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

Novel therapeutic drug identification and gene correlation for fatty liver disease using high-content screening: Proof of concept

Non-alcoholic fatty liver disease (NAFLD) is a problem in obese people caused by increasing intake of high-calorie food such as fructose implicated in the elevated prevalence. It is necessary to identify novel drugs to develop effective therapies. In this study, we combined LOPAC® (The Library of Pharmacologically Active Compounds) and High-Content screening to identify compounds that significantly reduced intracellular lipid droplets (LD) after high fat medium (HFM) treatment. Among 1280 compounds, we identified 239 compounds that reduced LD by >50%. Of these, 17 maintained cell viability. Nine of them were selected for validation using normal primary hepatocytes, of which five compounds showed dose-dependent efficacy. Whole genome transcriptomic network analysis was performed to construct the underlying regulatory network. There were 831 (711 up-regulated and 120 down-regulated genes) and 3480 (2009 up-regulated and 1471 down-regulated genes) genes that showed a significant change (>2-fold; p < 0.05) after 12 and 24 h HFM treatment, respectively. Gene enrichment and pathway analysis showed several immune responses mediated by MIF, IL-17, TLR, and IL-6. These compounds modulate lipogenesis via GSK3β and CREB1, which is followed by an alteration in the expression of several downstream genes related to hepatocellular carcinoma and hepatitis. CREB1 is a core transcription factor and may be a potential therapeutic target for liver disease. In conclusion, this proof of concept provides a strategy for identifying novel drugs for treatment of fatty liver disease as well as elucidates their underlying mechanisms. This research provides opportunity for developing future pharmaceutical therapeutics.

Surgical treatment of obesity

Obesity prevalence continues to increase worldwide, as do the numerous chronic diseases associated with obesity, including diabetes, non-alcoholic fatty liver disease, dyslipidemia, and hypertension. The prevalence of bariatric surgery also continues to increase and remains the most effective and sustainable treatment for obesity. Over the last several years, numerous prospective and longitudinal studies have demonstrated the benefits of bariatric surgery on weight loss, mortality, and other chronic diseases. Even though the mechanisms underlying many of these beneficial effects remain poorly understood, surgical management of obesity continues to increase given its unmatched efficacy. In this commentary, we discuss recent clinical advancements as well as several areas needed for future research, including indications for bariatric and metabolic surgery, determination of responders and non-responders, metabolic surgery in non-obese individuals, and the evolving role of bariatric surgery in adolescents.

Obesity and response to anti-tumor necrosis factor-α agents in patients with select immune-mediated inflammatory diseases: A systematic review and meta-analysis

OBJECTIVES

We sought to evaluate the association between obesity and response to anti-tumor necrosis factor-α (TNF) agents, through a systematic review and meta-analysis.

METHODS

Through a systematic search through January 24, 2017, we identified randomized controlled trials (RCTs) or observational studies in adults with select immune-mediated inflammatory diseases-inflammatory bowel diseases (IBD), rheumatoid arthritis (RA), spondyloarthropathies (SpA), psoriasis and psoriatic arthritis (PsA)-treated with anti-TNF agents, and reporting outcomes, stratified by body mass index (BMI) categories or weight. Primary outcome was failure to achieve clinical remission or response or treatment modification. We performed random effects meta-analysis and estimated odds ratios (OR) and 95% confidence interval (CI).

RESULTS

Based on 54 cohorts including 19,372 patients (23% obese), patients with obesity had 60% higher odds of failing therapy (OR,1.60; 95% CI,1.39-1.83;I2 = 71%). Dose-response relationship was observed (obese vs. normal BMI: OR,1.87 [1.39-2.52]; overweight vs. normal BMI: OR,1.38 [1.11-1.74],p = 0.11); a 1kg/m2 increase in BMI was associated with 6.5% higher odds of failure (OR,1.065 [1.043-1.087]). These effects were observed across patients with rheumatic diseases, but not observed in patients with IBD. Effect was consistent based on dosing regimen/route, study design, exposure definition, and outcome measures. Less than 10% eligible RCTs reported outcomes stratified by BMI.

CONCLUSIONS

Obesity is an under-reported predictor of inferior response to anti-TNF agents in patients with select immune-mediated inflammatory diseases. A thorough evaluation of obesity as an effect modifier in clinical trials is warranted, and intentional weight loss may serve as adjunctive treatment in patients with obesity failing anti-TNF therapy.

Development of weight and height in Norwegian children: The Health Oriented Pedagogical Project (HOPP)

AIMS

High prevalence of overweight and obesity increases the disease burden with higher risk for an expanding set of chronic diseases, including cardiovascular disease, diabetes mellitus, chronic kidney disease, certain types of cancers and an array of musculoskeletal disorders. Over the last decades, trends in children's weight have changed worldwide.

METHODS

Anthropometric measurements of height and weight and calculations of body mass index (BMI) were recorded for 2297 children, aged 6-12 years.

RESULTS

Percentiles for weight and height are presented, as well as overweight and obesity cut-off points according to International Obesity Task Force guidelines for each age group. Children's BMI is higher compared to older studies; however, a levelling-off of weight is evident, as 14-15% of the children are overweight in the present study. Children within the 90th and 97.5th percentiles display a higher annual increase in weight/height ratio compared to other percentiles. Parental level of education shows association with children's BMI.

CONCLUSIONS

A levelling-off of weight gain among children is evident; however, overweight children tend to gain more weight than normal-weight children.

Handgrip strength in 6-12-year-old children: The Health Oriented Pedagogical Project (HOPP)

AIMS

The aim of the study was to describe the natural course of handgrip strength development in primary school children and to establish a reference material to be used in future screening studies. In addition, the study aims to investigate a possible association between handgrip strength and cardiovascular risk factors.

METHODS

Anthropometric measures along with results for handgrip strength, endurance tests, blood pressure and cholesterol were measured on 2272 children of both sexes. An ROC analysis was used to estimate the suitability of handgrip strength as a predictor for known cardiometabolic risk factors.

RESULTS

A reference material for handgrip strength is presented for boys and girls aged 6-12 years. The results indicate that handgrip strength is unsuitable as a predictor for cardiometabolic risk factors in children.

CONCLUSIONS

The results may be used as reference values for handgrip strength in 6-12-year-old children of both sexes. Handgrip strength may not be used as a screening tool for cardiometabolic risk factors in pre-pubertal children.

