Health Effects of Overweight and Obesity in 195 Countries over 25 Years

Gut microbiota-derived 4-hydroxyphenylacetic acid from resveratrol supplementation prevents obesity through SIRT1 signaling activation

Resveratrol (RSV), a natural polyphenol, has been suggested to influence glucose and lipid metabolism. However, the underlying molecular mechanism of its action remains largely unknown due to its multiple biological targets and low bioavailability. In this study, we demonstrate that RSV supplementation ameliorates high-fat-diet (HFD)-induced gut microbiota dysbiosis, enhancing the abundance of anti-obesity bacterial strains such as Akkermansia, Bacteroides and Blautia. The critical role of gut microbiota in RSV-mediated anti-obesity effects was confirmed through antibiotic-induced microbiome depletion and fecal microbiota transplantation (FMT), which showed that RSV treatment effectively mitigates body weight, histopathological damage, glucose dysregulation and systematic inflammation associated with HFD. Metabolomics analysis revealed that RSV supplementation significantly increases the levels of the gut microbial flavonoid catabolite 4-hydroxyphenylacetic acid (4-HPA). Notably, 4-HPA was sufficient to reverse obesity and glucose intolerance in HFD-fed mice. Mechanistically,4-HPA treatment markedly regulates SIRT1 signaling pathways and induces the expression of beige fat and thermogenesis-specific markers in white adipose tissue (WAT). These beneficial effects of 4-HPA are partially abolished by EX527, a known SIRT1 inhibitor. Collectively, our findings indicate that RSV improve obesity through a gut microbiota-derived 4-HPA-SIRT1 axis, highlighting gut microbiota metabolites as a promising target for obesity prevention.

miR-6402 targets Bmpr2 and negatively regulates mouse adipogenesis

Obesity is characterized by macrophage infiltration into adipose tissue. White adipose tissue remodelling under inflammatory conditions involves both hypertrophy and adipogenesis and is regulated by transcription factors, which are influenced by bone morphogenetic protein (BMP) signalling. MicroRNAs (miRNAs) regulate gene expression and are involved in obesity-related processes such as adipogenesis. Therefore, we identified differentially expressed miRNAs in the epididymal white adipose tissue (eWAT) of mice fed a normal diet (ND) and those fed a high-fat diet (HFD). The expression of miR-6402 was significantly suppressed in the inflamed eWAT of HFD-fed mice than in ND-fed mice. Furthermore, Bmpr2, the receptor for BMP4, was identified as a target gene of miR-6402. Consistently, miR-6402 was downregulated in the inflamed eWAT of HFD-fed mice and in 3T3-L1 cells (preadipocytes) and differentiated 3T3-L1 cells (mature adipocytes) , and BMPR2 expression in these cells was upregulated. Adipogenesis was induced in WAT by BMP4 injection (in vivo) and in 3T3-L1 cells by BMP4 stimulation (in vitro), both of which were inhibited by miR-6402 transfection. Inflamed eWAT showed higher expression of BMPR2 and the adipogenesis markers C/EBPβ and PPARγ, which was suppressed by miR-6402 transfection. Our findings suggest that miR-6402 is a novel anti-adipogenic miRNA that combats obesity by inhibiting the BMP4/BMPR2 signalling pathway and subsequently reducing adipose tissue expansion.

Cost-effectiveness of semaglutide in people with obesity and cardiovascular disease without diabetes

AIMS

The cardioprotective effects of semaglutide 2.4 mg reported in the SELECT cardiovascular (CV) outcomes trial (ClinicalTrials.gov NCT03574597) provide clinical benefit for subjects with overweight or obesity and established CV disease without type 2 diabetes (T2D). We assessed cost-effectiveness of semaglutide 2.4 mg in this population against the American College of Cardiology/American Heart Association value framework.

MATERIALS AND METHODS

A cohort-level Markov-state cost-effectiveness model using trial-derived data with outcomes from a healthcare sector perspective measured over a lifetime horizon was developed. Treatment costs were based on US list prices; scenario analyses used literature-reported estimated rebates. Healthcare costs and benefits were discounted at 3.0%. A simulated cohort of 100,000 subjects was aligned to the SELECT trial population baseline characteristics and time-on-treatment. Subjects received either semaglutide 2.4 mg or placebo in addition to standard of care (SoC). Modelled outcomes included clinical events (CV events, progression to T2D, chronic kidney disease [CKD]) and health economic measures, including direct costs and quality-adjusted life years (QALYs).

RESULTS

Mean semaglutide 2.4 mg treatment duration was 2.79 years. Per 100,000 subjects, treatment avoided 2,791 non-fatal myocardial infarctions, 3,000 coronary revascularizations, 487 non-fatal strokes, and 115 CV deaths over the modeled lifetime horizon. Average per-subject lifetime treatment costs were $47,353; savings arose from avoided T2D ($14,431), CKD ($2,074), and CV events ($1,512). Semaglutide 2.4 mg was associated with increased lifetime costs ($29,767), additional QALYs gained (0.218) and an incremental cost-effectiveness ratio of $136,271/QALY at list price; a scenario using an empirically estimated 48% rebate predicted $32,219/QALY.

LIMITATIONS

The generalizability of observations from SELECT to a broader US population is unknown. Our model does not capture all outcomes nor costs that may be affected by weight loss. Modeling assumptions may present limitations.

CONCLUSIONS

Semaglutide 2.4 mg use as in SELECT is cost-effective at list price, using a $150,000/QALY willingness-to-pay threshold.

Association of lipid accumulation products, or cardiometabolic index with asymptomatic intracranial arterial stenosis: A population-based study in Shandong, China

OBJECTIVES

This study aimed to investigate the association of novel obesity indicators (lipid accumulation product [LAP] and cardiometabolic index [CMI]) with asymptomatic intracranial arterial stenosis (aICAS), particularly in different obesity statuses.

MATERIALS AND METHODS

The study included 1994 participants (aged ≥ 40 years) from the Rose Asymptomatic Intracranial Artery Stenosis (RICAS) study, free of stroke or transient ischemic attack. Participants with aICAS were screened using transcranial Doppler ultrasound and diagnosed via magnetic resonance angiography. Multivariate logistic regression and receiver operating characteristic (ROC) curves were used to explore the association of LAP or CMI with aICAS.

RESULTS

A total of 146 participants were diagnosed with aICAS. Higher levels of LAP and CMI were associated with aICAS, particularly with moderate-to-severe aICAS. Notably, LAP was significantly associated with aICAS (OR 1.58; 95 % CI, 1.00-2.49; P = 0.048), and was showed the highest area under the curve (AUC, 0.654) among the three indicators (LAP, CMI, and BMI) in underweight and normal weight participants (Body mass index [BMI] ≤23.9 kg/m²). In the obesity population (BMI ≥28.0 kg/m2), CMI was significantly associated with aICAS (OR 1.40; 95 % CI, 1.11-1.77; P = 0.005), and was showed the highest AUC (0.610).

CONCLUSIONS

This study found a positive association between elevated levels of LAP or CMI and aICAS. Furthermore, LAP was significantly correlated with aICAS in underweight and normal weight individuals, while CMI was associated with aICAS in obesity individuals. Our findings may provide additional risk stratification information for aICAS.

The Composite Number Needed to Treat for Semaglutide in Populations with Overweight or Obesity and Established Cardiovascular Disease Without Diabetes

INTRODUCTION

Number needed to treat (NNT), an outcome measure derived from the estimated risk results of clinical trials, is widely used to demonstrate value to stakeholders by identifying how many patients require treatment to avoid one event of interest. However, NNTs calculated for primary trial endpoints may underestimate a treatment's value by not considering other outcomes. In this secondary analysis of data from the SELECT cardiovascular (CV) outcomes trial, we aimed to determine the NNT for semaglutide for major adverse cardiovascular events (MACE), in addition to NNTs when other clinically and payer-relevant outcomes are included.

METHODS

This study is a secondary analysis of data from the randomized, double-blind SELECT trial (ClinicalTrials.gov NCT03574597) of once-weekly subcutaneous administration of semaglutide compared with placebo in 17,604 patients with overweight or obesity and with established cardiovascular disease (CVD) (39.8 months mean follow-up). The outcomes were NNT3P-MACE (based upon the trial's composite primary endpoint of death from cardiovascular causes, non-fatal myocardial infarction, non-fatal stroke), NNTEXTENDED (inclusive of NNT3P-MACE, hospitalization for any cause, coronary revascularization, and non-CV death), and NNTCKM (inclusive of NNTEXTENDED, glycated hemoglobin level [HbA1c] ≥ 6.5%, and a 5-point nephropathy composite).

RESULTS

The relative risk reductions observed for the events comprising the NNTs were 20% (NNT3P-MACE), 20% (NNTEXTENDED), and 41% (NNTCKM). At 1 and 4 years post initiation of semaglutide, NNT3P-MACE was 125 and 58, NNTEXTENDED was 49 and 25, and NNTCKM was 20 and 11, respectively.

CONCLUSION

When clinically and payer-relevant outcomes from the SELECT trial are included in calculations of NNT, semaglutide was associated with greater risk reductions and lower estimates of NNT than for the primary endpoint alone. Our findings suggest that including the broader effects of semaglutide beyond the primary trial endpoint recognizes additional value to stakeholders.

