Body Mass Index: Obesity, BMI, and Health: A Critical Review

Efficacy and safety of acupuncture for weight management: A systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Obesity is a chronic health problem worldwide, leading to an increased focus on weight management. Acupuncture is widely used in weight loss as traditional and complementary medicine because of its economy, simplicity, and safety. This study aimed to identify the latest evidence on acupuncture for weight loss and evaluate the efficacy and safety of the included randomized controlled trials (RCTs).

METHODS

Seven databases were searched to identify RCTs published since January 2013 on using acupuncture for weight management. The STRICTA, CONSORT, and Cochrane Collaboration's Risk of Bias tools were used to evaluate the included trials' quality and risk of bias. All eligible trials were included in this meta-analysis.

RESULTS

Sixty-four trials were included. Compared to control groups, acupuncture had a significant effect on BMI (mean difference (MD) = -2.15, 95 % confidence interval (CI) = -2.86 to -1.44, P < 0.01), body weight (MD = -2.67, 95 % CI = -4.07 to -1.28, P < 0.01), waist circumference (MD = -3.61, 95 % CI = -4.72 to -2.50, P < 0.01), and some blood test indicators. Serious adverse events were not observed. However, the quality of the included trials was generally poor, and the risk of bias was uncertain.

CONCLUSIONS

Our study showed that acupuncture is effective for weight management. However, there are no clear conclusions regarding its safety. Studies of higher quality and longer duration are needed to improve the evidence base of acupuncture in weight management for clinical reference.

Association Between Prevention Focus and Sedentary Behavior in Older Adults: Cross-Sectional Study

Background

Older adults engage in increased amounts of sedentary behavior (SB), which can result in a significant decline in muscle function and overall health. An understanding of the motivational driving factors that lead older adults to engage in SB can help to create effective intervention programs.

Objective

This study aimed to determine the association between prevention and promotion focus with SB in older adults, as well as compare these associations with two factors (ie, age and BMI) that are commonly known to have an association with SB among older adults.

Methods

A cross-sectional analysis was conducted among 93 community-dwelling older adults with a mean age of 74.98 (SD 6.68) years. Prevention and promotion focus were both assessed using the Regulatory Focus Questionnaire. Correlation analysis was performed to determine the associations between prevention focus, promotion focus, age, and BMI with SB. Anderson-Darling tests confirmed nonnormal data distributions for all factors (except age); therefore, Spearman rank correlation was used to determine correlations between factors. Comparative analysis of significant correlations was performed using Fisher Z transformation.

Results

Prevention focus had the greatest statistically significant correlation with SB (ρ=0.296; P=.004), followed by BMI (ρ=0.204; P=.049). Both age (ρ=0.116; P=.27) and promotion focus (ρ=0.002; P=.99) had statistically insignificant correlations with SB, indicating no associations. The correlation between prevention focus and SB did not significantly differ from the correlation between BMI and SB (P=.51).

Conclusions

Prevention focus was found to have a weak, but significant positive association with SB in older adults. Although age and BMI have been found to have an association with SB in previous literature, age was not associated with SB in this study, while BMI had a significant but relatively weaker association with SB than that with prevention focus. However, the association found between BMI and SB did not statistically differ from the association found between prevention focus and SB. These findings suggest that older adults could be driven to engage in increased amounts of SB due to having a dominant prevention focus, which revolves around thoughts of safety and avoiding negative consequences. The recognition of this association has the potential to aid in developing intervention programs that could promote shifting from prevention to promotion focus, thereby reducing SB in older adults.

Associations between the neural-hematopoietic-inflammatory axis and DNA methylation of stress-related genes in human leukocytes: Data from the Washington, D.C. cardiovascular health and needs assessment

Chronic stress is associated with cardiovascular disease (CVD) risk and elevated amygdala activity. Previous research suggests a plausible connection between amygdala activity, hematopoietic tissue activity, and cardiovascular events; however, the underlying biological mechanisms linking these relationships are incompletely understood. Chronic stress is thought to modulate epigenomic modifications. Our investigation focused on associations between amygdala activity (left (L), right (R), maximum (M), and average (Av) AmygA), and splenic (SpleenA), and bone marrow activity (BMA) as determined by 18Fluorodeoxyglucose (FDG) on Positron Emission Tomography/Computed Tomography (PET/CT) scans. Subsequently, we assessed how these markers of chronic stress and hematopoietic activity might relate to the DNA methylation of stress-associated genes in a community-based cohort of African American individuals from Washington D.C. at risk for CVD. To assess the relationships between AmgyA, SpleenA, BMA, and DNA methylation, linear regression models were run and adjusted for body mass index and 10-year predicted atherosclerotic CVD risk. Among 60 participants (93.3% female, mean age 60.8), M-AmygA positively associated with SpleenA (β = 0.29; p = 0.001), but not BMA (β = 0.01; p = 0.89). M-AmygA (β = 0.37; p = 0.01 and β = 0.31; p = 0.02, respectively) and SpleenA (β = 0.73; p < 0.01 and β = 0.59; p = 0.005, respectively) were associated with both IL-1β and TNFα. Decreased M-AmygA, SpleenA, IL-1β, and TNFα were associated with methylation of NFκB1 at cg07955720 and STAT3 at cg19438966. Our findings suggest a potential association between AmygA, SpleenA, and pro-inflammatory cytokines in the setting of chronic stress, suggesting an adverse hematopoietic effect. Furthermore, findings reveal associations with epigenetic markers of NFκB and JAK/STAT pathways linked to chronic stress.

White matter microstructure in obesity and bipolar disorders: an ENIGMA bipolar disorder working group study in 2186 individuals

Although specific risk factors for brain alterations in bipolar disorders (BD) are currently unknown, obesity impacts the brain and is highly prevalent in BD. Gray matter correlates of obesity in BD have been well documented, but we know much less about brain white matter abnormalities in people who have both obesity and BD. We obtained body mass index (BMI) and diffusion tensor imaging derived fractional anisotropy (FA) from 22 white matter tracts in 899 individuals with BD, and 1287 control individuals from 20 cohorts in the ENIGMA-BD working group. In a mega-analysis, we investigated the associations between BMI, diagnosis or medication and FA. Lower FA was associated with both BD and BMI in six white matter tracts, including the corpus callosum and thalamic radiation. Higher BMI or BD were uniquely associated with lower FA in three and six white matter tracts, respectively. People not receiving lithium treatment had a greater negative association between FA and BMI than people treated with lithium in the posterior thalamic radiation and sagittal stratum. In three tracts BMI accounted for 10.5 to 17% of the negative association between the number of medication classes other than lithium and FA. Both overweight/obesity and BD demonstrated lower FA in some of the same regions. People prescribed lithium had a weaker association between BMI and FA than people not on lithium. In contrast, greater weight contributed to the negative associations between medications and FA. Obesity may add to brain alterations in BD and may play a role in effects of medications on the brain.

A systematic review of evidence that environmental contaminant exposure impedes weight loss and glycemic control during calorie-restricted diets in humans

Calorie-restricted diets cause weight loss and can drive type 2 diabetes remission. However, many patients struggle to achieve clinically relevant weight loss, and the reasons are not well understood. Chemical exposure is associated with obesity and type 2 diabetes development, and some evidence from preclinical experiments suggests it can limit the clinical benefits of calorie restriction. We systematically reviewed the evidence for the effects of environmental chemical exposure on mass loss and glycemic control during diet-induced weight management in humans (PROSPERO: CRD42022339993). Of 222 unique citations, only six papers directly examined this question. Only one targeted people with type 2 diabetes. One linked phthalates and parabens, but not bisphenols, with slower fat loss. Two showed per- and polyfluoroalkyl substances were not associated with mass loss, but with faster subsequent mass regain. One linked impaired adiposity improvements with air pollutants. Two papers reported weight loss-induced elevation in plasma organochlorines associated with altered glycemic control. The risk of bias largely arose from the potential for deviation from the intended diet, and statistics and reporting. The role of chemical exposure in impeding the effectiveness of weight management programs needs to be better understood to provide suitable support to people living with obesity and type 2 diabetes.

Liver steatosis is positively associated with plasminogen activator inhibitor-1 in apparently healthy individuals with overweight and obesity: A FibroScan-Based Cross-Sectional study

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common cause of steatotic liver disease and has major implications on cardiovascular safety.

STUDY AIMS

As the precise role linking MASLD to cardiovascular diseases is still unclear, the present study aims to investigate the association between liver steatosis and fibrosis and circulating plasminogen activator inhibitor-1 (PAI-1) levels.

METHODS

Eighty-two patients (41.6 ± 12.4 yrs, 34 men, 41%), naïve to medications, who attended the Nutrition Center for the Research and Care of Obesity and Metabolic Diseases at the National Institute of Gastroenterology "Saverio de Bellis" for weight management, were cross-sectionally evaluated. Demographic, anthropometric, clinic, and laboratory data were collected and analyzed. All patients underwent liver ultrasonographic assessment by FibroScan to diagnose liver steatosis (controlled attenuation parameter or CAP > 275 dBm) and fibrosis (liver stiffness > 8.2 kPa).

RESULTS

Sixty-one individuals (74.4%) had liver steatosis, and 17 (20.7%) had liver fibrosis. PAI-1 mean levels were 3,261 ± 1,270 pg/mL, mean body mass index (BMI) and waist circumference (WC) values were 36.6 ± 7.1 kg/m2 and 114.1 ± 16.5 cm, respectively. Mild systolic and diastolic arterial pressure elevation and significantly high values of fasting plasma insulin (19.6 ± 12.6 IU/mL) and homeostatic model assessment of insulin resistance or HOMA-IR (4.8 ± 3.5) were also found. CAP values were correlated with several anthropometric, clinical, and laboratory parameters of insulin resistance. We found a significant association between PAI-1 and CAP (β = 1.605; p = 0.004), and noteworthily, when PAI-1 increased by 100 units, the expected variation of CAP values was by + 1.6 units (p = 0.004). Notably, the association was independent of gender, age, and insulin resistance.

DISCUSSION

Circulating PAI-1 levels are correlated with liver steatosis and, to a lesser extent, fibrosis in apparently healthy patients with a BMI ≥ 25 kg/m2. This is the first study to show these results in patients naïve to medications, using FibroScan assessment. The bidirectional relationship between circulating PAI-1 levels and CAP measurement highlights the relevance of our research from a diagnostic and pathophysiological-prognostic viewpoint. Longitudinal trials are needed to clarify the cause-effect association between MASLD and PAI-1 levels.