Secretion of autoimmune antibodies in the human subcutaneous adipose tissue

The adipose tissue (AT) contributes to systemic and B cell intrinsic inflammation, reduced B cell responses and secretion of autoimmune antibodies. In this study we show that adipocytes in the human obese subcutaneous AT (SAT) secrete several pro-inflammatory cytokines and chemokines, which contribute to the establishment and maintenance of local and systemic inflammation, and consequent suboptimal immune responses in obese individuals, as we have previously shown. We also show that pro-inflammatory chemokines recruit immune cells expressing the corresponding receptors to the SAT, where they also contribute to local and systemic inflammation, secreting additional pro-inflammatory mediators. Moreover, we show that the SAT generates autoimmune antibodies. During the development of obesity, reduced oxygen and consequent hypoxia and cell death lead to further release of pro-inflammatory cytokines, “self” protein antigens, cell-free DNA and lipids. All these stimulate class switch and the production of autoimmune IgG antibodies which have been described to be pathogenic. In addition to hypoxia, we have measured cell cytotoxicity and DNA damage mechanisms, which may also contribute to the release of “self” antigens in the SAT. All these processes are significantly elevated in the SAT as compared to the blood. We definitively found that fat-specific IgG antibodies are secreted by B cells in the SAT and that B cells express mRNA for the transcription factor T-bet and the membrane marker CD11c, both involved in the production of autoimmune IgG antibodies. Finally, the SAT also expresses RNA for cytokines known to promote Germinal Center formation, isotype class switch, and plasma cell differentiation. Our results show novel mechanisms for the generation of autoimmune antibody responses in the human SAT and allow the identification of new pathways to possibly manipulate in order to reduce systemic inflammation and autoantibody production in obese individuals.

Development and validation of the Child Three-Factor Eating Questionnaire (CTFEQr17)

OBJECTIVE

To develop and validate a child and adolescent version of the Three-Factor Eating Questionnaire (CTFEQr17) and to assess its psychometric properties and factor structure. We also examined associations between the CTFEQr17 and BMI and food preferences.

DESIGN

A two-phase approach was utilized, employing both qualitative and quantitative methodologies.

SETTING

Primary and secondary schools, UK.

SUBJECTS

In phase 1, seventy-six children (thirty-nine boys; mean age 12·3 (sd 1·4) years) were interviewed to ascertain their understanding of the original TFEQr21 and to develop accessible and understandable items to create the CTFEQr17. In phase 2, 433 children (230 boys; mean age 12·0 (sd 1·7) years) completed the CTFEQr17 and a food preference questionnaire, a sub-sample (n 253; 131 boys) had their height and weight measured, and forty-five children (twenty-three boys) were interviewed to determine their understanding of the CTFEQr17.

RESULTS

The CTFEQr17 showed good internal consistency (Cronbach's α=0·85) and the three-factor structure was retained: cognitive restraint (CR), uncontrolled eating (UE) and emotional eating (EE). Qualitative data demonstrated a high level of understanding of the questionnaire (95 %). High CR was found to be significantly associated with a higher body weight, BMI and BMI percentile. High UE and EE scores were related to a preference for high-fat savoury and high-fat sweet foods. The relationships between CTFEQr17, anthropometry and food preferences were stronger for girls than boys.

CONCLUSIONS

The CTFEQr17 is a psychometrically sound questionnaire for use in children and adolescents, and associated with anthropometric and food preference measures.

Morbid obesity impairs adequacy of thoracic compressions in a simulation-based model

Adequate cardiopulmonary resuscitation is an important predictor of survival, however, obesity provides a significant physical barrier to thoracic compressions. This study explores the effect of morbid obesity on compression adequacy. We performed a prospective randomised controlled crossover study, assessing the adequacy of thoracic compressions on a manikin modified to emulate a morbidly obese patient. Participants recruited from critical care departments were randomised to perform continuous compressions for two minutes on each manikin. Accelerometers were used to measure thoracic wall movement. The primary endpoint was a composite measure of compression adequacy (rate, depth and recoil). Secondary endpoints were the individual components of the composite outcome and measures of perceived effectiveness, fatigue, and pain. One hundred and one participants were recruited. There was a significant difference between the obese and control groups in the composite endpoint (4% versus 30%, <i>P</i> <0.001), as well as the individual components of adequacy (<i>P</i> <0.01 for all). Quartile data showed significant deterioration in adequacy of depth and recoil in both groups, and this occurred significantly earlier in the obese group (<i>P</i> ≤0.001). Participants' perception of effectiveness was significantly lower (<i>P</i> ≤0.001) in the obese group, and levels of fatigue (<i>P</i> ≤0.001) and pain (<i>P</i> ≤0.001) significantly higher. Morbid obesity impairs the adequacy of thoracic compressions for trained rescuers in a simulation-based model. Participants were not fully aware of how ineffective compressions were. There is evidence of earlier fatigue further reducing effectiveness. These findings have significant implications for the training of rescuers in a clinically relevant population and the planning of future research.

Of mice and men - environmental temperature, body temperature, and treatment of obesity

Mice are widely used for exploring obesity physiology and treatment. However, thermal biology is different between small and large mammals. In this Review, we discuss how the effect of environmental temperature must be understood to ensure applicability of mouse experiments to human obesity. At ambient environmental temperature (~ 22 °C), over one-third of energy expenditure in mice is devoted to maintaining core body temperature, largely by brown adipose tissue. To conserve this energy, mice can enter a regulated hypothermia, while humans do not. Since humans expend little or no energy specifically to keep warm, mice studied at thermoneutrality (~ 30 °C) may be a better model for human energy homeostasis. Studies indicate that environmental temperature also affects the efficacy of drugs that increase energy expenditure. In mice, dinitrophenol, a protonophore, and CL316243, a β3-adrenergic agonist, both increase metabolic rate at thermoneutrality, but only CL316243 increases it at 22 °C. Furthermore, mice housed at thermoneutrality may become more obese than mice at 22 °C. Thus, we discuss the importance of studying mice at both thermoneutrality and at lower temperatures in obesity research.

A dissonance-based intervention for women post roux-en-Y gastric bypass surgery aiming at improving quality of life and physical activity 24 months after surgery: study protocol for a randomized controlled trial

Background

Roux-en-Y gastric bypass (RYGB) surgery is the most common bariatric procedure in Sweden and results in substantial weight loss. Approximately one year post-surgery weight regain for these patient are common, followed by a decrease in health related quality of life (HRQoL) and physical activity (PA). Our aim is to investigate the effects of a dissonance-based intervention on HRQoL, PA and other health-related behaviors in female RYGB patients 24 months after surgery. We are not aware of any previous RCT that has investigated the effects of a similar intervention targeting health behaviors after RYGB.

Methods

The ongoing RCT, the “WELL-GBP”-trial (wellbeing after gastric bypass), is a dissonance-based intervention for female RYGB patients conducted at five hospitals in Sweden. The participants are randomized to either control group receiving usual follow-up care, or to receive an intervention consisting of four group sessions three months post-surgery during which a modified version of the Stice dissonance-based intervention model is used. The sessions are held at the hospitals, and topics discussed are PA, eating behavior, social and intimate relationships. All participants are asked to complete questionnaires measuring HRQoL and other health-related behaviors and wear an accelerometer for seven days before surgery and at six months, one year and two years after surgery. The intention to treat and per protocol analysis will focus on differences between the intervention and control group from pre-surgery assessments to follow-up assessments at 24 months after RYGB. Patients’ baseline characteristics are presented in this protocol paper.

Discussion

A total of 259 RYGB female patients has been enrolled in the “WELL-GBP”-trial, of which 156 women have been randomized to receive the intervention and 103 women to control group. The trial is conducted within a Swedish health care setting where female RYGB patients from diverse geographical areas are represented. Our results may, therefore, be representative for female RYGB patients in the country as a whole. If the intervention is effective, implementation within the Swedish health care system is possible within the near future.

Trial registration

The trial was registered on February 23th 2015 with registration number ISRCTN16417174.