Pollution, stress response, and obesity: A systematic review

Limited literature addresses the association between pollution, stress, and obesity, and knowledge synthesis on the associations between these three topics has yet to be made. Two reviewers independently conducted a systematic review of MEDLINE, Embase, and Web of Science Core Collection databases to identify studies dealing with the effects of semi-volatile organic compounds, pesticides, conservatives, and heavy metals on the psychosocial stress response and adiposity in humans, animals, and cells. The quality of papers and risk assessment were evaluated with ToxRTool, BEES-C instrument score, SYRCLE's risk of bias tool, and CAMARADES checklist. A protocol for the systematic review was registered on PROSPERO. Of 1869 identified references, 63 were eligible after title and abstract screening, 42 after full-text reading, and risk of bias and quality assessment. An important body of evidence shows a positive association between pollution, stress response, and obesity. Pollution stimulates the hypothalamic-pituitary-adrenal axis by activating the glucocorticoid receptor signaling and transcriptional factors responsible for adipocyte differentiation, hyperphagia, and obesity. Endocrine-disrupting chemicals also alter the Peroxisome Proliferator-activated Receptor gamma pathway to promote adipocyte hyperplasia and hypertrophy. However, these associations depend on sex, age, and pollutant type. Our findings evidence that pollution promotes stress, leading to obesity.

Association between 24-hour movement behaviors and adiposity in children and adolescents: A compositional data meta-analysis

PURPOSE

To quantitatively synthesize published evidence on the association between 24-hour movement behavior composition with adiposity in children and adolescents aged 3-18 years.

METHODS

Systematic literature searches were conducted in five electronic databases to identify papers published between January 2015 and January 2024. A machine learning-assisted systematic review was conducted to identify studies applying compositional data analysis to examine the association between 24-hour movement behaviors and adiposity in children and youth. Random effect meta-analyses were estimated to examine the relative association between each component of the 24-hour movement behavior composition and body mass index z-score (zBMI), waist circumference, fat mass percentage, and fat mass index (FMI).

RESULTS

A total of 16 studies reporting on 15,230 children and youth were included in the review. Most studies reported on zBMI (k = 14), followed by waist circumference (k = 5), body fat percentage (k = 3), and FMI (k = 2). Spending more time sleeping and engaged in moderate-to-vigorous intensity physical activity (MVPA) relative to other behaviors was associated with lower adiposity, while spending more time sedentary and engaged in light-intensity physical activity was associated with higher adiposity.

CONCLUSION

These results provide support for most recommendations of the 24-hour movement behavior guidelines, including getting an adequate amount of sleep, limiting sedentary time, and engaging in MVPA, to improve adiposity outcomes.

Burden of cancer attributable to high body mass index: A systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

High body mass index (BMI) is a well-established cancer risk factor. Reliable, updated data are essential for guiding public health policies and designing effective interventions to reduce the cancer burden associated with high BMI.

METHODS

Data from the Global Burden of Disease Study 2021 on cancer burden attributable to high BMI were analysed globally, stratified by sex, age, geographic region, cancer type, and socio-demographic index (SDI). Temporal trends in age-standardized rates from 1990 to 2021 were evaluated using estimated annual percentage changes.

RESULTS

In 2021, cancer attributable to high BMI resulted in 356.74 thousand deaths (95% uncertainty interval: 146.12-581.01) and 8.89 million (3.75-14.38) Disability-Adjusted Life Years (DALYs), with females bearing the largest burden. From 1990 to 2021, age-standardized rates of high BMI-related cancer deaths increased by 0.35% annually, while DALYs rose by 0.42% annually. In 2021, the burden of cancer deaths and DALYs attributable to high BMI varied considerably across geographical regions. Low-middle SDI regions experienced the largest increases in death and DALY rates attributable to high BMI, while these rates declined in high SDI regions. Colon and rectum cancers accounted for the greatest number of deaths and DALYs, while pancreatic cancer showed the most rapid growth in attributable burden.

CONCLUSIONS

High BMI is a major contributor to the global cancer burden, with significant variation by sex, cancer type, region, and SDI level. Targeted public health strategies are urgently needed to mitigate the growing impact of overweight and obesity on cancer.

Annual prevalence and factors associated with body mass index documentation in German general practices-A retrospective cross-sectional study

AIM

The aim of this study was to assess the prevalence of body mass index (BMI) documentation by general practitioners (GPs) in Germany and identify associated patient characteristics and determinants.

MATERIALS AND METHODS

A retrospective cross-sectional analysis was conducted using data from the IQVIA Disease Analyzer database, which provides anonymized medical data from over 3000 office-based GPs and specialists in Germany. The study included 989 955 patients aged ≥18 years who visited their GP in 2023 and were categorized based on whether they had documented BMI. The prevalence and likelihood of BMI documentation were assessed across age group, sex, health insurance and several health disorders. Associations were analysed using multivariable logistic regression.

RESULTS

BMI documentation was recorded for only 10.8% of the patients. The prevalence increased with age (7.3% for ≤40 years to 13.8% for those >70 years) and with the number of health disorders (7.3% for patients with no disorders to 23.2% for patients with more than four disorders). No notable differences were observed between sexes or insurance. Multivariable logistic regression revealed that older age groups (61-70 years: OR = 1.46, 95% CI: 1.43-1.49) and disorders such as obesity (OR = 2.15, 95% CI: 2.01-2.21) and type 2 diabetes mellitus (OR = 2.12, 95% CI: 2.08-2.17) had the strongest association with BMI documentation.

CONCLUSIONS

BMI is not documented routinely by GPs in Germany. However, older age and the presence of several disorders increase the likelihood of recording this information. These findings underscore a need to prioritize obesity assessment and management in primary care settings in Germany.

Impact of child summertime obesity interventions on body mass index and weight-related behaviors: A systematic review and meta-analysis

INTRODUCTION

Obesity during childhood is a critical public health issue. The summer break from school is a time when children are prone to accelerated weight gain. We aimed to investigate how obesity prevention or treatment programs implemented over the summer affect anthropometric measures or weight-related behaviors.

METHODS

Published studies examining the impact of obesity prevention/treatment interventions targeting the summer with anthropometric or weight-related behaviors in children (5-18 years old) were identified using systematic searches of Medline, Cochrane, Scopus, CINAHL, PsycINFO, and EMBASE until April 2024. The summarized effect estimate was computed by applying the random-effects approach. The evidence certainty was assessed using GRADE.

RESULTS

Forty-seven studies were identified for inclusion. The majority of studies identified focused on physical activity and dietary habits. Only six studies that examined the effects of prevention interventions on weight, body mass index (BMI), and waist circumference (WC) were meta-analyzed. There was no evidence that prevention interventions impacted children's weight, BMI, and WC. However, most of the studies included in the systematic review indicated beneficial effects of interventions for anthropometric measures.

CONCLUSION

There was no evidence that summertime obesity interventions targeting physical activity and dietary intake were effective in the prevention of obesity in children.

A mixed-methods approach to understanding barriers and facilitators to healthy eating and exercise from five European countries: highlighting the roles of enjoyment, emotion and social engagement

Healthy adults are consistently falling below national and international recommendations for physical activity and dietary intake across Europe. This study took a co-creative approach with adult samples from five European countries to qualitatively and quantitatively establish motivators, barriers and sustaining factors for positive health behaviour change. Stage 1 delivered a newly-designed online programme, creating a community who identified challenges, motivators and solutions to sustaining positive healthy eating and physical activity behaviours. Stage 2 administered an online survey (developed from Stage 1 findings) to a larger sample to quantify the relative importance of these motivators and barriers. Results from both stages indicated enjoyment, positive emotions, and reward as key motivators for both behaviours across all five countries. Barriers included habit-breaking difficulties, temptation and negative affective states. Those with a high BMI placed more importance on social pressure than those with healthy BMI. Participants' reports of motivators and barriers reflected relevant approaches from consumer science, behavioural economics, and psychology. Interventions supporting adults who are not chronically ill but would benefit from improved diet and/or physical activity should not focus exclusively on health as a motivating factor. Emphasis on enjoyable behaviours, social engagement and reward will likely improve engagement and sustained behaviour change.

Estimating healthcare resource utilisation and cardiovascular events in people with high body mass index and established cardiovascular disease

AIMS

Obesity and its complications contribute to the burden of cardiovascular disease (CVD). Here, we characterised individuals with high body mass index (BMI) and established CVD by assessing healthcare resource utilisation (HCRU) and costs, incidence of cardiovascular (CV) events and mortality.

MATERIALS AND METHODS

This was a retrospective open cohort study using UK Discover data (study period: January 2004 to December 2019). Included were individuals aged ≥45 years with BMI ≥ 27 kg/m2, without type 1 or type 2 diabetes, and with established CVD (previous myocardial infarction, stroke or peripheral artery disease). Serial annual cross sections were assembled to generate prevalence and incidence cohorts and for mapping of HCRU, costs and the incidence of selected events. CVD and mortality trajectories were modelled using a Markov model. HCRU and costs were layered onto this model to obtain associated trajectories.

RESULTS

In 2019, annual per-person healthcare costs for individuals with high BMI and established CVD (n = 27 313) were £3364. During 2015-2019, the incidence of major adverse CV events was 2812 per 100,000 person-years; the incidences of all-cause and CV mortality were 2896 and 774 per 100,000 person-years, respectively. Over 2022-2031, this population is projected to accrue estimated healthcare costs of £40.8 million. HCRU trajectory drivers included a history of CV events, older age, and multimorbidity.

CONCLUSIONS

Owing to a high disease and treatment burden, people with a history of CVD living with high BMI incur substantial healthcare costs and are at risk of mortality.

Incidence of new onset arterial hypertension after metabolic bariatric surgery: an 8-year prospective follow-up with matched controls

BACKGROUND

Metabolic bariatric surgery (MBS) reduces the risk of new-onset hypertension; however, it is unclear whether this effect varies according to patient sex, age, or socioeconomic background. This study aimed to assess the risk of new-onset arterial hypertension after MBS, with a special focus on these patient characteristics.