Prevalence of sarcopenia and its association with clinical features and health-related quality of life in Brazilian women with systemic lupus erythematosus

OBJECTIVES

To assess the prevalence of sarcopenia and examine its association with clinical features, health-related quality of life (HRQoL), muscle-specific strength and body composition in patients with systemic lupus erythematosus (SLE).

METHODS

In this cross-sectional multicentre study, women with SLE (18-50 years old) were included. Data collected included clinical features and HRQoL. Muscle strength was assessed using the handgrip test (kg), appendicular skeletal muscle mass index (ASMI, kg/m²) was measured using dual-energy X-ray absorptiometry. Physical performance was assessed using the timed-up-and-go test (TUG, seconds). Sarcopenia was defined by the European Working Group on Sarcopenia in Older People-2 criteria. The muscle-specific strength was evaluated by dividing their arm strength by their lean arm mass. Pearson's or Spearman's correlation coefficients were performed (accepted at p<0.05).

RESULTS

Seventy-three SLE women were included, with median (IQR) age and disease duration of 37 (30-44) years old and 10.0 (4.0-16.8) years, respectively. Most of the patients (83.5%) had inactive or low disease activity and 31.0% presented a disease damage index score ≥1. Mean (±SD) handgrip strength, ASMI and muscle-specific strength was 25.58±8.31 kg, 6.62±0.97 kg/m² and 6.6±2.3, respectively. Median TUG was 6.9 (6.1-8.2) s. The prevalence of probable sarcopenia was 11.1%, and sarcopenia was 2.7%. Lower muscle strength, lower muscle-specific strength and lower physical performance, as well as sarcopenia, were correlated with worse HRQoL (p<0.05).

CONCLUSION

In Brazilian patients with SLE with inactive or low disease activity, the prevalence of sarcopenia was low. However, low muscle strength, low muscle-specific strength and low physical performance were correlated with worse HRQoL, emphasising the need for muscle strength assessments in SLE management.

The Effect of the L-Carnitine Supplementation on Obesity Indices: An Umbrella Meta-Analysis

AIMS

Obesity, one of the most frequent health risks, represents a global public health problem. The potential impact of L-carnitine, a vital nutrient for energy metabolism, on weight loss is worth considering. However, given the inconclusive results from recent meta-analyses on L-carnitine, we conducted an umbrella meta-analysis of placebo-controlled and controlled trials to evaluate the effect of L-carnitine on anthropometric indices.

METHODS

Data synthesis: A comprehensive search approach using the relevant keywords was performed in PubMed, Web of Science, Scopus databases, and Google Scholar up to March 2023. Meta-analyses published in English that provided quantitative statistical analyses regarding the effects of L-carnitine on body weight, waist circumference (WC), and body mass index (BMI) were included. A random-effects model and subgroup analysis were performed based on the L-carnitine dosage and study population.

RESULTS

A total of 16,352 participants were included. Intervention durations ranged from 8 to 30 weeks, with L-carnitine dosages ranging between 150 and 4000 mg/day. The pooled results of the eight included meta-analyses indicated that L-carnitine supplementation can significantly decrease weight (effect size (ES) = -1.11; 95% confidence intervals (CIs): -1.90, -0.33, p = 0.005; I2 = 90.6%, p < 0.001), BMI (ES = -0.33; 95% CI: -0.61, -0.04, p = 0.026; I2 = 89.8%, p < 0.001), and WC (ES = -1.34; 95% CI: -1.83, -0.85, p < 0.001; I2 = 00.0%, p = 0.442).

CONCLUSION

The findings of this umbrella meta-analysis support that supplementation of L-carnitine supplementation can successfully manage weight, BMI, and WC reduction. Therefore, L-carnitine might help treat obesity. PROSPERO Registration Number: CRD42022307951.

Cardiovascular Health Trajectories and Prevalent Metabolic Dysfunction-Associated Steatotic Liver Disease in Midlife: The CARDIA Study

BACKGROUND

Metabolic-dysfunction associated steatotic liver disease (MASLD) is associated with prevalent cardiovascular disease. More favorable cardiovascular health (CVH) profiles are associated with a lower prevalence of MASLD in cross-sectional studies. The relationship between long-term CVH patterns and MASLD prevalence in midlife remains unknown.

METHODS AND RESULTS

Participants (aged 18-30 years at baseline) of the CARDIA (Coronary Artery Risk Development in Young Adults) study who had individual CVH components measured at 7 examinations over 20 years and liver fat assessed by noncontrast computed tomography at year 25 follow-up were included. CVH score was defined using published American Heart Association definitions. Group-based trajectory modeling was used to identify CVH trajectories. MASLD was defined as liver attenuation of ≤51 Hounsfield units with at least 1 metabolic risk factor after excluding other causes of liver fat. Logistic regression was used to examine associations of CVH trajectory groups and MASLD prevalence. At baseline, 39% of 2529 participants had high and 5% had low CVH, respectively. MASLD prevalence at year 25 was 23% (n=587). Five distinct CVH trajectories were identified. Between the 2 groups that started at similar CVH scores, those whose CVH declined over time had a higher prevalence of MASLD at year 25 (7.0% in high-stable versus 23.0% high-decreasing; 24.4% in moderate-stable versus 35.7% in moderate-decreasing). Lower and decreasing trajectories were associated with higher year-25 MASLD prevalence compared with the high-stable trajectory.

CONCLUSIONS

Achieving and maintaining high CVH scores starting in young adulthood lowers the risk of prevalent MASLD in midlife.

AcuSim: A Synthetic Dataset for Cervicocranial Acupuncture Points Localisation

The locations of acupuncture points (acupoints) differ among human individuals due to variations in factors such as height, weight and fat proportions. However, acupoint annotation is expert-dependent, labour-intensive, and highly expensive, which limits the data size and detection accuracy. In this paper, we introduce the "AcuSim" dataset as a new synthetic dataset for the task of localising points on the human cervicocranial area from an input image using an automatic render and labelling pipeline during acupuncture treatment. It includes a creation of 63,936 RGB-D images and 504 synthetic anatomical models with 174 volumetric acupoints annotated, to capture the variability and diversity of human anatomies. The study validates a convolutional neural network (CNN) on the proposed dataset with an accuracy of 99.73% and shows that 92.86% of predictions in validation set align within a 5mm threshold of margin error when compared to expert-annotated data. This dataset addresses the limitations of prior datasets and can be applied to applications of acupoint detection and visualization, further advancing automation in Traditional Chinese Medicine (TCM).

Association of maternal psychological distress and milk cortisol with infant temperament and growth

During psychological distress, breastmilk cortisol levels are increased and may affect infant temperament and behavior. We studied the association of maternal psychological distress and milk cortisol with infant temperament and growth. Using a cross-sectional design, 140 mother-infant dyads were studied. Infants were 3-4 months old and were exclusively breastfed. Maternal psychological distress and infant temperament were assessed by the depression, anxiety, and stress scale and infant behavior questionnaires, respectively. Milk cortisol concentrations and growth indices were determined. Maternal obesity and infant growth indicators did not show significant associations with the severity of maternal distress. Negative emotionality of infants had the most frequent and strongest association with maternal psychological distress: depression (b = 5.38; 95% CI 3.04, 7.72; P < 0.001), anxiety (b = 6.01; 95% CI 3.70, 8.32; P < 0.001), and stress (b = 4.10; 95% CI 2.74, 5.45; P < 0.001). The association existed both directly and indirectly through the mediating effect of breastmilk cortisol. Regulatory capacity was positively associated with maternal depression (b = 3.73; 95% CI 1.10, 6.37; P = 0.006) and anxiety (b = 3.02; 95% CI 0.33, 5.71; P = 0.030), but the association was not mediated by milk cortisol. Surgency was not associated with maternal depression, but it had negative associations with maternal anxiety and stress. Infant temperament was also reciprocally associated with maternal emotional states and breastmilk cortisol concentrations. Overall, this study highlighted associations between maternal psychological distress and infant mood and temperament, emphasizing the mediating effect of breastmilk cortisol.

Potential Association Between Atherogenic Coefficient, Prognostic Nutritional Index, and Various Obesity Indices in Diabetic Nephropathy

Background/Objectives: Type 2 diabetes mellitus (T2DM), is a rapidly growing global health concern, often accompanied by chronic kidney disease (CKD) and metabolic disturbances. Obesity-related indices, such as the visceral adiposity index (VAI) and body adiposity index (BAI), have been linked to cardiovascular and renal complications in diabetic patients. However, studies integrating both the atherogenic coefficient (AC) and prognostic nutritional index (PNI) for evaluating diabetic nephropathy (DN) remain limited. This study aimed to assess the associations of obesity-related indices with immunological and nutritional factors in patients with T2DM and prediabetes (PreDM). Methods: A retrospective, cross-sectional study was conducted over six months at a university clinical hospital in Dolj County, Romania. The study enrolled 268 newly diagnosed T2DM patients and 150 PreDM patients. Anthropometric parameters, laboratory tests, and demographic data were collected. AC and PNI were calculated using standard formulas, and statistical analyses were performed to determine their associations with metabolic and inflammatory markers. Results: Our study found that T2DM patients had significantly lower PNI values, indicating mild malnutrition, while PreDM patients maintained a normal nutritional status. AC was significantly higher in T2DM patients, correlating with lipid profile alterations and systemic inflammation. Obesity indices, particularly VAI, were significantly elevated in T2DM patients with higher AC values. Statistically significant differences in total cholesterol, low-density lipoprotein cholesterol (LDL-c), and triglycerides were observed between AC subgroups, reinforcing its role in cardiovascular risk assessment. Conclusions: The findings highlight the potential of AC and PNI as biomarkers for assessing nutritional, inflammatory, and lipemic status in diabetic patients. The significant associations between obesity-related indices, lipid profiles, and inflammation markers suggest that early assessment of these parameters may potentially aid in predicting diabetic complications. Further studies are needed to explore the clinical utility of AC and PNI in managing T2DM and CKD progression. Future research should investigate how the lipidic spectrum alters the progression of DN across various patient groups with diabetes and prediabetes.

The effect of fibrinogen levels on three-month neurological recovery in acute ischemic stroke patients

The present study aims to examine the relationship between post-stroke fibrinogen levels and long-term (three-month) prognosis in patients who had their first ischemic stroke and to determine the effect of fibrinogen levels on morbidity and mortality. A prospective study was carried out on 100 patients presenting with their first ischemic stroke at the Neurology Clinic of Gaziantep City Hospital. Stroke severity was examined utilizing the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) at initial admission and at third month post-stroke. Serum fibrinogen levels were recorded from routine blood tests, and the relationship between fibrinogen levels and clinical outcomes was analyzed statistically. Significant positive correlations were observed between fibrinogen levels and stroke severity and outcomes. Fibrinogen levels were associated with NIHSS admission scores (r = 0.371, p < 0.001) and mRS admission scores (r = 0.439, p < 0.001). At third month, fibrinogen levels were significantly related with NIHSS (r = 0.544, p < 0.001) and mRS (r = 0.538, p < 0.001) scores. Regression analysis revealed that a one-unit increase in fibrinogen levels resulted in a 0.018-unit increase in NIHSS scores and a 0.008-unit increase in mRS scores (p < 0.001). Elevated fibrinogen levels during the acute phase are related with poorer neurological outcomes and increased morbidity and mortality within the three-month follow-up period in patients with first-time ischemic stroke. These resultsindicate that fibrinogen could be considered a prognostic biomarker for stroke management and rehabilitation planning.