Is obesity related to the lung function of non-asthmatic children?

Overweight and obesity are highly prevalent in developed and developing countries among children and adolescents. During the last two decades, it became evident that excess weight is adversely related to respiratory health in childhood and adolescence mainly in terms of asthma occurrence. Additionally, there is a mounting body of evidence that overweight/obesity may also affect lung function in non-asthmatic subjects. The aim of this review was to present and discuss the studies that investigated this issue in non-asthmatic children and adolescents. Only a few studies have evaluated the impact of excess weight on static volumes and their results point towards an inverse relationship between overweight/obesity and functional residual capacity. More studies have been conducted on the impact of excess weight on dynamic lung volumes with inconsistent, however, results. Nevertheless, a relatively consistent finding was that the ratio of forced expiratory volume in 1 s/forced vital capacity was significantly lower among overweight/obese children compared to their counterparts with normal weight. The underlying mechanisms of these observations have not been adequately elucidated but it is believed to result from complex interaction of mechanical, developmental, and metabolic causes. There is a need for more well-designed studies in order to clarify the impact of excess weight on lung function in non-asthmatic subjects, as well as to explore the contribution of factors such as duration and degree of obesity, and fat distribution. Despite the absence of conclusive data, there are still convincing evidence to be communicated to the children and their families as part of the arguments to encourage them to adopt a healthier lifestyle.

Control of Eating Behavior Using a Novel Feedback System

Subjects eat food from a plate that sits on a scale connected to a computer that records the weight loss of the plate during the meal and makes up a curve of food intake, meal duration and rate of eating modeled by a quadratic equation. The purpose of the method is to change eating behavior by providing visual feedback on the computer screen that the subject can adapt to because her/his own rate of eating appears on the screen during the meal. The data generated by the method is automatically analyzed and fitted to the quadratic equation using a custom made algorithm. The method has the advantage of recording eating behavior objectively and offers the possibility of changing eating behavior both in experiments and in clinical practice. A limitation may be that experimental subjects are affected by the method. The same limitation may be an advantage in clinical practice, as eating behavior is more easily stabilized by the method. A treatment that uses this method has normalized body weight and restored the health of several hundred patients with anorexia nervosa and other eating disorders and has reduced the weight and improved the health of severely overweight patients.

Risk Factors Associated with Overweight and Obesity in Japanese-Brazilians

Objective

To estimate which risk factors (sociodemographic, lifestyle, and health conditions) are associated with overweight and obesity in Japanese-Brazilians.

Methods

This was a cross-sectional study carried out with Japanese-Brazilians living in the southern region of Brazil. Data were collected between March and December of 2016 through a household survey addressing sociodemographic characteristics, lifestyle, and health conditions. Data were analyzed by means of logistic regression considering 95% level of significance.

Results

A total of 542 Japanese-Brazilians with a mean age of 47.75 years were evaluated; 52.8% were eutrophic, 36.9% were overweight, and 10.3% were people with obesity. The following variables remained associated with overweight after adjustments; male gender (ORaj = 1.85, CI = 1.24-2.76), age range of 40-49 years (ORaj = 2.27, CI = 1.10-4.68), and 50 to 59 years (ORaj = 2.17, CI = 1.004-4.72), alcohol consumption (ORaj = 2.11, CI = 1.07-4.16), and presence of chronic disease (ORaj = 1.59, CI = 1.02-2.46). The following were independent factors associated with obesity: male gender (ORaj = 3.63, CI = 1.78-7.40), the presence of chronic disease (ORaj = 4.13, CI = 1.96-8.71), the age range of 30 to 39 years (ORaj = 4.74, CI = 1.65-13.64) and 40 to 49 years (ORaj = 2.89, CI = 1.05-7.95), and irregularly active lifestyle (ORaj = 2.73, CI = 1.12-6.69).

Conclusion

The results of this study show that being a male in the age range of 30-49 years old, alcohol consumption, and presence of chronic disease are associated with overweight and obesity in Japanese-Brazilians.

Influence of socioeconomic status on changes in body size and physical activity in ageing black South African women

Background

The increasing prevalence of obesity in sub-Saharan African women is not well understood, and black South African women in the region are particularly vulnerable. This study aimed to examine whether the relationship of socioeconomic status (SES) with changes in body mass index (BMI) and waist circumference (WC) is mediated by physical activity in ageing African women.

Methods

In a longitudinal analysis of the 518 caregivers associated with the Birth to Twenty Plus study, the role of SES associated with 10-year changes in BMI and WC was tested using structural equation modelling (SEM). The degree of mediation of moderate-vigorous physical activity (MVPA) and sitting time in this association was also assessed.

Results

The prevalence of obesity increased significantly from baseline to follow-up (p < 0.0001). In the SEM models, baseline SES had a direct positive effect on changes in BMI (β, 95% CI, 0.02 (0.005 to 0.04), and a direct negative effect on changes in MVPA (β, 95% CI, - 3.81 (- 6.92 to - 0.70). Baseline MVPA had a direct negative effect (β, 95% CI, - 0.002 (- 0.003 to - 0.0003) and indirect positive effect via change in MVPA (β, 95% CI, 0.01 (0.0001 to 0.001) on change in WC.

Conclusions

Our study demonstrates the role and interaction of sociodemographic and behavioural predictors of obesity, and suggests a multifaceted approach to management of the crisis in communities of ageing urban African women.

Associations of body weight and weight change with cardiovascular events and mortality in patients with coronary heart disease

BACKGROUND AND AIMS

It is recommended that patients with coronary heart disease (CHD) pursue a normal body weight, while the effects of body weight and weight change on prognosis are still controversial. The present study was to assess these effects using a large-scale population with CHD in China.

METHODS

A total of 5276 patients with CHD were included from Jan 2000 to Dec 2014. Baseline and endpoint weights were measured. Outcomes including mortality and cardiovascular events were obtained.

RESULTS

Relative to patients with normal weight, risks for adverse outcomes were lowest in overweight patients and similar in obese patients. Hazard ratios (HRs) and 95% confidence interval (95% CI) for all-cause death were 1.42 (1.06, 1.91) if overweight turned into normal weight and were 2.01 (1.28, 3.16) or 5.33 (2.81, 10.1) if obese turned into overweight or normal weight. Death risk increased with the extent of weight loss and moderate or large weight gain (p<0.05 for all). Similar results were found when risks for cardiovascular mortality and events were considered. Furthermore, these results remained significant when the patients were stratified by several covariates and even when several definitions of weight change were considered.

CONCLUSIONS

Obesity did not increase adverse outcome risks in patients with CHD. Both weight loss and weight gain increased adverse outcome risks regardless of baseline body weight. The findings suggest that maintaining a stable weight may be a better strategy for the reduction of risks for cardiovascular outcomes and all-cause death in patients with CHD.

