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

Di (2-ethyl hexyl) phthalate and its metabolite-induced metabolic syndrome: a review of molecular mechanisms

OBJECTIVES

Metabolic disorders, as multifactorial disorders, are induced by genetic susceptibility and exposure to environmental chemicals. Di (2-ethyl hexyl) phthalate (DEHP), a ubiquitous plasticizer, is well known as an endocrine-disrupting chemical in living organisms. In recent decades, researchers have focused on the potential of DEHP and its main metabolite (Mono (2-ethylhexyl) phthalate) (MEHP) to induce metabolic disorders. In the present review, we aimed to summarize studies regarding DEHP and MEHP-induced Metabolic syndrome (MetS) as well as address the involved mechanisms.

METHODS

A search has been carried out in Google Scholar, PubMed, Scopus, and Web of Science databases using appropriate keywords including 'Metabolic syndrome' or 'Metabolic disorder' or 'Obesity' or 'Hyperglycemia' or 'Hyperlipidemia' or 'Hypertension' or 'Non-alcoholic fatty liver disease' and 'DEHP' or 'Di (2-ethyl hexyl) phthalate' or 'Bis(2-ethylhexyl) phthalate' or 'MEHP' or 'Mono (2-ethylhexyl) phthalate'. Studies were chosen based on inclusion and exclusion criteria. Inclusion criteria are in vitro, in vivo, epidemiological studies, and English-written studies. Exclusion criteria are lack of access to the full text of studies, editorial articles, review articles, and conference articles.

RESULTS

Animal studies indicate that DEHP and MEHP disrupt insulin hemostasis, increase glucose content, and induce hyperlipidemia and hypertension as well as obesity, which could lead to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). DEHP and its metabolite induce such effects directly through influence on nuclear receptors such as peroxisome proliferator-activated receptors (PPARs) or indirectly through reactive oxygen species (ROS) production. Both events led to the disruption of several molecular signaling pathways and subsequently metabolic syndrome (MetS). Furthermore, epidemiological studies showed that there was a correlation between DEHP metabolites levels and obesity, hyperglycemia, and hypertension.

CONCLUSIONS

According to studies, DEHP and its main metabolite have the potential to induce MetS by involving various molecular mechanisms. Epidemiological studies concerning the association of DEHP and MetS in humans are not sufficient. Therefore, more studies are needed in this regard.

Exploring Nontraumatic Brain Hemorrhage in Sudden and Unexpected Deaths: A Novel Autopsy-Based Investigation

Background  There has been a surge in sudden and unexpected deaths, presenting a significant challenge for health policymakers and researchers. These individuals showed no signs of recent or past illnesses and died suddenly during routine activities like walking, standing, or working. Objective  This study focuses on exploring nontraumatic brain hemorrhage as a cause of death in autopsies of individuals without prior illnesses. The research aims to explore patterns, prevalence, and risk factors associated with nontraumatic brain hemorrhage, specifically obesity in sudden and unexpected deaths. Materials and Methods  This retrospective, observational study was conducted using autopsy cases with nontraumatic brain hemorrhage as the identified cause of sudden and unexpected deaths. Information on demographic details, medical history, and circumstances surrounding the deaths was collected. The cases were classified based on the body mass index according to the classification of the World Health Organization. Results  From April 2023 to January 2024, 10 cases of sudden and unexpected deaths due to nontraumatic brain hemorrhage were identified. Key findings included predominantly cases of obesity or overweight, deaths occurring predominantly between 8 p.m. and midnight, and all cases being males. Conclusion  The study sheds light on the surge in sudden deaths, specifically attributed to nontraumatic brain hemorrhage. The findings reveal a significant association between obesity and brain hemorrhage in sudden deaths, especially among males. The study's temporal analysis adds depth to understanding these patterns.

Comprehensive assessment of distinct abdominal fat compartments beyond liver content in overweight/obese patients using MRI and ultrasound imaging

BACKGROUND

Ectopic fat deposition, involving lipid infiltration within organs and fat accumulating surrounding organs, plays a crucial role in the development of metabolic abnormalities in obesity. Current imaging measurements of obesity primarily focus on lipid infiltration within liver, neglecting fat deposition in other areas. This study aims to explore the methods of measuring and correlating different types of abdominal ectopic fat deposition in obese patients using magnetic resonance imaging (MRI) and ultrasound techniques, and to investigate the relationship between these fat parameters and obesity-related metabolic markers.

METHODS

Abdominal ectopic fat deposition including liver fat content, mesenteric fat thickness (MFT), perirenal fat thickness (PrFT) and preperitoneal fat thickness (PFT) were measured in 220 overweight/obese patients using both MRI and ultrasound techniques. Correlation analysis validated the concordance of fat parameters at specific sites between the two imaging methods and identified the cutoff values of hepatic attenuation coefficient (AC) for diagnosis of liver steatosis. Additionally, we investigated the correlation between fat parameters by both methods and obesity-related metabolic markers.

RESULTS

Ultrasonic measurement of PrFT and hepatic AC both had high correlation with PrFT (r = 0.829, p < 0.001) and hepatic Proton-density fat fraction (PDFF, r = 0.822, p < 0.001) measured via MR. Hepatic AC cutoff values for diagnosing mild, moderate, and severe fatty liver were 0.705 dB/cm/MHz (AUC = 0.922), 0.755 dB/cm/MHz (AUC = 0.923), and 0.875 dB/cm/MHz (AUC = 0.890) respectively. Hepatic AC correlated significantly with AST and ALT (r = 0.477 ~ 0.533, p < 0.001). MFT measured by ultrasound were positively associated with glycated hemoglobin (r = 0.324 ~ 0.371, p < 0.001) and serum triglyceride levels (r = 0.303 ~ 0.353, p < 0.001). PrFT measured by both methods showed significant positive correlations with serum creatinine levels (r = 0.305 ~ 0.308, p < 0.001).

CONCLUSIONS

Both MRI and ultrasound demonstrate metabolic correlations in quantifying mesenteric, hepatic, and perirenal fat. In addition to assessment of liver fat content, the measurements of ectopic fat deposition by MRI or ultrasound are a simple and crucial way for comprehensive fat evaluation in individuals with overweight/obesity.

Efficacy and safety of a novel oral hydrogel capsule in adults with overweight or obesity: the pivotal randomized RESET study

OBJECTIVE

The objective of this study was to investigate the efficacy and safety of the Epitomee capsule versus placebo as an adjunct to high-intensity lifestyle intervention in participants with overweight or obesity.

METHODS

The Randomized Evaluation of Efficacy and Safety of the Epitomee Capsule Trial (RESET) was a prospective, double-blind, placebo-controlled pivotal trial in adults with baseline BMI of 27.0 to 40.0 kg/m2. The co-primary endpoints at week 24 were percentage change from baseline in body weight for the Epitomee and placebo groups and proportion of Epitomee-treated patients achieving ≥5% weight loss compared with a 35% threshold. The primary safety endpoint was the incidence of device-related serious adverse events.

RESULTS

A total of 138 participants received Epitomee and 141 received placebo. Mean (SD) change in body weight from baseline was -6.6% (6.5%) with Epitomee and -4.6% ( 4.7%) with placebo; least-squares means were -6.1% (0.6%) and -4.2% (0.6%), respectively (p = 0.0054). Fifty-six percent of Epitomee-treated participants attained ≥5% weight loss from baseline, which was significantly greater than the 35% predefined threshold (p < 0.0001). Twenty-seven percent of Epitomee-treated and eleven percent of placebo-treated participants achieved ≥10% weight loss. Adverse event rates were similar between the groups. No device-related serious adverse events occurred.

CONCLUSIONS

The Epitomee capsule is a safe and efficacious nonpharmacological option for weight management with potential broad application in participants with overweight or obesity.

A Population-Based Study of Bariatric Surgery Trends in Australia: Variations Reflect Continuing Inequities in Access to Surgery

BACKGROUND

Obesity is increasingly prevalent and associated with higher morbidity and mortality. Bariatric surgery, particularly sleeve gastrectomy, provides durable weight loss and improves obesity-related conditions like type 2 diabetes and cardiovascular disease. Despite its benefits, significant concerns regarding inequities in access to bariatric surgery persist. This study aims to evaluate recent trends in bariatric surgery rates and to investigate patterns of access to bariatric surgery.

METHODS

A population-based study of age-adjusted bariatric procedure rates in adults in NSW, Australia, was conducted over the financial years 2013/14 to 2021/22. Trends in age-adjusted procedure rates were assessed by demographics and healthcare settings.

RESULTS

In 2021/22, 179.6 bariatric procedures per 100,000 population were performed, an 89.7% increase since 2013/14 (p < 0.001). Laparoscopic sleeve gastrectomy, the most common procedure, increased by 94.1% to 112.6/100,000/year (p < 0.001). Females had 3.6 times higher rates than males (232.3/100,000/year vs 64.9/100,000/year). The greatest increases occurred in younger patients (125.9% in the 18-24 age group; 142.4% in the 25-34 age group, p < 0.001). Private hospital rates were 15.6 times higher than public (132.2/100,000/year vs 8.5/100,000/year) and rose 92.3% (p < 0.001), whilst public hospital rates declined by 17.9% (p = NS). Patients from regional areas had the highest rates (175.7/100,000/year) and largest increase (169.8%; 89.4/100,000/year to 241.8/100,000/year, p < 0.001).

CONCLUSIONS

Bariatric surgery rates continue to increase, particularly among females, despite similar obesity prevalence between sexes. Most surgery is conducted in the private sector, suggesting differential access based on financial circumstances. Rates are highest in younger people, although obesity-related comorbidities increase with age. Regional patients undergo surgery at higher rates than rural patients despite greater obesity prevalence with increasing rurality. Efforts to address these disparities are essential to improve equitable access to obesity treatments.

