Obesity: global epidemiology and pathogenesis

The burden of diseases attributable to high body mass index in Asia from 1990 - 2019: results from the global burden of disease study 2019

AIM

Our study aimed to report the burden of diseases attributable to high body mass index (BMI) in Asia from 1990 to 2019.

METHODS

Utilizing data from the Global Burden of Disease (GBD) Study 2019, we calculated disability-adjusted life years (DALYs) and deaths, with trends quantified by the estimated annual percentage change (EAPC). We also made projections for selected countries and estimated the relationship between the Sociodemographic Index (SDI) and high BMI-related disease burden.

RESULT

From 1990 to 2019, high BMI-related diseases observed significant increases in the absolute number of deaths and DALYs, with EAPCs of 4.62 and 4.69, respectively, while the age-standardized rates of both deaths and DALYs also showed upward trends, with EAPCs of 1.39 and 1.80. Cardiovascular diseases, diabetes and kidney diseases, and neoplasms were the major contributors to the high BMI-related burden. The burden of high BMI-related diseases generally tended to be greater among males and older age groups. Predictions for selected countries indicated a continued rise in the number of deaths and DALYs for high BMI-related diseases, with a stabilization in the age-standardized rate. There was no significant association between SDI levels and the burden of high BMI-related diseases in Asia (coefficient=0.13, p = 0.39).

CONCLUSION

The burden of high BMI-related diseases, a major public health issue, was increasing in Asia. To address this problem, coordinated action by governments, civil society and other key stakeholders should be taken to enhance awareness of the risks associated with high BMI and effectively reduce its impact.

Fusobacterium mortiferum and its metabolite 5-aminovaleric acid promote the development of colorectal cancer in obese individuals through Wnt/β-catenin pathway by DKK2

Colorectal cancer (CRC) is one of the most prevalent cancers worldwide, with high incidence and mortality rates. An increasing body of research suggests that obesity is a significant risk factor for the development of CRC. Moreover, recent findings have highlighted the close association between the gut microbiota and both obesity and CRC. Despite this, the specific mechanisms by which the gut microbiota influences obesity and CRC remain unclear. This study aims to explore the role of the gut bacterium Fusobacterium mortiferum and its metabolite 5-aminovaleric acid (5-AVA) in the development of obesity and CRC. Our study found that the metabolite 5-aminovaleric acid produced by Fusobacterium mortiferum significantly inhibits the expression of the tumor suppressor DKK2. This inhibition leads to enhanced proliferation of CRC cells. Furthermore, we discovered that Fusobacterium mortiferum and 5-AVA can activate the Wnt/β-catenin signaling pathway by inhibiting DKK2, thereby promoting tumor growth. This finding was validated in CRC mouse models and in vitro experiments. Additional mechanistic studies revealed that 5-AVA interacts with the demethylase KDM6B, affecting the demethylation process of DKK2 and subsequently activating the Wnt/β-catenin signaling pathway. Our study retrospectively collected fecal samples from patients who underwent gastrointestinal endoscopy at the Sixth Affiliated Hospital of Sun Yat-sen University over the past five years. Participants were stratified into a healthy control group and an adenoma group based on the outcomes of their colonoscopies. Following this, we conducted metagenomic analysis to identify differential bacteria, and based on the results, we performed bacterial cultivation and metabolomic profiling. The roles of the targeted bacteria and their metabolites were further validated through animal models and cellular assays, employing techniques such as Western Blot, qPCR, immunohistochemistry, molecular docking simulations, and gene overexpression studies. This study uncovers the potential carcinogenic effects of Fusobacterium mortiferum and 5-AVA in the development of obesity and CRC. Our research emphasizes the complex interplay between the gut microbiota and host metabolism and suggests new directions for future research to explore how modulation of the gut microbiota could prevent and treat CRC.

Endocrine-disrupting chemicals in human adipose tissue and associations between exposure and obesity

Bio-accumulation of endocrine-disrupting chemicals (EDCs) in human body may result in various adverse health effects. This study measured the levels of 16 EDCs in the visceral adipose tissue of 55 participants in China and investigated their association with obesity. MeP, BPP, PrP, BPA, EtP, BPE, and BPC were frequently detected in more than 50 % of the adipose tissues. A positive correlation between bisphenol A and body mass index (BMI) was observed in both multivariate linear regression model (β = 0.87, 95 % confidence interval: 0.21-1.53, p = 0.011) and multivariate logistic regression analysis (odds ratio = 1.28, 95 % confidence interval: 1.01-1.62, 0.044). Restricted cubic spline regression analysis revealed a significant nonlinear association between bisphenol P and BMI. Weighted quantile sum regression and quantile-based g-computation revealed a slight positive trend between EDCs mixed exposure and BMI, with bisphenol A as the primary contributor to the positive correlation with BMI. Our findings suggest the extensive existence of environmental EDCs in the adipose tissue of the adult Chinese population and indicate that exposure to BPA in adipose tissue may be associated with the occurrence of obesity.

Subclinical myocardial work impairment in non-diabetic overweight and obese individuals: Impact of cardiometabolic traits

BACKGROUND

Early detection of cardiac impairment in overweight and obesity is essential for early preventive strategies against heart failure. Myocardial work is a novel echocardiographic parameter that incorporates left ventricular afterload into global longitudinal strain analysis. This study aimed to: 1) assess subclinical alterations of myocardial work among non-diabetic overweight and obese individuals with normal left ventricular ejection fraction (LVEF); 2) investigate the impact of cardiometabolic traits on these alterations; and 3) determine the correlation between myocardial work and myocardial tissue characteristics.

METHODS

In the prospective EARLY-MYO-OBESITY-II study (NCT04933188), we enrolled 150 non-diabetic participants, including 50 obese individuals (BMI ≥ 30 kg/m2), 50 age- and gender-matched overweight individuals (BMI 25-30 kg/m2), and 50 healthy lean controls (BMI < 25 kg/m2). Non-invasive myocardial work was calculated from two-dimensional speckle-tracking echocardiography and cuff blood pressure, while myocardial fibrosis was assessed using extracellular volume fraction (ECV) and native T1 value from cardiac magnetic resonance imaging.

RESULTS

Global work index (GWI) and constructive work (GCW) were decreased in the obese participants compared with the overweight and control groups. Both overweight and obese groups exhibited elevated global wasted work (GWW) and reduced global work efficiency (GWE). In multivariate regression analysis, elevated Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) values were independently associated with reduced GWI and GCW (β = -89.953 and -121.191, respectively). The overweight and obese groups showed elevated ECV and native T1 compared to the control group. GWW and GWE were significantly correlated with ECV (Spearman's Rho 0.516 and -0.547, respectively) and demonstrated superior predictive value for myocardial fibrosis (AUC = 0.86 and 0.82, respectively) compared to global longitudinal strain (AUC = 0.58).

CONCLUSIONS

Myocardial work is impaired in non-diabetic overweight and obese individuals, even with preserved LVEF. Insulin resistance is significantly and independently associated with myocardial work, highlighting the importance of targeting individuals with insulin resistance to reduce heart failure risk. Non-invasive myocardial work may serve as an image marker for detecting early cardiac fibrosis.

The dose-response relationships between all-cause and cardiovascular mortality and the accrual of various dietary habits

Objective

To evaluate the potential dose-response relationships of all-cause and cardiovascular death with the accumulation of various dietary habits.

Setting

A prospective cohort study.

Methods

Twenty-three dietary habits were assessed through face-to-face interviews with 57,737 participants in health check-up programs from 2015 to 2021. The total score of various dietary habits was calculated as the sum of each dietary habit multiplied by its own full-adjusted coefficient (β) for all-cause mortality in Cox proportional hazard models. Cox proportional hazard models were fitted for the associations of total and cause-specific mortality with the scores of various dietary habits.

Results

1,692 deaths occurred after the earliest check-ups in our center, followed up for a median time of 2.14 years (range: 1.01-7.71 years). Total mortality was 11.23/1,000 person-years, and the mean scores of dietary habits were 2.83±2.14. All-cause mortality increased significantly with the cumulative score of dietary habits (the highest quartile vs. lowest quartile: adjusted hazard ratio [AHR], 1.72; 95 % confidence interval [CI], 1.49-1.99; Plinear <0.01). Significance was also found for cardiovascular disease (CVD) mortality (HR, 1.82; 95 % CI, 1.47-2.27; Plinear <0.01), cancer mortality (AHR, 1.59; 95 % CI, 1.23-2.04; Plinear <0.01), and other-cause mortality (AHR, 2.00; 95 % CI, 1.46-2.73; Plinear <0.01). These dose-response trends were more significant in total mortality and CVD mortality among middle-aged adults, and non-obese population.

Conclusions

The greater the accumulation of diverse dietary habits, the higher the total mortality, CVD mortality, cancer mortality, and other mortality. This additive effect was particularly pronounced in the risk of death among middle-aged individuals and those with average body statures.

Social, cultural and ethnic determinants of obesity: From pathogenesis to treatment

AIMS

Obesity is a multifactorial disease influenced by several factors including poor diet, physical inactivity, and genetic predisposition. In recent years, the social and environmental context, along with race/ethnicity and gender, have been recognized as factors influencing obesity risk beyond traditional risk factors. This review aims to increase knowledge of these causal determinants and their implications for the treatment and management of obesity, addressing not only the individual but also the societal sphere.

DATA SYNTHESIS

A growing body of evidence emphasizes the interaction between the physical and social environments in shaping personal behaviors related to obesity. Social disparities, such as socioeconomic status (income, education, employment), racial/ethnic differences, and gender, contribute significantly to weight gain from childhood to adulthood. These factors increase the risk of obesity and related cardiovascular risk factors, independent of clinical and demographic variables, and may lead to stigma and discrimination against those affected.

CONCLUSIONS

Obesity prevention solutions, from community programs to national policies, may be more effective if they address social, gender, and ethnic barriers. Understanding obesity requires a comprehensive approach that includes social, environmental, and psychological factors, as well as biological causes, to help obesity experts develop more effective interventions tailored to obesity and related diseases.

