Obesity as a risk factor for COVID-19: an overview

Study protocol for a randomised controlled trial evaluating the efficacy of dietary modulation of probiotics on nutritional status and antibody response to SARS-CoV-2 in Indonesian adolescents: gut-lung axis (DIVINE)

INTRODUCTION

During the pandemic, overweight and obese adolescents were at a higher risk of COVID-19 infection. Indonesia's government has implemented prevention programmes and immunisation; however, the rise in SARS-CoV-2 infections among adolescents is exacerbated by low-quality diet and lifestyle habits. Also, the vaccine programme is not prioritised in this population. To address this, a solution involves providing probiotics and counselling on healthy lifestyle habits to improve diet and immunity. Therefore, we designed a protocol for a randomised controlled trial with a 20-week intervention to investigate the effect of probiotics supplementation and counselling on healthy lifestyle habits, including healthy eating and physical activity, and psychosocial stimulation, on nutritional status and antibody response against SARS-CoV-2 in this group.

METHODS AND ANALYSIS

This clinical trial aims to investigate the effects of probiotic supplementation on healthy overweight and obese adolescents. The study will involve 440 adolescents aged 12-17 living in Jakarta, Surabaya or Yogyakarta for at least 6 months and have completed at least two doses of the COVID-19 vaccine. The intervention group will receive daily probiotic supplementation of three strains, including Bifidobacterium animalis subsp. Lactis (BB-12), Lactobacillus acidophilus (LA-5) and Lactobacillus rhamnosus (LGG), at the level of 109-1010 colony-forming units for 20 weeks, while the control group will receive a placebo. Both groups will receive weekly counselling on healthy eating habits, physical activity and psychosocial stimulation. The primary outcomes will be changes in the body mass index for age z-score and IgG specific to SARS-CoV-2 titre concentrations between groups. The secondary outcomes will include changes in secretory IgA specific to SARS-CoV-2 titre concentrations, monoclonal antibodies against SARS-CoV-2 spike protein, gut microbiota diversity and the score of Healthy Eating Index 2015.

ETHICS AND DISSEMINATION

The study protocol was approved by the Ethics Committee of the Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital (KET 763/UN2.F1/ETIK/PPM.00.02/2022: 1 August 2022). The study results will be disseminated in open-access international journals, scientific meetings and conferences with stakeholders.

TRIAL REGISTRATION NUMBER

The study has been registered at https://clinicaltrials.gov with identifier number NCT05623007.

The territorialization of Severe Acute Respiratory Syndrome and its socioeconomic, demographic and public health policy risk factors in Belém, state of Pará, Eastern Amazon, Brazil: a cross-sectional and ecological study

Severe Acute Respiratory Syndrome is an important public health problem in Brazil due to the large number of cases. It has a high mortality rate related to risk factors that include systemic arterial hypertension, type 2 diabetes mellitus, male gender and advanced age. This cross-sectional and ecological study analyzed the spatial distribution of this disease related to the evolution of COVID-19 cases and their epidemiological, demographic, socioeconomic and public health policy conditions in the administrative districts of Belém, state of Pará, in the eastern Brazilian Amazon, from 2021 to 2023. Data from the Ministry of Health, the National Institute for Space Research and the Brazilian Institute of Geography and Statistics were used. The statistical and spatial analysis of the data used the chi-square test of equal expected proportions with a significance level of 0.05% and the techniques of ordinary multivariate linear regression and percentiles, with the results expressed by means of choropleth maps, using the Bioestat 5.4 and Arcgis 10.5.1 software. The epidemiological profile analyzed 3,511 cases, following the national pattern with statistical significance. The pathology was not distributed homogeneously in spatial terms and was associated with a territorial and socioeconomic segregation of the population in the neighborhoods and their administrative districts, with great differences in their demographic characteristics, living conditions and public services for treating the disease, especially when we consider the relationship between the outskirts and the center of the municipality. This has revealed unequal development, which has produced health inequalities in the study area. With that in mind, we emphasize the urgency of expanding these services in the places identified as most vulnerable, with a view to equal care access for the disease.

Safety profile of semaglutide versus placebo in the SELECT study: a randomized controlled trial

OBJECTIVE

The objective of this study was to assess safety of once-weekly subcutaneous semaglutide 2.4 mg versus placebo, beyond reduction in major adverse cardiovascular events, in patients with established cardiovascular disease and overweight or obesity.

METHODS

Safety data focused on serious adverse events (SAEs), all adverse events (AEs) leading to permanent treatment discontinuation irrespective of seriousness, and prespecified AEs of special interest irrespective of seriousness. Tests of treatment differences were determined by two-sided p values.

RESULTS

The proportion of patients with SAEs was lower with semaglutide versus placebo (33.4% vs. 36.4%; p < 0.001), primarily driven by cardiac disorders (11.5% vs. 13.5%; p < 0.001). The proportion of patients with AEs leading to discontinuation was higher with semaglutide versus placebo (16.6% vs. 8.2%; p < 0.001), a difference driven by gastrointestinal disorders (10.0% vs. 2.0%); however, proportions due to SAEs leading to discontinuation were similar (3.6% vs. 4.1%). Suicide/self-injury SAEs were low and balanced between groups (0.11% in both groups). Gallbladder-related disorders were more frequent with semaglutide versus placebo (2.8% vs. 2.3%; p = 0.04), mainly driven by cholelithiasis (1.4% vs. 1.1%), whereas proportions of cholecystitis were similar between groups (0.6% vs. 0.6%).

CONCLUSIONS

The long-term safety profile observed in the Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity (SELECT) study is consistent with previously reported semaglutide studies. No new safety concerns were identified for once-weekly semaglutide 2.4 mg.

Gestational weight gain during pregnancy is the risk factor for Omicron infection: a retrospective case-control study

BACKGROUND

It remains unclear whether gestational weight gain (GWG) during pregnancy is associated with Omicron infection in pregnant women.

OBJECTIVE

To investigate whether gestational weight gain during pregnancy is associated with an increased risk of Omicron infection.

METHODS

This is a retrospective case-control study of pregnant women from The Third Affiliated Hospital of Sun Yat-sen University from December 1 to 31, 2022. Pregnant women infected with Omicron were compared to those uninfected using chi-square statistics for categorical variables and t-tests or ANOVA for continuous variables. Multivariable logistic regression, along with subgroup analyses, was used to investigate the association between gestational weight gain during pregnancy and Omicron infection.

RESULTS

Our study included 369 pregnant women who met the eligibility criteria. The proportion of pregnant women in the term, infected and uninfected with Omicron was 113(30.6%) and 256(69.4%). Classified pregnant women according to GWG during pregnancy, GWG during pregnancy above IOM was significantly associated with an increased risk of Omicron infection (P = 0.006). After adjusting for demographic factors and pregnancy complications, this association was particularly notable (OR = 2.55, 95%CI = 1.35-4.85, P = 0.004). Classified pregnant women according to pregestational BMI, in normal-weight pregnant women, GWG during pregnancy above IOM was significantly associated with an increased risk of Omicron infection (P = 0.01). After adjusting for demographic factors and pregnancy complications, this association was particularly notable (OR = 2.56, 95%CI = 1.24-5.31, P = 0.01).

CONCLUSION

Among women with normal weight, gestational weight gain during pregnancy above IOM was an independent risk factor for Omicron infection.

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

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

Causal relationship between air pollution and infections: a two-sample Mendelian randomization study

Background

Traditional observational studies exploring the association between air pollution and infections have been limited by small sample sizes and potential confounding factors. To address these limitations, we applied Mendelian randomization (MR) to investigate the potential causal relationships between particulate matter (PM2.5, PM2.5-10, and PM10), nitrogen dioxide, and nitrogen oxide and the risks of infections.

Methods

Single nucleotide polymorphisms (SNPs) related to air pollution were selected from the genome-wide association study (GWAS) of the UK Biobank. Publicly available summary data for infections were obtained from the FinnGen Biobank and the COVID-19 Host Genetics Initiative. The inverse variance weighted (IVW) meta-analysis was used as the primary method for obtaining the Mendelian randomization (MR) estimates. Complementary analyses were performed using the weighted median method, MR-Egger method, and MR Pleiotropy Residual Sum and Outlier (MR-PRESSO) test.

Results

The fixed-effect IVW estimate showed that PM2.5, PM2.5-10 and Nitrogen oxides were suggestively associated with COVID-19 [for PM2.5: IVW (fe): OR 3.573(1.218,5.288), PIVW(fe) = 0.021; for PM2.5-10: IVW (fe): OR 2.940(1.385,6.239), PIVW(fe) = 0.005; for Nitrogen oxides, IVW (fe): OR 1.898(1.318,2.472), PIVW(fe) = 0.010]. PM2.5, PM2.5-10, PM10, and Nitrogen oxides were suggestively associated with bacterial pneumonia [for PM2.5: IVW(fe): OR 1.720 (1.007, 2.937), PIVW(fe) = 0.047; for PM2.5-10: IVW(fe): OR 1.752 (1.111, 2.767), P IVW(fe) = 0.016; for PM10: IVW(fe): OR 2.097 (1.045, 4.208), PIVW(fe) = 0.037; for Nitrogen oxides, IVW(fe): OR 3.907 (1.209, 5.987), PIVW(fe) = 0.023]. Furthermore, Nitrogen dioxide was suggestively associated with the risk of acute upper respiratory infections, while all air pollution were not associated with intestinal infections.

