Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss

The Contributions of Risk Factor Modifications to the Reduction of Cardiovascular Risk in Patients With Antidiabetic Treatment: A Meta-Regression Analysis and Model-Based Analysis

AIMS

This meta-regression analysis and model-based analysis aimed to assess the contributions of the risk factors and identify the predominant ones.

METHODS

PubMed/MEDLINE, Embase, and Cochrane databases were searched for randomized controlled trials with reports of cardiovascular events in patients receiving antidiabetic treatments. Five treatment-response factors such as changes in haemoglobin A1c (HbA1c), systolic blood pressure (SBP), body weight, low-density lipoprotein cholesterol (LDL-C) and estimated glomerular filtration rate (eGFR), and six baseline factors such as HbA1c, SBP, body weight, LDL-C, eGFR and age were included in the analyses. Eligible data were first analysed by a meta-regression analysis and then by a mathematical model-based analysis.

RESULTS

In all 41 studies were included. Among all treatment response factors, reduction in body weight and SBP were key factors in lowering cardiovascular risk. A 5-kg body weight reduction accounted for 5%, 33%, 11.6%, 13% and 31.2% risk reduction in MACE, CV death, MI, stroke, and HHF, respectively. A 5-mmHg SBP reduction contributed 42.3%, 34.9%, 38.5%, 11% and 21.4% to the risk reduction in MACE, CV death, MI, stroke and HHF, respectively. Among all baseline factors, an increase in the baseline body weight was the main contributor to cardiovascular risk reduction. A 5-kg increase in baseline body weight was associated with 12.5%, 3.5%, 6.5% and 8.4% risk reduction in MACE, CV death, MI, and stroke, respectively.

CONCLUSION

The reduction in body weight and SBP level were the dominant contributors to cardiovascular risk reduction among all 11 included potential factors. The treatment response factors might be more crucial to reduce cardiovascular risk when compared with baseline factors.

Effects of whole-body vibration exercise on cardiorespiratory fitness, muscular strength and body fat in women with overweight and obesity: A randomized pilot study

BACKGROUND AND AIM

Whole-body vibration (WBV) exercise has been acknowledged as an alternative exercise method for improving functional capacity. We examined the effects of an 8-week WBV exercise on cardiorespiratory fitness (CRF), muscular strength (MS) and body composition in young women.

METHODS AND RESULTS

Twenty-six inactive women with overweight and obesity (age: 30.2 ± 8.0 years, BMI: 25.7 ± 1.9 kg/m2) were randomly assigned to WBV exercise (n = 13) or control (n = 13) groups. The WBV exercise group participated in static and dynamic exercises on a vibration platform (3 sessions/week, 60 min/session) for 8 weeks. The control group maintained their usual lifestyle without structured exercise. CRF was measured by VO2peak and MS index was measured by the 1-RM (kg) for the chest and leg press, expressed relative to body weight (kg). Body composition was assessed by bioelectrical impedance analysis. Of the 26 participants randomized, 23 participants (13 WBV and 10 controls) completed the intervention, with 94.2 % exercise adherence rate. A two-way repeated measures ANOVA revealed that the WBV exercise group had reductions (p < 0.05 for all) in body weight (-2.4 kg), BMI (-0.9 kg/m2), body fat (-2.8 kg) and waist circumference (-3.5 cm) compared to the control group. VO2peak (pre: 27.9 ± 4.8 vs. post: 30.7 ± 4.4 ml/kg/min, p = 0.005) and MS index (pre: 2.0 ± 0.4 vs. post: 3.0 ± 0.7, p < 0.001) increased in the WBV exercise group, but not in the control group.

CONCLUSION

WBV exercise is effective for improving fitness and body fat in young women with overweight and obesity.

Trends in ischemic heart disease-related mortality in obese population in the United States

Obesity affects approximately 72 million Americans and is a significant contributor to ischemic heart disease (IHD). Given the scarcity of data, this observational study examines trends and disparities in IHD-related mortality among obese individuals in the United States from 2003 to 2019 using Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research data. Age-adjusted mortality rates (AAMRs) were calculated for IHD as the underlying cause of death and obesity as a contributing cause of death, revealing an increase in IHD-related mortality among obese adults. AAMR rose from 2.1 in 2003 to 3.9 in 2019, with higher rates in men, non-Hispanic Black individuals, the elderly, and those in nonmetropolitan and Midwest regions. These findings underscore significant sex, racial, and regional disparities in mortality, suggesting a need for targeted health policies and resource allocation, improving overall cardiovascular health outcomes.

Associations of body roundness index with cardiovascular disease and mortality among patients with metabolic syndrome

AIMS

The prevalence of metabolic syndrome (MetS) is increasing due to ageing populations and lifestyle changes, making it crucial to understand the relationship between body fat distribution and cardiovascular outcomes. Traditional measures such as body mass index (BMI) have limitations in assessing abdominal obesity. The body roundness index (BRI), a novel anthropometric measure combining waist circumference and height, has shown promise in evaluating this risk. This study aims to explore the association between BRI and cardiovascular disease (CVD) prevalence and mortality in a nationally representative sample of US adults with MetS.

MATERIALS AND METHODS

This retrospective study used data from the National Health and Nutrition Examination Surveys (NHANES) 2001-2016, including 10 527 MetS-diagnosed participants. BRI was calculated and the cohort was divided into quartiles. Logistic regression and Cox proportional hazards models assessed the relationship between BRI and CVD prevalence, all-cause mortality and cardiovascular-specific mortality. Kaplan-Meier curves and restricted cubic spline analyses visualized survival patterns and non-linear relationships, with sensitivity analysis for validation.

RESULTS

Higher BRI quartiles were significantly associated with increased CVD prevalence (odds ratio [OR]: 1.56 [1.32-1.84], p < 0.001). In the fully adjusted model, BRI demonstrated a U-shaped relationship with all-cause and cardiovascular mortality, with a threshold value of 6.89 (p for non-linear ≤0.001). Above this threshold, each additional unit in BRI was linked to a 9% increase in cardiovascular mortality risk (hazard ratio [HR]: 1.09 [1.02-1.15], p = 0.006) and an 8% rise in overall mortality (HR: 1.08 [1.04-1.12], p < 0.001). Conversely, BMI showed a paradoxical relationship with reduced mortality risk in unadjusted models, which became insignificant after adjusting for confounders (p = 0.195; 0.144).

CONCLUSIONS

BRI might be a more reliable predictor of cardiovascular outcomes and mortality in MetS patients than BMI. The identified threshold value of BRI can assist clinicians in making accurate prognostic evaluations. However, findings may vary by age and gender, underscoring the need for further research in diverse populations.

Obesity paradox in coronary artery disease: national inpatient sample analysis

BACKGROUND

Although existing literature highlights obesity as a significant predictor for coronary artery disease (CAD), the impact of BMI on hospital outcomes among CAD patients remains unclear.

METHODS

We extracted data from the National Inpatient Sample database for adult patients with CAD from 2018 to 2020. The study cohort was stratified into six BMI categories: underweight, normal weight, overweight, class I obesity, class II obesity, and class III obesity. Using multivariable logistic and linear regression, we assessed the impact of BMI on in-hospital mortality, length of stay (LOS), and inflation-adjusted total charges.

RESULTS

We identified a total of 3 693 570 hospitalizations (mean age: 69 ± 12 years). Underweight individuals had the highest in-hospital mortality rate (6.8%), followed by normal weight (5.2%), overweight (3.2%), class III obese (2.5%), class I obese (1.9%), and class II obese (1.8%) individuals. After adjusting for covariates, underweight patients had higher odds of in-hospital mortality compared to normal-weight individuals [odds ratio (OR), 1.38; 95% confidence interval (CI), 1.31-1.45; P < 0.001], while overweight or obese individuals had lower odds: overweight (OR, 0.75; 95% CI, 0.70-0.79; P < 0.001), obese class I: (OR, 0.54; 95% CI, 0.51-0.57; P < 0.001), obese class II: (OR, 0.56; 95% CI, 0.53-0.59; P < 0.001), obese class III: (OR, 0.78; 95% CI, 0.74-0.82; P < 0.001). Normal weight and underweight patients had the longest median LOS [5 days (3.0-9.0)]. Overweight patients incurred the highest total charges [$53 730 (28 587-105 184)].

CONCLUSION

Underweight patients experienced higher, while overweight and obese patients experienced lower in-hospital mortality than normal-weight patients, suggesting a protective effect of higher BMI against mortality in CAD.

Triglyceride-glucose indices predict all-cause mortality after stroke in NHANES 1999-2018

OBJECTIVE

The present study explores the prognostic relevance of triglyceride-glucose-based indices in assessing post-stroke survival among affected individuals.

METHODS

This study utilized a multifaceted analytical approach to assess how triglyceride-glucose-based indicators relate to death risk in stroke patients. This study was analyzed using a multivariate Cox proportional risk regression model incorporating sampling weights, while a restricted cubic spline function was introduced to assess trends in non-linear associations between exposure variables and outcomes. In addition, interaction terms were set and stratified analyses were conducted to verify the robustness and heterogeneity of the model results.

RESULTS

This research ultimately included 796 individuals diagnosed with stroke. When adjusting for a wide range of potential confounders, those in the top TyG-BMI quartile exhibited the most pronounced reduction in mortality risk compared to individuals in the lowest category, with a hazard ratio of 0.20 (95% CI: 0.08-0.50), highlighting its protective potential across TyG-BMI. In contrast, individuals falling within the fourth quartile of the TyG-WHtR index demonstrated the strongest positive correlation with the risk of all-cause mortality (Hazard Ratio = 4.61, 95% CI: 1.77-12.00). Moreover, analysis using restricted cubic splines indicated a significant non-linear association between TyG-BMI levels and mortality outcomes (p < 0.05). No statistical interactions were observed between mortality outcomes and demographic or clinical variables including age, sex, smoking, asthma, coronary artery disease, diabetes, or hypertension across any TyG-related indices (p > 0.05).

CONCLUSION

The study outcomes suggest that stroke patients with reduced TyG-BMI and elevated TyG-WHtR levels tend to face increased mortality risks. Nonetheless, addressing obesity may be crucial in exploring potential causal pathways.