The Close Link Between Obesity and Cardiovascular Disease: Current Insights and Remaining Challenges

Obesity is a global public health crisis, contributing to chronic disease development and poor prognosis. A large body of evidence consistently demonstrates that increased adiposity leads to many cardiovascular diseases (CVDs) and complications, such as coronary artery disease, heart failure, and arrhythmias, via direct and indirect mechanisms. Therefore, weight management is crucial to reduce and prevent cardiovascular risk. The recent emergence of glucose-like peptide-1 receptor agonists shows remarkable weight reduction and cardiovascular prevention. Despite the clear benefits, controversies and challenges on obesity-related CVD remain. This review aims to provide a comprehensive understanding of obesity-related CVD and explore current remaining tasks.

Association of novel inflammatory and metabolic markers with mortality in individuals with overweight and obesity

BACKGROUND AND AIMS

Stress hyperglycemia ratio (SHR) and pan-immune-inflammation value (PIV) are novel prognostic markers associated with metabolic changes and chronic inflammation, but their association with mortality risk in individuals with overweight and obesity remains unknown. We aimed to investigate impact of SHR and PIV on mortality risk in individuals with overweight and obesity.

METHODS AND RESULTS

This cohort study included 16,703 U S adults with overweight and obesity. SHR and PIV were estimated, and Cox regression, ROC, and Kaplan-Meier curves analyzed their associations with all-cause and cause-specific mortality. Subgroup and interaction analyses tested SHR and PIV consistency. Over a median follow-up of 110 months, there were 2432 all-cause deaths (14.6 %), including 677 cardiovascular, 577 cancer, and 130 cerebrovascular deaths. Participants were categorized by optimal SHR (≥1.038 or <1.038) and PIV (≥301 or <301) cutoffs. High SHR was associated with higher overall and cause-specific mortality (log-rank p < 0.001). High PIV was linked to increased risks of overall, cardiovascular, and cancer mortality (log-rank p < 0.001). Multivariate Cox models showed elevated SHR was associated with increased all-cause, cardiovascular, and cancer mortality (HR:1.59; 95%CI: 1.34-1.89; HR:1.45; 95%CI: 1.03-2.04; HR:1.66; 95%CI: 1.15-2.38, respectively). Elevated PIV was linked to higher all-cause and cardiovascular mortality (HR: 1.18; 95%CI: 1.02-1.37; HR:1.35; 95%CI: 1.02-1.79, respectively). Poorer survival was noted in obesity + high SHR and overweight + high PIV subgroups (log-rank p < 0.001).

CONCLUSIONS

Elevated SHR and PIV are significant predictors of increased all-cause and cause-specific mortality in individuals with overweight and obesity.

Effects of Exercise Interventions on Blood Pressure in Children and Adolescents With Overweight or Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This systematic review and meta-analysis aimed to quantify the effect of exercise interventions on blood pressure (BP) among children and adolescents with overweight or obesity. A systematic search of five databases was conducted from inception to July 26, 2024, to identify relevant randomized controlled trials (RCTs). Study quality was assessed using the revised Cochrane Risk of Bias Tool for randomized controlled trials. A random-effects model was performed, and subgroup analyses were further conducted. A total of 19 RCTs were included. All reported changes of systolic blood pressure (SBP), while 18 reported that of diastolic blood pressure (DBP). Exercise interventions significantly reduced SBP (standardized mean difference [SMD] = -0.71; 95% confidence interval [CI], -1.06 to -0.36; P<.001) and DBP (SMD= -0.67; 95% CI, -1.00 to -0.34; P<.001). Subgroup analyses indicated greater reductions in BP levels among girls and obese children and adolescents, or when the program was HIIT, or with a total time of at least 3000 minutes. Early exercise interventions may help to prevent or delay the onset of hypertension in this population.

Comparative efficacy and safety of GLP-1 receptor agonists for weight reduction: A model-based meta-analysis of placebo-controlled trials

Aim

Obesity is a global epidemic. The FDA has approved glucagon-like peptide-1 (GLP-1) receptor agonists such as Liraglutide, Semaglutide, and the GLP-1/gastric inhibitory polypeptide (GIP) dual agonist Tirzepatide for the treatment of obesity. Clinical trials of GLP-1/GIP/glucagon(GCG) triple agonists are ongoing. This study compared the efficacy and safety profiles of different GLP-1 receptor agonists (GLP-1RAs) for weight reduction and explored the related influencing factors, providing quantitative information for the development of GLP-1RAs and their clinical use.

Methods

This systematic review of public databases included placebo-controlled randomized clinical trials of GLP-1RAs. Time-course, dose-response, and covariate models were used to describe the efficacy characteristics and influencing factors of different GLP-1RAs. Subgroup analyses were performed to explore efficacy differences in receptor specificity. Meta-analyses compared the incidence of adverse event and dropout rates among different GLP-1RAs.

Results

Fifty-five studies involving 16,269 participants and 12 GLP-1RAs were included. Six drugs showed significant dose-response relationships. The maximum weight reduction effect ranged from 4.25 kg (Liraglutide) to 22.6 kg (Retatrutide). Reported onset times ranged from 6.4 weeks (Orforglipron) to 19.5 weeks (Tirzepatide). At 52 weeks, weight reduction effects were 7.03 kg, 11.07 kg, and 24.15 kg for mono-agonists, dual-agonists, and tri-agonists, respectively. There was a significant negative correlation in the exponential pattern between age and weight reduction effect, whereas baseline weight and BMI had no significant impact. Common adverse events of GLP-1RAs, reported in the literature include nausea, vomiting, diarrhea, and constipation, with a significantly higher incidence of nausea than that of placebo.

Conclusions

This study provides a quantitative evaluation of the efficacy and safety of GLP-1RAs and offers valuable insights into the assessment of new drugs for weight reduction.

Hope for the best, but prepare for the worst - Diagnostic accuracy of the American College of Surgeons National Surgical Quality Improvement Program - Risk model for patients undergoing abdominoplasty after massive weight loss - Results from a Retrospective Cohort Study

Background

This study aimed to validate the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk calculator for predicting outcomes in patients undergoing abdominoplasty after massive weight loss.

Methods

Patients' characteristics, pre-existing comorbidities and adverse outcomes in our department from 2013 to 2023 were collected retrospectively. Adverse events were defined according to ACS-NSQIP standards and predicted risks were calculated manually using the ACS-NSQIP risk calculator. Binary logistic regression and the Brier score were used to assess the diagnostic accuracy of the model.

Results

Among the 337 individuals who underwent abdominoplasty, 251 had achieved significant weight loss before surgery. After excluding 46 cases due to incomplete data, 205 cases remained for analysis. There were 20% cases of serious complications, 26.3% of some complications, 10.2% of readmissions, 18.8% returned to the operating theatre, 15.6% of surgical site infections and 0.5% each of pneumonia and venous thromboembolism. Although the calculator predicted a 1.5% discharge rate to nursing or rehabilitation facilities and a 0.1% rate of sepsis, neither outcome was observed. Elevated American Society of Anesthesiologists (ASA) status was significantly associated with a higher complication rate, except for surgical site infections (SSI) (p = 0.06). Additionally, an elevated Body Mass Index (BMI) before post-bariatric surgery and a higher resection weight were both associated with increased rates of return to the operating theatre (p = 0.01) and serious complications (p = 0.01). Predicted complication rates (0.1%-8.6%) underestimated actual complication rates (0.5%-26.3%). The Brier scores did not differ significantly from the null model for any outcomes except for general complications (p = 0.001) and logistic regression models demonstrated low sensitivity (0.0-9.8%) and weak odds ratios (1.28-1.46), indicating limited reliability.

Conclusion

The ACS-NSQIP risk calculator does not reliably predict adverse outcomes in this patient cohort.

Dual inhibition of carbonic anhydrases VA and VII by silychristin and isosilybin A from Silybum marianum: A potential antiobesity strategy

Obesity is a global health crisis linked to chronic diseases like cardiovascular disease and type 2 diabetes. Its prevalence, even in low-income countries, highlights the failure of traditional interventions. Safer pharmacological treatments are urgently needed, as many existing antiobesity drugs have been withdrawn due to severe side effects, leaving a critical therapeutic gap. A promising target in this context is human carbonic anhydrase V (hCA V), a mitochondrial enzyme that plays a key role in glucose homeostasis. Inhibiting hCA V has been shown to reduce lipogenesis and improve metabolic conditions. Natural plant extracts, such as silymarin from milk thistle, have demonstrated potential in managing obesity-related metabolic syndromes by lowering triglycerides, reducing cholesterol levels, and improving liver function. Our computational studies have identified active compounds in silymarin that effectively inhibit hCA V, shedding light on a potential mechanism for its antiobesity effects. Building on these findings, our research further reveals that these compounds also inhibit carbonic anhydrase VII (hCA VII), enhancing their therapeutic potential. This dual inhibitory action addresses both metabolic dysregulation and oxidative stress. Notably, the antioxidant properties of hCA VII provide additional protection against obesity-related complications by mitigating oxidative stress, a key contributor to the development of metabolic syndrome.

Characterization of a novel type 4 resistant starch from tapioca and its obesity-preventive effects through gut microbiota modulation in high-fat diet-treated mice

The rising pandemic of obesity has received significant attention. Yet, more safe and effective targeted strategies must be used to mitigate its impact on individual health and the global disease burden. While the health benefits of resistant starch (RS) are well-documented, the role of RT-90 (a phosphate-modified tapioca RS containing 90.1 % total dietary fiber) in mitigating obesity remains unknown. Accordingly, the physicochemical characteristics and protective effects of RT-90 on obesity were investigated in high-fat diet (HFD)-fed mice. Physicochemical property examinations showed that RT-90 consisted of small, round starch granules (D90: 20.69 ± 0.4 μm) with a crystalline structure, P-O-C stretching, and high peak melting temperature and enthalpy. Additionally, feeding mice with RT-90 significantly decreased body weight, improved oral glucose tolerance test (OGTT), reduced fatty liver and adipose tissue accumulation, lowered oxidative stress and inflammation by upregulating antioxidant enzymes (SOD, catalase, GPx) and anti-inflammatory cytokines (IL-4, IL-10), and enhanced fecal lipids and bile acid excretion. Notably, RT-90 administration in HFD-fed mice was associated with the inhibition of obesity-associated harmful bacteria ([Eubacterium]_xylanophilum group, Allobaculum, Clostridia_UCG-014, Dubosiella) and promotion of short-chain fatty acids (SCFAs)-producing gut flora, including Bifidobacterium, Lactobacillus, Bacteroides, and Parabacteroides, which suggests a possible mechanism by which RT-90 alters gut microbiota to attenuate obesity. These novel findings first revealed that RT-90 facilitates weight loss through its antioxidant, anti-inflammatory, and microbiota modulation abilities. This provides a promising strategy for managing overweight or obesity and holds potential for applications in developing healthy food products.