Conclusions

Our results support a role of related air pollution in the Corona Virus Disease 2019, bacterial pneumonia and acute upper respiratory infections. More work is need for policy formulation to reduce the air pollution and the emission of toxic and of harmful gas.

Gut microbiome dynamics and predictive value in hospitalized COVID-19 patients: a comparative analysis of shallow and deep shotgun sequencing

The COVID-19 pandemic caused by SARS-CoV-2 has led to a wide range of clinical presentations, with respiratory symptoms being common. However, emerging evidence suggests that the gastrointestinal (GI) tract is also affected, with angiotensin-converting enzyme 2, a key receptor for SARS-CoV-2, abundantly expressed in the ileum and colon. The virus has been detected in GI tissues and fecal samples, even in cases with negative results of the reverse transcription polymerase chain reaction in the respiratory tract. GI symptoms have been associated with an increased risk of ICU admission and mortality. The gut microbiome, a complex ecosystem of around 40 trillion bacteria, plays a crucial role in immunological and metabolic pathways. Dysbiosis of the gut microbiota, characterized by a loss of beneficial microbes and decreased microbial diversity, has been observed in COVID-19 patients, potentially contributing to disease severity. We conducted a comprehensive gut microbiome study in 204 hospitalized COVID-19 patients using both shallow and deep shotgun sequencing methods. We aimed to track microbiota composition changes induced by hospitalization, link these alterations to clinical procedures (antibiotics administration) and outcomes (ICU referral, survival), and assess the predictive potential of the gut microbiome for COVID-19 prognosis. Shallow shotgun sequencing was evaluated as a cost-effective diagnostic alternative for clinical settings. Our study demonstrated the diverse effects of various combinations of clinical parameters, microbiome profiles, and patient metadata on the precision of outcome prognostication in patients. It indicates that microbiological data possesses greater reliability in forecasting patient outcomes when contrasted with clinical data or metadata. Furthermore, we established that shallow shotgun sequencing presents a viable and cost-effective diagnostic alternative to deep sequencing within clinical environments.

The impact of COVID-19 on "biological aging"

The global impact of the SARS-CoV-2 pandemic has been unprecedented, posing a significant public health challenge. Chronological age has been identified as a key determinant for severe outcomes associated with SARS-CoV-2 infection. Epigenetic age acceleration has previously been observed in various diseases including human immunodeficiency virus (HIV), Cytomegalovirus (CMV), cardiovascular diseases, and cancer. However, a comprehensive review of this topic is still missing in the field. In this review, we explore and summarize the research work focusing on biological aging markers, i.e., epigenetic age and telomere attrition in COVID-19 patients. From the reviewed articles, we identified a consistent pattern of epigenetic age dysregulation and shortened telomere length, revealing the impact of COVID-19 on epigenetic aging and telomere attrition.

The effects of the COVID-19 pandemic on the mental health of people with obesity

Obesity is a risk factor for anxiety and depression. Obesity is also a risk factor for severe COVID-19 disease and therefore may have contributed to adverse mental health outcomes in this vulnerable population during the COVID-19 pandemic. We compare the trajectory of mental health outcomes of people with obesity with normal-weight people before and during the COVID-19 pandemic using nationally representative individual-level longitudinal data from the National Health Interview Survey and Difference-in-Difference regressions. Our results indicate that severe anxiety increased by 2.75 (95% CI: 0.0056-0.0494; p-value 0.014) percentage points, representing a 31.3% relative increase, and anxiety-related prescription drug usage increased by 2.75 (95% CI: 0.0076-0.0473; p-value<0.01) percentage points, representing a 19.2% relative increase among people with obesity, compared to normal-weight people. We conclude that people with obesity experienced an increase in the incidence of severe anxiety and anxiety-related prescription drug usage during the COVID-19 pandemic, which was not observed among normal-weight individuals. Furthermore, women, less-educated, and rural residents with obesity disproportionately bore the burden of the pandemic.

Increase in venous thromboembolism in SARS-CoV-2 infected lung tissue: proteome analysis of lung parenchyma, isolated endothelium, and thrombi

AIMS

COVID-19 pneumonia is characterized by an increased rate of deep venous thrombosis and pulmonary embolism. To better understand the pathophysiology behind thrombosis in COVID-19, we performed proteomics analysis on SARS-CoV-2 infected lung tissue.

METHODS

Liquid chromatography mass spectrometry was performed on SARS-CoV-2 infected postmortem lung tissue samples. Five protein profiling analyses were performed: whole slide lung parenchyma analysis, followed by analysis of isolated thrombi and endothelium, both stratified by disease (COVID-19 versus influenza) and thrombus morphology (embolism versus in situ). Influenza autopsy cases with pulmonary thrombi were used as controls.

RESULTS

Compared to influenza controls, both analyses of COVID-19 whole-tissue and isolated endothelium showed upregulation of proteins and pathways related to liver metabolism including urea cycle activation, with arginase being among the top upregulated proteins in COVID-19 lung tissue. Analysis of isolated COVID-19 thrombi showed significant downregulation of pathways related to platelet activation compared to influenza thrombi. Analysis of isolated thrombi based on histomorphology shows that in situ thrombi have significant upregulation of coronavirus pathogenesis proteins.

CONCLUSIONS

The decrease in platelet activation pathways in severe COVID-19 thrombi suggests a relative increase in venous thromboembolism, as thrombi from venous origin tend to contain fewer platelets than arterial thrombi. Based on histomorphology, in situ thrombi show upregulation of various proteins related to SARS-CoV-2 pathogenesis compared to thromboemboli, which may indicate increased in situ pulmonary thrombosis in COVID-19. Therefore, this study supports the increase of venous thromboembolism without undercutting the involvement of in situ thrombosis in severe COVID-19.

[Impact of the COVID-19 pandemic on cardiovascular disease mortality trends in Mexico, 2000-2022]

OBJECTIVE

To estimate the impact of the COVID-19 pandemic on cardiovascular disease (CVD) mortality trends in Mexico.

METHODS

An ecological study was conducted where deaths from CVD reported in Mexico under the ICD-10 classification with codes I10 to I99 for the period 2000-2022 were analyzed. Age-standardized mortality rates were calculated at the national and state levels, then the annual percentage variation was estimated using joinpoint analysis to know the changes in the mortality trend in the period studied.

RESULTS

There was an increase of 27.96 deaths per 100,000 inhabitants from 2000 to 2022 in Mexico. The joinpoint analysis shows in the period 2019-2021 an annual percentage change at the national level of 17,398 and subsequently a negative trend is presented between the years 2021-2022. The states of Guanajuato, Tlaxcala and Querétaro showed the largest increases in CVD mortality trends during the COVID-19 pandemic.

CONCLUSIONS

The trend in CVD mortality in Mexico increased significantly during the COVID-19 pandemic.

Evaluating NSAIDs in SARS-CoV-2: Immunomodulatory mechanisms and future therapeutic strategies

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely recognized for their analgesic and anti-inflammatory properties. Amidst the SARS-CoV-2 pandemic, the role of NSAIDs in modulating viral and bacterial infections has become a critical area of research, sparking debates and necessitating a thorough review. This review examines the multifaceted interactions between NSAIDs, immune responses, and infections. Focusing on the immunomodulatory mechanisms of NSAIDs in SARS-CoV-2 and their implications for other viral and bacterial infections, we aim to provide clarity and direction for future therapeutic strategies. NSAIDs demonstrate a dual role in infectious diseases. They reduce inflammation by decreasing neutrophil recruitment and cytokine release, yet potentially compromise antiviral defense mechanisms. They also modulate cytokine storms in SARS-CoV-2 and exhibit the potential to enhance anti-tumor immunity by inhibiting tumor-induced COX-2/PGE2 signaling. Specific NSAIDs have shown efficacy in inhibiting viral replication. The review highlights NSAIDs' synergy with other medications, like COX inhibitors and immunotherapy agents, in augmenting therapeutic effects. Notably, the World Health Organization's analysis found no substantial link between NSAIDs and the worsening of viral respiratory infections. The findings underscore NSAIDs' complex role in infection management. Understanding these interactions is crucial for optimizing therapeutic approaches in current and future pandemics. However, their dual nature warrants cautious application, particularly in vulnerable populations. NSAIDs present a paradoxical impact on immune responses in viral and bacterial infections. While offering potential benefits, their usage in infectious diseases, especially SARS-CoV-2, demands a nuanced understanding to balance therapeutic advantages against possible adverse effects.