Amylin: From Mode of Action to Future Clinical Potential in Diabetes and Obesity

Precision diabetology is increasingly becoming diabetes phenotype-driven, whereby the specific hormonal imbalances involved are taken into consideration. Concomitantly, body weight-favorable therapeutic approaches are being dictated by the obesity pandemic, which extends to all diabetes subpopulations. Amylin, an anorexic neuroendocrine hormone co-secreted with insulin, is deficient in individuals with diabetes and plays an important role in postprandial glucose homeostasis, with additional potential cardiovascular and neuroprotective functions. Its actions include suppressing glucagon secretion, delaying gastric emptying, increasing energy expenditure and promoting satiety. While amylin holds promise as a therapeutic agent, its translation into clinical practice is hampered by complex receptor biology, the limitations of animal models, its amyloidogenic properties and pharmacokinetic challenges. In individuals with advanced β-cell dysfunction, supplementing insulin therapy with pramlintide, the first and currently only approved injectable short-acting selective analog of amylin, has demonstrated efficacy in enhancing both postprandial and overall glycemic control in both type 2 diabetes (T2D) and type 1 diabetes (T1D) without increasing the risk of hypoglycemia or weight gain. Current research focuses on several key strategies, from enhancing amylin stability by attaching polyethylene glycol or carbohydrate molecules to amylin, to developing oral amylin formulations to improve patients' convenience, as well as developing various combination therapies to enhance weight loss and glucose regulation by targeting multiple receptors in metabolic pathways. The novel synergistically acting glucagon-like peptide-1 (GLP-1) receptor agonist combined with the amylin agonist, CagriSema, shows promising results in both glucose regulation and weight management. As such, amylin agonists (combined with other members of the incretin class) could represent the elusive drug candidate to address the multi-hormonal dysregulations of diabetes subtypes and qualify as a precision medicine approach that surpasses the long overdue division into T1DM and T2DM. Further development of amylin-based therapies or delivery systems is crucial to fully unlock the therapeutic potential of this intriguing hormone.Graphical abstract available for this article.

Adipose-targeted nanohybrid as a browning inducer for synergistic hyperthermia-pharmacotherapy of obesity

Inducing adipose browning to increase energy expenditure has recently emerged as a promising approach for antiobesity treatment. However, its therapeutic efficacy is often limited by poor adipose-targeted drug delivery and suboptimal browning efficiency. To address these challenges, an adipose-targeting aptamer (Apt8) and browning agent resveratrol (Res) were used to construct an Apt-modified and Res-loaded degradable mesoporous silica-coated Au nanorods nanocarriers (NC), termed Res@NC@Apt8, achieving adipose-targeted hyperthermia-pharmacotherapy. Upon internalization by adipocytes, laser irradiation induces mild local hyperthermia (LHT) via Res@NC@Apt8, triggering calcium ion (Ca2+) influx. Simultaneously, the interaction of the nanohybrid with local glutathione (GSH) releases Res. The dual mechanisms activate the adenosine 5'-monophosphate-activated protein kinase (AMPK) pathway, reduce the lipid droplet content, enhance mitochondrial biogenesis, and accelerate metabolism, thereby synergistically promoting adipose browning. Intravenous Res@NC@Apt8 administration in obese mice significantly drives adipose reduction and further achieves excellent antiobesity therapeutic efficacy. This synergistic treatment achieves a superior weight reduction of 17.2% compared with 6.9% and 10.6% achieved using LHT and pharmacotherapy alone, respectively. This study introduces a novel strategy for achieving activatable LHT and drug release for synergetic obesity treatment.

Efficacy of phentermine/topiramate extended release in weight management and metabolic profiles: A multicentre study in South Korea

AIMS

Clinical trials have demonstrated the effectiveness of the phentermine and topiramate combination in weight management. This research evaluated the efficacy and safety of phentermine/topiramate extended release (ER) for weight management, focusing on alterations in body weight and metabolic parameters in routine clinical practice.

MATERIALS AND METHODS

We retrospectively included people with obesity who initiated phentermine/topiramate ER between January 2020 and April 2023 at 10 tertiary hospitals in South Korea. The study assessed body weight changes at 5-6 months and for those who continued, at 12 months, along with metabolic parameters. Total body weight was measured using calibrated electronic scales with participants in light indoor clothing.

RESULTS

The cohort included 1839 patients (540 men and 1299 women), with a 5-6-month continuation rate of 48%. At 5-6 months, the mean weight reduction was 7.9%, with sex-specific losses of 7.1% in men and 8.2% in women. Over 56% of participants achieved more than 5% weight loss, with 23% exceeding a 10% reduction. Younger participants, women and those with moderate to severe obesity exhibited more pronounced weight loss compared to older men and individuals with mild obesity, respectively. Concurrently, phentermine/topiramate ER treatment improved glucose regulation, lipid profiles and decreased blood pressure: the HbA1c decreased by 0.4 ± 0.9%, low-density lipoprotein (LDL) cholesterol by 10 ± 32 mg/dL and systolic blood pressure by 6 ± 15 mmHg (all p < 0.001). Treatment was well-tolerated, with a 15% incidence of mild adverse events like paresthesia, dry mouth and insomnia. At 12 months, patients who persisted in treatment (21%) experienced an average weight loss of 9.6%, with 65% surpassing a 5% weight loss.

CONCLUSION

The study suggests phentermine/topiramate ER is an effective option for obesity management in a South Korean population, though long-term adherence remains a challenge.

Plant proteins and peptides as key contributors to good health: A focus on pulses

The growing interest of the public in healthy food products with adequate nutritional quality has triggered a search for novel sources of protein. This review discusses scientific evidence on the available sources, processing, and biological properties of plant-based protein and bioactive peptides, with a particular emphasis on pulses, as these are some of the most important sources of protein and peptides displaying a wide range of health benefits. Processing plant-based proteins and derived peptides require standardized methods ensuring the improvement of their nutritional quality to counteract limiting factors affecting their evenness to other protein sources. If protein and bioactive peptides can be produced as functional ingredients, the industry releases patents, making them highly marketable to develop functional food products. Current research supports that plant-based food products constitute a nutritious part of a healthy diet by preventing chronic non-communicable diseases, but more studies, particularly clinical trials, are needed to demonstrate these effects fully.

Management and impact of obesity in Canada: A real-world survey of people with obesity and their physicians

Background

Obesity is a chronic relapsing disease associated with multiple complications. This study described real-world demographic/clinical characteristics, including obesity-related complications (ORCs), prescribing rationale, and patient-reported outcome measures (PROMs) for adults living with obesity in Canada accessing treatment.

Methods

This was a cross-sectional survey of physicians and consulting people with obesity (PwO) in Canada with retrospective data capture in a real-world setting. Canadian data were drawn between July and November 2022 from the multinational Adelphi Real World Obesity Disease Specific Programme™. Consulting PwO were required to be on a weight management program and/or have a current body mass index of ≥30 kg/m2. Physicians completed questionnaires for the next 3-5 consecutive PwO seen in their routine clinical practice. A quota was applied for obesity management medication (OMM). PROMs including Work Productivity and Activity Impairment (WPAI) questionnaire were provided voluntarily by PwO. Analyses were descriptive.

Results

Overall, 50 physicians (35 general practitioners, 15 endocrinologists) and 199 PwO were analyzed. More than 85 % of PwO had ≥1 ORC. The most common ORCs were hypertension, dyslipidemia, depression, and type 2 diabetes, and one-quarter to one-half of ORCs were not optimally controlled. Approximately two-thirds of the cohort were employed full-time, almost half had private insurance, and almost 70 % were classified as high socio-economic status. Mean number of weight-reduction attempts over the past 3 years was 2.9. Pharmacological treatment for obesity was common among those with ORCs. A general trend towards greater work impairment among people with ORCs than for PwO without ORCs was observed.

Conclusions

Among PwO participating in our study, ORCs were common, often uncontrolled, and their presence impacted the likelihood of obesity treatment and possibly impaired work productivity. Medical treatment for obesity was often delayed until ORCs developed, suggesting that preventative healthcare measures are not the norm for PwO in Canada. A large proportion of PwO had high socioeconomic status, suggesting that PwO who access treatment may not be representative of the overall population of PwO in Canada.

Bariatric surgery in Poland in 2017-2022: retrospective analysis of public health system open data

Background

There little known about bariatric surgeries performed in Poland. We aimed to analyze trends in bariatric surgery performed in public health system in Poland.

Methods

Data was obtained from the National Health Fund (NFZ) database of aggregated statistics for the years 2017-2022. We retrieved data about hospitalizations during which bariatric surgery was performed. We performed descriptive statistics.

Results

From 2017 to 2022, the number of bariatric surgeries in Poland's public healthcare system increased from 3,278 to 5,580, with a temporary decline in 2020. The number of procedures per 100,000 residents increased from 8.5 in 2017 to 14.7 in 2022. The majority of surgeries (73.3%) were performed on women. Sleeve gastrectomy was the most frequently reported procedure. The median duration of hospitalizations was 3 days. The in-hospital mortality rate was equal to 0.057.

Conclusions

Between 2017 and 2022, bariatric surgeries in the Polish public healthcare system increased by about 70%, with a temporary drop in 2020. Nevertheless, Poland still reports fewer procedures per 100,000 residents compared to other developed countries. A key limitation of this study is the absence of data from private sector.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01600-0.

Effects of energy-restricted diets with or without nuts on weight, body composition and glycaemic control in adults: a scoping review

Energy-restricted (ER) diets promote weight loss and improve body composition and glycaemic control. Nut consumption also improves these parameters. However, less is known about the combined benefit of these two strategies. This scoping review implemented a systematic search of Medline, Embase and Scopus to identify randomised controlled trials evaluating the effect of ER diets with or without nuts on body mass, body composition and glycaemic control in adults. After reviewing titles and abstracts, twenty-nine full-text articles were screened, resulting in seven studies reported in eight papers that met the inclusion criteria. Energy restriction was achieved by prescribing a set energy target or reducing intake by 1000-4200 kJ from daily energy requirements. Interventions ranged from 4 to 52 weeks in duration and contained 42-84 g/d of almonds, peanuts, pistachios or walnuts. While all studies reported that energy restriction resulted in significant weight loss, the addition of nuts to ER diets demonstrated significantly greater weight loss in only approximately half of the included studies (4/7 studies). There was limited evidence to support additional benefits from nuts for body composition measures or glycaemic control. Although improvements in weight loss and glycaemia were not consistent when nuts were included in ER diets, no study revealed an adverse effect of nut consumption on health outcomes. Future studies could explore the effect of consuming different types and amounts of nuts, combined with various levels of energy restriction on weight, body composition and glycaemic control.

