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Hua Y, Xie D, Zhang Y, Wang M, Wen W, Sun J. Identification and analysis of key genes in adipose tissue for human obesity based on bioinformatics. Gene 2023; 888:147755. [PMID: 37659596 DOI: 10.1016/j.gene.2023.147755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Obesity is a complex condition that is affected by a variety of factors, including the environment, behavior, and genetics. However, the genetic mechanisms underlying obesity remains poorly elucidated. Therefore, our study aimed at identifying key genes for human obesity using bioinformatics analysis. METHODS The microarray datasets of adipose tissue in humans were downloaded from the Gene Expression Omnibus (GEO) database. After the selection of differentially expressed genes (DEGs), we used Lasso regression and Support Vector Machine (SVM) algorithm to further identify the feature genes. Moreover, immune cell infiltration analysis, gene set variation analysis (GSVA), GeneCards database and transcriptional regulation analysis were conducted to study the potential mechanisms by which the feature genes may impact obesity. We utilized receiver operating characteristic (ROC) curve to analysis the diagnostic efficacy of feature genes. Finally, we verified the feature genes in cell experiments and animal experiments. The statistical analyses in validation experiments were conducted using SPSS version 28.0, and the graph were generated using GraphPad Prism 9.0 software. The bioinformatics analyses were conducted using R language (version 4.2.2), with a significance threshold of p < 0.05 used. RESULTS 199 DEGs were selected using Limma package, and subsequently, 5 feature genes (EGR2, NPY1R, GREM1, BMP3 and COL8A1) were selected through Lasso regression and SVM algorithm. Through various bioinformatics analyses, we found some signaling pathways by which feature genes influence obesity and also revealed the crucial role of these genes in the immune microenvironment, as well as their strong correlations with obesity-related genes. Additionally, ROC curve showed that all the feature genes had good predictive and diagnostic efficiency in obesity. Finally, after validation through in vitro experiments, EGR2, NPY1R and GREM1 were identified as the key genes. CONCLUSIONS This study identified EGR2, GREM1 and NPY1R as the potential key genes and potential diagnostic biomarkers for obesity in humans. Moreover, EGR2 was discovered as a key gene for obesity in human adipose tissue for the first time, which may provide novel targets for diagnosing and treating obesity.
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Affiliation(s)
- Yuchen Hua
- The Second School of Clinical Medicine, Southern Medical University, No.1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong 510515, China
| | - Danyingzhu Xie
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, Guangdong Province 510282, China
| | - Yugang Zhang
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, Guangdong Province 510282, China
| | - Ming Wang
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, Guangdong Province 510282, China.
| | - Weiheng Wen
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, Guangdong Province 510282, China.
| | - Jia Sun
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, Guangdong Province 510282, China.
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Blüher M. [Medical care situation for people with obesity in Germany]. Dtsch Med Wochenschr 2023; 148:957-963. [PMID: 37494561 DOI: 10.1055/a-1847-2586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Obesity is a highly prevalent, chronically progressing disease. Obesity represents a challenge for people living with obesity, health care professionals and the society, because it is also associated with several comorbid diseases. For people with obesity in Germany, there is a significant deficit in the medical treatment infrastructure. The treatment access gap is mainly caused by a lack of legal frameworks for the guideline-driven obesity management. A currently developed disease management program for obesity has the potential to fill the gap in obesity management in the future.
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Römer C, Wolfarth B. Prediction of Relevant Training Control Parameters at Individual Anaerobic Threshold without Blood Lactate Measurement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4641. [PMID: 36901647 PMCID: PMC10001845 DOI: 10.3390/ijerph20054641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Active exercise therapy plays an essential role in tackling the global burden of obesity. Optimizing recommendations in individual training therapy requires that the essential parameters heart rate HR(IAT) and work load (W/kg(IAT) at individual anaerobic threshold (IAT) are known. Performance diagnostics with blood lactate is one of the most established methods for these kinds of diagnostics, yet it is also time consuming and expensive. METHODS To establish a regression model which allows HR(IAT) and (W/kg(IAT) to be predicted without measuring blood lactate, a total of 1234 performance protocols with blood lactate in cycle ergometry were analyzed. Multiple linear regression analyses were performed to predict the essential parameters (HR(IAT)) (W/kg(IAT)) by using routine parameters for ergometry without blood lactate. RESULTS HR(IAT) can be predicted with an RMSE of 8.77 bpm (p < 0.001), R2 = 0.799 (|R| = 0.798) without performing blood lactate diagnostics during cycle ergometry. In addition, it is possible to predict W/kg(IAT) with an RMSE (root mean square error) of 0.241 W/kg (p < 0.001), R2 = 0.897 (|R| = 0.897). CONCLUSIONS It is possible to predict essential parameters for training management without measuring blood lactate. This model can easily be used in preventive medicine and results in an inexpensive yet better training management of the general population, which is essential for public health.
