Obesity: Pathophysiology and Management

Jatrorrhizine retard obesity by modulating transcription factor c-Jun/c-Fos to downregulate Mmp12-mediated inflammation

Obesity is a systemic, chronic, low-grade inflammatory disease. Nutritional obesity, in particular, is also accompanied by inflammation and metabolic disorders, which are the primary causes of malignant metabolic diseases. Rhizoma Coptidis (Coptis Chinensis Franch) (RC), a traditional Chinese medicine, is primarily used for its anti-inflammatory and anti-diarrheal properties. Our previous studies have shown that RC can reduce body weight and lower fat levels, demonstrating its potential to improve nutritional obesity.However, the effects and mechanisms of the active small molecules in RC extracts in treating obesity-induced chronic inflammation need to be further investigated. In this study, we investigated the ameliorative effect and mechanism study of the monomeric jatrorrhizine (JAT) extracted from RC on high-fat diet-induced obese mice. First, JAT could dose-dependently reduce body weight and decrease the expression of inflammatory factors such as IL6, IL1β, and TNFα in the tissues of obese mice.Secondly, transcriptomics and bioinformatics studies of epididymal white adipose tissue (eWAT) identified Mmp12 as a key target through which JAT may alleviate obesity. Next, the effect of JAT on c-Jun/c-Fos promoter activity, which in turn down-regulates the transcript and protein levels of Mmp12, was analyzed and determined by qPCR, transcription factor prediction, single fluorescent promoter activity assay, Cell thermodynamic stability analysis (CETSA), molecular dynamics simulation mimicry, circular dichroism (CD) and Co-Immunoprecipitation (Co-IP). In conclusion, JAT may ameliorate high-fat diet-induced obesity and its associated inflammation through the c-Jun/c-Fos-Mmp12 axis.

Association of waist circumference with long-term all-cause mortality and cardiac death in patients with a pacemaker: a retrospective study

OBJECTIVES

To investigate the relationship between abdominal obesity and long-term prognosis in patients with a pacemaker.

METHODS

In the SUMMIT Study, patients were categorized by baseline waist circumference into obesity, normal, and lean groups. WC was measured at the midpoint between the last rib and hip bone after exhalation. Regular follow-ups were conducted, with all-cause mortality as the primary endpoint and cardiac death as the secondary endpoint.

RESULTS

In total, 492 patients were included in the analysis. The average baseline waist circumference was 84.2 ± 12.7 cm, and abdominal obesity was observed in 37.6% of patients. During a mean follow-up of 67.2 ± 17.5 months,71 death due to any cause (14.40%) and 24 cardiac death (4.87%) events occurred. All-cause mortality was associated with higher waist circumference (87.6 versus 83.6 cm, P = 0.014), but not body mass index (23.6 versus 23.5, P = 0.930). Multivariate Cox analysis showed compared with patients with abdominal obesity, lean patients had a significant lower risk in both all-cause mortality (HR 0.188, 95%CI 0.070-0.505, P = 0.001) and cardiac death (HR 0.097, 95% CI 0.012-0.792, P = 0.029).

CONCLUSIONS

Baseline waist circumference less than 80 cm for men and less than 75 cm for women in patients with a pacemaker had a significant lower risk in long-term all-cause mortality and cardiac death.

Transabdominal photobiomodulation applications: A systematic review and meta-analysis

INTRODUCTION

The escalating prevalence of obesity presents a multifaceted challenge involving genetic, environmental, and behavioral factors, with significant public health implications. Photobiomodulation (PBM) may positively influence metabolic activities in adipose cells and regulate inflammation, potentially impacting obesity.

METHODS

A systematic review and meta-analysis were conducted to assess the effects of transabdominal PBM treatments in preclinical and clinical obesity studies, covering a range of physical, psychological, and physiological variables. Research articles were sourced from PubMed, Web of Science, ScienceDirect, and Scopus databases. Following the inclusion and exclusion criteria, a total of 24 studies, comprising 1041 patients, and 100 mice were incorporated. R software was employed for conducting meta-analyses, and calculating effect sizes between experimental and control groups.

RESULTS

In human models, significant discrepancies were revealed in waist circumference (Z = -2.16; p = 0.031), hip circumference (Z = 2.11; p = 0.035), insulin levels (Z = 2.11; p = 0.035), and triglycerides (Z = -2.4674, p = 0.0136). In animal models, significant differences were observed in epididymal adipocyte area (Z = -5.6930; p < 0.0001), triglycerides (Z = -2.0254; p = 0.04848), and glucose area under the curve (AUC; Z = -6.4112; p < 0.0001).

CONCLUSIONS

This study underscores the necessity of considering diverse wavelengths in PBM research, particularly within the realm of obesity, and emphasizes the imperative for further investigations to comprehensively elucidate PBM mechanisms and applications. The exploration of innovative therapeutic approaches unfolds novel avenues in the pursuit of comprehensive strategies to address obesity and its underlying determinants.

Association between metabolic and bariatric surgery and malignancy: a systematic review, meta-analysis, trends, and conclusions

BACKGROUND

Conflicting studies have investigated the association between obesity, metabolic and bariatric surgery (MBS), and cancer.

OBJECTIVES

Our study aimed at elucidating the trends in cancer incidence that are related to obesity and weight loss managed through MBSs, like Colo-rectal, breast, uterine, and esophageal cancer.

SETTING

We conducted a search using PubMed, Embase, and the Cochrane Library electronic databases through May 2020.

METHODS

A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

RESULTS

MBS procedures surveyed included sleeve gastrectomy, gastric band, gastric bypass, gastric balloon, and banded gastroplasty/silastic ring gastroplasty. The initial search found 11,789 potential studies. After data extraction and filtering, 21 were included in the final analysis. Overall, the calculated risk of cancer was reduced after MBS in comparison to the patients suffering from obesity who were treated nonoperatively (mean effect size of -.33). It was also found as a protective factor against colorectal cancer (mean E.S. -.28), uterine cancer (mean E.S. -.42), breast cancer (mean E.S. -.37), and esophageal cancer (mean E.S. -.23). Other cancers, such as liver, pancreatic, and skin, did not show a significant change even though a trend was seen.

CONCLUSIONS

According to the data retrieved from patients who underwent MBS compared to nonoperated patients suffering from obesity, the overall risk for malignancy was lower in the MBS group. Additional information collected in this study revealed the behavior of specific types of cancer in response to induced weight loss by operative means. The benefit of surgery in patients suffering from obesity is not restricted to the improvement of obesity morbidity alone.

Risk factors for extubation-related complications in morbidly obese patients undergoing bariatric surgery: a retrospective cohort study

BACKGROUND

One-third of major anesthesia-related airway complications occur during or shortly after tracheal extubation. Obesity significantly impacts respiratory function and is a key contributor to morbidity and mortality. Patients with morbid obesity often require bariatric surgery. However, extubation-related complications in this specific surgical population have not been previously studied. This study aimed to determine the rate and frequency of complications during tracheal extubation in patients undergoing bariatric surgery and the associated risk factors for these complications.

MATERIALS AND METHODS

This was a retrospective cohort study of adult patients above 18 years of age with a body mass index ≥ 40 kg/m2 who underwent bariatric surgery between June 2016 and June 2024. Extubation-related complications were defined as the occurrence of any of the following: vomiting, aspiration, laryngospasm, bronchospasm, cardiovascular instability, airway edema, desaturation (SpO2 < 90%), or the need for a rescue device or reintubation during or after tracheal extubation. Logistic regression analysis, adjusted for age and sex, was performed to evaluate the associations. The significance level was adjusted by applying the Bonferroni correction (0.05/16 = 0.0031), and a p-value < 0.0031 was interpreted as statistically significant.

RESULTS

Data from 1193 patients were analyzed. The overall complication rate was 4.4%, with the most frequent complication being desaturation, which occurred in 3.2% of patients. Logistic regression analysis showed that the odds of extubation-related complications increased twofold for obese patients with body mass index 50-59 kg/m2 (odds ratio [OR] 1.97, 95% confidence interval [95%CI] 0.99-3.94, p = 0.055) and threefold for patients with body mass index > 60 kg/m2 (OR 2.95, 95%CI 0.99-8.81, p = 0.05). The most commonly associated comorbidities were hypertension and obstructive sleep apnea, with an odds ratio of 2.98 for hypertension and 2.15 for obstructive sleep apnea (95%CI 1.40-6.33, p = 0.005; and 95%CI 1.08-4.29, p = 0.03; respectively). Despite these clinically important results, after applying the Bonferroni correction, none of these associations remain statistically significant, as the corrected p-values are above the threshold of p = 0.0031.

CONCLUSION

This study identified desaturation as the most common complication post-extubation of morbidly obese patients who underwent bariatric surgery. Moreover, we found that the odds of extubation-related complications increased with increasing obesity classes, particularly in patients with body mass index 50-59 kg/m2 and > 60 kg/m2, as well as in patients with hypertension and obstructive sleep apnea. These findings suggest the importance of tailored extubation strategies and close perioperative monitoring in morbidly obese patients to mitigate extubation-related risks.

