Different correlation of body mass index with body fatness and obesity-related biomarker according to age, sex and race-ethnicity

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.

Prevalence of Obesity With and Without Confirmation of Excess Adiposity Among US Adults

This study compares the prevalence of obesity (assessed by body mass index only) vs obesity prevalence when excess adiposity is confirmed by waist circumference measurement or dual-energy x-ray absorptiometry in a nationally representative sample of US adults.

Trajectories of body fatness in adulthood and the risk of ovarian cancer

BACKGROUND

While excess body fatness in older adulthood has been linked to ovarian cancer, the influence of changes in body fatness over time is unclear. This study examined the association between adulthood trajectories of body mass index (BMI), a proxy for body fatness, and ovarian cancer.

METHODS

In a population-based case-control study (440 cases, 820 controls), we used a group-based trajectory approach to identify BMI trajectories from age 20-70. Using unconditional logistic regression, we estimated adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) for the associations between the estimated trajectories and ovarian cancer.

RESULTS

We identified three distinct BMI trajectories: a normal-stable trajectory, a normal-to-overweight trajectory and an overweight-to-obese trajectory, which included 63.2 %, 31.0 % and 6.8 % of the population, respectively. Multivariable aORs suggested that participants with normal weight at the onset of adulthood who became overweight over their adulthood time did not differ in their risk of ovarian cancer compared to those who maintained a normal weight throughout adulthood (aOR (95 %CI): 0.89 (0.69-1.16)). Among those in the overweight-to-obese trajectory, the aOR (95 %CI) was 1.45 (0.87-2.43), and thus in the direction of an increased ovarian cancer risk compared to those who maintained a normal weight.

CONCLUSION

Our findings underscore the need for further research to clarify the role of body fatness across the lifetime in the etiology of ovarian cancer.

Protein-enriched intermittent meal replacement combined with moderate-intensity training for weight loss and body composition in overweight women

The global rise in overweight and obesity has been exacerbated by sedentary lifestyles and suboptimal dietary habits. Traditional weight loss methods often struggle with adherence due to restrictive diets and metabolic adaptations. Intermittent meal replacement (IMR), incorporating formulated protein-enriched nutritional shakes, has emerged as a potential strategy for weight management. However, its combined effects with moderate-intensity continuous training (MICT) remain underexplored. This study aimed to evaluate the impact of a weight loss method incorporating formulated protein-enriched nutritional shake IMR in conjunction with MICT workout for overweight female adults. This 8-week parallel randomized controlled trial investigated the impact of protein-enriched IMR combined with MICT on weight loss and body composition in overweight female adults. Participants were randomly assigned to either the MICT group or MICT + IMR group. Body composition, hematological, and urinary biomarkers were assessed pre- and post-intervention. The MICT + IMR Group achieved a greater reduction in body weight (-3.70 kg vs. -1.17 kg, p < 0.001) and body fat mass (-2.25 kg vs. -1.19 kg, p < 0.001) compared to the MICT group. Additionally, fasting blood glucose and insulin levels significantly improved in the MICT + IMR Group, suggesting enhanced metabolic regulation. IMR, when combined with MICT, is a viable strategy for short-term weight loss in overweight women, offering improved fat reduction and metabolic benefits compared to exercise alone.Trial registration: Chinese Clinical Trail Registry, ChiCTR2300076750. Registered 17 October 2023, https://www.chictr.org.cn/bin/project/edit?pid=197611 .

BMI, waist circumference, and waist-to-hip trajectories and all-cause, CVD, and cancer mortality by sex in people without diabetes

OBJECTIVES

We examined the associations of BMI, waist circumference, and waist-to-hip ratio trajectories with mortality in people without diabetes.

METHODS

We analyzed 7601 people without diabetes from the Atherosclerosis Risk in Communities Study. We used latent class analysis to identify trajectory patterns for BMI, waist circumference, and waist-to-hip. We employed propensity score matching to enhance the balance of covariates and used Cox proportional hazards regression models to examine the associations.

RESULTS

In females, the high trajectory of BMI was associated with higher cancer mortality risks than the low group, with the hazard ratio and 95% confidence interval of 1.76 (1.14-2.73). The high waist circumference trajectory was related to increased all-cause, CVD, and cancer mortality risks in males. The moderate and high waist-to-hip ratio trajectories were associated with elevated all-cause and CVD mortality risks in females, and the high trajectory was associated with high all-cause mortality risks in males. The mean lifespan of deceased females did not significantly differ across the trajectories. However, the mean lifespan of males in the waist circumference high group (73.0 years) was shorter than the low group (75.3 years).

CONCLUSIONS

Sex differences were observed in the long-term impact of high BMI, waist circumference, and waist-to-hip ratio on mortality risks and lifespan in people without diabetes.

The Role of Adiposity and Anthropometrics on Disease Progression in Autosomal Dominant Polycystic Kidney Disease: A Narrative Review

PURPOSE OF REVIEW

Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder characterized by numerous cysts in kidneys and other organs which enlarge and cause organ dysfunction, with kidney involvement being the most common. Recently, increased body mass index, and adiposity have been associated with disease progression. In this review, we summarized the available literature on anthropometrics (body mass index, waist circumference, weight to hip ratio and visceral adipose tissue and their relationship with ADPKD progression.

RECENT FINDINGS

Although the mechanisms are not clear, various pathological processes and signaling pathways are aberrantly activated with increased adiposity in patients with ADPKD. These alterations may result in glomerular hyperfiltration, chronic inflammation, aberrant signaling, and metabolic alterations which cause disease progression in ADPKD. Although increased adiposity may be associated with ADPKD progression, the best anthropometric parameter related to disease progression is not known. Losing weight in overweight and obese individuals with ADPKD is probably beneficial but the type of diet (daily caloric restriction, intermittent fasting etc.) that is most effective needs to be clarified. Moreover, caution is warranted during weight loss, as caloric restriction may cause malnutrition.

Multiple bias calibration for valid statistical inference under nonignorable nonresponse

Valid statistical inference is notoriously challenging when the sample is subject to nonresponse bias. We approach this difficult problem by employing multiple candidate models for the propensity score (PS) function combined with empirical likelihood. By incorporating multiple working PS models into the internal bias calibration constraint in the empirical likelihood, the selection bias can be safely eliminated as long as the working PS models contain the true model and their expectations are equal to the true missing rate. The bias calibration constraint for the multiple PS models is called the multiple bias calibration. The study delves into the asymptotic properties of the proposed method and provides a comparative analysis through limited simulation studies against existing methods. To illustrate practical implementation, we present a real data analysis on body fat percentage using the National Health and Nutrition Examination Survey dataset.

Comparison of health measures between survey self-reports and electronic health records among Millennium Cohort Study participants receiving Veterans Health Administration care

BACKGROUND

Surveys are a useful tool for eliciting self-reported health information, but the accuracy of such information may vary. We examined the agreement between self-reported health information and medical record data among 116,288 military service members and veterans enrolled in a longitudinal cohort.

METHODS

Millennium Cohort Study participants who separated from service and registered for health care in the Veterans Health Administration (VHA) by September 18, 2020, were eligible for inclusion. Baseline and follow-up survey responses (2001-2016) about 39 medical conditions, health behaviors, height, and weight were compared with analogous information from VHA and military medical records. Medical record diagnoses were classified as one qualifying ICD code in any diagnostic position between October 1, 1999, and September 18, 2020. Additional analyses were restricted to medical record diagnoses occurring before survey self-report and using specific diagnostic criteria (two outpatient or one inpatient ICD code). Positive, negative, and overall (Youden's J) agreement was calculated for categorical outcomes; Bland-Altman plots were examined for continuous measures.

RESULTS

Among 116,288 participants, 71.8% self-reported a diagnosed medical condition. Negative agreement between self-reported and VHA medical record diagnoses was > 90% for most (80%) conditions, but positive agreement was lower (6.4% to 56.3%). Mental health conditions were more frequently recorded in medical records, while acute conditions (e.g., bladder infections) were self-reported at a higher frequency. Positive agreement was lower when analyses were restricted to medical record diagnoses occurring prior to survey self-report. Specific diagnostic criteria resulted in higher overall agreement.

CONCLUSIONS

While negative agreement between self-reported and medical record diagnoses was high in this population, positive and overall agreement were not strong and varied considerably by health condition. Though the limitations of survey-reported health conditions should be considered, using multiple data sources to examine health outcomes in this population may have utility for research, clinical planning, or public health interventions.