Relation of Reproductive Lifespan with Obesity in Chinese Women: Results from a Large Representative Nationwide Population

Background: Research on the association between age at menarche and menopause, reproductive lifespan, and the risk of obesity in China is unclear and requires further clarification. Materials and Methods: Data were obtained from the China Hypertension Survey, a cross-sectional study using a stratified multistage random sampling method, conducted from October 2012 to December 2016, with a total of 187,162 women included in the analysis. Logistic regression models and restricted cubic spines were used to estimate the relationship between obesity and age at menarche, age at menopause, and reproductive lifespan. Results: The mean (standard deviation) age at menarche and menopause, and reproductive lifespan were 15.5 (1.8), 48.7 (3.5), and 33.2 (3.9) years, respectively. Age at menarche was negatively related to the risk of obesity (odds ratio [OR]: 0.968; 95% confidence interval [CI]: 0.961-0.975). There was a positive association between age at menopause and the risk of obesity in postmenopausal women (OR: 1.019; 95% CI: 1.014-1.023). Reproductive lifespan was positively related to obesity (OR: 1.020; 95% CI: 1.017-1.025). The restricted cubic spines showed the association between age at menarche, age at menopause, reproductive lifespan, and obesity was nonlinear when fully adjusted. Conclusions: Based on the large nationally representative sample, Chinese women with earlier age at menarche, later age at menopause, and longer reproductive lifespan have a higher risk of obesity.

Difficult airway management in 25 hospitals across China: A multicenter cross-sectional study

STUDY OBJECTIVE

Difficult airway management is a significant challenge in clinical anesthesia, critical care, and emergency medicine. Inadequate management can lead to severe complications including organ damage and death. This study assessed the variability in difficult airway management across China and focused on how patient and operator factors influenced outcomes in operating rooms.

DESIGN

A multicenter observational cross-sectional study.

SETTING

This study was conducted from November 2022 to November 2023 and included 25 secondary and tertiary hospitals across various regions in China.

PATIENTS

In the total of 181,399 general anesthesia patients, 384 (0.21 %) were identified as having difficult airways.

INTERVENTIONS

Data were gathered from a specialized questionnaire comprising four sections with 27 questions and analyzed using logistic regression in SPSS to identify key factors that influenced effective management of difficult airways.

MEASUREMENTS

This study focused on preoperative assessment, anesthesia selection, intubation attempts, and contingency planning for difficult airway management practices among anesthesiologists.

MAIN RESULTS

In anticipated difficult airways, rapid sequence induction was used in 51.7 % of the cases, maintaining spontaneous breathing under general anesthesia in 11.1 %, and awake intubation in 36 %. For unanticipated difficult airways, 95.9 % of the anesthesiologists opted for rapid sequence induction. Limited mouth opening was the most common cause of difficult airways and obesity and ankylosing spondylitis were identified as significant factors. The logistic regression analysis identified the type of difficult airway, anesthesiologist experience, and assessment methods as key factors influencing the first attempt intubation success.

CONCLUSIONS

The accuracy of difficult airway assessment and first attempt intubation success is influenced by both patient-related factors and the anesthesiologist's expertise. Regional and institutional variability in decision-making and tool selection underscores the critical need for standardized guidelines and comprehensive training to enhance airway management outcomes across diverse clinical settings in China.

Individuation of a cut-off value of triglyceride-glucose index for incident diabetes mellitus in patients with essential hypertension

The prevalence of obesity and diabetes, risk factors for atherosclerotic vascular diseases, is increasing worldwide; therefore, it is desirable to early identify them to reduce cardiovascular events. Thus, we investigated whether the triglyceride-glucose index (TyG index), a new marker of insulin resistance, is associated with incident diabetes in patients with newly diagnosed arterial hypertension. We selected 585 patients with newly diagnosed arterial hypertension referred to our tertiary Clinic of Catanzaro University Hospital for the evaluation of their cardiometabolic risk profile. None of the patients had diabetes mellitus at enrollment and took any drug known to affect glucose metabolism. Patients underwent medical history collection, clinical examination and laboratory tests. The TyG index was calculated as the ln [fasting TG (mg/dl) × FPG (mg/dl)/2], as previously suggested. During the follow-up [mean 8.5 years (range 3.1-10.7)], there were 78 new cases of incident diabetes (1.57% patient-year). Patients who developed diabetes mellitus were older and had a higher body mass index (BMI), baseline blood pressure, fasting glucose, insulin, homeostatis model sssessment (HOMA) index, triglyceride, creatinine and hs-CRP mean values, while estimated glomerular filtration rate values were lower. At the Cox regression analysis, covariates significantly associated with incident diabetes were: BMI (HR = 2.842, 95%CI = 2.299-3.514), TyG index (HR = 2.392, 95%CI = 1.745-3.192), age (HR = 1.944, 95%CI = 1.527-2.474), hs-CRP (HR = 1.409, 95%CI = 1.153-1.722), and HOMA (HR = 1.325, 95%CI = 1,079-1.756). The best estimated cut-off value of TyG index in predicting diabetes was 4.71. In addition, we documented a significant relationship between TyG index and HOMA (r = 0.575; p < 0.0001). Present data demonstrate that TyG index, a simple and cost-effective marker of insulin resistance, is useful in predicting incident diabetes in patients with arterial hypertension.

Nulliparous with Class III Obesity at Term: Labor Induction or Cesarean Delivery without Labor

OBJECTIVE

 This study aimed to compare maternal and neonatal outcomes between labor induction versus cesarean delivery (CD) without labor among nulliparous individuals with class III obesity (body mass index [BMI] ≥40 kg/m2).

STUDY DESIGN

 A retrospective cohort study of all nulliparous singleton deliveries at ≥37 weeks with a BMI of ≥40 kg/m2 at delivery between March 2020 and February 2022. We excluded individuals with spontaneous labor, fetal malformations, and stillbirths. The primary outcome was a composite of maternal mortality and morbidity, including infectious and hemorrhagic morbidity. The secondary outcome was a neonatal composite. A subgroup analysis evaluated patients with a BMI of ≥50 kg/m2. Another subgroup analysis compared outcomes between CD without labor and an indicated CD following induction. A multivariable logistic regression was applied. For adjustment, we used possible confounders identified in a univariate analysis.

RESULTS

 Among 8,623 consecutive deliveries during the study period, 308 (4%) met the inclusion criteria. Among them, 250 (81%) underwent labor induction, and 58 (19%) had a CD without labor. The most common indications for CD without labor were fetal malpresentation (26; 45%), suspected macrosomia (8; 14%), and previous myomectomy (5; 9%). Indicated CD occurred in 140 (56%) of the induced individuals, with the two leading indications being labor arrest (87; 62%) and non-reassuring fetal heart rate tracing (51; 36%). The rates of composite maternal morbidity (adjusted odds ratio [aOR] = 2.14, 95% confidence interval [CI]: 0.64-7.13) and composite neonatal morbidity (aOR = 3.62, 95% CI: 0.42-31.19) did not differ following a CD without labor compared to labor induction. The subgroup analyses did not demonstrate different outcomes between groups.

CONCLUSION

 Among nulliparous individuals with class III obesity at term who underwent induction, more than 50% had indicated CD; the rate of short-term maternal and neonatal morbidity, however, did not differ between labor induction and CD without labor.

KEY POINTS

· The rate of unplanned CD among those who underwent labor induction was relatively high (56.0%).. · Outcomes did not differ between those who underwent CD without labor and those who were induced.. · Outcomes also did not differ between those who underwent CD without labor and those with CD in labor..

Edible nonaqueous foams: Recent advances in the formation, stabilization, characterization, and applications

Edible nonaqueous foam has emerged as a novel direction for the development of fat-reducing products in recent years. This review critically summarizes the current progress of research on this foam mainly over the past decade. Initially, destabilization mechanisms that hinder its rational design are highlighted. Then, the preparation of nonaqueous foam is discussed, focusing on the types of stabilizers and foam properties. Additionally, the characterization methods of this foam and its applications are discussed. Finally, the gaps in the current research on edible nonaqueous foam and future perspectives are pointed out. Edible nonaqueous foam offers a novel avenue for developing fat replacers while preserving desirable sensory attributes. Moreover, this foam has demonstrated its potential in encapsulating flavor ingredients as well as developing responsive systems, thereby contributing to future advancements in personalized nutrition. This review has the potential to inspire innovative ideas for future research endeavors within the field of foam.

Acid Sphingomyelinase Regulates AdipoRon-Induced Differentiation of Arterial Smooth Muscle Cells via TFEB Activation

AdipoRon is a selective adiponectin receptor agonist that inhibits vascular remodeling by promoting the differentiation of arterial smooth muscle cells (SMCs). Our recent studies have demonstrated that activation of TFEB and its downstream autophagy-lysosomal signaling contribute to adipoRon-induced differentiation of SMCs. The present study was designed to examine whether acid sphingomyelinase (ASM; gene symbol Smpd1) is involved in mediating adipoRon-induced activation of TFEB-autophagy signaling and inhibition of proliferation/migration in arterial SMCs. Our results showed that adipoRon induced ASM expression and ceramide production in Smpd1+/+ SMCs, which were abolished in Smpd1-/- SMCs. Compared to Smpd1+/+ SMCs, Smpd1-/- SMCs exhibited less TFEB nuclear translocation and activation of autophagy signaling induced by adipoRon stimulation. SMC differentiation was further characterized by retarded wound healing, reduced proliferation, F-actin reorganization, and MMP downregulation. The results showed that Smpd1-/- SMCs were less responsive to adipoRon-induced differentiation than Smpd1+/+ SMCs. Mechanistically, adipoRon increased the expression of protein phosphatases such as calcineurin and PP2A in Smpd1+/+ SMCs. The calcineurin inhibitor FK506/cyclosporin A or PP2A inhibitor okadaic acid significantly attenuated adipoRon-induced activation of TFEB-autophagy signaling. In addition, adipoRon-induced expressions of calcineurin and PP2A were not observed in Smpd1-/- SMCs. However, activation of calcineurin by lysosomal TRPML1-Ca2+ channel agonist ML-SA1 rescued the activation of TFEB-autophagy signaling and the effects of adipoRon on cell differentiation in Smpd1-/- SMCs. Taken together, these data suggested that ASM regulates adipoRon-induced SMC differentiation through TFEB activation. This study provided novel mechanistic insights into the therapeutic effects of adipoRon on TFEB signaling and pathological vascular remodeling.