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Balakrishnan P, Jacyshyn-Owen E, Eberl M, Friedrich B, Etter T. Real-world demographic patterns of users of a digital primary prevention service for diabetes. Cardiovasc Endocrinol Metab 2023; 12:e0275. [PMID: 36582668 PMCID: PMC9750647 DOI: 10.1097/xce.0000000000000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
Rapid urbanization has led to an exponential increase in lifestyle-associated metabolic disorders presenting a huge socioeconomic burden. Waya is a digital prevention program that guides overweight and obese individuals to maintain a healthy lifestyle through exercise, diet, and educational videos. Objectives and aims We aimed to study the demographic patterns of the Waya cohort and examine the prevalence of diabetes (the most common lifestyle-associated metabolic disorder) and its risk factors in comparison to the GEDA 2014/2015-European Health Interview Survey population. Methods Waya participants who registered by 1 October 2020 and who answered at least one health survey question were included in this study. Factors such as obesity, hypertension, and diabetes between the two populations were compared using Chi-square test. Results Of the 837 participants, 86.1% were women. The proportion of obese participants was higher in Waya than in the German Health Update (GEDA) cohort (women: 39.4% vs. 18%, P < 0.05; men: 37.1% vs. 18.3%, P < 0.05), whereas the proportion of participants with hypertension (women: 12.1% vs. 30.9% in GEDA, P < 0.05; men: 22.4% vs. 32.8% in GEDA, P < 0.05) was lower. The proportion of women with diabetes was low in our cohort (3.9% vs. 7% in GEDA, P < 0.05); however, the proportion of men with diabetes remained the same between the two groups. We observed significant differences between the GEDA and Waya cohorts due to changes in the prevalence pattern over time or target bias of the digital program. Conclusion These findings showcase the usability of Waya in collecting real-world insights, which will be beneficial in monitoring the prevalence of chronic metabolic disorders and associated risk factors over time.
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Meng F, Nie P, Sousa-Poza A. The intangible costs of overweight and obesity in Germany. HEALTH ECONOMICS REVIEW 2023; 13:14. [PMID: 36809392 PMCID: PMC9942367 DOI: 10.1186/s13561-023-00426-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Previous literature documents the direct and indirect economic costs of obesity, yet none has attempted to quantify the intangible costs of obesity. This study focuses on quantifying the intangible costs of one unit body mass index (BMI) increase and being overweight and obese in Germany. METHODS By applying a life satisfaction-based compensation value analysis to 2002-2018 German Socio-Economic Panel Survey data for adults aged 18-65, the intangible costs of overweight and obesity are estimated. We apply individual income as a reference for estimating the value of the loss of subjective well-being due to overweight and obesity. RESULTS The intangible costs of overweight and obesity in 2018 amount to 42,450 and 13,853 euros, respectively. A one unit increase in BMI induced a 2553 euros annual well-being loss in the overweight and obese relative to those of normal weight. When extrapolated to the entire country, this figure represents approximately 4.3 billion euros, an intangible cost of obesity similar in magnitude to the direct and indirect costs documented in other studies for Germany. These losses, our analysis reveals, have remained remarkably stable since 2002. CONCLUSIONS Our results underscore how existing research into obesity's economic toll may underestimate its true costs, and they strongly imply that if obesity interventions took the intangible costs of obesity into account, the economic benefits would be considerably larger.
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Affiliation(s)
- Fan Meng
- Institute for Health Care & Public Management, University of Hohenheim, 70599, Stuttgart, Germany
| | - Peng Nie
- Institute for Health Care & Public Management, University of Hohenheim, 70599, Stuttgart, Germany
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, 710061, China
- IZA, Bonn, Germany
- Health Econometrics and Data Group, University of York, York, UK
| | - Alfonso Sousa-Poza
- Institute for Health Care & Public Management, University of Hohenheim, 70599, Stuttgart, Germany.
- IZA, Bonn, Germany.