Dietary and lifestyle determinants of vitamin D status in the UK Biobank Cohort study for predictive modeling

BACKGROUND

Vitamin D (VD) is involved in a wide variety of physiological processes. The high prevalence of VD deficiency in the population requires stronger preventive measures.

OBJECTIVE

Characterize the dietary and lifestyle determinants of VD levels in blood and of VD deficiency to further develop predictive models of these two outcomes.

METHODS

63,759 participants from the UK Biobank study with available data on dietary intake of VD, assessed via 24-hour recalls, and with measurements of serum 25(OH)D levels. Linear and logistic regression models were applied to identify factors associated with VD levels and VD deficiency outcomes, and to evaluate the influence of covariates on the association between VD in serum and VD in the diet. Predictive models were constructed using classical regression models and machine learning methods based on penalized likelihood methods.

RESULTS

Approximately 10% of the participants had VD deficiency (VD < 25 nmol/L), and 38.9% were at risk of VD inadequacy (VD 25-49 nmol/L). The dietary intake of VD was significantly lower in the VD deficient group. This latter group showed lower engagement in physical activity (22.1%) compared to the non-deficient group (13.4%; p < 0.001). Also, overweight and obesity (vs normal weight) were related to a greater likelihood of VD deficiency (OR = 1.18 and 1.96, respectively). A similar odds of VD deficiency was observed for abdominal obesity (OR = 1.83). A weaker association was observed between dietary VD intake, based on participant reports, and VD levels. With regard to sunlight exposure, darker skin tones (OR dark vs fair skin = 3.11), season (OR winter vs autumn = 3.76) and less outdoor time activities (OR per 1 hour increase = 0.96) were also related to VD deficiency. Predictive models for both classical regression and machine learning, showed good accuracy (AUC = 0.8-0.9 for VD deficiency).

CONCLUSIONS

While a rich diet in VD boosts its levels, sun exposure plays a more significant role particularly in populations from the UK or Northern Europe. A predictive model including key determinants could effectively assess VD deficiency.

North Carolina Healthy Active Living: Describing a Wellness Coaching Program for First-Episode Psychosis Clinics

Cardiovascular disease presents a ten-fold higher risk of death than suicide in individuals with serious mental illness. Individuals experiencing first-episode psychosis already have high rates of modifiable risk factors contributing to cardiovascular disease. The initial 12 months are crucial for implementing behavioral interventions for effective risk factor modification and disease prevention. Coordinated Specialty Care (CSC) outpatient clinics provide multi-disciplinary team-based treatment for teens and young adults in the early stages of psychotic illness, significantly improving mental health outcomes and quality of life. However, these clinics lack support for addressing lifestyle behavior changes in their clients. The North Carolina Healthy Active Living (NC HeAL) program is an innovative clinical service offered to all CSC clients in this state. It offers personalized health and wellness coaching to help clients achieve meaningful health improvements. This paper provides a detailed description of the program's development, the target population and setting, the roles and skills of the NC HeAL team, program components and evidence-based program measures. Results of program measures, feasibility, acceptability, implementation, and fidelity will be published separately.

Psychometric evaluation of the problem areas in diabetes (PAID) scale among people with type 2 diabetes in Ethiopia: a tool validation study

OBJECTIVE

to assesses the psychometric properties of the Problem Area in Diabetes (PAID) scale for Ethiopian patients with type 2 diabetes.

RESULTS

The confirmatory factor analysis for the Ethiopian Problem Area in Diabetes (Eth-PAID) scales demonstrated good model fit to the one, two, three, and four factor structures. The one-factor model Eth-PAID-20 scale showed acceptable internal consistency (α = 0.82), but the "Diabetes distress" subscale of two, three, and four-factor structures partially satisfied the internal consistency (ranged α = 0.74-77). The Eth-PAID-20 scale correlated negatively with self-care efficacy (r = 0.131, P = 0.06) and positively with Fasting Blood Sugar (FBS) level (r = 0.02, P = 0.86), which implies poor convergent validity. Moreover, "lack of confidence," "food-related problem," and "support-related problem" subclasses of two, three, and four-factor models showed very weak convergent validity. Discriminative validity revealed that female patients (30.16 ± 13.11), t = - 2.73, p = 0.007, d = 0.4) and patients who lived alone (28.05 ± 12.98), t = 2.542, p = 0.021, d = 0.5) had significantly higher distress scores in Eth-PAID-20 as one factor model.

A Comparative Evaluation of Adiposity Indices for Predicting Visceral Adipose Tissue Magnitude: Insights from NHANES 2011-2018

Background and Aims: Visceral adipose tissue (VAT) is a key cardiometabolic risk factor. This study evaluates the association between VAT and adiposity indices and identifies reliable predictors of increased VAT. Methods: This cross-sectional study utilized data from 4696 participants in the National Health and Nutrition Examination Survey 2011-2018. VAT was measured via dual-energy X-ray absorptiometry. Adiposity indices included body mass index (BMI), waist circumference (WC), lipid accumulation product, visceral adiposity index, body shape index, body roundness index, and metabolic score for visceral fat (METS-VF). Correlation analysis, receiver operating characteristic curve analysis, and multivariate adaptive regression splines (MARS) modeling evaluated the performance of indices and identified key predictors of VAT. Results: All adiposity indices were significantly correlated with VAT (P < 0.001). Among them, METS-VF demonstrated the highest predictive performance for increased VAT (>130 cm2) followed by WC. Optimal cutoff values for METS-VF were 7.1 [areas under the curve (AUC): 0.887, 95% confidence interval (CI): 0.873-0.899] in men and 7.5 (AUC: 0.904, 95% CI: 0.891-0.916) in women. For WC, the cutoff values were 99.5 cm (AUC: 0.866, 95% CI: 0.851-0.879) in men and 96 cm (AUC: 0.883, 95% CI: 0.869-0.896) in women. MARS modeling identified race, age, WC, BMI, glucose, high-density lipoprotein cholesterol, and triglycerides as significant predictors of VAT, achieving an R2 of 75.2%. Conclusion: METS-VF demonstrated the highest predictive value among the indices evaluated for predicting increased VAT. It may serve as a valuable tool in assessing visceral obesity and associated cardiometabolic risks.

Differential Associations of Cigar, Pipe, and Smokeless Tobacco Use Versus Combustible Cigarette Use With Subclinical Markers of Inflammation, Thrombosis, and Atherosclerosis: The Cross-Cohort Collaboration-Tobacco Working Group

BACKGROUND

Understanding the associations of tobacco product use with subclinical markers is essential in evaluating health effects to inform regulatory policy. This is particularly relevant for noncigarette products (eg, cigars, pipes, and smokeless tobacco), which have been understudied because of their low prevalence in individual cohorts.

METHODS

This cross-sectional study included 98 450 participants from the Cross-Cohort Collaboration-Tobacco data set. Associations between the use of tobacco products and subclinical markers (high-sensitivity C-reactive protein, interleukin-6, fibrinogen, D-dimer, coronary artery calcium, carotid intima-media thickness, carotid plaque, and ankle-brachial index) were evaluated. The analyses used multivariable linear and logistic regression models to examine current use status for each product, with additional analyses of "sole" and "exclusive" noncigarette use (versus never use of either cigarettes or specific noncigarette tobacco). Sole use was defined as the current use of a given noncigarette tobacco without concurrent combustible cigarette use, whereas exclusive use was defined as current noncigarette tobacco use without any history of combustible cigarette use.

RESULTS

A total of 20.0%, 3.0%, 0.8%, and 1.5% of participants were current cigarette, cigar, pipe, or smokeless tobacco users, respectively. Current cigarette use was linked to higher levels of all markers compared with never cigarette use. Compared with respective reference groups, current, sole, and exclusive cigar use was associated with 10% (95% CI, 1-20), 19% (95% CI, 12-26), and 11% (95% CI, 2-21) higher high-sensitivity C-reactive protein levels on the geometric mean scale. Similar associations were noted for pipe and smokeless tobacco use. For interleukin-6, we observed that sole cigar use was associated with a 15% (95% CI, 6-24) higher level, whereas current, sole, and exclusive pipe use were associated with 22% to 32% (all P values <0.05) higher levels compared with their respective reference groups. Fibrinogen levels were 2% to 6% higher (all P values <0.05) among sole users of cigars, pipes, and smokeless tobacco, compared with their respective reference groups. Additionally, noncigarette tobacco use was moderately associated with carotid plaque and carotid intima-media thickness.

CONCLUSIONS

Use of noncigarette tobacco products is linked to subclinical markers related to cardiovascular harm. Inflammatory markers, such as high-sensitivity C-reactive protein and interleukin-6, have the potential for assessing early cardiovascular harm from using these products and aiding regulatory authorities in evaluating their associated risks.

Microbiome-Maternal Tract Interactions in Women with Recurrent Implantation Failure

Microorganisms play an important role in regulating various biological processes in our bodies. In women, abnormal changes in the reproductive tract microbiome are associated with various gynecological diseases and infertility. Recent studies suggest that patients with recurrent implantation failure (RIF) have a reduced genus Lactobacillus population, a predominant bacterial species in the vagina and uterus that protects the reproductive tract from pathogenic bacterial growth via the production of various metabolites (e.g., lactic acid, bacteriocin, and H2O2). Moreover, a higher percentage of pathogenic bacteria genera, including Atopobium, Gardnerella, Prevotella, Pseudomonas, and Streptococcus, was found in the uterus of RIF patients. This review aimed to examine the role of pathogenic bacteria in RIF, determine the factors altering the endometrial microbiome, and assess the impact of the microbiome on embryo implantation in RIF. Several factors can influence microbial balance, including the impact of extrinsic elements such as semen and antibiotics, which can lead to dysbiosis in the female reproductive tract and affect implantation. Additionally, probiotics such as Lacticaseibacillus rhamnosus were reported to have clinical potential in RIF patients. Future studies are needed to develop targeted probiotic therapies to restore microbial balance and enhance fertility outcomes. Research should also focus on understanding the mechanisms by which microorganisms generate metabolites to suppress pathogenic bacteria for embryo implantation. Identifying these interactions may contribute to innovative microbiome-based interventions for reproductive health.