Traditional Chinese medicine constitutions and mortality risk in the elderly: A single-center retrospective cohort study and survival analysis of over 17,000 individuals

The theory of traditional Chinese Medicine (TCM) constitution plays a crucial role in personalized diagnosis, treatment, and health management. However, survival analyses related to TCM are rarely conducted. This study aims to investigate the survival patterns of different TCM constitution types among the elderly in China, exploring their relationship with longevity and providing insights for personalized geriatric care. A retrospective cohort study was conducted using electronic records of elderly individuals (≥60 years) from Deyang City, Sichuan (2017-2024). Exclusions included incomplete follow-up, missing TCM constitution data, and demographic gaps. Sample size was adjusted for Bonferroni correction (α = 0.05/36). Kaplan-Meier and Cox proportional hazards models were used for survival analysis. Statistical analyses were performed using R, with P < .05 considered significant. A total of 9 TCM constitution types were identified, with Balanced constitutions representing the largest proportion (61.15%) and Phlegm-dampness constitutions the second largest (24.04%). Significant differences in survival rates were observed among constitution types (P = .0149). The Balanced type consistently was observed to exhibit higher survival probabilities. Age, sex, exercise frequency, dietary habits, BMI, and smoking status were significant factors that influenced mortality risk across the majority of constitutions. The results of time-dependent Cox regression analysis revealed that Qi-deficiency was associated with the highest mortality risk (hazard ratio = 1.83, P = .00), while Phlegm-dampness was associated with a reduced risk (hazard ratio = 0.66, P = .00). This study provides evidence for the objectivity the theory of TCM constitution and its potential significance in predicting longevity. Our findings imply that personalized health management strategies based on TCM constitutions may be beneficial for improving health outcomes among the elderly population.

Neural Mechanisms in Cardiovascular Health and Disease

Although the neurocardiac axis is central to cardiovascular homeostasis, its dysregulation drives heart failure and cardiometabolic diseases. This review examines the bidirectional interplay between the autonomic nervous system and the heart, highlighting the role of this interplay in disease progression and its therapeutic potential. The autonomic nervous system modulates cardiac function and vascular tone through its sympathetic and parasympathetic branches. However, in heart failure, chronic sympathetic overdrive and parasympathetic withdrawal exacerbate myocardial remodeling and metabolic dysfunction, both of which are exacerbated by cardiometabolic conditions such as obesity and diabetes. These conditions are increasingly recognized to impair neurocardiac regulation, thereby promoting inflammation and adverse outcomes. An important emerging area concerns neuroimmune control, in which the brain orchestrates systemic inflammation through circuits involving the bone marrow, spleen, and other organs, thereby amplifying cardiovascular damage. This neuroimmune axis integrates peripheral signals to influence immune responses that contribute to disease progression. Lifestyle factors, such as stress, sleep, exercise, and diet, affect autonomic and immune balance and, thus, cardiovascular disease. Therapeutically, targeting neurocardiac and neuroimmune pathways pharmacologically or via neuromodulation (eg, vagal or splenic nerve stimulation) offers promise although the clinical translation of the latter remains challenging. In this review, we synthesize preclinical and clinical data to highlight the neurocardiac axis as a critical nexus in heart failure and cardiometabolic disease. Harnessing neuroimmune and neurocardiac interactions may inform precision approaches to reduce the burden of these conditions.

Investigating the Interplay of Toxic Metals and Essential Elements in Cardiovascular Disease

Cardiovascular diseases (CVDs) are the leading cause of mortality globally, accounting for approximately one-third of all deaths. Exposure to toxic metals poses significant risks to cardiovascular health, contributing to the development of CVDs. Essential elements are crucial for maintaining cardiovascular function; however, imbalances or deficiencies in these elements can exacerbate the risk and progression of CVDs. Understanding the interactions between toxic metals and essential elements is crucial for elucidating their impact on cardiovascular health. This study aims to examine the individual and combined effects of toxic metals-lead (Pb), cadmium (Cd), and mercury (Hg)-along with essential elements-manganese (Mn), iron (Fe), and selenium (Se)-on CVDs. We explored the effects of toxic metals and essential elements using data from the National Health and Nutrition Examination Survey (NHANES, 2017-2018). We conducted descriptive analyses and applied advanced statistical methods, including Bayesian kernel machine regression (BKMR), weighted quantile sum regression (WQSR), and quantile g-computation, to assess the associations between these toxic metals and essential elements on key cardiovascular-related biomarkers. The results revealed distinct patterns of influence across the toxic metals and essential elements. Spearman correlation showed a stronger association among toxic metals than essential elements. Bayesian kernel machine regression (BKMR) and posterior inclusion probability (PIP) analysis identified lead, mercury, iron, and selenium as key contributors to CVD risk, with lead strongly linked to high-density lipoprotein (HDL), diastolic blood pressure (DBP), and systolic blood pressure (SBP). Selenium was linked to low-density lipoprotein (LDL) cholesterol and non-high-density lipoprotein (non-HDL) cholesterol. Univariate and bivariate analyses confirmed lead and mercury's strong associations with triglycerides and blood pressure, while lead, selenium, and iron were linked to different cholesterol outcomes. Single-variable analysis revealed an interaction between individual exposures and combined exposures. The overall exposure effect assessing the impact of all exposures combined on CVD markers revealed a steady positive association with triglycerides, total cholesterol, LDL, non-HDL cholesterol, and DBP, with HDL and SBP increasing from the 65th percentile. Quantile g-computation and WQSR confirmed lead's consistent positive association across all outcomes, with variations among other toxic metals and essential elements. In conclusion, our study suggests that toxic metals and essential elements are important factors in CVD outcomes, with different metals and elements associated with variations in specific biomarkers.

Associations between triglyceride-glucose body mass index and all-cause mortality in ICU patients with sepsis and acute heart failure

BACKGROUND

The triglyceride‒glucose body mass index (TyG-BMI) has been recognized as a significant predictor of cardiovascular disease risk and plays a crucial role in assessing insulin resistance. However, the correlation between the TyG-BMI and clinical outcomes in patients with sepsis and acute heart failure (AHF) has not been sufficiently explored. This study aimed to investigate the associations between TyG-BMI and clinical outcomes in patients with sepsis and AHF.

METHODS

We conducted a retrospective analysis of ICU-admitted patients via data from the MIMIC-IV database. Multivariable logistic regression, sensitivity analysis, and restricted cubic spline (RCS) models were used to assess the relationship between TyG-BMI and all-cause mortality. K‒M survival analysis and Boruta analysis were employed to evaluate the predictive value of the TyG-BMI. Subgroup analyses considered the effects of age, sex, ethnicity, and comorbidities.

RESULTS

Among the 1,729 patients, a higher TyG-BMI was associated with lower all-cause mortality at 90 and 180 days. Each standard deviation increase in the TyG-BMI was linked to 0.2% and 0.3% reductions in 90-day and 180-day all-cause mortality, respectively. Kaplan‒Meier analysis revealed significantly lower all-cause mortality in patients with higher TyG-BMIs (P < 0.0001). The RCS model revealed a nonlinear relationship between the TyG-BMI and mortality. Boruta analysis identified the TyG-BMI as an important clinical feature. Sensitivity analyses revealed that the association remained significant after patients with myocardial infarction, malignancies, or missing data were excluded. The subgroup analysis revealed that for the 90-day and 180-day mortality rates, significant interactions were found only in the subgroup of patients with kidney diseases (P < 0.05).

CONCLUSION

The TyG-BMI may have potential value in predicting mortality in ICU patients with sepsis and AHF, supporting early risk assessment and clinical intervention. This study provides critical insights into patient prognosis.

Association of weight change with cardiovascular events and all-cause mortality in obese participants with cardiovascular disease: a prospective cohort study

BACKGROUND

Studies have examined the association between weight change and risk of cardiovascular (CV) outcomes in the general population. However, very few literature reported the association among obese people with established CV disease (CVD) and the factors associated with weight change are not clear. We sought to investigate this using the UK Biobank data.

METHODS

In this large prospective population-based cohort study, absolute interval change scores in weight were calculated between weight measurements at baseline and the follow-up. The estimated HRs with 95% CIs were obtained from the Cox regression models to assess the association between weight change and the risk of CV death, cerebrovascular and ischaemic heart diseases and all-cause mortality.

RESULTS

Of the 8297 obese participants who had CVD with repeated weight measurements, 43.1% were female. The mean age was 56.6 (SD: 7.2) years. The overall median follow-up of the study was 13.9 (IQR: 13.1-14.6) years. 52.7% of the participants had stable weight change (weight loss or gain<5 kg), 14.2% had large weight loss (≥10 kg) and 5.1% had large weight gain (≥10 kg). Compared with stable weight, only large weight gain was associated with an increased risk of CV death and all-cause mortality (fully adjusted HR (95% CI): 3.05 (1.40 to 6.67) for CV death and 1.93 (1.15 to 3.26) for all-cause mortality).

CONCLUSIONS

Among obese individuals with CVD, large weight gain is associated with a higher risk of CV death and all-cause mortality. Further studies are needed to understand the exact mechanisms underlying the associations between weight loss or weight gain and mortality.

Cold atmospheric plasma control metabolic syndromes via targeting fat mass and obesity-associated protein

Both obesity and metabolic disorders are global medical problems. Driven by prolonged inflammation, obesity increases the risk of developing metabolic syndromes such as fatty liver, diabetes, cardiovascular diseases and cancers. The fat mass and obesity-associated protein (FTO) is an m6A demethylase, elevated activity of which is known to promote the pathogenesis of many metabolic disorders, leading to the establishment of various FTO inhibitors. By combing through intrinsic connections among obesity and the four primary metabolic problems, we attribute their shared pathological cause to prolonged inflammation. By reviewing the roles of FTO in promoting these disorders and the current status of existing FTO inhibitors in treating these syndromes, we underpinned the paramount potential of resolving these clinical issues by targeting FTO and the urgent need of establishing novel FTO inhibitors with maximized efficacy and minimized side effect. Cold atmospheric plasma (CAP) is the fourth state of matter with demonstrated efficacy in treating various diseases associated with chronic inflammation. By introducing the medical characteristics of CAP, we proposed it as a possible solution to unresolved issues of current FTO inhibitors given its anti-inflammation feature and demonstrated clinical safety. We also emphasized the need of intensive investigations in exploring the feasibility of using CAP in treating obesity and associated metabolic syndromes that might function through targeting FTO.