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Vesikansa A, Mehtälä J, Mutanen K, Lundqvist A, Laatikainen T, Ylisaukko-oja T, Saukkonen T, Pietiläinen KH. The association between body mass index groups and metabolic comorbidities with healthcare and medication costs: a nationwide biobank and registry study in Finland. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2166313. [PMID: 36684852 PMCID: PMC9858397 DOI: 10.1080/20016689.2023.2166313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The increasing prevalence of obesity imposes a significant cost burden on individuals and societies worldwide. OBJECTIVE In this nationally representative study, the association between body mass index (BMI) groups and the number of metabolic comorbidities (MetC) with total direct costs was investigated in the Finnish population. STUDY DESIGN, SETTING, AND PARTICIPANTS The study cohort included 5,587 adults with BMI ≥18.5 kg/m2 who participated in the cross-sectional FinHealth 2017 health examination survey conducted by the Finnish Institute for Health and Welfare. Data on healthcare resource utilization (HCRU) and drug purchases were collected from national healthcare and drug registers. MAIN OUTCOME MEASURE The primary outcome was total direct costs (costs of primary and secondary HCRU and prescription medications). RESULTS Class I (BMI 30.0-34.9 kg/m2) and class II - III (BMI ≥35.0 kg/m2) obesity were associated with 43% and 40% higher age- and sex-adjusted direct costs, respectively, compared with normal weight, mainly driven by a steeply increased comorbidity in the higher BMI groups. In all BMI groups combined, individuals with ≥2 MetCs comprised 39% of the total study population and 60% of the total costs. CONCLUSION To manage the cost burden of obesity, treatment should be given equal consideration as other chronic diseases, and BMIs ≥30.0 kg/m2 should be considered in treatment decisions.
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Affiliation(s)
| | | | | | | | - Tiina Laatikainen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Joint Municipal Authority for North Karelia Social andHealth Services (Siun Sote), Joensuu, Finland
| | - Tero Ylisaukko-oja
- MedEngine Oy, Helsinki, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | | | - Kirsi H. Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki,Helsinki, Finland & Obesity Center, Abdominal Center, Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Römer C, Wolfarth B. Heart Rate Recovery (HRR) Is Not a Singular Predictor for Physical Fitness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:792. [PMID: 36613113 PMCID: PMC9819190 DOI: 10.3390/ijerph20010792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND For optimal recommendations in cardiovascular training for the general population, knowing the essential parameters for physical fitness is required. Heart rate recovery (HRR) is an easy-to-measure parameter and is discussed to derive the physical fitness of an individual subject. This study evaluates HRR as a potential physical fitness parameter for public health programs, as it is measured in every ergometry. METHODS In this retrospective cross-sectional study, we analyzed HRR regarding physical fitness (W/kg (IAT: individual anaerobic threshold)). In total, we analyzed 1234 performance protocols in cycle ergometry. Significance tests (p < 0.001) and multiple linear regression were performed. RESULTS The analysis of HRR and weight-related performance showed a significant correlation with a moderate coefficient of determination (R2 = 0.250). The coefficient of determination increases from very weak correlation levels at 1 min post-workout towards weak to moderate levels of correlation at 5 min post-workout. CONCLUSIONS In this study HRR and the weight-related performance at the IAT showed a significant correlation with a mean strength. Thus, a prediction or conclusion on physical performance based singularly on HRR decrease is not recommended. However, in preventive medicine, HRR should be measured and observed on a long-term basis, for analysis of vagal activity and to draw to inferences of mortality.
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Thiem H, Rychlik RP, Weimann A. Kosten-Effektivitäts-Analyse des Optifast 52 Programms bei
Patienten mit Adipositas Grad III und Diabetes mellitus Typ 2. AKTUELLE ERNÄHRUNGSMEDIZIN 2022. [DOI: 10.1055/a-1955-0935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Zusammenfassung
Hintergrund Adipositas stellt für eine Vielzahl weiterer
Erkrankungen einen wesentlichen Risikofaktor dar, darunter insbesondere Diabetes
mellitus Typ 2 (DMT2). DMT2 als Adipositas-assoziierte Folgeerkrankung bedeutet
sowohl aus medizinischer als auch ökonomischer Sicht eine hohe Belastung
für das deutsche Gesundheitssystem. Ziel therapeutischer
Maßnahmen zur Gewichtsreduktion bei Patienten mit DMT2 ist somit immer
auch die Verbesserung der diabetischen Stoffwechsellage. Bei Patienten mit
Adipositas Grad III (BMI≥40 kg/m2) kann
alternativ zu einer metabolischen bariatrischen Operation auch ein
strukturiertes, multimodales Therapieprogramm (Optifast 52 Programm) angeboten
werden.