Body Mass Index and Risk of All-Cause and Cardiovascular Disease Mortality in Patients With Type 2 Diabetes Mellitus

CONTEXT

The correlations between body mass index (BMI) and risk of all-cause and cardiovascular disease (CVD) mortality in patients with type 2 diabetes mellitus (T2DM) are still controversial.

OBJECTIVE

To explore the correlation between BMI and the risk of all-cause and CVD mortality in patients with T2DM.

METHODS

The data sources China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, PubMed, Web of Science, Embase, and The Cochrane Library were searched up until May 25, 2024. After adjusting for confounding factors, the original study on the association between BMI and all-cause and CVD mortality in patients with T2DM was analyzed. Number of all-cause and CVD mortality events, BMI, and basic characteristics were extracted.

RESULTS

Twenty-eight papers with a total of 728 321 participants were finally included. Compared to normal-weight patients with T2DM, the risk of all-cause (HR = 1.61; 95% CI [1.51, 1.72]; P = .000) and CVD (HR = 1.31; 95% CI [1.10, 1.54]; P = .002) mortality were increased in underweight patients; however, they were reduced (HR = 0.85; 95% CI [0.81, 0.89]; P = .000) and (HR = 0.86; 95% CI [0.78, 0.96]; P = .007), respectively in patients with overweight. Also, there were significant reductions in the risk of all-cause (HR = 0.85; 95% CI [0.78, 0.92]; P = .000) and CVD (HR = 0.81; 95% CI [0.74, 0.89]; P = .000] mortality in patients with mild obesity. The difference in the risk of all-cause mortality (HR = 0.98; 95% CI [0.80, 1.21]; P = .881) in patients with moderate obesity was not statistically significant.

CONCLUSION

We found that there were correlations between BMI and the risk of all-cause and CVD mortality in patients with T2DM. The obesity paradox remains.

Dioxins and their impact: a review of toxicity, persistence, and novel remediation strategies

Dioxins rank among the most hazardous persistent organic pollutants, presenting a serious threat due to their long environmental lifespan and capacity for bioaccumulation. This comprehensive review delves into the historical, chemical, and toxicological aspects of dioxins, spotlighting significant incidents such as the Seveso disaster and the repercussions of Agent Orange. The review offers a thorough analysis of the sources of dioxin formation, encompassing natural occurrences like volcanic eruptions and wildfires, alongside man-made activities such as industrial combustion and waste incineration. It examines regional variations in dioxin contamination, revealing air concentrations that can range from less than 0.01 pg TEQ per m3 in remote regions to as high as 2 pg TEQ per m3 in urban environments. With global dioxin emissions estimated at around 97.0 kg TEQ per year, Asia and Africa emerge as the highest emitters among the continents, with the total global dioxin release approximately at 100.4 kg TEQ annually. Dioxin emissions per capita show stark contrasts across six continents, from 10.77 g TEQ per capita in Europe to a concerning 71.66 g TEQ per capita in Oceania. Furthermore, the concentration of dioxin compounds produced during combustion varies significantly, ranging from 15 to 555 ng m-2. While dioxin emission regulations are intricate and differ globally, most nations require that concentrations remain below one ng m-2. Globally, dioxin production is estimated at 17 226 kilograms annually, equating to about 287 kilograms in toxic equivalent (TEQ). This review critically examines the severe health implications of dioxins, which include carcinogenic effects, endocrine disruption, and immunotoxicity. Innovative remediation strategies, such as using nanomaterials for adsorption and advanced oxidation processes, are identified as promising pathways to tackle this pressing issue. Ultimately, this review underscores the necessity for enhanced monitoring systems and comprehensive policy frameworks to facilitate sustainable dioxin management and regulatory compliance. Taking decisive action is vital to protect public health and the environment from the ongoing threat posed by dioxins.

A political economy analysis of the legislative response to unhealthy food and beverage marketing in Chile, Canada and the UK

United Nations bodies call for legal responses to restrict children's exposure to unhealthy food marketing; however, few governments have introduced legislative controls. This research studies the underlying political economy influences that impacted the introduction of legal responses. We used a multiple case study methodology to examine the political economy influences on the policy process in three contexts (Chile, Canada and the UK). Data from documentary evidence and 21 semi-structured key informant interviews were analysed using a political economy framework studying the institutions, interests, ideas and the associated power dynamics that shaped the policy process. The prevailing neoliberal ideologies and overarching institutional paradigm, in which all actors were operating, meant any form of government intervention had to be justified, evidence-based and no more intrusive on commercial enterprise and public life than necessary. The neoliberal paradigm permeated each of the political economy elements (institutions, ideas and interests). In addition, its influence was observed in all stages of the policy process, from introduction through to adoption of the resulting law or regulation, and experienced in both the executive and legislative branches of government. A paradigm shift away from the protection and primacy of commercial enterprise and limited government interference would reduce the barriers governments face when introducing legislative responses to unhealthy food marketing. These dynamics may be tempered if institutional, actor and discursive power is harnessed in support of the legitimate public health measure, which would involve a strong mandate for the ministry responsible and a dedicated and influential policy entrepreneur. - Provides an insight into how three different governments legislated unhealthy food marketing. - Provides lessons for other governments about what challenges those countries faced and how they overcame them. - Considers the political reality behind policy making that impacts on how evidence-based policy making occurs.

Associations of Obesity and Prognostic Nutritional Index on 1-Year Mortality in Patients with Acute Heart Failure

Background

Increased BMI is paradoxically associated with improved survival among patients with acute heart failure (AHF). However, the impact of different nutritional status on this obesity paradox on 1-year mortality is underreported. The prognostic nutritional index is a simple tool to assess nutrition status.

Methods

From 10,027 emergency department admissions at the Amager and Hvidovre Hospital, Copenhagen University Hospital in Denmark, all patients with AHF were identified. Patients were categorised by BMI (normal: 18.5-24.9 kg/m2, overweight: 25-29.9 kg/m2, obese: ≥30 kg/m2) and nutritional status using the prognostic nutritional index (malnourished: <38, well-nourished: ≥38). Kaplan- Meier curves analysed cumulative survival, and Cox regression examined associations between BMI, nutritional status and outcomes, expressed as HR and 95% CI.

Results

Among 383 AHF patients (median age 76 years), 41.3% were malnourished and 58.7% well nourished. In the well-nourished group, obesity was inversely associated with 1-year mortality (adjusted HR 0.48; 95% CI [0.24-0.95]; p=0.035). However, this correlation disappeared in the malnourished group (adjusted HR 1.08; 95% CI [0.59-2.00]; p=0.798). Mortality rates were significantly lower in the well-nourished group among patients with overweight and obesity.

Conclusion

Obesity was associated with reduced 1-year mortality only in AHF patients with good nutritional status, while in malnourished patients, obesity was not associated with 1-year mortality. The prognosis in patients with AHF depends on both the presence of obesity and their nutritional status, highlighting the need for nutritional assessment for risk stratification.

Food Chain and Food Policies: Causes and Solutions for the Obesity Pandemic

This article highlights the prevalence, epidemiology, and pathophysiology of obesity in the United States, including its increasing link to cardiovascular disease (CVD). We discuss food policies-ranging from societal to regional, state, and federal levels-and their healthcare impact. While multiple examples show some success in reducing the global obesity pandemic via the food chain, much research is still needed to demonstrate the robust impact of these multi-prong interventions and their ability to decrease the CVD burden.8.

Obesity and cardiovascular disease: an ESC clinical consensus statement

The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.

Global and regional burden of kidney cancer due to high body index in adults from 1990 to 2021 and predictions to 2036

Monitoring the evolving global and regional burden of kidney cancer attributable to high BMI is vital for informing prevention and healthcare policies. This study aimed to evaluate historical trends in the global and regional burden of kidney cancer attributable to high BMI from 1990 to 2021 and to predict future trends through 2036 for individuals aged 20 years and older. We conducted a retrospective analysis using the Global Burden of Disease 2021 database. We analyzed data on mortality and disability-adjusted life years (DALYs) linked to kidney cancer from high BMI. Stratifications included sociodemographic index (SDI), region, sex, and age. Temporal trends were assessed using joinpoint regression models, while the relationship between SDI and regional burden was examined. Projections were generated using Bayesian age-period-cohort models. In 2021, high BMI contributed to 19.86% of global kidney cancer deaths (0.032 million) and 19.00% of DALYs (0.782 million), representing an increase since 1990. Globally, age-standardized mortality rate and age-standardized disability rate have declined in recent years. However, rates have risen in developing regions such as South Asia and East Asia. Projections indicate stable global rates with slight fluctuations through 2036. The global kidney cancer burden attributable to high BMI shows signs of decline but continues to rise in some developing regions. Addressing this disparity requires strengthening obesity prevention and control strategies tailored to regional needs.

Changes in olive oil consumption and long-term body weight changes in 3 United States prospective cohort studies

BACKGROUND

Olive oil intake is inversely associated with risk of cardiometabolic diseases. However, its energy density has raised concerns about weight gain.

OBJECTIVE

To examine the associations between long-term changes in olive oil consumption and changes in body weight in three prospective cohort studies.