Huatanhuoxue decoction alleviates airway inflammation by regulating IL-17A signaling pathway in obese asthmatic mice

ETHNOPHARMACOLOGICAL RELEVANCE

Huatanhuoxue Decoction (HTHX) is a traditional Chinese formula consisting of nine herbs. It is used to improve obesity-related asthma symptoms and reduce airway inflammation.

AIM OF THE STUDY

To study HTHX effects on airway inflammation in obese asthmatic mice via the IL-17 A signaling pathway.

MATERIALS AND METHODS

Network pharmacology was used to predict the bioactive ingredients in HTHX. Subsequently, an obese asthma model was established by high-fat diet feeding and exposure to house dust mite. The effects of HTHX on obesity-related asthma progression were investigated using histopathological examinations, airway hyperresponsiveness determinations, and enzyme-linked immunosorbent assays. The mechanism of action of HTHX was confirmed by Western blots, flow cytometry, immunohistochemistry, and immunofluorescence analyses.

RESULTS

HTHX alleviated the development in obese asthma mice by improving the pathological condition of lung tissue, airway hyperresponsiveness, and inflammatory factors. Network pharmacology identified the involvement of the IL-17 signaling pathway. HTHX decreased the production of neutrophils and the expression of NETs in lung tissue. HTHX also reduced group 3 innate lymphoid cells and Th17 cells, which are responsible for producing IL-17 A. The production of IL-17 A-related protein was also suppressed. The results indicate that HTHX inhibited the excessive activation of the IL-17 A signaling pathway.

CONCLUSIONS

HTHX alleviated airway inflammation by regulating the IL-17 A signaling pathway in obese asthmatic mice.

The interplay between body mass index, motivation for food consumption, and noncommunicable diseases in the European population: A cross-sectional study

INTRODUCTION

Consuming unhealthy foods in emotional states can increase body mass index (BMI), contribute to becoming overweight, and lead to the development of chronic diseases. This study aims to investigate the associations between BMI, emotional motivation for food consumption, and health outcomes.

MATERIALS AND METHODS

"The Motivations for Food Choices" (EATMOT) questionnaire was used to assess the emotional components of food consumption in 9,036 individuals from 12 European countries. The multivariate analysis included linear and logistic regression to examine associations between variables.

RESULTS

Regression models confirmed associations between BMI, emotional motivation for food consumption (β = 0.13; p < 0.001), obesity (β = 0.35; p < 0.001), diabetes mellitus, and hypertension (β = 0.04; p < 0.001 for both). Using food as a coping mechanism for stress contributed to an increase in BMI [OR = 1.31 (95% CI 1.14-1.51); p < 0.001]. Emotional consolation was associated with a higher likelihood of an increased BMI [OR = 1.22 (95% CI 1.03-1.44); p = 0.020] and obesity [OR = 1.47 (95% CI 1.06-2.06); p = 0.022]. Participants with obesity had a greater likelihood of developing noncommunicable diseases, such as cardiovascular diseases [OR = 2.18 (95% CI 1.45-3.28); p < 0.001], diabetes mellitus [OR = 2.02 (95% CI 1.31-3.12); p = 0.001], hypercholesterolemia [OR = 1.62 (95% CI 1.13-2.32); p = 0.009], hypertension [OR = 1.85 (95% CI 1.36-2.52); p < 0.001], and gastric disorders [OR = 1.81 (95% CI 1.16-2.85); p = 0.010].

CONCLUSION

These results underscore the need for targeted public health interventions that address emotional eating behaviors and promote healthier coping strategies to mitigate the risk of obesity and related health complications.

Impact of other macronutrient composition within high-protein diet on body composition and cardiometabolic health: a systematic review, pairwise, and network meta-analysis of randomized controlled trials

BACKGROUND/OBEJCTIVE

Although the high-protein diets (HPDs) on weight control and body composition management are well investigated, mix results have been reported across studies and this variability may be attributed to differences in the composition of other macronutrients within HPDs. The aim of this study was to evaluate the impacts of HPDs with varied macronutrient compositions on body composition and cardiometabolic health outcomes through a systematic review, pairwise, and network meta-analysis.

METHODS

A comprehensive search of four databases (PubMed, Embase, CINAHL, and Web of Science) was conducted to identify relevant randomized controlled trials. A total of 83 articles were selected for systematic review and both meta-analyses.

RESULTS

Significant reduction in body mass (BM) (standardized mean difference [SMD] = -0.25; 95% CI: -0.40, -0.11), body mass index (BMI) (SMD = -0.26; 95% CI: -0.38, -0.15), waist circumference (WC) (SMD = -0.19; 95% CI: -0.33, -0.04), fat mass (FM) (mean difference [MD] = -0.64 kg; 95% CI: -0.98, -0.29), along with increase in lean body mass (LBM) (MD = 0.34 kg; 95% CI: 0.11, 0.57) were observed with HPDs regiments compared to normal-protein diets. Specifically, the high-protein, moderate-carbohydrate and high-fat diet ranked the best in reducing BM, BMI, WC, FM, systolic blood pressure, diastolic blood pressure and increasing LBM; while the high-protein, low-carbohydrate and high-fat diet obtained the highest score in reducing triglyceride and increasing high-density lipoprotein cholesterol.

CONCLUSION

HPDs effectively reduce FM and increase LBM, and offers potential cardiometabolic benefits. Additionally, the manipulation of carbohydrate content in HPDs may further influence these outcomes.

REGISTRATION

PROSPERO (CRD42023483907).

Impact of body mass index on recurrent stroke in stroke survivors: An updated systematic review and meta-analysis

BACKGROUND

This updated systematic review and meta-analysis aimed to re-evaluate the potential impact of body mass index (BMI) on the risk of recurrent stroke among stroke survivors.

METHODS

We systematically searched PubMed, EMBASE, and Cochrane CENTRAL databases for studies published up to January 20, 2025. Eligible studies included randomized controlled trials, cohort studies, or case-control studies enrolling adult stroke or transient ischemic attack (TIA) survivors, with at least one year of follow-up, and reporting stroke recurrence by BMI categories. Studies were required to define stroke using clinical diagnosis or the International Classification of Disease (ICD) codes, and to categorize BMI using the World Health Organization (WHO) or Asia-Pacific classifications. The primary outcome was recurrent stroke risk between individuals with and without obesity, assessed using risk ratios (RRs). Secondary outcomes evaluated recurrent stroke risk across WHO BMI categories using adjusted hazard ratios (HRs). (PROSPERO: CRD42024580168) RESULTS: Fourteen studies (136,581 subjects) were included in the qualitative review (systematic review). Two using Asia-Pacific criteria were excluded, leaving 12 studies using WHO-classified BMI for quantitative synthesis (meta-analysis). Meta-analysis showed no significant difference in stroke recurrence between individuals with and without obesity (RR = 0.89, 95 % CI: 0.71-1.13). Meta-analysis of adjusted HRs showed no significant difference in stroke recurrence risk for individuals with underweight or overweight compared to those with normal weight. However, in the subgroup with ≥ 3 years follow-up, overweight was significantly associated with lower recurrent stroke risk (HR = 0.91). Also, individuals with obesity had a significantly lower stroke recurrence risk than normal weight individuals (HR = 0.85), particularly among those aged ≥ 65 years (HR = 0.82).

CONCLUSIONS

Overweight and obesity may be associated with a lower risk of stroke recurrence, particularly in older adults and during long-term follow-up (≥ 3 years). These findings suggest a potential obesity paradox in stroke survivors, warranting further investigations.

Metabolic Comorbidities Among Relatives of Type 2 Diabetes Patients Stratified by Weight: Implications for Prevention and Care

Introduction

Diabetes, affecting 18.3% of young adults in Mexico (6), is influenced by both genetic factors and shared unhealthy habits within families.

Objective

To determine the metabolic abnormalities in relatives of people with T2D, stratified by body mass index.

Materials and Methods

This observational, descriptive study was conducted at the Center for Comprehensive Care for Patients with Diabetes (CAIPaDi). The study involved relatives of participants with type 2 diabetes mellitus (T2DM), recruited between June 2017 and December 2020. The relatives were people without diabetes, including spouses, siblings, offspring, or close family members aged 18 to 65 who spent over four days a week with the patient. Exclusion criteria included relatives diagnosed with diabetes, smokers, or any individual from a patient-relative pair that was excluded. All participants underwent laboratory tests and body measurements. Relatives were classified into three groups based on body weight: normal weight, overweight, and obesity. The relatives attended four monthly visits and then annual evaluations. Ethical approval was obtained.

Results

The study enrolled 220 relatives of people with T2DM, 69% women, median age 49±12 years; 19.5% with normal weight, 40.4% overweight, and 40% with obesity. Prediabetes (39.4%), dyslipidemia (67.2%), and abnormal liver function tests (32.2%) were prevalent. Higher levels of triglycerides and LDL cholesterol were associated with increased risk for comorbid conditions. Anxiety and depression showed no significant differences across weight categories.

Conclusion

These results highlight the importance of overweight and obesity as factors associated with the presence of comorbidities and the metabolic syndrome. It is essential to implement strategies to promote healthy habits among family members of people with diabetes, especially in those who are overweight or obese to reduce the risk of developing future metabolic and cardiovascular diseases.