Predicting doxorubicin-induced cardiotoxicity in breast cancer: leveraging machine learning with synthetic data

Doxorubicin (DOXO) is a primary treatment for breast cancer but can cause cardiotoxicity in over 25% of patients within the first year post-chemotherapy. Recognizing at-risk patients before DOXO initiation offers pathways for alternative treatments or early protective actions. We analyzed data from 78 Brazilian breast cancer patients, with 34.6% developing cardiotoxicity within a year of their final DOXO dose. To address the limited sample size, we utilized the DAS (Data Augmentation and Smoothing) method, creating 4892 synthetic samples that exhibited high statistics fidelity to the original data. By integrating routine blood biomarkers (C-Reactive protein, total cholesterol, LDL-c, HDL-c, hematocrit, and hemoglobin) and two clinical measures (weighted smoking status and body mass index), our model achieved an AUROC of 0.85±0.10, a sensitivity of 0.89, and a specificity of 0.69, positioning it as a potential screening instrument. Notably, DAS outperformed the established methods, Adaptive Synthetic Sampling (ADASYN), Synthetic Minority Over-Sampling Technique (SMOTE), and Synthetic Data Vault (SDV), underscoring its promise for medical synthetic data generation and pioneering a cardiotoxicity prediction model specifically for DOXO.

Ventricular arrhythmogenic remodelling in diet-induced metabolic syndrome driven by right-to-left regional differences in action potential duration and dominant frequency gradients

Metabolic syndrome (MetS) has been associated with an increased prevalence of cardiac arrhythmias and sudden cardiac death caused by ventricular fibrillation (VF), but the exact underlying mechanisms are not known. Our aim here was to study the effects that diet-induced MetS produces on ventricular remodelling and its potential electrophysiological arrhythmogenic mechanisms. Thirty-five male NZW rabbits were assigned to a control (n = 16) or MetS group (n = 19), fed for 28 weeks with a high-fat and high-sucrose diet. Echocardiography and electrocardiography were performed before diet and at weeks 14 and 28. Hearts were isolated and perfused in a Langendorff system and epicardial optical mapping was performed using two EMCCD cameras focused on the left (LV) and right (RV) ventricles. mRNA expression levels for ion channel proteins were examined by quantitative RT-PCR. A mixed-model ANOVA and unpaired t test were used for statistical analysis. MetS animals showed LV hypertrophy and electrophysiological abnormalities (increased PQ, QRS, QTc and T wave). In isolated hearts, MetS animals had shorter optical APD90 (action potential duration at 90% repolarization), increased restitution slope and alternans, and faster frequency of activation during VF in the RV, whereas no difference was observed in the LV. The mRNA expression for KvLQT1 and KChIP2 increased in the RV. MetS produced LV hypertrophy, and altered atrioventricular and ventricular conduction and repolarization abnormalities. In isolated hearts, the physiological gradients of refractoriness and frequency of activation during VF were abolished in MetS animals, with fast activation rates in both ventricles, which could be explained, at least in part, by upregulation of KvLQT1 and KChIP2 in the RV. KEY POINTS: Metabolic syndrome (MetS) has been associated with ventricular arrhythmias and sudden cardiac death, but the exact underlying mechanisms are not known. Previous studies have addressed the effects that individual components of MetS exert, individually, upon electrical cardiac remodelling, but the results obtained in some cases prove inconclusive or contradictory. We investigated the effects of diet-induced MetS on ventricular remodelling and its potential electrophysiological arrhythmogenic mechanisms. We found that diet-induced MetS produced altered activation-repolarization abnormalities as well as fast-activation non-stable flattening of the spatial distribution of dominant frequencies driving ventricular fibrillation, which might be explained, at least in part, due to increased expression of potassium channels in the right ventricle.

Impact of waitlist weight change on outcomes in heart transplant recipients: a UNOS database analysis

BACKGROUND

While the effect of pre-transplant weight on patient outcomes following heart transplantation (HTx) has previously been studied, data regarding the impact of dynamic weight change prior to HTx are extremely limited.

OBJECTIVES

We sought to elucidate the interaction between HTx listing weight and weight change while waitlisted, and explore how that interaction impacts post-HTx survival in a continuous manner.

METHODS

Adult patients listed for HTx from 1987 to 2020 were identified from UNOS database. Three-dimensional restricted cubic spline analysis explored post-HTx survival relative to both changes in BMI/weight and BMI at time of HTx listing. Continuous predictor variables were analyzed with Cox proportional hazards method.

RESULTS

9,628 included patients underwent HTx. Median recipient age was 55 [IQR 46-62] years, and 21% were females. 53% of patients lost while 47% gained weight on the waitlist. Median BMI (27.6 kg/m2 [24.3-31.3] vs. 27.4 kg/m2 [24.2-30.9], paired p < 0.001) and weight (84.8 kg [73.0-98.0] kg vs. 84.4 kg [72.6-96.6], p < 0.001) were similar at listing and transplant. One-year survival was 89.3%. Weight loss over 3 BMI points or 10 kg was associated with higher hazard of death irrespective of listing BMI. In non-obese patients, some weight gain (1-4 BMI points or 5-15 kg) was associated with improved survival. In cachectic patients (BMI < 18.5), failure to gain weight was associated with worse survival.

CONCLUSIONS

Impact of weight change varies depending on listing BMI. While a survival benefit is seen in non-obese patients who gain some weight, significant weight loss is associated with poorer survival.

The Effects of Curcuminoids Supplementation on Serum Adipokines: An Umbrella Review of Meta-Analyses of Randomized Controlled Trials

This umbrella review of randomized clinical trials aims to provide a unique and detailed understanding of curcumin's effects on adipokines, adding a novel perspective to the existing body of research. We carried out a thorough search of international databases up to April 2024, including MEDLINE, SciVerse Scopus, and Clarivate Analytics Web of Science. A random-effects model was utilized to evaluate the impact of curcuminoid on adipokines. The umbrella review incorporated meta-analyses that examined the effects of curcuminoid supplementation on adipokines, presenting associated effect sizes (ES) and confidence intervals (CI). We applied the GRADE and AMSTAR (A Tool for Assessing the Risk of Bias in Systematic Reviews system) to assess the certainty of the evidence and the quality of the systematic reviews. Our analysis of one meta-analysis, including 14 RCTs plus 1 RCT not included in meta-analyses, revealed significant and impactful findings. We found a substantial increase in serum adiponectin levels with curcuminoid supplementation, indicating a positive effect (SMD: 0.9; 95% CI, 0.4 to 1.3, p < 0.001; I2 = 92.2%). However, we did not observe a significant impact on serum leptin. The GRADE assessment supports the effect of curcuminoids on adiponectin with moderate evidence, while the impact on leptin was supported by low evidence. Curcuminoid supplementation significantly increases serum adiponectin levels with moderate-quality evidence and has no significant impact on serum leptin. This provides evidence as to the safety and effectiveness of curcuminoids in enhancing adiponectin without adverse effects, reassuring the audience about their potential in adipokine research.

Clinical impact of visceral adiposity on long-term mortality in patients undergoing coronary artery bypass grafting

INTRODUCTION AND OBJECTIVES

Although visceral adiposity increases cardiovascular risk in the general population, the obesity paradox has been reported in critically ill patients. However, evidence for its prognostic role in patients undergoing coronary artery bypass grafting (CABG) is limited. This study evaluated the prognostic implications of visceral adiposity in patients who underwent CABG using computed tomography-based measurement of visceral fat.

METHODS

A total of 2810 patients who underwent CABG from 2007 to 2017 were analyzed. The study population was classified into 3 groups according to visceral fat area index (VFAI) tertiles. VFAI was calculated as visceral fat area (cm2)/height2 (m2) at the L3 level. The primary outcome was all-cause mortality during follow-up.

RESULTS

Patients in the low VFAI group (lowest tertile) were younger and had a lower body mass index and less subcutaneous fat than those in the high VFAI group (highest tertile). During a median 8.7-year follow-up, VFAI was significantly associated with the risk of mortality in restricted cubic spline curve analysis (HR, 0.94 per 10 increases; 95%CI, 0.91-0.97; P<.001). Patients in the low VFAI group had a higher incidence of long-term mortality than those in the intermediate and high VFAI groups (T1 36.1%, T2 27.2%, and T3 29.1%; T1 vs T2; adjusted HR, 1.36; 95%CI, 1.15-1.61; P<.001; T1 vs T3; adjusted HR, 1.37; 95%CI, 1.16-1.62; P<.001). Similar results were obtained after inverse probability treatment-weighting analysis.

CONCLUSIONS

Low visceral adiposity was associated with an increased risk of long-term mortality in patients who underwent CABG.

Association between body roundness index and obstructive sleep apnea: a cross-sectional study from the NHANES (2005-2008 to 2015-2020)

BACKGROUND

Obstructive sleep apnea (OSA) is linked to obesity, and the body roundness index (BRI) is an innovative measure of obesity that more accurately reflects visceral and total body fat. The relationship between BRI and the likelihood of OSA is unclear, so we aimed to investigate the association between BRI and the prevalence of OSA.

METHODS

We used data from the National Health and Nutrition Examination Survey (NHANES; 2005-2008 to 2015-2020) to conduct a cross-sectional study involving 24,476 individuals aged 18 years or older. OSA was assessed using three standardized NHANES questionnaire items measuring monthly daytime sleepiness, weekly apnea events, and habitual snoring frequency. A formula that uses the height and waist measures from the body measurements is used to calculate the BRI. Covariates, including sex, age, race/ethnicity, education level, marital status, poverty-income ratio (PIR), alcohol consumption, smoking status, high blood pressure (HBP), diabetes, and sleep duration were controlled using multivariate logistic regression models. Subgroup analyses, interaction tests, and smoothed curve fitting were also performed.

RESULTS

After controlling for confounders, BRI showed a positive correlation with OSA. Among the 24,476 participants aged 18 and older, 11,856 were diagnosed with OSA. The full model revealed a significant positive association between BRI and OSA incidence (OR = 1.11, 95% CI: 1.08-1.14, p < 0.0001). Participants in the highest percentile of BRI had an 87% greater likelihood of developing OSA compared to those in the lowest percentile (OR = 1.87, 95% CI: 1.62-2.16, p < 0.0001).