Supplementation of mixed Lactobacillus alleviates metabolic impairment, inflammation, and dysbiosis of the gut microbiota in an obese mouse model

Introduction

Obesity is a complex metabolic disease, which is often accompanied with impaired glucose and lipid metabolism and chronic inflammation. Probiotics have been considered as a strategy for treating obesity, while the genus of Lactobacillus is the most commonly tested and approved probiotics. Some multi-strain probiotics were proven to produce synergistic effects on treating obesity as compared to mono-strain ones.

Methods

The purpose of this study was to investigate the anti-obesity effect of a new probiotic formation contained Lactobacillus plantarum L14, Lactobacillus paracasei L9, Lactobacillus rhamnosus GG, and Lactobacillus sakei X-MRS-2, designated as L-PPRS. Multi-strain probiotics L-PPRS was shown to have a better antiadipogenic effect than mono-strain probiotics in 3T3-L1 cell. Subsequently, L-PPRS was orally supplemented to a high-fat diet (HFD) induced obese mouse model for two kinds of treatment course, a short-term (8 weeks) one and a long-term (12 weeks) one.

Results

We found that intervention of L-PPRS not only significantly inhibited weight gain in HFD-fed mice, but also improved glucose tolerance, insulin sensitivity and reduced serum lipid levels. Furthermore, L-PPRS intervention reduced fat accumulation in the adipose tissue and the liver, and ameliorated the antioxidant capacity of liver in HFD-fed mice. L-PPRS intervention modulated the expression of lipid-metabolic genes, and exhibited excellent anti-inflammatory effect. In addition, L-PPRS intervention restored the dysbiosis of gut microbiota via reducing the Firmicutes/ Bacteroidetes ratio, and increasing the abundance of beneficial intestinal bacteria. In conclusion, this study proved that L-PPRS could effectively prevent the development of obesity and its associated abnormalities, and the long-term supplementation of L-PPRS provided a more profound benefit than the short-term.

Discussion

This study highlights the potential of L-PPRS as an effective anti-obesity strategy.

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

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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

Aim

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

Methods

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

Results

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

Conclusions

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

Hypoabsorption in Bariatric Surgery: Is the Benefit Worth the Risk?

Metabolic and bariatric surgery has been well described in the existing literature to be an effective and safe modality for weight loss in patients with obesity. Recently, hypoabsorptive procedures such as one-anastomosis gastric bypass (OAGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis duodenoileostomy with sleeve (SADI-S) have gained traction, particularly among patients with severe obesity. These procedures combine restrictive and hypoabsorptive mechanisms, resulting in significant and sustainable weight loss, especially in those with severe obesity and associated comorbidities. However, the risk of malnutrition and nutritional deficiency following these procedures has been a deterrent for surgeons in their adoption. This review evaluates the existing literature on the safety, efficacy, and long-term outcomes of OAGB, BPD-DS, and SADI-S. While these hypoabsorptive procedures represent highly effective options for treating obesity, the associated nutritional complications necessitate the need for long-term follow-up and supplementation and highlight the need for careful patient selection.

Dietary Inflammatory index and its association with fatty liver disease: a study in obese and non-obese populations

BACKGROUND

The worldwide incidence of non-alcoholic fatty liver disease (NAFLD) is a pressing health issue, with chronic inflammation critically influencing its development. The Dietary Inflammatory Index (DII) measures the inflammatory potential of one's diet. Our study aimed to investigate the association between DII and fatty liver disease in obese and non-obese individuals.

METHODS

Data from the 1999--2001 National Health and Nutrition Examination Survey (NHANES), encompassing 3456 adults aged 20 years and above, were utilized for the analysis. The multivariable analysis assessed the correlation between DII, NAFLD, and obesity while adjusting for demographic variables. The restricted cubic spline (RCS) method was also applied with restricted degrees of freedom to establish a non-linear relationship model between DII and NAFLD.

RESULTS

Our study demonstrated significant differences across DII tertiles in various demographic and clinical characteristics. An increase in t DII score by one standard deviation resulted in a 21% increase in the fatty liver risk. This association persisted after adjusting for age, sex, and other covariates. The risk of fatty liver disease increased significantly by 39% in the highest DII tertile. Regression analysis revealed a non-linear correlation between DII and the risk of fatty liver in obese adults. The subgroup analysis showed consistent findings across all subgroups, with particularly strong associations in specific demographic categories.

CONCLUSIONS

Our findings suggest a significant association between the DII score and risk of fatty liver disease, particularly in obese individuals. These results underscore the potential role of diet-induced inflammation in pathogenesis of NAFLD.

Metabolic Response After a Single Maximal Exercise Session in Physically Inactive Young Adults (EASY Study): Relevancy of Adiponectin Isoforms

The metabolic response to a maximal exercise test in physically inactive adults remains poorly understood, particularly regarding the role of adiponectin, an adipokine with insulin-sensitizing and anti-inflammatory properties. Adiponectin circulates in three isoforms-low (LMW), medium (MMW), and high-molecular-weight (HMW)-with differing bioactivities. While exercise is known to influence adiponectin levels, evidence is conflicting, and few studies have explored isoform-specific changes. This study aimed to evaluate the effects of a single maximal exercise session on circulating adiponectin isoforms and their associations with metabolic and kidney function markers in physically inactive young adults. In this quasi-experimental study, twenty-one physically inactive participants (mean age 24.6 ± 2.1 years, 85.7% women) completed a progressive cycle ergometer test. Circulating levels of LMW and MMW adiponectin, metabolic outcomes (e.g., cholesterol, triglycerides, fibroblast growth factor 21 (FGF21)), and kidney function markers (e.g., creatinine, proteinuria) were assessed before and after exercise using biochemical assays and Western blotting. Comparisons between pre- and post-exercise values were made with the Wilcoxon test. Exercise increased lipid metabolism markers (total cholesterol, triglycerides, HDL) and kidney stress indicators (albuminuria, proteinuria) (p < 0.05). LMW and MMW adiponectin levels showed no significant overall changes, but LMW adiponectin positively correlated with changes in total cholesterol and FGF21, while MMW adiponectin negatively correlated with creatinine and proteinuria (p < 0.05). HMW adiponectin was undetectable by our methods. A single maximal exercise session revealed isoform-specific associations between adiponectin and metabolic or kidney stress markers, emphasizing the complex role of adiponectin in exercise-induced metabolic responses. Future research should explore mechanisms underlying these differential associations to optimize exercise interventions for metabolic health improvement.

Comparison of short‑ and long‑term outcomes between laparoscopic and open pancreaticoduodenectomy in overweight patients: a propensity score‑matched study

BACKGROUND

Overweight is thought to affect the outcome of minimally invasive surgery. There is still a lack of controlled studies of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD) in overweight patients. This study was designed to compare short-term and long-term outcomes in overweight patients treated with LPD and OPD.

METHODS

Clinical and follow-up data on overweight patients who received LPD or OPD at Shandong Provincial Hospital from January 2015 to December 2022 were analyzed retrospectively. The bias between groups were balanced by 1:1 propensity score matching (PSM). Kaplan-Meier survival curves described long-term survival outcomes in overweight pancreatic ductal adenocarcinoma (PDAC) patients.

RESULTS

A total of 502 overweight patients were enrolled in the study. There were 276 patients in the LPD group and 226 in the OPD group. After matching, 196 patients were enrolled in each group. Compared with the OPD group, the LPD group had fewer estimated blood loss (EBL) (140 vs. 200 mL, P < 0.001), more lymph node dissection (14 vs. 12, P = 0.010), and shorter postoperative length of stay (LOS) (13 vs. 16 days, P < 0.001). There were no significant differences in severe complications, 90-day readmission and mortality rates (all P > 0.05). The subgroup analysis of obese patients also showed that the LPD group had fewer intraoperative EBL, more lymph node dissection, and shorter LOS. The survival analysis showed that overweight patients with PDAC who underwent LPD or OPD had similar overall survival (OS) (23.8 vs.25.7 months, P = 0.963) after PSM.

CONCLUSION

It is safe and feasible for overweight patients undergoing LPD to have less EBL, more lymph node harvesting, and a shorter LOS. There was no statistically significant difference in long-term survival outcomes among overweight PDAC patients between the two approaches.

Effectiveness of combining Qingyanyin formulated granules with press needles in treating abdominal obesity: a multicenter randomized controlled trial

OBJECTIVE

To assess the efficacy and safety of the Qingyanyin formulated granules (, QYY), press needles (PN), and their combined application in addressing abdominal obesity (AO). This trial aims to offer a more scientifically grounded therapeutic regimen for clinical interventions.

METHODS

From March 2021 to July 2021, a multicenter, triple －blind, randomized 2 × 2 factorial design clinical trial was conducted across 7 centers in 4 major cities within mainland China. The trial participants were patients diagnosed with AO. The trial followed a 1∶1∶1∶1 random allocation ratio, assigning participants to one of four groups: QYY placebo plus simulated press needles (SPN) (placebo + SPN), QYY plus SPN (QYY + SPN), QYY placebo plus PN (placebo + PN), and QYY plus PN (QYY + PN). The trial participants received treatment for 12 weeks. Observe the changes in waist circumference, body weight, body mass index (BMI), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) scores, and Pittsburgh Sleep Quality Index (PSQI) before and after treatment.