Analysis of the clinical-organizational pathway and well-being of obese patients undergoing bariatric surgery: impact on satisfaction and quality of life

Bariatric surgery is an effective treatment for obesity, promoting significant and lasting weight loss while improving health and quality of life. The study examines the clinical and organizational pathway of patients undergoing it, assessing the impact of health services on their well-being through health status analysis. It also seeks to understand whether patient satisfaction during the care process correlates with improved quality of life. A total of 50 patients with severe obesity were included between July 2020 and October 2022. The evaluation was conducted using the Short Form Health Survey 36 and an ad hoc questionnaire at three stages: before the intervention (T0), at six months (T1) and at 12 months (T2). ANOVA analysis showed significant differences between T0, T1 and T2 for most variables except for the number of health professionals consulted (p = 0.09). The Tukey post-hoc test confirmed these differences for several variables, with some exceptions, including medication use (T0-T1: p = 0.14), number of health professionals consulted (T0-T1: p = 0.68; T0-T2: p = 0.08; T1-T2: p = 0.37), and patient-care team relationship between T1 and T2 (p = 0.08). The study confirms the effectiveness of bariatric surgery and emphasizes the importance of a multidisciplinary approach to patient management.

Obesity and its associations with autonomic and cognitive functions in the general population

BACKGROUND

Obesity poses a significant global health burden. This study aimed to investigate the prevalence of obesity in Mongolia and its associations with autonomic and cognitive functions while considering potential psychosocial risk factors.

METHODS

This population-based, cross-sectional study included 382 participants who underwent physical examinations, completed health-related questionnaires, and participated in heart rate variability (HRV) testing for autonomic assessment and the mini-mental state examination for cognitive evaluation.

RESULTS

Obesity prevalence was 28.1% (age-sex adjusted). Individuals with obesity were more likely to be older, married, have lower education, and engage in less physical activity. They exhibited autonomic imbalance, decreased autonomic nervous system activity, lower cognitive function, and sleep disturbances compared to the individuals without obesity. Body mass index, and waist circumference inversely correlated with HRV indices. Female sex, lower education, apartment living, alcohol consumption, sleep disturbances, and autonomic dysfunction emerged as significant risk factors for obesity. Independent predictors of autonomic dysfunction included systolic blood pressure, physical activity, and neck circumference, while age, education, height, sleep apnea, and autonomic dysfunction predicted cognitive decline. Furthermore, generalized linear mediation models revealed a partial mediation effect of autonomic dysfunction on the association between obesity and cognitive decline.

CONCLUSION

This study highlights a high prevalence of obesity in the general population (28.1%) and identifies distinct characteristics associated with the condition. Furthermore, our findings suggest a potential indirect effect of obesity on cognitive function, mediated by autonomic dysfunction. Further research is needed to elucidate the causal relationships and develop targeted interventions for high-risk groups (females, individuals with lower education) and promotion initiatives of healthy lifestyles (less alcohol, exercise, and sleep hygiene) to address both obesity and its associated health complications, including autonomic dysfunction.

The association between relative fat mass (RFM) and lumbar bone density in US adults: Insight from 2011-2018 NHANES

BACKGROUND

The relationship between obesity and osteoporosis has been widely studied. Studies have shown that relative fat mass (RFM) can be used to predict obesity. However, its relationship with bone mineral density (BMD) is unclear. The aim of this study was to investigate the relationship between RFM and lumbar BMD.

METHODS

We used data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Multiple linear regression models were applied to examine the relationship between RFM and lumbar BMD. We used smoothed curve fitting and threshold effect analysis to check for non-linear trends. Subgroup analyses were performed to explore differences in various populations. The Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic potential of body mass index (BMI), weight-adjusted waist circumference index (WWI), waist circumference (WC), and RFM for OP.

RESULTS

A total of 10636 participants were included. Multiple linear regression showed a significant negative link between RFM and lumbar BMD. In subgroup studies and smoothed curve fitting, RFM was consistently associated with lower BMD across subgroups. ROC curve indicate that RFM is more sensitive than BMI, WWI and WC in diagnosing OP capacity.

CONCLUSION

RFM is negatively associated with lumbar BMD in US adults. This suggests that RFM contributes to the study of low BMD.

Body mass index and weight changes in patients with HER2-positive early breast cancer: A sub-analysis of the APHINITY trial

BACKGROUND

Body mass index (BMI) may affect prognosis in patients with breast cancer (BC). We assessed the association of BMI and weight changes with outcomes of patients with HER2-positive early BC included in the APHINITY trial.

METHODS

This is an exploratory analysis of APHINITY (NCT01358877), randomized trial testing adjuvant dual vs. single HER2 blockade plus chemotherapy in HER2-positive early BC. BMI was collected at baseline and at two years after randomization. Patients were classified as underweight/normal weight (BMI<25 kg/m2) and overweight/obese (BMI≥25 kg/m2). The association of BMI with invasive disease-free survival (iDFS), distant recurrence-free interval (DRFI) and overall survival (OS) was investigated. Landmark approach was used to compare event for weight change ≥ 5.0 % at 2 years from baseline.

RESULTS

Of 4787 patients included, 2252 (47 %) were overweight/obese and 2535 (53 %) underweight/normal weight. Patients who were overweight/obese had more often chemotherapy discontinuation compared to underweight/normal weight patients (14 % vs. 9 %, p < 0.001). Patients who were overweight/obese exhibited worse iDFS (adjusted hazard ratio [aHR] 1.27; 95 % CI 1.06-1.52), DFRI (aHR 1.32; 95 % CI 1.06-1.64) and OS (aHR 1.38; 95 %CI 1.08-1.77) than underweight/normal weight patients. This effect on iDFS remained after adjusting for chemotherapy discontinuation (iDFS aHR 1.26, 95 % CI 1.05-1.51; DRFI aHR 1.31, 95 % CI 1.06-1.63; OS aHR 1.35 95 % CI 1.05-1.73). Weight changes at 2 years were not associated with clinical outcomes.

CONCLUSIONS

Our exploratory findings suggest that overweight/obesity at diagnosis was associated with worse survival outcomes.

Novel Cholecystokinin Secretion-Stimulating Peptides from Oat Protein Hydrolysate: Sequence Identification and Insight into the Mechanism of Action

Cholecystokinin (CCK), secreted by enteroendocrine cells, plays a vital role in suppressing appetite. This study aimed to evaluate the in vivo effect of oat protein hydrolysate (OPH) on CCK secretion and elucidate the structural characteristics of the responsible peptides and their underlying mechanism of action. OPH was prepared by a simulated gastrointestinal digestion model. Intragastric administration of OPH in mice significantly increased plasma CCK levels. Using size exclusion column chromatography and liquid chromatography-tandem mass spectrometry, ten peptides were successfully identified, and their abilities to stimulate CCK secretion were evaluated in STC-1 cells. Four novel CCK secretion-stimulating peptides, including LLL, QQVFQPQ, QGDVVALPA, and DVNNNANQLEPR, were validated. Among them, QGDVVALPA exhibited the strongest activity. Inhibition experiments demonstrated that the calcium-sensing receptor and its coupled G-protein subtype Gq were involved in QGDVVALPA-stimulated CCK secretion. Additionally, downstream signaling molecules including intracellular Ca2+ and Ca2+/CaM-dependent protein kinase (CaMKII) were also required for QGDVVALPA to induce CCK secretion. Our findings highlight the potential of oat protein-derived hydrolysate and peptides as functional food ingredients to regulate satiety.

A new homozygous pathogenic LEPR variant causing severe, early onset obesity in a Senegalese child

We report the case of a three-year-old Senegalese child presenting with severe obesity and hyperphagia since birth. Despite normal birth parameters and non-consanguineous parents with average BMI, the child exhibited rapid weight gain, surpassing obesity thresholds before the age of one. Genetic analysis revealed a novel homozygous variant in the LEPR gene (c.3190 G>T; p.(Glu1064Ter)). Functional assays demonstrated impaired leptin receptor signaling due to this truncating mutation. This case highlights the importance of considering monogenic causes in early-onset obesity. Identifying specific mutations enables the proposal of targeted therapies and the adaptation of clinical management.

Exploring the genetic intersection between obesity-associated genetic variants and insulin sensitivity indices

Insulin sensitivity (IS) is a key determinant of metabolic health and may share genetic factors with obesity-related traits. Previous large-scale genetic studies have identified variants associated with IS as well as obesity related traits like body mass index (BMI) and waist-to-hip ratio (WHR). Notably, many of these associations are shared across traits, indicating a potential genetic overlap. However, the genetic intersection between IS and obesity-related traits remains underexplored. To explore this gap, we investigated associations between six IS indices, including fasting and post-glucose load measures, and genetic variants linked to BMI and WHR to determine their influence on IS and related cardiometabolic traits. To achieve this, we calculated six IS indices using fasting and oral glucose tolerance test (OGTT) data from 5,007 non-diabetic individuals, grouping them into fasting, OGTT0,120, and OGTT0,30,120 categories. A total of 678 BMI-associated and 265 WHR-associated genetic variants were analysed using linear regression, adjusting for age and sex, with sex-specific analyses for WHR. Analyses were conducted with and without BMI adjustments and corrected for multiple testing (padj). Additionally, we explored the relationship between IS-linked variants and their associations with type 2 diabetes (T2D), coronary artery disease (CAD) and stroke. Among the 678 BMI-associated variants, 100 showed nominal associations (p < 0.05) with at least one IS index; and 20 remained significant after multiple testing correction (padj < 0.05) when not adjusting for BMI. After adjusting for BMI, 70 variants retained nominal associations, and six remained significant (padj < 0.05). In sex-specific analyses of the 265 WHR-associated variants, 12 variants were associated in females when adjusted for BMI, whereas no significant associations were observed in males. Furthermore, BMI- and WHR-associated variants linked to decreased IS, such as those in FTO and VPS13C loci, were also associated with increased T2D and stroke risk, whereas IS-increasing variants, including those in VPS13C and PPARG, were linked to lower T2D and stroke risk, with some, like THADA, showing opposing effects on CAD. This study offers insights into genetic variants that influence both IS and obesity-related traits, revealing BMI- and WHR-associated variants with both positive and negative effects on IS and their potential impact on cardiometabolic health.

The flowers extracts of Citrus aurantium regulates fat metabolism in obese C57BL/6J mice by improving intestinal microbiota disorders

BACKGROUND

Obesity can lead to many diseases such as diabetes, hypertension, cancer and cardiovascular diseases, which seriously affect people's quality of life and health.