CONCLUSION

BRI levels have shown a favorable correlation with the rising rates of OSA in the United States. The BRI serves as a straightforward anthropometric predictor of OSA.

Association between the body mass index and risk of cardiovascular events in sodium-glucose cotransporter 2 inhibitor users compared with dipeptidyl-peptidase 4 inhibitor users: A nationwide cohort study in Korea

AIMS

There is limited evidence regarding whether obesity modifies the association between the use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and the risk of cardiovascular events. We assessed whether baseline body mass index (BMI) modifies the association between SGLT2i use and the risk of major adverse cardiovascular events (MACE) and heart failure (HF) in patients with type 2 diabetes (T2D).

MATERIALS AND METHODS

We used the nationwide claims data of Korea (September 2014-December 2022) to construct an active-comparator, new-user cohort of patients with T2D stratified by the Asian BMI categories: normal weight, 18.5-23 kg/m2; overweight, 23-25 kg/m2; and obesity, ≥25 kg/m2. New-users of SGLT2i were propensity score (PS)-matched with new-users of dipeptidyl peptidase 4 inhibitor (DPP4i) in a 1:1 ratio. The co-primary outcomes were 4-point MACE and hospitalization for HF (HHF). Patients were followed up using an as-treated exposure definition. PS-matched hazard ratios (HR) with 95% confidence intervals (CI) were estimated using the Cox model.

RESULTS

New-users of SGLT2i and DPP4i were PS-matched in a 1:1 ratio (n = 231 332 pairs; normal weight, 21 285 pairs; overweight, 35 372 pairs; and obesity, 174 675 pairs). The overall HR for the risk of MACE with SGLT2i versus DPP4i use was 0.90 (95% CI: 0.86-0.95), with no evidence of effect modification by baseline BMI (p for homogeneity = 0.27). The risk of HHF decreased in the overall cohort (HR: 0.53, 95% CI: 0.44-0.64), as well as in the obesity (HR: 0.47, 95% CI: 0.37-0.58) and overweight (HR: 0.49, 95% CI: 0.31-0.78) groups but not in the normal-weight (HR: 0.88, 95% CI: 0.59-1.31) group, with evidence of effect modification by the BMI (p for homogeneity = 0.01).

CONCLUSIONS

The association between SGLT2i use and the risk of MACE and HHF was significant in patients with obesity. Baseline BMI was an effect modifier in the association between SGLT2i use and the risk of HHF, with a more pronounced association observed with increasing BMI and with no significant effect modification of the association noted in patients with normal weight.

Obesity: pathophysiology and therapeutic interventions

Over the past few decades, obesity has transitioned from a localized health concern to a pressing global public health crisis affecting over 650 million adults globally, as documented by WHO epidemiological surveys. As a chronic metabolic disorder characterized by pathological adipose tissue expansion, chronic inflammation, and neuroendocrine dysregulation that disrupts systemic homeostasis and impairs physiological functions, obesity is rarely an isolated condition; rather, it is frequently complicated by severe comorbidities that collectively elevate mortality risks. Despite advances in nutritional science and public health initiatives, sustained weight management success rates and prevention in obesity remain limited, underscoring its recognition as a multifactorial disease influenced by genetic, environmental, and behavioral determinants. Notably, the escalating prevalence of obesity and its earlier onset in younger populations have intensified the urgency to develop novel therapeutic agents that simultaneously ensure efficacy and safety. This review aims to elucidate the pathophysiological mechanisms underlying obesity, analyze its major complications-including type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), non-alcoholic fatty liver disease (NAFLD), obesity-related respiratory disorders, obesity-related nephropathy (ORN), musculoskeletal impairments, malignancies, and psychological comorbidities-and critically evaluate current anti-obesity strategies. Particular emphasis is placed on emerging pharmacological interventions, exemplified by plant-derived natural compounds such as berberine (BBR), with a focus on their molecular mechanisms, clinical efficacy, and therapeutic advantages. By integrating mechanistic insights with clinical evidence, this review seeks to provide innovative perspectives for developing safe, accessible, and effective obesity treatments.

A comprehensive review of m6 A methylation in coronary heart disease

The morbidity and mortality rates of coronary heart disease (CHD) are high worldwide. The primary pathological changes in CHD involve stenosis and ischemia caused by coronary atherosclerosis (AS). Extensive research on the pathogenesis of AS has revealed chronic immunoinflammatory processes and cell proliferation in all layers of coronary vessels, including endothelial cells (ECs), vascular smooth muscle cells, and macrophages. m6 A methylation is a common posttranscriptional modification of RNA that is coordinated by a variety of regulators (writers, readers, erasers) to maintain the functional stability of modified mRNAs and ncRNAs. In recent years, there has been increasing focus on the involvement of m6 A methylation in the incidence and progression of CHD, which starts with atherosclerotic plaque formation, leads to myocardial ischemia, and ultimately results in the occurrence of myocardial infarction (MI). m6 A regulators modulate relevant signaling pathways to participate in the inflammatory response, programmed death of cardiomyocytes, and fibrosis. Therefore, diagnostic models based on m6 A profiling are helpful for the early detection of CHD, and m6 A methylation shows promise as a sensitive target for new drugs to treat CHD in the future.

In-Hospital Outcomes in Patients With Acute Myocardial Infarction and No Standard Modifiable Cardiovascular Risk Factors Across Varying Body Mass Index: Findings From the CCC-ACS Project

BACKGROUND

Individuals who present with acute myocardial infarction in the absence of standard modifiable cardiovascular risk factors (ie, SMuRF-less) seem to have a significantly increased risk of mortality; however, it remains unclear whether the "SMuRF paradox" would be influenced by patients' baseline body mass index (BMI) status.

METHODS

Using data from the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project from November 2014 to July 2019, we analyzed patients with acute myocardial infarction with and without SMuRFs and categorized their BMI as underweight (<18.5 kg/m2), normal weight (18.5-24 kg/m2), overweight (24-28 kg/m2), and obese (>28 kg/m2). The primary outcome was in-hospital all-cause mortality. Multivariable logistic regression models were used to estimate BMI-stratified associations between SMuRF-less status and outcomes.

RESULTS

The study included 44 538 patients with first-presentation acute myocardial infarction, of whom 4454 were SMuRF-less. The incidence of SMuRF-lessness declined from 16.2% to 6.5% as BMI increased by category, and it prevailed more frequently among women and older people regardless of their BMI status. Patients who were SMuRF-less had a significant increase in in-hospital mortality than patients with ≥1 SMuRF (adjusted odds ratio [OR], 1.750 [95% CI, 1.057-2.896], P<0.001). The highest mortality rate was observed in the group who were SMuRF-less and underweight (3.5%). Considering patients with ≥1 SMuRF and obesity as the reference group, the group who were SMuRF-less underweight exhibited the highest increase in mortality (adjusted OR, 3.854 [95% CI, 2.130-6.973], P<0.001).

CONCLUSIONS

Among patients with first-presentation acute myocardial infarction, compared with those with ≥1 SMuRF, patients who were SMuRF-less have a significantly higher risk of in-hospital mortality, especially in those underweight, whereas in-hospital survival was the most favorable among patients with ≥1 SMuRF and obesity.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT0230661.

Obesity, Visceral Adipose Tissue, and Essential Hypertension: Evidence From a Mendelian Randomization Study and Mediation Analysis

This study aims to investigate the causal relationship between obesity and essential hypertension, and evaluate the mediation effect of visceral adipose tissue (VAT) by Mendelian randomization (MR) analysis. We included body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), WC adjusted for BMI (WCadjbmi), and WHR adjusted for BMI (WHRadjbmi) as obesity-related anthropometric traits. In the bidirectional MR analyses, we found that higher BMI (OR, 1.638; p = 3.97 × 10-19), WC (OR, 1.702; p = 1.45 × 10-12), and WHR (OR, 1.863; p = 1.84 × 10-8) were significantly associated with increased risk of essential hypertension, while no evidence of reverse causality was observed. Then, in the two-step MR analyses, all five anthropometric traits had a positive and significant association with VAT mass, especially WC (OR, 2.315; p = 1.00 × 10-210). Meanwhile, higher predicted VAT mass was significantly associated with increased risk of essential hypertension (OR, 1.713; p = 1.18 × 10-38). Furthermore, the mediation analyses revealed that VAT had a significant mediation effect on the causal relationship between obesity-related anthropometric traits and essential hypertension, and mediated proportions in BMI, WC, and WHR were 77.8%, 80.1%, and 41.4%, respectively. Finally, the sensitivity analyses using two other datasets showed a similar result. In conclusion, our results showed that BMI, WC, and WHR have a positive and significant association with increased risk of essential hypertension. Moreover, VAT has a significant mediation effect on the causal relationship between obesity-related anthropometric traits and essential hypertension. Our study provided important statistical evidence suggesting that VAT may play a crucial meditation role in the occurrence and development of obesity-related hypertension.

Association between energy intake and activities of daily living in patients with acute stroke at hospital discharge: a retrospective cohort study

OBJECTIVE

This study aimed to investigate the effects of energy intake on activities of daily living (ADL) in patients with acute stroke, with a focus on the differences between obese and non-obese patients.

METHODS

This retrospective observational study was conducted in a neurological hospital and included patients hospitalized for acute stroke. During the acute phase (1 week after admission), energy intake was assessed, and the main outcome was defined as the Functional Independence Measure in the motor domain (FIM-M) at discharge. All subjects were divided into two groups based on their body mass index (BMI) at admission, with BMI ≥ 25 defining the obese stroke group and BMI < 25 defining the non-obese stroke group. Linear regression analysis was performed to examine the relationship between energy intake and FIM-M in each group.

RESULTS

A total of 307 patients with acute stroke (median age: 72 years) were included in this study, with 118 patients (39%) in the obese stroke group. In the non-obese stroke group, a significant and independent relationship was observed between FIM-M and energy intake (β = 0.103, p = 0.031, adjusted R2 = 0.687). However, in the obese stroke group, no significant relationship was found between FIM-M and energy intake (β = 0.076, p = 0.302).