Influence of the 6-month physical activity programs on renal function in obese boys

BackgroundWe intended to evaluate the effects of physical activity (PA) programs on renal function in obese boys.MethodsThirty-nine boys participated in one of the following three groups: soccer (SG, n=13), traditional PA (AG, n=13), and sedentary control (CG, n=13). SG and AG were involved in 6-month PA programs, involving three sessions/week for 60-90 min. Anthropometric measurements, body composition, creatinine and cystatin C plasmatic levels, and estimated glomerular filtration rate (eGFR) were evaluated.ResultsAt baseline (n=39), age and lean mass index (LMI) were positively correlated with creatinine levels. After 6 months, both intervention groups decreased the BMI z-score and waist circumference, while the CG increased the body fat percentage (BFP). LMI increased in all the groups. SG presented a small increment in plasma creatinine and a decrease in the eGFR values, using the Schwartz formula. Concerning the cystatin C levels and eGFR values using Filler (cystatin C-based) or Combined Zappitelli (creatinine/cystatin C-based) formulas, no significant changes were observed in any group.ConclusionThe combined Zappitelli formula showed no significant impact of PA on eGFR in obese boys. Although plasma creatinine is significantly influenced by lean body mass, cystatin C is likely to be a more accurate marker of renal function in this population.

Body mass index and mortality in patients with and without diabetes mellitus

OBJECTIVE

Investigate the association between body mass index (BMI), length of stay (LOS), and mortality in hospitalized patients with and without diabetes mellitus (DM).

METHODS

Historical prospectively collected data of adult patients hospitalized between 2011 and 2013. Body mass index was calculated according to measurement or self-report on admission and classified as follows: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), obese (30-34.9), and severely obese (≥35). The main outcomes were LOS, in-hospital, and end-of-follow-up mortality.

RESULTS

Cohort included 24 233 patients (53% male; mean age ± SD, 65 ± 18), including 7397 patients with DM (31%). Among patients with normal BMI, LOS was shorter compared with underweight patients, but it was longer compared with overweight and obese patients. Following multivariate adjustment, this difference remained significant only for patients with DM. There was a significant interaction between DM status and BMI group, in the models for in-hospital and end-of-follow-up mortality. Compared with normal BMI, in-hospital mortality risk was increased by 80% and 100% for the underweight with and without DM, respectively. For patients with and without DM, in-hospital mortality risk was 30% to 40% lower among overweight and obese patients, and there was no difference between severely obese and normal weight patients. At the end-of-follow-up, mortality risk was 1.6-fold and 1.7-fold higher among underweight patients with and without DM, respectively. For overweight, obese, and severely obese patients, mortality risk was decreased by 30% to 40% in those with DM and by 20% to 30% in those without DM.

CONCLUSIONS

In hospitalized patients with and without DM, there was an inverse association between BMI and mortality.

Gut Microbes and Health: A Focus on the Mechanisms Linking Microbes, Obesity, and Related Disorders

The past decade has been characterized by tremendous progress in the field of the gut microbiota and its impact on host metabolism. Although numerous studies show a strong relationship between the composition of gut microbiota and specific metabolic disorders associated with obesity, the key mechanisms are still being studied. The present review focuses on specific complex pathways as well as key interactions. For instance, the nervous routes are explored by examining the enteric nervous system, the vagus nerve, and the brain, as well as the endocrine routes (i.e., glucagon-like peptide-1, peptide YY, endocannabinoids) by which gut microbes communicate with the host. Moreover, the key metabolites involved in such specific interactions (e.g., short chain fatty acids, bile acids, neurotransmitters) as well as their targets (i.e., receptors, cell types, and organs) are briefly discussed. Finally, the review highlights the role of metabolic endotoxemia in the onset of metabolic disorders and the implications for alterations in gut microbiota-host interactions and ultimately the onset of diseases.

Cardiovascular risk factors in a child population: The Health Oriented Pedagogical Project (HOPP)

Aims: The main aim of the present study was to investigate the clustering of risk factors for cardiovascular diseases and metabolic syndrome in a large, healthy representative Norwegian child population. Methods: From a population of 2817, parents of 2297 children agreed to participate. Values of waist circumference (WC), total cholesterol (TC), high-density lipoprotein (HDL), systolic blood pressure (sysBP), haemoglobin-A1c (HbA1c) and Andersen aerobic fitness test were used to test clustering of cardiometabolic risk factors in this sample. Expected distributions of probability for zero to five risk factors are, respectively, 23.7%, 39.6%, 26.4%, 8.8%, 1.5% and 0.1%. A cardiometabolic risk score from zero to five for each individual was derived by adding the number of variables in the least desirable quartile (highest for WC, sysBP, TC and HbA1c; lowest for aerobic fitness and HDL). Results: A risk ratio of 5.8 (95% confidence interval 0.7–46.9) was found for five risk factors, though the small sample size rendered the results non-significant. An explorative analysis combining children with four and five risk factors did not reveal any significant clustering either. Conclusions: No clustering of risk factors was found among Norwegian children aged 6–12 years.

Association of Weight Control Behaviors with Body Mass Index in Korean Adolescents: A Quantile Regression Approach

PURPOSE

Adolescents are interested in weight control but likely practice unhealthy weight control behaviors. This study aimed to examine weight control behaviors associated with body mass index (BMI) in Korean adolescents.

DESIGN AND METHODS

In this descriptive cross-sectional study of 16- to 19-year-old adolescents (97 girls and 90 boys), analyses were conducted of physical activity, sedentary behaviors, dietary behaviors, and self-efficacy for physical activity and diet. Daily steps were measured using pedometers. Height and weight were self-reported. We conducted descriptive statistics and quantile regression analysis using STATA 14.0.

RESULTS

About 10% were underweight, and 8.6% overweight and obese. Average weekday and weekend steps/day were <10,000. Only 4.3% reported performing moderate-to-vigorous physical activity (MVPA) daily. Less than half (42.5%) reported that they had three meals/day every day. Most (89.3%) had milk less than once/day. Quantile regression showed that, for the 5th BMI percentile group, (1) age (β = 0.941) and milk consumption (β = 2.148) were significantly positively associated with BMI, whereas (2) dietary self-efficacy (β = -0.083) was significantly negatively associated with BMI. For the 95th percentile group, having three meals/day (β = 2.558) was significantly positively associated with BMI, whereas MVPA (β = -5.440) and muscle-strengthening exercise (β = -3.392) were significantly negatively associated with BMI.

CONCLUSIONS

Milk consumption was positively associated with BMI of underweight adolescents, whereas physical activities were negatively associated with BMI of overweight and obese adolescents.

PRACTICE IMPLICATION

Weight control programs for adolescents may need to be tailored for differing BMI levels.

Burden of obesity in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study

OBJECTIVES

We used the Global Burden of Disease (GBD) 2015 study results to explore the burden of high body mass index (BMI) in the Eastern Mediterranean Region (EMR).

METHODS

We estimated the prevalence of overweight and obesity among children (2-19 years) and adults (≥20 years) in 1980 and 2015. The burden of disease related to high BMI was calculated using the GBD comparative risk assessment approach.

RESULTS

The prevalence of obesity increased for adults from 15.1% (95% UI 13.4-16.9) in 1980 to 20.7% (95% UI 18.8-22.8) in 2015. It increased from 4.1% (95% UI 2.9-5.5) to 4.9% (95% UI 3.6-6.4) for the same period among children. In 2015, there were 417,115 deaths and 14,448,548 disability-adjusted life years (DALYs) attributable to high BMI in EMR, which constitute about 10 and 6.3% of total deaths and DALYs, respectively, for all ages.