AIMS OF THE STUDY

To investigate the main components and potential of n-butanol extract from Citrus aurantium L. var. amara Engl to reduce lipid accumulation and to explore its modulatory effects on the gut microbiota.

METHODS

The main components of n-butanol extract were analyzed using liquid chromatography quadrupole trap mass spectrometry (LC-QTRAP-MS) and a high-fat diet-induced obese mouse model was established to analyze its effects on the determination of gene expression levels and intestinal microbiota using reverse transcription quantitative polymerase chain reaction (RT-qPCR) and 16S rRNA gene sequence method.

RESULTS

The n-butanol extract mainly consists of 15 components, and it could significantly inhibit weight gain, reduce liver coefficient and improve oxidative damage. By regulating the expression of related genes, it inhibited hepatic steatosis and hypertrophy of epididymal tissue. The n-butanol extract increased the diversity of intestinal microbiota, improved the composition and structure of the flora, and reversed the high-fat diet-induced disturbance of intestinal microbiota in mice.

CONCLUSION

These results indicated that the n-butanol extract of C. aurantium could inhibit lipid accumulation and provide a more comprehensive basis for the development and utilization of C. aurantium in anti-obesity activity. © 2025 Society of Chemical Industry.

Specific dietary fibers steer toward distal colonic saccharolytic fermentation using the microbiota of individuals with overweight/obesity

BACKGROUND

Evidence suggests that increased distal short-chain fatty acid (SCFA) production beneficially impacts metabolic health. However, indigestible carbohydrate availability is limited in the distal colon; consequently, microbes shift toward protein fermentation, often linked to adverse metabolic health effects. We aimed to identify specific fiber(s) that promote saccharolytic fermentation in the distal colon and thereby may (partially) inhibit proteolytic fermentation.

METHODS

Potato-fiber, pectin, and inulin were studied individually and in combination against a high (predigested) protein background using an in vitro model of the colon (TIM-2) inoculated with pooled, standardized fecal microbiota from individuals with overweight/obesity. Microbiota composition and activity were assessed at different timepoints to simulate the travel throughout the colon (proximal: 0-8 h, distal: 8-24 h) and compared to a high protein (HP)_control, receiving only proteins.

RESULTS

Fiber addition increased total SCFA production compared to HP_control (52.11 ± 1.49 vs 27.07 ± 0.26 mmol) whereas total branched-chain fatty acids (BCFA; a marker for protein fermentation) production only slightly decreased (3.31 ± 0.10 vs 4.18 ± 0.40 mmol). Combining potato-fiber and pectin led to the highest total and distal SCFA production and distal SCFA:BCFA. Fiber addition attenuated HP-induced increases in several bacterial taxa including Mogibacterium and Coprococcus, independent of fiber type. Additionally, time- and fiber-specific microbial signatures were identified: inulin increased Bifidobacterium (proximal) relative abundance and pectin and/or potato-fiber increased Prevotella 9 (distal) relative abundance.

CONCLUSION

The most marked increase in distal colonic SCFA production was induced by combining potato-fiber and pectin. Further research should elucidate whether this switch toward saccharolytic fermentation translates into beneficial metabolic health effects in humans.

Effects of Exercise Training on Body Composition and Exercise Capacity After Bariatric Surgery: A Systematic Review and Meta-Analysis

PurposeBariatric surgery is a widely used treatment for obesity; however, it may be associated with certain complications. Effective postoperative management, including lifestyle interventions and exercise training, is essential for optimal outcomes. This study explores the effectiveness of exercise training in postoperative care.MethodsWe searched PubMed, Web of Science, Cochrane, and Embase up to April 3, 2024. Articles were screened and data extracted based on inclusion/exclusion criteria. Risk of bias was assessed using RoB 2.0, and data were analyzed with Stata 15.0.ResultsTwenty-three articles involving 1940 patients were included; 16 were analyzed quantitatively. Exercise training did not significantly reduce body weight compared to routine care (WMD: -0.26; 95% CI, -2.11 to 1.58; I2 = 54%), but it significantly reduced fat mass (WMD: -2.42; 95% CI, -3.50 to -1.34; I2 = 42.9%) and maintained lean mass (WMD: 1.40; 95% CI, 0.32 to 2.48; I2 = 0.0%). Additionally, it reduced waist circumference (WMD: -2.58; 95% CI, -4.43 to -0.73; I2 = 13.4%) and improved exercise capacity (VO₂ max: WMD: 1.88; 95% CI, 0.64 to 3.13; I2 = 0.0%).ConclusionWhile exercise training did not significantly lower body weight post-surgery, it effectively reduced fat mass, maintained lean mass, and improved waist circumference and exercise capacity. Given the limited sample sizes in most studies, further large-scale controlled trials are warranted for more definitive conclusions, along with further consideration of their long-term impact on health metrics.

Obesity accelerates age-related memory deficits and alters white matter tract integrity in Ldlr-/-.Leiden mice

Background

Obesity in mid-adulthood has been suggested to promote brain aging and is associated with progressive cognitive impairment later in life. However, the structural and functional alterations that underlie obesity-related cognitive dysfunction are still poorly understood, partly owing to the lack of translational models replicating age- and obesity-related brain pathology.

Methods

The effect of age and high-fat diet (HFD)-induced obesity was investigated in adult Ldlr-/-.Leiden mice, an established translational model for obesity and its comorbidities. During mid-adulthood, from three to eight months of age, brain structure and function (hippocampal volume, cortical thickness, white matter integrity, cerebral blood flow (CBF), resting-state functional connectivity) were monitored with brain magnetic resonance imaging, and cognitive function was evaluated using cognitive tests. Brain pathology was further examined with histopathological and gene expression analyses.

Results

Ldlr-/-.Leiden mice showed age-related decreases in cortical thickness, CBF, brain connectivity, and neurogenesis along with the development of neuroinflammation and (short-term) memory impairments. On HFD feeding, Ldlr-/-.Leiden mice exhibited similar features, but memory deficits started at a younger age than in chow-fed mice. HFD-fed mice additionally showed a rise in CBF with concomitant decline in fractional anisotropy in white matter tracts. Analyses of hippocampal gene expression further revealed an age-related suppression of processes related to metabolic and neuronal function while HFD feeding strongly activated neuroinflammatory pathways.

Conclusions

Ldlr-/-.Leiden mice show similar critical age-related changes in brain structure and function as observed in humans. In this mouse model, HFD feeding particularly trigger disturbances in brain blood perfusion and white matter tract integrity, which may underlie an accelerated cognitive decline in obesity.

Differences in anti-obesity effects between raw and ripened Pu-erh tea polyphenols: impact on gut microbiota enterotypes

BACKGROUND

Pu-erh tea, a dark tea from China, is classified into raw and ripened types. Both have significant anti-obesity effects. Polyphenols are among their major bioactive components. This study aimed to explore the anti-obesity properties and mechanisms of raw (R-TP) and ripened (F-TP) Pu-erh tea polyphenols.

RESULTS

The results showed that R-TP and F-TP significantly reduced body weight, improved insulin resistance, and enhanced glucose and lipid metabolism in high-fat-diet (HFD)-induced obese mice. Mild differences were observed in their impact on fat metabolism, carbohydrate metabolism, and inflammation levels. Both R-TP and F-TP were able to restore the disrupted intestinal flora caused by HFD treatment, returning them to a composition and levels similar to those of normal mice. Interestingly, the gut microbiota of all the mice could be reclassified into three enterotypes (enterotype Type-1, Type-2, and Type-HFD). Lactobacillaceae predominated in Type-1. Lactobacillaceae, Muribaculaceae, and Lachnospiraceae were the most common in Type-2. Type-HFD was primarily composed of Atopobiaceae, Lachnospiraceae, Lactobacillaceae, Ruminococcaceae, and Erysipelotrichaceae. The small differences in the effects of R-TP and F-TP may be due to variations in enterotypes.

CONCLUSION

These findings indicate that R-TP and F-TP can alleviate obesity by regulating the enterotype of gut microbiota, suggesting that they possess the potential for application in the treatment of obesity and the development of anti-obesity agents. © 2025 Society of Chemical Industry.

Real-world use and effectiveness of tirzepatide among people without evidence of type 2 diabetes in the United States

AIM

To understand treatment patterns and effectiveness of tirzepatide among people without type 2 diabetes (T2D) in the US.

METHODS

This retrospective, observational, descriptive study used the Healthcare Integrated Research Database (index date: first-observed tirzepatide claim; index period: May 13, 2022-May 24, 2023). Key eligibility criteria were: age ≥ 18 years; ≥ 1 tirzepatide claim; no T2D diagnosis codes or glycated hemoglobin ≥ 6.5 %, no anti-diabetes medications (except metformin); and continuous medical/pharmacy enrollment for ≥ 12 months pre-index (Overall cohort). Tirzepatide persistence and utilization (6-months post-index) were assessed among obesity management medication (OMM)-eligible individuals (body mass index [BMI] ≥ 30 kg/m2, or ≥ 27 kg/m2 with ≥ 1 obesity-related complication [ORC]; OMM-eligible cohort). Tirzepatide effectiveness was assessed among individuals who were OMM-eligible, naive to glucagon-like peptide-1 receptor agonists, and persistent on tirzepatide for ≥6 months (Persistent+GLP-1 naive cohort).

RESULTS

The overall cohort included 4,177 individuals with mean age 46.0 years, 75.6 % female, and mean BMI 37.1 kg/m2. At baseline, 73.8 % of individuals had ≥ 1 ORC while 51.0 % had ≥ 2 ORCs. Persistence in the OMM-eligible cohort was 73.8 %; by the sixth prescription fill, 56.2 % were receiving < 10 mg tirzepatide. Individuals in the Persistent+GLP-1 naive cohort with pre- and post-index weight and BMI measurements (n = 200) achieved mean weight reduction of 12.9 % at 6-months post-index (≥ 5 %: 88.5 %; ≥ 10 %: 69.0 %).

