Prevalence of overweight and obesity in China: Results from a cross-sectional study of 441 thousand adults, 2012-2015

Prevalence of overweight and obesity in adults from the Middle East: A large-scale population-based study

AIMS

Although there are population-level estimates of the prevalence of overweight and obesity (OAO), there are few direct epidemiological surveys of OAO prevalence at scale.

MATERIALS AND METHODS

This was a cross-sectional, multi-centre, population-based study of all adults aged >18 years attending the Dubai Academic Health Corporation (DAHC) between January 2018 and August 2023. OAO was defined according to WHO standards or modified WHO cut points for individuals from WHO South-East Asian Region (SEAR) countries. Clinical obesity, defined according to new Lancet Commission diagnostic criteria, was estimated using ICD-10 codes corresponding to end-organ dysfunction.

RESULTS

Of 440 590 participants, 48.5% were female, 52% were aged 19-39 years and 37.1% were UAE nationals. 63.4% of the population were living with OAO. Significantly more UAE nationals (68.3%) were living with OAO than nationals from SEAR countries (59.7%, p < 0.001) or elsewhere (63.6%, respectively, p < 0.001). Significantly more females than males were living with obesity (30.4% vs. 25.9%, p < 0.001). About a half of female UAE nationals aged ≥40 years were living with obesity, about one in five of whom had class 2 or class 3 obesity. Using modified ethnicity-specific thresholds increased the overall proportion of people living with obesity in the UAE from 28.0% to 35.8%. About a third of individuals with a body mass index ≥40 kg/m2 also had signs or symptoms of ongoing organ dysfunction classifiable as clinical obesity.

CONCLUSIONS

This is the largest epidemiological study to provide direct prevalence data on OAO at this scale in the region and one of the largest globally. Using standard WHO cut points to define OAO may severely underestimate the prevalence of clinically actionable obesity in individuals of Southeast Asian ethnicity. This first application of new diagnostic criteria of clinical obesity suggests that some individuals may be disqualified from therapy who might otherwise benefit from a patient-centric approach.

Natural selection shaped the protective effect of the mtDNA lineage against obesity in Han Chinese populations

Mitochondria play a key role in lipid metabolism, and mitochondrial DNA (mtDNA) mutations are thus considered to affect obesity susceptibility by altering oxidative phosphorylation and mitochondrial function. In this study, we investigate mtDNA variants that may affect obesity risk in 2877 Han Chinese individuals from 3 independent populations. The association analysis of 16 basal mtDNA haplogroups with body mass index, waist circumference, and waist-to-hip ratio reveals that only haplogroup M7 is significantly negatively correlated with all three adiposity-related anthropometric traits in the overall cohort, verified by the analysis of a single population, i.e., the Zhengzhou population. Furthermore, subhaplogroup analysis suggests that M7b1a1 is the most likely haplogroup associated with a decreased obesity risk, and the variation T12811C (causing Y159H in ND5) harbored in M7b1a1 may be the most likely candidate for altering the mitochondrial function. Specifically, we find that proportionally more nonsynonymous mutations accumulate in M7b1a1 carriers, indicating that M7b1a1 is either under positive selection or subject to a relaxation of selective constraints. We also find that nuclear variants, especially in DACT2 and PIEZO1, may functionally interact with M7b1a1.

Developmental Trends of Metabolic Syndrome in the Past Two Decades: A Narrative Review

Background/Objectives: Metabolic syndrome (MetS) is a complex disorder characterized by insulin resistance (IR), central obesity, atherogenic dyslipidemia, and higher glucose levels. It increases the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM), imposing an economic burden on the healthcare system. However, the historical origins of MetS as well as the development and evolution of its definitions have not been conclusively documented in the literature. This study seeks to enhance the understanding of the developmental trends of MetS during the preceding two decades, placing particular emphasis on the definition, diagnosis and prevalence. Methods: An extensive search was performed from 1920 to 2023 across prominent scientific research engines, including Scopus, PubMed, MDPI, and others. Results: Despite advancements, many aspects of MetS remain inadequately understood. As the understanding of the nature and pathophysiology of MetS progresses, the development and refinement of its diagnostic criteria, and assessment and treatment guidelines will continue. Additionally, there exists significant variation in the global prevalence of metabolic syndrome, ranging from 14 to 39%. This prevalence is projected to increase due to the adoption of less healthy dietary patterns and sedentary lifestyles. The observed disparities in metabolic syndrome prevalence can be attributed to multiple factors, including demographic characteristics. Furthermore, the lack of a standardized definition across studies also contributes to the variation in reported prevalence rates. Conclusions: Further studies focusing on the standardization of the MetS definition across different research are crucial. The establishment of consistent criteria would enhance the reliability and validity of research findings, enabling more meaningful comparisons and interpretations.

Air Pollution and Diabetes Mellitus: Association and Validation in a Desert Area in China

CONTEXT

Despite the growing evidence pointing to the detrimental effects of air pollution on diabetes mellitus (DM), the relationship remains poorly explored, especially in desert-adjacent areas characterized by high aridity and pollution.

OBJECTIVE

We conducted a cross-sectional study with health examination data from more than 2.9 million adults in 2 regions situated in the southern part of the Taklamakan Desert, China.

METHODS

We assessed 3-year average concentrations (2018-2020) of particulate matter (PM1, PM2.5, and PM10), carbon monoxide (CO), nitrogen dioxide (NO2), and sulfur dioxide (SO2) through a space-time extra-trees model. After adjusting for various covariates, we employed generalized linear mixed models to evaluate the association between exposure to air pollutants and DM.

RESULTS

The odds ratios for DM associated with a 10 µg/m3 increase in PM1, PM2.5, PM10, CO, and NO2 were 1.898 (95% CI, 1.741-2.070), 1.07 (95% CI, 1.053-1.086), 1.013 (95% CI, 1.008-1.018), 1.009 (95% CI, 1.007-1.011), and 1.337 (95% CI, 1.234-1.449), respectively. Notably, men, individuals aged 50 years or older, those with lower educational attainment, nonsmokers, and those not engaging in physical exercise appeared to be more susceptible to the adverse effects of air pollution. Multiple sensitivity analyses confirmed the stability of these findings.

CONCLUSION

Our study provides robust evidence of a correlation between prolonged exposure to air pollution and the prevalence of DM among individuals living in desert-adjacent areas. This research contributes to the expanding knowledge on the relationship between air pollution exposure and DM prevalence in desert-adjacent areas.

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

Background

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

Methods

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

Results

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

Conclusion

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

Triglyceride-glucose index (TyG) as a novel biomarker in the era of cardiometabolic medicine

In the period of increasing prevalence of metabolic disorders such as obesity and diabetes, healthcare professionals are facing significant challenges. Therefore, an accurate global assessment of insulin resistance is of utmost importance. Current medical research is focused on identifying an easily accessible and reproducible gold-standard surrogate marker for insulin resistance. Ideally, such a marker would enable healthcare providers to predict the risk of type 2 diabetes and cardiovascular diseases. The triglyceride-glucose index (TyG) is a promising marker for preventive cardiology and cardiometabolic medicine. This narrative review article aims to provide a comprehensive evaluation of the credibility of TyG as a surrogate marker of insulin resistance among patients at different stages across the cardiometabolic continuum. This assessment fully complies with evidence-based medicine and offers valuable insight into the clinical utility of TyG.

Effect of marriage on overweight and obesity: evidence from China

BACKGROUND

The number of overweight and obese people in China is showing a rapidly rising trend. Exploring the reasons behind this phenomenon is an urgent academic topic. This study aims to evaluate the effect of marriage on overweight and obesity in China.

METHODS

A total of 44,095 samples were analyzed Data came from China Family Panel Studies (CFPS), a national, large-scale, multidisciplinary social tracking survey. Four periods of panel data were used and fixed effects regression was performed. Overweight and obesity were defined as BMI ≥ 24 kg/m2 and BMI ≥ 28 kg/m2, respectively.

RESULTS

Marriage significantly increases the probability of being overweight (6.5%, p < 0.01) and obese (2.8%, p < 0.01). An important influencing factor is the reduction of exercise behavior after marriage; that is, marriage reduces exercise time but has no significant effect on drinking. Additionally, we see a greater impact on those aged between 20 and 30, but it has no significant effect on those aged between 40 and 50.

CONCLUSION

Marriage is an important socioeconomic factor that led to overweight and obesity. It is urgent to encourage married people to control their weight and government health departments should provide more convenient exercise facilities.

Prevalence and inequalities of obesity and associated complications in China: A multicentre nationwide survey

OBJECTIVES

Obesity is a risk factor for chronic diseases. The prevalence of obesity is rapidly increase and a significant social inequality exists. This study aimed to analyse obesity prevalence and complications in different regions and occupations in China.

STUDY DESIGN

Multicentre cross-sectional study.

METHODS

Data from 62,893 adults in 10 Chinese provinces were collected in 2022. Measures included body mass index (BMI), metabolic status and complications. Analysis was stratified by gender, age, region and occupation, with results adjusted for age and gender.