CONCLUSIONS

This is the first study to estimate trends in obesity burden for the EMR from 1980 to 2015. We call for EMR countries to invest more resources in prevention and health promotion efforts to reduce this burden.

Safety and Effectiveness of an Endoscopically Placed Duodenal-Jejunal Bypass Device (EndoBarrier®): Outcomes in 114 Patients

BACKGROUND

The duodenal-jejunal bypass liner (DJBL) is an endoscopically placed device designed to achieve weight loss and improve glycemic control in obese patients. Previous studies report promising results but typically included small patient numbers and short follow-up. This study aims to determine the safety and effectiveness of the device.

METHODS

Study design: A series of all patients treated by the DJBL at our institutions.

OUTCOME MEASUREMENTS

Weight loss, biochemical measures, complications.

RESULTS

Between July 2012 and March 2015, 114 consecutive patients were treated for a mean 51.1 weeks (standard deviation (SD) 19.9 weeks). Mean total body weight change from baseline was 12.0 kg (SD 8.5 kg, p < 0.001). Mean percent total body weight loss (%TWL) was 10.5% (SD 7.3%). Mean HbA1c was not significantly improved, but of 10 patients on insulin, 4 ceased insulin and 4 reduced insulin dosages. There was a significant decrease in hemoglobin and total cholesterol and a significant increase in serum alkaline phosphatase. Seventy-four percent of patients experienced at least one adverse event, some of them serious including 6 device obstructions, 5 gastrointestinal hemorrhages, 2 liver abscesses, and 1 acute pancreatitis. Seventy-four percent of patients experienced weight gain after removal with a mean 4.5 ± 6.1 kg (p < 0.0001) within the first 6 months after explantation.

CONCLUSIONS

The DJBL provides significant but highly variable weight loss. Glycemic control was variable. Most insulin-requiring T2DM patients ceased or reduced insulin. Most patients experience an adverse event and most regain significant weight after device removal. Major adverse events can occur, including the potentially life-threatening complications of hepatic abscess and gastrointestinal hemorrhage.

Retinal vascular diameters in relation to physical activity in Danish children - The CHAMPS Eye Study

Our objective was to determine associations between retinal vascular caliber and physical activity (PA) in a school-based child cohort. In a prospective study, we created a childhood cumulative average PA-index using objectively measured PA (accelerometry) assessed at four periods between 2009 and 2015. Cumulative exposure to PA intensities was estimated. Cross-sectional examinations on biomarkers, anthropometry, and ophthalmological data including retinal fundus photographs were performed in 2015. Semi-automated measurements of retinal vascular diameters were performed and summarized into central retinal arteriolar and venular equivalents (CRAE, CRVE). We included 307 participants. Mean age in 2015 was 15.4 years (0.7). The mean CRAE and CRVE were 156.5 μm (2.8) and 217.6 μm (7.7), respectively. After adjusting for age, gender, and axial length, more time in PA was independently related to thinner retinal venules (β-coefficient = -1.25 μm/%, 95% confidence interval = -2.20, -0.30, P < .01). Sedentary time was associated with wider venules (P < .01). Furthermore, birthweight (β-coefficient = 0.56 μm/%, 95% confidence interval = 0.18, 0.95, P < .01) was associated with CRVE. Blood pressure was associated with thinner retinal arterioles (β-coefficient = -0.19 μm/mmHg, 95% confidence interval = -0.36, -0.01, P = .04). We concluded that children with higher PA in childhood had thinner retinal venular caliber. Our results suggest that PA during childhood positively impacts the retinal microcirculation and that retinal vascular analysis may be a possible assessment to detect microvascular impairments in children with an increased risk of future cardiovascular disease.

Cardiovascular Risk in Cancer Survivors

PURPOSE OF REVIEW

As the number of cancer survivors continues to rise with improved early-detection methods and advancing therapies, along with it, there come adverse health outcomes as a result of physiological and psychological effects of cancer, as well as adverse effects of cancer treatment itself. This paper reviews the risk of cardiovascular disease in cancer survivors.

RECENT FINDINGS

Cancer survivors are at higher risk of having modifiable cardiovascular (CV) risk factors, such as hypertension, diabetes mellitus, obesity, tobacco smoking, and physical inactivity. Cardiotoxicity is a well-established adverse effect of various anticancer regimens, which further elevates the cardiovascular risk in cancer patients. The increased risk of CVD and CVD-related death in cancer survivors is likely to be multifactorial, involving cardiotoxic effects of cancer treatments as well as comorbidities and harmful lifestyle habits. Targeting and managing known cardiac risk factors should be a main target in CVD prevention in cancer survivors.

Operative techniques for improving surgical exposure in basic cardiac surgery

Operative exposure is key to ensuring surgical efficiency and patient safety in cardiac surgery. As the population ages and the prevalence of obesity increases, cardiac surgeons will be challenged to consider obese patient physiology and body habitus, surgical exposure and sternotomy closure techniques, and postoperative medical management to ensure optimal outcomes. In this article, we describe techniques to improve operative exposure in both obese and non-obese patients undergoing basic cardiac surgery and highlight the roles of surgical team members to ensure patient safety and provide optimal anesthetic management. We describe pre-operative techniques regarding incision-site marking and alternative positioning techniques on the operating table to improve visualization and decrease risk of upper extremity injury. We summarized the roles of surgical team members regarding patient positioning, especially in those that are obese, and the challenges associated for anesthesia staff pre- and intraoperatively. Procedural techniques regarding sternotomy management and closure, cannulation, internal mammary harvest, and mitral valve exposure are discussed. Cardiac surgical teams must consider the risks associated with the obese patient population undergoing cardiac surgery procedures and employ techniques pre-, intra-, and postoperatively in a multidisciplinary fashion. Safe and efficacious techniques are paramount to optimal patient outcomes.

Burden of disease attributable to suboptimal diet, metabolic risks and low physical activity in Ethiopia and comparison with Eastern sub-Saharan African countries, 1990-2015: findings from the Global Burden of Disease Study 2015

BACKGROUND

Twelve of the 17 Sustainable Development Goals (SDGs) are related to malnutrition (both under- and overnutrition), other behavioral, and metabolic risk factors. However, comparative evidence on the impact of behavioral and metabolic risk factors on disease burden is limited in sub-Saharan Africa (SSA), including Ethiopia. Using data from the Global Burden of Disease (GBD) Study, we assessed mortality and disability-adjusted life years (DALYs) attributable to child and maternal undernutrition (CMU), dietary risks, metabolic risks and low physical activity for Ethiopia. The results were compared with 14 other Eastern SSA countries.

METHODS

Databases from GBD 2015, that consist of data from 1990 to 2015, were used. A comparative risk assessment approach was utilized to estimate the burden of disease attributable to CMU, dietary risks, metabolic risks and low physical activity. Exposure levels of the risk factors were estimated using spatiotemporal Gaussian process regression (ST-GPR) and Bayesian meta-regression models.