CONCLUSION

Real-world evidence suggests multimorbidity among tirzepatide initiators, slower tirzepatide dose escalation than in clinical trials, and clinically meaningful weight reduction among people persisting on tirzepatide for ≥ 6 months.

Lactucin and lactucopicrin ameliorate obesity in high-fat diet fed mice by promoting white adipose tissue browning through the activation of the AMPK/SIRT1/PGC-1α pathway

Lactucin and lactucopicrin are the characteristic lipid-lowering active components found in Cichorium glandulosum. However, their effects and underlying mechanisms in obesity remain unclear. In the present study, C57BL/6J mice were simultaneously subjected to a high-fat diet (HFD) and treated with drugs to investigate the impacts of lactucin and lactucopicrin on HFD-induced obese mice. The results demonstrated that in HFD obese mice, lactucin and lactucopicrin significantly decreased body weight and the weights of adipose tissues, improved serum metabolic parameters, and increased the content of irisin. Regarding the intermediate metabolites of intestinal flora, which are closely associated with white adipose tissue (WAT) browning, lactucin and lactucopicrin treatment led to a reduction in the levels of 12-α-OH/non-12-α-OH bile acids (BAs) and also tended to enhance the levels of short-chain fatty acids (SCFAs). qRT-PCR results indicated that lactucin and lactucopicrin treatment elevated the expression levels of genes related to beige fat markers, thermogenesis, mitochondrial biogenesis, and lipolysis in WAT, as well as those of thermogenesis and lipolysis genes in brown adipose tissue (BAT). Western blot analysis revealed that lactucin and lactucopicrin up-regulated the expression of uncoupling protein 1 (UCP1), the core protein in thermogenesis, in both WAT and BAT. Moreover, they also up-regulated the expression levels of AMP-activated kinase (AMPK), sirtuin 1 (SIRT1), and PPARγ coactivator 1-alpha (PGC-1α), which are key pathway proteins involved in WAT browning. Furthermore, 16S rRNA sequencing results showed that in HFD obese mice, lactucin and lactucopicrin improved the composition and function of the intestinal microbiota. In conclusion, lactucin and lactucopicrin may promote WAT browning by activating the AMPK/SIRT1/PGC-1α pathway, thereby ameliorating obesity in HFD mice.

The Ratio of Visceral to Subcutaneous Adipose Tissue Is Associated With Postoperative Anastomotic Leakage in Patients With Rectal Cancer With Gender Differences in Opposite Direction

BACKGROUND

Anastomotic leakage (AL) is a severe postoperative complication in colorectal cancer and exerts negative impacts on patients' outcomes. Studies have found that body composition measured by CT images was associated with increased overall postoperative complications in colorectal cancer; however, few focused on postoperative AL in rectal cancer. This study aimed to explore the association between body composition parameters measured by CT images and postoperative AL in patients with rectal cancer, with an emphasis on subgroup analysis by gender.

METHODS

From February 2014 to January 2020, a total of 444 patients with rectal adenocarcinoma who underwent radical proctectomy were included. Out of all patients, 21 developed AL after surgery. Body composition parameters, including the areas, mean CT values, height-normalized indices of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), intramuscular adipose tissue (IMAT) and skeletal muscle (SM) were derived from preoperative contrast-enhanced arterial phase CT images at the third lumbar level. The ratio of visceral to subcutaneous adipose tissue (VSR) was calculated. Clinical and body composition parameters were compared between the AL group and the non-AL group in all patients and separately in different genders.

RESULTS

Body composition parameters were not significantly different in the AL group and the non-AL group in all patients. However, most body composition parameters were significantly different between male and female patients. After separately analyzing by gender, VSR was significantly associated with postoperative AL in male and female. After multivariate regression, VSR remained an independent predictor for AL (OR: 0.1, p = 0.041 for male and OR: 39.1, p = 0.045 for female).

CONCLUSION

The VSR measured by CT images is an independent predictor for postoperative AL in patients with rectal cancer; however, it shows gender differences in opposite directions, serving as a protective factor in males, whereas as a risk factor in females.

CUN-BAE adiposity index prediction of incident type 2 diabetes: the Seguimiento Universidad de Navarra prospective cohort

BACKGROUND

Obesity is currently a pandemic and a cardinal risk factor for incident diabetes, a parallel growing pandemic. Measures commonly used to define obesity, i.e., BMI and waist circumference, do not accurately reflect body fatness.

METHODS

We examined the prognostic value of body fatness assessed with the 'Clínica Universidad de Navarra-Body Adiposity Estimator' (CUN-BAE, range: 18.4-65.0 %) in 18,594 participants of the "Seguimiento Universidad de Navarra" prospective longitudinal cohort (60.5% women) without diabetes at baseline. Participants were followed-up with biennial questionnaires and multivariable-adjusted Cox models were used to estimate incident diabetes.

RESULTS

During 13.7 years of median follow-up, 209 participants developed diabetes. Progressively ascending quartiles of CUN-BAE were significantly associated with incident diabetes in multivariable-adjusted models, even after adjusting for BMI > 30 kg/m2. For each 2-unit increment in the CUN-BAE index, diabetes risk relatively increased by 46% in men and women (95% CI: 33%-62%). When comparing ROC AUC for CUN-BAE and BMI the association was stronger for CUN-BAE (p < 0.001).

CONCLUSIONS

CUN-BAE index, an easy equation that can be used in any clinical setting, predicted better the risk of incident diabetes compared to BMI. Our results emphasize the importance of reducing and maintaining a low adiposity in order to prevent diabetes.

Global and regional burden of breast cancer attributable to high BMI, 1990-2036: A comprehensive analysis

OBJECTIVES

This study aimed to assess global, regional, and national trends in breast cancer burden attributable to high body mass index (BMI) from 1990 to 2021 and provide projections up to 2036 using data from the Global Burden of Disease (GBD) 2021 study.

STUDY DESIGN

Systematic analysis of the GBD 2021 dataset.

METHODS

We extracted high BMI-related breast cancer data from the GBD 2021 dataset, covering 204 countries and territories. Age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs) were calculated to analyze temporal patterns and regional differences. Future trends were projected using the Bayesian age-period-cohort (BAPC) model.

RESULTS

In 2021, high BMI contributed to 44,707 breast cancer deaths and 1,041,309 DALYs globally, reflecting a 138.5 % and 142.7 % increase, respectively, compared to 1990. While global age-standardized mortality and DALY rates remained relatively stable, the absolute burden significantly increased, particularly in low- and middle-SDI regions. High-SDI regions exhibited the highest age-standardized rates, but low-SDI regions showed the fastest growth. Projections indicate that the global burden of breast cancer due to high BMI will continue to rise until 2036, driven by increasing obesity rates and insufficient healthcare resources.

CONCLUSIONS

High body mass index is a major driver of the global breast cancer burden, showing increasing trends not only in high-income regions but more prominently in low-SDI regions. Effective strategies, including public health interventions targeting obesity management, are needed to control the rising burden.

Exploring the Link Between Thyroid Disorders and Obesity: Mechanisms, Impacts, and Clinical Implications

OBJECTIVE

Obesity and thyroid dysfunction are among the most significant challenges in endocrinology, frequently overlapping to create complexities in weight management. Even after achieving euthyroidism, weight variations persist, significantly affecting patients' quality of life. This review explores the mechanisms linking hypothyroidism and hyperthyroidism to weight fluctuations, emphasizing their impact on basal metabolic rate, appetite regulation, glucose and lipid metabolism, and thermogenesis.

METHODS

We conducted a comprehensive review using PubMed and Google Scholar, applying the search criteria: (obesity OR overweight) AND (Hashimoto's thyroiditis OR hyperthyroidism OR hypothyroidism OR Thyroid Cancer). From this search, we reviewed 500 publications and finally included 71 publications, focusing on broad clinical questions regarding the role of thyroid hormones in weight regulation and metabolism, the impact of thyroid disorders and their treatments on obesity, and approaches for managing obesity in the context of thyroid dysfunction.

RESULTS

In hypothyroidism, the impact of levothyroxine therapy on weight changes is discussed, along with the potential role of T3 supplementation. For hyperthyroid patients, the effects of antithyroid medications, radioactive iodine therapy, and thyroidectomy on weight regulation are explored. Pharmacological and nonpharmacological strategies for managing obesity in thyroid disorders are reviewed. Lifestyle interventions and pharmacotherapies are evaluated for their efficacy and potential effects on thyroid function. Lastly, the implications of bariatric surgery are explored, including its effects on thyroid function, medication absorption, and postsurgical management of thyroid disorders.

CONCLUSION

This review underscores the importance of an integrated, multidisciplinary approach to managing obesity in the context of thyroid dysfunction to optimize patient outcomes.

Dietary Relationships between Obesity and Inflammatory Bowel Diseases: A Narrative Review of Diets Which May Promote Both Diseases

PURPOSE OF REVIEW

The pandemic of obesity preceded global spread of Inflammatory Bowel diseases by almost 2 decades. A pathogenic relationship has been described between obesity and inflammatory bowel diseases, but Crohn`s disease may be selectively impacted. The role of diet in pathogenesis has also gained significant support in the last few decades. This review explores dietary relationships to account for epidemiological observations. Quantifiable indices for diets have been described including a glycemic index, inflammatory indices and levels of food processing. Meta-analyses have been published which examine each for effects on obesity and co-morbidities as well as Crohn's disease and ulcerative colitis. This review suggests that ultra-processed foods provide the best link between obesity and Crohn's disease explaining epidemiological observations. However, the other 2 types of dietary indices likely contribute to ulcerative colitis as well as to co-morbidities related to both obesity and inflammatory bowel diseases. The term ultra-processed foods cover a large number of additives and extensive work is needed to define individual or combined harmful effects. Furthermore, the interactions among the 3 main indices need clarification in order to precisely apply therapeutic diets to both diseases (obesity and inflammatory bowel disease).