Association Between a Body Shape Index and Body Roundness Index with Prevalence of Psoriasis: A Cross-Sectional Population-Based Study

Background

Previous studies have suggested an intimate association between obesity and psoriasis. This study aimed to evaluate and compare the association between traditional and novel obesity biomarkers - waist circumference (WC), body mass index (BMI), a body shape index (ABSI), and body roundness index (BRI) - and the risk of psoriasis.

Methods

This cross-sectional study utilized data from the 2003-2006 and 2011-2014 National Health and Nutrition Examination Survey. The association between obesity biomarkers and psoriasis risk was evaluated using multivariate logistic regression and smoothed curve fitting. The diagnostic performance of various biomarkers for identifying psoriasis were calculated and compared using receiver-operating characteristic curves.

Results

Overall, 12,406 participants without psoriasis, 287 with mild psoriasis, and 68 with moderate-severe psoriasis, were included. Compared to the lowest quartile of WC, BMI, and BRI, higher quartiles were associated with significantly higher risks of psoriasis (all P for trend < 0.05). The area under the curve for identifying psoriasis was highest for BRI, which was comparable to WC (0.581 vs 0.575, P=0.34) but significantly higher than that of ABSI (0.581 vs 0.546, P=0.04) and BMI (0.581 vs 0.569, P=0.007). The association between BRI and psoriasis risk was not influenced by participant's age, sex, smoking status, physical activity, hypertension and diabetes status.

Conclusion

BRI is positively associated with risk of psoriasis and outperforms BMI and ABSI in identifying psoriasis. Given the cross-sectional design of this study, future research employing prospectively designed longitudinal studies is necessary to validate our findings.

Body fat changes and risk of new onset of hypertension and hyperlipidaemia among Korean adults: A longitudinal study

BACKGROUND

This study examined the association between changes in body fat, body mass index (BMI), and the risk of newly developed hypertension and hyperlipidaemia in the general population.

METHODS

This longitudinal study included 17,598 individuals without prior hypertension and hyperlipidaemia who underwent at least three health examinations between January 2015 and December 2022. Body fat was classified as decreased (≥ 5%), stable (within 5%), and increased (≥ 5%) using bioelectrical impedance analysis. BMIs were categorised as healthy weight/underweight (BMI < 23), overweight (23 ≤ BMI < 25), and obesity (BMI ≥ 25). Hypertension and hyperlipidaemia were identified through self-reported medication use or clinical measurements.

RESULTS

Increases in BMI or body fat were associated with higher incidence rates of hypertension and hyperlipidaemia. Decreased body fat was associated with a lower risk of hypertension in the overweight (odds ratio: 0.638, 95% confidence interval: 0.464-0.876) and obese groups (0.724, 0.577-0.909). Individuals with healthy weight/underweight with increased body fat had a higher incidence of hyperlipidaemia than individuals with overweight with decreased body fat (87.2 vs 66.4 per 1,000 people). Compared to the stable body fat group, increased body fat raised the risk of hyperlipidaemia (healthy weight/underweight: 1.522, 1.248-1.855; overweight: 1.278, 1.032-1.583; and obesity: 1.214, 1.028-1.433). Individuals living with overweight with decreased body fat demonstrated a lower risk of hyperlipidaemia (0.546, 0.400-0.747).

CONCLUSIONS

Increased body fat was associated with a higher risk of hyperlipidaemia, even within the same BMI category. Decreasing body fat, particularly in individuals living with overweight, is associated with a lower risk of hypertension and hyperlipidaemia.

Controversies and challenges of anticoagulation therapy in obesity

INTRODUCTION

The relationship between anticoagulation efficacy and safety in obesity is complex and can vary between degrees of obesity and anticoagulant choice. Indeed, patients at extremes of body weight were under-represented in randomized trials. Additionally, the possibility of an 'obesity paradox' has been raised in atrial fibrillation, describing decreased thromboembolic risk in obese patients.

AREAS COVERED

We explore the current literature on anticoagulation in obesity, specifically with regard to efficacy in atrial fibrillation, efficacy in venous thromboembolism, and bleeding risk. Pharmacodynamic and pharmacokinetic considerations are also discussed.

EXPERT OPINION

As a class, direct oral anticoagulants are comparable to vitamin-K antagonists in preventing and treating thromboembolism in overweight and obese patients, whilst not increasing bleeding risk.

A Scoping Review of the Implications and Applications of Body Composition Assessment in Locally Advanced and Locally Recurrent Rectal Cancer

Background: A strong body of evidence exists demonstrating deleterious relationships between abnormal body composition (BC) and outcomes in non-complex colorectal cancer. Complex rectal cancer (RC) includes locally advanced and locally recurrent tumours. This scoping review aims to summarise the current evidence examining BC in complex RC. Methods: A literature search was performed on Ovid MEDLINE, EMBASE, and Cochrane databases. Original studies examining BC in adult patients with complex RC were included. Two authors undertook screening and full-text reviews. Results: Thirty-five studies were included. Muscle quantity was the most commonly studied BC metric, with sarcopenia appearing to predict mortality, recurrence, neoadjuvant therapy outcomes, and postoperative complications. In particular, 10 studies examined relationships between BC and neoadjuvant therapy response, with six showing a significant association with sarcopenia. Only one study examined interventions for improving BC in patients with complex RC, and only one study specifically examined patients undergoing pelvic exenteration. Marked variation was also observed in terms of how BC was quantified, both in terms of anatomical location and how cut-off values were defined. Conclusions: Sarcopenia appears to predict mortality and recurrence in complex RC. An opportunity exists for a meta-analysis examining poorer BC and neoadjuvant therapy outcomes. There is a paucity of studies examining interventions for poor BC. Further research examining BC specifically in patients undergoing pelvic exenteration surgery is also lacking. Pitfalls identified include variances in how BC is measured on computed tomography and whether external cut-off values for muscle and adipose tissue are appropriate for a particular study population.

BMI or not to BMI? debating the value of body mass index as a measure of health in adults

Body mass index (BMI) is used across public health to calculate height to weight ratio and translate into weight status. Whether BMI is appropriate as an individual- or population-level health measure for adults is debated. BMI is a cost-effective and feasible metric to establish health risk. Yet, BMI's historical underpinnings, weight categories, usefulness as clinical diagnostic measure, and application across population subgroups has called the measurement tool into question. At the annual ISBNPA meeting in June 2023, the co-authors engaged in a debate session on the topic. This paper presents the complexity of arguments for or against BMI as a measurement tool and proposes its evolution to support whole-person health.

Obesity and Cardiometabolic Disease: Insights From Genetic Studies

Obesity is a highly prevalent chronic disease and major driver of both atherosclerotic heart disease and heart failure. Obesity is also a heritable neuronal disease with heritability estimates of up to 70%. In this work I review how common genetic variants, usually with small effect sizes, contribute to the risk for developing obesity and cardiometabolic disease in the majority of people and how this can be further modulated by environmental factors. In some individuals, rare genetic variants with large effect sizes can influence the risk of developing obesity, in some cases in a Mendelian manner. I also address how identification of these rare variants has led to fundamental biologic insights into how satiety and reward are biologic processes, has led to more personalized treatments, and has identified potential novel drug treatments. Biologic insights derived from genetic studies of obesity have also improved our understanding of the causal mediators between obesity and cardiovascular disease. A major limitation of studies to date is that they involved mostly people of European ancestry. Studying more diverse populations will improve our understanding of obesity and cardiometabolic disease. Lessons derived from genetic studies make a compelling case for increasing accessibility to therapies that have sustained efficacy in managing obesity and improving health. This increased knowledge must also inform public health initiatives that will reduce the prevalence of obesity in the coming decades.

The renin-angiotensin-aldosterone system and salt sensitivity of blood pressure offer new insights in obesity phenotypes

OBJECTIVE

Individuals who have metabolically healthy overweight/obesity (MHOO) do not have cardiometabolic complications despite an elevated BMI. Renin-angiotensin-aldosterone system (RAAS) activation and salt sensitivity of blood pressure (SSBP) are cardiovascular disease (CVD) risks, which are increased in individuals with higher BMI values. Little is known about the differences in RAAS activation and SSBP between MHOO and metabolically unhealthy overweight/obesity (MUOO) phenotypes.