METHODS

This follow-up study with matched controls was nested in a large employee cohort, the Finnish Public Sector study, consisting of individuals with no hypertension at baseline. For each patient who underwent laparoscopic MBS between 2008 and 2016, two propensity-score matched controls were selected from individuals hospitalized with a diagnosis of obesity or individuals with self-reported severe obesity [body mass index (BMI) ≥ 35 kg/m 2 ] but no recorded history of MBS. Cases of new-onset hypertension were identified via linked electronic health records from the national health registries until December 31, 2016.

RESULTS

The study included 912 patients and 1780 matched controls. The rate of new-onset hypertension per 1000 person-years was 2.8 in the surgery group and 9.6 in the control group, with a rate ratio of 0.29 (95% confidence intervals 0.15-0.57) and a rate difference of -6.8 (95% confidence intervals -9.6 to -4.0) per 1000 person-years. No significant differences in rate reduction after MBS were observed to be associated with patient sex, age, or socioeconomic status.

CONCLUSION

Metabolic bariatric surgery reduces the risk of new-onset arterial hypertension across all age-, sex-, and socioeconomic subgroups.

TNF-α/NF-κB mediated upregulation of Dectin-1 in hyperglycemic obesity: implications for metabolic inflammation and diabetes

BACKGROUND

Dectin-1, a key innate immune receptor, plays a critical role in cellular responses and is implicated in chronic inflammation and metabolic syndromes. This study addresses a pivotal gap in elucidating the regulatory mechanism governing Dectin-1 expressionin obesity and diabetes, hypothesizing that hyperglycemia and TNF-α synergistically upregulate Dectin-1 in adipose tissue (AT), thereby exacerbating inflammatory responses and contributing to metabolic dysfunction.

METHODS

The study included 95 overweight and obese Kuwaiti individuals, categorized into prediabetic (HbA1c < 6.5%) and diabetic (HbA1c ≥ 6.5%) groups. Anthropometric and clinical measurements were recorded. AT biopsies were obtained for RNA extraction and immunohistochemistry. Pre-adipocytes from lean and obese individuals were cultured, differentiated into adipocytes, and treated with TNF-α under normal or high-glucose conditions to assess Dectin-1 expression. Chromatin immunoprecipitation (ChIP) assays analyzed NF-κB binding to the Dectin-1 promoter. Wildtype and TNF-α-/- mice were used to evaluate TNF-α's effect on Dectin-1 expression in AT.

RESULTS

Our data demonstrate that hyperglycemic obesity significantly induces Dectin-1 expression in AT through the TNF-α/NF-κB signaling pathway. In a cohort of 95 obese individuals, subdivided into prediabetics (HbA1c < 6.5%, n = 49) and diabetics (HbA1c ≥ 6.5%, n = 46), a strong positive correlation was observed between AT Dectin-1 transcripts and plasma HbA1c levels exclusively in diabetic participants, underscoring the specificity of Dectin-1 upregulation in hyperglycemic conditions. Elevated Dectin-1 expression was consistently associated to increased inflammation markers. Immunohistochemical analysis revealed co-localization and concurrent upregulation of Dectin-1 and TNF-α proteins in hyperglycemic AT. Functional assays in TNF-α deficient mice and human adipocytes further validated that TNF-α and hyperglycemia act cooperatively to regulate Dectin-1 expression. Mechanistically, we demonstrated that NF-κB directly binds to the Dectin-1 promoter, mediating its transcriptional activation in response to glucose and TNF-α.

CONCLUSION

This study significantly advances the understanding of upregulation Dectin-1 in metabolic inflammation, filling a crucial niche in diabetes research and suggesting new therapeutic targets for obesity-related metabolic disorders.

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.

Joint Associations Between Cardiorespiratory Fitness, Adiposity, and Mortality in Cardiac Outpatients Within a Secondary Prevention Program

PURPOSE

Both cardiorespiratory fitness (CRF) and obesity have been well-established as predictors of cardiometabolic risk and mortality. This study sought to investigate the joint association of CRF and adiposity measures with all-cause and cardiovascular (CVD) mortality in a cohort of patients with stable CVD.

METHODS

Data were extracted from the ITER registry. The sample was composed of 2860 cardiac patients involved in an exercise-based secondary prevention program between 1997 and 2023. Patient CRF was estimated using the 1-km treadmill walking test, and measures of body mass index (BMI) and predicted body fat percentage (pBF%) were determined. Cox proportional hazard models were used to determine associations with mortality. All results were adjusted for demographic and clinical confounders.

RESULTS

A total of 1034 deaths (463 of CVD) occurred over a median of 11 years. Each of the fitness-fatness combinations was associated with an increased risk of mortality as compared with normal weight-fit or low pBF%-fit groups. As regards BMI, compared to the reference group, higher mortality risks were observed for overweight-unfit (HR = 1.93: 95% CI, 1.55-2.41; P < .0001), and obese-unfit patients (HR = 1.63: 95% CI, 1.28-2.08; P < .0001). Similar magnitudes were detected in the moderate pBF%-unfit (HR = 2.47: 95% CI, 1.99-3.06) and high pBF%-unfit (HR = 2.07: 95% CI, 1.69-2.54; P < .0001) groups. A similar pattern was observed for CVD mortality.

CONCLUSION

While overweight and obesity have been associated with an increased risk of death, maintaining CRF can mitigate this risk. These findings support the fundamental role of CRF in exercise assessment and prescription in secondary prevention programs.

Comparison of central obesity prevalence among adults living with and without HIV in Botswana: a cross-sectional study

OBJECTIVES

The aim was to establish the community prevalence of central obesity in Botswana and assess its association with HIV status.

DESIGN

We performed a one-time central obesity assessment nested within a community-based cluster-randomised controlled HIV treatment and prevention trial (Botswana Combination Prevention Project (BCPP)) conducted in Botswana.

SETTING

The BCPP enrolled consenting adults from a random sample of 20% of households in 30 rural/peri-urban communities.

PARTICIPANTS

A subset of participants from 22 communities was selected for a nested central obesity study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Central obesity was defined as a waist-to-hip ratio (WHR)>0.90 for males and >0.85 for females or as a waist circumference (WC) ≥94 cm for males and ≥80 cm for females. A modified Poisson regression model was used to ascertain the association between central obesity and HIV status. Additionally, the same model was used to estimate the adjusted prevalence ratio (aPR) for central obesity among participants with missing waist and hip measurements by applying inverse probability weighting, and then adjusting for sex and age in the final multivariate models.

RESULTS

Of the 3981 adults, 2039 (51%) completed central obesity assessment (67% female, 29% people living with HIV and median age 35.4 years (IQR 26.4-48.3 years). Central obesity prevalence was 43.5% (95% CI 41.4% to 45.7%) and 50.8% (95% CI 48.6% to 52.9%) as defined by WHR and WC, respectively, and was higher among females than males by WHR (46.9% (95% CI 44.2% to 49.5%) vs 36.7% (95% CI 33.1% to 40.4%)) and WC 68.5% ((95% CI 65.9% to 70.9%) vs 15.1% (95% CI 12.4% to 17.8%)) and increased with age. In fully adjusted models, there was no difference in central obesity by HIV status for both WHR and WC, aPR 0.99 (95% CI 0.90 to 1.09), p value 0.88, and 0.93 (95% CI 0.85 to 1.01), p value 0.06, respectively.

CONCLUSION

Over two-thirds of adult females in Botswana had central obesity; however, living with HIV was not consistently associated with central obesity.

TRIAL REGISTERATION NUMBER

NCT01965470.

A Scoping Review of Dietary Intake among Young Adults in Low- and Middle-Income Countries

Poor dietary intake during young adulthood can increase the risk of chronic diseases, which are rising concerns in low- and middle-income countries (LMICs). This scoping review examined dietary intake among young adults in LMICs, highlighting their energy and nutrient intakes. Ovid MEDLINE, PubMed, Scopus, Web of Science, and EBSCOhost databases were searched to identify observational studies published in English from January 1, 2014 to July 31, 2024. Rayyan.ai was used to remove duplicates and facilitate the selection process, which two researchers independently carried out. Studies that reported on the energy and nutrient intake of healthy young adults aged 18 to 30 years in LMICs were included. A total of 14 studies were included (nine from upper-middle-income countries, five from lower-middle-income countries, zero from low-income countries). Most of the studies are cross-sectional studies (71.4%). The energy intake of young adults from upper-middle-income countries ranges from 1700 to 2400 kcal/day, while young adult women in lower-middle-income countries showed trends of low-energy intake and insufficient micronutrient intake. Most of the energy intake reported came from carbohydrates, followed by fat and protein. The findings highlighted a significant gap in data from low-income countries, underscoring the need for further research to inform policies and design effective interventions.

Sex differences in the impact of marital status on coronary artery disease outcomes in Korea

BACKGROUND

Coronary artery disease (CAD) outcomes are influenced by social determinants, including marital status. However, research on the sex-specific effects of marital status on CAD outcomes is limited. This study aimed to evaluate the relationship between marital status and clinical outcomes of patients with CAD stratified according to sex in Korea.

METHODS

A total of 3476 patients with CAD who underwent percutaneous coronary intervention (PCI) were enrolled in this retrospective observational study. Patients were categorized into married and nonmarried groups based on demographic data at the time of admission. The primary endpoint was all-cause mortality.

RESULTS

Among the study population, 20.7% of women and 11.5% of men who underwent PCI for CAD were nonmarried. For 87.1% of nonmarried women, the cause of being nonmarried was the death of a spouse, whereas for 48.3% of unmarried men, the most common cause was being unmarried. During a median follow-up of 53.3 months, in analysis using the Cox proportional hazard regression model, nonmarried status was associated with higher all-cause [adjusted hazard ratio (HR): 2.24, 95% confidence interval (CI): 1.22-4.09, P = 0.009] and cardiovascular (adjusted HR: 2.63, 95% CI: 19.91-5.80, P = 0.017) deaths in men but not in women.