RESULTS

The average BMI was 23.81 ± 3.42 kg/m2, with overweight and obesity prevalence at 34.29 % and 11.24 %, respectively. North China had the highest obesity rate (27.93 %), followed by West (26.64 %), South (25.37 %) and East China (20.06 %). Functionaries (e.g. as civil servants, corporate executives) had higher BMI than employees or intellectual professionals, while workers had higher BMI than farmers. Intellectual professionals had the lowest rates of metabolically healthy obesity (MHO) at 4.90 % and metabolically unhealthy obesity (MUO) at 3.47 %, followed by employees (MHO 6.63 %, MUO 4.45 %) and functionaries (MHO 6.74 %, MUO 4.94 %). Workers had the highest MHO prevalence rate at 8.51 %, while farmers had the highest MUO rate at 6.16 %. Obesity-associated complications were 1.5-3 times more common among obese individuals than those in the normal BMI category, with inequality observed across different occupational groups.

CONCLUSIONS

In China, a large number of adults with obesity have poor metabolic health, highlighting the importance of considering metabolic status when addressing obesity-related chronic diseases. Addressing the inequality in obesity rates can inform public health strategies to tackle the increasing problem of obesity and its associated complications in China.

Preferences of Individuals With Obesity for Online Medical Consultation in Different Demand Scenarios: Discrete Choice Experiments

BACKGROUND

Obesity is a unique chronic disease, with China having the largest number of people living with overweight and obesity in the world. There has been little research from the demand perspective for online medical consultation (OMC) by individuals living with obesity. With the growing demand for obesity OMC, especially due to the emergence of new pharmacotherapies, such as glucagon-like peptide-1 receptor agonists, individuals living with obesity are seeking both advice on obesity management and the prescription of obesity drugs. Therefore, our demand scenarios defined 2 OMC motivations to manage obesity: "For-Drugs" use and "For-Advice" use.

OBJECTIVE

This study aims to assess and compare the preferences for For-Drugs and For-Advice OMC among individuals living with obesity in China.

METHODS

Following the International Society for Pharmacoeconomics and Outcomes Research's checklist and comprising 400 participants assigned to the For-Drugs scenario and 400 to the For-Advice scenario, the For-Drugs and For-Advice preferences were estimated through discrete choice experiments. The groups in the 2 scenarios followed a similar distribution, and the 2 different demand scenarios shared the same discrete choice experiment design, comprising 16 choice sets with 6 representative attributes. Mixed logit modeling was used to estimate the willingness to pay and relative importance scores.

RESULTS

Doctors with well-known and general expert titles, versus ordinary doctors; doctors from high-level, provincial, tertiary, and municipal hospitals, versus lower-level county hospitals; less waiting time; and lower OMC fees were preferred in both the For-Drugs and For-Advice scenarios. The differences between the 2 scenarios lay in the consultation format, consultation duration, and the relative importance of consultation duration versus waiting time. The For-Advice group preferred telephone consultations, while the For-Drugs group did not; the For-Drugs group preferred longer consultation duration (β=.029), while the For-Advice group preferred shorter consultation duration (β=-.030); and the For-Drugs group rated consultation duration higher than waiting time, while the For-Advice group rated the waiting time as more important than consultation duration. Combined with our qualitative research, the differences can be explained by the different consultation needs in the 2 scenarios, where longer patient consultations were preferred by the For-Drugs patients who sought detailed advice on drug side effects, while quick and direct responses were preferred by the For-Advice participants.

CONCLUSIONS

By revealing user preferences on costs, doctors' titles and hospital level, wait time, and consultation duration and format, our research informs OMC platforms, OMC regulators, and doctors on market segmentation and service differentiation strategies.

Gallbladder cancer incidence and mortality rate trends in China: analysis of data from the population-based cancer registry

BACKGROUND

Gallbladder cancer is a major health concern in China, and awareness of the associated incidence and mortality rates is particularly important given the aging population.

OBJECTIVE

To determine trends in gallbladder cancer incidence and mortality rates over 12 years and quantitatively analyze the influence of demographic factors on these rates in China.

METHODS

We performed a retrospective study of 98,860 Chinese citizens using the Chinese Cancer Registry, a national database. Gallbladder cancer incidence and mortality data pertaining to patients treated between 2005 and 2017 were collected. Joinpoint regression models were used to estimate the annual percentage change (APC) and average APC (AAPC). We used age-period-cohort analyses and decomposition methods to investigate differing trends in incidence and mortality.

RESULTS

The age-standardized gallbladder cancer incidence and mortality rates in China trended downward between 2005 and 2017, with AAPCs of -2.023% and -1.603%, respectively. Coefficients of age effect for incidence rate increased with age up to 70 years and peaked at 70-79 years, while coefficients of age effect for the mortality rate showed a consistent increase with age. Both coefficients of period for incidence and mortality rates increased in more recent periods; in terms of the cohort effect, coefficients of cohort for rates generally decreased in later birth years but showed a partial rise between 1982 and 1996. The crude incidence rates of gallbladder cancer according to demographic and non-demographic factors were 626.09% and -526.09% respectively (366.23% and -266.23% among men, and 6068.93% and -5968.93% among women, respectively). The rates were 543.01% and -443.01%, respectively, in urban areas and were 68.22% and 31.78%, respectively, in rural areas. The mortality rates according to demographic and non-demographic factors were -495.93% and 595.93%, respectively (-1763.10% and -1863.10% for men and -270.56% and -370.56% for women, respectively). These rates were -930.33% and 1030.33%, respectively, in urban areas and were 101.48% and -1.48%, respectively, in rural areas.

CONCLUSIONS

The overall standardized gallbladder cancer incidence and mortality rates in China are trending downward, but not sufficiently so. Proper living and eating habits should be encouraged while exploring the establishment of long-term, standardized gallbladder cancer screening programs.

Evaluation of measurement properties of the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) instrument among Chinese overweight and obese populations

PURPOSE

To evaluate measurement properties of the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) instrument among Chinese overweight and obese populations.

METHODS

A representative sample of Chinese overweight and obese populations was recruited stratified by age, sex, residence and body mass index (BMI). Social-demographic characteristics, self-reported EQ-5D-5 L and IWQOL-Lite responses were collected through the online survey. Test-retest reliability was assessed using intraclass correlation coefficient (ICC) among a subgroup of the total sample. Structural validity was evaluated by confirmatory factor analysis (CFA). Convergent validity and known-group validity were examined using Spearman's rank correlation and effect sizes, respectively.

RESULTS

A total of 1000 respondents (48% female; mean age: 51.7 years; mean BMI: 27.4) were included in this study. Ceiling and floor effects of the IWQOL-Lite were 5.4% and 0.67%, respectively. The ICC between the two tests was 0.992 for IWQOL-Lite among the subgroup (N = 150). The results of the CFA suggested that the five-factor model had an acceptable structural validity (GFI = 0.894, CFI = 0.960, TLI = 0.957, RMSEA = 0.054 and SRMR = 0.033). The Spearman's rank correlation (range: 0.413-0.611) indicated a satisfactory convergent validity. The effect sizes values of IWQOL-Lite total score and different dimensions were moderate.

CONCLUSIONS

The IWQOL-Lite has been demonstrated to have satisfactory validity and reliability in measuring the HRQoL of Chinese overweight and obese populations. Further research is needed to confirm the sensitivity and responsiveness.

Cardiovascular Risk across Glycemic Categories: Insights from a Nationwide Screening in Mongolia, 2022-2023

(1) Background: Diabetes mellitus is a significant risk factor for cardiovascular disease (CVD), a leading cause of death globally. Recent studies have highlighted the role of pre-diabetes, particularly impaired fasting glucose (IFG), in elevating CVD risk even before the onset of diabetes. The objective of this study was to assess cardiovascular disease (CVD) risk across specific glycemic categories, including normoglycemia, impaired fasting glucose (IFG), newly diagnosed diabetes, and long-standing diabetes, in a large Mongolian population sample. (2) Methods: This cross-sectional study utilized data from a nationwide health screening program in Mongolia between 2022 and 2023, involving 120,266 adults after applying inclusion criteria. The participants were categorized based on fasting plasma glucose levels (NGT): normoglycemia, IFG, newly diagnosed diabetes, and long-standing diabetes. CVD risk was assessed using WHO risk prediction charts, considering factors like age, blood pressure, smoking status, and diabetes status. (3) Results: CVD risk varied significantly with glycemic status. Among those with NGT, 62.9% were at low risk, while 31.2% were at moderate risk. In contrast, the IFG participants had 49.5% at low risk and 39.9% at moderate risk. Newly diagnosed diabetes showed 38.1% at low risk and 43.3% at moderate risk, while long-standing diabetes had 33.7% at low risk and 45.9% at moderate risk. Regression analysis indicated that glycemic status was independently associated with moderate to high CVD risk (OR in IFG: 1.13; 95% CI: 1.09-1.18), even after adjusting for age, gender, and central obesity. (4) Conclusions: This study emphasizes the need for early cardiovascular risk assessment and intervention, even in pre-diabetic stages like IFG.

The Association between Marital Status and Obesity: A Systematic Review and Meta-Analysis

BACKGROUND

Obesity was included in the International Classification of Diseases in 1990 as a chronic disease characterized by the excessive accumulation of body fat and a body mass index (BMI) greater than 30 kg/m2.

AIM

This systematic review was aimed to examine the role of marital status in determining body mass index and the risk of obesity.

METHODS

We performed a systematic literature search using three databases (PubMed (Medline), Embase, and Google Scholar) with the search query.