Design and methods of a cluster-randomized pragmatic trial of post-discharge stroke care

BACKGROUND

Stroke is the 5th leading cause of death and a leading cause of adult disability in the United States (US). One in four strokes are recurrent events. Stroke patients experience persisting physical and cognitive impairments long-term, and their caregivers/family also experience psychological and health quality impacts. The current standard for stroke care in the US utilizes hospital certifications based on level of available care and includes proven acute and in-hospital care processes and offers limited post-discharge care coordination of risk factor management, secondary prevention, and early and continued rehabilitation that have been shown beneficial for recovery. The Joint Commission (TJC) Comprehensive Stroke Care (CSC) certification is awarded to hospitals that provide the most advanced level of stroke care. Another model of care in use in the US is a patient-centered, technology-enabled Integrated Stroke Practice Unit (ISPU) that incorporates team-based care components across the continuum. While risk factor management and early rehabilitation occur during hospitalization, these become the focus and are facilitated in the ISPU post-discharge. While both models have shown effectiveness, understanding which model yields better outcomes is critical scientific information for the stroke community.

METHODS

This paper reports the protocol for the Coordinated, Collaborative, Comprehensive, Family-Based, Integrated, and Technology-Enabled Stroke Care (C3FIT), including rationale, design, and methodology for the study. C3FIT is a pragmatic, multicenter, single masked, Phase III, cluster randomized clinical trial designed to determine effectiveness of two US stroke care models - TJC CSC care (CSC-Only; active control) compared to a model that layers the ISPU model on top of CSC care (ISPU+CSC; intervention). Up to 23 clinical sites were stratified by geographic region and patient admission volume and randomized at the site level. Participants included patients (or their Legally Authorized Representative) and their caregiver (if available). Participants in each treatment group were followed through in-person, virtual, or phone contact at 3-, 6-, and 12-months post-discharge; participants in the ISPU+CSC arm were also seen at 1-, 2-, 4-, 5-, 7-, 8-, 9-, 10- and 11-months post-discharge. Patient-centered primary outcomes were patient function and quality of life (measured using the simplified modified Rankin Scale and Stroke Impact Scale respectively) at 12-months post-stroke. Treatment differences were assessed using generalized linear mixed models incorporating assessments at 0, 3, 6 and 12 months, with the primary treatment differences evaluated by a contrast statement assessing the 12-month difference.

CONCLUSION

Results from C3FIT will help to determine which model of care yields better outcomes for patients and their caregivers, which will build scientific evidence about post-stroke recovery and has the potential to impact post-stroke care across the country.

TRIAL REGISTRATION

This trial is registered at ClinicalTrials.gov (NCT04000971).

Risk factors and outcomes of hyperactive delirium in older medical inpatients admitted to non-intensive care unit: a prospective cohort study

BACKGROUND

Hyperactive delirium is a common complication in older medical inpatients in non-intensive care units. This condition increases the risk of diminished physical function, morbidity, and mortality. Moreover, antipsychotics and sedatives were widely used in these patients, contributing to many drug interactions and adverse drug reactions. This study aimed to evaluate the risk factors for hyperactive delirium and assess adverse outcomes among these susceptible patients.

METHODS

We conducted a prospective observational study to examine hyperactive delirium as an exposure and its association with adverse outcomes without intervention. A total of 238 medical patients aged ≥ 60 admitted to non-intensive care units at Ramathibodi Hospital between September 1, 2022, and December 31, 2023, were enrolled. The clinical characteristics, physical examination, and biochemical profiles at baseline were assessed. Adverse clinical outcomes at 90 days after discharge were evaluated by reviewing electronic medical records (EMRs). The Confusion Assessment Method and Richmond Agitation-Sedation Scale (RASS) score of + 1 to + 4 were used to diagnose hyperactive delirium. The Cox proportional hazard model was performed to identify risk factors and adverse clinical outcomes associated with hyperactive delirium, with results reported as hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Overall, hyperactive delirium was diagnosed in 115 (48.3%) patients and had an incidence rate of 101.1 cases per 1000 person-days. The risk factors for hyperactive delirium were urinary incontinence (HR 1.69, 95% CI 1.11-2.57), clinical frailty scale (CFS) ≥ 5 (HR 2.79, 95% CI 1.69-4.62), and Montreal Cognitive Assessment (MoCA) score < 25 (HR 4.63, 95% CI 1.09-19.75). Within 90 days after discharge, 14 (12.2%) patients with delirium had died. Medical inpatients who experienced hyperactive delirium had an 8.23-fold increased risk of 90-day mortality following hospital discharge compared to those without delirium (HR 8.23, 95% CI 1.38-48.98).

CONCLUSIONS

The risk factors for hyperactive delirium were urinary incontinence, frailty (CFS score ≥ 5), and cognitive impairment (MoCA score < 25). Among older medical inpatients, hyperactive delirium was an independent predictor of 90-day mortality after discharge.

Physical literacy in school aged children: a preliminary analysis relating health factors

Introduction

Adolescents with high physical literacy (PL) have better health including cardiovascular fitness and reduced obesity. Improving these skills can lead to a healthier adulthood and reduce the risk of developing chronic diseases. However, physical activity (PA) levels are alarmingly low and PL has been proposed as a tool to improve them. This study aimed to investigate PL in school students [aged between 8 and 18 years (M = 13.08)] in southwestern Spain, explore sex differences and school location, and explore the correlations among PL, age, and Body Mass Index (BMI).

Methods

The Mann-Whitney U test was applied to determine the differences in the PPLI-Q according to sex and school location variables and the Bonferroni correction. Spearman's Rho was also applied to determine the correlations between PL and BMI and age, determining the effect size using Hedge's g for sex and high school location. Results: The results showed significant differences in sex and high school location in favor of boys (M = 4.12, SD = 0.56) and rural settings (M = 4.11, SD = 0.52). The correlation between BMI and PL was significant, with an inverse and medium effect (BMI, ρ = -0.102, p = 0.006*).

Discussion

These results suggest that females have a lower PL perception, and its correlation with BMI underscores the importance of intervention in improving their health. It is also important to intervene in the same way in older students and those with a higher BMI to improve their PL and increase their PA practices to establish healthier habits.

Effect of Aerobic Exercises on Lung Function in Women With Fibromyalgia: A Randomized Controlled Trial

BACKGROUND

Aerobic exercises (AEs) have gained much interest in managing fibromyalgia (FM). This trial aimed to find out how AEs affect women with FM in terms of lung function, chest expansion, dyspnea, exercise capacity, and quality of life.

METHODS

Eighty FM-diagnosed women were allocated randomly into 2 equal-sized groups. For 12 weeks, the AEs group did moderate-intensity aerobic cycling and diaphragmatic breathing exercises while the control group did just diaphragmatic breathing exercises. Outcome measures included forced vital capacity, forced expiratory volume in the first second, and total lung capacity for lung function; upper and lower chest expansions; Medical Research Council dyspnea scale for dyspnea; maximal oxygen consumption for exercise capacity; and physical component score and mental component score components of the 12-item Short Form Health Survey for quality of life.

RESULTS

By study completion, all outcomes improved significantly in the AEs and control groups (P < .05). Compared with the group of control, the AEs group revealed more substantial increases in forced vital capacity (9.51% vs 4.95%, P = .04), forced expiratory volume in the first second (8.72% vs 4.54%, P = .03), total lung capacity (11.02% vs 5.39%, P = .001), upper chest expansion (21.22% vs 10.03%, P = .02), lower chest expansion (31.35% vs 11.2%, P = .01), maximal oxygen consumption (55.89% vs 36.94%, P = .03), physical component score (18.8% vs 10.9%, P = .001), and mental component score (25.67% vs 15.26%, P = .02) accompanied with greater declines in Medical Research Council dyspnea scale scores (37.71% vs 19.45%, P = .03).

CONCLUSIONS

In FM women, moderate AEs could improve lung function, chest expansion, dyspnea, exercise capacity, and quality of life.

Robotic versus laparoscopic colorectal surgery for patients with obesity: an updated systematic review and meta-analysis

BACKGROUND

Obesity poses significant challenges in colorectal surgery, affecting operative difficulty and postoperative recovery. The choice of minimally invasive approach for this patient population remains a challenge during preoperative planning. This review aims to provide an updated synthesis of studies comparing laparoscopic and robotic approaches for adult patients with obesity undergoing colorectal surgery.

METHODS

MEDLINE, Embase and CENTRAL were searched up to August 2023. Articles were included if they compared laparoscopic and robotic colorectal surgery outcomes in adults with obesity (BMI ≥30 kg/m2). Outcomes included overall postoperative morbidity, conversion to laparotomy, and operative time. Inverse variance random-effects meta-analyses were used to pool effect estimates.

RESULTS

After screening 2187 citations, 10 observational studies were included with 3281 patients with obesity undergoing robotic surgery (mean age: 58.1 years, female: 43.9%) and 11 369 patients with obesity undergoing laparoscopic surgery (mean age: 58 years, female: 53.2%). Robotic surgery resulted in longer operative times (MD 46.71 min, 95% CI 33.50-59.92, p < 0.01, I2 = 93.79%) with statistically significant reductions in conversions to laparotomy (RR 0.50, 95% CI 0.39-0.65, p < 0.01, I2 = 67.15%). No significant differences were seen in postoperative morbidity (RR 0.94, 95% CI 0.82-1.08, p = 0.40, I2 = 36.08%).

CONCLUSION

These data suggest that robotic colorectal surgery in patients with obesity may reduce the risk for conversion to laparotomy, but at the expense of increased operative times and with no overt benefits in postoperative outcomes. Further high quality randomized controlled trials assessing the utility of robotic surgery in patients with obesity undergoing colorectal surgery are warranted.

Understanding the role of family functioning, dietary adherence, and culture on glycemic control among adults with type 2 diabetes: A mediation and moderation analysis

BACKGROUND

Families and cultural contexts can impact dietary adherence and glycemic control of type 2 diabetes (T2D). Yet little is known about these relationships in Africa, where poor dietary adherence and glycemic control are prevalent. To address this gap, this study investigated whether dietary adherence mediates family functioning and glycemic control among T2D adults in Benin, West Africa. We also explored whether cultural identity affected the association between family functioning and dietary adherence.