CONCLUSION

Marital status independently predicted the adverse outcomes in men with CAD but not in women, highlighting the importance of sex-specific approaches to the assessment of social determinants in cardiovascular care. Future studies should explore broader social and economic factors to inform targeted interventions.

Interventions to prevent or treat obesity in adult Indigenous Australians: A systematic review

BACKGROUND

Aboriginal and Torres Strait Islander (Indigenous) Australians experience a disproportionately higher prevalence of obesity compared with non-Indigenous Australians. We aimed to describe existing research into lifestyle, pharmacological or surgical interventions for preventing or treating obesity in Indigenous Australians.

METHODS

A systematic review of published and grey literature was performed. Medline, Embase, Emcare (on the OVID platform), Web of Science and website searches were conducted to April 2024. Observational and randomised studies of adult Indigenous Australians were included if an intervention was implemented to prevent and/or treat obesity and post-intervention results were reported. The PRISMA systematic review reporting methods was used to collate data.

RESULTS

Of 1019 records screened, 17 were included; most described educational initiatives or lifestyle programs for improving diet and exercise. There were no reports of pharmacotherapies for weight management. The effect of lifestyle programs on weight reduction was modest (∼2-4 kg after 4-12 months). There were five reports on short-term (12 week) structured exercise programs. Two non-randomised studies of structured exercise showed reduction in weight in the highest weight groups whilst the two randomised trials showed ∼2 kg weight reduction compared with control. One observational study described mean ∼26 kg weight reduction at two years after laparoscopic adjustable gastric banding in 26 Indigenous Australians.

CONCLUSIONS

Community-based lifestyle interventions to manage excess weight can be successfully conducted in Indigenous Australians, but with generally limited efficacy. Providing background community-based lifestyle programs may facilitate the conduct of randomised trials of newer, effective anti-obesity pharmacotherapy in this high priority population.

Cth/Mpst double ablation results in early onset fatty liver disease in lean mice

Metabolic dysfunction-associated fatty liver disease (MAFLD), a condition that stems from hepatic lipid accumulation in the absence of liver damage and overt inflammation, has become the most common hepatic disorder worldwide. Hydrogen sulfide (H2S), a gasotrasmitter, endogenously generated mainly by cystathionine-γ lyase (CTH), cystathionine-β synthase (CBS) and 3-mercaptopyruvate sulfurtransferase (MPST) enzymes, exhibits protective effect in steatosis. Herein, we have demonstrated that CTH and MPST play a central role in MAFLD pathogenesis. Young Cth/Mpst knockout (Cth/Mpst-/-) mice, fed a normal diet, had increased liver mass caused by enhanced hepatic lipid accumulation. Decreased insulin and glucose sensitivity was observed in CTH/MPST-deficient mice. At the cellular level, CTH/MPST inhibition resulted in increased lipid deposition and glucose uptake in hepatocytes. Transcriptome analysis revealed significant upregulation of cholesterol biosynthesis and SREBP-related genes in the liver of Cth/Mpst-/- mice. Transcription factor enrichment analysis of differentially expressed genes between two genotypes, revealed a major impact of LXR, RXR and PPARA in the observed phenotype. Sulfide donor (SG1002) treatment attenuated the fatty liver disease of CTH/MPST-deficient mice. Our findings underline the importance of endogenously produced H2S in the pathogenesis of MAFLD and introduce the Cth/Mpst-/- mouse as a new animal model of early onset hepatic steatosis.

Effects of different training modes on hemodynamics and vascular endothelial function in young obese adults

Comparing the effects of 8 weeks of aerobic (AE) and resistance exercise (RE) on cardiovascular function in obese young adults. Exploring the mechanisms of resistance exercise on cardiovascular function. 44 subjects (22.4 ± 2.7 years, female/male: 26/18) were randomly divided into the AE and RE group. AE group performed platform running with 70-75% heart rate max. RE group performed deep squat, bench press, and hard pull training in sequence with 70-75% 1 repetition maximum. Body composition, cardio-vascular function indicators were measured before and after the interventions. After eight weeks, body fat percentage was reduced in both groups (AE: P < 0.0001, RE:P = 0.03). Hemodynamic indices (P < 0.05), endothelium-dependent diastolic function (AE:P = 0.01, RE:P = 0.024) and endothelial nitric oxide synthase (P < 0.0001) were increased. Both AE and RE exercise increased cardiac function (P < 0.05). The RE group (P = 0.002) had a significantly higher muscle mass. Brachial-ankle pulse wave conduction velocity (left: P = 0.006; right: P < 0.0001) was significantly lower in the AE group. Both AE and RE significantly reduced the body fat percentage, improved cardiac function, hemodynamic, and vascular endothelial function in obese young adults. AE has a stronger effect on reducing arterial stiffness, whereas resistance exercise has a stronger effect on building muscle, but does not change arterial stiffness.

Neighbourhoods' social, built, and natural environment characteristics and body mass index in Latin American cities

BACKGROUND

Features of neighbourhoods affect body mass index (BMI) but this has been poorly acknowledged within the highly heterogeneous and unequal contexts of Latin American cities. We evaluated associations between social, built, and natural environment characteristics of neighbourhoods with BMI, and investigated whether these associations were modified by individual socioeconomic position (SEP).

METHODS

We linked individual data (n = 43 968) from national health surveys to data on neighbourhoods (n = 3428) and cities (n = 165) in Argentina, Chile, Colombia, and Mexico. Linear mixed models were used to estimate associations between neighbourhood education, intersection density, and greenness with BMI, adjusting for individual- and city-level characteristics.

RESULTS

Associations between neighbourhood education and BMI varied by country, in both magnitude and direction. In Argentina and Chile, higher neighbourhood education was associated with lower BMI. This negative association was also observed among women in Colombia and Mexico, although it was weaker. Among men in Colombia and Mexico, however, the association was positive. Associations of neighbourhood intersection density and greenness with BMI were less robust. In general, we did not find strong evidence of effect modification by individual SEP.

CONCLUSION

Neighbourhood education is associated with BMI beyond individual and city characteristics, although the associations are heterogenous across countries and by gender. Associations with built and natural features were less clear. Our results highlight the relevance of context-specific analysis for planning interventions that are aimed to reduce BMI and its unequal distribution in Latin American cities.

Whole genome sequencing analysis of body mass index identifies novel African ancestry-specific risk allele

Obesity is a major public health crisis associated with high mortality rates. Previous genome-wide association studies (GWAS) investigating body mass index (BMI) have largely relied on imputed data from European individuals. This study leveraged whole-genome sequencing (WGS) data from 88,873 participants from the Trans-Omics for Precision Medicine (TOPMed) Program, of which 51% were of non-European population groups. We discovered 18 BMI-associated signals (P < 5 × 10-9), including two secondary signals. Notably, we identified and replicated a novel low-frequency single nucleotide polymorphism (SNP) in MTMR3 that was common in individuals of African descent. Using a diverse study population, we further identified two novel secondary signals in known BMI loci and pinpointed two likely causal variants in the POC5 and DMD loci. Our work demonstrates the benefits of combining WGS and diverse cohorts in expanding current catalog of variants and genes confer risk for obesity, bringing us one step closer to personalized medicine.

Global burden of pediatric urolithiasis: A trend and health inequalities analysis from 1990 to 2021

This research seeks to evaluate the worldwide burden, health inequities, and projected trends of pediatric urolithiasis from 1990 through 2021. We calculated age-standardized incidence rates, prevalence rates, and disability-adjusted life years rates from the 2021 Global Burden of Disease database. Joinpoint regression was applied for time-trend analysis. Health disparities were measured by using Spearman correlation analysis, Relative Concentration Index, and Slope Index of Inequality. Bayesian Age-Period-Cohort models predicted future global age-standardized incidence rates trends. Global age-standardized incidence rates declined from 79 (95% confidence interval [CI], 38-132) cases per 100,000 population in 1990 to 75 (95% CI, 37-124) cases per 100,000 in 2021, although the total number of cases rose. Age-standardized incidence rates decrease sharper in high Socio-Demographic Index regions. Geographical differences reveal significant health disparities, with age-standardized disability-adjusted life years rates higher in countries with a low Socio-Demographic Index. Bayesian Age-Period-Cohort models forecast a slight rise in global age-standardized incidence rates.

CONCLUSIONS

While global age-standardized incidence rates for pediatric urolithiasis have shown a downward trend, the increasing number of cases and persistent age-standardized disability-adjusted life years rates burden in low-SDI regions underscore pressing concerns. Efforts focused on prevention, early detection, and equitable access to healthcare are critical to bridging these gaps and improving global outcomes.

WHAT IS KNOWN

• Pediatric urolithiasis imposes a significant global burden, with higher recurrence rates and long-term impacts on kidney function. • The incidence of urolithiasis in children varies greatly in different countries or regions around the world.

WHAT IS NEW

• This study provides the comprehensive analysis of global trends and health inequalities in pediatric urolithiasis from 1990 to 2021 using GBD 2021 data. • Persistent inequalities remain, with disadvantaged regions bearing heavier burdens despite global improvements.

A multi-omics microbiome signature is associated with the benefits of gastric bypass surgery and is differentiated from diet induced weight loss through 2 years of follow-up

Roux-en-Y gastric bypass (GBP) surgery is an effective treatment for reducing body weight and correcting metabolic dysfunction in individuals with severe obesity. Herein, we characterize the differences between very low energy diet (VLED) and GBP induced weight loss by multi-omic analyses of microbiome and host features in a non-randomized, controlled, single-center study. Eighty-eight participants with severe obesity were recruited into two arms - GBP versus VLED with matching weight loss for 6 weeks and 2-years of follow-up. A dramatic shift in the distribution of gut microbial taxa and their functional capacity was seen in the GBP group at Week 2 after surgery and was sustained through 2 years. Multi-omic analyses were performed after 6 weeks of matching weight loss between the GBP and VLED groups, which pointed to microbiome derived metabolites such as indoxyl sulphate as characterizing the GBP group. We also identified an inverse association between Streptococcus parasanguinis (an oral commensal) and plasma levels of tryptophan and tyrosine. These data have important implications, as they reveal a significant robust restructuring of the microbiome away from a baseline dysbiotic state in the GBP group. Furthermore, multi-omics modelling points to potentially novel mechanistic insights at the intersection of the microbiome and host.