RESULTS

Of the 105 studies included in the systematic review, 76 studies (72%) reported a greater risk of obesity in married individuals compared to unmarried individuals. A meta-analysis of 24 studies included a total population of 369,499 participants: 257,257 married individuals (40,896 of whom had obesity) and 112,242 comparison subjects (single, divorced, or widowed individuals, 15,084 of whom had obesity). Odds ratios for obesity found a significant pooled odds ratio for obesity in married individuals compared with controls (OR 1.70; 95% CI 1.38-2.10). The socioeconomic environment was not the same throughout the period of studies analyzed. The odds of obesity in married individuals during economic crises was greater than during the period between crises: OR 2.56 (95% CI 2.09-3.13) during crises vs. OR 1.55 (95% CI 1.24-1.95) between crises.

CONCLUSION

The results of this review confirm the importance of considering marital status in determining the risk of obesity.

CT Quantitation and Prediction of the Risk of Type 2 Diabetes Mellitus in Non-Obese Patients with Pancreatic Fatty Infiltration

Purpose

To examine the risk of type 2 diabetes mellitus in non-obese patients with pancreatic fatty infiltration through abdominal computed tomography (CT) quantitation.

Patients and Methods

We carried out a retrospective analysis of abdominal CT and inpatient medical records of 238 inpatients from July 2019 to April 2021. The patients were divided into a normal non-obese group (BMI < 25, n = 135) and diabetic non-obese group (BMI < 25, n = 103). Abdominal CT-related parameters included body width; mean CT values of the pancreas, liver, and spleen; difference between pancreas and spleen CT values (P-S); pancreas-to-spleen attenuation ratio (P/S); and liver-to-spleen attenuation ratio (L/S). Logistic regression was used to estimate the risk factors for comorbid diabetes in a non-obese population.

Results

The P-values of the pancreas CT value, P-S, P/S, body width, and L/S were all <0.05 and correlated to comorbid diabetes in non-obese patients. Worsening pancreatic fatty infiltration increased the risk of developing diabetes. Using a P/S of 1.0 as reference, every successive decrease in this ratio by 0.1 increases patient risk by 3.981, 4.452, 6.037, and 12.937 times.

Conclusion

The risk of developing type 2 diabetes mellitus in non-obese patients increases with the degree of pancreatic fatty infiltration as assessed by CT.

Geographic and ethnicity variation in the prevalence of middle-aged and elderly adult obesity in China in 2020

AIM

The objective of this study is to evaluate the mean body mass index (BMI), general obesity and abdominal obesity in adults aged ≥40 years residing in China in 2020, and to analyse variations in these factors across different geographic areas and subpopulations.

METHODS

We utilized data from the National Stroke High-Risk Population Screening programme to calculate and compare the mean BMI and prevalence of obesity across various demographics, including sex, age, urban-rural locality, geographical region (province) and ethnicity status.

RESULTS

In our study, we found that the standardized mean BMI level was 24.65 kg/m2 [95% confidence interval (CI): 24.50-22.84] in men and 24.31 kg/m2 (95% CI: 24.15-24.45) in women. Using the criteria from China, we found that the standardized prevalence of general obesity and abdominal obesity was 13.13% (95% CI: 13.05-13.21%) and 33.03% (95 CI: 32.92-33.14%), respectively. Our study also identified significant effects of age, sex, urban-rural locality, province and ethnicity status on the prevalence of obesity. Overall, our study estimated that in 2020, approximately 91.1 million adults aged ≥40 years in China were obese (46.5 million men and 44.6 million women), while 229.2 million adults (110.4 million men and 118.8 million women) were diagnosed with abdominal obesity.

CONCLUSION

Our research has revealed compelling new evidence about the obesity epidemic among Chinese adults aged ≥40 years, particularly at the provincial and ethnic levels. As a result, more targeted and effective prevention strategies should be developed to alleviate the burden of obesity.

Fat loss and muscle gain: The possible role of cortical glutamate in determining the efficacy of physical exercise

BACKGROUND

Physical exercise is widely acknowledged for its health benefits, but its effectiveness in treating obesity remains contentious due to variability in response. Owing to the roles of glutamate in appetite regulation, food addiction, and impulsivity, this observational cohort-study evaluated medial prefrontal cortex (mPFC) glutamate as a predictor of variability in exercise response, specifically in terms of fat loss and muscle gain.

METHODS

Healthy non-exercising adult men (n = 21) underwent an 8-week supervised exercise program. Baseline glutamate levels in the mPFC were measured through magnetic resonance spectroscopy. For exercise-dependent changes in body composition (fat and muscle mass), basal metabolic rate (BMR), and blood metabolic biomarkers related to lipid and glucose metabolism, measurements were obtained through bioelectrical impedance and blood sample analyses, respectively.

RESULTS

The exercise program resulted in significant improvements in body composition, including reductions in percentage body fat mass, body fat mass, and waist-to-hip ratio and an increase in mean muscle mass. Furthermore, BMR and metabolic indicators linked to glucose and lipids exhibited significant changes. Notably, lower baseline glutamate levels were associated with greater loss in percentage body fat mass (r = 0.482, p = 0.027), body fat mass (r = 0.441, p = 0.045), and increase in muscle mass (r = -0.409, p = 0.066, marginal) following the exercise program.

CONCLUSION

These preliminary findings contribute to our understanding of the neurobiology of obesity and emphasize the significance of glutamate in regulating body composition. The results also highlight cortical glutamate as a potential predictor of exercise-induced fat loss and muscle gain.

The relationship between Marriage and Body Mass Index in China：Evidence from the China Health and Nutrition Survey

This study investigates the impact of marriage on the body mass index (BMI) of individuals aged 18-45 in China. We used data from ten rounds of the China Health and Nutrition Survey spanning from 1989 to 2015, and applied Difference-in-Differences (DID) model to examine the impact of marriage on BMI. Our findings reveal that marriage has a significant positive effect on BMI, especially among males, with post-marriage elevation of male BMI continuing to increase over time. Moreover, marriage is associated with a 5.2% increase in the prevalence of overweight and a 2.5% rise in the incidence of obesity among males. While energy intake levels for Chinese women did not undergo significant changes after marriage, nor did their energy expenditure levels, men experienced a marked alteration in energy balance, characterized by an increase in caloric intake and a decrease in physical activity. Furthermore, our study confirms significant period differences in the effect of marriage on BMI, with post-marriage elevation of male BMI continuing to rise over time. In contrast, there was no clear trend for female BMI after marriage. Our research highlights the importance of promoting physical fitness and health management within families while fostering intimate relationships through marriage. Public health policies should consider the potential impact of marriage as an intervention window for addressing individuals' weight management needs. Distinct post-marriage body management plans should be designed for both genders.

Mapping IWQOL-Lite onto EQ-5D-5L and SF-6Dv2 among overweight and obese population in China

PURPOSE

To develop the mapping functions from the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) scores onto the EQ-5D-5L and SF-6Dv2 utility values among the overweight and obese population in China.

METHODS

A representative sample of the overweight and obese population in China stratified by age, sex, body mass index (BMI), and area of residence was collected by online survey and the sample was randomly divided into development (80%) and validation (20%) datasets. The conceptual overlap between the IWQOL-Lite and the EQ-5D-5L or SF-6Dv2 was evaluated by Spearman's correlation coefficients. Five models, including OLS, Tobit, CLAD, GLM, and PTM were explored to derive mapping functions using the development dataset. The model performance was assessed using MAE, RMSE, and the percentage of AE > 0.05 and AE > 0.1 in the validation dataset.

RESULTS

A total of 1000 respondents (48% female; mean [SD] age: 51.7 [15.3]; mean [SD] BMI: 27.4 [2.8]) were included in this study. The mean IWQOL-Lite scores and the utility values of EQ-5D-5L and SF-6Dv2 were 78.5, 0.851, and 0.734, respectively. The best-performing models predicting EQ-5D-5L and SF-6Dv2 utilities both used IWQOL-Lite total score as a predictor in the CLAD model (MAE: 0.083 and 0.076 for the EQ-5D-5L and SF-6Dv2; RMSE: 0.125 and 0.103 for the EQ-5D-5L and SF-6Dv2; AE > 0.05: 20.5% and 27.5% for the EQ-5D-5L and SF-6Dv2; AE > 0.10: 9.5% and 15.0% for the EQ-5D-5L and SF-6Dv2).

CONCLUSION

CLAD models with the IWQOL-Lite total score can be used to predict both the EQ-5D-5L and SF-6Dv2 utility values among overweight and obese population in China.

The association between outdoor light at night exposure and adult obesity in Northeastern China

Previous studies have linked exposure to light at night (LAN) with various health outcomes, but evidence is limited for the LAN-obesity association. Thestudy analysed data from 24,845 participants of the 33 Communities Chinese Health Study and obesity (BMI ≥28 kg/m2) was defined according to the Working Group on Obesity in China. The Global Radiance Calibrated Nighttime Lights data were used to estimate participants' LAN exposure. The mixed-effect regression models examined the LAN-BMI and LAN-obesity association. We found that higher LAN exposure was significantly associated with greater BMI and higher risk of obesity. Changes of BMI and the odds ratios (ORs) of obesity and 95% confidence intervals (CIs) for 2nd, 3rd, and 4th against the 1st quartile of LAN exposure were 0.363 (0.208, 0.519), 0.364 (0.211, 0.516) and 0.217 (0.051, 0.383); 1.228 (1.099, 1.371), 1.356 (1.196, 1.538) and 1.269 (1.124, 1.433), respectively. Age and regular exercise showed significant modification effects on the LAN-obesity association.

Knowledge, attitude, and practice toward non-nutritive sweeteners among the population with reduced sugar intake requirement

Introduction

This study aimed to explore the knowledge, attitude, and practice (KAP) toward non-nutritive sweeteners among a population with reduced sugar intake requirements.