RESULTS

The QYY + PN group exhibited significant improvements in waist circumference compared to placebo + PN [Difference = －1.59, 95% CI (－3.03, －0.16)] and placebo + SPN groups [Difference = －2.01, 95% CI (－3.46, －0.57)]. QYY + PN demonstrated a significant advantage over placebo + SPN [Difference = －2.01, 95% CI (－3.46, －0.57)], and no statistically significant interaction was observed between the two interventions (P > 0.05). In terms of weight and BMI improvements, the QYY + PN, QYY + SPN, and the PN + placebo groups all experienced trending greater reductions in weight compared to the placebo group. In terms of the total scores of PSQI, BAI, and BDI, all four groups exhibited improvements compared to the baseline. Specifically, concerning the change in total PSQI scores, the QYY + PN group exhibited a greater reduction; Regarding the change in total BAI scores, the PN + placebo group demonstrated a greater decrease;As for the change in total BDI scores, the QYY + SPN group displayed a greater reduction.

CONCLUSION

This study confirmed that QYY + PN can effectively reduce the waist circumference of patients with AO. Furthermore, the combined approach offers greater benefits than either treatment alone, all without any reported serious adverse events.

Effect of weight loss following Roux-en-Y gastric bypass on cancer risk: A Mendelian randomization study

Cancer incidence and development are strongly correlated with obesity, however there is insufficient data to support a causal relationship between intentional weight loss and the prevention or promotion of cancer. We investigated the causal relationship between weight loss following Roux-en-Y gastric bypass (RYGB) and the incidence of 18 cancers using Mendelian randomization (MR). A genome-wide association studies (GWAS) data related to weight loss following RYGB from the GWAS catalog database were used as exposure, and GWAS data related to 18 cancers from the Medical Research Council integrative epidemiology unit open GWAS project were used as outcomes. In order to investigate the causal relationship between exposure and results, we used a two-sample MR approach. The primary analysis technique was inverse variance weighting, with weighted median, and MR-Egger regression utilized as supplemental techniques to confirm the findings. Heterogeneity and horizontal pleiotropy were investigated using a variety of sensitivity studies, including the Cochran Q test, MR-Egger regression pleiotropy test, MR pleiotropy residual sum and outlier, and leave-one-out analysis. We included a total of 4 single-nucleotide polymorphisms as instrumental variables through rigorous quality control screening. Under the limitations of Bonferroni correction threshold (P < 2.78 × 10-3), our results suggest that the weight loss following RYGB has a significant causal relationship with a reduced risk of breast (odds ratio [OR]: 0.784; 95% confidence interval [CI]: 0.762-0.808; P = 2.167e-58) and lung cancer (OR: 0.992; 95% CI: 0.987-0.997; P = .0023), and a potential causal relationship with a decreased risk of hematological cancer (OR: 0.9998462; 95% CI: 0.9997088-0.9999836; P = .028) and an increased risk of cervical cancer (OR: 1.000123; 95% CI: 1.0000313-1.000215; P = .009). Sensitivity analysis confirms the robustness of our analysis results. Genetically predicted weight loss following RYGB has significant causal effects in reducing the risk of breast and lung cancer. It also has potential benefits in lowering the risk of hemotological cancers and increasing the risk of cervical cancer. Considering the limitations of our study, the reliability of its results and the underlying mechanisms require further investigation.

Adipocentric Strategy for the Treatment of Type 2 Diabetes Mellitus

The global prevalence of obesity and type 2 diabetes mellitus (T2D) has risen in parallel over recent decades. Most individuals diagnosed with T2D exhibit adiposopathy-related diabetes (ARD), a condition characterized by hyperglycemia accompanied by three core features: increased ectopic and visceral fat deposition, dysregulated adipokine secretion favoring a pro-inflammatory state, and insulin resistance. Despite advancements in precision medicine, international guidelines for T2D continue to prioritize individualized therapeutic approaches focused on glycemic control and complications, and many healthcare providers predominantly maintain a glucocentric strategy. This review advocates for an adipocentric treatment paradigm for most individuals with T2D, emphasizing the importance of prioritizing weight loss and visceral fat reduction as key drivers of therapeutic intensification. By combining lifestyle modifications with pharmacological agents that promote weight loss-including SGLT-2 inhibitors, GLP-1 receptor agonists, or dual GLP-1/GIP receptor agonists-and, when appropriate, metabolic surgery, this approach offers the potential for disease remission in patients with shorter disease duration. For others, it enables superior metabolic control compared to traditional glucose-centered strategies while simultaneously delivering cardiovascular and renal benefits. In conclusion, an adipocentric treatment framework for ARD, which represents the majority of T2D cases, effectively integrates glucocentric and cardio-nephrocentric goals. This approach constitutes the optimal strategy for ARD due to its efficacy in achieving disease remission, improving metabolic control, addressing obesity-related comorbidities, and reducing cardiovascular and renal morbidity and mortality.

Moderate-intensity interval exercise exacerbates cardiac lipotoxicity in high-fat, high-calories diet-fed mice

Physical exercise is a cornerstone for preventing diet-induced obesity, while it is unclear whether physical exercise could offset high-fat, high-calories diet (HFCD)-induced cardiac dysfunction. Here, mice were fed with HFCD and simultaneously subjected to physical exercise. As expected, physical exercise prevented HFCD-induced whole-body fat deposition. However, physical exercise exacerbated HFCD-induced cardiac damage. Further metabolomic analysis results showed that physical exercise induced circulating lipid redistribution, leading to excessive cardiac lipid uptake and lipotoxicity. Our study provides valuable insights into the cardiac effects of exercise in mice fed with HFCD, suggesting that counteracting the negative effect of HFCD by simultaneous physical exercise might be detrimental. Moreover, inappropriate physical exercise may damage certain organs even though it leads to weight loss and overall metabolic benefits. Of note, the current findings are based on animal experiments, the generalizability of these findings beyond this specific diet and mouse strain remains to be further explored.

Urine exosome biomarkers of obesity after Lekhana Basti treatment - Report of a pilot study

BACKGROUND

Obesity is a rising risk factor for various diseases including cardiovascular diseases and Cancer. The limitations of targeted obesity-treatment approaches employed in the clinic presently underscore the importance of developing integrative management strategies for identification of specific biomarkers of obesity.

OBJECTIVES

Given the specificity of exosome/extracellular vesicle (EV) biomarkers, we aimed here to identify the EV biomarkers of Ayurveda treatment - Lekhana Basti - for Obesity.

METHODOLOGY

A total of eighteen 24-h urine samples from 6 participants with BMI>30 kg/m2 were used in this study, collected over 3 time-points during the Lekhana basti (medicated enema for obesity) treatment. Urine EV were isolated using Polyethylene Glycol (PEG). The proteins were resolved by 1-d gel electrophoresis and identified using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) and quantified by label-free methods. Significant Protein-Protein Interactions, KEGG pathway analysis and enrichment, functional gene ontology (GO) annotation were identified and shortlisted in comparison to Obesity reference genes from DisGeNET.

RESULTS

With UniProt as a reference subsequent to LC-MS/MS-identification, a total of 210 exosome proteins were identified. Seventy-three proteins were overexpressed in pathway enrichment analysis. Further, GO functional annotation identified 15 common proteins involved. Finally, the 8 hub proteins associated with obesity were identified and their differential expression profile compared between three different time-points during Lekhana Basti treatment. Six protein markers overexpressed during obesity were downregulated post Lekhana Basti treatment, while 2 markers increased in abundance post-treatment.

CONCLUSION

To our knowledge, this is the first study to isolate and identify urine EV protein abundance profiles from obese female participants of India. The study results indicate significant changes in the differential expression profile of 8 hub proteins involved in obesity, after Lekhana Basti treatment. The biomarker signature of the pilot study indicates the role of Ayurveda treatment and the possible pathways involved in the treatment of Obesity. Further, this study underlines the specificity of urine exosomes/EV as diagnostic markers as well as the potential of Ayurveda treatment in effective management of obesity.

Postoperative atrial fibrillation following cardiac surgery in severe obesity: the added value of waist circumference

INTRODUCTION

Obesity is an independent risk factor for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) surgery. POAF in patients with severe obesity (body mass index [BMI] ≥ 35 kg/m2) is less studied. Whether waist circumference (WC) improves prediction of POAF independently of BMI among patients with severe obesity remains unknown.

AIM

To evaluate the risk of POAF, the role of WC in predicting POAF and postoperative complications after CABG surgery in severe obesity.

METHODS

Our cohort included 7995 patients undergoing CABG surgery (2006-19). POAF risk was compared across BMI and WC categories. In patients with severe obesity, the association of an increase in WC with POAF risk was assessed.

RESULTS

763 (9.5%) patients had a BMI ≥ 35 kg/m2. In this group, BMI was 38.5 ± 3.6 kg/m2 and WC was 123.4 ± 10.8 cm. More patients with severe obesity developed POAF compared to patients with a normal BMI (37 vs. 29%, aRR: 1.52[95%CI 1.36-1.72], p < 0.01). Within each BMI category, the risk of POAF was higher per increasing tertile of WC (p < 0.05). Among patients with a BMI ≥ 35 kg/m2, every 10 cm increment in WC was associated with an increased risk of POAF (aRR: 1.16[95%CI 1.08-1.24], p < 0.01). POAF in patients with severe obesity was associated with increased hospital length of stay.