Methodik In einer Kosten-Effektivitäts-Analyse sollen die
gesundheitsökonomischen Auswirkungen des Optifast 52 Programms im
Vergleich zur metabolischen Operation bei adipösen Patienten (BMI
40–50 kg/m2) mit DMT2 als
Adipositasassoziierter Begleiterkrankung ermittelt werden. Ziel beider
Therapieoptionen ist die Remission des DMT2 aufgrund von Gewichtsreduktion.
Mithilfe eines Entscheidungsbaum-Modells wird die Therapie des DMT2 für
einen Zeitraum von drei Jahren modelliert. Berücksichtigt werden die
direkten medizinischen Kosten aus Perspektive der gesetzlichen
Krankenversicherung in Deutschland.
Ergebnisse Die kumulierten Behandlungskosten des DMT2 liegen unter
Anwendung des Optifast 52 Programms bei durchschnittlich 9.425,01 Euro
für den Gesamtzeitraum von drei Jahren im Vergleich zu 13.727,94 Euro
für Patienten mit metabolischer Operation. Unter
Berücksichtigung der Effektivität der beiden Therapieoptionen
zeigt sich, dass das Optifast 52 Programm mit 11.536,33 Euro im Vergleich zu
14.908,56 Euro für eine metabolische Operation kosteneffektiv ist.
Schlussfolgerung Die Reduktion des Körpergewichts ist bei
Patienten mit Adipositas wesentlich für eine erfolgreiche Therapie des
DMT2. Die metabolische Operation kann dabei zu deutlichen Gewichtsverlusten
führen, ist jedoch aufgrund der vergleichsweise höheren
Komplikationsraten und der hohen finanziellen Belastung für das deutsche
Gesundheitssystem kritisch zu sehen. Aus gesundheitsökonomischer Sicht
stellt das Optifast 52 Programm deswegen eine kosteneffektive Alternative zur
metabolischen Operation dar.
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Affiliation(s)
- Helena Thiem
- Institut für Empirische Gesundheitsökonomie,
Burscheid
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Spanggaard M, Bøgelund M, Dirksen C, Jørgensen NB, Madsbad S, Panton UH, Pedersen MH, Reitzel SB, Johansen P. The substantial costs to society associated with obesity - a Danish register-based study based on 2002-2018 data. Expert Rev Pharmacoecon Outcomes Res 2022; 22:823-833. [PMID: 35297718 DOI: 10.1080/14737167.2022.2053676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The Danish national health registers were used to investigate the economic burden of obesity, associated costs of comorbidities and a breakdown into direct and indirect costs. METHODS The study population comprised all Danish adult citizens registered with a hospital diagnosis of obesity in the Danish National Patient Register between 2002 and 2018. Cases were matched with five controls via the Danish Civil Registration System. We estimated the difference in total healthcare costs and indirect costs between cases and controls and the difference in healthcare resource utilization. In a sub-analysis, we estimated total healthcare costs for persons who had been registered with one or more of 11 predefined comorbidities. RESULTS People with obesity experienced a statistically significant twofold increase in average direct healthcare costs per year (EUR 5,934), compared with controls (EUR 2,788) and had statistically significantly higher indirect costs compared to controls. Total healthcare costs for people with obesity and one or more of the 11 comorbidities were 91.7%-342.8% higher than total healthcare costs of the population with obesity but none of the 11 comorbidities. CONCLUSION Obesity was associated with an increase in both direct and indirect costs. The presence of comorbidities was associated with additional healthcare costs. KEY POINTS Obesity is associated with an increase in direct and indirect costs in Denmark.Comorbidities are associated with additional healthcare costs.