METHODS

We examined data from 121,119 females and males from the Nurses' Health Study (NHS, 1990-2010), NHSII (1991-2015), and Health Professionals Follow-up Study (HPFS, 1990-2014), aged 65 y or younger and who were free from chronic disease at baseline. We assessed the associations between changes in olive oil intake within each 4-y interval and concurrent body weight changes using multivariable linear regression models. Results across the 3 cohorts were pooled using inverse-variance weights.

RESULTS

At baseline, the mean body mass index (BMI in kg/m2) was between 25.9 and 26.1 across the 3 cohorts. The mean weight change over each of the 4-y follow-up cycles was highest in the NHSII (1.8 kg; 95% CI [confidence interval]: -6.8, 11.3 kg), followed by the NHS (1.2 kg; 95% CI: -6.8, 9.1 kg), and lastly the health professionals follow-up study HPFS (0.9 kg; 95% CI: -5.4, 7.3 kg). After multivariable adjustment, each ½ tablespoon (7 g) serving per day increment in olive oil consumption was inversely associated with body weight (β coefficient: -0.09 kg, 95% CI: -0.11, -0.08 kg; P < 0.0001). In contrast, each 7 g serving per day increase in other types of added fat (vegetable oils, butter, and margarine) was positively associated with changes in body weight. Results were consistent in stratified analyses by age and BMI. In substitution analyses, replacing margarine, butter, and other vegetable oils with equal amounts of olive oil was associated with less weight gain.

CONCLUSIONS

A long-term increase in olive oil intake was inversely associated with body weight in middle-aged adults in the United States. Conversely, increased consumption of other added fats, such as butter and margarine, was positively associated with body weight.

Gender differences in the relationship between cardiometabolic index and all-cause and specific mortality in the United States adults: a national study

Background

The cardiometabolic index (CMI) is a new comprehensive measure that reflects visceral obesity and metabolic function. This study aimed to examine associations between CMI and adult mortality from all causes and specific causes, as well as gender differences, using the National Health and Nutrition Examination Survey (NHANES) database.

Methods

We included 37,539 adult participants with complete data from the 1999-2018 NHANES database. We categorized the participants according to gender and constructed three models to investigate the relationship between CMI and the outcome variables. These were analyzed using Kaplan-Meier curve analysis, COX proportional risk models, and restricted cubic spline (RCS).

Results

Baseline characteristics showed that among both male and female participants, those who died exhibited higher levels of CMI compared to those who survived. Kaplan-Meier curves showed an increasing trend in all-cause and specific mortality with increasing follow-up time. When CMI was categorized according to quartiles (Q1-Q4), the probability of survival was lower in the Q4 group compared to Q1. We found no gender differences between all three mortality rates. In COX regression analyses, all-cause, cardiovascular, and diabetes mortality were significantly higher in Q4 in the whole population and female participants, whereas no significant differences were identified among male participants. The RCS showed a nonlinear positive correlation in diabetes mortality for females and a linear positive correlation in all-cause and cardiovascular mortality. As for males, CMI was positively and nonlinearly associated with all-cause and diabetes mortality. Besides, there is no statistically significant correlation for males in cardiovascular mortality.

Conclusion

There were gender differences in the correlation between CMI and all-cause mortality, cardiovascular mortality, and diabetes mortality in the adult population. The findings indicated that adult females with elevated CMI levels were at an elevated risk of mortality from all causes, cardiovascular disease, and diabetes. At the same time, there were no significant associations in adult males.

Obstructive sleep apnoea syndrome and future risk of dementia among individuals managed in UK general practice

BACKGROUND

Obstructive sleep apnoea syndrome (OSAS) has been recognised as a potential risk factor for cognitive decline, yet its precise relationship with dementia remains uncertain. This study aimed to determine the risk of dementia among individuals with and without OSAS.

METHODS

Data derived from 2.3 million adults (aged ≥18 years) were extracted from the Clinical Practice Research Datalink (2000-2022), a nationally representative primary care electronic health records database in the UK. 193 600 individuals with OSAS were propensity score-matched to 536 701 individuals without OSAS. Cox proportional hazard regression models were applied to quantify the risk of developing all-cause dementia, vascular dementia and Alzheimer's disease between individuals with and without OSAS.

RESULTS

With a median follow-up of 4.0 (IQR 1.8-7.5) years, 2802 and 6211 individuals developed all-cause dementia in those with and without OSAS, corresponding to crude incidence rates of 2.47 and 2.34 per 1000 person-years, respectively. The presence of OSAS was associated with higher risks of all-cause dementia (adjusted HR (aHR) 1.12, 95% CI 1.07 to 1.17), vascular dementia (1.29, 95% CI 1.19 to 1.41) and unchanged risk of Alzheimer's disease (1.07, 95% CI 0.99 to 1.16). Individuals with OSAS who had received continuous positive airway pressure (CPAP) treatment exhibited a similar risk of all-cause dementia as their matched counterparts (0.99, 95% CI 0.74 to 1.32).

CONCLUSION

OSAS is associated with higher risks of all-cause dementia and some of its subtypes. Further investigation is needed to investigate the clinical benefits of screening for cognitive impairment in people with OSAS and to further evaluate the impact of CPAP on cognitive decline and dementia risk.

Effect of semaglutide with obesity or overweight individuals without diabetes: an Umbrella review of systematic reviews

OBJECTIVE

Summarize the effectiveness and safety of Semaglutide for non-diabetic obese patients through umbrella analysis.

METHODS

From inception to May 2024, we searched PubMed, EMbase, Web of Science, and The Cochrane Library for a systematic review and meta-analysis of semaglutide in non-diabetic obesity. AMSTAR-2 assessed review quality, ROB scrutinized RCT quality, and RCTs were selected based on overlap. Random-effects meta-analysis synthesized data on weight, waist, BMI, ect.

RESULTS

The study encompassed 7 reviews and 10 RCTs, revealing that semaglutide induced average weight loss 11.71 kg [-13.16, -10.26] in non-diabetic obese patients, a 12.79% reduction [-14.4, -11.18]. Notably, ≥5, ≥10, ≥15, and ≥20% weight-loss rates significantly increased. Semaglutide also reduced waist by 9.39 cm [-10, -8.79], BMI by 4.27 kg/m^2 [-4.78, -3.75], SBP by 4.78 mmHg [-5.63, -3.93], DBP by 2.56 mmHg [-3.96, -1.17], and lipids by 3.2 mmol/l [-5.65, -0.75]. FBG significantly dropped by 5.46 mmol/l [-8.99, -1.93], and SF-36 scores improved by 1.7 points [0.78, 2.63]. However, common adverse reactions included nausea [RR: 2.59], diarrhea [RR: 1.77], and constipation [RR: 2.07].

CONCLUSIONS

Semaglutide shows significant weight loss and health benefits in non-diabetic obesity. However, Recent studies show semaglutide can cause NAION and erectile dysfunction, beyond previously reported adverse reactions. Besides, High overlap in current research highlights a lack of RCTs. And there is a high degree of heterogeneity across included studies. More large-scale, rigorous RCTs are needed to assess safety and support clinical use.

REGISTER

The study was registered at PROSPERO on 24 December 2023 (registration number:CRD42023493235).

STING1 targets MYH9 to drive adipogenesis through the AKT/GSK3β/β-catenin pathway

Stimulator of interferon response cGAMP interactor 1 (STING1), as an innate immune adaptor protein that mediates DNA sensing, has attracted tremendous biomedical interest. However, several recent researches have revealed the key role of STING1 in regulating the metabolic pathway. Here, we investigated its role in adipocyte differentiation. Preadipocytes with lentivirus-mediated Sting1 knockdown or overexpression were constructed to examine the effect of STING1 on adipocyte differentiation in vitro. Proteomics was performed in adipocytes to explore the mechanisms by which STING1 exerts pro-adipogenesis effects. Coimmunoprecipitation (CoIP)/mass spectrometry (MS) assay were used to identify the interacting partners of STING1. Our results showed that STING1 was upregulated during adipogenic differentiation of 3T3-L1 and white adipose tissue-derived stromal vascular precursor cells (WAT-SVF), accompanied by upregulation of adipocyte marker genes, peroxisome proliferator-activated receptor gamma (Pparg) and CCAAT/enhancer-binding protein beta (Cebpβ). Knockdown or overexpression of Sting1 altered adipogenesis in adipocytes. Mechanistically, proteomics and CoIP/MS assay revealed that STING1 targets non-muscle myosin protein (MYH9) to block its expression, which enhances AKT/GSK3β signaling and mediates β-catenin accumulation, affecting adipogenesis-related genes in adipocytes. These findings suggest that STING1 targeting combined with MYH9 regulates adipocyte differentiation through the AKT/GSK3β/β-catenin pathway. This is a new potential target for the treatment of hypertrophic adipose tissue, or obesity.

Accurate prediction of bleeding risk after coronary artery bypass grafting with dual antiplatelet therapy: A machine learning model vs. the PRECISE-DAPT score

BACKGROUND

Dual antiplatelet therapy (DAPT) after coronary artery bypass grafting (CABG), although might be protective for ischemic events, can lead to varying degrees of bleeding, resulting in serious clinical events, including death. This study aims to develop accurate and scalable predictive tools for early identification of bleeding risks during the DAPT period post-CABG, comparing them with the PRECISE-DAPT score.

METHODS

Clinical data were collected from patients who underwent isolated CABG at Nanjing Drum Tower Hospital between June 2021 and December 2023. The dataset was split into derivation and validation cohorts at a 7:3 ratio. Machine learning models were developed to predict bleeding within six months post-CABG in DAPT patients and tested in a temporal external validation cohort. The SHapley Additive exPlanations method visualized variable importance regarding outcomes. The performance of the PRECISE-DAPT score was also validated in this cohort.

RESULTS

Among 561 enrolled patients, 165 (29.4 %) experienced bleeding events, with 49 (8.7 %) cases being significant. In the validation cohort, eXtreme gradient boosting (XGB) achieved the highest area under the receiver operating characteristic curve (0.915) and precision-recall curve (0.692). Compared to PRECISE-DAPT, XGB showed no difference in AUROC (p = 0.808) but had a higher AUPRC (p = 0.009). In the temporal external validation cohort, the XGB model has an AUROC of 0.926 and an AUPRC of 0.703. We developed a dynamic high-accuracy bleeding risk calculator based on the XGB model and created a mobile-friendly QR code for easy access to this tool.