CONCLUSIONS

Severe obesity increases the risk of POAF after CABG surgery. In this subgroup, elevated WC may provide additional prognostic value independently of BMI. Since POAF is associated with adverse long-term outcomes, abdominal obesity by measurement of WC should be assessed and targeted even in patient with severe obesity. Central Illustration Increasing waist circumference associated with increased atrial fibrillation risk post coronary artery bypass grafting. Bar graph of the unadjusted absolute risk and 95% confidence interval of postoperative atrial fibrillation for each tertile of waist circumference per body mass index category. Comparison of postoperative atrial fibrillation risk with chi-square test showing an increasing risk of postoperative atrial fibrillation related to increasing waist circumference within each body mass index category.

ABBREVIATIONS

BMI, body mass index; POAF, postoperative atrial fibrillation; WC, waist circumference.

Integrated Insights into Metabolic and Bariatric Surgery: Improving Life Quality and Reducing Mortality in Obesity

Metabolic and bariatric surgery (MBS) is an effective intervention for patients with severe obesity and metabolic comorbidities, particularly when non-surgical weight loss methods prove insufficient. MBS has shown significant potential for improving quality of life and metabolic health outcomes in individuals with obesity, yet it carries inherent risks. Although these procedures offer a multifaceted approach to obesity treatment and its clinical advantages are well-documented, the limited understanding of its long-term outcomes and the role of multidisciplinary care pose challenges. With an emphasis on quality-of-life enhancements and the handling of postoperative difficulties, the present narrative review seeks to compile the most recent findings on MBS while emphasizing the value of an integrated approach to maximize patient outcomes. Effective MBS and patients' management require a collaborative team approach, involving surgeons, dietitians, psychologists, pharmacists, and other healthcare providers to address not only physiological but also psychosocial patient needs. Comparative studies demonstrate the efficacy of various MBS methods, including Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy that may considerably decrease morbidity and mortality in individuals with obesity. Future studies should target long-term patient treatment, and decision making should be aided by knowledge of obesity, comorbidity recurrence rates, and permanence of benefits.

A gut microbial metabolite cocktail fights against obesity through modulating the gut microbiota and hepatic leptin signaling

BACKGROUND

Excessive body weight and obesity elevate the risk of chronic non-communicable diseases. The judicious application of the gut microbiome, encompassing both microorganisms and their derived compounds, holds considerable promise in the treatment of obesity.

RESULTS

In this study, we showed that a cocktail of gut microbiota-derived metabolites, comprising indole 3-propionic acid (IPA), sodium butyrate (SB) and valeric acid (VA), alleviated various symptoms of obesity in both male and female mice subjected to a high-fat diet (HFD). The 16S ribosomal RNA (rRNA) sequencing revealed that administering the cocktail via oral gavage retained the gut microbiota composition in obese mice. Fecal microbiota transplantation using cocktail-treated mice as donors mitigated the obesity phenotype of HFD-fed mice. Transcriptomic sequencing analysis showed that the cocktail preserved the gene expression profile of hepatic tissues in obese mice, especially up-regulated the expression level of leptin receptor. Gene delivery via in vivo fluid dynamics further validated that the anti-obesity efficacy of the cocktail was dependent on leptin signaling at least partly. The cocktail also inhibited the expression of appetite stimulators in hypothalamus. Together, the metabolite cocktail combated adiposity by retaining the gut microbiota configuration and activating the hepatic leptin signaling pathway.

CONCLUSIONS

Our findings provide a sophisticated regulatory network between the gut microbiome and host, and highlight a cocktail of gut microbiota-derived metabolites, including IPA, SB, and VA, might be a prospective intervention for anti-obesity in a preclinical setting. © 2024 Society of Chemical Industry.

Long-term effects of a lifestyle modification program for men with obesity delivered in German football clubs

This study examined the long-term effects of a lifestyle modification program delivered at German Bundesliga football clubs. Weekly 90-minute group sessions over 12 weeks combined health education and physical activity and were delivered by coaches affiliated with the football clubs. A total of 371 men (mean age 49.7 years [SD = 7.6]) attended 41 classes at 19 clubs in 2017 and 2018 and participated in the long-term follow-up. Primary outcome was weight-loss at follow-up with a mean observation period of 20.4 months after baseline. Measures were taken partly by research staff and partly by participants themselves. At baseline, the men had a mean weight of 111.3 kg (SD = 16.9). Three months after baseline (posttest), the men had lost a mean of 6.3 kg (95% CI: 5.7-6.9). From posttest to follow-up, growth curve model showed men lost an average of 0.8 kg (95% CI: 0.2-1.4). Weight regain from posttest to follow-up of at least 3% was observed in 75 participants (20.2%) and was associated with less improvement in vegetable consumption in an adjusted logistic regression model. The data suggest that participation in a male-only lifestyle modification program offered by German football clubs may lead to sustained weight loss, but lack of a randomized control group and drop-outs prevent generalization of the results.

Association of N-terminal pro-B natriuretic peptide with all-cause mortality and cardiovascular mortality in obese and non-obese populations and the development of a machine learning prediction model: National Health and Nutrition Examination Survey (NHANES) 1999-2004

AIMS

To explore the potential of N-terminal pro-B natriuretic peptide (NTproBNP) in identifying adverse outcomes, particularly cardiovascular adverse outcomes, in a population with obesity, and to establish a risk prediction model.

METHODS

The data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES) for 6772 participants without heart failure, for the years 1999 to 2004. Multivariable Cox regression models, cubic spline restricted models and Kaplan-Meier curves were used to evaluate the relationship between NTproBNP and both all-cause mortality and cardiovascular mortality. Predictive models were established using seven machine learning methods, and evaluation was conducted using precision, recall, F1 score, accuracy, and area under the curve (AUC) values.

RESULTS

During the population follow-up, out of 6772 participants, 1554 died, with 365 deaths attributed to cardiovascular disease. After adjusting for relevant covariates, NTproBNP levels ≥300 pg/mL were positively associated with both all-cause mortality (hazard ratio [HR] 3.00, 95% confidence interval [CI] 2.48, 3.67) and cardiovascular mortality (HR 6.05, 95% CI 3.67, 9.97), and remained significant across different body mass index (BMI) strata. However, in participants without abdominal obesity, the correlation between NTproBNP and cardiovascular mortality was significantly reduced. Among the seven machine learning methods, logistic regression demonstrated better predictive performance for both all-cause mortality (AUC 0.86925) and cardiovascular mortality (AUC 0.85115). However, establishing accurate cardiovascular mortality prediction models for non-abdominal obese individuals proved challenging.

CONCLUSION

The study showed that NTproBNP can serve as a predictive factor for all-cause mortality and cardiovascular mortality in individuals with different BMIs, including obese individuals. However, significant cardiovascular mortality correlation was observed only for NTproBNP levels ≥300 pg/mL, and only among participants with abdominal obesity.

Impact of daily fasting duration on body composition and cardiometabolic risk factors during a time-restricted eating protocol: a randomized controlled trial

BACKGROUND

Time-restricted eating (TRE) is a dietary regimen that limits food intake for at least 12 h daily. Unlike other fasting protocols, TRE does not dictate what or how much to eat but rather focuses on the timing of meals. This approach has been previously demonstrated to improve body composition in individuals with obesity or metabolic impairments. However, its impact on body composition and cardiometabolic factors in healthy individuals remains unclear. Furthermore, the optimal fasting duration is still debated. Thus, we aimed to compare the effects of 8 weeks of different fasting durations on body composition and biochemical parameters in metabolically healthy, non-trained individuals using a parallel randomized controlled trial.

METHODS

Forty-one volunteers were randomly assigned to one of the four experimental groups: TRE 16:8 (16 h of fasting,8 h of eating), TRE 14:10 (14 h of fasting,10 h of eating), TRE 12:12 (12 h of fasting,12 h of eating) or a normal diet group (ND; no dietary restriction). Participants underwent body composition measurements and blood tests for lipid profiles (i.e., total cholesterol, LDL, HDL, and triglycerides), fasting glucose, leptin, and anabolic hormones (i.e., insulin and testosterone) levels. Data were analyzed using both intention-to-treat (ITT) and per-protocol (PP) analysis to account for compliance. A two-way ANOVA for repeated measures was employed to assess interactions between time and group.

RESULTS

In the ITT analysis, TRE 16:8 reduced body mass (-2.46%, p = 0.003) and absolute fat mass (-8.65%, p = 0.001) with no changes in lean soft tissue and in calorie intake. These results were consistent with the PP analysis which included 8 participants in TRE 16:8, 5 in TRE 14:10, 9 in TRE 12:12, and the entire ND group. Participants in the TRE 16:8 group spontaneously reduced their total caloric intake, although this reduction was not statistically significant. None of the other measurements significantly changed after 8 weeks.

CONCLUSIONS

Our results suggest that a 16-hour fasting window, even without caloric restriction, may be a viable strategy for improving body composition in healthy and non-trained individuals, whereas a shorter fasting period may be insufficient to produce significant changes in a healthy population.

TRIAL REGISTRATION

NCT, NCT04503005. Registered 4 August 2020, https://clinicaltrials.gov/study/NCT04503005 .