METHODS

We studied 1430 adults on controlled dietary sodium. Individuals in the MHOO group had BMI ≥ 25 kg/m2 without comorbidities (e.g., diabetes, dyslipidemia, hypertension, CVD), whereas individuals in the MUOO group had BMI ≥ 25 kg/m2 and at least one comorbidity. The control group included healthy individuals (BMI 18.5-24.9 kg/m2).

RESULTS

BMI was similar between the MHOO (28.9 kg/m2) and MUOO groups (29.3 kg/m2; p = 0.317). On liberal sodium, the MUOO group had activated RAAS compared with the MHOO group, including higher plasma aldosterone concentration (mean [SD], 1.11 [0.48] ng/dL; p = 0.020), plasma angiotensin II levels (4.11 [2.0] pg/mL; p = 0.040), and percentage of individuals with plasma renin activity ≥ 1.0 ng/mL/h (+3.6%; p = 0.017). The MUOO group had higher SSBP than the MHOO group (6.0 [1.9] mm Hg; p = 0.002). Applying a zero-to-six-point metabolic health score found that a worse score was associated with higher measurements of RAAS activity and SSBP (p < 0.001).

CONCLUSIONS

Compared to the MHOO group, the MUOO group was characterized by an increase in the following two CVD risk factors: higher RAAS activity and SSBP on controlled sodium diets. Therapeutic interventions targeting the effects of angiotensin II and/or aldosterone may offer cardiometabolic protection for individuals with the MUOO phenotype.

Long-term outcomes and risk modifiers of metabolic dysfunction-associated steatotic liver disease between lean and non-lean populations

One-third of adults across the globe exhibit metabolic dysfunction-associated steatotic liver disease (MASLD)-formerly known as nonalcoholic fatty liver disease (NAFLD). To date, MASLD is the fastest-growing etiology of chronic liver disease and hepatocellular carcinoma (HCC). Besides the population with obesity, MASLD can also be found in lean populations, accounting for 13% of the global population, especially Asians. Notably, individuals with lean MASLD face equal or higher overall mortality rates compared to their non-lean counterparts. Risk modifiers encompass advanced age, hepatic fibrosis, and type 2 diabetes mellitus (T2DM). Moreover, the population with lean MASLD is associated with an increased risk of HCC, while their non-lean counterparts are more prone to cardiovascular outcomes and T2DM. Existing evidence indicates a similar risk of liver-related events and extrahepatic cancer between the two groups. However, MASLD-related genetic variants, such as PNPLA3 and TM6SF2, did not significantly affect mortality between the two populations. Still, underreporting alcohol consumption and regional representation limits the study's comprehensiveness. Longitudinal studies and mechanistic explorations are needed to understand differences in lean versus non-lean MASLD populations. This review highlights the need for awareness and tailored interventions in managing MASLD, considering lean individuals' unique risks.

Masseter Muscle Volume, Sarcopenia, and Muscle Determinants: Insights from ACTN3 Polymorphism in Elderly Japanese in the Bunkyo Health Study

AIM

Sarcopenia has been with a decrease in masseter muscle (MM) thickness in high-risk older populations. However, the relationship between sarcopenia and determinants of MM volume (MMV) in the general elderly population remains unclear.

METHOD

In a cross-sectional study of 1,484 older adults in Tokyo, we evaluated MMV using 3D MRI scanning, appendicular skeletal muscle mass (ASMM), handgrip strength, dietary intake, smoking, insulin-like growth factor 1 (IGF-1) levels, and the ACTN3 R577X polymorphism. Participants were divided into quintiles based on MMV (Q1-5).

RESULTS

Participants in our study had a mean age of 73.0 ± 5.3 years and their MMV (Men: 35.3 ± 7.8 mL, Women: 25.0 ± 5.1 mL) was significantly higher in men than in women. A significant association between MMV and sarcopenia was observed, with the lowest quintile (Q1) showing a higher risk compared to the highest quintile (Q5) in both sexes. Body mass index (BMI) and age were independent determinants of ASMM in both sexes, whereas BMI, but interestingly not age, was a determinant of MMV. Moreover, IGF-1 was positively correlated with MMV in both sexes; smoking was negatively correlated with MMV in women. The ACTN3 577XX genotype was only associated with smaller MMV in men.

CONCLUSION

Low MMV increased the risk of sarcopenia, particularly in men. BMI and age strongly influenced ASMM, while MMV was only weakly associated with BMI and not with age. Notably, IGF-1 level was positively associated with MMV only, and ACTN3 genotype was associated to reduced MMV only in men.

Combined Association of Plasma Metabolites with Body Mass Index and Physical Activity Level

Metabolomic analysis of the changes in plasma metabolites in obesity along with physical activity interaction may contribute to disease diagnosis and treatment. We sought to make a comprehensive assessment of the plasma metabolite profile of subjects with a lean (n = 20, BMI = 22.3) or overweight/obese (n = 29, BMI = 29) body mass index (BMI) and low (n = 33, IPAQ = 842) or high (n = 16, IPAQ = 6935) index of physical activity questionnaire (IPAQ), using an untargeted metabolomic approach. Two-way analysis of variance was applied to the data obtained from liquid chromatography-mass spectrometry analyses and resulted in 64 metabolites, mainly responsible for the data variance among the different groups. Finally, a complex network approach reveals the most relevant metabolites. The majority of the relevant metabolites are oxidized species of phospholipids. Most species of phosphatidylcholine and a species of phosphatidylglycerol were found to be decreased in obese subjects, while most species of phosphatidylethanolamine, phosphatidylserine, and phosphatidylinositol were increased. Only a single species each of prostaglandin, phosphatidylglycerol, and phosphatidylinositol were modulated by IPAQ, but interaction effects between BMI and IPAQ were found for most of the metabolites in the combination of obese BMI with low IPAQ.

Molecular Pathways Linking High-Fat Diet and PM2.5 Exposure to Metabolically Abnormal Obesity: A Systematic Review and Meta-Analysis

Obesity, influenced by environmental pollutants, can lead to complex metabolic disruptions. This systematic review and meta-analysis examined the molecular mechanisms underlying metabolically abnormal obesity caused by exposure to a high-fat diet (HFD) and fine particulate matter (PM2.5). Following the PRISMA guidelines, articles from 2019 to 2024 were gathered from Scopus, Web of Science, and PubMed, and a random-effects meta-analysis was performed, along with subgroup analyses and pathway enrichment analyses. This study was registered in the Open Science Framework. Thirty-three articles, mainly case-control studies and murine models, were reviewed, and they revealed that combined exposure to HFD and PM2.5 resulted in the greatest weight gain (82.835 g, p = 0.048), alongside increases in high-density lipoproteins, insulin, and the superoxide dismutase. HFD enriched pathways linked to adipocytokine signaling in brown adipose tissue, while PM2.5 impacted genes associated with fat formation. Both exposures downregulated protein metabolism pathways in white adipose tissue and activated stress-response pathways in cardiac tissue. Peroxisome proliferator-activated receptor and AMP-activated protein kinase signaling pathways in the liver were enriched, influencing non-alcoholic fatty liver disease. These findings highlight that combined exposure to HFD and PM2.5 amplifies body weight gain, oxidative stress, and metabolic dysfunction, suggesting a synergistic interaction with significant implications for metabolic health.

A Proposed Cost-Benefit Analysis of Adult EFNEP Utilizing Biomarkers of Chronic Disease Risk

OBJECTIVE

To assess whether the adult Expanded Food and Nutrition Education Program (EFNEP) is a cost-effective intervention that generates sustained improvement in biomarkers of chronic disease risk.

DESIGN

A longitudinal quasi-experimental design with 2 parallel arms (untreated comparison vs EFNEP) and 4 waves of data collection (pretest, posttest, 6 months, and 12 months after completion).

SETTING

Eligible adult EFNEP community settings in Colorado, Florida, Maryland, and Washington.

PARTICIPANTS

Free-living adults (n = 500) aged 18-50 years, with income ≤ 185% of the Federal Poverty Line.

INTERVENTION(S)

Adult EFNEP delivered using an evidence-based curriculum, Eating Smart • Being Active.

MAIN OUTCOME MEASURE(S)

Chronic disease biomarkers (body mass index, blood pressure, and HbA1c), food and physical activity behaviors, dietary intake, health status, and demographics will be measured using objective biometric indicators, the Adult EFNEP Questionnaire, a 24-hour dietary recall, a health questionnaire, and demographic forms.