Methods

This cross-sectional study used self-developed questionnaires to collect demographic characteristics and KAP towards non-nutritive sweeteners among respondents with reduced sugar intake requirements, i.e., overweight or obese individuals and patients with pre-diabetes or diabetes.

Results

A total of 639 valid questionnaires were collected, and 51.64% of participants were male. The KAP scores were 7.63 ± 3.58 (range: 0-11), 34.28 ± 7.47 (range: 12-60), and 15.48 ± 3.97 (range: 7-35), respectively. Pearson's correlation analysis showed that knowledge score was positively correlated with attitude (r = 0.229, p < 0.001) and practice score (r = 0.467, p < 0.001), while attitude was positively correlated with practice (r = 0.312, p < 0.001). The structural equation model showed that knowledge was directly and positively associated with attitude (path coefficient = 0.48, p < 0.001) and practice (path coefficient = 0.46, p < 0.001). In addition, the attitude was directly and positively associated with practice (path coefficient = 0.12, p < 0.001). Besides, diabetes was associated with lower knowledge (path coefficient = -0.81, p = 0.038) and practice (path coefficient = -0.42, p < 0.041).

Discussion

Population with the reduced sugar intake requirement showed poor knowledge, negative attitudes, and suboptimal practices toward non-nutritive sweeteners. To optimize the utilization of non-nutritive sweeteners in accordance with medical prescriptions, especially for individuals with diabetes, tailored educational interventions may be designed for participants with lower KAP.

Online medical consultation in China: Demand-side analysis of obese patients' preferences and willingness-to-pay for online obesity consultations

Objective

With obesity a major health concern and call on healthcare resources in China, we explored the preferences and willingness to pay (WTP) for obesity OMC, including the influencing factors behind WTP and preferences.

Method

We recruited 400 obese participants to undertake a discrete choice experiment (DCE) and the contingent value method (CVM) survey. We used CVM to measure obese participants' WTP for one-click services (OCS) and used DCE to estimate obesity participants' preferences and WTP for OMC with different attributes.

Results

Obese participants were willing to pay more than RMB80 on average for OCS, and more than 50% of participants had a WTP over RMB50 and 5% had a WTP over RMB300, reflecting the strong willingness of Chinese obese patients to pay for OMC. Educational background, income, ethnicity, previous OMC experience and accessibility to offline hospitals with different levels impacted WTP. The relative importance score of attributes in descending order was cost, doctors' hospital level, doctors' level, online waiting time, consultation time and consultation form. Obese patients preferred lower cost, doctors from higher-level hospitals, doctors with higher expertise levels, shorter waiting time and consultation duration, and telephone consultation were preferred. 30-min waiting time, 15-min consultation duration and telephone consultation were the most economically efficient set we found.

Conclusion

To maximize health resources, provincial tertiary and municipal hospitals face different paths to developing obesity OMC platforms. We encouraged young doctors to use OMC. OMC regulators should implement consumer protection policies to optimize OMC pricing and address potential 'unfair' pricing.

Pharmacoeconomic evaluation of anti-obesity drugs for chronic weight management: a systematic review of literature

Introduction

Pharmacological therapy is recommended as a second-line alternative to reverse obesity. Currently, five anti-obesity drugs (AODs) have been approved by the U.S. Food and Drug Administration (FDA) for chronic weight management. The aim of this paper is to investigate the pharmacoeconomic evaluation of AODs through a systematic review with a special focus on methodological considerations.

Methods

We searched the general and specific databases to identify the primary pharmacoeconomic evaluation of AODs.

Results

A total of 18 full-text articles and three conference abstracts were included in this review. Most of the economic assessments were still about Orlistat. And the observations we could make were consistent with the previous systematic review. A few studies were on the combined therapies (i.e. PHEN/TPM ER and NB ER) compared to different comparators, which could hardly lead to a generalized summary of the cost-effectiveness. Most recently, pharmacoeconomic evidence on the newest GLP 1 RA approved for the indication of obesity or obesity with at least one comorbidity emerged gradually. Modelling-based cost-utility analysis is the major type of assessment method. In the modelling studies, a manageable number of the key health states and the state transitions were structured to capture the disease progression. In particular, the principal structure of the decision model adopted in the three studies on the newly approved drug was nearly the same, which enables more in-depth comparisons and generalizations of the findings.

Conclusion

This study provided an up-to-date overview of the strengths and areas for improvement in the methodological design of the pharmacoeconomic evaluation of the licensed drugs for chronic weight management. Future modelling evaluations would benefit from a better understanding of the long-term weight loss effects of the current therapeutic options and the weight rebound process after the discontinuation of treatment.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022302648, identifier CRD42022302648.

Family cohesion and intuitive eating in Chinese college students: A serial mediation model

Improving intuitive eating can effectively prevent emotional eating, restrained eating, and overeating, and help improve people's physical and mental health. Based on the acceptance model of intuitive eating, ecological systems theory, family stress model, and transactional model of stress and coping, the present study aimed to explore the relationship between family cohesion and intuitive eating and its underlying mechanisms through a cross-sectional study design. A random sample of 702 college students from 29 provinces in China, aged from 18 to 26 years (54.56% male, M age = 21.12 years), voluntarily participated in the survey. Demographic variables, family cohesion, intuitive eating, perceived stress, and coping style were measured. The results indicated that family cohesion was significantly positively correlated with intuitive eating and the direct effect between them was significant. Meanwhile, there was a significant indirect effect of family cohesion on intuitive eating through perceived stress and positive coping styles. Moreover, perceived stress and positive coping styles, rather than negative coping styles, acted as serial mediators in the association between family cohesion and intuitive eating. The findings shed light on the prevention and intervention for disordered eating and obesity and provided a new theoretical perspective for the mental health education of college students. In addition, implications and directions for future research were also discussed.

Prevalence of obesity and associated complications in China: A cross-sectional, real-world study in 15.8 million adults

AIM

To evaluate the prevalence of overweight/obesity and associated complications from a large, cross-sectional, nationwide database in China.

MATERIALS AND METHODS

Data were obtained from 519 Meinian health check-up centres across 243 cities. Eligible participants were aged ≥18 years, with a routine check-up in 2019 (N = 21 771 683) and complete height, weight, sex and region data. The unadjusted prevalence rates of overweight/obesity were calculated by age, sex and region. In addition, the nationwide prevalence rates of overweight and obesity were standardized according to the 2010 China census by age group and sex. The prevalence of obesity-related complications by body mass index (BMI) groups was calculated using logistic regression.

RESULTS

There were 15 770 094 eligible participants (median age 40 years; mean BMI 24.1 kg/m2 ; 52.8% male). By Chinese BMI classification, 34.8% were overweight and 14.1% were obese. Overweight and obesity were more prevalent in male than female participants (standardized: overweight 40.2% vs. 27.4%; obesity 17.6% vs. 9.6%, respectively). The prevalence of assessed complications was higher in participants with overweight/obesity versus those with normal BMI (P < 0.001 for trends). The most prevalent complications in participants with overweight/obesity were fatty liver disease, prediabetes, dyslipidaemia and hypertension. The number of complications increased with higher BMI.

CONCLUSIONS

Overweight/obesity and related complications are highly prevalent in this population. These data may better inform management and prevention public health strategies in China.

Comparison of the measurement properties of the EQ-5D-5L and SF-6Dv2 among overweight and obesity populations in China

OBJECTIVE

To evaluate and compare the measurement properties of the EQ-5D-5L and SF-6Dv2 among Chinese overweight and obesity populations.

METHODS

A representative sample of Chinese overweight and obesity populations was recruited stratified by age, gender, body mass index (BMI), and area of residence. Social-demographic characteristics and self-reported EQ-5D-5L and SF-6Dv2 responses were collected through the online survey. The agreement was assessed using intraclass correlation coefficients (ICC). Convergent validity and known-group validity were examined using Spearman's rank correlation and effect sizes, respectively. The test-retest reliability was assessed using among a subgroup of the total sample. Sensitivity was compared using relative efficiency and receiver operating characteristic.

RESULTS

A total of 1000 respondents (52.0% male, mean age 51.7 years, 67.7% overweight, 32.3% obesity) were included in this study. A higher ceiling effect was observed in EQ-5D-5L than in SF-6Dv2 (30.6% vs. 2.1%). The mean (SD) utility was 0.851 (0.195) for EQ-5D-5L and 0.734 (0.164) for SF-6Dv2, with the ICC of the total sample was 0.639 (p < 0.001). The Spearman's rank correlation (range: 0.186-0.739) indicated an acceptable convergent validity between the dimensions of EQ-5D-5L and SF-6Dv2. The EQ-5D-5L showed basically equivalent discriminative capacities with the SF-6Dv2 (ES: 0.517-1.885 vs. 0.383-2.329). The ICC between the two tests were 0.939 for EQ-5D-5L and 0.972 for SF-6Dv2 among the subgroup (N = 150). The SF-6Dv2 had 3.7-170.1% higher efficiency than the EQ-5D-5L at detecting differences in self-reported health status, while the EQ-5D-5L was found to be 16.4% more efficient at distinguishing between respondents with diabetes and non-diabetes.

CONCLUSIONS

Both the EQ-5D-5L and SF-6Dv2 showed comparable reliability, validity, and sensitivity when used in Chinese overweight and obesity populations. The two measures may not be interchangeable given the systematic difference in utility values between the EQ-5D-5L and SF-6Dv2. More research is needed to compare the responsiveness.