Trends in the burden of most common obesity-related cancers in 16 Southern Africa development community countries, 1990-2019. Findings from the global burden of disease study

Background

Obesity-related cancers in the 16 Southern African Development Community (SADC) countries is quite prominent. The changes and time trends of the burden of obesity-related cancers in developing countries like SADC remain largely unknown. A descriptive epidemiological analysis was conducted to assess the burden of obesity-related cancers, (liver, esophageal, breast, prostate, colon/rectal, leukemia, ovarian, uterine, pancreatic, kidney, gallbladder/biliary tract, and thyroid cancers) in SADC countries.

Methods

Data from the 2019 Global Burden of Diseases Study was used. Deaths extracted from vital registration, verbal autopsies and ICD codes. Cancer-type, mortality and prevalence per 100,000 population and 95% uncertainty intervals (UIs) were calculated using the Cause of Death Ensemble model and Spatio-Temporal Gaussian process with mixed effects regression models. Annual rates of change (AROCs) between 1990 and 2019 and the corresponding UIs were calculated.

Results

The top age-standardized mortality rates per 100,000 in 2019 for males were leukemia, 20.1(14.4-26.4), esophageal cancer, 15.1 (11.2-19.1), and colon and rectal cancer, 10.3 (8.6-12.6). For females, breast cancer, 20.6 (16.6-25.0), leukemia, 17.1 (11.4-23.7), and esophageal cancer, 8.3 (5.5-10.7), had the leading mortality rates. For males, AROC substantial (p < 0.05) increase for kidney cancer for 11 of the countries (AROC from 0.41% to 1.24%), colon cancer for eight of the countries (from 0.39% to 0.92%), and pancreatic cancer for seven countries (from 0.26% to 1.01%). In females, AROC showed substantial increase for pancreatic cancer for 13 of the countries from (0.34%-1.67%), nine countries for kidney cancer (from 0.27% to 1.02%), seven countries each for breast cancer (0.35%-1.13%), and ovarian cancer (from 0.33% to 1.21%).

Conclusions

There is need for location-specific and culturally appropriate strategies for better nutrition and weight control, and improved screening for all cancers. Health promotion messaging should target kidney, colon, pancreatic, and breast cancers and encourage clinically tested methods of reducing BMI such as increasing personal physical activity and adoption of effective dietary regimes.

Lung protection of Chimonanthus nitens Oliv. essential oil driven by the control of intestinal disorders and dysbiosis through gut-lung crosstalk

This work aimed to investigate whether Chimonanthus nitens Oliv. essential oil (CEO)-mediated lung protection was implicated in gut-lung crosstalk. Results showed that CEO attenuated lung and intestinal impairment by improving histopathological changes and inhibiting TLR4/NF-κB signaling pathway in LPS-stimulated rats, suggesting that there might be a mechanism for its lung protection involved in gut-lung interaction through manipulating the overlap in pathological changes via the similar inflammatory response. Furthermore, CEO-triggered intestinal protection was in parallel with the mitigation of ROS production, apoptosis, Ca2+ transport and mitochondrial membrane potential loss in vivo, and its intestinal protection was confirmed in vitro through IEC-6 cells. Importantly, a combination with CEO and LPS significantly remodeled gut microbiota composition compared with LPS alone in rats, while no significant impact on lung microbiota. Therefore, CEO-exerted lung protection was linked to gut and lung interactions involvement with the control of intestinal disorders and dysbiosis.

Planetary Health, Nutrition, and Chronic Kidney Disease: Connecting the Dots for a Sustainable Future

The increasing consumption of ultra-processed food (UPF) and the global chain of food production have a negative impact on human health and planetary health. These foods have been replacing the consumption of nonprocessed healthy foods. This shift has not only worsened human health by increasing the risk of the development of noncommunicable diseases, but also resulted in environmental perturbations. This review aims to bring awareness of the problems caused by the industrialized food production chain, addressing the negative effects it has on the environment and human health, with special reference to chronic kidney disease (CKD). We discuss possible solutions focusing on the benefits of adopting plant-based diets with low UPF content to promote a sustainable and healthy food production and diet for patients with CKD. For a sustainable future we need to "connect the dots" of planetary health, food production, and nutrition in the context of CKD.

The association between obesity with treatment duration, ICU length of stay and the risk of death in critically ill patients with COVID-19

BACKGROUND

Despite the confirmed association between higher BMI with increased risk of the acute respiratory distress syndrome (ARDS), the association between obesity with mortality in critically ill patients with coronavirus disease 2019 (COVID-19) is not clear. The present study aimed to investigate the association between obesity with treatment duration, ICU length of stay, and the risk of death in critically ill patients with COVID-19.

METHODS

This case-control study was performed on 223 patients with COVID-19 including 148 surviving patients as the control group and 75 eventually dead patients as the case group in Rasht, Iran. Data on demographic factors, comorbidities, anthropometric measurements, the length of hospitalization and the mortality were obtained from patients' medical records.

RESULTS

The mortality rate was significantly associated with weight (OR = 1.04, 95% CI: 1.002-1.083, p = .04), but not with BMI after adjustments for age, gender, length of stay in ICU, chronic diseases and smoking. The results did not change after further adjustments for biochemical and pathological factors.

CONCLUSIONS

Weight was positively associated with mortality after controlling for confounding variables. Further studies should consider the patient's body composition such as fat mass to establish the relationship between obesity and COVID-19 outcomes.

Association of adiposity and its changes over time with COVID-19 risk in older adults with overweight/obesity and metabolic syndrome: a longitudinal evaluation in the PREDIMED-Plus cohort

BACKGROUND

Cross-sectionally, older age and obesity are associated with increased coronavirus disease-2019 (COVID-19) risk. We assessed the longitudinal associations of baseline and changes in adiposity parameters with COVID-19 incidence in older adults at high cardiovascular risk.

METHODS

This analysis included 6874 men and women (aged 55-75 years) with overweight/obesity and metabolic syndrome in the PREDIMED-Plus lifestyle intervention trial for cardiovascular risk reduction. Body weight, body-mass-index (BMI), waist circumference, waist-to-height ratio (WHtR), and a body shape index (ABSI) were measured at baseline and annual follow-up visits. COVID-19 was ascertained by an independent Event Committee until 31 December 2021. Cox regression models were fitted to evaluate the risk of COVID-19 incidence based on baseline adiposity parameters measured 5-6 years before the pandemic and their changes at the visit prior to censoring.

RESULTS

At the time of censoring, 653 incident COVID-19 cases occurred. Higher baseline body weight, BMI, waist circumference, and WHtR were associated with increased COVID-19 risk. During the follow-up, every unit increase in body weight (HRadj (95%CI): 1.01 (1.00, 1.03)) and BMI (HRadj: 1.04 (1.003, 1.08)) was associated with increased COVID-19 risk.

CONCLUSIONS

In older adults with overweight/obesity, clinically significant weight loss may protect against COVID-19.

TRIAL REGISTRATION

This study is registered at the International Standard Randomized Controlled Trial (ISRCT; http://www.isrctn.com/ISRCTN89898870 ).

The causal relationship between air pollution, obesity, and COVID-19 risk: a large-scale genetic correlation study

OBJECTIVE

Observational evidence reported that air pollution is a significant risk element for numerous health problems, such as obesity and coronavirus disease 2019 (COVID-19), but their causal relationship is currently unknown. Our objective was to probe the causal relationship between air pollution, obesity, and COVID-19 and to explore whether obesity mediates this association.

METHODS

We obtained instrumental variables strongly correlated to air pollutants [PM2.5, nitrogen dioxide (NO2) and nitrogen oxides (NOx)], 9 obesity-related traits (abdominal subcutaneous adipose tissue volume, waist-to-hip ratio, body mass index, hip circumference, waist circumference, obesity class 1-3, visceral adipose tissue volume), and COVID-19 phenotypes (susceptibility, hospitalization, severity) from public genome-wide association studies. We used clinical and genetic data from different public biological databases and performed analysis by two-sample and two-step Mendelian randomization.

RESULTS

PM2.5 genetically correlated with 5 obesity-related traits, which obesity class 1 was most affected (beta = 0.38, 95% CI = 0.11 - 0.65, p = 6.31E-3). NO2 genetically correlated with 3 obesity-related traits, which obesity class 1 was also most affected (beta = 0.33, 95% CI = 0.055 - 0.61, p = 1.90E-2). NOx genetically correlated with 7 obesity-related traits, which obesity class 3 was most affected (beta = 1.16, 95% CI = 0.42-1.90, p = 2.10E-3). Almost all the obesity-related traits genetically increased the risks for COVID-19 phenotypes. Among them, body mass index, waist circumference, hip circumference, waist-to-hip ratio, and obesity class 1 and 2 mediated the effects of air pollutants on COVID-19 risks (p < 0.05). However, no direct causal relationship was observed between air pollution and COVID-19.