CONCLUSION

In patients with acute stroke, energy intake positively affects functional outcomes in non-obese patients but not in obese patients. This study highlights the importance of considering obesity as a potential factor in determining energy intake in patients with acute stroke.

The role of bariatric surgery in hypertension control: a systematic review and meta-analysis with extended benefits on metabolic factors

BACKGROUND

By 2025, global obesity rates are projected to reach 16% in men and 21% in women, imposing a significant public health burden. Obesity is a major contributor to hypertension (HTN), exacerbating cardiovascular risks. This review and meta-analysis evaluated the effectiveness of non-surgical treatments versus bariatric surgery in managing hypertension among obese individuals.

METHODS

We searched PubMed, Scopus, Embase, and Cochrane databases up to May 2024. Randomized controlled trials (RCTs) comparing bariatric surgery (e.g., Roux-en-Y Gastric Bypass (RYGB), Sleeve gastrectomy (SG), Laparoscopic adjustable gastric banding (LAGB), Duodenal-jejunal bypass liner/Biliopancreatic diversion (DJBL/BPD)) with non-surgical interventions (e.g., lifestyle modifications, medications) in hypertensive obese patients were included. Primary outcomes were changes in systolic and diastolic blood pressure. Secondary outcomes included changes in fasting blood sugar (FBS), HbA1c, and lipid profiles. Data were synthesized using a random-effects model, with heterogeneity and publication bias assessed.

RESULTS

From 7,187 records, 29 studies involving 2,548 patients met the inclusion criteria. Bariatric surgery resulted in greater reductions in systolic (MD: -4.506 mmHg; 95% CI: -6.999 to -2.013) and diastolic (MD: -3.040 mmHg; 95% CI: -4.765 to -1.314) blood pressure compared to non-surgical interventions. Roux-en-Y gastric bypass had the most significant impact. Bariatric surgery also led to substantial reductions in FBS (MD: -30.444 mg/dl; 95% CI: -41.288 to -19.601), HbA1c (MD: -1.108%; 95% CI: -1.414 to -0.802), and triglycerides (MD: -39.746 mg/dl; 95% CI: -54.458 to -25.034), and increased HDL levels (MD: 7.387 mg/dl; 95% CI: 5.056 to 9.719). The quality of evidence was high for most outcomes, supporting these findings.

CONCLUSION

Bariatric surgery is superior to non-surgical treatments in managing obesity-related hypertension and metabolic disorders. Reductions in blood pressure, glycemic indexes, and lipid profiles highlight bariatric surgery's critical role in improving cardiovascular health and metabolic outcomes in obese hypertensive patients.

Mortality With Impella Is Lowest in Overweight and Obese but Is Highest in Morbid Obesity

INTRODUCTION

Mortality of cardiogenic shock remains high, prompting increased use of mechanical circulatory support devices such as Impella. This study sought to characterize whether weight categories predict mortality in patients who received Impella devices.

METHODS

We used data from the National Inpatient Sample (NIS) database from the years 2016 to 2020 and ICD-10-CM/PCS codes to evaluate the effect of weight categories on mortality in patients undergoing Impella implantation.

RESULTS

A total of 86 810 patients underwent Impella device implantation, with an overall mortality of 29.85%. Mortality for normal weight was 30.4%, similar to cachexia (30.3%) and morbidly obese patients (31.1%). However, the overweight and obese categories had the lowest mortality (13.4% and 24.9%, p < 0.0001). Using multivariate analysis adjusting for comorbid conditions, overweight and obesity remained significantly associated with the lowest mortality (overweight: OR: 0.3, CI: 0.16-0.68, p = 0.003, Obese: OR: 0.8, CI: 0.71-0.91, p < 001) whereas morbid obesity was associated with the highest mortality (OR: 1.17, CI: 1.02-1.34, p = 0.02).

CONCLUSION

Using a large database, we found that overweight and obesity have a protective effect on mortality in patients undergoing Impella insertion. However, morbid obesity appears to have detrimental effects.

Association between Hemoglobin Glycation Index and In-Hospital all-cause mortality of patients with Congestive Heart Failure: a retrospective study utilizing the MIMIC-IV database

Background

The aim of this study was to explore the relationship between the hemoglobin glycation index (HGI) of Congestive Heart Failure (CHF) patients and their risk of mortality within 365 days.

Patients and methods

The Medical Information Mart for Intensive Care (MIMIC-IV) database supplied the patient data for this study, which was categorized into quartiles based on the HGI. The primary endpoint was all-cause mortality within a 365-day period. Kaplan-Meier (K-M) analysis was utilized to compare this primary endpoint across the four aforementioned groups. The relationship between the HGI and the endpoint was examined using restricted cubic splines (RCS) and a Cox proportional hazards analysis.

Results

A total of 985 patients were included in this study. HGI was significantly associated with 30 days mortality (15.9%; HR, 0.79; 95% CI, (0.67~0.92); P=0.003) and 60 days mortality (19.3%; HR, 0.83; 95% CI, (0.72~0.96); P=0.011) and 90 days mortality (22.1%; HR, 0.86; 95% CI, (0.75~0.99); P=0.031) and 365 days mortality (30.7%; HR, 0.97; 95% CI, (0.86~1.09); P=0.611) in patients with critical CHF in the completely adjusted Cox proportional risk model. RCS analysis revealed a U-shaped relationship between HGI and outcome events. KM curves survival analysis suggests a correlation between 30 days and 365 days mortality in HGI and CHF patients.

Conclusions

A higher HGI has a more protective effect than a low HGI for patients with CHF and was directly associated with short-term mortality rates. These findings may be helpful in the management of patients with CHF.

Association between TyG index with obesity indicators and coronary heart disease: a cohort study

The potential of utilizing the Triglyceride Glucose Index (TyG), along with its combination with obesity indicators, for predicting the risk of coronary heart disease (CHD) in the middle-aged and elderly population remains uncertain. This research aims to conduct a cohort study to assess the predictive capacity of the TyG and its combination with obesity indicators in forecasting the 10-year incidence of new-onset CHD among the middle-aged and elderly population in the Luzhou region. The study population was derived from the The China Cardiometabolic Disease and Cancer Cohort (4C) Study, comprising 8647 ordinary residents meeting specific criteria. The subjects were grouped based on quartiles of TyG, TyG-WC, TyG-WtHR, TyG-BMI, and TyG-WHR, and the occurrence of new-onset coronary heart disease was observed over a 10-year period. The study comprised 8647 participants, with 484 developing new-onset CHD, resulting in an incidence rate of 5.5% of the overall follow-up population. The comparison of new-onset CHD across quartiles of different indicators revealed a statistically significant difference (P < 0.001), with the order being the 4th quartile > 3rd quartile > 2nd quartile > 1st quartile. Cox proportional hazards regression analysis results indicated that, after adjusting for multiple influencing factors, the risk of new-onset CHD gradually increased with the quartiles of the 5 indicators. Specifically, when grouped according to TyG and TyG-WC quartiles, a statistically significant difference (P < 0.05) was observed between the 3rd and 4th quartiles compared to the 1st quartile. The ROC curve analysis results demonstrate that TyG-WC (area under the curve 0.608, P < 0.001) and TyG-WtHR (area under the curve 0.608, P < 0.001) exhibit superior predictive value for new-onset coronary heart disease compared to TyG (area under the curve 0.568, P < 0.001), TyG-BMI (area under the curve 0.576, P < 0.001), and TyG-WHR (area under the curve 0.595, P < 0.001). 1. TyG, TyG-WC, TyG-WtHR, TyG-BMI, and TyG-WHR demonstrate varying degrees of correlation with the incidence of new-onset coronary heart disease in the middle-aged and elderly population. 2. Specifically, TyG-WC may serve as a significant predictive factor for the occurrence of coronary heart disease in the elderly population.

Body Composition Risk Assessment of All-Cause Mortality in Patients With Coronary Artery Disease Completing Cardiac Rehabilitation

BACKGROUND

Obesity, measured by body mass index, is a risk factor for cardiovascular disease. However, the role of body composition, including body fat percentage and lean body mass (LBM), in cardiovascular outcomes has not been well studied in patients with coronary artery disease (CAD). This study aims to evaluate the association of body composition with cardiovascular outcomes and all-cause mortality in patients with CAD.

METHODS AND RESULTS

Body composition was obtained via bioelectrical impedance analysis from 1291 patients with CAD before starting cardiac rehabilitation. Patients were divided into quintiles by body composition and analyzed in total and after sex stratification. All-cause mortality and a composite of major adverse cardiovascular events, including acute coronary syndrome, coronary revascularization, heart failure hospitalization, and stroke, were primary study outcomes. In the total cohort adjusted analyses, body mass index, body fat percentage, and LBM were not predictors of all-cause mortality or major adverse cardiovascular events. In sex-stratified analyses, among women, the third LBM quintile was associated with decreased risk of all-cause mortality compared with the lowest LBM quintile (adjusted hazard ratio, 0.07 [95% CI, 0.01-0.57]; P=0.01). No other body composition variables were associated with all-cause mortality or major adverse cardiovascular events in either sex.

CONCLUSIONS

In women with CAD, moderate LBM was associated with lower mortality when compared with low LBM, whereas body fat percentage and body mass index were not associated with mortality or major adverse cardiovascular events in either sex. Future research studying the implications of changes in body composition on outcomes in men and women with CAD is warranted.

Estudio del metabolismo lipídico en niños aragoneses con sobrepeso/obesidad vs. niños normopeso

Objetivos

La obesidad y el sobrepeso en la infancia y/o adolescencia han aumentado considerablemente en los países europeos, durante los últimos años, representando actualmente un importante problema de salud pública mundial. El objetivo de este estudio es la detección precoz en un grupo de niños con sobrepeso/obesidad (8–12 años) de las alteraciones metabólicas que pueden conducirles, incluso en edades tempranas, a alteraciones en el metabolismo de la glucosa y/o enfermedad cardiovascular.

Métodos

Se estudiaron una serie de parámetros del metabolismo lipídico y de control metabólico, en un grupo de 61 niños y niñas con sobrepeso/obesidad y en un grupo de 45 niños y niñas sanos, normopeso, de edades comprendidas, todos ellos, entre 8 y 12 años, comparando los resultados obtenidos.