Marginal effects of public health measures and COVID-19 disease burden in China: A large-scale modelling study

China had conducted some of the most stringent public health measures to control the spread of successive SARS-CoV-2 variants. However, the effectiveness of these measures and their impacts on the associated disease burden have rarely been quantitatively assessed at the national level. To address this gap, we developed a stochastic age-stratified metapopulation model that incorporates testing, contact tracing and isolation, based on 419 million travel movements among 366 Chinese cities. The study period for this model began from September 2022. The COVID-19 disease burden was evaluated, considering 8 types of underlying health conditions in the Chinese population. We identified the marginal effects between the testing speed and reduction in the epidemic duration. The findings suggest that assuming a vaccine coverage of 89%, the Omicron-like wave could be suppressed by 3-day interval population-level testing (PLT), while it would become endemic with 4-day interval PLT, and without testing, it would result in an epidemic. PLT conducted every 3 days would not only eliminate infections but also keep hospital bed occupancy at less than 29.46% (95% CI, 22.73-38.68%) of capacity for respiratory illness and ICU bed occupancy at less than 58.94% (95% CI, 45.70-76.90%) during an outbreak. Furthermore, the underlying health conditions would lead to an extra 2.35 (95% CI, 1.89-2.92) million hospital admissions and 0.16 (95% CI, 0.13-0.2) million ICU admissions. Our study provides insights into health preparedness to balance the disease burden and sustainability for a country with a population of billions.

Prevalence of overweight and obesity in patients with major depressive disorder with anxiety: Mediating role of thyroid hormones and metabolic parameters

BACKGROUNDS

Anxiety is a common comorbidity in major depressive disorder (MDD); however, its role in overweight and obesity in MDD patients remains unclear. We examined the relationship between severe anxiety and overweight and obesity, as well as the mediating role of thyroid hormones and metabolic parameters in MDD patients.

METHODS

This cross-sectional study recruited 1718 first-episode drug-naïve MDD outpatients. All participants were rated on the Hamilton Depression Rating Scale for depression and Hamilton Anxiety Rating Scale for anxiety and measured in thyroid hormones and metabolic parameters.

RESULTS

A total of 218 (12.7 %) individuals had severe anxiety. The prevalence of overweight and obesity in patients with severe anxiety was 62.8 % and 5.5 %, respectively. Severe anxiety symptoms were associated with overweight (Odds Ratio [OR]: 1.47, 95 % CI: 1.08, 2.00) and obesity (OR: 2.10, 95 % CI: 1.07, 4.15). The association between severe anxiety and overweight was mainly attenuated by thyroid hormones (40.4 %), blood pressure (31.9 %), and plasma glucose (19.1 %). For obesity, the association with severe anxiety was mainly attenuated by thyroid hormones (48.2 %), blood pressure (39.1 %), and total cholesterol (28.2 %).

LIMITATIONS

Due to the cross-sectional design, no causal relationship could be derived.

CONCLUSIONS

Thyroid hormones and metabolic parameters can explain the risk of overweight and obesity associated with severe anxiety in MDD patients. These findings add to the knowledge of the pathological pathway of overweight and obesity in MDD patients with comorbid severe anxiety.

The role of pyroptosis in cognitive impairment

Cognitive impairment is a major global disease, manifests as a decline in cognitive functioning and endangers the health of the population worldwide. The incidence of cognitive impairment has increased rapidly with an increasingly aging population. Although the mechanisms of cognitive impairment have partly been elucidated with the development of molecular biological technology, treatment methods are very limited. As a unique form of programmed cell death, pyroptosis is highly pro-inflammatory and is closely associated with the incidence and progression of cognitive impairment. In this review, we discuss the molecular mechanisms of pyroptosis briefly and the research progress on the relationship between pyroptosis and cognitive impairment and its potential therapeutic values, to provide a reference for research in the field of cognitive impairment.

The prevalence and determinant of overweight and obesity among residents aged 40-69 years in high-risk regions for upper gastrointestinal cancer in southeast China

Being overweight or obese is one of the public health concerns worldwide, and its prevalence is gradually increasing. Obesity has been proven to be associated with some cancers, including upper gastrointestinal cancer (UGC). However, studies on the prevalence of obesity among residents of areas at high risk of UGC in China are minimal. The aim of this study is to assess the prevalence of obesity and its influencing factors among people aged 40-69 years (high-risk population) in high-risk areas for UGC in Jiangsu Province, southeast China. This cross-sectional study involved 45,036 subjects aged 40-69 years identified in the Rural Early Diagnosis and Treatment of UGC Project database in Jiangsu Province from 2017 to 2021. Differences in prevalence across gender and age were assessed using the Chi-square test. Using a multinomial logistic regression model, we examined independent risk factors for overweight/obesity and their gender and age differences. The prevalence of overweight, obesity, and overweight/obesity varied based on the standards used: Chinese standard (42.1%, 11.9%, and 54.0%) and WHO standard (34.7%, 4.7%, and 39.4%), respectively. Being overweight was more common in men than women, while obesity was more common in women than men. Age of 50-59 years, married, household size of 7-9, drinking, soy products, pickled food, and hot food intake were positively associated with overweight/obesity. Females, 60-69 years, higher education level, household size of 4-6, annual family income of more than 60,000 CNY, smoking, and fresh fruit intake were negatively associated with overweight/obesity. Stratified analysis showed that the effects of age, education and meat, egg and dairy products on overweight/obesity were different across gender. The impact of fresh fruit and vegetables on overweight/obesity was also heterogeneous between the younger (40-59 years) and older (60-69 years) groups. In conclusion, the prevalence of overweight and obesity is high among adults aged 40-69 years from high-risk areas for UGC of Jiangsu Province, southeast China. Independent influencing factors of being overweight/obese included gender, age, marital status, education, household size, annual family income, smoking, drinking, fresh fruit, soy products, pickled food and hot food intake, and may vary by gender and age. Screening-based interventions should be considered to control obesity levels among screened participants. Besides, heterogeneity of influencing factors across subgroups could be focused on to improve intervention effectiveness.

Dietary diversity indices v. dietary guideline-based indices and their associations with non-communicable diseases, overweight and energy intake: evidence from China

OBJECTIVES

To evaluate various diet quality indices and to estimate their associations with major non-communicable diseases (NCD) (i.e. diabetes mellitus (DM) and myocardial infarction (MI)) and risk for overweight (OW).

DESIGN

Four dietary diversity indices (namely, count index (Count), dietary diversity score index, berry index (BI) and entropy index (EI)) and three Chinese dietary guideline-based indices (namely, China healthy diet index, Chinese food pagoda score and diet quality divergence index) were employed to evaluate Chinese diet quality. DM, MI and OW were used as diet-related health indicators. Logit regressions were employed to unveil the associations between diet quality indices and NCD and risk for OW. The relationships between diet quality indices and daily energy intakes were checked with ordinary least squares linear regressions.

SETTING

Four recent waves (2004, 2006, 2009, 2011) of longitudinal individual data from China Health and Nutrition Survey.

PARTICIPANTS

Chinese adults (aged 18-64 years) from twelve provinces were included in the analysis (n 30 350).

RESULTS

Count, BI, and EI were positively associated with higher OW risk and daily energy intakes. As dietary guideline-based indices got better, people were exposed to lower DM and OW risks and got lower daily energy intakes. Finally, dietary guideline-based indices properly revealed the expected relationships that high-quality diets would reduce NCD and risk for OW, while high diversity indices were usually correlated with over-nutrition and high risks.

CONCLUSIONS

Increasing diversity of the diet does not necessarily improve the nutrition and health. Dietary guideline-based indices are more robust than dietary diversity indices; thus, they should be highly recommended when evaluating diet quality.

Characteristics of hypertension in the last 16 years in high prevalence region of China and the attribute ratios for cardiovascular mortality

BACKGROUND

Tianjin is one of the cities with the highest prevalence of hypertension in China and one of the first regions to develop community management of hypertension. Our aim was to analyze the characteristics of hypertension in the last 16 years, and estimate the population attributable fraction for cardiovascular mortality in Tianjin, China.

METHODS

We compared the epidemiological characteristics of hypertension between 2002 and 2018 by analyzing data from the National Nutrition and Chronic Disease Risk Factor Survey. Subsequently, we obtained the cause-specific mortality in the same year from the Tianjin All Cause of Death Registration System (CDRS), and the population attributable fraction was used to estimate the annual cardiovascular disease (CVD) deaths caused by hypertension.

RESULTS

In 2002 and 2018, the crude prevalence, awareness, treatment rate in diagnosed, control rate in treated, and overall control rate of hypertension were 36.6% and 39.8%, 36.0% and 51.9%, 76.0% and 90.1%, 17.4% and 38.3%, 4.8% and 17.9%, respectively (P < 0.05). The mean SBP for males between the ages of 25 and 50 was significantly higher in 2018 than in 2002. The number of CVD deaths attributed to hypertension was 13.8 thousand in 2002 (account for 59.1% of total CVD deaths), and increased to 21.7 thousand in 2018 (account for 58.8% of total CVD deaths). The population attributable fraction have increased in the age groups of 25-44 and 75 and above, and decreased in the age group of 45-74 from 2002 to 2018.

CONCLUSIONS

Compare to 2002, the proportion of CVD deaths attributed to hypertension remains high, particularly among younger and older people, despite a very significant increase in treatment and control rates for hypertension in 2018.