Myeloperoxidase impacts vascular function by altering perivascular adipocytes' secretome and phenotype in obesity

Obesity, a main driver of cardiovascular morbidity, contributes to endothelial dysfunction and inflammation in adipose tissues. Perivascular adipose tissue (PVAT) surrounds arteries and influences vascular function. In obesity, immune cells, including myeloperoxidase (MPO)-releasing myeloid cells, accumulate in PVAT. In this study, we show MPO levels to correlate with body weight and endothelial function in obese patients (n = 33) and mice. In addition, MPO deficiency reduces immune cell frequency, enhances PVAT beiging via soluble guanylyl cyclase β1 (sGC-β1), and increases oxygen consumption in vivo. Further, nitrotyrosine formation and inflammatory cytokine release are attenuated in obese Mpo-/- mice. Mechanistically, adiponectin (APN) secretion improves endothelial function and reduces arterial stiffness. In vitro, MPO-treated human white adipocytes show lower APN and brown adipocyte marker expression but increased inflammation. Thus, MPO impairs vascular function via PVAT inflammation and suppression of vasoprotective mediators, making it a potential therapeutic target in obesity-related cardiovascular disease.

A Pilot Randomized Controlled Trial of a Produce Prescription Program for Adults With Food Insecurity and Obesity

BACKGROUND

Produce prescription programs may improve dietary quality and health but have not been well tested among adults with food insecurity and obesity.

OBJECTIVE

Our aim in this pilot randomized controlled trial was to examine the feasibility and preliminary effects of ProduceRx, a produce program combined with behavioral weight loss counseling, compared with wait-list control (WLC).

METHODS

Adults with obesity and food insecurity (N = 32) were randomly assigned to ProduceRx or WLC. ProduceRx had weekly counseling sessions and received $20 of produce vouchers weekly, whereas WLC had a 12-week wait period before enrolling in the program. All participants completed assessments at baseline and 12 weeks.

RESULTS

The retention rate was 90.6%. Groups did not differ significantly in changes in dietary quality, food security, mood, and stress. ProduceRx lost 2.4% ± 0.7% of initial body weight, which was more than WLC who gained 0.4% ± 0.7% (P = .01). Compared with WLC, ProduceRx had significantly greater improvements in eating self-efficacy (P = .04).

CONCLUSIONS

Produce prescriptions combined with behavioral weight loss demonstrated preliminary feasibility and efficacy in helping adults with food insecurity and obesity.

Exploring the multifaceted factors influencing overweight and obesity: a scoping review

Introduction

Obesity and overweight problems in public health have substantial impacts which affect the health status of individuals and community well-being and healthcare service provision worldwide. This scoping review aims to identify and classify factors from social, technological, environmental, economic and political domains which influence obesity and overweight conditions. The systematic analysis of determinants in this study generates usable information to guide public health intervention design and obesity epidemic management strategies.

Methods

The study utilized the ProQuest, ISI Web of Science, PubMed, and Scopus databases, and it also included grey literature in its analysis. The research objectives focused on identifying factors that contribute to overweight or obesity issues. The researchers used framework analysis to examine the qualitative data collected from these studies.

Results

The synthesis incorporated 121 research studies which satisfied the established criteria. This comprised 98 studies from 46 different countries, 17 studies conducted at the international level, and 6 studies involving multiple countries. Eighty-two factors influencing overweight and obesity were identified as determinants and categorized into five main categories: sociocultural, economic, technological, environmental, and political. Most of the identified determinants belong to the socio-cultural category, which demonstrates their substantial impact on lifestyle and health behaviors.

Conclusion

The implementation of public health prevention and intervention programs depends on complete knowledge of all factors that affect overweight and obesity rates. This issue needs a comprehensive approach which analyzes sociocultural aspects together with economic, technological, environmental, and political factors, as well as other policy goals within defined societal challenges. Effective solutions to resolve this situation depend on multi-sectoral collaboration to tackle obesity and promote health-enhancing factors for the entire community.

Doctor-patient communication in obesity disease - the perspective of Polish primary care physicians

BACKGROUND

Obesity is a chronic disease that is affecting an increasing number of patients. The prevalence of obesity, the age of patients affected, and the range of associated comorbidities suggest that general practitioners will engage with this patient group extensively throughout their professional careers. It is regrettable that numerous obstacles impede the efficacious treatment of obesity by primary care physicians. These include inadequate training in obesity management and communication with patients, as well as a pervasive and problematic bias in the approach to the treatment of patients with obesity.

METHODS

The objective of the study was to examine the knowledge, self-assessment, experiences and perceptions of primary care doctors in Poland with regard to the communication and management of obesity. The data were collected via computer-assisted telephone interviewing (CATI). The sample was deliberately random selected from the available database of numbers. The inclusion criteria were aged 24 or over and active working as a primary care doctor in Poland. The research sample comprised 150 primary care doctors with various medical specialties, including the following: family medicine, internal medicine, pediatrics, endocrinology, diabetology, and others. An even distribution of participants was not ensured with respect to the parameters considered.

RESULTS

The findings of our study indicate that primary care physicians mostly disagreed with the view that patients living with obesity are less hardworking or more demanding but just over half disagreed that these patients are lazier than others. Doctors reported rarely using fear-based language or blaming excessive food consumption for obesity. Instead, many emphasized that obesity is a disease and considered the patient's perspective. Doctors who rated their communication skills and medical knowledge needed for conversations with patients living with obesity more highly were more likely to address this topic during a visit for an unrelated medical condition. Those who avoided the topic often felt they lacked the skills or knowledge to engage patients effectively. Almost half of the surveyed physicians had not received any training in communicating with patients living with obesity and only 11% had the issue addressed in a course for specialization.

CONCLUSIONS AND IMPLICATIONS

The study indicates a necessity for changes in the curricula of both pre- and postgraduate education, including an enhancement of the knowledge and abilities of primary care providers in the domain of communication during visits with patients with obesity, the encouragement of lifestyle modifications and the implementation of efficacious treatments for obesity, as well as activities designed to modify the negative attitudes of primary care physicians towards patients living with obesity which should not appear in healthcare at all.

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

AIMS

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Comparative diabetes mellitus burden trends across global, Chinese, US, and Indian populations using GBD 2021 database

Diabetic mellitus (DM) poses a significant challenge and stress to global health, comparing the burden of disease in the world's three most populous countries while projecting changes in trends in age-standardized rate (ASR) -deaths and disability adjusted life years (DALYs) up to 2050. Using GBD2021 data, we examined DM trends in China, US, India and globally for 1990-2021, and projected deaths and DALYs for DM (types 1 and 2) for 2022-2050 using Bayesian age-period-cohort (BAPC) model. It was found that the ASR-DALYs and deaths for T1DM are trending downward globally, while those for T2DM are trending upward. In terms of gender differences, the burden of T1DM by gender was insignificant, whereas the burden of disease was significantly higher in men with T2DM than in women. The burden of disease for T1DM peaks around the ages of 40-44 years, while the burden of disease for T2DM peaks at 65-69 years. Population growth and ageing are major factors influencing the disease burden of diabetes. The projection of ASR-deaths and DALYs globally for 2022-2050 showed a decreasing trend in T1DM and an increasing trend in T2DM (especially in China and India). The increasing burden of T2DM disease globally and in three countries by 2050 should be taken seriously.

Body mass index and post-thyroidectomy hypocalcemia: a protective effect of overweight through non-surgical mechanisms-a propensity score-matched study

BACKGROUND

Postoperative hypocalcemia is a common complication after total thyroidectomy (TT). Recent studies suggest that body mass index (BMI) may influence its occurrence. This study aimed to investigate whether overweight reduces postoperative hypocalcemia after TT and to investigate the impact of surgical and non-surgical factors on postoperative hypocalcemia in patients undergoing total thyroidectomy.

METHODS

A retrospective analysis was conducted on 228 patients who underwent TT for papillary thyroid carcinoma between January 2021 and January 2024. Patients were categorized into overweight (BMI ≥ 25 kg/m2, n = 96) and non-overweight groups (BMI < 25 kg/m2, n = 132). Propensity score matching (PSM) was performed to balance confounding factors. Postoperative hypocalcemia, hypoparathyroidism rates, and related biochemical markers were compared between matched groups.

RESULTS

After PSM (51 pairs), baseline characteristics were balanced except for Total Cholesterol (TC) (1.40 ± 0.83 vs 1.99 ± 1.80 mmol/L, P = 0.036), High-density lipoprotein cholesterol (HDL-C) (1.30 ± 0.34 vs 1.10 ± 0.23 mmol/L, P < 0.001), and fatty liver presence (35.5% vs 75.0%, P = 0.001). Postoperative hypocalcemia was significantly higher in the non-overweight group (78.4% vs 54.9%, P = 0.020), while hypoparathyroidism rates showed no significant difference (54.9% vs 62.7%, P = 0.546). Postoperative calcium levels were higher in the overweight group (2.11 ± 0.12 vs 2.05 ± 0.12 mmol/L, P = 0.014).

CONCLUSIONS

Non-overweight patients are more likely to develop hypocalcemia after TT compared to overweight patients. The protective effect of overweight appears to operate through non-surgical mechanisms, as evidenced by similar hypoparathyroidism rates between groups. Further research is needed to elucidate the specific mechanisms involved.