RESULTS

In 2015, there were 58,783 [95% uncertainty interval (UI): 43,653-76,020] or 8.9% [95% UI: 6.1-12.5] estimated all-cause deaths attributable to CMU, 66,269 [95% UI: 39,367-106,512] or 9.7% [95% UI: 7.4-12.3] to dietary risks, 105,057 [95% UI: 66,167-157,071] or 15.4% [95% UI: 12.8-17.6] to metabolic risks and 5808 [95% UI: 3449-9359] or 0.9% [95% UI: 0.6-1.1] to low physical activity in Ethiopia. While the age-adjusted proportion of all-cause mortality attributable to CMU decreased significantly between 1990 and 2015, it increased from 10.8% [95% UI: 8.8-13.3] to 14.5% [95% UI: 11.7-18.0] for dietary risks and from 17.0% [95% UI: 15.4-18.7] to 24.2% [95% UI: 22.2-26.1] for metabolic risks. In 2015, Ethiopia ranked among the top four countries (of 15 Eastern SSA countries) in terms of mortality and DALYs based on the age-standardized proportion of disease attributable to dietary and metabolic risks.

CONCLUSIONS

In Ethiopia, while there was a decline in mortality and DALYs attributable to CMU over the last two and half decades, the burden attributable to dietary and metabolic risks have increased during the same period. Lifestyle and metabolic risks of NCDs require more attention by the primary health care system of the country.

Circulating MOTS-c levels are decreased in obese male children and adolescents and associated with insulin resistance

BACKGROUND AND AIMS

A novel bioactive peptide, mitochondrial-derived peptide (MOTS-c), has recently attracted attention as a potential prevention or therapeutic option for obesity and type 2 diabetes mellitus (T2DM). MOTS-c profiles have not yet been reported in human obesity and T2DM. We aimed to determine circulating MOTS-c levels in obesity and explore the association between MOTS-c levels and various metabolic parameters.

METHODS

In this case-control study, 40 obese children and adolescents (27 males) and 57 controls (40 males) were recruited in the Hubei Province of China in 2017. Circulating MOTS-c levels were measured, clinical data (eg, glucose, insulin, and lipid profile) were recorded, and anthropometric measurements were performed. Finally, we investigated correlations between MOTS-c levels and related variables.

RESULTS

MOTS-c levels were significantly decreased in the obese group compared with the control group (472.61 ±22.83 vs 561.64 ±19.19 ng/mL, P <.01). After classification by sex, MOTS-c levels were significantly decreased in obese male children and adolescents compared to their counterparts (465.26 ±24.53 vs 584.07 ±21.18 ng/mL, P <.001), while they were comparable between the obese and healthy female subjects (487.89 ±49.77 vs 508.85 ±38.76 ng/mL, P >.05). Further, MOTS-c levels were negatively correlated with body mass index (BMI), BMI SD score, waist circumference, waist-to-hip ratio, fasting insulin level, homeostasis model assessment of insulin resistance (HOMA-IR), and glycated hemoglobin (HbA1c) in the male cohort.

CONCLUSIONS

Circulating MOTS-c levels were decreased in obese male children and adolescents and correlated with markers of insulin resistance and obesity.

Association between skipping breakfast in parents and children and childhood overweight/obesity among children: a nationwide 10.5-year prospective study in Japan

BACKGROUND/OBJECTIVES

The longitudinal association between skipping breakfast in parents and their children, and the subsequent risk of childhood overweight/obesity is unknown, especially in children under 10 years of age. We therefore aimed to prospectively assess the association between parents who skip their breakfast and the risk of children skipping their breakfast, as well as the risk of childhood overweight/obesity in children who skip their breakfast, using a10.5-year follow-up data on nationality representative samples.

METHODS

A total of 43, 663 children aged 1.5 years in 2002 were followed until 12 years of age. An overweight body mass index (BMI), including obesity, was defined as a BMI greater than or equal to 25 kg/m², according to the International Obesity Task Force cut-off points for children. Associations between parents, when children were 1.5 years of age, and children (2.5-12 years of age) skipping breakfast, as well as childhood overweight/obesity were calculated using logistic regression models.

RESULTS

Of the 42 663 children included, 12 and 32% of their mothers and fathers usually skipped breakfast when the child was 1.5 years of age, respectively. Children whose mothers or fathers skipped breakfast were more likely to skip breakfast, than those whose parents ate breakfast for all ages: the range of multivariable odds ratios (ORs) was 1.90 (95% confidence interval (CI) 1.56-2.31) to 2.98 (95% CI 2.28-3.90) among mothers and 1.42 (95% CI 1.33-1.51) to 2.43 (95% CI 1.90-3.11) among fathers. When both parents skipped breakfast, the strongest association was observed. Compared to children who did not skip breakfast, children who skipped breakfast had 18-116% increased risk of overweight/obesity; the multivariable ORs were 1.18 (95% CI 1.05-1.32) and 2.16 (95% CI 1.55-2.99), respectively.

CONCLUSIONS

There was a significant association between skipping breakfast in parents and children. Children who skipped breakfast had significantly increased risk of childhood overweight/obesity.

A behavioral rating system predicts weight loss and quality of life after bariatric surgery

BACKGROUND

Bariatric surgery represents the most effective intervention for severe obesity available today; however, significant variability in postoperative outcomes exists. Effective tools that predict postoperative outcomes are needed for decision-making and patient counseling.

OBJECTIVES

We hypothesized that a validated behavioral assessment tool, the Cleveland Clinic Behavioral Rating Scale (CCBRS), would predict excess weight loss, health-related quality of life, depression, anxiety, and alcohol use after bariatric surgery.

SETTING

Hospital in the United States.

METHODS

A prospective observational study with 2-year planned follow-up was conducted with patients who completed a psychological clinical interview, the Short Form 36 (SF-36) v.2 Health Survey and brief self-report questionnaires measuring depression (PHQ-9), anxiety (GAD-7), and alcohol use (AUDIT) preoperatively. At the conclusion of the preoperative psychological evaluation, the psychologist completed the CCBRS. All questionnaires were readministered at 6, 12, 18, and 24 months after surgery. Generalized estimating equations were used to assess whether any CCBRS ratings predicted surgery outcomes.

RESULTS

One hundred seventy-nine patients (113 Roux-en-Y gastric bypass and 66 sleeve gastrectomy) were included in the analyses. SF-36 scores, PHQ-9 scores, and the AUDIT total scores improved significantly after surgery, while GAD-7 scores did not change appreciably. Higher preoperative CCBRS ratings predicted higher SF-36 scores, and lower PHQ-9, GAD-7 and AUDIT scores. The CCBRS social support rating predicted higher postoperative percent excess weight loss.

CONCLUSION

A behavioral rating scale (CCBRS) completed before bariatric surgery predicted postoperative weight loss, quality of life, depression, and anxiety. Therefore, this tool may prove useful in patient counseling and expectation management before surgery.

Causal associations between body mass index and mental health: a Mendelian randomisation study

Background

Body mass index (BMI) is correlated negatively with subjective well-being and positively with depressive symptoms. Whether these associations reflect causal effects is unclear.

Methods

We examined bidirectional, causal effects between BMI and mental health with Mendelian randomisation using summary-level data from published genome-wide association studies (BMI: n=339 224; subjective well-being: n=204 966; depressive symptoms: n=161 460). Genetic variants robustly related to the exposure variable acted as instrumental variable to estimate causal effects. We combined estimates of individual genetic variants with inverse-variance weighted meta-analysis, weighted median regression and MR-Egger regression.