CONCLUSION

Our study suggested that exposure to heavy air pollutants causally increased risks for obesity. Besides, obesity causally increased the risks for COVID-19 phenotypes. Attention needs to be paid to weight status for the population who suffer from heavy air pollution, as they are more likely to be susceptible and vulnerable to COVID-19.

Challenges encountered by parents from urban, lower social economic class in changing lifestyle behaviors of their children who are overweight or obese

BACKGROUND

Parents from urban, lower social economic classes often encounter unique challenges in their lives, which shape how they work with their children who are overweight or obese to change their exercise and eating behaviors at home. The present study took an initial step to address a gap in the literature by describing the challenges that parents from lower social economic classes in an urban city encountered in changing exercise and eating behaviors of their children who are overweight or obese.

METHODS

A conversational style semi-structured interview with prompts and probes was conducted to 44 parents whose child is overweight or obese. Inductive content analysis and constant comparison was used to analyze the data. Data trustworthiness was established by using a variety of strategies.

RESULTS

Two major themes with eight sub-themes emerged from the data: Challenges to promote a healthy active lifestyle, and challenges from their child's development and lifestyle behavior. Eight sub-themes were: (1) Need for effective strategies for a lifestyle behavior change, (2) monitor and promote healthy choices, (3) money, time, and dangerous neighborhood, (4) scientific knowledge to promote a healthy active lifestyle, (5) developmental changes of adolescence, (6) unmotivated and lack of persistence, (7) sneaking eating, and (8) peer pressure.

CONCLUSION

The challenges, from economic to parenting, are certainly of importance, and understanding these challenges will be crucial to help school-based professionals develop interventions. Those identified challenges should be clearly placed within family-school collaboration practices.

Severity-onset prediction of COVID-19 via artificial-intelligence analysis of multivariate factors

Progression to a severe condition remains a major risk factor for the COVID-19 mortality. Robust models that predict the onset of severe COVID-19 are urgently required to support sensitive decisions regarding patients and their treatments. In this study, we developed a multivariate survival model based on early-stage CT images and other physiological indicators and biomarkers using artificial-intelligence analysis to assess the risk of severe COVID-19 onset. We retrospectively enrolled 338 adult patients admitted to a hospital in China (severity rate, 31.9%; mortality rate, 0.9%). The physiological and pathological characteristics of the patients with severe and non-severe outcomes were compared. Age, body mass index, fever symptoms upon admission, coexisting hypertension, and diabetes were the risk factors for severe progression. Compared with the non-severe group, the severe group demonstrated abnormalities in biomarkers indicating organ function, inflammatory responses, blood oxygen, and coagulation function at an early stage. In addition, by integrating the intuitive CT images, the multivariable survival model showed significantly improved performance in predicting the onset of severe disease (mean time-dependent area under the curve = 0.880). Multivariate survival models based on early-stage CT images and other physiological indicators and biomarkers have shown high potential for predicting the onset of severe COVID-19.

Setmelanotide optimization through fragment-growing, molecular docking in-silico method targeting MC4 receptor

Obesity has emerged as a global issue, but with the complex structures of multiple related important targets and their agonists or antagonists determined, the mechanism of ligand-protein interaction may offer new chances for developing new generation agonists anti-obesity. Based on the molecule surface of the cryo-EM protein structure 7AUE, we tried to replace D-Ala3 with D-Met in setmelanotide as the linker site for fragment-growing with De novo evolution. The simulation results indicate that the derivatives could improve the binding abilities with the melanocortin 4 receptor and the selectivity over the melanocortin 1 receptor. The improved selectivity of the newly designed derivatives is mainly due to the shape difference of the molecular surface at the orthosteric peptide-binding pocket between melanocortin 4 receptor and melanocortin 1 receptor. The new extended fragments could not only enhance the binding affinities but also function as a gripper to seize the pore, making it easier to balance and stabilize the other component of the new derivatives. Although it is challenging to synthesize the compounds designed in silico, this study may perhaps serve as a trigger for additional anti-obesity research.Communicated by Ramaswamy H. Sarma.

The impact of mean body mass index on reported mortality from COVID-19 across 181 countries

Accountability for global health issues such as a pandemic and its devastating consequences are usually ascribed to a virus, but a comprehensive view should also take into account the state of the host. Data suggests that excessive nutrition is to blame for a yet unknown but not negligible portion of deaths attributed to severe acute respiratory syndrome coronavirus 2. We analyzed the correlation between mean body mass index (BMI) and 2-year coronavirus disease 2019 (COVID-19) mortality rates reported by 181 countries worldwide. Almost two thirds of the countries included had a mean BMI greater or equal to 25, with death rates ranging from 3 to 6,280 per million. Death rates in countries with a mean BMI below 25 ranged from 3 to 1,533. When the analysis was restricted to countries where the extent of testing was deemed more representative of actual mortality, only 20.1% had a mean BMI &lt;25 but the mortality difference persisted. A second analysis looking at pre-vaccination mortality obtained from a different source led to similar conclusions. Due to the nature of the variables, reverse causation can be excluded while common causation can not. A mean BMI &lt;25 for a country seems to spare its citizens from the highest COVID-19 mortality rates. The impact of excess weight on global COVID-19 mortality is suspected to have been much higher than what currently perceived, here estimated at no less than a fourfold increase in mortality. Countries with normal mean BMI constitute precious test beds for the quantification of the effects of overeating on COVID-19 mortality.

Gut microbiota and synbiotic foods: Unveiling the relationship in COVID-19 perspective

The Coronavirus disease 2019 (COVID-19) has spread across the globe and is causing widespread disaster. The impact of gut microbiota on lung disease has been widely documented. Diet, environment, and genetics all play a role in shaping the gut microbiota, which can influence the immune system. Improving the gut microbiota profile through customized diet, nutrition, and supplementation has been shown to boost immunity, which could be one of the preventative methods for reducing the impact of various diseases. Poor nutritional status is frequently linked to inflammation and oxidative stress, both of which can affect the immune system. This review emphasizes the necessity of maintaining an adequate level of important nutrients to effectively minimize inflammation and oxidative stress, moreover to strengthen the immune system during the COVID-19 severity. Furthermore, the purpose of this review is to present information and viewpoints on the use of probiotics, prebiotics, and synbiotics as adjuvants for microbiota modification and its effects on COVID-19 prevention and treatment.

COVID-19 infection and metabolic comorbidities: Mitigating role of nutritional sufficiency and drug - nutraceutical combinations of vitamin D

The vulnerability of human health is amplified in recent times with global increase in non-communicable diseases (due to lifestyle changes and environmental insults) and infectious diseases (caused by newer pathogens and drug-resistance strains). Clinical management of diseases is further complicated by disease severity caused by other comorbid factors. Drug-based therapy may not be the sole approach, particularly in scenarios like the COVID-19 pandemic, where there is no specific drug against SARS-CoV-2. Nutritional interventions are significant in armouring human populations in disease prevention, and as adjunctive therapy for disease alleviation. Amidst ongoing clinical trials to determine the efficacy of Vit. D against infections and associated complications, this review examines the pleiotropic benefits of nutritional adequacy of vitamin D (Vit. D) in combating viral infections (COVID-19), its severity and complications due to co-morbidities (obesity, diabetes, stroke and Kawasaki disease), based on research findings and clinical studies. Supplements of Vit. D in combination with other nutrients, and drugs, are suggested as promising preventive-health and adjunct-treatment strategies in the clinical management of viral infections with metabolic comorbidities.

COVID-19 is not a causal risk for miscarriage: evidence from a Mendelian randomization study

OBJECTIVE

Coronavirus disease 2019 (COVID-19) has caused a global pandemic in the last three years. The lack of reliable evidence on the risk of miscarriage due to COVID-19 has become a concern for patients and obstetricians. We sought to identify rigorous evidence using two-sample Mendelian randomization (MR) analysis.

METHODS

Seven single-nucleotide polymorphisms (SNPs) associated with COVID-19 were used as instrumental variables to explore causality by two-sample MR. The summary data of genetic variants were obtained from the Genome Wide Association Study (GWAS) among European populations in the UK Biobank and EBI database. Inverse variance weighting (IVW) method was taken as the gold standard for MR results, and other methods were taken as auxiliary. We also performed sensitivity analysis to evaluate the robustness of MR.

RESULTS

The MR analysis showed there was no clear causal association between COVID-19 and miscarriage in the genetic prediction [OR 0.9981 (95% CI, 0.9872-1.0091), p = 0.7336]. Sensitivity analysis suggested that the MR results were robust [horizontal pleiotropy (MR-Egger, intercept = 0.0001592; se = 0.0023; p = 0.9480)].

CONCLUSIONS

The evidence from MR does not support COVID-19 as a causal risk factor for miscarriage in European populations. The small probability of direct placental infection, as well as the inability to stratify the data may explain the results of MR. These findings can be informative for obstetricians when managing women in labor.