ANALYSIS

Linear mixed models will be used to assess whether adult EFNEP has a significant (P < 0.01) impact on 3 chronic disease biomarkers. The program's estimated impact on chronic disease biomarkers will be incorporated into a cost-benefit analysis framework to assess the economic value generated by adult EFNEP through chronic disease risk reduction.

A Guideline-Directed Approach to Obesity Treatment

This article summarizes and compares 18 sets of guidelines for adult obesity treatment, highlighting key recommendations for patient evaluation, lifestyle intervention, anti-obesity medications (AOMs), and metabolic and bariatric surgery. Guidelines are consistent in many regards, although there is divergence regarding preferred AOMs. Metabolic and bariatric surgery is still recognized as the most durable form of obesity treatment, and newer guidelines suggest these procedures at lower BMI thresholds for people with uncontrolled type 2 diabetes. Overall, guidelines for obesity treatment show a high degree of agreement, although updates are needed to incorporate new treatment innovations.

Relationships among Physical Activity Bone Mineral Density and Body Composition in Obese and Athletes

BACKGROUND

Osteoporosis is a significant global public health issue, increasingly affecting younger individuals and placing substantial economic burdens on society. Risk factors vary, with non-modifiable ones like age and ethnicity, as well as modifiable factors including corticosteroid use, caffeine intake, and reduced exercise. This study examines the relationship between bone density, body components, and physical activity (PA) in enhancing bone health, particularly in obese athletes.

METHODS

The 66 participants aged 18 to 30 were classified into two groups: 34 obese and 32 athletes. Measured parameters included body composition through bioelectrical impedance analysis, and bone mineral density (BMD) via quantitative ultrasound, while PA was assessed using the International PA Questionnaire.

RESULTS

Our findings revealed a significant positive correlation between BMD and PA (r=0.284, P=0.023). Additionally, PA demonstrated strong negative correlations with body mass index (BMI), fat mass, and visceral fat (r=-0.738, r=-0.733, and r=-0.704 respectively, all P<0.001). In contrast, no significant correlation was observed between PA and lean mass (r=0.065, P=0.609). BMD was negatively associated with BMI and visceral fat, while a robust correlation between basal metabolic rate and lean mass was evident.

CONCLUSIONS

A study comparing athletes involved in high-impact sports indicated that these athletes maintained adequate BMD for their chronological age (Z-score≥-2.0). Moreover, a significant difference in BMD was observed when comparing the athletes to the obese group(P=0.018).

The Correlation Between Body Mass Index and Health-Related Quality of Life: Data from Two Weight Loss Intervention Studies

INTRODUCTION

The correlation between body mass index (BMI) and utility in participants with obesity was assessed using health-related quality-of-life data collected in two weight loss intervention studies, SCALE and STEP 1.

METHODS

Short Form Health Survey 36-Item (SF-36) scores from SCALE and STEP 1 were mapped to EuroQoL-5 dimensions-3 levels (EQ-5D-3L) using an established algorithm to derive utilities for the UK. SF-36 scores from STEP 1 were converted into Short Form 6 dimension (SF-6D) utilities for Portugal using the tool developed by the University of Sheffield. The correlation between baseline BMI and utility was assessed by multiple linear regression analyses, controlling for demographic and clinical parameters.

RESULTS

A higher baseline BMI correlated with lower EQ-5D-3L and SF-6D utilities, although the trend was non-significant. Assuming linearity between BMI ranges 30-40 kg/m2, an additional unit of BMI correlated with 0.0041 and 0.0031 lower EQ-5D-3L scores in SCALE and 0.0039 and 0.0047 lower EQ-5D-3L and 0.0027 and 0.0020 lower SF-6D scores in STEP 1 for men and women, respectively.

CONCLUSION

In individuals with comparable demographic characteristics and weight-related comorbidities, a 1 unit change in BMI leads to a difference of up to 0.005 in utility indices.

TRIAL REGISTRATION

ClinicalTrials.gov identifiers: SCALE (NCT01272219) and STEP 1 (NCT03548935).

Complementary Role of BMI and EOSS in Predicting All-Cause and Cause-Specific Mortality in People with Overweight and Obesity

OBJECTIVE

To assess the complementary role of the Body Mass Index (BMI) and Edmonton Obesity Staging System (EOSS) in predicting all-cause and cause-specific mortality in people living with overweight and obesity (PLwOW/O).

METHODS

A longitudinal analysis of prospectively collected data from the 1999-2018 cycles of the National Health and Nutrition Examination Survey (NHANES) was conducted. The association between BMI, EOSS, and mortality was evaluated through Cox regression models, adjusted for confounders.

RESULTS

The analysis included 36,529 subjects; 5329 deaths occurred over a median follow-up of 9.1 years (range: 0-20.8). An increased mortality risk was observed for obesity class II and III (HR = 1.21, 95% CI 1.08-1.36, p = 0.001 and HR = 1.58, 95% CI 1.39-1.80, p < 0.001; compared to overweight), and for EOSS stage 2 and 3 (HR = 1.36, 95% CI 1.16-1.58, p < 0.001 and HR = 2.66, 95% CI 2.26-3.14, p < 0.001; compared to stage 0/1). The prognostic role of BMI was more pronounced in younger patients, males, and non-Black individuals, while that of EOSS was stronger in women. Both BMI and EOSS independently predicted cardiovascular- and diabetes-related mortality. EOSS stage 3 was the only predictor of death from malignancy or renal causes.

CONCLUSIONS

BMI and EOSS independently predict all-cause and cause-specific mortality in PLwOW/O. Their integrated use seems advisable to best define the obesity-related mortality risk.

Validating the use of body mass index with computed tomography in a racially and ethnically diverse cohort of patients admitted with SARS-CoV-2

BACKGROUND

Body mass index (BMI) is criticized for being unjust and biased in relatively healthy racial and ethnic groups. Therefore, the current analysis examines if BMI predicts body composition, specifically adiposity, in a racially and ethnically diverse acutely ill patient population.

METHODS

Patients admitted with SARS-CoV-2 having an evaluable diagnostic chest, abdomen, and/or pelvic computed tomography (CT) study (within 5 days of admission) were included in this retrospective cohort. Cross-sectional areas (centimeters squared) of the subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intramuscular adipose tissue (IMAT) were quantified. Total adipose tissue (TAT) was calculated as sum of these areas. Admission height and weight were applied to calculate BMI, and self-reported race and ethnicity were used for classification. General linear regression models were conducted to estimate correlations and assess differences between groups.

RESULTS

On average, patients (n = 134) were aged 58.2 (SD = 19.1) years, 60% male, and racially and ethnically diverse (33% non-Hispanic White [NHW], 33% non-Hispanic Black [NHB], 34% Hispanic). Correlations between BMI and SAT and BMI and TAT were strongest revealing estimates of 0.707 (0.585, 0.829) and 0.633 (0.534, 0.792), respectively. When examining the various adiposity compartments across race and ethnicity, correlations were similar and significant differences were not detected for TAT with SAT, VAT, or IMAT (all P ≥ 0.05).

CONCLUSIONS

These findings support the routine use of applying BMI as a proxy measure of total adiposity for acutely ill patients identifying as NHW, NHB, and Hispanic. Our results inform the validity and utility of this tool in clinical nutrition practice.

Body Mass Index and Diabetes Incidence Across the Adult Lifespan: The Baltimore Longitudinal Study of Aging

Context

Body composition and glucose metabolism change with aging. Whether different levels of body-mass-index (BMI) are needed to define diabetes risk across the adult lifespan is unknown.

Objective

This work aimed to investigate whether BMI similarly reflects relative fat mass (FM) and diabetes risk across age groups.

Methods

Participants without diabetes from the Baltimore Longitudinal Study of Aging (973 men, 1073 women), stratified by age (<50, 50-59, 60-69, ≥70 years) and categorized by either World Health Organization (WHO)-defined BMI categories (for normal weight, overweight or obesity) or BMI quartiles. The primary exposure was BMI. The primary outcome was diabetes incidence. The relationship of BMI to dual-energy x-ray absorptiometry-derived FM was also investigated in older vs younger participants.