CONCLUSION

Bleeding risk during DAPT in post-CABG patients can be reliably predicted using selected baseline features. The XGB model outperforms the Precise-Dapt model, showing better precision and recall.

Assessing the Effectiveness of Digital Health Behavior Strategies on Type 2 Diabetes Management: Systematic Review and Network Meta-Analysis

BACKGROUND

Various mobile technologies and digital health interventions (DHIs) have been developed for type 2 diabetes mellitus (T2DM) management. Strategies are crucial for ensuring the effectiveness of DHIs. However, there is currently a lack of categorization and summarization of the strategies used in DHIs for T2DM.

OBJECTIVE

This study aims to (1) identify and categorize the strategies used in DHIs for T2DM management; (2) assess the effectiveness of these DHI strategies; and (3) compare and rank the efficacy of different strategy combinations on glycated hemoglobin A1c (HbA1c) levels, fasting blood glucose (FBG) levels, BMI, and weight loss.

METHODS

Relevant randomized controlled trials (RCTs) were extracted from PubMed, Web of Science, and Scopus databases. Three rounds of screening and selection were conducted. The strategies were identified and categorized based on the principles of behavior change techniques and behavior strategies. The synthesis framework for the assessment of health IT was used to structure the evaluation of the DHI strategies qualitatively. A network meta-analysis was performed to compare the efficacy of different strategy combinations. The data quality was assessed using the Cochrane Risk of Bias tool.

RESULTS

A total of 52 RCTs were included, identifying 63 strategies categorized into 19 strategy themes. The most commonly used strategies were guide, monitor, management, and engagement. Most studies reported positive or mixed outcomes for most indicators based on the synthesis framework for the assessment of health IT. Research involving a medium or high number of strategies was found to be more effective than research involving a low number of strategies. Of 52 RCTs, 27 (52%) were included in the network meta-analysis. The strategy combination of communication, engagement, guide, and management was most effective in reducing HbA1c levels (mean difference [MD] -1.04, 95% CI -1.55 to -0.54), while the strategy combination of guide, management, and monitor was effective in reducing FBG levels (MD -0.96, 95% CI -1.86 to -0.06). The strategy combination of communication, engagement, goal setting, management, and support was most effective for BMI (MD -2.30, 95% CI -3.16 to -1.44) and weight management (MD -6.50, 95% CI -8.82 to -4.18).

CONCLUSIONS

Several DHI strategy combinations were effective in reducing HbA1c levels, FBG levels, BMI, and weight in T2DM management. Health care professionals should be encouraged to apply these promising strategy combinations in DHIs during clinical care. Future research should further explore and optimize the design and implementation of strategies.

TRIAL REGISTRATION

PROSPERO CRD42024544629; https://tinyurl.com/3zp2znxt.

Changes of metabolic syndrome status alter the risks of cardiovascular diseases, stroke and all cause mortality

Previous research focused primarily on static metabolic syndrome (MetS) status, with less discussion on the effects of its dynamic changes on cardiovascular diseases (CVD), stroke, and all-cause mortality. This study examines the impact of MetS status changes on these health outcomes. This study used data from two prospective cohorts: the China Longitudinal Study of Health and Retirement (CHARLS) and the Wuhan Elderly Health Examination Center community (WEHECC). MetS was determined using the ATP III criteria. Participants were classified based on changes in MetS status, defined as MetS-free, MetS-recovery, MetS-developed, and MetS-chronic, assessed at baseline and at follow-up (three years later for CHARLS and six years later for WEHECC cohort). The primary outcomes for CHARLS included all-cause mortality, physician-diagnosed CVD, and stroke, while WEHECC cohort focused solely on all-cause mortality. Logistic regression models were utilized to calculate the odds ratios (ORs) and 95% confidence intervals (95% CI). Over the follow-up period from 2015 to 2018 in CHARLS, 335 participants (7.1%) developed CVD, and 237 (5.1%) experienced a stroke. Relative to the MetS-free group, individuals with MetS-chronic displayed higher risks of CVD (OR, 1.63 [95% CI, 1.25 to 2.13]) and stroke (OR, 2.95 [95% CI, 2.11 to 4.15]). In the WEHECC cohort, 40 participants died by 2022, with the MetS-chronic group showing a increased risk of all-cause mortality (OR, 2.76 [CI, 1.03 to 7.39]). Changes in MetS status are associated with different risks of CVD, stroke, and mortality, with chronic MetS significantly increasing these risks compared to MetS-free.

Umbrella Review of Systematic Reviews and Meta-Analyses on the Consumption of Different Food Groups and the Risk of Overweight and Obesity

BACKGROUND/OBJECTIVES

Dietary choices play an essential role in energy balance and weight gain. This systematic umbrella review investigates the association between the intake of various food groups (whole grains, refined grains, fruits, vegetables, nuts, legumes, fish, eggs, total dairy, red meat, white meat, processed meat, added sugar, and sugar-sweetened beverages) and their associations to the risk of obesity and being overweight.

METHODS

We systematically searched Medline, Embase, Web of Science, and Epistemonikos for systematic reviews and meta-analyses. A total of 2925 articles were screened, and 13 articles were included in our analysis.

RESULTS

For each food group, data included a mean of 166,100 participants and 36,760 cases, ranging from 19,885 participants and 7183 cases for red meat to 520,331 participants and 91,256 cases for nuts. Heterogeneity was high for most of the food groups except for whole grains and sugar-sweetened beverages. The quality of the most comprehensive meta-analyses was high for all food groups, except for processed meats, which was of low quality. High intakes of whole grains, legumes, nuts, and fruits are associated with a reduced risk of overweight and obesity. In contrast, high intakes of red meat and sugar-sweetened beverages are associated with increased risk of overweight and obesity. No significant results were found for the remaining food groups, and no meta-analysis was found for fish, eggs, white meat, and added sugars.

CONCLUSIONS

Diets rich in whole grains, legumes, nuts, and fruits are associated with a lower risk of developing obesity and being overweight. In contrast, diets high in red meat and sugar-sweetened beverages are associated with an increased risk of overweight and obesity.

Evaluating the discriminatory capacity of traditional and novel anthropometric indices in cardiovascular disease risk factors, considering sex differences

OBJECTIVE

Cardiovascular disease (CVD) rates are rising rapidly worldwide, making it crucial to implement simple and effective screening measures to identify individuals at increased risk for CVD risk factors. This study aims to examine the relationship between innovative anthropometric indices and the occurrence of cardiovascular risk factors among the population of Mashhad, located in northeastern Iran, over a ten-year follow-up period.

METHODS

In this cohort study, a total of 9704 individuals aged 35-65 years were recruited at baseline, with 7560 individuals completing the study. Anthropometric indices were measured and calculated using standardized methods. After a 10-year follow-up, the incidence of hypertension (HTN), diabetes mellitus (DM), dyslipidemia, obesity, and metabolic syndrome (MetS) and their association with each anthropometric index were determined using Cox regression analysis. Receiver operating characteristic (ROC) analysis was employed to assess the predictive capacity of each index for the CVD risk factors.

RESULTS

We found that WHtR exhibited the strongest association with various CVD risk factors. However, the predictive capacity of BMI was higher than other indices in DM and MetS (AUCs: 0.69 and 0.78, respectively). Moreover, BMI, WHtR, and BRI showed equal discriminatory power to predict HTN (AUCs: 0.61). Our analysis indicated that Iranian individuals with a BMI of more than 24.71, 26, and 25.2 kg/m2 are at a 54%, 88%, and 121% increased risk for the development of HTN, DM, and MetS over 10 years; respectively.

CONCLUSION

In this study, BMI was identified as the most powerful predictor of CVD risk factors among the anthropometric indices examined. These findings support previous research indicating that BMI is a valuable screening tool for identifying individuals at higher risk of developing CVDs and associated conditions.

The Association of Phytochemical Index and oxidative balance score with bone Mineral density: a case-control study

BACKGROUND

Phytochemical index (PI) and oxidative balance score (OBS) have not been previously evaluated in women with osteoporosis. The present study aimed to investigate their relationship with bone mineral density (BMD) in postmenopausal women.

METHODS

The current case-control study included healthy postmenopausal women (n = 131) and postmenopausal women with abnormal BMD (osteopenia: T-score between - 1 and - 2.5; osteoporosis: T-score less than - 2.5) (n = 131). All participants were recruited from the Isfahan Bone Densitometry Center. Dual-energy X-ray absorptiometry (DXA) measured BMD at the lumbar vertebrae and femoral neck, expressed in grams per square centimeter. A validated semi-quantitative food frequency questionnaire was used to assessed PI and OBS. Binary logistic regression was performed to analyze the association between PI and OBS with BMD.

RESULTS

A positive association was observed between PI and both lumbar and femoral BMD (P < 0.001 for both of them). Similarly, a significant positive association was found between OBS and both lumbar and femoral BMD (P < 0.001 for both of them). Compared to the first tertile of PI, significantly higher odds of abnormal BMD were observed in the last tertile across all models (crude model: odds ratio (OR) = 0.25, 95% confidence interval (CI): 0.13-0.46, P < 0.001 - adjusted model 1: OR = 0.23, 95% CI: 0.12-0.44, P < 0.001 - adjusted model 2: OR = 0.28, 95% CI: 0.14-0.55, P < 0.001). Similarly, compared to the first tertile of OBS, higher odds of abnormal BMD were in the last tertile across all models (crude model: OR = 0.25, 95% CI: 0.13-0.47, P < 0.001 - adjusted model 1: OR = 0.24, 95% CI: 0.13-0.46, P < 0.001 - adjusted model 2: OR = 0.26, 95% CI: 0.13-0.52, P < 0.001).

CONCLUSIONS

Overall, the present study highlighted the important role of PI and OBS in abnormal BMD. The findings indicated that higher PI and OBS were inversely associated with the odds of abnormal BMD.

Prevalence and associated factors of adult overweight and obesity in Southwestern China

Background

Data on the prevalence of overweight and obesity in Southwestern China were limited. The aims of this study were to estimate the prevalence of overweight/obesity and their associated factors in this area.