Independent and Joint Associations of BMI and Waist Circumference With the Onset of Type 2 Diabetes Mellitus in Chinese Adults: Prospective Data Linkage Study

BACKGROUND

General obesity and abdominal obesity, typically measured by BMI and waist circumference (WC), respectively, are associated with an increased risk of type 2 diabetes mellitus (T2DM). However, the magnitude of the association of these two obesity indicators and their joint association with the onset of T2DM remain controversial.

OBJECTIVE

The aim of this study was to investigate the associations between these two obesity indicators and T2DM among the Chinese population to contribute scientific evidence for appropriate T2DM interventions.

METHODS

A cohort of 3001 eligible participants was selected from the Ningbo Adult Chronic Disease Surveillance Project running since 2015. Based on BMI, individuals were categorized into groups of underweight or normal, overweight, and obesity. Based on WC, individuals were categorized in groups of normal, precentral obesity, and central obesity. Follow-up was performed by linking data of the baseline data set with the diabetes registry data set and the vital registry data set (both from the Ningbo Municipal Integrated Noncommunicable Disease Collaborative Management System), mainly using the participants' identity numbers. Follow-up was completed when a participant was diagnosed with T2DM. The associations were estimated with multivariate Cox proportional hazard regression.

RESULTS

In the cohort, 90 of 3001 participants developed T2DM (incidence density: 6.483/1000 person-years) with a median 4.72 years of follow-up. After controlling for age, sex, hypertension, dyslipidemia, smoking status, and family history of diabetes, the multivariate adjusted hazard ratios (HRs) across underweight/normal, overweight, and obesity BMI categories were 1.000, 1.653 (95% CI 1.030-2.654), and 2.375 (95% CI 1.261-4.473), respectively. The multivariate adjusted HRs across the normal, precentral obesity, and central obesity WC categories were 1.000, 1.215 (95% CI 0.689-2.142), and 1.663 (95% CI 1.016-2.723), respectively. Compared with the reference group (normal WC with an underweight/normal BMI), the multivariate adjusted HR for participants with both central obesity according to WC and obesity according to BMI was 2.489 (95% CI 1.284-4.825).

CONCLUSIONS

Both elevated BMI and WC at baseline increased the risk of T2DM. Compared with WC, BMI as an obesity indicator was more strongly associated with the onset of T2DM.

Clinical efficacy of weight loss herbal intervention therapy and lifestyle modifications on obesity and its association with distinct gut microbiome: A randomized double-blind phase 2 study

GOALS

To assess the efficacy and safety of Chinese Medicine Prescription "W-LHIT" in subjects with simple obesity, and to explore its potential mechanism of action.

METHODS

Thirty-seven patients aged 18 to 60 from Wei-En hospital (Weifang City, Shandong, China), participated in a double blinded, placebo-controlled study. Subjects were randomly divided into 2 groups, 18 in treatment and 19 in placebo group. The treatment group took the "W-LHIT" capsules for two months, while the control group received placebo capsules. Both groups accepted healthy lifestyle education materials. After a 2-month treatment, the placebo group transferred to open-label treatment after unblinding.

RESULTS

72.22% participants in the treatment group lost more than 5% of their body weight, compared with 36.84% in the placebo group (p < 0.001). Body weight loss and body mass index reduction of the treatment group were also significantly higher than those of the placebo group (p < 0.05). These changes were accompanied by increased abundance of Akkermansia muciniphila and Enterococcus faecium, and decreased abundance of Proteobacteria in gut microbiota. Furthermore, the treatment group also showed improvement in obesity-related comorbidities such as hypertension and elevation of liver enzymes. No serious adverse reactions were found during the study period. Weight did not rebound at a follow-up visit 2 months after treatment.

CONCLUSION

W-LHIT significantly improved body weight and comorbid conditions without obvious adverse reaction or rebound weight gain. These effects were associated with increased abundance of probiotics in gut microbiota. W-LHIT may have a potential for treating obesity in conjunction with healthy lifestyle modifications.

Exposure to Polybrominated Diphenyl Ethers and Phthalates in China: A Disease Burden and Cost Analysis

Increasing evidence indicates that endocrine-disrupting chemicals (EDCs) cause a variety of adverse health outcomes and contribute to substantial disease burden. This study summarized the exposure status of polybrominated diphenyl ethers (PBDEs) and phthalates (PAEs) in China and evaluated the disease burden attributable to PBDEs and PAEs in 2015. The results showed that PBDE and PAE concentrations were higher in coastal areas. The disease burden attributable to PBDEs was 0.77 million cases, and the economic costs were CNY 18.92 billion. Meanwhile, 3.02 million individuals suffered from diseases attributable to PAEs, and the economic costs were CNY 49.20 billion. The economic burden caused by PBDEs and PAEs accounted for 0.28% and 0.72% of China's Gross Domestic Product (GDP) in 2015, respectively. When comparing China's results from 2010, it was determined that the GDP ratio of economic costs caused by PAEs in 2015 (0.72%) was lower than in 2010 (1.42%). Finally, compared with the results of the European Union and North America, the GDP ratios of economic costs caused by PAEs in 2015 were 0.19% in Canada (lower than China), 0.29% in the United States (lower than China), and 1.44% in the European Union (higher than China). This study provides important reference values for China's health governance, and further research should be conducted in the future.

The prevalence of obesity-related hypertension among middle-aged and older adults in China

Objective

The aim of our study was to assess the prevalence and geographic variation of obesity-related hypertension in China among adults aged 45 years or older.

Methods

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015. Stratified sample households covered 150 counties/districts and 450 villages/urban communities from 28 provinces by using household questionnaires, clinical measurements, and blood-based bioassays. A multivariable non-conditional logistic regression model was used to analyze the risk factors correlated with obesity-related hypertension.

Results

The prevalence of obesity-related hypertension was 22.7%, ~120 million people, among adults aged 45 years or older in China. For people in the age ranges of 45-54, 55-64, 65-74, and ≥75 years, the prevalence of obesity-related hypertension was 16.7, 24.3, 27, and 26.7%, respectively, and the prevalence of obesity-related hypertension among hypertensive participants was 66.0, 60.9, 54.2, and 47.3%, respectively. Compared with non-obesity-related hypertension, the obesity-related hypertensive patients had a higher prevalence of diabetes mellitus, dyslipidemia, and hyperuricemia (all P < 0.0001). The prevalence of obesity-related hypertension showed a decreasing gradient from north to south and from east to west. Multivariate logistic regression analysis showed that female gender, living in urban areas, diabetes mellitus, dyslipidemia, and hyperuricemia were positively correlated with obesity-related hypertension.

Conclusion

The prevalence of obesity-related hypertension among adults aged 45 years or older was high in China. Among hypertensive participants, older age was negatively correlated with obesity-related hypertension. Obesity-related hypertensive participants are more prone to aggregation of risk factors of atherosclerotic cardiovascular disease.

Prevalence of Obesity and Its Associated Factors Among Malaysian Adults: Finding From the National Health and Morbidity Survey 2019

In 2016, World Health Organization (WHO) estimated more than 650 million obese adults, resulting in a country's health burden. This study aims to determine the prevalence of obesity and its associated factors among Malaysian adults. A total of 5820 respondents, aged 18 to 59 years, from the National Health and Morbidity Survey 2019, were included for the data analysis. The prevalence of obesity was described and multivariate analyses were conducted to determine the factors associated with obesity. The prevalence of obesity among Malaysian adults was 20.1%, based on the findings from this study. Multivariate analyses showed that women, being Malays, Indians, and other Bumiputeras, were significantly associated with a higher risk of obesity. Besides, those diagnosed with diabetes mellitus and hypertension were also significantly associated with greater risk of obesity. This information is crucial for policy makers in formulating effective strategies or targeted programs in preventing obesity among Malaysian adults.

Change of weight status during school age and its association with late adolescent blood pressure: Results from a 15-year longitudinal study in China

Background

Change in obesity risk could be related to shift in high blood pressure (HBP) risk, while individualized influence of weight change on high blood pressure is in need of exploration.

Methods

A total of 16,446 children (53.47% boys) and 13,9021 effective annual measurements from 2006 to 2020 were recruited. Children's weight status, both at baseline and endpoint, was categorized as underweight, normal, overweight, and obese according to the age and sex-specific Body Mass Index z scores. HBP at late adolescence was defined with the last two measurements for each child. Populational attributable risk (PAR) of weight trait on HBP risk was calculated.

Results

Compared to children who maintained normal weight during follow-up, staying obese was associated with the highest HBP risk with OR of 6.39 (95% CI: 4.46, 9.15; p < 0.001) and PAR of 28.71% (95% CI: 21.58, 35.54) in boys, and OR of 6.12 (95% CI: 2.80, 13.37; p < 0.001) and PAR of 12.75% (95% CI: 4.29, 21.02) in girls. Returning from obese to normal weight was associated with lowered HBP risk, with ORs of 1.07 (95% CI: 0.69, 1.66; p = 0.771) in boys and 0.73 (95% CI: 0.25, 2.12; p = 0.566) in girls.

Conclusion

Weight loss program could be effective to reduce HBP risk during school age, while the underlying mechanism needs further exploration.

Association of body mass index and waist circumference with type 2 diabetes mellitus in older adults: a cross-sectional study

BACKGROUND

The prevalence of obesity and diabetes is rising. The aim of this study was to determine the association of body mass index (BMI) and waist circumference (WC) with type 2 diabetes mellitus (T2DM) in the elderly and to compare the discriminatory abilities of BMI, WC and other anthropometric indicators, including waist-to-height ratio (WHtR), body adiposity estimator (BAE) and body roundness index (BRI) for T2DM.