Results

The median (range) follow-up time was 7.1 years (range, 0-29.0 years). Within WHO-defined BMI categories, different age groups demonstrated significantly different FM percentage, FM/lean mass, and waist circumference (P < .05). WHO-defined BMI categories for overweight and obesity were generally related to higher diabetes risk compared to normal weight in all ages except 50 to 59 years. When BMI was categorized by quartiles, diabetes incidence increased dramatically beginning in quartile 2 (23-25 kg/m2) in older groups. BMI cutoffs with equivalent diabetes incidence rate as BMI 25 kg/m2 and 30.0 kg/m2 in individuals younger than 50 years were 22.7 kg/m2 and 25.2 kg/m2 for ages 50 to 59 years; 22.8 kg/m2 and 25.0 kg/m2 for ages 60 to 69 years; and 23.2 kg/m2 and 25.8 kg/m2 for ages 70 years and older, respectively.

Conclusion

WHO-defined BMI categories do not reflect similar diabetes risk across the lifespan. Diabetes incidence is greater at lower levels of BMI in older adults and may lead to underestimation of diabetes risk with aging, particularly among those traditionally classified as normal-weight individuals.

Nutritional status and dietary habits in older adults with fixed implant dental prostheses: a case-control study

Aim

To evaluate the nutritional status, nutritional risk, and dietary habits of patients treated with bimaxillary implant-supported fixed prostheses in comparison with a group of natural dentate patients.

Methods

A study group (n = 25, 8 women, mean age = 70.6 ± 7.5 years) with bimaxillary implant-supported fixed prostheses and a control group (n = 25, 13 women, mean age = 69.0 ± 5.3) with a mean of 27.7 ± 1.8 natural teeth were recruited. The nutritional status and nutritional risk of the participants were evaluated with Mini Nutritional Assessment (MNA) and Seniors in the Community: Risk Evaluation for Eating and Nutrition; (SCREEN-14), while the dietary habits were recorded by data from a three-day dietary record. The data were analyzed with the Mann-Whitney U-test and independent t-test to evaluate the differences between the groups.

Results

The results showed that although both the groups had normal nutrition status as revealed by the MNA scores the study group showed significantly higher BMI (p = 0.005) but lower SCREEN-14 (p = 0.012) scores, than the control group. The results also showed that higher SCREEN-14 scores were significantly associated with higher odds of being in the control group, with an odds ratio of 1.159 (p = 0.024). Further, the results of the analysis of the dietary records showed that the participants in the study group consumed fewer meals (p = 0.006) and fewer varieties of food (p < 0.001), particularly fewer fruits (p = 0.011) than the control group.

Conclusion

The results indicate that people with fixed implant prostheses may be susceptible to nutritional deficiencies according to the SCREEN-14 scores compared to their natural dentate counterparts. Further, people with implant prostheses also tend to have higher BMI and consume a smaller variety of foods, especially fruits, than the natural dentate control group.

Time trends of the association of body mass index with mortality in 3.5 million young Swedish adults

PURPOSE

We investigated time trends of the obesity-mortality association, accounting for age, sex, and cause-specific deaths.

METHODS

We analysed pooled nationwide data in Sweden for 3,472,310 individuals aged 17-39 years at baseline in 1963-2016. Cox regression and flexible parametric survival models investigated BMI-mortality associations in sub-groups of sex and baseline calendar years (men: <1975, 1975-1985, ≥1985 and women: <1985, 1985-1994, ≥1995).

RESULTS

Comparing men with obesity vs. normal weight, all-cause and "other-cause" mortality associations decreased over periods; HR (95% CI) 1.92 (1.83-2.01) and 1.70 (1.58-1.82) for all-cause and 1.72 (1.58-1.87) and 1.40 (1.28-1.53) for "other-cause" mortality in <1975 and ≥1985, but increased for CVD mortality; HR 2.71 (2.51-2.94) and 3.91 (3.37-4.53). Higher age at death before 1975 coincided with more obesity-related deaths at higher ages. Furthermore, the all-cause mortality association for different ages in men showed no clear differences between periods (p-interaction=0.09), suggesting no calendar effect after accounting for attained age. Similar, but less pronounced, results were observed in women. Associations with cancer mortality showed no clear trends in men or in women.

CONCLUSIONS

Accounting for differences in age and death causes between calendar periods when investigating BMI-mortality time trends may avoid misinterpreting the risks associated with obesity over time.

Opportunities to optimize lifestyle interventions in combination with glucagon-like peptide-1-based therapy

Obesity is a chronic multi-system disease and major driver of type 2 diabetes and cardiometabolic disease. Nutritional interventions form the cornerstone of obesity and type 2 diabetes management. Some interventions such as Mediterranean diet can reduce incident cardiovascular disease, probably independently of weight loss. Weight loss of 5% or greater can improve many adiposity-related comorbidities. Although this can be achieved with lifestyle intervention, it is often difficult to sustain in the longer term due to adaptive endocrine changes. In recent years glucagon-like-peptide-1 receptor agonists (GLP-1RAs) have emerged as effective treatments for both type 2 diabetes and obesity. Newer GLP-1RAs can achieve average weight loss of 15% or greater and improve cardiometabolic health. There is heterogeneity in the weight loss response to GLP-1RAs, with a substantial number of patients unable to achieve 5% or greater weight. Weight loss, on average, is lower in older adults, male patients and people with type 2 diabetes. Mechanistic studies are needed to understand the aetiology of this variable response. Gastrointestinal side effects leading to medication discontinuation are a concern with GLP-1RA treatment, based on real-world data. With weight loss of 20% or higher with newer GLP-1RAs, nutritional deficiency and sarcopenia are also potential concerns. Lifestyle interventions that may potentially mitigate the side effects of GLP-1RA treatment and enhance weight loss are discussed here. The efficacy of such interventions awaits confirmation with well-designed randomized controlled trials.

Unravelling relationships between obesity, diabetes, and factors related to somatosensory functioning in knee osteoarthritis patients

OBJECTIVE

This study explores the association between obesity, diabetes, and somatosensory functioning in patients with knee osteoarthritis (OA), aiming to understand how metabolic conditions are related to pain mechanisms in this patient population. We hypothesized that higher body mass index (BMI), fat mass, and glycated hemoglobin levels (HbA1c) are associated with signs of altered somatosensory functioning.

METHODS

A cross-sectional analysis was conducted as part of a larger multicentre prospective cohort study. Data were collected from patients awaiting total knee arthroplasty in Belgium and the Netherlands. Associations between BMI, fat mass, HbA1c, and various pain-related variables were examined employing Pearson and Spearman correlation analyses which were further analyzed with linear regression techniques.

RESULTS

The study included 223 participants. Analysis revealed a significant although weak negative correlation between fat mass and pressure pain thresholds (PPT) at multiple locations, suggesting a link between higher fat mass and increased mechanical hyperalgesia. There were no significant correlations between BMI and pain-related outcomes. HbA1c levels showed very weak positive correlations with pain measures but did not withstand correction for multiple testing.

CONCLUSION

The findings indicate that fat mass may be closely associated with altered somatosensory functioning in patients with knee OA. However, no significant correlations were found between BMI or HbA1c levels and pain-related outcomes. Future research should focus on longitudinal studies to elucidate the causal relationships and further explore the impact of metabolic factors on pain mechanisms in this patient population. Key Points • The findings indicate that fat mass may be closely associated with altered somatosensory functioning in patients with knee OA.

Comparative analysis of body mass index and obesity-related anthropometric indices for mortality prediction: a study of the Namwon and Dong-gu cohort in Korea

OBJECTIVES

This study investigated the associations between several obesity-related anthropometric indices and mortality in middle-aged and elderly populations to compare the indices' predictive ability with that of the body mass index (BMI).

METHODS

We analyzed data on 12 indices calculated from 19,805 community-based cohort participants (average age, 63.27 years; median follow-up, 13.49 years). Each index was calculated using directly measured values of height, weight, waist circumference (WC), and hip circumference (HC). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for each index using Cox regression and evaluated mortality prediction with the Harrell concordance index (c-index).

RESULTS

Adding anthropometric indices to the basic mortality model (c-index, 0.7723; 95% CI, 0.7647 to 0.7799) significantly increased the predictive power of BMI (c-index, 0.7735; 95% CI, 0.7659 to 0.7811), a body shape index (ABSI; c-index, 0.7735; 95% CI, 0.7659 to 0.7810), weight-adjusted waist index (WWI; c-index, 0.7731; 95% CI, 0.7656 to 0.7807), and waist to hip index (WHI; c-index, 0.7733; 95% CI, 0.7657 to 0.7809). The differences between the BMI model and the other 3 models were not statistically significant.