METHODS

A cross-sectional study of 512 T2D patients from six health centers was conducted to assess: 1) family functioning with the 12-item McMaster Family Assessment Device-General Functioning Subscale (FAD-GF); 2) dietary adherence via the Perceived Dietary Adherence Questionnaire (PDAQ); and 3) cultural identity with the 12-item Multigroup Ethnic Identity Measure (MEIM). The three-month glycemic control was determined with Glycated Hemoglobin - HbA1c. Mediation and moderation analyses were conducted using Stata's structural equation model (SEM).

RESULTS

Healthy family functioning, good dietary adherence and good glycemic control rates were 56.8%, 33%, and 30.5% respectively. Path analysis showed that healthy family functioning was significantly associated with lower HbA1c levels (-0.34, 95% CI: [-0.72, -0.03]), and there was a significant indirect effect via greater dietary adherence (-0.12, 95% CI: [-0.22, -0.01]). However, cultural identity did not significantly impact the relationship between family functioning and dietary adherence.

CONCLUSIONS

Our study revealed that family functioning, adherence to dietary recommendations, and glycemic control are interconnected in adults with T2D. Interventions should target modifiable factors like dietary adherence and address relevant risk and resilience sources to improve glycemic control in urban African families.

Parent and carer experiences of health care professionals' communications about a child's higher weight: a qualitative systematic review

OBJECTIVE

The objective of this systematic review was to identify, critically appraise, and synthesize the best available qualitative evidence on parent and carer experiences of communications from health care professionals concerning their child's higher weight.

INTRODUCTION

Public discourse on obesity has shifted in recent years and created pressure to change the way that weight is discussed in health care. A child's higher weight can be a sensitive issue to discuss in health care, but successful communication with parents can increase parental compliance with treatment and improve overall family welfare. It is, therefore, important to explore how parents and carers experience the communication about children's higher weight to ensure effective, up-to-date, and ethical counseling on childhood obesity.

INCLUSION CRITERIA

This qualitative review included studies that focused on the experiences of parents or carers of children (birth to 12 years) with a higher weight who received verbal or written communication from health care professionals about their child's weight.

METHODS

The following databases were systematically searched from 2010 onward: MEDLINE (EBSCOhost), CINAHL (EBSCOhost), PsycINFO (Ovid), Scopus, LILACS, and the Finnish health sciences database MEDIC. ProQuest Dissertations and Theses (ProQuest) was searched for unpublished articles. The search was conducted in July 2022 and updated in October 2023. No country or language limits were applied. A manual search was used to supplement the database searches. Study selection including title and abstract screening, full-text screening, critical appraisal, and data extraction were performed by 2 reviewers. The research findings were categorized and aggregated into synthesized findings. The synthesized findings were assigned confidence scores, and categories and finalized synthesized findings were agreed upon by all reviewers.

RESULTS

The 33 included studies varied in qualitative study design and methodological quality. There were over 900 eligible participants (parents and carers) and 147 unequivocal and credible research findings. The research findings yielded 8 categories and 3 synthesized findings with low confidence scores. The synthesized findings were as follows: i) Parents receiving communication on a child's higher weight experience strong feelings that can affect their parenting; ii) A health care professional's active and individual communication, with the sensitive use of words, creates a good communication experience for parents; and iii) Parents want to receive information about the child's higher weight that is useful to them and is based on an acceptable weight estimation.

CONCLUSION

Although confidence in the synthesized findings is low, this review indicates that communication from a health care professional on a child's higher weight should meet the parents' expectations and the family's situation and needs. Having the skills to deal with heightened emotions, using expertise and empathy as a professional, and providing appropriate information create a good communication experience for parents. In addition, parents' desire to protect their child and the strengthening of the parenting experience should be acknowledged to conduct safe communication.

SUPPLEMENTAL DIGITAL CONTENT

A Finnish-language version of the abstract of this review is available at: http://links.lww.com/SRX/A92 .

Influence of Home Language Use on the Association Between Parent Education and Child Adiposity in Latino Families

BACKGROUND

Parent education and language use are associated with child obesity, but the impact of their interaction is less known. This study assessed whether parent education was associated with child adiposity and if this association was moderated by home language use in Latino families.

METHODS

Participants (n = 415) were Latino families from the Long Beach area. Demographic data were obtained by self-report parent surveys, and children's body size was objectively assessed via bioelectric impedance. Independent t-tests and hierarchical linear regressions were performed on baseline data from a larger intervention study.

RESULTS

In the overall sample, parent education and child body mass index (BMI) percentile were not related (p = .050). However, stratification by home language use revealed that parent education was inversely associated with child BMI percentile among those whose primary home language was Spanish (p = .049), but not English/bilingual homes (p = .296). There were no significant associations with child percent body fat.

CONCLUSION

Higher education was associated with a lower BMI percentile only in Spanish-speaking homes. Research to understand how home language influences this relationship is warranted, particularly as it relates to a subset of education and health literacy. Significant results with BMI percentile but not percent body fat highlight the fact that these distinct markers of obesity are not interchangeable.

Youth With Functional Abdominal Pain Disorders Have More Sleep Disturbances. A School-Based Study

BACKGROUND

There is a bidirectional relationship between sleep and pain disturbances. Sleep disturbances increase the risk for chronic pain, while chronic pain can interfere with sleep. Hence, we assessed the subjective sleep characteristics of youth with functional abdominal pain disorders (FAPDs) compared to healthy youth and examined associations with gastrointestinal symptoms.

METHODS

We included youth ages 10-18 years without a sleep or organic GI disorder diagnosis from a large private school. Participants completed demographics, sleep history, and validated questionnaires: sleep quality (ASWS-SF), insomnia (PISI), daytime sleepiness (ESS), sleep disturbance (PROMIS SD), sleep-related impairment (PROMIS SRI), and Rome 4 diagnostic questionnaire. Cases (FAPDs) completed abdominal pain index (API), nausea severity (NSS), anxiety, depression (PROMIS), and functional disability (FDI). Parents filled sleep hygiene metrics (SHIP). Cases were matched 1:1 with controls based on age and gender.

RESULTS

Of 120 youth (60 cases and 60 controls), the mean age was 13.5 ± 1.9 years and 50% were females. Youth with FAPDs had higher insomnia, sleep disturbance, sleep-related impairment, daytime sleepiness, sleep hygiene, gasping, and nightmares than healthy youth (p < 0.05). Higher insomnia severity was associated with worse abdominal pain (r = 0.41, p < 0.01), higher daytime sleepiness with a family history of disorders of gut-brain interaction (DGBIs, OR = 14.7, p = 0.002), and higher sleep-related impairment (OR = 5.6, p = 0.02) and depression (OR = 6.1, p = 0.01) with black race.

CONCLUSION

Youth with FAPDs have worse sleep than healthy youth and multiple sleep parameters are associated with abdominal pain. Future studies could focus on determining mechanisms by which sleep disturbances affect abdominal pain and vice versa.

The impact of insulin resistance on thyroid function and the prevalence of thyroid follicular nodular disease in pregnant women

Introduction

Insulin resistance (IR) is a phenomenon commonly observed in pregnancy. Increased insulin concentrations might impact thyroid function and structure during gestation.

Objectives

This study investigates the bidirectional relationship between IR indices and thyroid function and morphology in pregnant women.

Methods

In 1,069 gravid participants of the Polish National Programme for Elimination of Iodine Deficiency (2007-2017), blood samples were analyzed for thyroid-stimulating hormone (TSH), FT3, FT4, aTPO, fasting glucose and insulin concentrations, and the thyroid structure was assessed with ultrasound (in 1,065 subjects). Based on calculated homeostatic model assessment of insulin resistance (HOMA-IR) values, participants were stratified into two subgroups: HOMA-nl (HOMA-IR <2.5) and HOMA-h (HOMA-IR ≥2.5), comprising 894 and 175 women, respectively.

Results

Significant difference in mean TSH (1.77 ± 1.17 vs 1.96 ± 1.04; P = 0.008) and mean FT4 (12.65 ± 2.3 vs 11.47 ± 1.9; P = 0.001) concentrations between HOMA-nl and HOMA-h groups was found. The subgroups did not differ in thyroid nodularity or multinodular goiter prevalence. HOMA-IR positively correlated with TSH concentrations, BMI and thyroid volume. Serum FT3 and FT4 concentrations showed negative correlations with HOMA-IR.

Conclusions

IR seems to affect the thyroid function of gravid women by diminishing the ability to respond to increased thyroid hormone demand. Thyroid volume increase during pregnancy may be influenced by IR; however, its short-term effect on thyroid nodularity appears to be negligible.

Prevalence and Sociodemographic Factors Associated with Overweight and Obesity Among Adults in Colombia: A Pooled Analysis

Given the increased prevalence of overweight and obesity in adults in Colombia, estimating the effect of sociodemographic factors on overweight and obesity is crucial for creating and implementing public health policies. A pooled analysis was performed using a multinomial logistic regression model through Colombian Nutritional Situation Surveys held in 2010 and 2015. The study included Colombian adults between 18 and 64 years old (n = 162,119). Overall, the prevalence of obesity increased from 16.47 percent in 2010 to 18.67 percent in 2015, being higher in women than in men in both surveys. Multinomial logistic regression analysis revealed that the most critical factor of being overweight and obese were older age, having a higher level of education, being engaged in household activities, and living in regions other than the country's capital. Additionally, for obesity, belonging to the Afro Colombian racial-ethnic group and being a woman were associated with an increased probability. In conclusion, these results provide more information on the sociodemographic factors related to overweight and obesity, which will help focus public health policies on higher-risk populations, such as racial-ethnic communities.

The risk of revision surgery after trainee-led primary total hip replacement

INTRODUCTION

The aim of this study was to determine the impact of operating surgeon grade and level of supervision on the incidence of one-year patient mortality and all-cause revision following elective primary total hip replacement (THR).

METHODS

National Joint Registry data from 2005 to 2020 for a single University Teaching Hospital were used, with analysis performed on the 15-year dataset divided into 5-year block periods (B1, 2005-2010; B2, 2010-2015; B3, 2015-2020). Outcome measures were mortality and revision surgery at one year, in relation to lead surgeon grade, and level of supervision for trainee-led (TL) operations.

RESULTS

A total of 9,999 eligible primary THRs were performed, of which 5,526 (55.3%) were consultant-led (CL), and 4,473 (44.7%) TL. Of TL, 2,404 (53.7%) were nonconsultant-supervised (TU) and 2,069 (46.3%) consultant-supervised (TS). The incidence of one-year patient mortality was 2.05% (n=205), and all-cause revision was 1.11% (n=111). There was no difference in one-year mortality between TL and CL operations (p=0.20, odds ratio (OR) 0.78, confidence interval (CI) 0.55-1.10). The incidence of one-year revision was not different for TL and CL operations (p=0.15, OR 1.37, CI 0.89-2.09). Overall, there was no temporal change for either outcome measure between TL or CL operations. A significant increase in revision within one-year was observed in B3 between TU compared with CL operations (p=0.005, OR 2.81, CI 1.35-5.87).