Waning Effectiveness of the BNT162b2 Vaccine Against Infection in Adolescents in Israel

BACKGROUND

The short-term effectiveness of a 2-dose regimen of the BioNTech/Pfizer BNT162b2 vaccine for adolescents has been demonstrated. However, little is known about the long-term effectiveness in this age group. It is known, however, that waning of vaccine-induced immunity against infection in adult populations is evident within a few months.

METHODS

Leveraging the database of Maccabi Healthcare Services (MHS), we conducted a matched case-control design for evaluating the association between time since vaccination and the incidence of infections, where 2 outcomes were evaluated: documented SARS-CoV-2 infection (regardless of symptoms) and symptomatic infection (COVID-19). Cases were defined as individuals aged 12-16 with a positive polymerase chain reaction (PCR) test occurring between 15 June and 8 December 2021, when the Delta variant was dominant in Israel. Controls were adolescents who had not tested positive previously.

RESULTS

We estimated a peak vaccine effectiveness between 2 weeks and 3 months following receipt of the second dose, with 85% (95% confidence interval [CI]: 84-86%) and 90% (95% CI: 89-91%) effectiveness against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19), respectively. However, in line with findings for adults, waning effectiveness was evident. Long-term protection was reduced to 73% (95% CI: 68-77%) against infection and 79% (95% CI: 73-83%) against COVID-19 3-5 months after the second dose and waned to 53% (95% CI: 46-60%) against infection and 66% (95% CI: 59-72%) against COVID-19 after 5 months.

CONCLUSIONS

Although vaccine-induced protection against both infection and COVID-19 continues over time in adolescents, the protection wanes with time since vaccination, starting 3 months after inoculation and continuing for more than 5 months.

The Impact of LEP rs7799039 Polymorphism and Obesity on the Severity of Coronavirus Disease-19

BACKGROUND AND AIMS

SARS-CoV-2 infection has been recorded in 230 countries to date. Obesity has a negative impact on one's quality of life and is one of the main causes of mortality globally. Obesity affects the immune system, making the host more susceptible to infectious infections. Also, obesity commonly provokes the severity of respiratory diseases so the correlation of LEP rs7799039 Polymorphism in corpulent patients with COVID-19 infection was clearly investigated in the current study.

METHODS

A total of 232 patients were recruited, 116 patients were obese with COVID-19 infection, and 116 patients were non obese COVID-19. Fasting blood glucose test (FBG), hemoglobin A1C (HbA1C), complete blood count (CBC), international normalized ratio (INR), urea, alanine transaminase (ALT), aspartate aminotransferase (AST), D dimer and C-reactive protein (CRP) were estimated. C.T. scan was performed for each patient, and C.T. severity score was calculated. Genotyping for the leptin rs7799039 SNPs was performed by TaqMan^® (Applied Biosystems Step One ^TM Real-time PCR).

RESULTS

Regarding LEP polymorphism, all individuals of non-obese groups significantly had the homozygous allele GG (100%), whereas only 56% of obese groups had GG alleles (P = 0.001). The severity scores significantly (P = 0.001) varied regarding LEP polymorphism regarding Rs7799039, where the largest proportion of those with Grade IV had the homozygous allele AA (57.1%).

CONCLUSION

There was a correlation between the leptin gene allelic discrimination and COVID-19 CT brutality in obese patients. The A allele was considered a risk factor for severity in COVID-19 patients while the G allele contributes to decreasing that risk.

Intensive Weight-Loss Lifestyle Intervention Using Mediterranean Diet and COVID-19 Risk in Older Adults: Secondary Analysis of PREDIMED-Plus Trial

OBJECTIVES

We tested the effects of a weight-loss intervention encouraging energy-reduced MedDiet and physical activity (PA) in comparison to ad libitum MedDiet on COVID-19 incidence in older adults.

DESIGN

Secondary analysis of PREDIMED-Plus, a prospective, ongoing, multicentre randomized controlled trial.

SETTING

Community-dwelling, free-living participants in PREDIMED-Plus trial.

PARTICIPANTS

6,874 Spanish older adults (55-75 years, 49% women) with overweight/obesity and metabolic syndrome.

INTERVENTION

Participants were randomised to Intervention (IG) or Control (CG) Group. IG received intensive behavioural intervention for weight loss with an energy-reduced MedDiet intervention and PA promotion. CG was encouraged to consume ad libitum MedDiet without PA recommendations.

MEASUREMENTS

COVID-19 was ascertained by an independent Event Committee until December 31, 2021. COX regression models compared the effect of PREDIMED-Plus interventions on COVID-19 risk.

RESULTS

Overall, 653 COVID-19 incident cases were documented (IG:317; CG:336) over a median (IQR) follow-up of 5.8 (1.3) years (inclusive of 4.0 (1.2) years before community transmission of COVID-19) in both groups. A significantly lowered risk of COVID-19 incidence was not evident in IG, compared to CG (fully-adjusted HR (95% CI): 0.96 (0.81,1.12)).

CONCLUSIONS

There was no evidence to show that an intensive weight-loss intervention encouraging energy-reduced MedDiet and PA significantly lowered COVID-19 risk in older adults with overweight/obesity and metabolic syndrome in comparison to ad libitum MedDiet. Recommendations to improve adherence to MedDiet provided with or without lifestyle modification suggestions for weight loss may have similar effects in protecting against COVID-19 risk in older adults with high cardiovascular risks.

Cardio-cerebrovascular complications in COVID-19 patients: A retrospective cohort study

Background

Recent studies have highlighted the cardio-cerebrovascular manifestations of coronavirus disease 2019 (COVID-19).

Objective

This study aimed to analyze the likelihood of cardiovascular and cerebrovascular manifestations among patients with COVID-19-positive individuals in South Korea.

Methods

A cohort database for COVID-19 from the National Health Insurance Service was used which included patients diagnosed with COVID-19 between January 1 and June 4, 2020. Individuals who tested COVID-19 positive, notwithstanding the severity of the disease, were designated as cases. COVID-19- negative individuals were used as controls for the study. The exclusion criteria included people who had a history of cardiovascular and cerebrovascular diseases between 2015 and 2019. A new diagnosis of cardiovascular and cerebrovascular complications was considered the primary endpoint. The adjusted incidence rate ratio (IRR) of development of complications was estimated using log-link Poisson regression. The model was adjusted at two levels, the first one included age and sex while the second included age, sex, residence area, and level of income. The hazard ratio (HR) was estimated using Cox-proportional hazard regression analysis while adjusting for all demographic variables and covariates.

Results

Significant results were obtained for acute conditions, such as ischemic heart disease and cerebral hemorrhage. The IRR of COVID-19- positive individuals compared with that of controls for the diagnosis of ischemic heart disease was 1.78 (1.57-2.02; 95% confidence interval [CI]) when adjusted for age and sex. HR was calculated as 3.02 (2.19-4.17; 95% CI) after adjusting for the covariates. In case of cerebral hemorrhage, the adjusted IRR was 2.06 (1.25-3.40; 95% CI) and the adjusted HR was 4.08 (0.90-19.19; 95% CI).

Conclusion

The findings of our study suggest that COVID-19 infection can be a significant risk factor for acute cardiovascular complications, such as ischemic heart disease and acute cerebrovascular complications, such as cerebral infarction, after properly adjusting for covariates.

Lycopene: a therapeutic strategy against coronavirus disease 19 (COVID- 19)

Lycopene is a group of phytochemicals found in nature, primarily in fruits and vegetables. Lycopene is thought to protect against a variety of diseases attributed to its antioxidant capabilities. Lycopene has anti-inflammatory, anti-cancer, and immunity-boosting qualities, among other biological and pharmacological benefits. COVID-19 (coronavirus disease 19) is an infectious disease caused by the SARS-CoV-2 virus, which has recently emerged as one of the world's leading causes of death. Patients may be asymptomatic or show signs of respiratory, cytokine release syndrome, gastrointestinal, or even multiple organ failure, all of which can lead to death. In COVID-19, inflammation, and cytokine storm are the key pathogenic mechanisms, according to SARS-CoV-2 infection symptoms. ARDS develops in some vulnerable hosts, which is accompanied by an inflammatory "cytokine syndrome" that causes lung damage. Immunological and inflammatory markers were linked to disease severity in mild and severe COVID-19 cases, implying that inflammatory markers, including IL-6, CRP, ESR, and PCT were significantly linked with COVID-19 severity. Patients with severe illness have reduced levels of several immune subsets, including CD4 + T, NK, and CD8 + cells. As a result, lycopene can be commended for bolstering physiological defenses against COVID-19 infections.

Association between the Health Belief Model, Exercise, and Nutrition Behaviors during the COVID-19 Pandemic

INTRODUCTION

The COVID-19 pandemic has affected our nation's health further than the infection it causes. Physical activity levels and dietary intake have suffered while individuals grapple with the changes in behavior to reduce viral transmission. With unique nuances regarding the access to physical activity and nutrition during the pandemic, the constructs of Health Belief Model (HBM) may present themselves differently in nutrition and exercise behaviors compared to precautions implemented to reduce viral transmission studied in previous research. The purpose of this study was to investigate the extent of exercise and nutritional behavior change during the COVID-19 pandemic and explain the reason for and extent of this change using HBM constructs (perceived susceptibility, severity, benefit of action, and barriers to action).