CONCLUSIONS

In predicting all-cause mortality, the ABSI, WWI, and WHI models based on WC or HC had stronger predictive power than conventional risk factors but were not significantly different from the BMI model.

A literature review of biomarkers used for diagnosis of relative energy deficiency in sport

Introduction

The review aims to summarize the markers used in diagnosing relative energy deficiency in sport (REDs) and compare them with the REDs CAT2 score.

Methods

A systematic search was performed in the PubMed, Web of Science, and SPORTDiscus databases during April 2023. The descriptors used were "athlete" AND "REDs," along with respective entry terms. The selection process followed the PRISMA 2020 recommendations, identifying 593 records, from which 13 studies were ultimately selected. Seventy-nine markers were identified and categorized into six groups: bone mineral density (BMD), metabolic resting rate, blood biomarkers, anthropometrics, nutritional intake, and performance parameters. The most frequently utilized biomarkers included BMD, anthropometric parameters (e.g., body mass index, body mass, and fat mass), and the triiodothyronine (T3) concentration.

Results

According to the REDs CAT2 pointed indicators, the biomarkers varied among the studies, while 7 out of the 13 included studies achieved a ≥60% agreement rate with this tool. The prevalence of low energy availability, an etiological factor in the development of REDs, was detected in 4 out of 13 studies, with an average of 39.5%.

Conclusion

In conclusion, this review highlights the most commonly used markers in diagnosing REDs, such as BMD, anthropometric parameters, and T3 hormone concentration. Due to the current inconsistencies, standardizing diagnostic methodologies is crucial for future research. By focusing on widely used markers, this review aids future research planning and result interpretation and points out the ongoing need for methodological consistency in evolving diagnostic tools.

Systematic Review Registration

https://www.crd.york.ac.uk/, PROSPERO (CRD42022320007).

Associations of Ultra-Processed Food Intake with Body Fat and Skeletal Muscle Mass by Sociodemographic Factors

BACKGRUOUND

The effects of excessive ultra-processed food (UPF) consumption on body composition measures or sociodemographic disparities are understudied in Korea. We aimed to investigate the association of UPF intake with percent body fat (PBF) and percent appendicular skeletal muscle mass (PASM) by sociodemographic status in adults.

METHODS

This study used data from the Korea National Health and Nutrition Examination Survey 2008-2011 (n=11,123 aged ≥40 years). We used a NOVA system to classify all foods reported in a 24-hour dietary recall, and the percentage of energy intake (%kcal) from UPFs was estimated. PBF and PASM were measured by dual-energy X-ray absorptiometry. Tertile (T) 3 of PBF indicated adiposity and T1 of PASM indicated low skeletal muscle mass, respectively. Multinomial logistic regression models were used to estimate odds ratios (OR) with 95% confidence interval (CI) after adjusting covariates.

RESULTS

UPF intake was positively associated with PBF-defined adiposity (ORper 10% increase, 1.04; 95% CI, 1.002 to 1.08) and low PASM (ORper 10% increase, 1.05; 95% CI, 1.01 to 1.09). These associations were stronger in rural residents (PBF: ORper 10% increase, 1.14; 95% CI, 1.06 to 1.23; PASM: ORper 10% increase, 1.15; 95% CI, 1.07 to 1.23) and not college graduates (PBF: ORper 10% increase, 1.06; 95% CI, 1.02 to 1.11; PASM: ORper 10% increase, 1.07; 95% CI, 1.03 to 1.12) than their counterparts.

CONCLUSION

A higher UPF intake was associated with higher adiposity and lower skeletal muscle mass among Korean adults aged 40 years and older, particularly in those from rural areas and with lower education levels.

Breaking Academic Silos: Pedagogical Recommendations for Equitable Obesity Prevention Training and Research During an Age of Nutrition Polarization

Introduction

Obesity is a preventable chronic condition and a risk factor for poor health and early mortality. Weight stigma and weight-neutral medicine are popular topics in social media that are often at odds with current medical guidelines on obesity treatment and prevention. This conflict may erode the public's trust in science, impede research progress on preventing obesity in marginalized groups, and uphold the ongoing and historical lack of diversity among nutrition trainees.

Methods

The authors conducted a series of student-led dialogue sessions with nutrition graduate students in Boston, Massachusetts, from March to May 2023 to understand perceptions of obesity research, health equity, and racism and discrimination. This article summarizes the lessons learned and provides pedagogical recommendations for jointly addressing obesity at the population level and the recruitment, training, and retention of diverse scholars, clinicians, and public health practitioners.

Results

Dialogue sessions revealed that students perceive a disproportionate focus on the harms of obesity as a chronic disease, highlighting that inadequate attention is given to weight stigma and discrimination. Some participants believed that weight-based discrimination is equally detrimental to individual health and wellbeing as having obesity. Discussions also emphasized the need to pinpoint the multidimensional and cultural manifestations of weight stigma, which necessitates collaboration across social sectors and academic disciplines. Students recognized the urgent need to apply an equity lens to obesity research and teaching but felt limited in their access to experts within nutrition science who specialize in racism, discrimination, eating disorders, and weight stigma.

Conclusions

This study identified concrete opportunities for urgently needed new training and research in population-level obesity prevention, emphasizing antiracism, harm reduction, and elimination of stigma and bias across multiple levels of science and society. Overall, the decision to use the BMI within pedagogy and training must be explicitly stated-research, population surveillance, decision-making, or treatment pedagogy and training-while acknowledging its strengths and limitations across diverse settings. Finally, the social determinants of obesity should incorporate not only weight stigma but also racism and multiple forms of discrimination.

Associations Between Gait Speed and Fat Mass in Older Adults

Purpose

Although both gait speed and fat mass are crucial for healthy aging, evidence suggests that the associations between these components remain unclear. Therefore, the main purpose of the study was to examine the associations between gait speed and fat mass.

Patients and Methods

In this cross-sectional study, we recruited 643 older men and women aged >60 years. Fat mass was assessed using bioelectrical impedance analysis, while gait speed was determined by calculating the time an individual has taken to walk across a 4.6-m distance. Receiver operating characteristic (ROC) curves and odds ratios (OR) were performed to determine cut-off points and mutual associations.

Results

In older men, the optimal threshold of gait speed to detect high level of fat mass was 1.40 m/s with the area under the curve (AUC) being 0.82 (95% CI 0.76-0.89, p < 0.001). In older women, the optimal cut-off point was 1.37 m/s (AUC = 0.85, 95% CI 0.81-0.90, p < 0.001). Older men and women who walked below the newly developed threshold were approximately 12 times more likely to have high level of fat.

Conclusion

In summary, newly developed cut-off points of gait speed have adequate discriminatory ability to detect older men and women with high level of fat mass. Although gait speed may be considered as a satisfactory screening tool for fat mass, its utility in clinical practice needs to be further investigated.

Obesity blunts insulin sensitivity improvements and attenuates strength gains following resistance training in nondiabetic men

PURPOSE

Impaired insulin sensitivity is central in the etiology of type 2 diabetes in people with obesity. The effectiveness of resistance training (RE) alone in improving insulin sensitivity in people with obesity is undetermined. This study aimed to determine the influence of obesity on insulin sensitivity responses to RE.

METHODS

Nineteen sedentary men were allocated to Lean (BMI 22.7 ± 2.5 kg m-2; n = 10) or Obese group (BMI 33.2 ± 3.2 kg m-2; n = 9). Participants were evaluated before and after a 10-week supervised progressive RE (3 sets of 10 repetition maximum (RM), 3 d/wk) for insulin sensitivity indexes using an oral glucose tolerance test, body composition using anthropometrics, and strength using 1RM.

RESULTS

Groups were matched at baseline for all variables except for body composition and absolute strength. Body fat was not changed in both groups. Matsuda insulin sensitivity index, hepatic insulin resistance, and insulin area under the curve improved by 64.3 ± 61.9 unit, - 58.2 ± 102.9 unit, 2.3 ± 4.1 unit, and - 721.6 ± 858.2 µU/ml, respectively, only in the Lean group. The increased 1RM% for leg press was greater in the Lean (49.5 ± 18.7%) than in the Obese (31.5 ± 13.9), but not different for bench press (18.0 ± 9.1% vs. 16.4 ± 6.0%, respectively).