Resultados

Se encontraron concentraciones más elevadas en el grupo de niños con sobrepeso/obesidad, respecto al de niños normopeso, en: triglicéridos e insulina; y más bajas en: colesterol HDL y apolipoproteína A1. El cociente apolipoproteína B/apolipoproteína A1, el índice triglicéridos-glucosa y el índice HOMA fueron más elevados y la ratio colesterol LDL/apolipoproteína B más baja en los niños con sobrepeso/obesidad.

Conclusiones

Según nuestros resultados, la obesidad a edades tempranas (8–12 años) afecta ya a la concentración de los parámetros lipídicos, habiéndose encontrado un perfil lipídico más aterogénico con mayor concentración de partículas remanentes y partículas LDL pequeñas y densas, mayor insulinoresistencia y mayor riesgo de desarrollar diabetes mellitus de tipo 2  y/o enfermedad cardiovascular en los niños con sobrepeso/obesidad, al compararlos con los normopeso.

Association between body mass index and clinical outcomes in patients with acute myocardial infarction and reduced systolic function: Analysis of PARADISE-MI trial data

AIMS

The relationship between body mass index (BMI) and clinical outcomes in patients with cardiovascular disease, including acute heart failure (AHF) and acute myocardial infarction (AMI), remains debated. This study investigates the association between BMI and clinical outcomes within the PARADISE-MI cohort, while also evaluating the impact of angiotensin receptor-neprilysin inhibitor (ARNI) versus angiotensin-converting enzyme inhibitor (ACE-I) treatment on this relationship.

METHODS AND RESULTS

The analysis included 5589 patients from the PARADISE-MI study with available baseline BMI data. The cohort comprised patients with AMI and pulmonary congestion and/or left ventricular ejection fraction ≤40%. Patients were categorized into six World Health Organization BMI subgroups. The primary outcome of interest was the composite endpoint of cardiovascular death, heart failure (HF)-associated hospitalization, and outpatient symptomatic HF episodes. The mean baseline BMI of the cohort was 28.1 ± 5.0 kg/m2. The lowest rate of the primary composite endpoint (6.2/100 patient-years) was observed in overweight patients (BMI 25-29.9 kg/m2), while the highest rates were found in the lowest and highest BMI subgroups (8.4/100 patient-years for BMI <18.5 kg/m2 and 9.7/100 patient-years for BMI >40 kg/m2). There was no significant interaction between BMI and the treatment effect of ARNI versus ACE-I on the primary composite outcome (p = 0.73). Additionally, no significant differences in the incidence of adverse events or serious adverse events were noted across the BMI subgroups.

CONCLUSIONS

In AMI with AHF patients, the relationship between BMI and the primary composite outcome is non-linear, with the lowest event rates observed in overweight individuals. Outcomes and safety profiles for ARNI and ACE-I treatments were similar across BMI subgroups.

Lipid metabolism in overweight/obese children vs. normal weight children in a north-eastern region of Spain

Objectives

Obesity and overweight have increased in children and adolescents in Europe in the recent years, accounting for a major global public health problem. The objective of this study was the early detection of metabolic abnormalities in overweight/obese children (8-12 years old) that may ultimately induce impaired glucose metabolism and/or cardiovascular diseases.

Methods

Lipid metabolism and metabolic control parameters were measured and monitored in a group of 61 male and female children with overweight/obesity and a group of 45 healthy, normal weight children, comparing the results obtained. Ages ranged from 8 to 12 years.

Results

Higher levels of triglycerides and insulin and lower levels of high-density lipoprotein (HDL) cholesterol and apolipoprotein A1 were observed in overweight/obese children, as compared to normal weight children. Overweight/obese children exhibited higher apolipoprotein B/apolipoprotein A1 ratio, triglyceride-glucose ratio and HOMA index and a lower low-density lipoprotein (LDL) cholesterol/apolipoprotein B ratio.

Conclusions

Obesity at an early age (8-12 years) negatively affects lipid parameters. Hence, overweight/obese children presented a more atherogenic lipid profile, manifested as higher concentrations of remnant particles and small dense LDL particles, higher insulin resistance and a higher risk for developing diabetes mellitus type 2 and cardiovascular disease, as compared to normal weight children.

Association between obesity and prevalence of significant regurgitant valvular heart disease over time: A cohort study

BACKGROUND

The association between valvular heart disease and obesity is poorly documented. The present study evaluated the prevalence and worsening over time of valvular regurgitation by obesity category.

METHODS

This cohort study included 11385 patients who underwent two echocardiographic examinations at least 1 year apart. Mitral, tricuspid, and aortic regurgitation were graded at the first and last visits. Regurgitation worsening was defined as those going from non/trace to moderate/severe or from moderate to severe. Frequency and worsening of regurgitant valvular heart disease were evaluated across body mass index (BMI) categories and adjusted for age, sex, follow-up time, and significant regurgitation at first exam.

RESULTS

Patients aged 63 ± 15 years old at the last visit (43 % women, 29 % with obesity, median follow-up time of 3 years [interquartile range 2-6]). Valve regurgitation was more common in patients without obesity than in those with obesity across all age groups. The prevalence of mitral, tricuspid and aortic valve regurgitations at the last visit diminished for increased BMI categories: 24 %, 19 %, 16 % and 14 % for patients with normal weight, overweight, obesity and severe obesity, respectively (p < 0.001). The regurgitation worsening observed in any valve followed a similar trend: 14 %, 11 %, 9 % and 8 %, respectively (p < 0.001). These inverse associations with BMI remained significant after adjustments for cofactors.

CONCLUSIONS

Obesity was associated with lower valvular regurgitation prevalence and worsening that persisted in the mitral and tricuspid valves after adjusting for confounders and excluding patients changing weight over time, suggesting the existence of an obesity paradox in valvular heart diseases.

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.

The interplay of heart rate variability and ventricular repolarization parameters in the obese state: a review

The impact of obesity on heart rate variability (HRV) and ventricular repolarization, both vital indicators of cardiovascular health, is the focus of this review. Obesity, measured by BMI, waist circumference, and waist-to-hip ratio, significantly increases cardiovascular disease (CVD) risk due to structural and autonomic heart changes. Findings show that obese individuals exhibit prolonged QT and Tpeak-to-Tend (Tpe) intervals, suggesting delayed ventricular recovery and greater arrhythmia risk. Additionally, obesity-induced autonomic imbalance favors sympathetic activity over parasympathetic, reducing HRV and raising arrhythmogenic potential. Elevated QT and Tpe intervals reflect extended cardiac recovery phases, which contribute to poor cardiac outcomes. The Tpe interval could serve as an early marker of cardiac dysfunction in obese populations, highlighting the importance of early intervention to reduce CVD risk and enhance treatment strategies for obesity-related cardiovascular changes.

Food insecurity and cardiovascular disease risk factors among U.S. adults

BACKGROUND

Food insecurity is an ongoing public health issue that involves limited or uncertain access to food. National rates of food insecurity among U.S. households have increased from 10.2% (~ 13,500,000 households) in 2021 to 12.8% (~ 17,000,000 households) in 2022 and most recently 13.5% (~ 18,000,000 households) in 2023. Food insecurity is associated with various health conditions and behaviors that raise the risk of cardiovascular disease (CVD). Little is known about whether the associations between food insecurity and CVD risk factors among U.S. adults differ by gender and race/ethnicity.

METHODS

The 2017-2018 National Health and Nutrition Examination Survey dataset was accessed for a cross-sectional study on the associations between food insecurity and six CVD risk factors among U.S. adults. Food insecurity was measured with the 10-item Adult Food Security Survey Module. General linear models were used to analyze the associations between food insecurity and high blood pressure, high cholesterol, diabetes, cigarette smoking, sedentary time, and body mass index (BMI). Moderation analyses examined differences in the association between food insecurity and CVD risk factors by gender and race/ethnicity.

RESULTS

Food insecurity was positively associated with high blood pressure (B = 0.104, p = 0.04), diabetes (B = 0.087, p = 0.006), and cigarette smoking (B = 0.239, p = 0.002); and food insecurity was negatively associated with sedentary time (B=-0.765, p = 0.02). Moderation analyses for gender revealed that women who were food insecure had greater BMI than men who were food insecure (B = 2.284, p = 0.02). Moderation analyses for race/ethnicity determined that, compared to White adults with food insecurity, high blood pressure rates were lower among Asian (B=-0.164, p = 0.04) and Black (B=-0.153, p = 0.04) adults with food insecurity, high cholesterol rates were greater among Latino adults with food insecurity (B = 0.168, p = 0.04), and cigarette smoking rates were lower among Black (B=-0.246, p = 0.03) and Latino (B=-0.380, p = 0.006) adults with food insecurity.

CONCLUSIONS

This research produced useful insight into how food insecurity relates to conditions and behaviors that increase CVD risk. Evidence from this study can inform both longitudinal and prevention efforts aimed at investigating food insecurity as both a harmful social determinant of health and a potential predictor of CVD risk among U.S. adults.

TRIAL REGISTRATION

N/A.

Unmasking the Complex Interplay of Obesity Hypoventilation Syndrome, Heart Failure, and Sleep Dysfunction: A Physiological and Psychological Perspective in a Digital Health World

Obesity hypoventilation syndrome (OHS) is a multifaceted condition characterized by significant respiratory, cardiovascular, and psychological consequences. Positive airway pressure (PAP) therapy remains the cornerstone treatment, improving respiratory function, neurocognition, and mental health disorders such as depression and anxiety. However, its long-term impact on quality of life, physical activity, and broader health outcomes is not fully understood. Challenges such as residual apnoea/hypopnea index, reduced physical activity, and impaired quality of life persist despite high adherence rates. Factors like hypercapnia and daytime respiratory symptoms play a pivotal role in patient outcomes, underscoring the need for strategies beyond adherence alone. This review explores the interplay between OHS, heart failure, and sleep dysfunction, advocating for personalized PAP settings, targeted management of residual respiratory events, and enhanced patient education. Digital health technologies, including remote monitoring and feedback systems, present promising tools to optimize care delivery and foster holistic management. By integrating physiological, psychological, and digital health perspectives, this narrative review aims to advance understanding and improve outcomes for patients with OHS and other complex sleep-disordered breathing conditions.