Methods

A cross-sectional study was conducted from 2013 to 2014 in Chengdu and Chongqing, two megacities in Southwestern China. Data were obtained from questionnaires, physical examinations and lab tests. A total of 11,096 residents aged 35-79 years were included in the final analysis of this study.

Results

The prevalence of overweight and obesity among adults aged 35-79 years in Southwestern China were 29.7 and 4.4%, respectively. Multivariable logistic regression analysis suggested that women, non-smokers, ex-smokers, being hypertensive and diabetic were related to higher obesity prevalence, and that physically active adults and those aged 65-79 years were less likely to have obesity.

Conclusion

Obesity and overweight were prevalent in Southwestern China, especially among women, those with diabetes and/or hypertension, and those who have quitted smoking for more than 3 years.

Age-stratified analysis of the BMI-kidney stone relationship: findings from a national cross-sectional study

Background

The association between body mass index (BMI) and kidney stone formation may vary across different age groups and follow nonlinear patterns.

Methods

This study analyzed data from NHANES 2009-2018, including 14,880 participants aged ≥20 years, to evaluate the association between BMI and the risk of kidney stones. BMI was categorized as normal weight (<25.0 kg/m2), overweight (25.0-29.9 kg/m2), and obesity (≥30.0 kg/m2). Weighted logistic regression models were employed to adjust for multiple confounders, including sex, age, race/ethnicity, education level, smoking history, alcohol consumption, coronary heart disease, diabetes mellitus, hypertension, and physical activity. Interaction effects between BMI and key variables such as sex, race/ethnicity and other factors were also analyzed. Age-stratified analyses were performed for the groups aged 20-39 years, 40-59 years, and ≥ 60 years. A restricted cubic spline model was used to explore the non-linear relationship between BMI and the risk of kidney stones.

Results

After adjusting for confounders, participants with a BMI ≥30 kg/m2 had a significantly higher risk of kidney stones compared to those with a BMI <25 kg/m2 (adjusted OR [aOR]: 1.86; 95% CI: 1.48-2.34; p < 0.001), with the association being most pronounced in the 40-59-year age group (aOR: 2.02; 95% CI: 1.36-3.02; p < 0.001). The interaction analysis did not reveal significant interactions between BMI and sex or other factors. Non-linear analysis indicated that the relationship between BMI and kidney stone risk differed across age groups. In the 40-59-year group, the risk of kidney stones peaked and then plateaued as BMI increased beyond a certain threshold. In the ≥60-year age group, risk initially increased with BMI but then slightly declined. This non-linear relationship suggests that the impact of BMI on kidney stone risk varies by age and should be considered in clinical strategies.

Conclusion

High BMI is significantly associated with an increased risk of kidney stones, particularly among middle-aged and older adults. The relationship between BMI and kidney stones is non-linear, highlighting the need to develop age-specific BMI management strategies to reduce the occurrence of kidney stones.

The Metabolic Score for Visceral Fat (METS-VF) as a predictor of diabetes mellitus: Evidence from the 2011-2018 NHANES study

INTRODUCTION

With 42.4% of obese US population, the prevalence of diabetes mellitus (DM) is increasing. Visceral fat, even at the same body mass index, has significant deleterious effects. This study aims to investigate the association between the Metabolic Score for Visceral Fat (METS-VF) and DM.

METHODS

The study utilized data from NHANES dataset, covering cycles from 2011 to 2018. Multivariate logistic regression and Receiver Operating Characteristic (ROC) analysis assessed the association between METS-VF and DM. Additionally, the study compared visceral adipose tissue (VAT) measurement indices to METS-VF for the prediction of DM.

RESULTS

In 3,445 participants, METS-VF was positively associated with diabetes [(OR 6.8; 95% CI 5.3-8.6) (AUC 0.791; 95% CI 0.768-0.814)], the association increased across quartiles (METS-VF >6.5; OR 53.8; 95% CI 0.17-169).METS-VF significantly identifies diabetes compared to other VAT indices (LAP, VAI, waist circumference, and WHtR). Additionally premenopausal females with BMI >25 and METS-VF >6.5 are at a higher risk of developing diabetes.

CONCLUSION

METS-VF positively associates with the prevalence of diabetes. It is an effective score compared to surrogate markers for VAT measurement. Routine screening of VAT using METS-VF score could be implemented in daily clinical settings and large-scale epidemiological studies to help identify early diabetes.

Arthrocolin B Impairs Adipogenesis via Delaying Cell Cycle Progression During the Mitotic Clonal Expansion Period

Obesity and its related diseases severely threaten people's health, causing persistently high morbidity and mortality worldwide. The abnormal proliferation and hypertrophy of adipocytes mediate the expansion of adipose tissue, which is the main cause of obesity-related diseases. Inhibition of cell proliferation during the mitotic clonal expansion (MCE) period of adipogenesis may be a promising strategy for preventing and treating obesity. Arthrocolins are a series of fluorescent dye-like complex xanthenes from engineered Escherichia coli, with potential anti-tumor and antifungal activities. However, the role and underlying mechanisms of these compounds in adipocyte differentiation remain unclear. In this study, we discovered that arthrocolin B, a member of the arthrocolin family, significantly impeded adipogenesis by preventing the accumulation of lipid droplets and triglycerides, as well as by downregulating the expression of key factors involved in adipogenesis, such as SREBP1, C/EBPβ, C/EBPδ, C/EBPα, PPARγ, and FABP4. Moreover, we revealed that this inhibition might be a consequence of cell cycle arrest during the MCE of adipocyte differentiation, most likely by modulating the p53, AKT, and ERK pathways, upregulating the expression of p21 and p27, and repressing the expression of CDK1, CDK4, Cyclin A2, Cyclin D1, and p-Rb. Additionally, arthrocolin B could promote the expression of CPT1A during adipocyte differentiation, implying its potential role in fatty acid oxidation. Overall, our research concludes that arthrocolin B has the ability to suppress the early stages of adipocyte differentiation mainly by modulating the signaling proteins involved in cell cycle progression. This work broadens our understanding of the function and mechanisms of arthrocolins in regulation of adipogenesis and might provide a potential lead compound for treating the obesity.

Obesity mediates the association between psoriasis and diabetes incidence: a population-based study

INTRODUCTION

The aim of this study was to explore the association between psoriasis and diabetes and to assess the potential moderating role of obesity in this relationship.

METHODS

The study involving data from 21,835 NHANES participants during 2003-2006 and 2009-2014. The analysis included body mass index (BMI), as well as information about psoriasis and diabetes obtained from questionnaires. The study employed weighted logistic regression to examine the association between psoriasis and diabetes. The nonlinear relationship between obesity, diabetes, and psoriasis was explored through smooth curve fitting, stratified by age and gender. In addition, the authors conducted mediation analysis, which suggested that obesity partially mediated the association between psoriasis and diabetes prevalence.

RESULTS

After adjusting for relevant variables, we found that individuals with psoriasis had a significantly higher incidence of diabetes (OR = 1.48, 95% CI = 1.16-1.90, P = 0.002). A positive relationship was identified between BMI levels and diabetes occurrence among individuals with psoriasis, with a significant difference observed between the highest (Q4) and lowest (Q1) BMI quartiles (P < 0.05). Further analysis using smooth curve fitting demonstrated the consistent association between BMI and diabetes, which was also evident in psoriasis patients. Age-stratified analysis showed that diabetes was more prevalent among older adults compared to younger individuals at the same BMI levels. For psoriasis, an inflection point was noted in men where its prevalence began to decline as BMI exceeded a certain threshold. Similarly, in younger adults, psoriasis prevalence decreased above a specific BMI threshold. Additionally, mediation analysis indicated that obesity played a partial role in linking psoriasis and diabetes, accounting for approximately 22.91% of this association.

CONCLUSION

The study found an association between psoriasis and diabetes. Additionally, the analysis suggested that obesity may partially contribute to this relationship, indicating it could play a role in linking the two conditions.

Burden of benign prostatic hyperplasia in the Middle East and North Africa Region, 1990-2021

OBJECTIVE

To examine the burden of benign prostatic hyperplasia (BPH) in the Middle East and North Africa (MENA) region from 1990 to 2021 by age and sociodemographic index (SDI).

METHODS

Data were sourced from the Global Burden of Disease (GBD) 2021 database. We analysed the incidence, prevalence, and years lived with disability (YLDs) attributable to BPH across the MENA region and its constituent countries.

RESULTS

In 2021, the MENA region had an estimated 4.7 million prevalent cases of BPH, with an age-standardised prevalence rate of 2168.6 per 100,000. BPH contributed to 93.6 thousand YLDs, with an age-standardised YLD rate of 42.8 per 100,000. The highest prevalence and incidence rates were observed in Jordan, Qatar, and Iran, while Egypt and Yemen recorded the lowest rates. The burden of BPH was found to increase with age, peaking in the 65-69 age range.

CONCLUSION

This study reveals an increasing burden of BPH in the MENA region, primarily due to aging populations. These findings underscore the need for tailored public health policies and strategies to enhance early detection, prevention, and management of BPH, thereby reducing its impact on healthcare systems and individuals.

The importance of genotyping within the climate-smart plant breeding value chain - integrative tools for genetic enhancement programs

The challenges faced by today's agronomists, plant breeders, and their managers encompass adapting sustainably to climate variability while working with limited budgets. Besides, managers are dealing with a multitude of issues with different organizations working on similar initiatives and projects, leading to a lack of a sustainable impact on smallholder farmers. To transform the current food systems as a more sustainable and resilient model efficient solutions are needed to deliver and convey results. Challenges such as logistics, labour, infrastructure, and equity, must be addressed alongside adapting to increasingly unstable climate conditions which affect the life cycle of transboundary pathogens and pests. In this context, transforming food systems go far beyond just farmers and plant breeders and it requires substantial contributions from industry, global finances, transportation, energy, education, and country developmental sectors including legislators. As a result, a holistic approach is essential for achieving sustainable and resilient food systems to sustain a global population anticipated to reach 9.7 billion by 2050 and 11.2 billion by 2100. As of 2021, nearly 193 million individuals were affected by food insecurity, 40 million more than in 2020. Meanwhile, the digital world is rapidly advancing with the digital economy estimated at about 20% of the global gross domestic product, suggesting that digital technologies are increasingly accessible even in areas affected by food insecurity. Leveraging these technologies can facilitate the development of climate-smart cultivars that adapt effectively to climate variation, meet consumer preferences, and address human and livestock nutritional needs. Most economically important traits in crops are controlled by multiple loci often with recessive alleles. Considering particularly Africa, this continent has several agro-climatic zones, hence crops need to be adapted to these. Therefore, targeting specific loci using modern tools offers a precise and efficient approach. This review article aims to address how these new technologies can provide a better support to smallholder farmers.