Fermentation of Seaweed Saccharina japonica Using Lactobacillus brevis and its In Vitro Anti-Obesity Effects

This study investigated the effects of fermenting brown seaweed Saccharina japonica with Lactobacillus brevis on bioactive products' antioxidant properties and potential anti-obesity effects. The S. japonica fermented by L. brevis (SFB) extract showed the highest ABTS scavenging activity at 3000 μg/mL (79.3%), followed by the L. brevis cells (LBC) extract (68.1%) and S. japonica hydrolysate (SJH) extract (59.5%). At the same concentration, the DPPH radical scavenging activities of the LBC and SFB extracts were 63.2% and 68.5%, respectively, significantly higher than that of the SJH extract (38.5%). After treating cells with a 400 μg/mL concentration for 8 days, Oil Red O staining revealed a dose-dependent decrease in cytoplasmic lipid droplets. The lowest lipid accumulation rates were 64.2%, 55.2%, and 51.4% for SJH, LBC, and SFB, respectively. RT-qPCR results indicate reduced mRNA levels of lipid metabolism-related gene expressions. Overall, the combination of S. japonica and L. brevis fermentation has a potential application as a dietary food process for improving obesity.

The Evolving Role of Macrophage Metabolic Reprogramming in Obesity

Recent research has extensively explored the critical role of energy metabolism in shaping the inflammatory response and polarization of macrophages in obesity. This rapidly growing field emphasizes the need to understand the connection between metabolic processes that support macrophage polarization in obesity. While most published research in this area has focused on glucose and fatty acids, how the flux through other metabolic pathways (such as ketone and amino acid oxidation) in macrophages is altered in obesity is not well defined. This review summarizes the main alterations in uptake, storage, and oxidation of oxidative substrates (glucose, fatty acids, ketone bodies and amino acids) in macrophages and how these alterations are linked to macrophage polarization and contribution to augmented inflammatory markers in obesity. The review also discusses how oxidative substrates could modulate macrophage energy metabolism and inflammatory responses via feeding into other non-oxidative pathways (such as the pentose phosphate pathway, triacylglycerol synthesis/accumulation), via acting as signalling molecules, or via mediating post-translational modifications (such as O-GlcNAcylation or β-hydroxybutyrylation). The review also identifies several critical unanswered questions regarding the characteristics (functional and metabolic) of macrophages from different origins (adipose tissue, skeletal muscle, bone marrow) in obesity and how these characteristics contribute to early vs late phases of obesity. We also identified a number of new therapeutic targets that could be evaluated in future investigations. Targeting macrophage metabolism in obesity is an exciting and active area of research with significant potential to help identify new treatments to limit the detrimental effects of inflammation in obesity.

Systematic Review and Meta-analysis of Randomized Clinical Trials Comparing Time-Restricted Eating With and Without Caloric Restriction for Weight Loss

CONTEXT

Although it is well established that caloric restriction (CR) is the primary driver of weight loss, circadian-driven metabolic benefits have been recognized as possibly enhancing the effects of CR. Time-restricted eating (TRE) has emerged as a promising approach in this context.

OBJECTIVE

We conducted a systematic review and meta-analysis to compare the effects of TRE with isocaloric diet controls (analysis 1) and non-isocaloric controls (analysis 2) on anthropometric and body-composition parameters in adults with overweight or obesity.

DATA SOURCES

A search was carried out in the Medline, LILACS, Embase, and CENTRAL databases using Medical Subject Heading (MeSH) and similar terms such as "Obesity," "Obesity, Abdominal," "Time-restricted eating," "Body weight," "Changes in body weight," and others.

DATA EXTRACTION

We included 30 studies involving a total of 1341 participants. Studies were screened based on titles and abstracts followed by full-text reading, and data were extracted from eligible studies using a pre-established form. All these steps were performed by 2 authors independently and blinded, with discrepancies resolved by a third author.

DATA ANALYSIS

The results of main findings revealed that, in studies using non-isocaloric controls, the TRE group showed significant reductions in body weight (BW) (mean difference [MD]: -2.82 kg; 95% CI: -3.49, -2.15), fat mass (FM) (MD: -1.36 kg; 95% CI: -2.09, -0.63), and fat-free mass (FFM) (MD: -0.86 kg; 95% CI: -1.23, -0.49). In studies that used isocaloric control strategies, the TRE group showed significant reductions in BW (MD: -1.46 kg; 95% CI: -2.65, -0.26), FM (MD: -1.50 kg; 95% CI: -2.77, -0.24), and FFM (MD: -0.41 kg; 95% CI: -0.79, -0. 03).

CONCLUSION

TRE yields favorable anthropometric and clinical outcomes, even when intake is isocaloric between the intervention and control groups. This result suggests that circadian effects may enhance the impact of CR on excess weight.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022301594.

Impact of monotherapy and combination therapy with glucagon-like peptide-1 receptor agonists on exosomal and non-exosomal MicroRNA signatures in type 2 diabetes mellitus: a systematic review

BACKGROUND

Glucagon-like peptide-1 receptor agonist (GLP-1RAs) is a potent therapy for type 2 diabetes mellitus (T2DM) and obesity, especially in patients who are resistant to long-term insulin therapy. Although microRNAs have been linked to GLP-1 signaling, their role in GLP-1RA monotherapy and combination therapy remains unclear. This review synthesizes current evidence of GLP-1RA-induced exosomal and non-exosomal miRNA changes in human and animal models of T2DM.

METHODS

Scopus, PubMed/Medline, Web of Science, and Google Scholar searches returned 83 studies, of which 11 met the study eligibility criteria (PROSPERO No: CRD42024586000).

RESULTS

Human studies showed GLP-1RA combined with metformin modulated non-exosomal miR-27b, miR-130a, and miR-210a, which were linked to cardiovascular health. In T2DM patients on metformin, higher baseline miR-378-3p or miR-126-3p correlated with greater HbA1c improvement after one year of GLP-1RA therapy. Notably, > 5% weight loss correlated with higher baseline levels of miR-15a-5p. Preclinical findings suggested GLP-1RA monotherapy increased cardiovascular action via non-exosomal miR-29b-3p, miR-34a-5p, miR-26a-5p, miR-181a-5p, and miR-93-5p. Silencing non-exosomal miR-204, miR-375, or miR-139-5p augmented exendin-4/liraglutide monotherapy-induced glucose-stimulated insulin secretion. Interestingly, GLP-1RA monotherapy reduced hepatic lipid accumulation in T2DM models with comorbid NAFLD via ABHD6 mRNA modulation by non-exosomal miR-5120. No clinical studies reported exosomal miRNAs, but a preclinical study linked GLP-1RA-induced exosomal let-7c-2-3p/miR-322-3p to bone protection in estrogen-deficient T2DM models.

CONCLUSION

GLP-1RAs, both as first-line and second-line therapies, are beneficial for T2DM complicated by obesity, NAFLD, cardio-metabolic disease, and postmenopausal osteoporosis. Longitudinal trials that incorporate innovative multi-omics approaches are essential for distinguishing their miRNA expression pattern from other anti-diabetics.

Analysis of risk factors affecting obesity in Korean adolescents: based on the 2017-2020 Korea national health and nutrition examination survey

Background

Obesity, which is caused by various congenital factors, lifestyle changes, and modernized eating habits, has recently emerged as a serious health concern in children and adolescents. According to the Korea National Health and Nutrition Examination Survey (KNHANES) conducted from 2007 to 2020, the prevalence of obesity and overweight in youth has shown an increasing trend over time. Notably, obesity has been studied in several studies. However, given its close association with rapidly changing societal environments and lifestyle patterns, continuous updates are necessary. Therefore, investigating the current state of obesity in children and adolescents is crucial. Herein, we investigated factors related to the prevalence of obesity.

Materials and methods

We investigated 1912 adolescents between the ages of 12 and 18 years from 2017 to 2020 using data from the KNHANES. Known and suspected risk factors for lifestyle and eating habits were analyzed using univariate and multivariate logistic regression analyses.

Results

Our study revealed a gradual increase in the proportion of individuals having overweight and obesity. Regarding risk factors for obesity, in the unadjusted model, older age (Odds ratio [OR], 1.11), sedentary time ≥12 h (OR, 1.29), and a higher calorie intake from protein (OR, 1.06) were positively associated with obesity, whereas female sex (OR, 0.52) and sleep duration ≥8 h (OR, 0.56) were negatively associated with obesity. These trends remained consistent in the adjusted model, with older age (OR, 1.10), sedentary time ≥12 h (OR, 1.46), higher protein intake (OR, 1.05), and skipping dinner ≥3 times per week (OR, 2.22) being positively associated with obesity and female sex (OR, 0.60) and sleep duration of 6-8 h (OR, 0.54) and ≥8 h (OR, 0.48) being negatively associated with obesity.

Conclusion

Obesity in Korean adolescents was significantly correlated with shorter sleep duration, more sedentary time, higher protein intake, and frequent meal skipping at dinner. These results highlight the necessity of focused public health initiatives that support healthy living practices, including healthy eating habits, less sedentary activity, and more sleep time.

Hepatic lipidomics analysis reveals the anti-obesity effects of insoluble dietary fiber from okara combined with intermittent fasting treatment in high-fat diet-fed mice

Introduction

Emerging evidence has revealed that supplementation with insoluble dietary fiber (IDF) improves lipid metabolic disorders caused by a high-fat diet (HFD). Except for dietary supplementation, intermittent fasting (IF) has received widespread attention as a new dietary strategy against obesity. We hypothesized that IDF combined with IF treatment may synergistically alleviate HFD-induced lipid metabolic imbalance.

Methods

This study integrated biochemical analysis with hepatic lipidomics to explore lipid biomarkers and potential mechanisms associated with the anti-obesity effects of IDF combined with IF treatment.

Results and discussion

The results indicated that IDF combined with IF treatment improved metabolic parameters associated with the obesity phenotype. Lipidomics analysis revealed that IDF combined with IF treatment altered hepatic lipid metabolic patterns in HFD-fed mice. Moreover, 15 differentially regulated lipid species were identified as lipid biomarkers. Moreover, the expression of lipogenesis-, lipid oxidation-, and cholesterol metabolism-related genes was also regulated. Our results indicate that IDF combined with IF treatment ameliorates lipid metabolism disorders in HFD-fed mice by regulating hepatic lipid metabolites and related gene expression, providing evidence for its anti-obesity effects.

