with diabetes mellitus (DM) experience poorer glycemic outcomes and lower adherence to self-management regimens compared to other age groups. The coronavirus 2019 (COVID-19) pandemic posed new barriers to DM self-management, including social distancing measures and additional stressors. We conducted a scoping review of peer-reviewed literature to examine self-management regimens and outcomes among adolescents aged 10-17 years with type 1 and type 2 DM during the pandemic. Our scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched three online databases, screened articles through a rigorous process, and assessed bias using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. The findings from the included articles were categorized into six thematic areas: glycemic control/monitoring, insulin administration/regimens, weight/lifestyle behaviors, inpatient care/acute complications, outpatient care/telemedicine utilization, and psychosocial well-being. The findings from the included articles (n = 32) varied. Adolescents who used continuous glucose monitoring (CGM), regularly adjusted insulin doses, and utilized telemedicine generally maintained or improved glycemic control during the pandemic. However, many adolescents gained weight, reduced their physical activities, worsened their diet and sleep habits, and experienced increased stress, all of which negatively impacted glycemic control. Rates of acute complications and hospitalizations varied among adolescents. Telemedicine was widely used and viewed positively by adolescents with DM. Adolescents with DM faced various physical, behavioral, and psychosocial challenges during the COVID-19 pandemic. Further research is needed to assess the long-term impacts of the pandemic on this population. Multilevel interventions and preparedness efforts are required to improve and sustain adolescents' DM self-management outcomes during public health emergencies, particularly focused on promoting CGM use, increasing physical activity levels, improving dietary habits, and reducing stress.

Sleep apnoea from a dentist's point of view

OBJECTIVES

The aim of this study was to confirm the relevance of knowledge a dentist has regarding obstructive sleep apnoea (OSA), considering the fact that based on specific risk factors a dentist may be the first clinician to identify patients who are at risk of being affected by this serious condition.

METHODS

The cohort consisted of 53 subjects who underwent a routine dental examination. Anthropometric data and data on tongue size (Mallampati classification), tonsil size (Friedman classification), daytime sleepiness (Epworth Sleepiness Scale) and systemic risk factors were recorded in a record sheet. On the basis of the monitored parameters, selected subjects underwent polysomnography in order to objectivise the parameters observed.

RESULTS

Polysomnography confirmed a 96% success rate in our identifying subjects as being at high risk of developing OSA. This indicates that the parameters monitored during a routine dental examination were properly selected to identify patients with this condition in advance.

CONCLUSION

The relevance of information dentists have about the early identification of patients with OSA may be crucial in the management of further therapy to be provided to these patients.

Childhood Body Fat Patterns and Obesity Prevalence in Kazakhstan

Background

In Kazakhstan the pediatric population levels of obesity based on fat mass (FM) assessment are currently unknown. The present work aimed to assess average childhood FM levels and the prevalence of high levels of adiposity (based upon FM levels).

Methods

Cross-sectional data from 2015 to 2020 nationally representative Childhood obesity surveillance initiative and 2022 regional surveys were used for this study of children aged 8 years (n = 4770) and 9 years (n = 3863). Childhood FM assessment was made using a validated prediction model using height, weight, age, sex and ethnicity. Average levels of FM, fat mass percent (FM%) and the prevalence of overfat and obesity were estimated.

Results

Amongst 8-year-olds, the population average FM% was 32.3% (95% CI: 31.7%-32.8%) for boys and 35.2% (95% CI: 34.8-35.6) for girls (2015) and 32.7% (95% CI: 32.3-33.1) for boys and 35.1% (95% CI: 34.7-35.5) for girls in 2020. The Almaty region had the average FM% 32.7% (95% CI: 32.1-33.2) and 34.8% (95% CI: 34.3-35.4) for boys and girls respectively in 2022. The similar pattern was observed for 9 year old children.

Conclusions

The present study reveals high FM% levels in primary school age children from Kazakhstan across study years. Understanding patterns of FM levels is important for preventing and addressing childhood obesity.

Asprosin: the potential player in combined double diabetes and hypothyroidism

BACKGROUND

Double diabetes is a term used to describe people with type 1 diabetes who are overweight, show signs of insulin resistance, or have a family history of type 2 diabetes. Asprosin is a novel glucogenic adipokine; Asprosin regulates appetite and glucose metabolism. The study aimed to investigate the level of asprosin in people with double diabetes with and without hypothyroidism and its association with markers of insulin resistance.

SUBJECTS AND METHODS

This case-control study was conducted in Iraq between March 2022 and January 2023. One hundred sixty participants were enrolled; the selected participants were classified into three age and sex-matched groups. The first group consisted of eighty healthy controls served as the control group. Of eighty participants with newly discovered DD, half (40) have DD alone, and 40 have both DD and hypothyroidism. Serum asprosin, insulin, thyroid, lipid profile, glucose, and glycated hemoglobin were measured. The estimated glucose disposal rate, triglyceride-glucose index, and HOMA-IR were calculated.

RESULTS

Participants with double diabetes had significantly (p ≤ 0.001) greater circulation asprosin levels than subjects in the control group. Comparatively, to double diabetes participants without hypothyroidism, asprosin levels were also higher in double diabetes subjects with hypothyroidism (p ≤ 0.001), and the insulin resistance markers increased in a stepwise way across the asprosin quartiles (p ≤ 0.001). Asprosin significantly correlated with insulin resistance markers, eGDR, plasma glucose, HbA1C, triglycerides, HDL-C, and LDL-C.

CONCLUSION

Elevated asprosin levels might be a potential biomarker for the alteration in glucose metabolism, insulin resistance, and double diabetes. It may be the missing link between metabolic and endocrine disorders.

State affect and body image effects of body positive social media content within a female chronic illness sample

Body positivity refers to a movement, popularized on social media, that encourages the normalization and acceptance of bodies diverging from sociocultural ideals, specifically within marginalized communities. Previous studies suggest that briefly viewing body positive social media content may lead to increased body satisfaction and positive affect in young women relative to thin-ideal and appearance-neutral content. Diminished body functionality and appearance change due to chronic illness poses a unique challenge to positive body image in young adults living with chronic illness. Typical body positive social media content may not be useful for this community since chronic illnesses are often not outwardly depicted, so the current study aimed to examine the state effects before and after viewing body positive social media content in a sample of young women (N=201) with at least one self-reported chronic illness. Participants (Mage = 29.4, SD = 6.74; 79.2 % white) were randomly assigned to view one of two sets of 10 images: chronic illness body positive and typical body positive. Participants completed a Visual Analogue Scale (VAS) pre- and post-stimuli exposure. Findings from repeated measures ANOVA revealed significant interaction between time and group for negative affect (F(1198) = 4.402, p =.037) and broad conceptualization of beauty (F(1199) = 4.288, p =.040), such that those exposed to the chronic illness stimuli reported a larger reduction in negative affect and an increase in conceptualization of beauty beyond the non-chronically ill ideal post-exposure. Thus, exposure to body positive social media content inclusive of chronic illness may be more useful in stabilizing affect and promoting greater positive body image within the community. These findings highlight the importance of inclusive body positive portrayals in terms of dimensions beyond weight and shape to account for the effects of diminished body functionality.