High prevalence of overweight/obesity and central obesity among women in a rural district of Nepal in 2012-2013: a population-based study

Background

The prevalence of overweight is rapidly escalating, especially in South-Asia. We aimed to estimate the prevalence of overweight/obesity and central obesity, and associated risk factors among women in a rural setting of Nepal.

Methods

A cross-sectional study addressing reproductive health and non-communicable diseases (NCDs) was conducted 2012-2013 in a rural district of Nepal. Married, non-pregnant women ≥15 years of age were included. Height, weight, and waist circumference (WC) were measured, and body mass index (BMI) calculated. WHO cut-offs for Asians were used to assess the prevalence of overweight (23.0-27.4 kg/m2), obesity (≥ 27.5 kg/m2) and central obesity (WC ≥ 80 cm). Data concerning socioeconomic and lifestyle factors were collected.

Results

Altogether, 1,391 women 43.1 ± 14.4 years of age were included. The majority belonged to the Adhivasi/Janajati ethnicity, were uneducated and worked in agriculture. Altogether, 30.5% were overweight, 12.0% obese, and 34.2% centrally obese; 25.7% were both overweight/obese and centrally obese. Underweight (< 18.5 kg/m2) was observed in 9.6%. Among women with normal weight or underweight, 14.9 and 15.3% had central obesity, respectively. Hypertension was observed in 13.4% and was associated with both overweight/obesity and central obesity. Instant noodle intake ≥2 times weekly was associated with increased prevalence of central obesity and overweight/obesity.

Conclusion

We observed a high prevalence of overweight/obesity and central obesity among women in a rural district of Nepal, which entails an increased risk of metabolic complications and NCDs. Our findings underscore the need for public health programs addressing nutritional patterns and physical activity to prevent obesity.

Adipose tissue-derived microRNA-450a-5p induces type 2 diabetes mellitus by downregulating DUSP10

Type 2 diabetes mellitus (T2DM) has rapidly increased worldwide, emerging as the fifth leading cause of death. The treatment of T2DM is challenging due to the side effects of oral hypoglycemic drugs and the limited efficacy of long-term insulin therapy, which can lead to insulin resistance (IR). Consequently, there is significant in discovering new drugs that have minimal side effects and a pronounced hypoglycemic effect. In obesity, microRNA levels have been implicated in glucose metabolism disorders and T2DM, although many aspects remain unresolved. Here, we confirmed that visceral adipose tissue and serum microRNA-450a-5p content increased under obesity and T2DM, and it was significantly positively associated with fasting blood glucose, triglycerides, cholesterol, low-density lipoproteins-cholesterol levels of the subjects. In high-fat diet (HFD)-induced obese mice, microRNA-450a-5p expression was increased in the serum, liver, and white adipose tissue. Moreover, the adipose Dicer-knockout mouse model was constructed to identify adipose tissue as the main source of microRNA-450a-5p. microRNA-450a-5p could inactivate the insulin signal pathway by targeting the inhibited Dual Specificity Phosphatase 10 (DUSP10) and inducing IR and glucose metabolism disorders in vitro cultured hepatocytes and adipocytes. Additionally, microRNA-450a-5p was found to regulate DUSP10 expression and insulin signaling activity, influencing glucose tolerance and insulin sensitivity across various models, including normal diet, HFD-induced obese, adipose tissue-specific microRNA-450a-5p-knockout, and db/db mice. Furthermore, gallic acid might play a potential role in inhibiting glucose levels by decreasing microRNA-450a-5p expression. Thus, microRNA-450a-5p emerges as an attractive therapeutic target for addressing obesity, IR, and T2DM.

Vitamin D Enhancement of Adipose Biology: Implications on Obesity-Associated Cardiometabolic Diseases

Vitamin D is activated into 1α,25(OH)2D through two hydroxylation steps that are primarily catalyzed by 25-hydroxylase in the liver and 1α-hydroxylase in the kidneys. The active form of vitamin D regulates myriads of cellular functions through its nuclear receptor, vitamin D receptor (VDR). Vitamin D metabolizing enzymes and VDR are expressed in adipose tissues and vitamin D regulates multiple aspects of adipose biology including the recruitment and differentiation of adipose stem cells into adipocytes and metabolic, endocrine, and immune properties. Obesity is associated with low vitamin D status, which is thought to be explained by its sequestration in large mass of adipose tissues as well as dysregulated vitamin D metabolism. Low vitamin D status in obesity may negatively impact adipose biology leading to adipose tissue dysfunctions, the major pathological factors for cardiometabolic diseases in obesity. In this review, the current understanding of vitamin D metabolism and its molecular mechanisms of actions, focusing on vitamin D-VDR regulation of adipose biology with their implications on obesity-associated diseases, is discussed. Whether improving vitamin D status leads to reductions in adiposity and risks for cardiometabolic diseases is also discussed.

Cellular and Molecular Evidence of the Synergistic Antitumour Effects of Hydroxytyrosol and Metformin in Prostate Cancer

Prostate cancer (PCa) is the tumour pathology with the second highest incidence among men worldwide. PCa is strongly influenced by obesity (OB), which increases its aggressiveness. Hence, some metabolic drugs like metformin have emerged as potential anti-tumour agents against several endocrine-related cancers. Likewise, a high adherence to the Mediterranean diet has been associated with lower rates of OB and a reduction in PCa aggressiveness since this diet contains phenolic bioactive compounds such as hydroxytyrosol (HT) that is mainly present in extra virgin olive oil. Thus, we decided to analyse the therapeutic potential of the combination of HT + metformin in different PCa cell models. Specifically, combinations of different doses of HT and metformin were evaluated by analysing the proliferation rate of LNCaP, 22Rv1, DU-145, and PC-3 cells using the SynergicFinder method. The results revealed a synergistic effect of HT + metformin in significantly reducing proliferation, especially in LNCaP cells. This anti-tumour effect of HT + metformin was also confirmed in migration and tumoursphere formation assays in LNCaP. The effects on the cell cycle and apoptosis were also assessed by flow-cytometry, and a cycle arrest in the G1 phase and an increase in late apoptosis were observed with the combination of HT + metformin. The phosphorylation levels of critical components of different oncogenic pathways were measured which revealed that the combination of HT + metformin significantly reduced the activity of multiple components of the MAPK, AKT, and TGF-β pathways. Overall, the combination of HT + metformin might represent a new therapeutic avenue for the management of PCa patients, an observation that certainly warrants further investigation through a well-designed clinical trial.

Moderating carbohydrate digestion rate in mice promotes fat oxidation and metabolic flexibility revealed through a new approach to assess metabolic substrate utilization

PURPOSE

Superior metabolic flexibility, or the ability to efficiently switch between oxidation of carbohydrate and fat, is inversely associated with obesity and type 2 diabetes. The influence of dietary factors on metabolic flexibility is incompletely understood. This study examined the impact of dietary carbohydrate digestion rate on metabolic flexibility and metabolic substrate utilization.

METHODS

We employed percent relative cumulative frequency (PRCF) analyses coupled with a new application of modeling using the Mixed Weibull Cumulative Distribution function to examine respiratory exchange ratio (RER) data from adult wild-type mice and mice lacking the mucosal maltase-glucoamylase enzyme (Mgam) under different dietary carbohydrate conditions, with diets matched for total carbohydrate contents and containing different ratios of slowly digestible starch (SDS) and resistant starch (RS), or that were high in sucrose or fat. Fungal amyloglucosidase (AMG) was administered in drinking water to increase carbohydrate digestion rate. We devised a Metabolic Flexibility Factor (MFF) to quantitate metabolic flexibility for each dietary condition and mouse genotype, with higher MFF indicating higher metabolic flexibility.

RESULTS

Diets high in SDS exhibited lower average RER and higher metabolic flexibility (MFF) than diets high in resistant starch, sucrose, or fat. Diets containing high and intermediate amounts of SDS led to a more complete shift to fat oxidation. While mouse genotype had minimal effects on substrate oxidation and MFF, AMG supplementation shifted substrate utilization to carbohydrate oxidation and generally decreased MFF.

CONCLUSIONS

Consumption of slowly digestible carbohydrates improved measures of metabolic substrate utilization at the whole-body level in adult mice.

Global trends and projections of high BMI burden and its independent impact on atrial fibrillation and flutter

BACKGROUND

This study evaluates changes in the burden of high body mass index (BMI) and its impact on atrial fibrillation and flutter (AF/AFL) using the 2021 Global Burden of Disease database.

METHODS

Mortality and disability-adjusted life years rates were analysed globally, considering age, sex, geography and the Socio-demographic Index (SDI). Decomposition and frontier analyses assessed the impact of epidemiological drivers and SDI on the burden. The nordpred model validated the predictions.

RESULTS

The burden of high BMI is now 2.5 times greater than 30 y ago and will continue to increase over the next 20 y, heavily impacting cardiovascular and metabolic diseases. High BMI-related AF/AFL also poses a significant burden, especially in developed regions. Men's burden grows faster than women's. Decomposition analysis shows epidemiological changes mainly drive burden increases, while in women, population growth is more significant. Frontier analysis indicates that the gap between actual burden and theoretical optimal value has widened with increasing SDI, except in countries such as Bulgaria and the Czech Republic.

CONCLUSIONS

Over the past 30 y, the overall burden of high BMI and its impact on AF/AFL have increased significantly, highlighting the need for targeted public health strategies.