METHODS

This study used a cross-sectional design to collect 206 surveys. This survey collected information on self-reported exercise and nutrition changes during the pandemic and self-reported levels of the HBM constructs.

RESULTS

Findings showed individuals with medium or high exercise behavior change had greater odds of increased HBM score than individuals with little to no exercise behavior change (OR = 1.117, 95% CI: 1.020-1.223, SE: 0.0464, p = 0.0175). There was no association between nutritional behavior change and HBM score (OR = 1.011, 95% CI: 0.895-1.142, p = 08646).

CONCLUSION

Individuals who reported a more drastic change in either exercise had greater odds of increased feelings of perceived susceptibility and severity related to COVID-19 and decreased perceived benefits and increased barriers to exercise. This relationship was not found regarding nutrition behavior change. These results encourage public health practitioners to understand how an individual's perceived feelings about a threat may affect exercise and nutritional behaviors.

Antioxidant, Anti-Obesity, and Hypolipidemic Effects of Polyphenol Rich Star Anise (Illicium verum) Tea in High-Fat-Sugar Diet-Induced Obesity Rat Model

Star anise (Illicium verum Hook. fil.) is commonly utilized as a culinary and medicinal fruit and is most famous in indigenous systems of medicine. The present research work aims to appraise and validate the potential of polyphenol-rich star anise tea (SAT) on oxidative stress, obesity and related biochemical parameters in high-fat-sugar-diet (HFSD)-induced obesity model in rats. SAT was prepared using the traditional method in warm water. The Reverse Phase High Pressure Liquid Chromatography (RP-HPLC) analysis was performed for the simultaneous determination of phenolic acids and flavonoids in SAT. Two doses (250 and 500 mg/kg body weight) were selected to investigate the anti-obesity potential of SAT using HFSD-induced obese rat model. Major (>5 mg/100 mL) phenolic acids in SAT were p-coumeric acid, gallic aid, cinamic acid, chlorogenic acid and ferulic acid while catechin and rutin were the major flavonoids detected in the SAT. SAT exhibited 51.3% DPPH radical scavenging activity. In vivo study showed that higher doses of SAT (500 mg/kg body weight) significantly reduced the body weight increase (74.82%) and BMI (0.64 g/cm2). Moreover, significant reductions in the levels of serum total cholesterol, triglyceride, LDL and VLDL were recorded in all the treatment groups in comparison to the HFSDC group. Furthermore, SAT reduced the alterations in MDA, SOD and GSH levels of experimental groups thus showing the potential against oxidative stress. The SAT-500 group showed a significant decrease in the elevated kidney and liver weights and atherogenic index in comparison to the HFSDC group. The present study proved that SAT exhibited strong protective effects against obesity and oxidative stress, especially at higher doses.

Patient-specific stomach biomechanics before and after laparoscopic sleeve gastrectomy

BACKGROUND

Obesity has become a global epidemic. Bariatric surgery is considered the most effective therapeutic weapon in terms of weight loss and improvement of quality of life and comorbidities. Laparoscopic sleeve gastrectomy (LSG) is one of the most performed procedures worldwide, although patients carry a nonnegligible risk of developing post-operative GERD and BE.

OBJECTIVES

The aim of this work is the development of computational patient-specific models to analyze the changes induced by bariatric surgery, i.e., the volumetric gastric reduction, the mechanical response of the stomach during an inflation process, and the related elongation strain (ES) distribution at different intragastric pressures.

METHODS

Patient-specific pre- and post-surgical models were extracted from Magnetic Resonance Imaging (MRI) scans of patients with morbid obesity submitted to LSG. Twenty-three patients were analyzed, resulting in forty-six 3D-geometries and related computational analyses.

RESULTS

A significant difference between the mechanical behavior of pre- and post-surgical stomach subjected to the same internal gastric pressure was observed, that can be correlated to a change in the global stomach stiffness and a minor gastric wall tension, resulting in unusual activations of mechanoreceptors following food intake and satiety variation after LSG.

CONCLUSIONS

Computational patient-specific models may contribute to improve the current knowledge about anatomical and physiological changes induced by LSG, aiming at reducing post-operative complications and improving quality of life in the long run.

The Crystal Structure of Mouse Ces2c, a Potential Ortholog of Human CES2, Shows Structural Similarities in Substrate Regulation and Product Release to Human CES1

Members of the carboxylesterase 2 (Ces2/CES2) family have been studied intensively with respect to their hydrolytic function on (pro)drugs, whereas their physiological role in lipid and energy metabolism has been realized only within the last few years. Humans have one CES2 gene which is highly expressed in liver, intestine, and kidney. Interestingly, eight homologous Ces2 (Ces2a to Ces2h) genes exist in mice and the individual roles of the corresponding proteins are incompletely understood. Mouse Ces2c (mCes2c) is suggested as potential ortholog of human CES2. Therefore, we aimed at its structural and biophysical characterization. Here, we present the first crystal structure of mCes2c to 2.12 Å resolution. The overall structure of mCes2c resembles that of the human CES1 (hCES1). The core domain adopts an α/β hydrolase-fold with S230, E347, and H459 forming a catalytic triad. Access to the active site is restricted by the cap, the flexible lid, and the regulatory domain. The conserved gate (M417) and switch (F418) residues might have a function in product release similar as suggested for hCES1. Biophysical characterization confirms that mCes2c is a monomer in solution. Thus, this study broadens our understanding of the mammalian carboxylesterase family and assists in delineating the similarities and differences of the different family members.

Epidemiological Context and Risk Factors Associated with the Evolution of the Coronavirus Disease (COVID-19): A Retrospective Cohort Study

Since its initial appearance in December 2019, COVID-19 has posed a serious challenge to healthcare authorities worldwide. The purpose of the current study was to identify the epidemiological context associated with the respiratory illness propagated by the spread of COVID-19 and outline various risk factors related to its evolution in the province of Debila (Southeastern Algeria). A retrospective analysis was carried out for a cohort of 612 COVID-19 patients admitted to hospitals between March 2020 and February 2022. The results were analyzed using descriptive statistics. Further, logistic regression analysis was employed to perform the odds ratio. In gendered comparison, males were found to have a higher rate of incidence and mortality compared to females. In terms of age, individuals with advanced ages of 60 years or over were typically correlated with higher rates of incidence and mortality in comparison toindividuals below this age. Furthermore, the current research indicated that peri-urban areas were less affected that the urban regions, which had relatively significant incidence and mortality rates. The summer season was marked with the highest incidence and mortality rate in comparison with other seasons. Patients who were hospitalized, were the age of 60 or over, or characterized by comorbidity, were mainly associated with death evolution (odds ratio [OR] = 8.695; p = 0.000), (OR = 6.192; p = 0.000), and (OR = 2.538; p = 0.000), respectively. The study identifies an important relationship between the sanitary status of patients, hospitalization, over-age categories, and the case severity of the COVID-19 patient.

Mulberry leaf polyphenols alleviated high-fat diet-induced obesity in mice

Mulberry leaf is an important medicinal food plant, which is rich in polyphenol compounds. Mulberry leaf polyphenols (MLP) possess significant lipid-lowering and antioxidant effects, and healthcare functions. In this study, the polyphenol content of mulberry leaf ethanol extract was measured using HPLC. The analysis of mulberry leaf extract resulted in the identification of 14 compounds, of which Chlorogenic acid and Quercitrin were the highest. A high-fat diet (HFD)-induced obese mouse model was developed and treated with MLP for 12 weeks to explore their effect on lipid metabolism in HFD-induced obese mice. The results showed that the MLP could inhibit the weight gain and fat cell volume increase in the HFD-induced obese mice in a dose-dependent manner. Further analysis revealed that the MLP decelerated the fatty acid composition in the adipose tissues of HFD-induced obese mice, and significantly increased the polyunsaturated-to-saturated fatty acid (PUFA/SFA) ratio. The real-time quantitative PCR (RT-qPCR) results indicated that the MLP significantly inhibited the down regulation of uncoupling protein (UCP) 1 (UCP1), UCP3, and PR domain zinc finger protein 16 (PRDM16) caused by the HFD. These beneficial effects of MLP on HFD-induced obese mice might be attributed to their ability to change the fatty acid composition of adipose tissue and increase the expression of thermogenesis genes. Overall, the study results suggested that the MLP could serve as potential lipid-lowering and weight-loss functional food and healthcare products.