Gut Microbiota-microRNA Interactions and Obesity Pathophysiology: A Systematic Review of Integrated Studies

Obesity is the fifth leading cause of death globally and its comorbidities put a high burden on societies and cause disability. In this review, we aim to summarize the interactions and crosstalk between gut microbiota and micro-RNA (miRNA) in obesity. We searched for the relevant literature through PubMed, Web of Science, Scopus, and Science Direct. The study design is registered in the international prospective register of systematic reviews (Prospero). According to the inclusion criteria, eight studies were eligible for assessment (two studies including human subjects and six studies including animal subjects). We report that the interactions of miRNA and gut microbiota in the context of obesity are diverse and in some cases tissue specific. However, the interactions mediate obesity-associated pathways including the inflammatory response, oxidative stress, insulin signaling, gut permeability, and lipogenesis. To mention the most meaningful results, the expression of adipose tissue miRNA-378a-3p/5p was associated with Bifidobacterium and Akkermansia abundance, the expression of hepatic miRNA-34a was related to the Firmicutes phylum, and the expression of miRNA-122-5p and miRNA-375 was associated with the Bacteroides genus. miRNA-microbiota-associated pathological pathways seem to provide an intricate, but promising field for future research directed toward the treatment of obesity and its comorbidities.

Effect of bariatric surgery on mitochondrial remodeling in human skeletal muscle: a narrative review

In the context of obesity epidemic as a major global public health challenge, bariatric surgery stands out for its significant and long-lasting effectiveness in addressing severe obesity and its associated comorbidities. Skeletal muscle mitochondrial function, which is crucial for maintaining metabolic health, tends to deteriorate with obesity. This review summarized current evidence on the effects of bariatric surgery on skeletal muscle mitochondrial function, with a focus on mitochondrial content, mitochondrial dynamics, mitochondrial respiration and mitochondrial markers in glucolipid metabolism. In conclusion, bariatric surgery impacts skeletal muscle through pathways related to mitochondrial function and induces mitochondrial remodeling in skeletal muscle in various aspects. Future studies should focus on standardized methodologies, larger sample sizes, and better control of confounding factors to further clarify the role of mitochondrial remodeling in the therapeutic benefits of bariatric surgery.

Association between major dietary patterns and obesity phenotypes in southwest China: baseline survey results from Hechuan

Background

This study aimed to identify the main dietary patterns in Hechuan and clarify how they are associated with obesity phenotypes.

Methods

A cross-sectional study was conducted based on a baseline survey of a general population cohort study in southwest China. A semi-quantitative food frequency questionnaire (FFQ) was used to investigate the dietary habits of the participants in the past year. Principal component analysis was conducted to identify the main dietary patterns, and multinomial logistic regression analysis was conducted to describe the association between the major dietary patterns and obesity phenotypes.

Results

Three major dietary patterns were identified. The participants who followed the wheaten food dietary pattern had a higher likelihood of having metabolically normal obesity (MHO) (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.02-1.08), metabolically abnormal normal weight (MUNW) (OR 1.08, 95%CI 1.00-1.16), and metabolically abnormal obesity (MUO) (OR 1.07, 95%CI 1.04-1.11). Specifically, those with the highest wheaten food dietary pattern were 1.60 times more likely to have MHO (OR 1.60, 95%CI 1.25-2.05), 2.62 times more likely to have MUNW (OR 2.62, 95%CI 1.28-5.37), and 2.01 times more likely to have MUO (OR 2.01, 95%CI 1.51-2.69) than those with the lowest wheaten food dietary pattern.

Conclusion

The wheaten food dietary pattern may increase the risk of obesity and metabolic abnormalities. Therefore, timely interventions should be carried out for this group of people.

Transvaginal natural orifice transluminal endoscopic surgery hysterectomy in patients with body mass index >50: An Asian experience

We present two cases of patients with body mass index (BMI) >50 undergoing transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy for gynecological indications. Case 1 involves a 52-year-old woman with post-menopausal bleeding and suspicion of ovarian torsion, while case 2 describes a patient with newly diagnosed endometrial adenocarcinoma. Both cases highlight the feasibility and challenges of vNOTES in this patient population. To date, this is the first paper to describe the use of vNOTES in patients of Asian ethnicity, with BMI >50.

A systematic review of obesity burden in Saudi Arabia: Prevalence and associated co-morbidities

Introduction

Saudi Arabia has experienced an increasing trend in obesity prevalence in the last three decades; obesity is a significant risk factor for non-communicable diseases, which may cause healthcare and economic burdens. In this systematic review, we aim to explore the obesity prevalence, obesity-related complications (ORCs), and the economic burden of obesity in Saudi Arabia.

Methods

Literature searches for relevant local studies across Saudi Arabia spanning 2012 to 2022 were performed in PubMed and EMBASE, along with supplementary searches for relevant congress abstracts. Only studies that discussed obesity prevalence in Saudi Arabia in relation to any gender or age group, the prevalence of ORCs in Saudi Arabia for any gender or age group, and/or the economic burden of obesity and how it impacts the healthcare system in Saudi Arabia, and were published in the English language, were selected for inclusion. No age or gender restrictions were imposed.

Results

The prevalence of obesity in Saudi Arabia ranged from 20% to 39% and up to 19.4% among adults and adolescents, respectively. The most reported ORCs were hypertension (67.6%), type 2 diabetes (60.7%), and hypercholesterolaemia (51.3%), and an association between obesity and ORCs was established, showing an increased risk with increasing body mass index. The economic burden of obesity across Saudi Arabia was estimated to be 6.4 billion US dollars (USD) for treatment and management.

Conclusion

Obesity affects a substantial proportion of the Saudi general population and is a significant burden on individuals, as demonstrated by the prevalence of ORCs. Multifaceted, short- and long-term approaches involving interventions that operate at multiple levels and target both individuals and communities are urgently needed; there is a particular need for a national strategy and a specific, systems-based policy. Further research will help increase awareness of obesity and its management, which will be crucial for transforming the healthcare system under Vision 2030.

Normative high resolution esophageal manometry values in asymptomatic patients with obesity

BACKGROUND

Surgical bariatric interventions, while highly effective, can be associated with post-operative esophageal symptoms, gastroesophageal reflux disease and esophageal dysmotility. Whether pre-operative physiology impacts this risk is unknown, in part because expected values on esophageal manometry in patients with obesity are not well understood. This study seeks to establish normative values on esophageal high resolution manometry (HRM) and the prevalence of esophageal dysmotility in the asymptomatic patient with obesity.

METHODS

This retrospective study included adult patients with body mass index (BMI) ≥35 kg m-2 without esophageal symptoms undergoing preoperative bariatric surgical evaluation, including HRM, at a single tertiary care center between February, 2019 and February, 2020.

RESULTS

Of 104 asymptomatic patients with obesity, HRM identified normal esophageal motility in 94 (90.4%) with the remaining 10 having ineffective esophageal motility (3.8%), manometric esophagogastric junction outflow obstruction (3.8%), distal esophageal spasm (1.0%), and hypercontractile esophagus (1.0%). Mean of median lower esophageal sphincter integrated relaxation pressure (LES IRP) was 10.6 mmHg supine (95th percentile 21.5 mmHg) and 8.5 mmHg upright (95th percentile 21.3 mmHg). 86% of patients had intragastric pressure above 8 mmHg. Mean of mean distal contractile integral (DCI) was 2261.6 mmHg cm s-1 (95th percentile 5889.5 mmHg cm s-1).

CONCLUSION

The vast majority of asymptomatic patients with obesity had normal manometry. LES IRP and DCI were higher than that observed in non-obese cohorts. Additionally, BMI correlated to increased intragastric pressure. These data suggest that normative values in patients with obesity should be adjusted to prevent overdiagnosis of EGJOO or hypercontractile esophagus.

Sestrin2 in POMC neurons modulates energy balance and obesity related metabolic disorders via mTOR signaling

Sestrin2 is a highly conserved protein that can be induced under various stress conditions. Researches have revealed that the signaling pathway of the mammalian target of rapamycin (mTOR) is essential in modulating both glucose and lipid metabolism. However, the precise involvement of Sestrin2 in the hypothalamus, particularly in pro-opiomelanocortin (POMC) neurons, in control of energy homeostasis remains uncertain. In this study, we aimed to investigate the functional role of Sestrin2 in hypothalamic POMC neurons in regulation of energy balance, as well as revealing the underlying mechanisms. Therefore, cre-dependent AAV virus encoding or silencing Sestrin2 was injected into the hypothalamic ARC of pomc-cre transgenic mice. The results demonstrated that Sestrin2 overexpression in POMC neurons ameliorated high-fat diet (HFD)-induced obesity and increased energy expenditure. Conversely, Sestrin2 deficiency in POMC neurons predisposed mice to HFD induced obesity. Additionally, the thermogenesis of brown adipose tissue and lipolysis of inguinal white adipose tissue were both enhanced by the increased sympathetic nerve innervation in Sestrin2 overexpressed mice. Further exploration revealed that Sestrin2 overexpression inhibited the mTOR signaling pathway in hypothalamic POMC neurons, which may account for the alleviation of systematic metabolic disturbance induced by HFD in these mice. Collectively, our findings demonstrate that Sestrin2 in POMC neurons plays a pivotal role in maintaining energy balance in a context of HFD-induced obesity by inhibiting the mTOR pathway, providing new insights into how hypothalamic neurons respond to nutritional signals to protect against obesity-associated metabolic dysfunction.