Associations of Body Mass Index Growth Rates and Body Composition With Cardiometabolic Risks in Chinese Preschool Children

OBJECTIVE

To examine the relationship between body mass index (BMI) growth rates, body composition, and cardiometabolic markers in preschool children.

METHODS

Three-year-old children were recruited for this cohort study. BMI and body composition measurements were obtained at enrollment, with multiple BMI measurements spanning ages 1 month to 3 years extracted from medical records. Levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol (non-HDL-C), remnant cholesterol (RC), uric acid (UA), and fasting plasma glucose were measured at 3 years. Data analyses employed piecewise linear mixed models and logistic regression models.

RESULTS

Out of 3822 children recruited, 3015 were included in the analysis. The accelerated BMI z-score growth rate between 6 and 24 months was positively correlated with high TG and LDL-C levels, with sex, birthweight, and size for gestational age disparities. Obesity increased the risks of high TG level and the highest RC quartile in boys. Fat mass index and percentage of fat mass were linked with high UA level and dyslipidemia, particularly high TG and non-HDL-C levels, in boys. Fat-free mass index showed negative associations with high levels of TC and non-HDL-C in boys and high LDL-C level in girls (P < .05).

CONCLUSION

This study underscores the significant impact of BMI growth rates and body composition on cardiometabolic markers in 3-year-old children. The effects of BMI growth rates in specific periods varied by sex, birthweight, and size for gestational age, and boys exhibited a higher susceptibility to adverse outcomes.

Association of Prepregnancy Obesity versus Excessive Gestational Weight Gain with Adverse Maternal Outcomes in the United States

Prepregnancy body mass index (BMI) >30 kg/m2 or prepregnancy obesity (PPO) and excessive gestational weight gain (eGWG) are associated with increased risks for adverse maternal outcomes. There is little is known regarding the individual effects of PPO and eGWG. The objective of this study was to compare the effects of PPO and eGWG with adverse maternal outcomes.This was a retrospective cohort study of singleton, live births in the United States in 2018 using data from the National Vital Statistics System. Pregnancies complicated by pregestational diabetes, chronic hypertension, and with unknown maternal BMI were excluded. Institute of Medicine recommendations were used to define gestational weight gain (GWG). These births were divided into four groups: (1) normal prepregnancy BMI and normal GWG, (2) normal prepregnancy BMI and eGWG, (3) PPO and normal GWG, and (4) PPO and eGWG. Outcomes such as gestational diabetes, hypertensive disorders of pregnancy, cesarean delivery, maternal transfusion, and medical intensive care unit admissions were compared among groups using analysis of variance and multivariable logistic regression analysis.Of the 1,432,602 births included in the study, 22.2, 42.3, 10.1, and 25.4% were in Groups 1 to 4, respectively. Compared with pregnancies in Group 1 (adjusted odds ratio [95% confidence interval]), Groups 3 and 4 had higher risk for gestational diabetes (2.80 [2.72-2.88] and 2.28 [2.22-2.34]), respectively, whereas Groups 2 to 4 had higher risk of hypertensive disease of pregnancy (1.58 [1.53-1.64], 3.88 [3.74-4.03], and 5.07 [4.90-5.23]); eclampsia (1.61 [1.33-1.95], 2.99 [2.42-3.69], and 3.57 [2.97-4.29]), and cesarean delivery (1.21 [1.19-1.23], 1.97 [1.92-2.02], and 2.45 [2.40-2.50]), respectively.Both PPO and eGWG are independently associated with higher odds of gestational diabetes, gestational hypertension, preeclampsia, and cesarean sections, with the highest risk among pregnancies with both PPO and eGWG. These data support the importance of prepregnancy weight management in preventing adverse pregnancy outcomes. · Maternal obesity is associated with adverse maternal outcomes.. · Maternal obesity is due to PPO or eGWG.. · To study the contribution of adverse maternal outcomes by PPO as distinct from eGWG..

Association of Prepregnancy Obesity versus Excessive Gestational Weight Gain with Adverse Neonatal Outcomes in the United States

Prepregnancy obesity (PPO) and excessive gestational weight gain (eGWG) during pregnancy, both are associated with adverse neonatal outcomes. The objective of this study was to compare the independent associations of PPO and eGWG with adverse neonatal outcomes.This was a retrospective cohort study of singleton, live births in the United States in 2018 using National Vital Statistics System data. These were divided into four groups: 1) normal prepregnancy BMI and normal GWG, 2) normal prepregnancy BMI and eGWG, 3) prepregnancy BMI >30 kg/m2 (PPO) and normal GWG and 4) PPO and eGWG. The adverse neonatal outcomes, including preterm delivery, large for gestational age (LGA) infants, assisted neonatal ventilation, low 5-minute Apgar scores, neonatal intensive care unit (NICU) admissions, and surfactant use were studied. These outcomes were compared among groups using ANOVA and multivariable analyses.Of the 1,477,062 births included, 21.8, 41.6, 10.4, and 26.3% were in groups 1 to 4, respectively. With group 1 as the reference group after correcting for significant factors, groups 2 to 4 had a higher risk (adjusted odds ratio with 95% confidence interval), for preterm delivery of <37 weeks 1.17 (1.14-1.20), 1.05 (1.02-1.09), and 1.14 (1.11-1.18) and for LGA infants 2.38 (2.31-2.44), 2.37 (2.29-2.45), and 3.91 (3.80-4.02) in groups 2 to 4, respectively. Further, patients with PPO with and without eGWG also had increased risk of immediate assisted neonatal ventilation 1.07 (1.02-1.12) and 1.16 (1.12-1.22), for 5-minute Apgar score <3 1.40 (1.19-1.65) and 1.38 (1.20-1.58), and for NICU admission in 1.04, (1.01-1.08) and 1.12 (1.09-1.15) for groups 3 and 4, respectively.Both PPO and eGWG were independently associated with preterm delivery and LGA infants. PPO with or without excessive GWG was also associated with low Apgar scores, more NICU admissions, and a higher need for immediate ventilatory support. This data supports the importance of prepregnancy weight loss to prevent or decrease adverse neonatal outcomes. · Maternal obesity is associated with adverse neonatal outcomes.. · Maternal obesity is due to PPO or eGWG.. · To study the contribution of adverse neonatal outcomes by PPO as distinct from excessive GWG.. · To study the increasing maternal prepregnancy BMI to the incidence of adverse neonatal outcomes..

Obesity-fertility cohort study: protocol for the assessment of children aged 6-12 years and their mothers

INTRODUCTION

Maternal preconception obesity and adverse gestational metabolic health increase the risk of childhood obesity in offspring, but the preconception period may be an opportune time to intervene, given the motivation of the mother and the epigenetic changes that may be beneficial for the gametes during this period. However, there is a lack of studies evaluating children born to women who have had a preconception intervention. Our group has therefore designed an ancillary study to assess children born to women enrolled in the obesity-fertility randomised controlled trial (RCT), who were 6-12 years of age, with the objective of evaluating the effect of a lifestyle intervention delivered during preconception and pregnancy on adiposity and cardiometabolic parameters in the offspring. This manuscript details the study protocol.

METHODS AND ANALYSIS

This is an ancillary nested cohort study of the obesity-fertility RCT. Women with obesity and infertility were recruited at an academic fertility clinic and randomised to the control group, which followed usual care, or to the intervention group, which received a lifestyle intervention alone for the first 6 months and then in combination with fertility treatments for up to 18 months or until the end of pregnancy. Those who have given birth to a single child are invited to participate in this follow-up study with their child aged 6-12 years. This study started in November 2023 and is expected to end in May 2025. The primary outcome is age-adjusted and sex-adjusted body mass index z-scores in children. Secondary outcomes are anthropometry, body composition, lifestyle, physical fitness level and blood or saliva markers of cardiometabolic health in both mothers and children. Of the 130 women who participated in the obesity-fertility RCT, 52 mother-child dyads (24 in the control group; 28 in the intervention group) were potentially eligible for this follow-up study. Comparisons between groups will be performed using unpaired tests and adjusted for potential confounders using multivariable regression models. This study will provide important new data on the impact of a preconception lifestyle intervention, maintained throughout pregnancy, on the health trajectory of children and mothers 6-12 years after delivery.

ETHICS AND DISSEMINATION

The study has been approved by the institutional research ethics review boards of the Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke. The results will be widely disseminated to the scientific community, relevant health professionals and general public.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT06402825).

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.

Outcomes and risk factors for liver transplantation using steatotic grafts for hepatocellular carcinoma: a multicenter study

INTRODUCTION

A growing number of steatotic grafts have been used in liver transplantation (LT), including hepatocellular carcinoma (HCC) patients. However, the impact of steatotic grafts on the prognosis of HCC recipients remains unclear. This study aims to evaluate the impact of steatotic graft in long-term prognosis for HCC recipients and development an algorithm for minimizing the risk of these grafts.

MATERIALS AND METHODS

The clinicopathologic data of HCC patients undergoing LT from 2003 to 2022 in the United Network for Organ Sharing database was analyzed. The disease-free survival (DFS) and overall survival (OS) of recipients were compared between non-steatotic (macrosteatosis <30 %) and steatotic (macrosteatosis ≥30 %) graft groups after propensity score matching (PSM). Interaction analysis was conducted to identify factors that amplified the negative impact of steatotic grafts on DFS.

RESULTS

A total of 8345 eligible HCC patients were included. Three factors exhibited significant interaction effect with steatotic grafts: cold ischemia time ≥6h (HR = 1.447; P = 0.023), donor body mass index ≥40 (HR = 1.771; P = 0.018) and recipient with non-alcoholic fatty liver disease (HR = 1.632; P = 0.032). Hazard Associated with Macrosteatotic Liver (HAML) score was created based on these three factors. In HAML ≥1 cohort, the DFS and OS of steatotic graft group were significantly reduced compared to non-steatotic graft group. But in HAML = 0 cohort, no significant differences in DFS and OS were observed between the two groups.

CONCLUSIONS

The risk of steatotic grafts in LT for HCC could be minimized through evaluating HAML score.