Results

There was evidence for a causal, increasing effect of BMI on depressive symptoms and suggestive evidence for a decreasing effect of BMI on subjective well-being. We found no evidence for causality in the other direction.

Conclusion

This study provides support for a higher BMI causing poorer mental health. Further research should corroborate these findings and explore mechanisms underlying this potential causality.

Integration of human adipocyte chromosomal interactions with adipose gene expression prioritizes obesity-related genes from GWAS

Increased adiposity is a hallmark of obesity and overweight, which affect 2.2 billion people world-wide. Understanding the genetic and molecular mechanisms that underlie obesity-related phenotypes can help to improve treatment options and drug development. Here we perform promoter Capture Hi-C in human adipocytes to investigate interactions between gene promoters and distal elements as a transcription-regulating mechanism contributing to these phenotypes. We find that promoter-interacting elements in human adipocytes are enriched for adipose-related transcription factor motifs, such as PPARG and CEBPB, and contribute to heritability of cis-regulated gene expression. We further intersect these data with published genome-wide association studies for BMI and BMI-related metabolic traits to identify the genes that are under genetic cis regulation in human adipocytes via chromosomal interactions. This integrative genomics approach identifies four cis-eQTL-eGene relationships associated with BMI or obesity-related traits, including rs4776984 and MAP2K5, which we further confirm by EMSA, and highlights 38 additional candidate genes.

A retrospective study on association between obesity and cardiovascular risk diseases with aging in Chinese adults

This study aimed to investigate the prevalence of overweight and obesity and its relationship with cardiovascular risk diseases among different sex and age groups in an urban Chinese adult population. A retrospective analysis was performed on 384,061 Chinese adults aged 20 years and older in Nanjing. The age-standardized prevalence of overweight and obesity was 42.8% and 13.2% in men and 23.9% and 6.6% in women. A gradually increasing trend was observed in the prevalence of overweight and obesity from 2008 to 2016, especially in individuals aged 20~39 years. Overweight and obesity were significantly associated with increased risks of dyslipidemia, diabetes mellitus, hypertension, and hyperuricemia. Age weakened such relationship for both genders, which spiked in individuals aged 20~39 years. For men and women aged 20~39 years, the OR (95% CI) of obesity reached 4.23 (4.01–4.47) and 5.29 (4.63–6.04) for dyslipidemia, 3.70 (2.97–4.60) and 6.38 (3.86–10.55) for diabetes mellitus, 6.19 (5.76–6.64) and 9.36 (7.86–11.13) for hypertension, and 3.66 (3.45–3.88) and 6.65 (5.70–7.74) for hyperuricemia, respectively. The increasing trend in the epidemic of overweight and obesity is a risk factor for cardiovascular risk diseases in Chinese adults, especially in individuals aged 20~39 years.

Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study

Background

The level of body-mass index (BMI) associated with the lowest risk of death remains unclear. Although differences in muscle mass limit the utility of BMI as a measure of adiposity, no study has directly examined the effect of muscle mass on the BMI-mortality relationship.

Methods

Body composition was measured by dual-energy x-ray absorptiometry in 11,687 participants of the National Health and Nutrition Examination Survey 1999–2004. Low muscle mass was defined using sex-specific thresholds of the appendicular skeletal muscle mass index (ASMI). Proportional hazards models were created to model associations with all-cause mortality.

Results

At any level of BMI ≥22, participants with low muscle mass had higher body fat percentage (%TBF), an increased likelihood of diabetes, and higher adjusted mortality than other participants. Increases in %TBF manifested as 30–40% smaller changes in BMI than were observed in participants with preserved muscle mass. Excluding participants with low muscle mass or adjustment for ASMI attenuated the risk associated with low BMI, magnified the risk associated with high BMI, and shifted downward the level of BMI associated with the lowest risk of death. Higher ASMI was independently associated with lower mortality. Effects were similar in never-smokers and ever-smokers. Additional adjustment for waist circumference eliminated the risk associated with higher BMI. Results were unchanged after excluding unintentional weight loss, chronic illness, early mortality, and participants performing muscle-strengthening exercises or recommended levels of physical activity.

Conclusions

Muscle mass mediates associations of BMI with adiposity and mortality and is inversely associated with the risk of death. After accounting for muscle mass, the BMI associated with the greatest survival shifts downward toward the normal range. These results provide a concrete explanation for the obesity paradox.

Friday Night Is Pizza Night: A Comparison of Children's Dietary Intake and Maternal Perceptions and Feeding Goals on Weekdays and Weekends

Childhood obesity is a serious issue in the U.S. While obesity is the result of a multitude of factors, a great deal of research has focused on children's dietary intake. While children's eating patterns vary throughout the week, not much else is known about weekday-weekend differences. Therefore, the current study examined differences in the frequency and portion size of school-age children's consumption of common foods and beverages, as well as mothers' perceptions of those items and their child feeding goals, on weekdays and weekends. A total of 192 mothers of children aged 7 to 11 were recruited through Amazon's Mechanical Turk. Results showed a consistent pattern of more frequent consumption and larger portions of unhealthy foods and beverages on weekends. This aligned with mothers' perceptions of those foods and beverages as weekend items, as well as their feeding goals of health and price being less important on weekends. It is quite possible that weekends are viewed as having less structure and facilitate schedules that allow children to consume more meals away from home. These findings shed light on additional risk factors in children's eating patterns and highlight the serious implications that day of the week can have on childhood obesity.

Effects of gastric bypass surgery followed by supervised physical training on inflammation and endothelial function: A randomized controlled trial

BACKGROUND AND AIMS

Obesity and physical inactivity are both associated with low-grade inflammation and endothelial dysfunction. Bariatric surgery improves markers of inflammation and endothelial function, but it is unknown if physical training after bariatric surgery can improve these markers even further. Therefore, we aimed to investigate the effects of Roux-en-Y gastric bypass (RYGB) followed by physical training on markers of low-grade inflammation and endothelial function.

METHODS

Sixty patients approved for RYGB underwent examinations pre-surgery, 6, 12, and 24 months post-surgery. Six months post-surgery, they were randomized 1:1 to an intervention group or a control group. The interventions consisted of two weekly sessions of supervised moderate intensity physical training for a period of 26 weeks. Fasting blood samples were analyzed for concentrations of interleukin 6 (IL-6), C-reactive protein (CRP), intercellular adhesion molecule 1 (ICAM-1), tissue-type plasminogen activator antigen (t-PA:Ag) and von Willebrand factor (vWF).

RESULTS

RYGB markedly improved markers of inflammation (IL-6, CRP) (p < 0.001) and endothelial function (ICAM-1, t-PA:Ag, vWF) (p < 0.05), and the improvements were sustained 24 months post-surgery (p < 0.01), except for the effects on vWF. We found no correlations between the changes in weight or BMI and the changes in markers of inflammation and endothelial function, except that the change in vWF was found to be inversely correlated with the changes in weight and BMI. We observed no effects of supervised physical training on markers on inflammation or endothelial function (p>0.1 for all).

CONCLUSIONS

RYGB causes substantial and sustained favorable effects on markers of inflammation and endothelial function. Supervised physical training after RYGB did not cause additional improvements.