Population-level impact of semaglutide 2.4 mg in patients with obesity or overweight and cardiovascular disease: A modelling study based on the SELECT trial

AIM

To estimate the impact of semaglutide 2.4 mg treatment on the risk of major adverse cardiovascular events (MACE) in adults with overweight/obesity in the United States based on the SELECT trial of patients with atherosclerotic cardiovascular disease.

MATERIALS AND METHODS

Using 2023 census projections and National Health and Nutrition Examination Survey data, we developed Markov population-based predictive models for US adults meeting SELECT inclusion criteria and, separately, for adults eligible for semaglutide 2.4 mg for its MACE risk reduction indication. The 10-year rate of recurrent MACE and deaths was estimated based on the Secondary Manifestations of ARTerial disease 2 risk calculator and estimated semaglutide 2.4 mg treatment effect as per the SELECT MACE hazard ratio.

RESULTS

Of 6 164 019 US adults meeting the SELECT criteria, 2 523 218 (40.9%) are estimated to have ≥1 new MACE in the next 10 years with no additional intervention. Semaglutide 2.4 mg may prevent 496 400 events, a 16% relative reduction. An estimated 2 103 630 deaths are predicted over the next 10 years, of which 332 597 deaths (any cause, 16% relative reduction) could be avoided with semaglutide 2.4 mg. Among the estimated 22 653 158 meeting the MACE risk reduction FDA label criteria, 42.7% could experience ≥1 new MACE; treatment could prevent 1 934 493 MACE and 1 231 295 deaths (16% relative reduction for both).

CONCLUSION

Four in 10 individuals in the United States meeting the SELECT criteria are estimated to experience a recurrent CV event without additional intervention. Semaglutide 2.4 mg can potentially prevent between half a million and up to 2 million MACE over the next 10 years in the population meeting SELECT and MACE risk reduction eligibility.

PLAIN LANGUAGE SUMMARY

What is the context and purpose of this research study? More than 7 in 10 US adults have overweight or obesity, which increases the risk of heart disease. Semaglutide is a medication used to treat type 2 diabetes and obesity. A clinical study called SELECT found that semaglutide reduces the risk of heart attack, stroke, or death by 20% in adults with overweight or obesity and heart disease. What was done? Our research estimated how many people in the United States would meet the criteria for participation in SELECT, how many heart disease events they might have with regular medical care over the next 10 years, and how many could be avoided with semaglutide 2.4 mg treatment in addition to regular medical care. We also estimated how many people would still be alive if they were treated with semaglutide. We estimated the same information for all people eligible for treatment with semaglutide based on the US Food and Drug Administration (FDA) indication of semaglutide 2.4 mg in patients with heart disease. These estimations were based on a large survey of US adults. What were the main results? We found that over 6 million people would meet the SELECT study criteria. Of these, 41% are estimated to have at least 1 new heart disease event in the next 10 years. If treated with semaglutide 2.4 mg, nearly 500 000 heart disease events and more than 300 000 deaths could be avoided. More than 22 million adults would qualify for semaglutide 2.4 mg, according to the FDA indication. If all of these people were treated with semaglutide 2.4 mg, nearly 2 million heart disease events and more than 1 million deaths might be prevented. What is the originality and relevance of this study? Treatment with semaglutide 2.4 mg can reduce the risk of new heart disease events and death in patients with existing heart disease, showing a substantial impact of semaglutide treatment in a real-world setting in the United States. Our study used different analyses to add to the existing research about reducing the risk of heart disease in people with overweight or obesity.

Impact of Preoperative COVID-19 on Postoperative Outcomes in Patients Undergoing Bariatric/Metabolic Surgery: an Updated Analysis of TrinetX Databases

BACKGROUND

The impact of preoperative coronavirus disease (COVID-19) on outcomes after metabolic and bariatric surgery (MBS) remains incompletely understood, as previous studies were conducted early in the pandemic, when viral strains and management differed.

METHODS

Using the TriNetX database, we conducted a retrospective analysis of patients who underwent MBS between June 2022 and December 2024. Patients with COVID-19 within 4 weeks before surgery were propensity-score matched 1:1 with controls without prior COVID-19 based on demographics, obesity-associated medical condition, and laboratory values. The primary outcome was the incidence of postoperative pulmonary complications (i.e., pneumonia or acute respiratory failure), while the secondary outcomes included the incidence of acute kidney injury (AKI), intensive care unit (ICU) admission, other infections (i.e., surgical site infection or urinary tract infection), mortality, and emergency department (ED) visits.

RESULTS

Among 34,652 matched patients, 30-day pulmonary complications showed no significant difference between the COVID-19 and control groups (odds ratio[OR]: 0.898, 95%CI:0.674-1.197, p = 0.4646). However, the COVID-19 group experienced higher rates of AKI (OR:1.407, 95%CI:1.087-1.823, p = 0.0093) and ED visits (OR:1.169, 95%CI:1.082-1.264, p < 0.0001). Other secondary outcomes were similar between the groups. COPD, anemia, and old age were significant risk factors for pulmonary complications. Risk factors for AKI include chronic kidney disease, male sex, anemia, diabetes mellitus, and cardiovascular diseases.

CONCLUSION

Recent preoperative COVID-19 was not associated with increased risk of pulmonary complications following MBS, suggesting surgery need not be delayed for this concern. However, enhanced monitoring of renal complications and post-discharge care may be warranted in patients with identified risk factors.

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.

Serum miR-365b-5p/miR-222-5p as a potential diagnostic biomarker for long-term weight loss in patients with morbid obesity after bariatric surgery

BACKGROUND

The successful weight loss following bariatric surgery is not achieved in all patients with morbid obesity (MO). This study aims to determine whether a serum miRNA profile can predict this outcome.

DESIGN

Thirty-three patients with MO were classified in "Good Responders" (GR, percentage of excess weight loss (%EWL) ≥ 50 %) or "Non-Responders" (NR, %EWL < 50 %) according to the %EWL 5-8 year following bariatric surgery. Baseline serum miRNA sequencing was performed to find predictor biomarkers and human adipocyte culture were performed to determine their effect.

RESULTS

Fifty-six differentially expressed miRNAs were found between GR and NR. Logistic regression models showed two miRNAs, hsa-miR-365b-5p (upregulated in GR) and hsa-miR-222-5p (upregulated in NR) associated to %EWL. Receiver operating characteristic curves showed that the combination of these miRNAs was the best serum miRNAs profile that distinguished between GR and NR. The experimentally validated target genes of these miRNAs were involved in processes related to the response to stress, cell cycle, transduction, and development and proliferation processes. The in vitro expression of six genes involved in adipogenesis and adipocyte differentiation (STAT3, ILR7, PARP1, SOD2, FGF2 and TMEM18) was downregulated in lipogenic and upregulated in lipolitic conditions in human adipocytes incubated with the combination of a hsa-miR-365b-5p mimic and a hsa-miR-222-5p inhibitor.

CONCLUSIONS

Baseline serum hsa-miR-365b-5p and hsa-miR-222-5p were able to predict %EWL 5-8 years following bariatric surgery. The combination of these potential predictive biomarkers was involved in regulating the expression levels of genes associated with obesity. However, these effects could be modified depending of other stimuli.

Global burden, trends and inequalities for ischaemic heart disease attributable to high fasting plasma glucose, high low-density lipoprotein cholesterol and high systolic blood pressure, 1990-2021: An analysis of the Global Burden of Disease Study 2021

AIMS

The three key and direct risk factors for the significant health issue prevalent worldwide, ischaemic heart disease(IHD), are high fasting plasma glucose (HFPG), high low-density lipoprotein (HLDL) and high systolic blood pressure (HSBP) in metabolic syndrome (MetS). A comprehensive study is essential to present the most recent global epidemiological trends.

METHODS

IHD data attributable to HFPG, HLDL and HSBP (3H) were obtained from the Global Burden of Disease Study (GBD) 2021. The absolute burden was manifested in the number of death cases and disability-adjusted life years (DALY). The relative burden was quantified through the age-standardized mortality rate (ASMR) and the age-standardized DALY rate (ASDR). Estimated annual percentage change (EAPC) was used to measure trends.

RESULTS

HSBP caused the greatest IHD burden, followed by HLDL, which was much higher than HFPG. The IHD burden associated with HLDL and HSBP were more alike and notably different from HFPG. From 1990 to 2021, ASDR for HSBP and HLDL-related IHD generally declined, with the EAPC of -1.28 (95% CI: -1.34, -1.23) and -1.38 (95% CI: -1.44, -1.33). But the trend was less pronounced for HFPG-related IHD, with the EAPC of -0.90 (95% CI: -2.25, 0.46). The absolute burden was higher in men under 80 and peaked 5-10 years earlier than women. Compared to HSBP and HLDL, HFPG caused a significant increase in burden in low-middle and low socio-demographic index (SDI) regions. The high-middle SDI region, which originally had the highest burden, showed a clear downward trend after 2005 and was gradually overtaken by the low-middle region. Eastern Europe, Central Asia, North Africa and the Middle East had the highest burden among the regions with the same SDI level in Europe, Asia and Africa.

CONCLUSION

The HFPG-related IHD burden should be managed differently from HSBP and HLDL. Particular attention should be paid to men, older age groups and regions with low-middle SDI.