CONCLUSIONS

We found no difference in overall one-year mortality or all-cause revision rate between TL and CL primary THR. Despite a reduction in unsupervised THR in the latest five-year period (2015-2020), unsupervised TL THR resulted in an increased risk of early revision.

Associations between Class I, II, or III Obesity and Health Outcomes

BACKGROUND

The burden of obesity-related health conditions remains incompletely explored. Previous studies have been underpowered to study severe obesity, focused on a limited set of health outcomes, and lacked diversity in study populations.

METHODS

We studied 270,657 participants from the All of Us research program with linked electronic health records and body mass index (the weight in kilograms divided by the square of the height in meters) greater than or equal to 18.5. We investigated the prevalence and incidence of 16 a priori-identified outcomes covering cardiovascular-kidney-metabolic syndrome and others: hypertension, type 2 diabetes mellitus, hyperlipidemia/dyslipidemia, heart failure, atrial fibrillation, atherosclerotic cardiovascular disease, chronic kidney disease, pulmonary embolism, deep vein thrombosis, gout, metabolic dysfunction-associated steatotic liver disease, biliary calculus, obstructive sleep apnea, asthma, gastroesophageal reflux disease, and osteoarthritis. Adjusted hazard ratios were calculated for each BMI category and compared with normal weight. The population-attributable fraction was calculated for different obesity classifications.

RESULTS

The included population was 62.0% women and 22.0% Black. Class I, II, and III obesity was observed in 21.2%, 11.3%, and 9.8% of participants, respectively. Obesity was strongly associated with all incident outcomes, with graded associations across higher classes of obesity. Class III obesity was most strongly associated with obstructive sleep apnea, type 2 diabetes mellitus, and metabolic dysfunction-associated steatotic liver disease (hazard ratio [95% confidence interval {CI}], 10.94 [9.97 to 12.00], 7.74 [7.03 to 8.53], and 6.72 [6.01 to 7.50], respectively), with weaker associations for asthma, osteoarthritis, and atherosclerotic cardiovascular disease (hazard ratio [95% CI], 2.14 [1.95 to 2.35], 2.06 [1.94 to 2.19], and 1.96 [1.70 to 2.25], respectively). Associations were consistent across sex and race. The obesity-related population-attributed fraction ranged from 14.0% (osteoarthritis) to 51.5% (obstructive sleep apnea) in this population.

CONCLUSIONS

Obesity, particularly severe obesity, was strongly associated with the incidence of 16 common health outcomes.

Gender differences in attentional processes and attractiveness evaluation models during gait observation

Introduction

Physical attractiveness plays a crucial role in building interpersonal relationships and in daily communication. Attractiveness is perceived through nonverbal information regarding one's morphological features, posture, movement, and behavior. Selective pressures throughout our species' evolutionary history have shaped sex differences in the evaluation of physical attractiveness. However, research on the process of body attractiveness perception has been limited to static information involving body images. Therefore, a better understanding of the attractiveness perception process in the real world requires an appreciation of the attractiveness perception mechanism of physical movement.

Methods

This study examined the attractiveness perception of 30-s walking animations, as well as gender differences in gaze behavior and statistical models of attractiveness evaluation. We recruited 16 men and 17 women and made gender comparisons of fixation ratio to each gaze area (head, trunk, hip, leg, and others). Furthermore, the standardized estimates of the statistical models were qualitatively compared between male and female observers.

Results

Male observers were highly fixated on the walkers' trunk, whereas female observers tended to shift their attention from the trunk to the legs, especially when observing high-preference animations. The statistical model for attractiveness evaluation, which used gait parameters for each gender, showed the tendency that when assessing attractiveness, male observers placed greater weight on the walkers' trunk silhouette, whereas female observers prioritized parameters requiring whole-body observation.

Discussion

Gender differences in gaze behavior were observed in the assessment and perception of human movement attractiveness; such differences may reflect the evaluation model for each gender. The results suggest that men assess female gait attractiveness based on observations of the reproductive regions of the female body. In contrast, women perceive other women as potential competitors and assess female gait attractiveness based on beauty standards, which are shaped by sociocultural environments and the walker's psychological state. Our findings are the first step toward understanding the process of perceiving the attractiveness of physical movement and are expected to help generate attractive biological motions.

Prevalence of Text Neck Between Different Female Students at Taibah University, Saudi Arabia; Cross Section Design

Background: Text neck is a common postural malalignment that significantly affects daily activities. Reliable and user-friendly assessment tools are essential for physiotherapists, and evaluating text neck prevalence in both sitting and standing positions is crucial for effective rehabilitation. This study aimed to compare text neck prevalence between students in practical and non-practical disciplines using multiple assessment methods. Methodology: A total of 82 female students (18-24 years) from Taibah University participated. The practical group included students from the Colleges of Medical Rehabilitation Sciences and Applied Medical Sciences, who engage in hands-on learning. The non-practical group consisted of Business Administration students, whose coursework is primarily theoretical. Text neck was assessed using observational methods, tragus to wall distance (TWD), craniovertebral angle (CVA) via a smartphone application, and PostureCo in both sitting and standing positions. Results: Observational assessment showed text neck prevalence of 95.5% in the non-practical group and 70% in the practical group while sitting, and 91% versus 80% while standing. Based on TWD, prevalence was 48% in non-practical students and 32% in practical students. Using Physiomaster, prevalence was 71% in standing and 54% in sitting for non-practical students, compared to 39% and 14%, respectively, for practical students. Significant differences were found between groups in sitting (p < 0.002) and standing (p < 0.001) using TWD, and in CVA measurements (p < 0.0001). Conclusions: Text neck is more prevalent among non-practical students, while practical students exhibit milder cases. Both sitting and standing assessments are essential for accurate diagnosis and rehabilitation planning. Future studies should analyze the accuracy of various measurement tools to identify the most precise methods for assessing text neck prevalence, taking into consideration both sitting and standing positions.

Evaluating Heat Stress in Occupational Setting with No Established Safety Standards Using Collective Data from Wearable Biosensors

In recent years, living and occupational environments have been increasingly exposed to extreme heat. While the risk of heatstroke rises with greater heat stress, conventional knowledge and safety standards may no longer adequately assess heat stress under such extreme conditions. To address this issue, we propose a method for evaluating heat stress using collective data from wearable biosensors that monitor heart rate and physical activity in a group of workers. The novelty of this approach lies in utilizing collective data from wearable biosensors to assess environmental heat stress rather than individual health status. To quantify heat stress in specific environments or conditions, we introduce the heart rate response intercept, defined as the heart rate at 1 MET when the heart rate response to physical activity is approximated linearly. Using this heat stress index, we examined the effects of ambient temperature, aging, and obesity on heat stress. Our findings indicate that heat stress among obese workers was significantly high and should not be overlooked. Furthermore, because this method can quantify the effectiveness of heatstroke countermeasures, it serves as a valuable tool for improving occupational environments.

Potential Therapeutic Exploitation of G Protein-Coupled Receptor 120 (GPR120/FFAR4) Signaling in Obesity-Related Metabolic Disorders

The increasing prevalence of overweight and obesity not only in adults but also among children and adolescents has become one of the most alarming health problems worldwide. Metabolic disorders accompanying fat accumulation during pathological weight gain induce chronic low-grade inflammation, which, in a vicious cycle, increases the immune response through pro-inflammatory changes in the cytokine (adipokine) profile. Obesity decreases life expectancy, largely because obese individuals are at an increased risk of many medical complications, often referred to as metabolic syndrome, which refers to the co-occurrence of insulin resistance (IR), impaired glucose tolerance, type 2 diabetes (T2D), atherogenic dyslipidemia, hypertension, and premature ischemic heart disease. Metabotropic G protein-coupled receptors (GPCRs) constitute the most numerous and diverse group of cell surface transmembrane receptors in eukaryotes. Among the GPCRs, researchers are focusing on the connection of G protein-coupled receptor 120 (GPR120), also known as free fatty acid receptor 4 (FFAR4), with signaling pathways regulating the inflammatory response and insulin sensitivity. This review presents the current state of knowledge concerning the involvement of GPR120 in anti-inflammatory and metabolic signaling. Since both inflammation in adipose tissue and insulin resistance are key problems in obesity, there is a rationale for the development of novel, GPR120-based therapies for overweight and obese individuals. The main problems associated with introducing this type of treatment into clinical practice are also discussed.

Impact of the dietary antioxidant index on bone mineral density gain among mexican adults: a prospective study

In the Mexican population, low dietary antioxidant intake (DAI) is associated with reduced bone mineral density (BMD). A decline in DAI over time further contributes to BMD loss, particularly at the total hip, femoral neck, and lumbar spine, with a more pronounced effect in women over 45 years old.

PURPOSE

Bone remodeling, balancing resorption and formation, is crucial for bone health. Aging shifts this balance, reducing BMD and increasing osteoporosis risk. Reactive oxygen species (ROS) contribute to bone loss through oxidative stress. Antioxidants may help mitigate this damage, but their impact on BMD in populations with inadequate nutrient intake, like Mexicans, needs to be better understood. This study explores the association between DAI changes and BMD in a Mexican population.

METHODS

Data were sourced from the Health Worker Cohort Study (HWCS), including 1,318 participants (aged ≥ 20) with BMD measurements and complete dietary information at two time points. The study employed a longitudinal design was used, whit data from two waves of the study (2010-2012 and 2017-2019), providing a median follow-up time of 6.4 years for men and 6.8 years for women. Dietary antioxidant intake was assessed using a validated Food Frequency Questionnaire for the Mexican diet. BMD was measured at the femoral neck, total hip, and lumbar spine using dual-energy X-ray absorptiometry (DEXA). Fixed-effects regression models were applied to analyze the association between DAI and BMD at different sites, adjusting for time-varying covariates.

RESULTS

Changes in DAI scores were associated with lower BMD at various sites. Each unit decrease in DAI over time was associated with a BMD loss of -0.002,-0.004 g/cm2 at the total hip, femoral neck, and lumbar spine. Notable declines were observed in women, particularly those over 45 years old, where specific antioxidant components, like zinc, magnesium, and selenium, were linked to lower BMD.

CONCLUSION

This study underscores the role of reduced dietary antioxidant intake in contributing lower BMD, particularly among older adults. Diets low in antioxidant may increase the risk of osteoporosis, especially in populations with insufficient nutrient intake.