METHODS

This cross-sectional study included 69,388 subjects aged ≥ 60 years living in Xinzheng, Henan Province, from January to December 2020. The data came from the residents' electronic health records of the Xinzheng Hospital Information System. Logistic regression was used to examine the relationships. Fully adjusted models adjusted for age, sex, place of residence, alcohol consumption, smoking, physical exercise, SBP and RHR. The area under the receiver operating characteristic curve (AUC) was used to compare the discriminatory ability of different anthropometric indicators for T2DM under the influence of potential risk factors.

RESULTS

After adjusting for multiple covariates, compared with the first BMI quintile, the odds ratios (ORs) and 95% confidence intervals (CIs) from the second to fifth quintile for T2DM were 1.416 (1.335-1.502), 1.664 (1.570-1.764), 1.879 (1.774-1.990) and 2.156 (2.037-2.283), respectively. Compared with the first WC quintile, the ORs and 95% CIs from the second to fifth quintiles for T2DM were 1.322 (1.244-1.404), 1.549 (1.459-1.643), 1.705 (1.609-1.807) and 2.169 (2.048-2.297), respectively. Among men, compared with other anthropometric indicators (BMI, WHtR, BAE and BRI), WC showed the highest AUC (AUC: 0.629; 95% CI: 0.622-0.636). Among women, the AUCs of BMI (AUC: 0.600; 95% CI: 0.594-0.606), WC (AUC: 0.600; 95% CI: 0.593-0.606) and BAE (AUC: 0.600; 95% CI: 0.594-0.607) were similar, and the AUCs of BMI, WC and BAE were higher than WHtR, BRI.

CONCLUSIONS

All anthropometric indicators were positively associated with T2DM. In men, WC with the strongest positive association with T2DM was the best predictor of T2DM. In women, BMI was most strongly associated with T2DM, and the predictive powers of BMI, WC and BAE were similar. After adjusting the potential confounding factors including age, sex, place of residence, alcohol consumption, smoking, physical exercise, SBP and RHR, the effect of these factors was eliminated, the findings were independent of the covariates considered.

Quantitative analysis of the risk of type 2 diabetes and fatty liver in non-obese individuals by computed tomography

PURPOSE

To explore the risk of fatty liver and type 2 diabetes with quantitative parameters of abdominal computed tomography (CT) in a non-obese population.

METHODS

A retrospective analysis of abdominal CT and hospitalization records of inpatients admitted from May 2019 to May 2021 were divided into a non-obese control group (n = 143 cases) and a non-obese diabetes group (n = 105 cases). The measured abdominal CT parameters included body width, liver and spleen CT values, and the ratio of the liver CT value to the spleen CT value (L/S ratio). Logistic regression was used to analyze the risk factors for diabetes in non-obese individuals.

RESULTS

Three variables including body width (P < 0.001), liver CT value (P = 0.013), and L/S ratio (P = 0.002) were significantly correlated with the presence of diabetes in non-obese individuals.

CONCLUSION

Body width, liver CT value, and L/S ratio can be used to indicate the risk of type 2 diabetes in non-obese individuals.

Benchmarking the driver acceleration impact on vehicle energy consumption and CO2 emissions

The study proposes a methodology for quantifying the impact of real-world heterogeneous driving behavior on vehicle energy consumption, linking instantaneous acceleration heterogeneity and CO₂ emissions. Data recorded from 20 different drivers under real driving are benchmarked against the Worldwide Harmonized Light Vehicle Test Cycle (WLTC), first by correlating the speed cycle with individual driver behavior and then by quantifying the CO₂ emissions and consumption. The vehicle-Independent Driving Style metric (IDS) is used to quantify acceleration dynamicity, introducing driving style stochasticity by means of probability distribution functions. Results show that the WLTC cycle assumes a relatively smooth acceleration style compared to the observed ones. The method successfully associates acceleration dynamicity to CO₂ emissions. We observe a 5% difference in the CO₂ emissions between the most favourable and the least favourable case. The intra-driver variance reached 3%, while the inter-driver variance is below 2%. The approach can be used for quantifying the driving style induced emissions divergence.

Hypertension modifies the associations of body mass index and waist circumference with all-cause mortality among older Chinese: a retrospective cohort study

BACKGROUND

The effect of baseline hypertension status on the BMI-mortality association is still unclear. We aimed to explore the relationships of body mass index (BMI) and waist circumference (WC) with all-cause mortality among older hypertensive and normotensive Chinese individuals.

METHODS

This retrospective cohort study was conducted in Xinzheng, Henan Province, Central China. The data came from the residents' electronic health records of the Xinzheng Hospital Information System. A total of 77,295 participants (41,357 hypertensive participants and 35,938 normotensive participants) aged ≥ 60 years were included from January 2011 to November 2019. Cox proportional hazard regression model was used to examine the relationships.

RESULTS

During a mean follow-up of 5.3 years, 10,755 deaths were identified (6,377 in hypertensive participants and 4,378 in normotensive participants). In adjusted models, compared with a BMI of 18.5-24 kg/m2, the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of BMI < 18.5, 24-28 and ≥ 28 kg/m2 for mortality in hypertensive participants were 1.074 (0.927-1.244), 0.881 (0.834-0.931) and 0.856 (0.790-0.929), respectively, and 1.444 (1.267-1.646), 0.884 (0.822-0.949) and 0.912 (0.792-1.051), respectively, in normotensive participants. Compared with normal waist circumference, the adjusted HRs and 95% CIs of central obesity for mortality were 0.880 (0.832-0.931) in hypertensive participants and 0.918 (0.846-0.996) in normotensive participants. A sensitivity analysis showed similar associations for both hypertensive and normotensive participants.

CONCLUSION

Low BMI and WC were associated with a higher risk of all-cause mortality regardless of hypertension status in older Chinese individuals. The lowest risk of death associated with BMI was in the overweight group in normotensive participants and in the obesity group in hypertensive participants.

Association of waist circumference with blood pressure and familial dietary habits in preschool children: a cross-sectional study in northeastern China

Background

Childhood obesity increases the risk of elevated blood pressure (BP) in children. Body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) are traditional obesity indices, but the extent to which these indices are associated with elevated BP in childhood remains debatable. Moreover, the familial dietary environment plays an important role in obesity, so it is necessary to determine the most relevant dietary factors for childhood obesity to prevent elevated BP. Our study aimed to identify the obesity indices that are most closely associated with elevated BP and then to determine the independent familial dietary factors for those obesity indices.

Method

A total of 605 children aged 2 to 6 years, as well as their parents, were involved in this study. The weight, height, WC and BP of the children were measured. Information on familial environments was obtained by questionnaires completed by the parents. BMI, WC and WHtR were standardized into z scores, and categorical variables of these three obesity indices were defined as BMI Category, WC Category and WHtR Category. Logistic regression was used to analyse the associations between all obesity indices and elevated BP. Multivariate linear regression and logistic regression were used to determine the independent factors for obesity indices.

Results

The obesity indices that were most closely associated with elevated BP were WC and WC Category. Parental BMI, birth weight, eating wheat as a staple food, appetite, eating speed, snacking while watching TV, parental encouragement to eat a diverse assortment of foods and drinking milk were independently associated with WC in both males and females. The risk of abdominal obesity increased 1.375 times in males and 1.631 times in females if appetite increased one level. If eating speed increased one level, the risk of abdominal obesity increased 1.165 times in males and 0.905 times in females. Females who drank milk more than 6 times per week had a 0.546 times lower risk of abdominal obesity.

Conclusion

WC was an anthropometric parameter more closely associated with elevated BP. In addition to genetics, some familial dietary factors involving eating preference, eating habits and parental feeding practice were independently associated with WC and abdominal obesity in preschool children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13052-022-01236-3.

Is the relationship between BMI and body appreciation explained by body dissatisfaction and body image inflexibility among older adults? A study among older Chinese men and women

A number of previous studies reported a link between body mass index (BMI) and body appreciation; however, many of these studies were conducted in Western countries and addressed younger samples. Older adults, especially in East Asia, remain insufficiently examined. Therefore, the objective of this study was to examine the relationship between BMI and body appreciation and to explore two potential mediators, body dissatisfaction and body image inflexibility, as proposed in a previous meta-analysis. A community-based cross-sectional study was performed among 313 older Chinese men and women (M = 67.90, SD = 7.94). Mediation tests were conducted to examine the roles of body dissatisfaction and body image inflexibility in the relationship between BMI and body appreciation. BMI correlated significantly with body appreciation, body dissatisfaction, and body image inflexibility among older women but did not correlate with body appreciation among older men. Body dissatisfaction and body image inflexibility emerged as significant mediators in the relationship between BMI and body appreciation among older Chinese women. Reducing body dissatisfaction and body image inflexibility may be potential targets for helping older women with high BMI to promote their body appreciation.

Metabolic indexes of obesity in patients with common mental disorders in stable stage

BACKGROUND

Obesity is a serious worldwide public health problem, especially for people with mental disorders.

AIM

To explore the related factors of obesity by analyzing the metabolic indexes of patients with common mental disorders in stable stage.

METHODS

Five hundred seventy-six subjects with major depressive disorder (MDD), bipolar disorder (BD) or schizophrenia (SCZ) were included, who received fixed drug dose and routine drug treatment for 2 years or more. Their venous blood was collected, and the blood metabolic indexes were analyzed.