Obesity classified by anthropometric parameters was associated with mitochondrial bioenergetics impairment of peripheral blood mononuclear cells in the elderly population

Waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR), even in individuals who have a normal body mass index (BMI), are correlated with cardiovascular events. The aim of this study is to establish the association between obesity and mitochondrial bioenergetics in peripheral blood mononuclear cells (PBMCs). The study included 1584 subjects from the Electricity Generating Authority of Thailand (EGAT) cohort. The mean age of participants in this study was 68.4 years. There was 24.2 % diabetes mellitus (DM) with a mean HbA1c level of 6.8. WC, WHR, and WHtR were associated with decreased basal, maximal respiration, spare respiratory capacity (SRC), and ATP production, whereas BMI was only associated with reduced maximal respiration and SRC. We further stratified the participants into four groups based on obesity classified by WHR and DM status: Non-DM/Non-obese (n = 468), Non-DM/Obese (n = 733), DM/Non-obese (n = 84), and DM/Obese (n = 299). Both obesity and DM were associated with mitochondrial bioenergetic impairment and increased mitochondrial oxidative stress. Interestingly, there was no difference in mitochondrial bioenergetics impairment between non-DM/Obese and DM participants. Our study demonstrated that WC, WHR, and WHtR better reflected underlying mitochondrial dysfunction in PBMCs compared to BMI. Furthermore, obesity was associated with mitochondrial dysfunction to the same degree as DM.

Needs and challenges of the payor and regulatory community towards integrating obesity into a chronic care framework

OBJECTIVES

Obesity acts as the gateway disease to all Non-Communicable Diseases (NCDs). As the impact of NCDs continues to increase, projected to exceed 70 % of global mortality, there is an urgent need to improve the management of people living with obesity. People involved with health care policy must address the social and economic challenges that will likely develop as a result of the rise and severity in obesity. Therefore, we aimed to explore in the payors and regulatory community across Europe their needs and challenges to implement obesity in a chronic care framework.

STUDY DESIGN

Cross-sectional qualitative study.

METHODS

In this cross-sectional qualitative study, payors and regulators from various European countries were invited by purposive sampling between 14th of October 2023, and 15th of March 2024, to participate. Payors and regulators were interviewed, and data were transcribed and analysed using thematic analysis according to Qualitative Analysis Guide of Leuven (QUAGOL).

RESULTS

A total of 9 payors and 6 regulators were interviewed coming from 11 different European countries. Four themes (Structure of the healthcare system, political challenges, obesity perceptions, obesity treatment and management) were identified wherein challenges were mentioned for obesity. Payors and regulators emphasized the need for a proactive healthcare model, recognition of obesity as a policy-prioritised NCD, the integration of obesity care pathways and health promotion centres, and the registration of obesity in all care settings.

CONCLUSIONS

The payor and regulatory community advocated for a proactive approach to obesity, focusing on preventive interventions to mitigate the costs and health complications associated with NCDs.

Cardiovascular Hospitalizations Among Older Adults in the US and Denmark

Importance

Cardiovascular disease is the leading cause of death in the US. However, it remains unclear how the burden of cardiovascular events in the US compares with that of other high-income countries with distinct health care systems like Denmark, both overall and by income.

Objective

To compare cardiovascular hospitalization rates (acute myocardial infarction [MI], heart failure [HF], ischemic stroke) and associated outcomes among adults 65 years or older, overall and by income, between the US and Denmark.

Design, Setting, and Participants

This population-based cross-sectional study used national data from the US and Denmark from January 1, 2021, to January 1, 2022. The study population included all Medicare beneficiaries 65 years or older in the US and all adults 65 years or older in Denmark.

Main Outcomes and Measures

The primary outcome was age- and sex-standardized hospitalization rates for MI, HF, and ischemic stroke, as well as 30-day all-cause mortality rates.

Results

The US study population included 58 614 110 adults 65 years or older (mean [SE] age, 74.6 [7.7] years; 32 179 146 female [54.9%]) of whom 1 171 058 (2.0%) were hospitalized for a cardiovascular event. The Danish study population included 1 176 542 adults 65 years or older (mean [SE] age, 75.3 [7.1] years; 634 217 female [53.9%]) of whom 16 305 (1.4%) were hospitalized with a cardiovascular event. The overall age- and sex-standardized cardiovascular hospitalization rate was significantly higher in the US compared with Denmark (risk ratio [RR], 1.50; 95% CI, 1.47-1.52), as were associated 30-day all-cause mortality rates (RR, 1.12; 95% CI, 1.06-1.17). Across conditions, the risk of hospitalization for MI (RR, 1.56; 95% CI, 1.51-1.61) and HF (RR, 2.37; 95% CI, 2.31-2.43) was significantly higher in the US compared with Denmark, whereas hospitalizations for ischemic stroke were lower (RR, 0.90; 95% CI, 0.88-0.93). Overall cardiovascular hospitalization rates in the US were more than 2-fold higher among low-income adults compared with higher-income adults (RR, 2.38; 95% CI, 2.25-2.47), whereas the magnitude of income-based disparities was smaller in Denmark (RR, 1.45; 95% CI, 1.39-1.50).

Conclusions and Relevance

In this international cross-sectional study, cardiovascular hospitalization rates were significantly higher in the US compared with Denmark. There were income-based differences in the burden of cardiovascular hospitalizations in both countries, although the magnitude of these disparities was much greater in the US.

Identifying effective obesity prevention intervention components: An umbrella review mapping systematic review evidence

This overview of reviews synthesizes the effectiveness of obesity prevention interventions in children and adults on BMI/zBMI, following JBI and Cochrane Handbook guidelines. The protocol was prospectively registered in OSF in September 2020. Searches for eligible reviews were run in five databases and gray literature in May 2022. Systematic reviews published in 2010 and assessed BMI/zBMI outcomes of obesity prevention interventions were eligible. Screening, data extraction, and quality assessment were performed independently and in duplicate using standardized tools. For similar interventions, the more recent, higher-quality review was included. Thirty reviews reporting on 60 discrete interventions (i.e., a specific intervention component), mapped to 14 of 21 IOM sub-domains, were included. Nine interventions were classified as effective in improving BMI outcomes, including digital health or counseling interventions for adults in 'healthcare environments', behavioral interventions for children (broadly nutrition education), physical education curriculum modifications, and policies targeting food and beverages in 'School environments'. This review extends on previous reviews by consolidating evidence from high-quality, recent reviews to identify effective intervention components. Thus, this review provides direction for implementation efforts and highlights research gaps, where future research is warranted. However, as primary studies were not directly analyzed, gaps may reflect a lack of systematic reviews rather than primary research.

Semaglutide normalizes increased cardiomyocyte calcium transients in a rat model of high fat diet-induced obesity

AIMS

Obesity increases the risk of heart failure with preserved (HFpEF), but not reduced ejection fraction (HFrEF). The glucagon-like peptide-1 receptor agonist (GLP-1-RA) semaglutide improves outcome of patients with obesity with or without HFpEF, while GLP-1-RAs were associated with adverse outcome in patients with HFrEF. Here, we investigate the effect of in vivo treatment with semaglutide on excitation-contraction coupling in a rat model of obesity.

METHODS AND RESULTS

Rats received high-fat/high-fructose diet for 8 weeks and were then randomized to semaglutide (HFD/Sema) or vehicle (HFD/Veh) for another 8 weeks, during which they could choose between HFD and a low-fat/high-fructose diet (LFD). Control rats received either standard chow (CON), HFD or LFD only, without treatment. After 16 weeks, sarcomere shortening and cytosolic Ca2+ concentrations ([Ca2+]c) were determined in isolated cardiomyocytes. Compared with CON, HFD/Veh increased the amplitude of [Ca2+]c transients and systolic sarcomere shortening in absence or presence of β-adrenergic stimulation, which was reversed by HFD/Sema. Caffeine-induced sarcoplasmic reticulum (SR) Ca2+ release and L-type Ca2+ channel (LTCC) currents were reduced by HFD/Sema versus HFD/Veh, while SR Ca2+ ATPase activity remained unaffected. Compared with HFD, LFD increased [Ca2+]c transients and sarcomere shortening further despite similar effects on body weight.

CONCLUSIONS

While HFD increased cardiomyocyte [Ca2+]c transients and systolic sarcomere shortening, semaglutide normalized these alterations, mediated by reduced SR Ca2+ load and LTCC currents. Because increased LTCC currents were previously traced to cardiac hypertrophy, these effects may explain why GLP-1-RAs provide benefits for patients with obesity with or without HFpEF, but rather adverse outcome in HFrEF.

The relationships between sleep and adiposity amongst multi-ethnic Asian populations: a cross-sectional analysis of the Health for Life in Singapore (HELIOS) study

BACKGROUND

Short sleep duration and poor sleep quality have been associated with obesity. Asian populations report shorter sleep duration compared to other groups. We therefore aimed to explore the relationships between sleep duration, sleep quality, dozing, daytime napping, snoring, insomnia and adiposity in a multi-ethnic Asian population, and investigate the potential contribution of disturbed sleep to the risk of obesity amongst Asian populations.

METHODS

We studied 8876 participants of the HELIOS study, a multi-ethnic population-based cohort comprising Chinese, Malay, and Indian Asian men and women living in Singapore. Sleep traits and psychological symptoms were assessed using validated tools which included the Pittsburg Sleep Quality Index, Generalised Anxiety Disorder-7, and Patient Health Questionnaire-9. We employed multivariable regression models to examine the associations between sleep and adiposity, while also conducting sub-group and sensitivity analyses to strengthen the reliability of our results.

RESULTS

The 8876 participants were 69.3% Chinese, 12.5% Malays, and 18.2% Indians, with mean age: 51.7 ± 11.8 years (standard deviation). Malays had the shortest sleep duration, while Chinese had the best sleep quality. Short sleep duration, poor sleep quality, and snoring were associated with higher BMI and waist circumference, independent of age, sex, ethnicity, and various confounding factors (education, household income, current smoking, regular alcohol drinking status, presence of diabetes and hypertension, and markers for anxiety and depression; P < 0.005). The estimated population attributable fraction for short sleep and snoring as contributors to obesity were 6.6% (95% CI: 2.5-10.6%) and 18.6% (95% CI: 17.0-20.2%), respectively.