Probiotics in the Management of Mental and Gastrointestinal Post-COVID Symptomes

Patients with “post-COVID” syndrome manifest with a variety of signs and symptoms that continue/develop after acute COVID-19. Among the most common are gastrointestinal (GI) and mental symptoms. The reason for symptom occurrence lies in the SARS-CoV-2 capability of binding to exact receptors, among other angiotensin converting enzyme 2 (ACE2) receptors in gastrointestinal lining and neuropilin-1 (NRP-1) in the nervous system, which leads to loss of gastrointestinal and blood-brain barriers integrity and function. The data are mounting that SARS-CoV-2 can trigger systemic inflammation and lead to disruption of gut-brain axis (GBA) and the development of disorders of gut brain interaction (DGBIs). Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are the most common DGBIs syndromes. On the other hand, emotional disorders have also been demonstrated as DGBIs. Currently, there are no official recommendations or recommended procedures for the use of probiotics in patients with COVID-19. However, it can be assumed that many doctors, pharmacists, and patients will want to use a probiotic in the treatment of this disease. In such cases, strains with documented activity should be used. There is a constant need to plan and conduct new trials on the role of probiotics and verify their clinical efficacy for counteracting the negative consequences of COVID-19 pandemic. Quality control is another important but often neglected aspect in trials utilizing probiotics in various clinical entities. It determines the safety and efficacy of probiotics, which is of utmost importance in patients with post-acute COVID-19 syndrome.

Evaluation of the Relationship between Nutritional Status of COVID-19 Patients Admitted to the ICU and Patients' Prognosis: A Cohort Study

Background

Malnutrition in COVID-19 critically ill patients can lead to poor prognosis. This study aimed to evaluate the association between nutritional status (or risk) and the prognosis of critically ill COVID-19 patients. In this study, prognosis is the primary outcome of "hospital mortality" patients. The second outcome is defined as "need for mechanical ventilation."

Methods and Materials

In this single-center prospective cohort study, 110 patients admitted to the Intensive Care Unit of Imam Khomeini Hospital Complex (Tehran, Iran) between April and September 2021 were enrolled. Participants formed a consecutive sample. MNA-SF, NRS-2002, mNUTRIC, and PNI scores were used to evaluate nutritional assessment. Patients' lab results and pulse oximetric saturation SpO₂/FiO₂ (SF) ratio at the time of intensive care unit (ICU) admission were collected. Patients were screened for nutritional status and categorized into two groups, patients at nutritional risk and nonrisk.

Results

Sixty-five (59.1%) of all patients were men. The overall range of age was 52 ± 15. Thirty-six (32.7%) of patients were obese (BMI ≥ 30). The hospital mortality rate was 59.1% (n = 65). According to the different criteria, malnutrition rate was 67.3% (n = 74) (NRS), 28.2% (n = 31) (MNA), 34.5% (n = 38) (mNUTRIC), and 58.2% (n = 64) (PNI). There was a statistically significant association between chronic kidney disease (CKD) and mNUTRIC risk (OR = 13.5, 95% CI (1.89-16.05), P=0.002), diabetes mellitus (DM) and MNA risk (OR = 2.82, 95% CI (1.01-7.83), P=0.041), hypertension (HTN) and MNA risk (OR = 5.63, 95% CI (2.26-14.05), P < 0.001), and malignancy and mNUTRIC risk (P=0.048). The nutritional risk (all tools) significantly increased the odds of in-hospital death and need for mechanical ventilation. The length of stay was not significantly different in malnourished patients.

Conclusion

In the critical care setting of COVID-19 patients, malnutrition is prevalent. Malnutrition (nutritional risk) is associated with an increased risk of need for mechanical ventilation and in-hospital mortality. Patients with a history of HTN, CKD, DM, and cancer are more likely to be at nutritional risk at the time of ICU admission.

Severe COVID-19 Is Characterised by Perturbations in Plasma Amines Correlated with Immune Response Markers, and Linked to Inflammation and Oxidative Stress

The COVID-19 pandemic raised a need to characterise the biochemical response to SARS-CoV-2 infection and find biological markers to identify therapeutic targets. In support of these aims, we applied a range of LC-MS platforms to analyse over 100 plasma samples from patients with varying COVID-19 severity and with detailed clinical information on inflammatory responses (>30 immune markers). The first publication in a series reports the results of quantitative LC-MS/MS profiling of 56 amino acids and derivatives. A comparison between samples taken from ICU and ward patients revealed a notable increase in ten post-translationally modified amino acids that correlated with markers indicative of an excessive immune response: TNF-alpha, neutrophils, markers for macrophage, and leukocyte activation. Severe patients also had increased kynurenine, positively correlated with CRP and cytokines that induce its production. ICU and ward patients with high IL-6 showed decreased levels of 22 immune-supporting and anti-oxidative amino acids and derivatives (e.g., glutathione, GABA). These negatively correlated with CRP and IL-6 and positively correlated with markers indicative of adaptive immune activation. Including corresponding alterations in convalescing ward patients, the overall metabolic picture of severe COVID-19 reflected enhanced metabolic demands to maintain cell proliferation and redox balance, alongside increased inflammation and oxidative stress.

The Impact of the Highly Virulent SARS-CoV-2 Gamma Variant on Young Adults in the State of São Paulo: Was It Inevitable?

Background

The coronavirus disease 2019 (COVID-19) pandemic had and is still having a tremendous impact on people all over the world, but it has been particularly harsh in South America. Nine out of 13 South American countries are among the 50 countries with the highest COVID-19 death rates. The gamma severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant that emerged by the end of 2020 in the Brazilian Amazon quickly spread throughout the country causing the harsh COVID-19 second wave. This variant displayed high viral loads, high transmissibility, and increased virulence as compared to previous variants.

Aims

The aim of this retrospective study is to revisit and analyse the epidemiology of the COVID-19 second wave in the state of São Paulo, the most populous Brazilian state. In addition to examining the possible factors that led to the emergence and propagation of the gamma variant, measures that could have prevented its spread and that of other highly virulent variants were also investigated.

Materials and methods

Data from São Paulo's official sources on morbidity, mortality, age distribution, and testing prior to and during the COVID-19 second wave (February - June 2021) and data regarding the distribution of SARS-CoV-2 variants in the country were parsed, analyzed, and compared to the period that anteceded the eruption of the second COVID-19 wave.

Results

In the state of São Paulo, the toll of the COVID-19 second wave surpassed that of the first 11 months of the pandemic (from March 2020 to January 2021), as 56% of the deaths occurred in the five months of the second wave between February and June 2021. The mean age of COVID-19 victims, which was already below life expectancy in the state dropped even further in the pandemic's second wave, reaching an average of 60 years of age. The years of life lost per death per month doubled and the case-fatality rate (CFR) of young adults (20-39 years old) more than trebled during this period. A number of hypotheses have been raised that might explain the emergence and spread of the gamma variant and the measures that could have been taken to prevent it and minimise its impact on the population.

Conclusions

Over 142,000 people died as a result of the SARS-CoV-2 gamma variant sweep in São Paulo in the first semester of 2021. Due to its high viral load, the gamma variant displayed high transmissibility and a high degree of virulence resulting in increased case fatality rates across most age tiers. Notably, this second wave was marked by a very significant increase in deaths among young adults. This increase was at least partially due to a deterioration in general health provoked by non-pharmaceutical interventions. In hindsight, a safer and more effective measure might have been to allow the free spread of the virus among the young and healthy in the first wave, thus conferring immunity against more virulent variants that emerged later on.

Reviving the mutual impact of SARS-COV-2 and obesity on patients: From morbidity to mortality

Obesity-related metabolic dysfunction, endothelium imbalance, chronic inflammation, immune dysregulation, and its comorbidities may all have a role in systemic inflammation, leading to the pulmonary fibrosis and cytokine storm, which leads to failure of lung function, which is a hallmark of severe SARS-CoV-2 infection. Obesity may also disrupt the function of mucociliary escalators and cooperation of epithelial cell's motile cilia in the airway, limiting the clearance of the coronavirus that causes severe acute respiratory syndrome (SARS-CoV-2). Adipose tissues in obese patients have a greater number of proteases and receptors for SARS-CoV-2 admittance, proposing that they could serve as an accelerator and reservoir for this virus, boosting immunological response and systemic inflammation. Lastly, anti-inflammatory cytokines such as anti-IL-6 and the infusion of mesenchymal stem cells could be used as a modulation therapy of immunity to help COVID-19 patients. Obesity, on the other hand, is linked to the progress of COVID-19 through a variety of molecular pathways, and obese people are part of the SARS-CoV-2 susceptible individuals, necessitating more protective measures.

Mortality Analysis of Patients with COVID-19 in Mexico Based on Risk Factors Applying Machine Learning Techniques

The new pandemic caused by the COVID-19 virus has generated an overload in the quality of medical care in clinical centers around the world. Causes that originate this fact include lack of medical personnel, infrastructure, medicines, among others. The rapid and exponential increase in the number of patients infected by COVID-19 has required an efficient and speedy prediction of possible infections and their consequences with the purpose of reducing the health care quality overload. Therefore, intelligent models are developed and employed to support medical personnel, allowing them to give a more effective diagnosis about the health status of patients infected by COVID-19. This paper aims to propose an alternative algorithmic analysis for predicting the health status of patients infected with COVID-19 in Mexico. Different prediction models such as KNN, logistic regression, random forests, ANN and majority vote were evaluated and compared. The models use risk factors as variables to predict the mortality of patients from COVID-19. The most successful scheme is the proposed ANN-based model, which obtained an accuracy of 90% and an F1 score of 89.64%. Data analysis reveals that pneumonia, advanced age and intubation requirement are the risk factors with the greatest influence on death caused by virus in Mexico.