Physical activity, cardiovascular disease, and mortality across obesity levels

Aims

High physical activity (PA) is associated with decreased risk of cardiovascular disease (CVD) and mortality. However, whether PA can be sufficient to reduce the risk of CVD and mortality contributing to adiposity remains unclear. From the standpoint of predictive, preventive, and personalized medicine (PPPM/3PM), joint assessment of PA and adiposity provides novel insights for individual risk assessment, targeted prevention, and personalized intervention of CVD.

Methods

This prospective cohort study included 92,931 participants in the Kailuan study in Tangshan, followed between the years 2006 and 2020. Adiposity was assessed by body mass index (BMI) and waist circumference (WC). The CVD incidence and all-cause mortality associated with 3 PA levels (low, medium, and high PA) were analyzed by applying Cox regression models to different adiposity subgroups.

Results

After a median follow-up period of 14.02 years, 9997 incident CVD cases and 12,586 deaths occurred. Surprisingly, low PA and lean body mass were at a lower risk for CVD than other phenotypes. Participants with high PA still had a 35% higher CVD risk from obesity (hazard ratio (HR) BMI: 1.35, 95% confidence interval (CI): 1.18-1.54) and a 10% higher CVD risk from central obesity (HRcentral obesity: 1.10, 95% CI: 1.00-1.21) than those with lean. However, only in obese individuals, high PA has a protective effect on CVD (HR: 0.78, 95% CI: 0.64-0.95). Overall obesity and high PA were not associated with increased risk of all-cause mortality, whereas high PA could not attenuate mortality risk associated with central obesity.

Conclusion

High PA did not attenuate the risk of CVD associated with adiposity compared with lean body mass among the Chinese population, whereas the combination of high PA and healthy WC might improve healthy aging and longevity. In addition, this study revealed the importance of maintaining muscle health in obese individuals via PA or other ways. It provides a novel strategy for mitigating the risk of CVD by exercising intervention or maintaining body mass, thereby enhancing effective prevention and targeted intervention.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-025-00397-5.

Body Mass Index (BMI) as a Prognostic Factor Influencing Outcomes of Gastric Cancer Resection Including Curative Gastrectomy

BACKGROUND/AIM

This study evaluated the influence of the body mass index (BMI) on outcomes of gastric cancer resection, with a specific focus on curative gastrectomy.

PATIENTS AND METHODS

A total of 756 patients who underwent gastric cancer resection, including 372 cases of curative gastrectomy, were analyzed. The impact of BMI on overall, systemic, and surgical complications, as well as on relaparotomy, perioperative mortality, and 5-year survival was examined.

RESULTS

Underweight (BMI <18.5 kg/m2), and obesity (BMI ≥30 kg/m2) were identified as independent risk factors for overall complications (p<0.0001, and p<0.0001), systemic complications (p<0.0001, and p=0.001), and surgical complications (p<0.0001, and p=0.023) in all gastric cancer resections. Similar trends were observed for curative gastrectomy, where underweight and obese patients demonstrated more overall complications (p<0.0001, and p<0.0001), systemic complications (p<0.001, and p=0.0001), and surgical complications (p<0.0001, and p=0.0032). No differences in 5-year survival were observed among BMI categories in 372 cases of curative gastrectomy. However, being underweight was associated with a poorer 5-year survival in all 756 cases of gastric cancer resection (odds ratio=0.45, 95% confidence interval= 0.27-0.73, p=0.0016).

CONCLUSION

BMI significantly influences the outcomes of gastric cancer resection, with underweight and obese patients demonstrating higher complication rates. Underweight status is also linked to poorer long-term survival in the broader gastric cancer population but not in curative resection cases.

Evaluating the impact of caloric restriction, body mass index and exercise on primary open-angle glaucoma: A review

This literature review evaluates any possible links between primary open-angle glaucoma (POAG) and caloric restriction (CR), body mass index (BMI), and exercise, aiming to map the extent of the literature. Its primary objective is to recognise the nature and breadth of research evidence, identify possible gaps in these topics and develop future studies. The databases searched were MEDLINE (PudMed), Scopus and ScienceDirect, in April 2023 for articles published in English, with no date restriction. A total of 447 search results were retrieved. Of these, 73 were related to CR, 249 to BMI, and 125 to exercise. Records identified included systematic reviews, meta-analyses, randomised controlled trials, cohort studies and animal studies. CR has been shown to halt the degeneration of retinal ganglion cells and protect against various glaucomatous processes in animal models. Low BMI has been shown to be associated with an increased risk of POAG and a faster rate of visual field deterioration in POAG. However, the association between high BMI and POAG is not consistent. Exercise has been shown to cause mechanical, vascular, and neurobiological changes affecting the pathophysiology of POAG. The present review helps identify key characteristics and factors relating to the impacts of CR, BMI, or exercise on POAG.

Muscle contributions to propelling the body upward differ between skipping and running

Skipping represents a training alternative to running due to its lower knee contact forces and higher whole-body metabolic cost. The increased metabolic cost of skipping is associated with a higher vertical center-of-mass (COM) displacement during the support and flight phases of the skipping hop compared to running. However, skipping has lower muscle force impulses than running. Therefore, the study purpose was to compare the flow of mechanical power between body segments during skipping and running to determine the mechanisms enabling higher vertical displacement in skipping despite the lower vertical impulse. Running and skipping cycles were simulated in OpenSim for 5 adults (22.4 ± 2.2 y) using motion capture data collected at 2.5 m/s on an instrumented dual-belt treadmill. A segmental power analysis quantified muscle contributions to vertical body segment mechanical power, which were integrated over the stance phase of running (Run) and the hop (Skip 1) and step (Skip 2) of skipping to calculate mechanical work. Higher vertical work was done by the gluteus maximus, vasti, and soleus in Skip 1, primarily through power generation to the trunk, compared to power absorption in Run and Skip 2. Thus, despite lower muscle force impulses in Skip 1, muscles generate power through concentric contractions, leading to greater metabolic cost than in running. These muscle force impulses contribute to propelling the COM upward in Skip 1 (rather than decelerating downward COM motion in Run and Skip 2), which raises the COM and contributes to the greater COM displacement in skipping compared to running.

Racialized body dissatisfaction in Black women: development of the Black feminist model of body image

BACKGROUND

Body image has predominantly been examined among young White women. As a result, the guiding theories in this area of study are based on implicit assumptions that this population's experience is normative. These assumptions include thinness as the ideal body type and the lack of consideration of body shape, skin tone, and hair texture in body image. As a result, research examining body image among Black women has been limited by using theoretical constructs that do not fully capture the lived experiences of this population. The purpose of the study was to investigate the role of the racialized beauty aesthetic in Black women's body image.

METHODS

Eight focus groups were conducted with 30 Black women aged 18-29 with a Body Mass Index (BMI) ≥ 25-kg/m2. Focus groups used a semi-structured interview guide to assess race, beauty ideals, pressures to meet the beauty ideals, and the social costs and benefits of obtaining the ideals. We used a constructivist grounded theory approach to develop a conceptual model. This method's steps include initial, focused, and theoretical coding.

RESULTS

Results indicated that the standardization of Eurocentric beauty standards resulted in the stigmatization and devaluation of Black women based on appearance. Participants described being stigmatized on the basis of their appearance and feeling devalued due to the prevalence of negative stereotypes about Black women's appearance and behavior. Experiences of gendered racism resulted in racialized body dissatisfaction. Participants coped with these experiences by engaging in shifting behaviors to reduce the appearance of stigmatizing marks or by rejecting normative Whiteness. Both coping methods came with costs and benefits; participants expressed that they felt they were in a no-win situation, which had adverse health consequences. These findings resulted in the development of the Black Feminist Model of Body Image.

CONCLUSIONS

Consideration of Black women's body image in the context of their intersectional marginalized identities highlights how Eurocentric beauty standards are used to perpetuate the stigmatization of Black women. This work implies that efforts to improve the health of Black women must seriously consider the role of body image and racialized body dissatisfaction on their mental and physical health.

Associations between mobile phone involvement, BMI levels, and sleep quality among Chinese university students: evidence from a multi-regional large-scale survey

Objective

This study aims to explore the association between mobile phone involvement, body mass index (BMI) levels, and the sleep quality of Chinese university students.

Methods

Using a cluster sampling method, we selected 17,085 university students from three universities in eastern, central, and western China as the study subjects. Demographic information such as age and sex were collected. The Pittsburgh Sleep Quality Index (PSQI) and the Mobile Phone Involvement Questionnaire (MPIQ) were utilized to measure their sleep quality scores and mobile phone involvement scores, respectively. Pearson correlation analysis, two-way ANOVA, and multiple linear regression were employed to examine the relationship between BMI levels, mobile phone involvement, and sleep quality.

Results

The results show that 15.87% (2,712 participants) are classified as overweight, and 18.45% (3,151 participants) are classified as obese. Additionally, 35.87% (6,125 participants) exhibit mobile phone involvement, while 57.94% (9,899 participants) reported poor sleep quality. Pearson correlation analysis indicates a significant negative correlation (p < 0.01) between sleep quality and both BMI levels and mobile phone involvement. Two-way ANOVA shows the significant effect of BMI levels (p < 0.001) and mobile phone involvement (p < 0.001) on sleep quality, and there is no interaction effect between the two. Additionally, the sleep quality of overweight and obese individuals is significantly poorer than that of those with normal weight (p < 0.05), while the sleep quality of overweight individuals is significantly lower than that of obese individuals (p < 0.05). Multiple linear regression analysis indicates that, after controlling for age and gender, both BMI (β = -2.69) levels and mobile phone involvement (β = -1.34) are significantly negatively associated with sleep quality (p < 0.001), accounting for 19% of the variance in poor sleep quality.

Conclusion

This study found that BMI levels and mobile phone involvement are both independently associated with sleep quality among Chinese university students. However, among individuals with excess BMI, although their sleep quality is worse than individuals with normal weight, overweight individuals may have poorer sleep quality than obese individuals. This study also revealed high rates of overweight and obesity, with over half of participants reporting poor sleep quality, highlighting the need for targeted interventions to address weight management and mobile phone usage to improve sleep health in this population.

Exploring body mass index and gender-based self-esteem differences in Saudi Arabia

Background

Self-esteem (SE) and obesity have been associated in various studies. This study investigates this relationship among adults in Saudi Arabia. The objectives of this study are to investigate the relationships between SE and body mass index (BMI) and to examine the interactions between sociodemographic-related factors.

Methods

We designed a cross-sectional study using an online survey that included sociodemographics, a BMI measure, and the Rosenberg Self-Esteem Scale.