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Affiliation(s)
| | | | - Carsten Dirksen
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Steen Madsbad
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
| | - Ulrik Haagen Panton
- Novo Nordisk North West Europe Pharmaceuticals A/S, Crowne Plaza Copenhagen Towers, Copenhagen, Denmark
| | | | | | - Pierre Johansen
- Novo Nordisk North West Europe Pharmaceuticals A/S, Crowne Plaza Copenhagen Towers, Copenhagen, Denmark
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Nather K, Bolger F, DiModica L, Fletcher‐Louis M, Salvador J, Pattou F, Panton UH, Cancino A. The impact of COVID-19 on obesity services across Europe: A physician survey. Clin Obes 2021; 11:e12474. [PMID: 34254445 PMCID: PMC8420525 DOI: 10.1111/cob.12474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/13/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022]
Abstract
Obesity is a risk factor for severe complications from coronavirus disease 2019 (COVID-19). During the COVID-19 pandemic in Spring 2020, many clinics and obesity centers across Europe were required to close. This study aimed to determine the impact of COVID-19 on the provision of obesity services across 10 European countries via a survey of physicians (n = 102) specializing in treating persons with obesity (PwO). In total, 62-95 out of 102 physicians reported that COVID-19 affected obesity-related services, with cancellations/suspensions ranging from 50% to 100% across the 10 countries. Approximately 75% of cancellations/suspensions were provider- rather than patient-initiated. A median increase of 20%-25% in waiting times was reported for most services across the countries. When services resume, 87 out of 100 physicians consider factors influencing down-stream patient outcomes as the most relevant factors for prioritizing interventional treatment. Responses showed that 65 out of 102 and 36 out of 102 physicians believed it (highly) likely that a change in treatment guidance will occur to prioritize earlier interventional treatment for the management of PwO, by either using bariatric surgery or pharmacotherapy, respectively. Results from this study provide important learnings, such as opportunities for, and discrepancies in, the provision of alternative care in light of services cancellations or delays, which may be important for the future management of obesity, especially during future waves of COVID-19 or other infectious pandemics.
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Affiliation(s)
| | | | | | | | - Javier Salvador
- Department of Endocrinology & NutritionClínica Universidad de NavarraPamplonaSpain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN)Instituto de Salud Carlos IIIMadridSpain
| | - François Pattou
- Univ Lille, CHU de Lille, InsermLille Pasteur Institute, Integrated Obesity CenterLilleFrance
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Mehlhose C, Schmitt D, Risius A. PACE Labels on Healthy and Unhealthy Snack Products in a Laboratory Shopping Setting: Perception, Visual Attention, and Product Choice. Foods 2021; 10:foods10040904. [PMID: 33924093 PMCID: PMC8074289 DOI: 10.3390/foods10040904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 12/29/2022] Open
Abstract
Informative food labels are one way to increase nutritional awareness in society and can essentially help individuals maintain balanced dietary practices. Nonetheless, making food labels ‘informative’, in the sense of applicability, is not always easy. Physical activity calorie equivalent (PACE) food labeling is one approach to achieve this goal. Yet, it is neither understood how consumers perceive PACE labels, nor how effective they are in regards to healthy food choices. Moreover, it is of interest to assess the perception of real products in close-to-realistic environments. Therefore, this study examined a simulated purchase situation and consumers’ visual attention on PACE labels—on 20 different real snack products with varying health values. In a laboratory-shopping environment, the gaze behaviors of 91 consumers were examined with a head-mounted eye-tracker. In regards to perception, it was elucidated that every participant noticed at least one PACE label. On average 1.39 PACE label fixations on different products were counted with a mean fixation duration of 0.55 s and a mean time to first fixation of 22.46 s. On average, 22.9% of the participants viewed the PACE labels at least once, but the intensity and duration varied greatly between the different products; ’healthier products’ attracted more visual attention than ‘unhealthier products’. In regards to health choice, it became obvious that the choices observed were rather healthy and PACE labels attracted attention. This may have been especially true for participants with little involvement in physical activity and health behavior, which may have been the main target group. Hence, catchy, communicable PACE labels, as well as balanced product offerings may facilitate more healthy food choices. The real-world laboratory setting offered valuable insights, which should be followed-up on.
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Tittlbach SA, Hoffmann SW, Bennie JA. Association of meeting both muscle strengthening and aerobic exercise guidelines with prevalent overweight and obesity classes - results from a nationally representative sample of German adults. Eur J Sport Sci 2021; 22:436-446. [PMID: 33369530 DOI: 10.1080/17461391.2020.1870161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES German national physical activity guidelines specify adults (≥18 years) should engage in at least: (i) 150 min of aerobic moderate-to-vigorous-intensity physical activity/week (MVPA); and (ii) muscle-strengthening exercise (MSE) 2 days/week. However, the relationship between MVPA and MSE and overweight/obesity has not been examined among German adults. Aim of this study was to examine whether meeting the guidelines for both MVPA and MSE is associated with a lower prevalence of overweight/obesity compared to meeting MVPA or MSE alone or none of them, among a nationally representative sample of German adults. METHODS The cross-sectional study drew data from the 2014 German Health Update (GEDA) (n=22,822; ≥18 years). Physical activity (MVPA-MSE), height/weight, socio-demographic, health and lifestyle factors were assessed by self-report via validated questionnaires. Generalized linear models with Poisson regression were used to assess prevalence ratios of Body Mass Index-derived (BMI) overweight/obesity across categories of physical activity guideline adherence (met neither; MSE only; MVPA only; met both). RESULTS Compared to other physical activity groups, meeting both the MVPA-MSE guidelines was associated with the lowest prevalence rate of overweight/obesity (Adjusted Prevalence Ratios [APR] range: 0.25-0.73). Associations between BMI and physical activity were strongest among Class II obesity (APR range: 0.25-0.45). The associations remained consistent after adjusting sociodemographic and lifestyle factors. CONCLUSIONS Meeting the combined MVPA-MSE guideline, as suggested in the German national physical activity recommendations, showed the lowest overweight/obesity prevalence. Promoting uptake and adherence of both MVPA and MSE at the population level could help to reduce the public health burden of obesity.