CONCLUSION

Sustained obesity precludes insulin sensitivity improvements and attenuates strength gains in response to progressive RE. Additional strategies such as caloric restriction might be necessary for RE to improve insulin sensitivity, particularly at high levels of obesity.

The impacts of early environmental adversity on cognitive functioning, body mass, and life-history behavioral profiles

Early adverse experiences or exposures have a profound impact on neurophysiological, cognitive, and somatic development. Evidence across disciplines uncovers adversity-induced alternations in cortical structures, cognitive functions, and related behavioral manifestations, as well as an energetic trade-off between the brain and body. Based on the life history (LH) framework, the present research aims to explore the adversity-adapted cognitive-behavioral mechanism and investigate the relation between cognitive functioning and somatic energy reserve (i.e., body mass index; BMI). A structural equation modeling (SEM) analysis was performed with longitudinal self-reported, anthropometric, and task-based data drawn from a cohort of 2,607 8- to 11-year-old youths and their primary caregivers recruited by the Adolescent Brain Cognitive Development (ABCDSM) study. The results showed that early environmental adversity was positively associated with fast LH behavioral profiles and negatively with cognitive functioning. Moreover, cognitive functioning mediated the relationship between adversity and fast LH behavioral profiles. Additionally, we found that early environmental adversity positively predicted BMI, which was inversely correlated with cognitive functioning. These results revealed an adversity-adapted cognitive-behavioral mechanism and energy-allocation pathways, and add to the existing knowledge of LH trade-off and developmental plasticity.

Risk assessment of obesity-related noncommunicable diseases through body mass index trajectories in adulthood: NHANES 2007-2018

AIM

To assess the impact of adult body mass index (BMI) trajectories on the risk of obesity-related noncommunicable diseases (NCDs) in the U.S. adults after adjustment for sociodemographic and lifestyle factors.

METHODS

Data were extracted from the National Health and Nutrition Examination Survey conducted from 2007 to 2018, including male and female participants aged 29-59 years. Rao-Scott adjusted chi-square was employed to detect associations between categorical variables in descriptive analyses. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for NCDs and BMI trajectories, adjusted for sociodemographic and lifestyle factors. Kaplan-Meier curves illustrated the cumulative incidence over time.

RESULTS

Analyses were carried out on 15 721 participants and revealing significant differences among BMI trajectories in terms of demographic, lifestyle, and health characteristics. The overall prevalence of NCDs was 28.0% (95%CI:26.6-28.9). The cumulative incidence over time was higher in the high increase, moderate increase, and mixed trajectory groups, with a correspondingly higher cumulative risk (p < 0.001). Non-overweight trajectory was considered reference category in Cox models. The BMI trajectories were independently associated with an increased risk of NCDs, even after adjusting for potential confounders (HR: 1.7; 95%CI: 1.4-1.9 for moderate increase; HR: 3.6; 95%CI: 3.2-4.1 for high increase; and HR: 2.4; 95%CI: 2.1-2.7, for mixed). Furthermore, differences between males and females were also observed.

CONCLUSION

The transition to and persistence of obesity into adulthood increases the risk of NCDs. The implementation of targeted interventions with long-term monitoring of BMI may be beneficial in the prevention of future obesity-related NCDs.

A Comparative Study of Food Intake and Adipose Tissue Distribution in Saudi Women with Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) is a frequent disorder that affects reproductive-aged women and has reproductive, metabolic, and psychosocial effects. This research was intended to investigate the comparison between food intake and adipose tissue distribution in Saudi women suffering from PCOS and a control group. To determine the sociodemographic variables, a case-control study was performed with patients from King Fahad Medical City's Reproductive Endocrine and Infertility Medicine Department (REIMD). The case-control study comprised 42 PCOS patients (PCOS-Ps) and 63 as a control group, all aged 20-45 years. Three-day records were collected from participants to estimate the nutrient intake of cases and controls. A body composition analyzer was used to measure body mass index (BMI), body fat (BF), and visceral fat (VF). Biochemical measurements were taken to determine the lipid profile, total testosterone, and serum vitamin D-25-OH. The women's frequency distribution based on sociodemographic characteristics revealed significant differences within and between the groups. The variations in dietary intake between the PCOS-P and control groups were primarily in terms of total calories, carbohydrates, niacin, and folate, all of which were significantly higher in the PCOS-P group. Dietary fiber, unsaturated fat, vitamin A, vitamin B12, calcium, phosphorus, and selenium, on the other hand, were significantly higher in the control group. A majority of both groups had significantly higher BMI (overweight or obese) and higher BF, but normal VF. According to the findings, testosterone levels in PCOS-Ps were significantly higher than in the control group, but vitamin D-25-OH and high-density-lipoprotein cholesterol (HDL-C) were significantly lower. Age, monthly income, cholesterol, low-density-lipoprotein cholesterol (LDL-C), and testosterone were the fundamental causes impacting women's anthropometric indices. In conclusion, although both groups were overweight or obese, and differences in calorie and nutrient intake, HDL-C, testosterone, and vitamin D-25-OH levels were observed. The study advises such population groups to limit their consumption of foods high in calories.

Association Between Body Mass Index and Functional Outcomes in Patients With Intracerebral Hemorrhage

BACKGROUND AND OBJECTIVES

Evidence of the so-called "obesity paradox," which refers to the protective effect and survival benefit of obesity in patients with spontaneous intracerebral hemorrhage (ICH), remains controversial. This study aims to determine the association between body mass index (BMI) and functional outcomes in patients with ICH and whether it is modified by race/ethnicity.

METHODS

Included individuals were derived from the Ethnic/Racial Variations of Intracerebral Hemorrhage study, which prospectively recruited 1,000 non-Hispanic White, 1,000 non-Hispanic Black, and 1,000 Hispanic patients with spontaneous ICH. Only patients with available BMI were included. The primary outcome was 90-day mortality. Secondary outcomes were mortality at discharge, modified Rankin Scale (mRS), Barthel Index, and self-reported health status measures at 90 days. Associations between BMI and ICH outcomes were assessed using univariable and multivariable logistic, ordinal, and linear regression models, as appropriate. Sensitivity analyses after excluding frail patients and by patient race/ethnicity were performed.

RESULTS

A total of 2,841 patients with ICH were included. The median age was 60 years (interquartile range 51-73). Most patients were overweight (n = 943; 33.2%) or obese (n = 1,032; 36.3%). After adjusting for covariates, 90-day mortality was significantly lower among overweight and obese patients than their normal weight counterparts (adjusted odds ratio [aOR] = 0.71 [0.52-0.98] and aOR = 0.70 [0.50-0.97], respectively). Compared with patients with BMI <25 kg/m2, those with BMI ≥25 kg/m2 had better 90-day mRS (aOR = 0.80 [CI 0.67-0.95]), EuroQoL Group 5-Dimension (EQ-5D) (aβ = 0.05 [0.01-0.08]), and EQ-5D VAS (aβ = 3.80 [0.80-6.98]) scores. These differences persisted after excluding withdrawal of care patients. There was an inverse relationship between BMI and 90-day mortality (aOR = 0.97 [0.96-0.99]). Although non-Hispanic White patients had significantly higher 90-day mortality than non-Hispanic Black and Hispanic (26.6% vs 19.5% vs 18.0%, respectively; p < 0.001), no significant interactions were found between BMI and race/ethnicity. No significant interactions between BMI and age or sex for 90-day mortality were found, whereas for 90-day mRS, there was a significant interaction with age (pinteraction = 0.004).

CONCLUSION

We demonstrated that a higher BMI is associated with decreased mortality, improved functional outcomes, and better self-reported health status at 90 days, thus supporting the paradoxical role of obesity in patients with ICH. The beneficial effect of high BMI does not seem to be modified by race/ethnicity or sex, whereas age may play a significant role in patient functional outcomes.