Effects of Lactiplantibacillus plantarum CBT LP3 and Bifidobacterium breve CBT BR3 supplementation on weight loss and gut microbiota of overweight dogs

The prevalence of obesity in dogs is increasing worldwide. This study evaluated the effects of a mixed probiotic formula on the weight, body condition score (BCS), blood metabolite profiles, and gut microbiota of overweight and obese dogs over a 12-week supplementation period to determine the anti-obesity effects of Lactiplantibacillus plantarum CBT LP3 and Bifidobacterium breve CBT BR3. This was a community-based, randomized study that sampled 41 overweight and obese dogs with a veterinarian-determined BCS of 6 or more. The physical activity of all the subjects was measured using a pedometer designed exclusively for dogs. The food intake was measured using the developed application. Only the treatment group received the mixed probiotic formula twice daily (3 g per dose). A significant decrease in body weight (p < 0.0001), BCS (p < 0.0001), serum TG (p < 0.0001), serum TC (p = 0.0400), and serum leptin (p = 0.0252), and a significantly increased serum adiponectin levels (p = 0.0007) were observed in the treatment group compared with the values in the control group. Microbiota analysis showed that Lactiplantibacillus increased and Erysipelatoclostridium, Staphylococcus, and Gemella decreased more significantly in the treatment group than in the control group. These results suggested that Lactiplantibacillus plantarum CBT LP3 and Bifidobacterium breve CBT BR3 may be effective in alleviating obesity in dogs.

Morus alba: natural and valuable effects in weight loss management

Overweight and obesity are conditions associated with serious comorbidities, such as diabetes and cardiovascular disease. Prevalence of excessive fat accumulation is increasing worldwide, and thus the need for efficient and sustainable weight loss regimes has become a major issue in clinical practice. Despite the important advances in the development of anti-obesity medications (AOM), their side effects, cost, and accessibility, are limiting factors for their routine use. Conversely, the studies of medicinal plants for weight management holds strong promise as a growing area of research. This review consolidates the representative evidence about the beneficial impacts of Morus alba on weight management and associated metabolic parameters, encompassing: inhibition of digestive enzymes, and thus contribution to the energy deficit required for weight loss, improvements in glucose and lipid metabolism, and attenuation of adiposity. Findings from in vitro, in vivo, and clinical investigations reviewed in the paper, demonstrate that white mulberry extracts have the potency to supplement efficiently and safely a healthy weight management approach.

Real-World Clinical Effectiveness of Liraglutide for Weight Management in Türkiye: Insights from the LIRA-TR Study

Introduction: Obesity is a complicated chronic disease associated with a series of other conditions. A weight loss of 5-10% has been shown to reduce obesity-related complications and improve quality of life. The efficacy and safety of liraglutide for reducing body weight have been demonstrated in clinical trials. This study evaluated the weight loss efficacy and adverse effects of liraglutide in those with obesity in the Turkish population. Methods: This is a retrospective cohort study; the patients that were included had a body mass index (BMI) of 27 or greater with additional comorbidities or a BMI of 30 or greater, and the patients were prescribed liraglutide for obesity treatment from the tertiary private clinic between January 2022 and January 2024. Their metabolic and anthropometric parameters were recorded at the initial appointment, and their body weight and adverse effects were followed up on during therapy. Results: For the 568 patients, of whom 487 (85.6%) were female, the mean values for age, weight, and BMI were 42.37 ± 10.50, 98.09 ± 17.48 kg, and 35.77 ± 5.45 kg/m2, respectively. Reductions in body weight at the 4th, 8th, 12th, and 24th weeks were 6.45 ± 2.32 kg, 10.66 ± 3.41 kg, 15.38 ± 8.30 kg, and 19 ± 9.06 kg, respectively; reductions in BMI at the 4th, 8th, 12th, and 24th weeks were 2.36 ± 1.00, 3.88 ± 1.25, 5.36 ± 1.76, and 7.09 ± 2.93, respectively; and the percentages of overall body weight loss at the 4th, 8th, 12th, and 24th weeks were 6.62 ± 2.1%, 10.75 ± 2.71%, 14.97 ± 6.8%, and 18.55 ± 4.63%, respectively (all p values < 0.0001). The percentage of patients who lost more than 5% and more than 10% of their initial weight was 100% at the 24th week. The most common side effect was nausea; no pancreatitis was observed. Conclusions: The results of our study indicate that liraglutide is an efficacious and safe treatment option for obesity in the Turkish population, in accordance with the findings from previous research.

A Saudi Heart Association Position Statement on Obesity and Cardiovascular Disease

Objectives

The obesity pandemic is a major public health concern in Saudi Arabia, with significant impact on cardiovascular disease (CVD). This position statement aims to provide an overview of available evidence as well as the recommendations of the Saudi Heart Association on the management of obesity associated with CVD.

Methods

Under the auspices of the Saudi Heart Association, a multidisciplinary expert panel comprised of cardiologists and endocrinologists discussed available evidence and provided recommendations on the management of obesity in CVD. The expert panel discussions occurred between September of 2023 and May of 2024 and also took into consideration local expertise in addition to published data in the management of obesity and CVD in the Kingdom of Saudi Arabia.

Results and conclusions

The expert panel explored studies on obesity and its implication on CVD assessment modalities, while also examining the efficacy and cardiovascular safety of available interventions for weight reduction. The association between obesity and CVD is undeniable. The treatment of obesity, be it through lifestyle changes, pharmacological therapy or surgery, is an effective strategy for both weight loss as well as the primary and secondary prevention of CVD. The Saudi Heart Association position statement thus provides guidance and recommendations for the management of obesity/overweight and CVD in Saudi Arabia. This position statement is expected to contribute towards obesity and CVD prevention efforts in Saudi Arabia by promoting adequate and time-appropriate treatment of these conditions.

Identification and characterization of circulating and adipose tissue infiltrated CD20+T cells from subjects with obesity that undergo bariatric surgery

T cells play critical roles in adipose tissue (AT) inflammation. The role of CD20+T cell in AT dysfunction and their contributing to insulin resistance (IR) and type 2 diabetes progression, is not known. The aim was to characterize CD20+T cells in omental (OAT), subcutaneous (SAT) and peripheral blood (PB) from subjects with obesity (OB, n = 42), by flow cytometry. Eight subjects were evaluated before (T1) and 12 months post (T2) bariatric/metabolic surgery (BMS). PB from subjects without obesity (nOB, n = 12) was also collected. Higher percentage of CD20+T cells was observed in OAT, compared to PB or SAT, in OB-T1. CD20 expression by PB CD4+T cells was inversely correlated with adiposity markers, while follicular-like CD20+T cells were positively correlated with impaired glucose tolerance (increased HbA1c). Notably, among OB-T1, IR establishment was marked by a lower percentage and absolute number of PB CD20+T cells, compared nOB. Obesity was associated with higher percentage of activated CD20+T cells; however, OAT-infiltrated CD20+T cells from OB-T1 with diabetes displayed the lowest activation. CD20+T cells infiltrating OAT from OB-T1 displayed a phenotype towards IFN-γ-producing Th1 and Tc1 cells. After BMS, the percentage of PB CD4+CD20+T cells increased, with reduced Th1 and increased Th17 phenotype. Whereas in OAT the percentage of CD20+T cells with Th1/17 and Tc1/17 phenotypes increased. Interestingly, OAT from OB pre/post BMS maintained higher frequency of effector memory CD20+T cells. In conclusion, CD20+T cells may play a prominent role in obesity-related AT inflammation.

A multiphase very-low calorie ketogenic diet improves serum redox balance by reducing oxidative status in obese patients

The very-low calorie ketogenic diet (VLCKD) is recommended as an effective dietary approach for the management of obesity. This study investigated changes in circulating biomarkers of redox homeostasis induced by a multiphase VLCKD in obese individuals. A total of 40 obese subjects were prescribed a multiphasic VLCKD for eleven weeks. Anthropometric measurements, body composition parameters, calorimetric measures, and standard laboratory markers of glucose and lipid metabolism were evaluated at baseline (T0) and at the end of the dietary intervention (T1). Additionally, circulating markers of oxidative damage and antioxidant status were analyzed in serum and erythrocytes. Compared to T0, at T1 the multiphase VLCKD induced significant weight loss and reduction of waist circumference, with beneficial effects on body composition parameters and the glucose/lipid biochemical profile. Moreover, a decrease in serum markers of oxidative damage was reported at T1, while no changes in serum markers of antioxidant status and in erythrocyte redox markers were observed. In addition, a significant association was found between variations in anthropometric measurements, body composition, glucose metabolism parameters, and changes in circulating markers of oxidative damage. Regression models showed that variation in lipofuscin was significant predictor of changes in body mass index, fat mass, visceral adiposity, and insulin sensitivity. In conclusion, this study demonstrated that the multiphase VLCKD improves serum redox balance by reducing markers of oxidative damage in obese individuals, highlighting the interplay between adiposity, glucose metabolism, and redox homeostasis in the pathogenesis of obesity. Furthermore, these data provide a rationale for future investigations aimed at testing serum lipofuscin as a reliable redox marker in obesity.