The Impact of Obesity on Cardiovascular Diseases: Heart Failure

Obesity and heart failure (HF) are two intersecting public health challenges, each with rising prevalence worldwide. Obesity alters cardiac structure and function, leading to ventricular systolic and diastolic dysfunction. However, weight loss interventions, whether through lifestyle changes, pharmacological agents, or bariatric surgery, can improve cardiac function, reduce symptoms, and lower hospitalization rates. Interestingly, the "obesity paradox" suggests that HF patients with obesity may experience better survival outcomes than HF patients with normal weight despite the adverse cardiac effects of obesity. Most importantly, focusing on strategies that aim to prevent HF in patients with obesity can potentially curb the burden of this chronic condition. This review explores the complex relationship between obesity and HF, emphasizing pathophysiological mechanisms, the paradoxical survival benefit, and the impact of weight loss strategies. A deeper understanding of this relationship is critical for optimizing care and outcomes in HF patients with obesity.

Obesity and Atherosclerotic Cardiovascular Disease: A Review of Social and Biobehavioral Pathways

In the United States, two out of every five adults have obesity. The obesity epidemic is a significant public health concern and a major risk factor for atherosclerotic cardiovascular disease (ASCVD), contributing to its development through a complex interplay of social, biologic and behavioral mechanisms. It exacerbates traditional cardiovascular risk factors such as dyslipidemia, hypertension, and type 2 diabetes, while visceral and epicardial fat deposition promotes inflammation and insulin resistance, thereby accelerating atherosclerosis. Beyond traditional pathophysiologic pathways, social determinants of health (SDoH) significantly contribute to obesity-related disparities, particularly among racial and ethnic minorities. SDoH factors such as socioeconomic status, access to health care, and limited availability of nutritious food and safe spaces for physical activity not only increase obesity prevalence but also exacerbate its psychological toll, including stress and anxiety, which further elevate cardiovascular risk. Environmental factors, such as limited green spaces and air pollution, further promote obesogenic behaviors and worsen cardiovascular outcomes. In this review, we explore the association between obesity and ASCVD and key mediating pathways including the role of SDoH and environmental risk factors. We also discuss potential strategies-including patient education, community engagement to address SDoH, and establishment of dedicated cardiometabolic and cardiovascular prevention clinics-to mitigate the population burden of obesity and improve downstream cardiovascular outcomes.

The association between visceral fat metabolic score and stroke: mediation by declining kidney function

BACKGROUND

Stroke is a leading cause of mortality and disability worldwide. Metabolic Score for Visceral Fat (METS-VF), a metric of visceral obesity, has emerged as a novel predictor of metabolic diseases. However, its association with stroke remains unclear. This study investigates the relationship between METS-VF and the risk of stroke, as well as the potential mediating role of kidney function.

METHODS

Data from the 1999-2020 National Health and Nutrition Examination Survey (NHANES) were analyzed, including 19,109 participants. Weighted logistic regression models were used to assess the association between METS-VF and stroke risk, with restricted cubic splines employed to explore their non-linear relationships. Mediation analysis examined the role of kidney function, measured by estimated glomerular filtration rate (eGFR). Subgroup and sensitivity analyses, including propensity score matching (PSM) and multiple imputations, were conducted to ensure the robustness of the findings.

RESULTS

Higher METS-VF was significantly associated with an increased risk of stroke (OR = 2.78, 95% CI: 1.71-4.52, P < 0.001) after adjusting for multiple covariates. A non-linear relationship was observed, with stroke risk sharply increasing when METS-VF exceeded 7.00. Mediation analysis revealed that declining eGFR mediated 26.72% of the METS-VF-stroke association. Subgroup analysis indicated that the association was stronger in men (OR = 5.06, 95% CI: 2.80-9.12, P < 0.001) than in women (OR = 2.01, 95% CI: 1.03-3.92, P = 0.04, P for interaction = 0.01). Sensitivity analyses using PSM and multiple imputations confirmed the robustness of the results.

CONCLUSIONS

METS-VF is independently associated with stroke risk, showing a non-linear relationship, with a potential mediating role of declining kidney function.

Harnessing Artificial Intelligence in Obesity Research and Management: A Comprehensive Review

Purpose: This review aims to explore the clinical and research applications of artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL), in understanding, predicting, and managing obesity. It assesses the use of AI tools to identify obesity-related risk factors, predict outcomes, personalize treatments, and improve healthcare interventions for obesity. Methods: A comprehensive literature search was conducted using PubMed and Google Scholar, with keywords including "artificial intelligence", "machine learning", "deep learning", "obesity", "obesity management", and related terms. Studies focusing on AI's role in obesity research, management, and therapeutic interventions were reviewed, including observational studies, systematic reviews, and clinical applications. Results: This review identifies numerous AI-driven models, such as ML and DL, used in obesity prediction, patient stratification, and personalized management strategies. Applications of AI in obesity research include risk prediction, early detection, and individualization of treatment plans. AI has facilitated the development of predictive models utilizing various data sources, such as genetic, epigenetic, and clinical data. However, AI models vary in effectiveness, influenced by dataset type, research goals, and model interpretability. Performance metrics such as accuracy, precision, recall, and F1-score were evaluated to optimize model selection. Conclusions: AI offers promising advancements in obesity management, enabling more personalized and efficient care. While technology presents considerable potential, challenges such as data quality, ethical considerations, and technical requirements remain. Addressing these will be essential to fully harness AI's potential in obesity research and treatment, supporting a shift toward precision healthcare.

Influence of autonomic neuropathy, systemic inflammation and other clinical parameters on mortality in dialysis patients

Background

Autonomic neuropathy (AN) is prevalent in diabetes and chronic kidney disease. The Composite Autonomic Symptom Score 31 (COMPASS 31) is a self-assessment test developed to determine not only cardiac AN but also AN of other organs, including the vasomotor, pupillomotor, secretomotor, and gastrointestinal systems. As yet there are no data on the effects of combined AN-scores of a variety of affected organ systems on mortality in dialysis patients.

Methods

In 119 patients undergoing hemodialysis therapy, symptoms of AN were documented using COMPASS 31. After 5 years, survival rates were calculated depending on AN scores and other parameters. After this 5-year period, AN scores were assessed for a second time and correlated with those obtained 5 years earlier.

Results

Survival rates for patients with lower AN scores were better than for those with higher AN scores. Patients with lower C-reactive protein levels showed better survival compared to those with higher values. Dialysis patients with diabetes had a lower survival rate compared to non-diabetic patients. In women, survival rates were better than in men. AN scores remained unchanged over the 5-year period.

Conclusion

AN is frequently observed in dialysis patients and can be identified through the COMPASS 31 questionnaire. Patients with higher AN scores exhibit poorer survival rates compared to those with lower scores. This observation is applicable not only for cardiac AN but also to AN scores reflecting changes in other organ systems. Therefore, AN scores can be used effectively to detect various AN symptoms in dialysis patients and identify their increased risk of mortality.

Leptin and Associated Neural Pathways Underlying Obesity-Induced Hypertension

Obesity rates have surged to pandemic levels, placing tremendous burden on our society. This chronic and complex disease is related to the development of many life-threatening illnesses including cardiovascular diseases. Hypertension caused by obesity increases the risk for cardiovascular mortality and morbidity by promoting stroke, myocardial infarction, congestive heart failure, and end-stage renal disease. Overwhelming evidence supports neural origins for obesity-induced hypertension and pinpoints the adipose-derived hormone, leptin, and the sympathetic nervous system as major causal factors. Hyperleptinemia in obesity is associated with selective leptin resistance where leptin's renal sympathoexcitatory and pressor effects are preserved while the metabolic actions are impaired. Understanding the mechanisms driving this phenomenon is critical for developing effective therapeutics. This review describes the neural mechanisms of obesity-induced hypertension with a focus on the molecular and neuronal substrates of leptin action.

The outcomes of the obesity paradox in pulmonary embolism: a study of the national inpatient sample database from 2016 to 2020

The "obesity paradox" suggests that, despite a higher baseline risk for adverse health outcomes, obese patients can experience a lower complication and mortality rate in conditions such as pulmonary embolisms (PE). This study aims to examine the association between obesity and inpatient outcomes of PE patients, utilizing the data from the National Inpatient Sample (NIS) database. We conducted a retrospective study analysis of obese adult PE patients (aged ≥ 18) using the NIS database from 2016 to 2020. Patients were categorized as either obese (body mass index (BMI) ≥ 30) or non-obese, excluding those with cancer diagnosis and age > 75 years to reduce confounding factors. Multivariable logistic regression, adjusted for confounders, compared the inpatient outcomes, including mortality, length of stay, need for mechanical invasive ventilation (MIV), incidence of shock requiring vasopressor use and use of reperfusion therapies. Our results showed obese patients had a lower in-hospital mortality and reduced risk for certain adverse outcomes when compared to non-obese patients. Limitations in our data, such as the lack of imaging confirmation and inability to track certain risk indicators in real time, affected precision in outcome severity classification. Our findings support the existence of an obesity paradox, particularly in PE patients, with obese patients experiencing better inpatient outcomes relative to their non-obese counterparts. This study advances the understanding of obesity's complex role in PE outcomes. However, further research is needed to further elucidate potential protective mechanisms to address our study limitations.

PFKFB3 Connects Glycolytic Metabolism with Endothelial Dysfunction in Human and Rodent Obesity

Obesity and type 2 diabetes (T2D) increase cardiovascular risk, largely due to altered metabolic state. An early consequence of T2D/obesity is the loss of endothelial function and impaired nitric oxide (NO) signaling. In blood vessels, endothelial nitric oxide synthase (eNOS) synthesizes NO to maintain vessel homeostasis. The biological actions of NO are compromised by superoxide that is generated by NADPH oxidases (NOXs). Herein we investigated how altered metabolism affects superoxide/NO balance in obesity. We found that eNOS expression and NO bioavailability are significantly decreased in endothelial cells (ECs) from T2D patients and animal models of obesity. In parallel, PFKFB3, a key glycolytic regulatory enzyme, is significantly increased in ECs of obese animals. EC overexpression of wild-type and a cytosol-restricted mutant PFKFB3 decreased NO production due to increased eNOS-T495 phosphorylation. PFKFB3 also blunted Akt-S473 phosphorylation, reducing stimulus-dependent phosphorylation of S1177 and the activation of eNOS. Furthermore, PFKFB3 enhanced the activities of NOX1 and NOX5, which are major contributors to endothelial dysfunction. Prolonged exposure of ECs to high glucose or TNFα, which are hallmarks of T2D, leads to increased PFKFB3 expression. These results demonstrate a novel functional relationship between endothelial metabolism, ROS, and NO balance that may contribute to endothelial dysfunction in obesity.