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Affiliation(s)
- Susanne A Tittlbach
- Department of Social and Health Sciences in Sport, Institute of Sport Science, University of Bayreuth, Universitätsstraße 30, 95440 Bayreuth, Germany
| | - Sascha W Hoffmann
- Department of Theory and Practice of Sports and Movement Fields, Institute of Sport Science, University of Bayreuth, Universitätsstraße 30, 95440 Bayreuth, Germany
| | - Jason A Bennie
- Physically Active Lifestyles Research Group (USQ PALs), Institute for Resilient Regions, Centre for Health Sciences Research, University of Southern Queensland, 37 Sinnathamby Boulevard, Springfield Central, QLD 4300, Australia
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Signs of Warning: Do Health Warning Messages on Sweets Affect the Neural Prefrontal Cortex Activity? Nutrients 2020; 12:nu12123903. [PMID: 33371197 PMCID: PMC7765959 DOI: 10.3390/nu12123903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/13/2020] [Accepted: 12/18/2020] [Indexed: 12/01/2022] Open
Abstract
In the global attempt to combat rising obesity rates, the introduction of health warning messages on food products is discussed as one possible approach. However, the perception of graphical health warning messages in the food context and the possible impact that they may have, in particular at the neuronal level, have hardly been studied. Therefore, the aim of this explorative study was to examine consumers’ reactions (measured as neuronal activity and subjective reporting) of two different types of graphical health warning messages on sweets compared to sweets without warning messages. One type used the red road traffic stop sign as graphical information (“Stop”), while the other one used shocking pictures (“Shock”), an approach similar to the images on cigarette packages. The neural response of 78 participants was examined with the neuroimaging technique functional near-infrared spectroscopy (fNIRS). Different hemodynamic responses in the orbitofrontal cortex (OFC), the frontopolar cortex (FOC), and the dorsolateral prefrontal cortex (dlPFC) were observed, regions which are associated with reward evaluation, social behavior consequences, and self-control. Further, the health warning messages were actively and emotionally remembered by the participants. These findings point to an interesting health information strategy, which should be explored and discussed further.
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Lortz J, Simanovski J, Kuether T, Kreitschmann-Andermahr I, Ullrich G, Steinmetz M, Rammos C, Jánosi RA, Moebus S, Rassaf T, Paldán K. Needs and Requirements in the Designing of Mobile Interventions for Patients With Peripheral Arterial Disease: Questionnaire Study. JMIR Form Res 2020; 4:e15669. [PMID: 32663154 PMCID: PMC7435621 DOI: 10.2196/15669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/11/2019] [Accepted: 03/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background The development of mobile interventions for noncommunicable diseases has increased in recent years. However, there is a dearth of apps for patients with peripheral arterial disease (PAD), who frequently have an impaired ability to walk. Objective Using a patient-centered approach for the development of mobile interventions, we aim to describe the needs and requirements of patients with PAD regarding the overall care situation and the use of mobile interventions to perform supervised exercise therapy (SET). Methods A questionnaire survey was conducted in addition to a clinical examination at the vascular outpatient clinic of the West-German Heart and Vascular Center of the University Clinic Essen in Germany. Patients with diagnosed PAD were asked to answer questions on sociodemographic characteristics, PAD-related need for support, satisfaction with their health care situation, smartphone and app use, and requirements for the design of mobile interventions to support SET. Results Overall, a need for better support of patients with diagnosed PAD was identified. In total, 59.2% (n=180) expressed their desire for more support for their disease. Patients (n=304) had a mean age of 67 years and half of them (n=157, 51.6%) were smartphone users. We noted an interest in smartphone-supported SET, even for people who did not currently use a smartphone. “Information,” “feedback,” “choosing goals,” and “interaction with physicians and therapists” were rated the most relevant components of a potential app. Conclusions A need for the support of patients with PAD was determined. This was particularly evident with regard to disease literacy and the performance of SET. Based on a detailed description of patient characteristics, proposals for the design of mobile interventions adapted to the needs and requirements of patients can be derived.