Inflammatory Pathways in Overweight and Obese Persons as a Potential Mechanism for Cognitive Impairment and Earlier Onset Alzeihmer's Dementia in the General Population: A Narrative Review

The overweight status or obesity can be confirmed through classical methods such as the body mass index (BMI) and the waist-to-hip ratio (WHR). Apart from metabolic issues such as atherosclerosis, liver steatosis, or diabetes mellitus, long-term obesity or overweight status can pose a risk for cardiovascular and neurovascular complications. While some acute adverse events like coronary syndromes of strokes are well-documented to be linked to an increased body mass, there are also chronic processes that, due to their silent onset and evolution, are underdiagnosed and not as thoroughly studied. Through this review, we aimed to collect all relevant data with regard to the long-term impact of obesity on cognitive function in all ages and its correlation with an earlier onset of dementia such as Alzheimer's disease (AD). The exact mechanisms through which a decline in cognitive functions occurs in overweight or obese persons are still being discussed. A combination of factors has been acknowledged as potential triggers, such as a sedentary lifestyle and stress, as well as a genetic predisposition, for example, the apolipoprotein E (ApoE) alleles in AD. Most research highlights the impact of vascular dysfunction and systemic inflammation on the nervous system in patients with obesity and the subsequent neurological changes. Obesity during the early to mid-ages leads to an earlier onset of cognitive dysfunction in various forms. Also, lifestyle intervention can reverse cognitive dysfunction, especially dieting, to encourage weight loss.

Lifestyle and host determinants of antitumor immunity and cancer health disparities

Lifestyle factors exert profound effects on host physiology and immunology. Disparities in cancer outcomes persist as a complex and multifaceted challenge, necessitating a comprehensive understanding of the interplay between host environment and antitumor immune responses. Determinants of health - such as obesity, diet, exercise, stress, or sleep disruption - have the potential for modification, yet some exert long-lasting effects and may challenge the notion of complete reversibility. Herein we review intersectional considerations of lifestyle immunity and the impact on tumor immunology and disparities in cancer outcomes, with a focus on obesity.

Relationship between Abdominal Volume Index and Body Adiposity Index and Scales of Insulin Resistance and Metabolic Syndrome

Introduction, objectives: Obesity is a global health problem with a great negative impact on health. Among the pathologies caused by obesity are insulin resistance and metabolic syndrome, which constitute an increasingly common health problem in both developed and developing countries. The aim of this study was to examine the relationship between two scales that assess obesity-based on hip circumference-and metabolic syndrome (MetS) and insulin resistance risk scales as predictors of these alterations.

MATERIALS, METHODS

A descriptive, cross-sectional study was carried out on 193,462 workers from different Spanish regions and work groups between January 2019 and September 2021. Abdominal volume index (AVI) and body adiposity index (BAI) were evaluated to assess obesity and its association with insulin resistance using three risk scales (TyG index, Triglycerides/HDL, and METS-IR), while their association with metabolic syndrome was determined using the NCEP ATP III, IDF, and JIS models.

RESULTS

The results of the ROC curves to determine the predictive value of BAI and AVI in relation to the three criteria evaluated to calculate MetS in all instances presented a higher area under the curve (AUC) for AVI. The high values of AVI stand out for predicting MetS when applying the IDF criteria. The cut-off point in women was 13.70 with a Youden index of 0.802, whereas in men, the cut-off point was set at 17.59 with a Youden index of 0.672. Regarding the relationship of BAI and AVI with insulin resistance risk scales for both sexes, the AUC only revealed high values when using the METS-IR formula for both AVI and BAI. The AVI cut-off points to predict high values of insulin resistance risk scales in women were established at 13.12 with a Youden index of 0.722. In men, the cut-off point was 17.59, with a Youden index of 0.626. The BAI cut-off points in women were set at 33.88 with a Youden index of 0.748. In men, the cut-off point was 27.91, with a Youden index of 0.598.

CONCLUSIONS

AVI demonstrated its value as a predictor of metabolic syndrome while exclusively applying the IDF criteria. AVI and BAI demonstrated their value as predictors of high values of insulin resistance risk scales only in the case of METS-IR. This predictive value is also higher in women.

Body composition, energy expenditure and caloric intake among breast cancer patients at a teaching hospital in Nigeria-a cross sectional study

Objective

This cross-sectional study was conducted on the associations between body composition, energy expenditure and caloric intake among 45 Nigerian breast cancer patients.

Methods

Forty-five Nigerian breast cancer patients were measured and analysed for their body composition, energy expenditure and caloric intake. Statistical analyses included a chi-square test, Student's t-test, paired t-test, Spearman correlation and linear regression using Statistical Package for the Social Sciences 23.0.

Results

The body fat indices (body mass index (BMI), fat mass index (FMI), and body fats percentage) show that more than 50% of breast cancer patients were either overweight or obese. The Spearman correlation showed that fat-free mass (FFM) was the most strongly correlated with energy expenditure (r = 0.84). BMI and (FMI - fat mass in relation to height) were significantly correlated with the Harris-Benedict equation for energy expenditure (p < 0.001; p = 0.002), but they were not correlated significantly with the Karnofsky performance status. A paired t-test showed that caloric intake was significantly higher than total energy expenditure (p < 0.001). FFM was the best predictor of resting energy expenditure (REE).

Conclusion

In conclusion, FFM remains the best predictor of REE. High body mass and high caloric intake indicate the need for support from nutritional programmes.

Temporal trends in obesity defined by the relative fat mass (RFM) index among adults in the United States from 1999 to 2020: a population-based study

OBJECTIVES

The body mass index (BMI) largely underestimates excess body fat, suggesting that the prevalence of obesity could be underestimated. Biologically, women are known to have higher body fat than men. This study aimed to compare the temporal trends in general obesity by sex, ethnicity and age among adults in the USA using the relative fat mass (RFM), a validated surrogate for whole-body fat percentage and BMI.

DESIGN

Population-based study.

SETTING

US National Health and Nutrition Examination Survey, from 1999-2000 to 2017-March 2020.

PARTICIPANTS

A representative sample of adults 20-79 years in the USA.

MAIN OUTCOME MEASURES

Age-adjusted prevalence of general obesity. RFM-defined obesity was diagnosed using validated cut-offs to predict all-cause mortality: RFM≥40% for women and ≥30% for men. BMI-defined obesity was diagnosed using a cut-off of 30 kg/m2.

RESULTS

Analysis included data from 47 667 adults. Among women, RFM-defined obesity prevalence was 64.7% (95% CI 62.1% to 67.3%) in 2017-2020, a linear increase of 13.9 percentage points (95% CI 9.0% to 18.9%; p<0.001) relative to 1999-2000. In contrast, the prevalence of BMI-defined obesity was 42.2% (95% CI 39.4% to 45.0%) in 2017-2020. Among men, the corresponding RFM-defined obesity prevalence was 45.8% (95% CI 42.0% to 49.7%), a linear increase of 12.0 percentage points (95% CI 6.6% to 17.3%; p<0.001). In contrast, the prevalence of BMI-defined obesity was 42.0 (95% CI 37.8% to 46.3%). The highest prevalence of RFM-defined obesity across years was observed in older adults (60-79 years) and Mexican Americans, in women and men. Conversely, the highest prevalence of BMI-defined obesity across years was observed in middle-age (40-59 years) and older adults, and in African American women.

CONCLUSIONS

The use of a surrogate for whole-body fat percentage revealed a much higher prevalence of general obesity in the USA from 1999 to 2020, particularly among women, than that estimated using BMI, and detected a disproportionate higher prevalence of general obesity in older adults and Mexican Americans.

Obesity Impairs Functional Recovery of Older Stroke Patients with Possible Sarcopenia: A Retrospective Cohort Study

The functional prognosis of older patients with coexisting obesity and possible sarcopenia remains uncertain following acute stroke. This study aimed to determine whether coexisting obesity independently affects activities of daily living (ADL) and balance ability at discharge in older patients with possible sarcopenia admitted to a stroke rehabilitation ward. A total of 111 patients aged 65 years or older with possible sarcopenia were included, of whom 36 (32.4%) had coexisting obesity. Possible sarcopenia was diagnosed based on low handgrip strength without reduced muscle mass, while obesity was determined by body fat percentage (≥25% for men, ≥30% for women). Multivariate linear regression analysis revealed that compared to patients without obesity, patients with obesity had a higher likelihood of poorer ADL (b = -0.169; p = 0.02) and balance ability (b = -0.14; p = 0.04) performance at discharge following a 4-week period of inpatient rehabilitation. These findings suggest that obesity may be a modifiable risk factor in the rehabilitation of older patients with possible sarcopenia and should be considered in the assessment of decreased muscle strength.