Fitness and Fatness as Health Markers through the Lifespan: An Overview of Current Knowledge

There is an increasing body of evidence supporting that both fitness and fatness levels relate to current and future individuals’ health status. In this article, we discuss the meaning of fitness and fatness/obesity, and make an overview of what is currently known about fitness and fatness as potentially modifiable risk factors related to health and disease from preschool children to older adults. We describe the methods available for fitness assessment in each age group, providing reference/criterion values when available. Most of the existing previous reviews are focused on specific age groups with the advantage of allowing more in-depth analysis of the evidence, but the disadvantage of losing the overall understanding of the fitness and fatness binomial through the human lifespan, which is the ultimate goal of the present article.

Young Adult Cancer: Influence of the Obesity Pandemic

OBJECTIVE

The purpose of this article is to review the association of the obesity pandemic with appearance of cancers in young adults under age 50 and to define potential mechanisms by which obesity may accelerate the development of malignancy.

METHODS

A comprehensive narrative review was performed to integrate preclinical, clinical, and epidemiologic evidence describing the association of obesity with cancer in young adults based on a search of PubMed and Google databases.

RESULTS

Results from more than 100 publications are summarized. Although they differ in age groups analyzed and incidence of obesity, sufficient data exists to suggest an influence of the obesity pandemic on the increase of cancer among young adults.

CONCLUSIONS

Cancer in young adults is occurring with increasing frequency. Overweight and obesity have become major public health issues reaching pandemic proportions. Excess weight is associated with increased cancer risk, morbidity, and mortality. Multiple murine models indicate that obesity not only increases cancer incidence but also accelerates its development. Thus, the possibility exists that overweight and obesity may be contributing to the appearance of specific malignancies at younger ages. This prospect, in association with the worldwide expansion of obesity, suggests an impending explosive increase in obesity-associated cancers in young adults.

Impaired natural killer cell subset phenotypes in human obesity

Obesity is associated with alterations in functionality of immune cells, like macrophages and natural killer (NK) cells, leading to an increased risk for severe infections and several cancer types. This study aimed to examine immune cell populations and functional NK cell parameters focusing on NK cell subset phenotypes in normal-weight and obese humans. Therefore, peripheral blood mononuclear cells (PBMCs) were isolated from normal-weight and obese individuals and analyzed by flow cytometry. Results show no significant changes in the frequency of monocytes, B lymphocytes, or NKT cells but a significantly increased frequency of T lymphocytes in obesity. The frequency of total NK cells was unaltered, whereas the number of low cytotoxic CD56bright NK cell subset was increased, and the number of high cytotoxic CD56dim NK cell subset was decreased in obese subjects. In addition, the frequency of CD56bright NK cells expressing the activating NK cell receptor NKG2D as well as intracellular interferon (IFN)-γ was elevated in the obese study group. In contrast, the frequency of NKG2D- and IFN-γ-positive CD56dim NK cells was lower in obesity compared to normal-weight individuals. Moreover, the expression of the activation marker CD69 was decreased in NK cells, which can be attributed to a reduction of CD69-positive CD56dim NK cells in obese subjects. In conclusion, data reveal an impaired NK cell phenotype and NK cell subset alterations in obese individuals. This NK cell dysfunction might be one link to the higher cancer risk and the elevated susceptibility for viral infections in obesity.

High prevalence of diabetes mellitus, hypertension and obesity among persons with a recorded diagnosis of intellectual disability or autism spectrum disorder

BACKGROUND

Obesity and lack of physical activity are frequently reported in persons with intellectual disability (ID) or autism spectrum disorder (ASD). We hypothesised a higher prevalence of diabetes and hypertension in this population.

METHOD

We used administrative data for all primary and specialist outpatient and inpatient healthcare consultations for people with at least one recorded diagnosis of diabetes mellitus, hypertension or obesity from 1998 to 2015. Data were drawn from the central administrative database for Stockholm County, Sweden. It was not possible to separate data for type 1 and type 2 diabetes. We stratified 26 988 individuals with IDs or ASD into three groups, with Down syndrome treated separately, and compared these groups with 1 996 140 people from the general population.

RESULTS

Compared with the general population, men and women with ID/ASD had 1.6-3.4-fold higher age-adjusted odds of having a registered diagnosis of obesity or diabetes mellitus, with the exception of diabetes among men with Down syndrome. A registered diagnosis of hypertension was only more common among men with ID/ASD than in the general population.

CONCLUSIONS

Diabetes and blood pressure health screening, along with efforts to prevent development of obesity already in childhood, are necessary for individuals with IDs and ASD. We believe that there is a need for adapted community-based health promotion programmes to ensure more equitable health for these populations.

Body Mass Index and Kidney Disease-Related Mortality in Midlife: A Nationwide Cohort of 2.3 Million Adolescents

OBJECTIVE

This study aimed to evaluate the association of body mass index (BMI) in adolescence with mortality attributed to kidney disease.

METHODS

In this study, 2,294,139 Jewish Israeli adolescents with measured weight and height at 17 years old during the military fitness assessment were analyzed with a follow-up extending up to 45 years. All kidney-related outcomes, coded by the Central Bureau of Statistics from death notifications as the underlying cause of death, were obtained by linkage. Cox hazards models were applied.

RESULTS

During 42,297,007 person-years of follow-up (median 18.4 years), 226 deaths related to kidney disease were recorded. There was an increased risk for kidney-related death among adolescents with overweight and obesity with adjusted hazard ratios of 2.7 (95% CI: 1.8-3.9) and 8.4 (5.1-13.8), respectively, with BMI between 18.5 and 22.0 kg/m² as the reference. A 15% increased risk for kidney-related mortality (1.11-1.19) per unit increment in BMI was observed. Furthermore, a multivariable spline model indicated a minimum risk for kidney-related mortality starting at BMI of 18.6 kg/m² with significantly increased risk seen above values of 22.8 kg/m² . The results withstood extensive sensitivity analyses, including stratification of kidney-related death attributed to acute, chronic, and total kidney disease.

CONCLUSIONS

Adolescent overweight and obesity are risk markers for kidney-related mortality over 4 decades.

Saponin from sea cucumber exhibited more significant effects than ginsenoside on ameliorating high fat diet-induced obesity in C57BL/6 mice

Obesity and its comorbidities are considered to be a severe public health problem. Many natural compounds found in food have been proved to ameliorate the metabolic abnormalities induced by obesity. The purpose of this study was to compare the effects of saponin from sea cucumber (SSC) and ginsenoside (SG) on improving the lipid metabolism in C57BL/6 mice fed with a high fat diet. The mice were randomly divided into six groups including a low fat diet group (LF), a high fat diet group (HF), and four dietary intervention groups. The administration of SSC for 8 weeks exhibited a more significant reduction in HF induced fat mass, weight gain, lipid levels in the liver and serum, and serum glucose and insulin levels than SG. Further research indicated that SSC ameliorated high fat diet-induced obesity in C57BL/6 mice mainly through inhibiting lipid synthesis and accelerating lipid β-oxidation and glycolysis in the liver. These results suggested that saponin from sea cucumber might be applied as a food supplement and/or functional ingredient to relieve metabolic disorders induced by obesity.