RESULTS

BD and SCZ are more prone to obesity than MDD. Multiple linear regression analysis showed that the value of BMI increased with the increase of age(B = 0.084, p < 0.001), TG(B = 0.355, p = 0.024), LDL(B = 0.697, p < 0.001), LDH(B = 0.011, p = 0.002), SCr(B = 0.051, p < 0.001), UA(B = 0.014, p < 0.001), HbA1c(B = 0.702, p = 0.004) and hsCRP(B = 0.101, p < 0.001). And It decreased with the increase of HDL(B = -1.493, p < 0.001).

DISCUSSION

People with mental disorders should regularly check blood indicators and strengthen weight management to reduce the risk of obesity and promote their health.

Prevalence and diagnostic agreement of sarcopenic obesity with different definitions among Chinese community-dwelling older adults

OBJECTIVE

this retrospective study aims to compare the prevalence and diagnostic agreement of sarcopenic obesity (SO) using different obesity diagnostic methods among Chinese community-dwelling older adults.

METHODS

SO was diagnosed with sarcopenia and obesity diagnostic methods. Sarcopenia was defined using the Asian Working Group for Sarcopenia criteria 2019 (AWGS2019). Four widely used indicators were used to define obesity: body mass index (BMI), waist circumference (WC), percent of body fat (PBF) and visceral fat area (VFA). Cohen's kappa was used to analyse the diagnosis agreement of SO between different diagnostic methods.

RESULTS

a total of 1,050 participants were included, including 347 men (71.3 ± 7.4 years) and 703 women (69.9 ± 7.5 years). The prevalence of sarcopenia was 25% in total participants, there was no difference between men (24.2%) and women (25.5%), (P = 0.705). With different obesity diagnostic methods, the obesity prevalence ranged from 4.1 to 42.2%, the SO prevalence was 0.1-7.9%. The diagnosis agreement of SO was poor-to-moderate (κ ranged from -0.002 to 0.682). Among the four diagnostic methods, AWGS combined with BMI had the poorest agreement (κ = -0.002 with other methods), AWGS combined with VFA had the best agreement (κ = 0.641 and 0.682 with AWGS combined with PBF and with AWGS combined with WC, respectively).

CONCLUSION

the prevalence of SO vary considerably and the diagnostic agreement is poor-to-moderate with non-uniform diagnostic methods. BMI has the lowest sensitivity, whereas VFA has the highest sensitivity in diagnosis of SO, and VFA has a relatively good diagnostic agreement with other diagnostic methods.

Age and Sex Differences in the Association of Sleep Duration and Overweight/Obesity among Chinese Participants Age above 45 Years: A Cohort Study

OBJECTIVES

We aimed to evaluate the association between sleep duration and obesity and estimate the attributable risk of sleep in the China Health and Retirement Longitudinal Study surveys (CHARLS).

METHODS

A total of 9061 adults aged 45 years above from CHARLS (2011-2015) were included. The main outcome of this study was incident overweight/obesity specific to general and abdominal obesity. Overweight/obesity was defined as BMI ≥ 23.0 (kg/m2) and BMI≥27.5 (kg/m2), respectively. Abdominal obesity was defined as waist circumference ≥90 cm for men and ≥80 cm for women. Self-reported sleep durations were obtained using a structured questionnaire. We assessed hazard ratios (HRs) and 95% confidence intervals (CIs) as well as the population attributable fraction (PAF) for associations between sleep duration and obesity.

RESULTS

986 and 606 participants were identified as overweight and general obesity respectively, 1253 experienced abdominal obesity events. In multivariable-adjusted models, participants with daytime sleep of 0-30 minutes and more than 30 minutes associated with 30% (HR: 0.70, 95% CI: 0.56-0.87) and 35% (HR: 0.65, 95% CI: 0.55-0.78) decreased incident overweight risk respectively compared to those having no daytime sleep, this association also found among females and middle-aged, not males or elderly. Similarly, 0-30 minutes (HR: 0.68, 95% CI: 0.48-0.96) and more than 30 minutes of daytime sleep (HR: 0.73, 95% CI: 0.59-0.91) were associated with a reduced risk of abdominal obesity, similar results also found among females and middle-aged. Compared with 7-9 hours of nocturnal sleep, people who slept 5-7 hours had a reduced risk of overweight (HR: 0.59, 95% CI=0.47-0.74),but not found in subgroups. The hazard role of long nocturnal sleep for abdominal obesity was only found among elderly (HR: 2.33, 95% CI=1.35-4.04) and males (HR: 2.24, 95% CI=1.17-4.29). Compared with moderate total sleepers (7-9hours/day), participants with short total sleep duration exhibited an elevated risk of overweight (HR: 1.13, 95% CI=1.00-1.28), this also found among middle-aged. The PAF for inadequate total sleep duration (<7 hours/day) was 10.77% for overweight individuals.

CONCLUSIONS

Insufficient sleep duration was associated with an elevated risk of overweight only detected among middle-aged not elderly and other subgroups specific by age. The risks for abdominal obesity were increased for males and middle-aged with long nocturnal sleep. Daytime sleep may significantly reduce the risk of overweight and abdominal obesity in female and middle-aged individuals. The link between sleep duration and obesity requires further study.

Prevalence and associated factors of obesity and overweight in Chinese patients with bipolar disorder

OBJECT

Despite abundant literature demonstrating a high prevalence of obesity and overweight in people with bipolar disorder (BD), little is known about this topic in China. Therefore, we assessed the prevalence and associated factors of obesity and overweight among inpatients with BD in our hospital, one of the largest public psychiatric hospitals in China.

METHODS

In this retrospective, cross-sectional study, 1,169 inpatients ≥18 years with BD during 2019 were included. Obesity was defined as having a BMI ≥25 kg/m², and overweight was defined as having a BMI from 23 kg/m² to <25 kg/m². Binary logistic regression analysis was performed to identify factors associated with obesity and overweight.

RESULTS

The prevalence of obesity and overweight was 21.0% and 32.2% in patients with BD, respectively. Compared to patients with overweight and normal weight, patients with obesity were older, had a longer duration of BD and a longer length of hospital stay, had a higher prevalence of diabetes and hypertension, and had a higher level of all metabolic indices, except for HDL cholesterol. Binary logistic regression analysis showed that duration of BD, uric acid, alanine aminotransferase (ALT), triglyceride, and LDL cholesterol were significantly associated with obesity, and male sex and uric acid level were significantly associated with overweight (p < 0.05).

CONCLUSIONS

Obesity and overweight were fairly prevalent in Chinese BD patients, and several factors were related to obesity and overweight. The results of the present study call for the need to implement early screening, prevention and interventions for obesity and overweight in patients with BD in China.

The correlation of body mass index with clinical factors in patients with first-episode depression

Depression is one of the major disease burdens worldwide. Few studies have addressed body mass index (BMI) in Chinese depression patients. This current study aimed to investigate the BMI in patients with depression and the correlation with clinical factors. A total of 211 inpatients with first-episode depression were enrolled. General and clinical data were collected by standardized questionnaires and the levels of hemoglobin, fasting blood glucose, uric acid, and blood lipid were measured. In total, 24-item Hamilton Depression Scale (HAMD) and 14-item Hamilton Anxiety Scale (HAMA) were rated for all the patients. The BMI of 211 patients with depression was 37 (17.5%) in the underweight group, 117 (55.5%) in the normal-weight group, 43 (20.4%) in the overweight group, and 14 (6.6%) in the obesity group. Multivariate logistic analysis showed that uric acid was the only risk factor for BMI. The ordered logit model showed that the risk of elevated uric acid increased with BMI grade. And the risk of severe depression was significantly greater in patients with underweight than those in normal-weight. The level of uric acid in patients with first-episode depression is positively correlated with BMI, and the score of depressive symptoms is higher in patients with underweight.

Absence of Obesity Paradox in All-Cause Mortality Among Chinese Patients With an Implantable Cardioverter Defibrillator: A Multicenter Cohort Study

Background: The results of studies on the obesity paradox in all-cause mortality are inconsistent in patients equipped with an implantable cardioverter-defibrillator (ICD). There is a lack of relevant studies on Chinese populations with large sample size. This study aimed to investigate whether the obesity paradox in all-cause mortality is present among the Chinese population with an ICD.

Methods: We conducted a retrospective analysis of multicenter data from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device–implanted Patients (SUMMIT) registry in China. The outcome was all-cause mortality. The Kaplan–Meier curves, Cox proportional hazards models, and smooth curve fitting were used to investigate the association between body mass index (BMI) and all-cause mortality.

Results: After inclusion and exclusion criteria, 970 patients with an ICD were enrolled. After a median follow-up of 5 years (interquartile, 4.1–6.0 years), in 213 (22.0%) patients occurred all-cause mortality. According to the Kaplan–Meier curves and multivariate Cox proportional hazards models, BMI had no significant impact on all-cause mortality, whether as a continuous variable or a categorical variable classified by various BMI categorization criteria. The fully adjusted smoothed curve fit showed a linear relationship between BMI and all-cause mortality (p-value of 0.14 for the non-linearity test), with the curve showing no statistically significant association between BMI and all-cause mortality [per 1 kg/m² increase in BMI, hazard ratio (HR) 0.97, 95% CI 0.93–1.02, p = 0.2644].

Conclusions: The obesity paradox in all-cause mortality was absent in the Chinese patients with an ICD. Prospective studies are needed to further explore this phenomenon.