More Active Intestinal Immunity Developed by Obese Mice Than Non-Obese Mice After Challenged by Escherichia coli

Obese mice presented lower mortality to non-fatal pneumonia induced by Escherichia coli (E. coli) than the non-obese mice. However, it remained obscure whether the intestine contributed to the protective effect of obese mice with infection. The 64 non-obese (NOB) mice were divided into NOB-uninfected and NOB-E. coli groups, while 64 high-fat diet-induced obesity (DIO) mice were divided into DIO-uninfected and DIO-E. coli groups. Mice in E. coli groups were intranasally instilled with 40 μl E. coli (4.0 ×109 colony-forming units [CFUs]), while uninfected groups with the same volume of phosphate buffer saline (PBS). The T subsets of Intraepithelial lymphocytes (IELs) and lamina propria lymphocytes (LPLs) in the intestine were collected for flow cytometry analysis at 0, 12, 24, and 72 h post-infection, also the duodenum and colon were harvested to survey histopathological change. The results showed that the percentage of CD3+T cells in LPLs in DIO-E. coli group was significantly lower than that in the DIO-uninfected group after infection (p &lt; 0.05). The percentage of CD4+T cells in IELs in NOB-E. coli was significantly lower than that in DIO-E. coli after infection (p &lt; 0.05). The percentage of CD8+T cells in LPLs in NOB-E. coli was significantly lower than that in DIO-E. coli at 12 and 24 h (p &lt; 0.05). The immunoglobulin A (IgA)+ cells in DIO-uninfected were higher than that in NOB-uninfected at all time points (p &lt; 0.05). The IgA+ cells in DIO-E. coli were higher than that in DIO-uninfected at 12, 24, and 72 h (p &lt; 0.05). The results revealed that the level of intestinal mucosal immunity in obese mice was more active than that in non-obese mice.

The Effects of Exercise Therapy Moderated by Sex in Rehabilitation of COVID-19

Standardized exercise therapy programs in pulmonary rehabilitation have been shown to improve physical performance and lung function parameters in post-acute COVID-19 patients. However, it has not been investigated if these positive effects are equally beneficial for both sexes. The purpose of this study was to analyze outcomes of a pulmonary rehabilitation program with respect to sex differences, in order to identify sex-specific pulmonary rehabilitation requirements. Data of 233 post-acute COVID-19 patients (40.4% females) were analyzed before and after a three-week standardized pulmonary rehabilitation program. Lung function parameters were assessed using body-plethysmography and functional exercise capacity was measured by the Six-Minute Walk Test. At post-rehabilitation, females showed a significantly smaller improvement in maximal inspiration capacity and forced expiratory volume (F=5.86, ω ²⁼ .02; p<0.05) than males. Exercise capacity improvements between men and women did not differ statistically. Females made greater progress towards reference values of exercise capacity (T(231)=−3.04; p<0.01) and forced expiratory volume in the first second (T(231)=2.83; p<0.01) than males. Sex differences in the improvement of lung function parameters seem to exist and should be considered when personalizing standardized exercise therapies in pulmonary rehabilitation.

Willingness to receive COVID-19 vaccination in people living with HIV/AIDS from Latin America

BACKGROUND

Prior research has established some risk factors for an increased risk of severe disease and mortality from coronavirus disease 2019 (COVID-19). However, the impact of HIV infection on SARS-CoV-2 susceptibility and severity is a significant gap in the literature. In the same way, not many studies across the globe have analyzed the degree of vaccination willingness among people living with HIV/AIDS (PLWHA) and considerations regarding prioritizing this population during vaccination plans, particularly in developing countries.

METHODS

A descriptive-analytical cross-sectional study was conducted. Self-completed electronic surveys directed to PLWHA were performed via Twitter in February 2021, using accounts of HIV activists.

RESULTS

460 (87.1%) participants were willing to be vaccinated with any COVID-19 vaccine. The reasons for that were listed as 1) the belief that vaccination prevents both the COVID-19 infection (81.3%) as well as being a spreader (52.2%); 2) having a high occupational risk of becoming infected with COVID-19 (22%); and 3) the belief that they would be at high risk of death because of COVID-19 (21.3%). Only 56 (10.6%) participants expressed hesitancy toward vaccination, and 12 (2.2%) stated they did not want to get vaccinated.

CONCLUSIONS

Our results may support the prioritization of people living with HIV during the implementation of vaccination plans in developing countries. New strategies should be adopted to overcome the hesitancy and unwillingness toward the COVID-19 vaccination, especially in populations with risk factors for severe disease.

Inequalities in Trust Levels and Compliance With Physical Distancing During COVID-19 Outbreaks: Comparing the Arab Minority and Jewish Populations in Israel

Objectives: This study explores associations between trust in directives and compliance with physical distancing by comparing two populations in Israel. Methods: Following two lockdowns, we conducted two cross-sectional surveys among the Arab minority and Jewish citizens of Israel (first survey, N = 613; second survey, N = 542). We conducted multivariable logistic regression analyses for the association between trust and compliance with physical distancing separately for each group in each survey. Results: In both surveys trust levels were significantly lower among Arabs than Jews (p < 0.001). Compared to Jews, Arabs were less likely to report compliance with physical distancing in the first and second surveys (OR = 0.52, 95% CI 0.32-0.84 and OR = 0.62, 95% CI 0.39-0.98, respectively). In both surveys trusting the directives was an important determinant of compliance with physical distancing among Jews only. Conclusion: Our findings indicate that momentum is important in building and maintaining public trust and compliance during pandemics. Policymakers should note the lack of trust among Arabs, which warrants further research and interventions.

Nutrition intervention in the management of novel coronavirus pneumonia patients

In this study, we explored the effect of nutrition intervention on the management of patients with novel coronavirus pneumonia (NCP). A total of 28 NCP patients receiving therapy in Ningbo First Hospital (China) were enrolled in this study. The nutrition risk was assessed using the Nutritional Risk Screening (NRS)-2002 for the patients subjected to nutrition intervention provided by the Nutritional Department in Ningbo First Hospital, China. Compared to the situation at admission, the body mass index (BMI) and weight of NCP patients were higher at the time of discharge, while no significant difference was observed (P > 0.05). The serum albumin and hemoglobin levels of NCP patients were significantly increased compared with those at admission and one week after admission (P < 0.05). The nutrition intervention can improve the nutritional status and prognosis of NCP patients.

Evaluating Possible Mechanisms Linking Obesity to COVID-19: a Narrative Review

Currently, pneumonia caused by the coronavirus disease 2019 (COVID-19) is a pandemic. To date, there is no specific antiviral treatment for the disease, and universal access to the vaccine is a serious challenge. Some observational studies have shown that COVID-19 is more common in countries with a high prevalence of obesity and that people with COVID-19 have a higher body mass index. In these studies, obesity increased the risk of disease, as well as its severity and mortality. This study aimed to review the mechanisms that link obesity to COVID-19.

Interrelationship between 2019-nCov receptor DPP4 and diabetes mellitus targets based on protein interaction network

Patients with diabetes are more likely to be infected with Coronavirus disease 2019 (COVID-19), and the risk of death is significantly higher than ordinary patients. Dipeptidyl peptidase-4 (DPP4) is one of the functional receptor of human coronavirus. Exploring the relationship between diabetes mellitus targets and DPP4 is particularly important for the management of patients with diabetes and COVID-19. We intend to study the protein interaction through the protein interaction network in order to find a new clue for the management of patients with diabetes with COVID-19. Diabetes mellitus targets were obtained from GeneCards database. Targets with a relevance score exceeding 20 were included, and DPP4 protein was added manually. The initial protein interaction network was obtained through String. The targets directly related to DPP4 were selected as the final analysis targets. Importing them into String again to obtain the protein interaction network. Module identification, gene ontology (GO) analysis and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis were carried out respectively. The impact of DPP4 on the whole network was analyzed by scoring the module where it located. 43 DPP4-related proteins were finally selected from the diabetes mellitus targets and three functional modules were found by the cluster analysis. Module 1 was involved in insulin secretion and glucagon signaling pathway, module 2 and module 3 were involved in signaling receptor binding. The scoring results showed that LEP and apoB in module 1 were the highest, and the scores of INS, IL6 and ALB of cross module associated proteins of module 1 were the highest. DPP4 is widely associated with key proteins in diabetes mellitus. COVID-19 may affect DPP4 in patients with diabetes mellitus, leading to high mortality of diabetes mellitus combined with COVID-19. DPP4 inhibitors and IL-6 antagonists can be considered to reduce the effect of COVID-19 infection on patients with diabetes.