Bone health in adults with obesity before and after interventions to promote weight loss

Obesity and its associated comorbidities constitute a serious and growing public health burden. Fractures affect a substantial proportion of people with obesity and result from reduced bone strength relative to increased mechanical loading, together with an increased risk of falls. Factors contributing to fractures in people with obesity include adverse effects of adipose tissue on bone and muscle and, in many people, the coexistence of type 2 diabetes. Strategies to reduce weight include calorie-restricted diets, exercise, bariatric surgery, and pharmacological interventions with GLP-1 receptor agonists. However, although weight loss in people with obesity has many health benefits, it can also have adverse skeletal effects, with increased bone loss and fracture risk. Priorities for future research include the development of effective approaches to reduce fracture risk in people with obesity and the investigation of the effects of GLP-1 receptor agonists on bone loss resulting from weight reduction.

Combination of diethylpropion with dietary intervention results in body weight and fat loss with preserved muscle mass in obese patients

Combining pharmacotherapy with lifestyle intervention is recommended for obese class II patients who fail lifestyle therapy and for obese class I patients. Diethylpropion, an obesity medication, has been approved for use in Indonesia, which is an Asia-Pacific country. This retrospective study aimed to assess the short-term effects of diethylpropion on weight and fat loss in obese patients in Indonesia. Secondary data were collected from 142 patients' medical records with a body mass index ≥ 25 kg/m2 who underwent short-term diethylpropion treatment for 84 days between January 2022 and November 2023 at the Kimia Farma Nutrition Clinic in Bandung, Indonesia. Blood pressure, body weight, height, waist circumference, and body composition were assessed at each follow-up visit to determine the fat and muscle mass. Patients were prescribed diethylpropion 25 mg 3 times daily every 2 weeks together with dietary intervention. Kruskal-Wallis test was used to analyze the changes in body weight, skeletal muscle, fat mass, and waist circumference after the diethylpropion therapy. Mann-Whitney test was used for the relation between age, sex, and body mass index with weight loss on the last day of follow-up. Simple linear regression analysis was also performed to identify the correlation between weight loss and therapy duration. This study showed body weight reduction of up to 9.5 ± 3 kg (10 ± 0.0%) (P = .008) on 84 days of treatment. Significant fat loss 11.5 ± 4.6 kg (20.5 ± 0.0%) (P = .005) was also reported in our study without significant loss of muscle mass -2.4 ± 4.6 kg (3.6 ± 1.3%) (P = .58). Waist circumference was insignificantly reduced by 5.6 ± 0.0 cm (4.9 ± 2.8%) (P = .21) after 84 days of diethylpropion therapy. This study revealed no significant changes in patient systolic and diastolic pressures despite showing mild increases after 70 days. The combination of diethylpropion and an appropriate diet resulted in weight loss accompanied by significant fat loss and preserved muscle mass without an increase in blood pressure during the 12-week treatment period.

Molecular Mechanisms Affecting Statin Pharmacokinetics after Bariatric Surgery

According to recent data, one in eight people in the world struggle with obesity. Obesity management is increasingly dependent on bariatric surgical interventions, as the combination of lifestyle modifications and pharmacotherapy could have a modest long-term effect. Surgery is recommended only for individuals whose body mass index (BMI) ≥ 40 kg/m2 and ≥ 35 kg/m2 in the presence of weight-related comorbidities. The most commonly performed procedures are sleeve gastrectomy and roux-en-Y gastric bypass. Pharmacokinetic and pharmacodynamic alterations occur as a result of the anatomical and physiological changes caused by surgery, which further differ depending on physicochemical drug factors and factors related to the dosage form. The following modifications are distinguished based on the type of bariatric surgery performed. Most bariatric patients have accompanying comorbidities, including dyslipidemia treated with hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors or statins. Significant improvements in the lipid profile are observed early in the postoperative period. The data reported in this review on statin pharmacokinetic alterations have demonstrated substantial inter- and intravariability, making it difficult to adopt clear guidelines. Based on the current literature review, reducing the statin dose to the lowest effective with continuous monitoring is considered an optimal approach in clinical practice.

Capsinoids Increase Antioxidative Enzyme Activity and Prevent Obesity-Induced Cardiac Injury without Positively Modulating Body Fat Accumulation and Cardiac Oxidative Biomarkers

BACKGROUND/OBJECTIVES

Capsinoids are potential antioxidant agents capable of reducing oxidative damage and the resulting complications triggered by obesity. Thus, this study aimed to investigate the effects of capsinoids on adiposity and biomarkers of cardiac oxidative stress in obese rats induced by a high-fat diet.

METHODS

Male Wistar rats were exposed to a high-fat diet for 27 consecutive weeks. After the characterization of obesity (week 19), some of the obese animals began to receive capsinoids (10 mg/kg/day) by orogastric gavage. Adiposity and comorbidities were assessed. In the heart, remodeling, injury, and biomarkers of oxidative stress were determined.

RESULTS

The treatment did not reduce obesity-induced adiposity but was efficient in reducing cholesterol levels. Capsinoid treatment did not cause a difference in heart and LV mass, despite having reduced troponin I concentrations. Furthermore, capsinoids did not reduce the increase in the advanced oxidation of protein products and carbonylated proteins caused by obesity in cardiac tissue. In addition, obese rats treated with capsinoids presented high levels of malondialdehyde and greater antioxidant enzyme activity compared to untreated obese rats.

CONCLUSIONS

In conclusion, treatment with capsinoids increases antioxidative enzyme activity and prevents obesity-induced cardiac injury without positively modulating body fat accumulation and cardiac oxidative biomarkers.

The Impact of Ten Days of Periodic Fasting on the Modulation of the Longevity Gene in Overweight and Obese Individuals: A Quasi-Experimental Study

BACKGROUND

Fasting potentially alters the aging process induced by obesity by regulating telomere integrity, which is related to longevity genes. However, the impact of periodic fasting (PF) on the expression of longevity genes, particularly Forkhead Box O Transcription Factors (FOXO3a) and the Human Telomerase Reverse Transcriptase (hTERT), is not fully understood. This study aimed to analyze the effects of PF, specifically on FOXO3a, hTERT expression, and other associated factors.

METHODS

A quasi-experimental 10-day study was conducted in Surabaya, East Java, Indonesia. This study consisted of an intervention group (PFG), which carried out PF for ten days using a daily 12 h time-restricted eating protocol, and a control group (CG), which had daily meals as usual. FOXO3a and hTERT expression were analyzed by quantitative real-time qPCR. A paired t-test/Wilcoxon test, independent t-test/Mann-Whitney U-test, and Spearman's correlation test were used for statistical analysis.

RESULT

Thirty-six young men participated in this study. During the post-test period, FOXO3a expression in the PFG increased 28.56 (±114.05) times compared to the pre-test, but the difference was not significant. hTERT expression was significantly higher in both the CG and PFG. The hTERT expression in the PFG was 10.26 (±8.46) times higher than in the CG, which was only 4.73 (±4.81) times higher. There was also a positive relationship between FOXO and hTERT in the CG.

CONCLUSIONS

PF significantly increased hTERT expression in the PFG; however, no significant increase was found in FOXO3a expression. PF regimens using the 12 h time-restricted eating approach may become a potential strategy for preventing obesity-induced premature aging by regulating longevity gene expression.

Endothelin-1 down-regulates nuclear factor erythroid 2-related factor-2 and contributes to perivascular adipose tissue dysfunction in obesity

Perivascular adipose tissue (PVAT) negatively regulates vascular muscle contraction. However, in the context of obesity, the PVAT releases vasoconstrictor substances that detrimentally affect vascular function. A pivotal player in this scenario is the peptide endothelin-1 (ET-1), which induces oxidative stress and disrupts vascular function. The present study postulates that obesity augments ET-1 production in the PVAT, decreases the function of the nuclear factor erythroid 2-related factor-2 (Nrf2) transcription factor, further increasing reactive oxygen species (ROS) generation, culminating in PVAT dysfunction. Male C57BL/6 mice were fed either a standard or a high-fat diet for 16 weeks. Mice were also treated with saline or a daily dose of 100 mg·kg-1 of the ETA and ETB receptor antagonist Bosentan, for 7 days. Vascular function was evaluated in thoracic aortic rings, with and without PVAT. Mechanistic studies utilized PVAT from all groups and cultured WT-1 mouse brown adipocytes. PVAT from obese mice exhibited increased ET-1 production, increased ECE1 and ETA gene expression, loss of the anticontractile effect, as well as increased ROS production, decreased Nrf2 activity, and downregulated expression of Nrf2-targeted antioxidant genes. PVAT of obese mice also exhibited increased expression of Tyr216-phosphorylated-GSK3β and KEAP1, but not BACH1 - negative Nrf2 regulators. Bosentan treatment reversed all these effects. Similarly, ET-1 increased ROS generation and decreased Nrf2 activity in brown adipocytes, events mitigated by BQ123 (ETA receptor antagonist). These findings place ET-1 as a major contributor to PVAT dysfunction in obesity and highlight that pharmacological control of ET-1 effects restores PVAT's cardiovascular protective role.

Differentiating monogenic and syndromic obesities from polygenic obesity: Assessment, diagnosis, and management

Background

Obesity is a multifactorial neurohormonal disease that results from dysfunction within energy regulation pathways and is associated with increased morbidity, mortality, and reduced quality of life. The most common form is polygenic obesity, which results from interactions between multiple gene variants and environmental factors. Highly penetrant monogenic and syndromic obesities result from rare genetic variants with minimal environmental influence and can be differentiated from polygenic obesity depending on key symptoms, including hyperphagia; early-onset, severe obesity; and suboptimal responses to nontargeted therapies. Timely diagnosis of monogenic or syndromic obesity is critical to inform management strategies and reduce disease burden. We outline the physiology of weight regulation, role of genetics in obesity, and differentiating characteristics between polygenic and rare genetic obesity to facilitate diagnosis and transition toward targeted therapies.