Characteristics of cardiopulmonary exercise capacity in adults with different degrees of obesity

Objective

To explore the characteristics of cardiopulmonary exercise capacity in adults with different degrees of obesity through cardiopulmonary exercise test (CPET).

Methods

From September 2019 to January 2024, the data of patients undergoing CPET in the Rehabilitation Department of the Affiliated Wuxi People's Hospital of Nanjing Medical University were analyzed retrospectively. A total of 231 cases were included. They were categorized into five groups based on their body mass index (BMI): the control group (18.5 ≤ BMI < 24 kg/m2, n = 28), the overweight group (24.0 ≤ BMI < 28 kg/m2, n = 48), the mild obesity group (28 ≤ BMI < 35 kg/m2, n = 75), the moderate obesity group (35.0 ≤ BMI < 40 kg/m2, n = 47), and the severe obesity group (BMI ≥ 40 kg/m2, n = 33). Collected informations on the age, gender, height, and weight of five groups of participants. The VO2 at anaerobic threshold (VO2AT), percentage of predicted VO2AT (VO2AT% Pred), peak oxygen consumption (VO2peak), percentage of predicted VO2peak (VO2peak% Pred), peak kilogram oxygen consumption (VO2peak/kg), maximum exercise power (WRmax), breathing reserve (BR), maximum heart rate (HRmax), percentage of predicted HRmax (HRmax% Pred), maximum O2 pulse (VO2/HRmax), percentage of predicted maximum O2 pulse (VO2/HRmax%Pred), maximum relative O2 pulse (VO2/HRmax/kg),heart rate response (HRr), forced vital capacity (FVC), ratio of forced expiratory volume to vital capacity in 1 s (FEV1/FVC), percentage of predicted forced vital capacity (FVC% Pred), percentage of predicted forced expiratory volume ratio of 1 s (FEV1% Pred), peak expiratory flow rate (PEF), maximum exercise ventilation (VEmax), maximum voluntary ventilation (MVV) and other indicators during the CPET were collected. Single factor analysis of variance was used to compare the mean of each index between groups. Spearman correlation analysis was used to analyze the correlation between BMI and various indicators.

Results

There was no statistical significance in gender composition, age, height, and exercise habit of the five groups of participants (P > 0.05). The body mass and BMI of the five groups had significant differences (P < 0.001). In terms of cardiopulmonary exercise capacity, there were statistical differences among the five groups in the overall distribution of VO2AT (H = 37.370,P < 0.001), VO2AT/kg (H = 34.747, P < 0.001), VO2peak (H = 23.018,P< 0.001), VO2peak/kg (H = 66.606, P < 0.001) and WRmax%Pred (H = 45.136, P < 0.001). There was no significant difference among the five groups in the overall distribution of VO2AT%Pred, VO2peak%Pred and WRmax. There were statistical significant difference among the five groups in HRmax (F = 2.443, P = 0.048), HRmax%Pred (F = 6.920, P < 0.001), VO2/HRmax (F = 8.803, P < 0.001), VO2/HRmax%Pred (F = 11.354, P < 0.001), VO2/HRmax/kg (F = 18.688, P < 0.001) and BR (F = 6.147, P < 0.001) and HRr (F = 9.467, P < 0.001). There were no significant differences among the five groups in RERmax (F = 0.336, P > 0.05). In terms of static pulmonary function, there were significant differences among the five groups in FVC%Pred (F = 4.577, P = 0.001), FEV1%Pred (F = 3.681, P = 0.006) and FEV1/FVC (F = 3.344, P = 0.011). There was no differences among the five groups in MVV(P> 0.05), and there were significant differences among the five groups in VEmax (P = 0.005) In terms of correlation analysis, BMI was positively correlated with VO2AT,VO2peak, VEmax and VO2/HRmax, and negatively correlated with VO2AT/kg, VO2peak/kg,WRmax%Pred, HRmax%Pred, VO2/HRmax%Pred, VO2/HRmax/kg,BR and HRr. In terms of static pulmonary function, BMI was negatively correlated with FVC%Pred, FEV1%Pred.

Conclusion

With the aggravation of obesity, the maximum exercise ability of adults decreases, VO2peak/kg and VO2/HRmax%Pred decreases, and the breathing reserve decreases.

Obesity and hypoxia have differential effects on myocardial innervation in the right ventricle of the male mouse heart

Obesity, along with hypoxia, is known to be a risk factor for pulmonary hypertension (PH), which can lead to right ventricular hypertrophy and eventually heart failure. Both obesity and PH influence the autonomic nervous system (ANS), potentially aggravating changes in the right ventricle (RV). This study investigates the combined effects of obesity and hypoxia on the autonomic innervation of the RV in a mouse model. Male C57BL/6N mice were subjected to a control diet (CD) or a high-fat diet (HFD) for 30 weeks, with subsets of the mice exposed to chronic normobaric hypoxia (13% O2) during the final 3 weeks. Light and electron microscopic stereology was used to quantify various parameters of nerve fibres innervating the RV myocardium. HFD-induced obesity significantly increased the total length of nerve fibres and axons in the RV under normoxic conditions, indicating hyperinnervation. Quantitatively, the length density of nerve fibres per unit volume of RV (unit: x10-3 µm-2) was similar in CD (0.158 ± 0.04), CD-Hyp (0.176 ± 0.06) and HFD-Hyp (0.147 ± 0.05). In contrast, in HFD the length density of nerve fibres showed higher values 0.206 ± 0.054. The total length of nerve fibres increased by 67% from 2.61 m ± 0.77 m in CD to 4.37 m ± 1.51 m in HFD. The total length of axons increased by 80% from 8.87 m ± 2.75 m to 15.95 m ± 4.62 m. However, when obesity was combined with hypoxia, the total axon length was significantly reduced by 27% in HFD-Hyp compared with HFD. In addition, the mean number of axon profiles per nerve fibre profile decreased from 3.44 ± 0.68 in HFD to 2.95 ± 0.43 in HFD-Hyp. Interestingly, chronic hypoxia alone did not significantly alter RV innervation but led to RV hypertrophy, independent of the diet. The attenuation of obesity-induced hyperinnervation by hypoxia suggests a complex and potentially antagonistic interaction between these conditions. In conclusion, obesity induced by a HFD caused hyperinnervation of the RV, whereas chronic hypoxia alone did not significantly alter RV innervation. Surprisingly, chronic hypoxia attenuated the obesity-induced changes in RV innervation. These findings indicate that the effects of obesity and hypoxia-induced PH on RV innervation are distinct and potentially antagonistic.

Exposure to specific polyfluoroalkyl chemicals is associated with cardiovascular disease in US adults: a population-based study

Background

Polyfluoroalkyl chemicals (PFCs) present potential health risks due to their persistence and bioaccumulation. However, there is currently insufficient evidence regarding their impact on cardiovascular disease (CVD). Consequently, it is imperative to investigate the correlation between PFCs and CVD.

Methods

The data was collected from National Health and Nutrition Examination Survey in 2005-2012. Logistic regression models were employed to assess the association between single PFC and CVD. Generalized additive model (GAM) was used for evaluating nonlinear relationships. Subgroup analyses were conducted to explore interaction effects. Bayesian kernel machine regression (BKMR) and weighted quantile sum (WQS) models were used to evaluate the joint effect of PFC exposures on CVD.

Results

In logistic regression, PFDE, MPAH, and PFUA were positively associated with CVD. In the GAM, there was a significant nonlinear relationship between MPAH and CVD. Subgroup analysis revealed the interaction of gender and race in the effects of PFCs and CVD. PFUA was positively correlated with CVD in males but show no significant difference in females. PFDE was positively associated with CVD among non-Hispanic white individual. The results of BKMR indicated that the impact of mixed PFCs on CVD increased initially and then weakened, showing an overall positive trend. The results of WQS suggested that PFDO contributed most to the effect.

Conclusion

Our study showed that serum PFDE, MPAH, and PFUA levels were positively correlated with CVD. PUFA was found to interact with gender and race in relation to CVD. A general positive correlation exists between mixed exposure to PFCs and CVD, with PFDO being the most contributory PFC. Our study provided important evidence for probing the impact of PFCs on CVD and laid a foundation for further mechanism research.

Association between sarcopenic obesity and risk of frailty in older adults: a systematic review and meta-analysis

BACKGROUND

Age-related changes in body composition such as muscle loss can lead to sarcopenia, which is closely associated with frailty. However, the effect of body fat accumulation on frailty in old age remains unclear. In particular, the association between the combination of these two conditions, known as sarcopenic obesity, and frailty in older adults is unclear.

OBJECTIVE

To synthesise the association between sarcopenic obesity and the risk of frailty and to investigate the role of obesity in the risk of frailty in old age.

METHODS

Six databases were searched from inception to 29 September 2024. Two reviewers independently extracted the data and assessed the risk of bias for the included observational studies using the adapted Newcastle-Ottawa scale. The control groups consisted of robust, obese and sarcopenic individuals. Meta-analyses were performed to examine the risk of frailty due to sarcopenic obesity and the role of obesity in frailty amongst sarcopenic older adults.

RESULTS

Sixteen eligible studies were included in meta-analyses from 1098 records. Compared to robust individuals, older adults with sarcopenic obesity were more vulnerable to frailty [odds ratio (OR), 3.76; 95% confidence interval (CI), 2.62 to 5.39; I2 = 79.3%; P < .0001]. Obesity was not associated with the risk of frailty (OR, 1.23; 95% CI, 0.99 to 1.53; I2 = 0.0%; P = .501) in sarcopenic older adults.

CONCLUSIONS

Sarcopenic obesity is associated with a high risk of frailty. Sarcopenia and obesity may have synergistic effects on frailty in older adults.