CONCLUSION

Sleep duration, sleep quality, and snoring are associated with adiposity in a multi-ethnic Asian population of Chinese, Malays, and Indians. Our findings suggest that a substantial portion of obesity in Asian populations could be averted through public health interventions aimed at improving sleep duration and quality.

An overview of obesity-related complications: The epidemiological evidence linking body weight and other markers of obesity to adverse health outcomes

Obesity is a highly prevalent chronic multisystem disease associated with shortened life expectancy due to a number of adverse health outcomes. Epidemiological data link body weight and parameters of central fat distribution to an increasing risk for type 2 diabetes, hypertension, fatty liver diseases, cardiovascular diseases including myocardial infarction, heart failure, atrial fibrillation, stroke, obstructive sleep apnoea, osteoarthritis, mental disorders and some types of cancer. However, the individual risk to develop cardiometabolic and other obesity-related diseases cannot entirely be explained by increased fat mass. Rather than excess fat accumulation, dysfunction of adipose tissue may represent the mechanistic link between obesity and adverse health outcomes. There are people living with obesity who seem to be protected against the premature development of cardiometabolic diseases. On the other hand, people with normal weight may develop typical obesity diseases upon dysfunction of adipose tissue and predominantly visceral fat distribution. The mechanisms linking impaired function of adipose tissue in people with obesity include adipocyte hypertrophy, altered cellular composition, limited expandability of safe subcutaneous fat stores, ectopic fat deposition in visceral depots, the liver and other organs, hypoxia, a variety of stresses, inflammatory processes, and the release of pro-inflammatory, diabetogenic and atherogenic signals. Genetic and environmental factors might contribute either alone or via interaction with intrinsic biological factors to variation in adipose tissue function. There are still many open questions regarding the mechanisms of how increased body weight causes obesity-related disorders and whether these pathologies could be reversed. Evidence-based weight loss interventions using behaviour change, pharmacological or surgical approaches have clarified the beneficial effects of realistic and sustained weight loss on obesity-related complications as hard outcomes. This review focusses on recent advances in understanding epidemiological trends and mechanisms of obesity-related diseases. PLAIN LANGUAGE SUMMARY: Obesity is a chronic complex and progressive disease characterized by excessive fat deposition that may impair health and quality of life. Worldwide, the number of adults living with obesity has more than doubled since 1990. Obesity may lead to reduced life expectancy, because it increases the risk for type 2 diabetes, cardiovascular diseases (e.g., myocardial infarction, high blood pressure, stroke), fatty liver diseases, musculoskeletal diseases, chronic respiratory diseases, depression and certain types of cancer. However, not every person with obesity develops these diseases. For better prevention and treatment, it is important to understand the mechanisms linking high fat mass to obesity related diseases. It has become clear that fat mass alone cannot explain the higher risk of obesity complications. People with obesity can have either high or low risk of developing complications. Compared to people with a low risk for obesity complications those with a high risk to develop obesity related diseases are characterized by higher central fat deposition in the abdominal region, on average bigger fat cells, higher number of immune cells in adipose tissue and altered signals released from adipose tissue that may directly affect the brain, liver, vasculature and other organs. Both inherited and environment factors may cause these abnormalities of adipose tissue function. However, weight loss through behaviour changes (e.g., lower calorie intake, higher physical activity), medications or obesity surgery can improve health, quality of life and reduce the risk for obesity related diseases.

Evaluation of clinical benefits and economic value of weight loss in a Swedish population using a simulation model

OBJECTIVE

The objective of this study was to estimate the 10-year clinical benefits and economic value of weight loss in a Swedish population with obesity using a value of weight-loss simulation model.

METHODS

Data on the prevalence of and costs associated with obesity and obesity-related complications (ORCs) were applied within an adapted simulation model to evaluate weight-loss benefits for a 2023 Swedish population over 10 years. The 10-year incidence of 10 ORCs and treatment costs in a random cohort of 10,000 individuals were estimated for a stable weight scenario and four weight-loss (5%-20%) scenarios.

RESULTS

The model included 887,272 individuals with obesity aged 20 to 60 years. Hypertension (24.1%), asthma (20.9%), dyslipidemia (18.3%), and type 2 diabetes (10.6%) were highly prevalent. For 10,000 individuals, a 5% to 20% weight loss was estimated to prevent ORCs over 10 years, leading to annual savings between 9.0 million Swedish krona (SEK)/€0.8 million (5% weight loss) and 30.0 million SEK/€2.6 million (20%) by 2033.

CONCLUSIONS

Annual treatment costs of ORCs in Sweden will double over 10 years, and weight loss would be associated with significant savings because of the reductions in the incidence of ORCs. Therefore, there is an urgent need to effectively treat obesity to prevent morbidity.

Interaction between genetic risk score and dietary carbohydrate intake on high-density lipoprotein cholesterol levels: Findings from the study of obesity, nutrition, genes and social factors (SONGS)

BACKGROUND & AIMS

Cardiometabolic traits are complex interrelated traits that result from a combination of genetic and lifestyle factors. This study aimed to assess the interaction between genetic variants and dietary macronutrient intake on cardiometabolic traits [body mass index, waist circumference, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, triacylglycerol, systolic blood pressure, diastolic blood pressure, fasting serum glucose, fasting serum insulin, and glycated haemoglobin].

METHODS

This cross-sectional study consisted of 468 urban young adults aged 20 ± 1 years, and it was conducted as part of the Study of Obesity, Nutrition, Genes and Social factors (SONGS) project, a sub-study of the Young Lives study. Thirty-nine single nucleotide polymorphisms (SNPs) known to be associated with cardiometabolic traits at a genome-wide significance level (P < 5 × 10-8) were used to construct a genetic risk score (GRS).

RESULTS

There were no significant associations between the GRS and any of the cardiometabolic traits. However, a significant interaction was observed between the GRS and carbohydrate intake on HDL-C concentration (Pinteraction = 0.0007). In the first tertile of carbohydrate intake (≤327 g/day), participants with a high GRS (>37 risk alleles) had a higher concentration of HDL-C than those with a low GRS (≤37 risk alleles) [Beta = 0.06 mmol/L, 95 % confidence interval (CI), 0.01-0.10; P = 0.018]. In the third tertile of carbohydrate intake (>452 g/day), participants with a high GRS had a lower concentration of HDL-C than those with a low GRS (Beta = -0.04 mmol/L, 95 % CI -0.01 to -0.09; P = 0.027). A significant interaction was also observed between the GRS and glycaemic load (GL) on the concentration of HDL-C (Pinteraction = 0.002). For participants with a high GRS, there were lower concentrations of HDL-C across tertiles of GL (Ptrend = 0.017). There was no significant interaction between the GRS and glycaemic index on the concentration of HDL-C, and none of the other GRS∗macronutrient interactions were significant.

CONCLUSIONS

Our results suggest that young adults who consume a higher carbohydrate diet and have a higher GRS have a lower HDL-C concentration, which in turn is linked to cardiovascular diseases, and indicate that personalised nutrition strategies targeting a reduction in carbohydrate intake might be beneficial for these individuals.

Rising Obesity-Associated Mortality in Men: Exploration of Gender Disparity from the Global Burden of Disease Study, 1990-2019

OBJECTIVES

The global rise in overweight, obesity, and related diseases is undeniable; however, the pathogenesis of obesity and obesity-associated diseases is heterogeneous, with varied complications and a discordant response to treatment. Intriguingly, men have a shorter lifespan than women, despite being half as likely to be obese. This paradox suggests a potential gender disparity in the impact of obesity on mortality, with men potentially being more vulnerable to obesity-associated health risks.

METHODS

This retrospective study utilized Global Burden of Diseases data from 204 countries/territories to bridge the knowledge gap in understanding gender disparities in obesity-related mortality. Outcomes were obesity-associated mortality, years of life lost, years lived with disability, and disability-adjusted life years (DALYs).

RESULTS

In 2019, the global overweight/obesity-related disease burden reached 160.2 million DALYs, with 5.02 million associated deaths. From 1990 to 2019, the age-standardized death rates increased in males (from 58.19 to 66.55 per 100,000 person-years, APC = 0.36%, 95% CI: 0.30 to 0.42%, P < 0.001), while females experienced a decrease in age-standardized death rates (from 59.31 to 58.14 per 100,000 person-years, APC = -0.22%, 95% CI: -0.29% to -0.14%, P < 0.001). Age-standardized DALYs increased more in males (1632.5 to 2070.34 per 100,000 years, APC = 0.74%, 95% CI: 0.70% to 0.78%, P < .001) compared to females (1618.26 to 1789.67 per 100,000 years, APC = 0.24%, 95% CI: 0.19% to 0.29%, P < 0.001). Disparities were more pronounced in countries with a higher socioeconomic status and predominantly affected younger populations.

CONCLUSIONS

Overweight/obesity-related morbidity and mortality are higher among male sex. Identifying differences in pathogenesis, complications and treatment response is crucial to develop targeted interventions and equitable public health policies to combat this global burden.

Next Steps in Efforts to Address the Obesity Epidemic

Obesity prevalence continues to rise globally at alarming rates, with adverse health and economic implications. In this state-of-the-art review, we provide an analysis of selected evidence about the current knowledge in the obesity literature, including a synthesis of current challenges in obesity and its determinants. In addition, we review past and current efforts to combat the obesity epidemic, highlighting both successful efforts and areas for further development. Last, we offer insights into the next steps to address the obesity epidemic and advance the field of obesity through both research and practice by (a) adopting a systems perspective, (b) fostering cross-sector and community collaborations, (c) advancing health equity, (d) narrowing the research-to-practice and research-to-policy gaps with multidisciplinary approaches, and (e) embracing complementary approaches for concurrent obesity prevention and treatment.