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Affiliation(s)
- Julia Lortz
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Simanovski
- Centre for Urban Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Tabea Kuether
- Centre of Competence Personal Analytics at the University of Duisburg-Essen, Department of Engineering Sciences, University of Duisburg-Essen, Duisburg, Germany
| | | | - Greta Ullrich
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Steinmetz
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Christos Rammos
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Susanne Moebus
- Centre for Urban Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Katrin Paldán
- Centre for Urban Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.,Centre of Competence Personal Analytics at the University of Duisburg-Essen, Department of Engineering Sciences, University of Duisburg-Essen, Duisburg, Germany
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15
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Tacke F, Boeker KHW, Klinker H, Heyne R, Buggisch P, Pathil A, Wiegand J, Cornberg M, Lange C, Berg T, Zeuzem S, Mauss S. Baseline risk factors determine lack of biochemical response after SVR in chronic hepatitis C patients treated with DAAs. Liver Int 2020; 40:539-548. [PMID: 31241820 DOI: 10.1111/liv.14186] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Liver function tests (alanine aminotransferase, ALT; gamma-glutamyltransferase, GGT) not always normalize after elimination of hepatitis C virus (HCV) by direct acting antivirals (DAAs), possibly indicating concomitant non-viral liver diseases. We analysed factors determining the biochemical response (normalized ALT/GGT) of DAA therapy in a large real-world cohort. METHOD The German Hepatitis C-Registry is a national multicenter registry study. Normal ALT was defined ≤35 U/L (female) and ≤50 U/L (male) or, according to AASLD, ≤19 U/L (female) and ≤30 U/L (male), normal GGT ≤40 U/L (female) and ≤60 U/L (male). RESULTS At baseline, ALT was elevated in 3705/4946 (74.9%), ALT (AASLD) in 4669/4946 (94.4%) and GGT in 3018/4906 (61.5%). In this study, 97% of patients achieved SVR12. At week 12 after end of therapy, ALT was elevated in 451/4946 (9.1%), ALT according to AASLD in 1906/4946 (38.5%) and GGT in 863/4879 (17.7%). Persistently elevated ALT after DAA therapy was independently associated with high body mass index (BMI), age <70 years, liver cirrhosis, diabetes, alcohol consumption and not achieving SVR12. Using the stricter AASLD criteria, opioid substitution and male sex were additional predictors. Higher GGT at week 12 was associated with high BMI, age >70 years, liver cirrhosis, diabetes, alcohol consumption, opioid substitution and non-SVR. Importantly, persistently elevated liver tests after treatment, particularly GGT, were associated with hepatic decompensation and mortality during 4-years follow-up. CONCLUSION Risk factors at baseline (obesity, diabetes, liver cirrhosis, alcohol consumption) are independently associated with persistently elevated liver function tests after SVR, indicating that these patients warrant further hepatological follow-up. CLINICAL TRIAL REGISTRATION German Clinical Trials Register (DRKS; ID DRKS00009717).
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Affiliation(s)
- Frank Tacke
- Department of Medicine III, University Hospital Aachen, Aachen, Germany.,Department of Hepatology/Gastroenterology, Charité University Medical Center, Berlin, Germany
| | | | | | | | - Peter Buggisch
- ifi-Institute for Interdisciplinary Medicine, Hamburg, Germany
| | - Anita Pathil
- Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Christian Lange
- Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Thomas Berg
- University Hospital Leipzig, Leipzig, Germany
| | - Stefan Zeuzem
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
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16
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Kurz CF, Rehm M, Holle R, Teuner C, Laxy M, Schwarzkopf L. The effect of bariatric surgery on health care costs: A synthetic control approach using Bayesian structural time series. HEALTH ECONOMICS 2019; 28:1293-1307. [PMID: 31489749 DOI: 10.1002/hec.3941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 05/07/2019] [Accepted: 06/29/2019] [Indexed: 06/10/2023]
Abstract
Surgical measures to combat obesity are very effective in terms of weight loss, recovery from diabetes, and improvement in cardiovascular risk factors. However, previous studies found both positive and negative results regarding the effect of bariatric surgery on health care utilization. Using claims data from the largest health insurance provider in Germany, we estimated the causal effect of bariatric surgery on health care costs in a time period ranging from 2 years before to 3 years after bariatric intervention. Owing to the absence of a control group, we employed a Bayesian structural forecasting model to construct a synthetic control. We observed a decrease in medication and physician expenditures after bariatric surgery, whereas hospital expenditures increased in the post-intervention period. Overall, we found a slight increase in total costs after bariatric surgery, but our estimates include a high degree of uncertainty.