Results

Levels of SE did not change substantially between the various age groups, as indicated by the Chi-Square test X2 (12, N = 332, = 5.278, p-value = 0.948). The results for males reveal that there is a variation in the levels of SE across the different BMI categories. This suggests that the BMI categories have a major influence on the levels of SE among males. In both genders, the results indicate a negative association between variables, with a higher BMI being associated with a lower level of SE. The significance of this association stands for both genders (p-value <0.001). For males, the association has a greater influence (Estimate = -0.110, p-value <0.001) than it does for females (Estimate = -0.099, p-value <0.001). In females, the negative link is larger for education (-0.273) and highly impactful (p-value <0.001) in comparison to men (Estimate = -0.157, p-value <0.001). Higher education levels are associated with a lower BMI (p-value = 0.018). For men, the indirect effects show that education (Estimate = 0.0173*) and marital status (Estimate = -0.0405*) significantly influence SE, with other factors mediating these effects. Both genders experience significant and detrimental impacts from BMI on SE, with males experiencing a more pronounced impact. There are considerable disparities in the ways in which these parameters impact SE in both genders, as revealed by the comparisons of the nested models.

Conclusion

There is a negative correlation between BMI and SE in both genders, with a more pronounced impact in men. Gender-specific differences in the relationship between BMI and SE underscore the importance of considering distinct pathways for males and females in future analyses.

The associations of obesity with demographic and lifestyle factors among Hong Kong adults

Background: Obesity is a risk factor for leading causes of death. Aim: This study investigated the associations of obesity with demographic and lifestyle factors among adults aged 18-64 in Hong Kong. Methods: The study uses data (n = 24,855) from the government online database. It uses T-tests to compare mean values for body mass index (BMI), waist circumference, and weight-to-height ratio obese; analysis of variance for not-obese, BMI-obese-only, central-obese, and BMI + central-obese; Pearson chi-square tests for categorical variables; and multinomial logistic regression to obtain the odd ratios. It uses IBM SPSS version 26 to conduct all analyses, and at a 95% confidence level. Results: The analyses show that the risks of central-obese, and BMI + central-obese increase by 4%, and 4%/year of age, respectively. Females have 60%, 38%, and 60% lower risks of BMI-obese-only, central-obese, and BMI + central-obese, respectively, and people with tertiary education have 28%, 20%, and 20% lower risks, respectively. Employed people have a 40% higher risk of BMI-obese-only when compared with the unemployed; students have a 46% lower risk of BMI + central-obese and home-makers have a 38% higher risk. The risk of central-obese decreases by 14%/10 min/day of moderate physical activity, but could be different among females, and vigorous physical activity yielded mixed results. The risk of BMI + central-obese decreases by 9%/day/week of vegetable intake. Conclusions: Obesity is associated with multiple demographic and lifestyle factors. Keep doing vigorous and moderate physical activity but state alert to obesity risk factors, and frequent vegetable intake are recommended. Lifelong learning and continuing education could be an effective strategy to combat obesity.

The Role of Body Mass Index on Physical Activity, Symptoms, and Related Outcomes Following Pediatric Concussion

OBJECTIVE

To determine the step count and self-reported activity levels for obese and nonobese pediatric patients following concussion and predict self-reported symptoms, quality of life, and psychological health over time.

STUDY DESIGN

Participants completed the Post-Concussion Symptom Scale (PCSS), Pediatric Quality of Life (PedsQL), and Behavioral Symptom Inventory-18 (BSI-18) at an initial visit (<72 hours), 3-5 days postinjury, 10-18 days postinjury, and 1 and 2 months postinjury. Physical activity data (eg, step count) were collected via a commercial actigraph. Participants were categorized into obese and nonobese body mass index (BMI) groups based on age- and sex-adjusted growth standards. Mann-Whitney U tests compared groups while nonparametric series regression models examined the effect of obese BMI and average daily step count on PCSS, PedsQL, and BSI-18 outcomes at 1 and 2 months postinjury.

RESULTS

One hundred ninety-four participants were included: 153 (78.9%; M = 14.6 ± 2.4 years; 50% female) in the nonobese group and 41 (21.1%; M = 14.2 ± 2.0 years; 44% female) in the obese group. The obese group had a 22.8% lower average daily step count in the week postinjury (P = .02). At 2 months, there was a significant association between obese BMI and worse PCSS total score (P = .042), PedsQL (P = .017), and BSI-18 anxiety (P = .046). Average daily step count in the first week postinjury was associated with a higher PCSS total score at 2 months (P = .031).

CONCLUSIONS

Pediatric patients following concussion with an obese BMI had a lower daily average step count in the week after injury and exhibited worse concussion symptoms, quality of life, and anxiety at 2 months compared with those with a nonobese BMI.

TRIAL REGISTRATION

Active Injury Management (AIM) after Pediatric Concussion: NCT03869970.

Impact of a dermatological rehabilitation program on cardiovascular risks of psoriasis patients

BACKGROUND AND OBJECTIVES

Psoriasis vulgaris is a common chronic inflammatory skin disease, associated with multiple cardiovascular comorbidities, which can ultimately lead to increased mortality. Dermatological rehabilitation programs represent an additional therapeutic option in patients with psoriasis besides the classical outpatient or inpatient management. This study aimed to investigate the impact of dermatological rehabilitation on cardiovascular risk factors, cardiorespiratory fitness and quality of life at the Clinic of Dermatology, Bad Bentheim, Germany.

PATIENTS AND METHODS

This prospective study included 105 patients (age > 18 years) with known psoriasis and/or psoriasis (pustulosa) palmoplantaris committing to a 3-week long rehabilitation program. Various patient reported outcomes including dermatological life and quality index, patient global assessment, physical activity, pruritus and smoking and alcohol consumption history were captured. Body mass index (BMI) and physical fitness were also assessed. Study parameters were collected by telephone at baseline, at discharge, and at 3 and 6 months.

RESULTS

Significant improvements in cardiorespiratory fitness (p < 0.001), BMI (p < 0.001), quality of life (p < 0.001), patients subjective estimation of disease severity (p < 0.001) and psoriasis area and severity index (p < 0.001) were shown.

CONCLUSIONS

The findings emphasize the importance of a rehabilitation program for patients with psoriasis due to its positive and sustained effects on cardiovascular risk factors.

Socioeconomic disparities in the postnatal growth of preterm infants: a systematic review

OBJECTIVE

To determine the effect of parental socioeconomic status (SES) on the postnatal growth of preterm infants.

METHODS

A systematic review (PROSPERO registration CRD42020225714) of original articles from Medline, Embase, CINAHL Plus and Web of Science published 1946-2023 was undertaken. Studies were included if they reported anthropometric growth outcomes for preterm infants according to parental SES. Data extraction and assessments of bias and health equity impact were conducted using custom-designed forms.

RESULTS

A narrative synthesis of twelve included studies was performed. Most infants were moderate to late preterm. The settings, growth outcomes, timings of growth measurement, and SES measures were heterogenous. Six studies demonstrated an adverse effect of low parental SES on the extrauterine growth of preterm infants, five studies showed no effect, and one study showed a potentially beneficial effect. All studies had a high risk of bias, especially confounding and selection bias. The health equity impact of included studies was largely negative.

CONCLUSION

Limited and low-quality evidence suggests that socioeconomic minoritisation may adversely impact the growth of preterm infants, thereby widening existing socioeconomic health inequities. Observational studies informed by theorisation of the mechanistic pathways linking socioeconomic minoritisation to adverse postnatal growth are required to identify targets for intervention.

IMPACT

Limited evidence suggests low parental socioeconomic status (SES) adversely affects the postnatal growth of preterm infants across different settings. Early growth of preterm infants predicts neurodevelopmental outcomes and the risk of cardiovascular and metabolic disease in adulthood. Systematic screening of over 15,000 articles identified only twelve studies which reported postnatal growth outcomes for preterm infants according to parental SES. The health equity impact of the included studies was systematically assessed, and found to be negative overall. This study highlights limitations in existing evidence on the association between parental SES and postnatal growth, and delineates avenues for future research.

Reframing Diabetes Prevention: From Body Shaming to Metabolic Reprogramming

This review integrates new developments in psychology with updated physiological insight on the complex relationships among chronic psychological stress (arising from weight stigmatization and body shaming), food composition, physical activity and metabolic health for the example of diabetes. We address how visual measures of health, such as body mass index (BMI) and waist-to-hip ratio, do not adequately capture metabolic health and can instead contribute to weight stigmatization, chronic stress, and system-wide impairment of metabolic health. We also emphasize the importance of food composition over calorie counting. We summarize how chronic stress interacts with nutritional deficiencies and physical inactivity to disrupt the stress response, immune response, gut microbiome, and function of fat depots. We specifically address how interactions among lifestyle factors and the gut microbiome regulate whether fat stored around the waist has a negative or positive effect on metabolic health. We aim to provide a resource and updated framework for diabetes prevention and health promotion by (i) highlighting metabolic imbalances triggered by lifestyle changes during the transition to industrialized society and (ii) detailing the potential to support metabolic health through access to modest, but comprehensive lifestyle adjustments.

Rehabilitation Management of Neck Pain-Development of a Diagnostic Framework Based on the Pain and Disability Drivers Management Model

RATIONALE

Neck pain is a major cause of disability worldwide, and current rehabilitation strategies show limited effectiveness. Subgrouping patients by their primary pain and disability drivers can help tailor treatments. At this end, the Pain and Disability Drivers Management (PDDM) was developed and has demonstrated preliminary effectiveness in the management of low back pain. Nevertheless, the PDDM model was only validated for this population. Adapting this framework to patients with neck pain would provide a more global view of the patient's experience of pain and support a genuine biopsychosocial intervention.

AIMS AND OBJECTIVES

The aim of this study was to develop and validate the content of the PDDM model for patients living with neck pain.

METHODS

Through a modified DELPHI study design, participants with clinical and research expertize in rehabilitation of neck pain were invited to participate. A questionnaire was developed using literature reviews and endorsed by a steering committee. The relevance of each element of the newly adapted model was evaluated on a 4-point Likert scale. An item reached consensus if it obtained the predefined threshold of > 78% "relevant" and "very relevant." Participants left comments on terminology and recommended items to add in early rounds. Quantitative and qualitative analyses were performed.

RESULTS

An invitation was sent to 1650 potential participants, from which 155 accessed the survey, 64 completed the first round and 55 the second round. A total of 70 elements met consensus and were distributed across six domains: "Nociceptive pain drivers", "nociplastic pain drivers," "drivers associated with neuropathic pain", "comorbidity drivers", "cognitive-emotional drivers" and "environmental or lifestyle drivers, and social determinants of health."

CONCLUSION

Through a modified DELPHI study, the PDDM model was updated and adapted to people with neck pain. Subsequent steps include clinical integration and measures of efficacy when used for assessment/treatment.