Methods

In this narrative review, we focused on case reports, case studies, and natural history studies of patients with monogenic and syndromic obesities and clinical trials examining the efficacy, safety, and quality of life impact of nontargeted and targeted therapies in these populations. We also provide comprehensive algorithms for diagnosis of patients with suspected rare genetic causes of obesity.

Results

Patients with monogenic and syndromic obesities commonly present with hyperphagia (ie, pathologic, insatiable hunger) and early-onset, severe obesity, and the presence of hallmark characteristics can inform genetic testing and diagnostic approach. Following diagnosis, specialized care teams can address complex symptoms, and hyperphagia is managed behaviorally. Various pharmacotherapies show promise in these patient populations, including setmelanotide and glucagon-like peptide-1 receptor agonists.

Conclusion

Understanding the pathophysiology and differentiating characteristics of monogenic and syndromic obesities can facilitate diagnosis and management and has led to development of targeted pharmacotherapies with demonstrated efficacy for reducing body weight and hunger in the affected populations.

Improving dietary patterns in obese mice: Effects on body weight, adiposity, anhedonia-like behavior, pro-BDNF expression and 5-HT system

INTRODUCTION

The excessive fat accumulation in obesity, resulting from an unbalanced diet, can lead to metabolic and neurological disorders and increase the risk of developing anxiety and depression.

AIM

Assess the impact of dietary intervention (DI) on the serotonergic system, brain-derived neurotrophic factor (BDNF) expression and behaviors of obese mice.

METHODS

Male C57BL/6 mice, 5 weeks old, received a high-fat diet (HFD) for 10 weeks for the induction of obesity. After this period, for 8 weeks, half of these animals received a control diet (CD), group obese (OB) + control diet (OB + CD, n = 10), and another half continued being fed HFD, group obese + HFD (OB + HFD, n = 10). At the end of the eighth week of intervention, behavioral tests were performed (sucrose preference test, open field, novel object recognition, elevated plus maze and tail suspension). Body weight and food intake were assessed weekly. Visceral adiposity, the hippocampal and hypothalamic protein expression of BDNF, 5-HT1A (5-HT1A serotonin receptor) and TPH2 (key enzyme in serotonin synthesis), were evaluated after euthanasia.

RESULTS

The dietary intervention involved changing from a HFD to a CD over an 8-week period, effectively reduced body weight gain, adiposity, and anhedonia-like behavior. In the OB + HFD group, we saw a lower sucrose preference and shorter traveled distance in the open field, along with increased pro-BDNF expression in the hypothalamus compared to the OB + CD mice. However, the levels of TPH2 and 5-HT1A remained unchanged.

CONCLUSION

The HFD model induced both obesity and anhedonia, but the dietary intervention successfully improved these conditions.

The association of weight-adjusted waist index with the risk of osteoporosis in patients with type 2 diabetes: a cross-sectional study

BACKGROUND

The relationship between obesity and type 2 diabetes with bone health has always been a topic of debate. The weight-adjusted waist index has become a commonly used indicator for assessing central obesity, fat, and muscle mass. However, currently there is no research reporting the association between weight-adjusted waist index and risk of osteoporosis in populations of type 2 diabetes. Therefore, this study aims to provide new information on the association between weight-adjusted waist index and risk of osteoporosis in type 2 diabetes.

METHODS

This cross-sectional study involved 963 patients with type 2 diabetes who were admitted to the Department of Endocrinology of Cangzhou Central Hospital. Multivariate logistic regression models were used to assess the association between weight-adjusted waist index and osteoporosis. The potential nonlinear association was evaluated. The effects of interaction between subgroups were assessed using the likelihood ratio test.

RESULTS

Weight-adjusted waist index was positively associated with the risk of osteoporosis, regardless of traditional confounding factors. For each 1 unit increased in weight-adjusted waist index, the risk of osteoporosis increased by 67%. Furthermore, there was a nonlinear relationship between weight-adjusted waist index and osteoporosis. The subgroup analysis did not reveal any significant interactions.

CONCLUSIONS

Our study indicated a positive association between weight-adjusted waist index and the risk of osteoporosis in adult Chinese type 2 diabetes patients, and this relationship was nonlinear.

Isokinetic Knee Strengthening Impact on Physical and Functional Performance, Pain Tolerance, and Quality of Life in Overweight/Obese Women with Patellofemoral Pain Syndrome

Background/Objectives: Patellofemoral syndrome is a common osteoarticular condition that affects many individuals. Various treatment options are available, with a significant emphasis on targeted muscle-strengthening exercises. The purpose of this study was to investigate the effect of isokinetic muscle strengthening on muscle strength, joint range of motion, quality of life, physical performance, and pain tolerance in overweight/obese women with patellofemoral syndrome. Methods: Twenty-four overweight or obese women with patellofemoral syndrome participated in the study during September and October 2023 in a private medical facility for physical medicine and functional rehabilitation. They were randomly assigned to one of two groups for six weeks of isokinetic muscle strengthening. The first group (ISO.G) followed a rehabilitation program combined with isokinetic muscle strengthening. A second group (PCM.G) followed a rehabilitation program that includes an isokinetic protocol in passive compensation movement. The extensors' peak torque was measured before and after training. Results: The flexors' peak torque, stair climbing test, 10 m walk, chair lift, monopodal support, goniometric knee flexion test, heel-buttock distance measurement, pain, and quality of life scores improved significantly in both groups. The ISO.G, on the other hand, benefited from a significant increase in quadriceps muscle strength revealed by the extensors' peak torque. Conclusions: For the treatment of patellofemoral syndrome, isokinetic muscle strengthening in concentric mode appears to have a significant advantage over the classic rehabilitation program with isokinetic passive compensation, particularly in muscle strength gain, in addition to the improvement of joint range of motion, quality of life, physical performance, and pain tolerance. Isokinetic training may be recommended as a beneficial approach for the rehabilitative treatment of patellofemoral pain syndrome in overweight/obese women.

Clinical Characteristics of Overweight Patients With Acute Exacerbation Chronic Obstructive Pulmonary Disease (AECOPD)

INTRODUCTION

Low body weight in patients with COPD is associated with a poor prognosis and more comorbidities. However, the impact of increased body weight in patients with COPD remains controversial. The aim of this study was to explore the clinical features of overweight patients with AECOPD.

METHODS

In this multicenter cross-sectional study, a total of 647 AECOPD patients were recruited. Finally, 269 normal weight and 162 overweight patients were included. Baseline characteristics and clinical and laboratory data were collected. The least absolute shrinkage and selection operator (LASSO) regression was performed to determine potential features, which were substituted into binary logistic regression to reveal overweight-associated clinical features. The nomogram and its associated curves were established to visualize and verify the logistic regression model.

RESULTS

Six potential overweight-associated variables were selected by LASSO regression. Subsequently, a binary logistic regression model identified that the rates of type 2 diabetes (T2DM) and hypertension and levels of lymphocytes (LYM)%, and alanine aminotransferase (ALT) were independent variables of overweight in AECOPD patients. The C-index and AUC of the ROC curve of the nomogram were 0.671 and 0.666, respectively. The DCA curve revealed that the nomogram had more clinical benefits if the threshold was at a range of 0.22~0.78.

CONCLUSIONS

Collectively, we revealed that T2DM and hypertension were more common, and LYM% and ALT were higher in AECOPD patients with overweight than those with normal weight. The result suggests that AECOPD patients with overweight are at risk for additional comorbidities, potentially leading to worse outcomes.

Tetrahydroberberrubine exhibits preventive effect on obesity by activating PGC1α-mediated thermogenesis in white and brown adipose tissue

The escalating prevalence of obesity presents formidable challenges, necessitating the development of effective therapeutic strategies. In this study, we aimed to elucidate the preventive effects on obesity of tetrahydroberberrubine (THBru), a derivative of berberine (BBR) and to unravel its underlying mechanism. Using an obese mouse model induced by a high-fat diet (HFD), THBru was found to markedly ameliorate obesity, as evidenced by reduced body weight, decreased Lee's index, diminished fat mass in epididymal white adipose tissue (WAT) and brown adipose tissue (BAT), alongside improved dyslipidemia. Notably, at the same dose, THBru exhibited superior efficacy compared to BBR. RNA-sequencing and gene set enrichment analysis indicated THBru activated thermogenesis, which was further confirmed in WAT, BAT, and 3T3-L1 cells. Bioinformatics analysis of RNA-sequencing data revealed the candidate gene Pgc1α, a key regulator involved in thermogenesis. Moreover, THBru was demonstrated to elevate the expression of PGC1α by stabilizing its mRNA in WAT, BAT and 3T3-L1 cells. Furthermore, PGC1α knockdown blocked the pro-thermogenic and anti-obesity action of THBru both in vivo and in vitro. This study unravels the preventive effects of THBru on obesity through the activation of PGC1α-mediated thermogenesis, thereby delineating its potential therapeutic implications for obesity and associated disorders.