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Affiliation(s)
- Christoph F Kurz
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Martin Rehm
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Christina Teuner
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
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17
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Hernáez Á, Zomeño MD, Dégano IR, Pérez-Fernández S, Goday A, Vila J, Civeira F, Moure R, Marrugat J. Exceso de peso en España: situación actual, proyecciones para 2030 y sobrecoste directo estimado para el Sistema Nacional de Salud. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.07.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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18
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Hernáez Á, Zomeño MD, Dégano IR, Pérez-Fernández S, Goday A, Vila J, Civeira F, Moure R, Marrugat J. Excess Weight in Spain: Current Situation, Projections for 2030, and Estimated Direct Extra Cost for the Spanish Health System. ACTA ACUST UNITED AC 2018; 72:916-924. [PMID: 30473259 DOI: 10.1016/j.rec.2018.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 07/13/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES Excess weight promotes the development of several chronic diseases and decreases quality of life. Its prevalence is increasing globally. Our aim was to estimate the trend in excess weight between 1987 and 2014 in Spanish adults, calculate cases of excess weight and its direct extra costs in 2006 and 2016, and project its trend to 2030. METHODS We selected 47 articles in a systematic literature search to determine the progression of the prevalence of overweight, nonmorbid obesity, and morbid obesity and average body mass index between 1987 and 2014. We projected the expected number of cases in 2006, 2016, and 2030 and the associated direct extra medical costs. RESULTS Between 1987 and 2014, the prevalence of overweight, obesity, and morbid obesity increased by 0.28%/y (P=.004), 0.50%/y (P <.001) and 0.030%/y (P=.006) in men, and by 0.10%/y (P=.123), 0.25%/y (P=.078), and 0.042%/y (P=.251) in women. The mean body mass index increased by 0.10 kg/m2/y in men (P <.001) and 0.26 kg/m2/y in women (significantly only between 1987 and 2002, P <.001). We estimated 23 500 000 patients with excess weight in 2016, generating 1.95 billion €/y in direct extra medical costs. If the current trend continues, between 2016 and 2030, there will be 3 100 000 new cases of excess weight, leading to 3.0 billion €/y of direct extra medical costs in 2030. CONCLUSIONS Excess weight in Spanish adults has risen since the creation of population registries, generating direct extra medical costs that represent 2% of the 2016 health budget. If this trend continues, we expect 16% more cases in 2030 and 58% more direct extra medical costs.
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Affiliation(s)
- Álvaro Hernáez
- Grupo de Investigación en Riesgo Cardiovascular, Nutrición y Envejecimiento, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Facultad de Ciencias de la Salud Blanquerna, Universitat Ramón Llull, Barcelona, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - M Dolores Zomeño
- Facultad de Ciencias de la Salud Blanquerna, Universitat Ramón Llull, Barcelona, Spain; Grupo de Investigación en Riesgo Cardiovascular y Nutrición-REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Programa de Doctorado en Alimentación y Nutrición, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Irene R Dégano
- Grupo de investigación REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Silvia Pérez-Fernández
- Grupo de investigación REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Goday
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Grupo de Investigación en Riesgo Cardiovascular y Nutrición-REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Servicio de Endocrinología, Hospital del Mar, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Vila
- Grupo de investigación REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Civeira
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Unidad de Lípidos y Arteriosclerosis, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Ricardo Moure
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Bioquímica y Biomedicina Molecular, Institut de Biomedicina IBUB, Universitat de Barcelona, Barcelona, Spain
| | - Jaume Marrugat
- Grupo de investigación REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
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19
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Abstract
Obesity in adolescence will probably have major implications not only for the affected adolescents but also for society. Those who have obesity during adolescence usually have obesity into adulthood, which causes many medical and psychological issues that can result in premature death. Furthermore, obesity in adolescents is associated with a range of social problems, including difficulties securing an apprenticeship or a job or finding a partner. Adolescents with obesity are also at increased risk of having children with obesity later in life. All these consequences lead to high costs for the health-care system. Although efficient treatment options are available that have been proven in randomized controlled trials, such as lifestyle interventions for adolescents with obesity and bariatric surgery for adolescents with severe obesity, these interventions frequently fail in clinical practice as treatment adherence is low in adolescents and most adolescents with obesity do not seek medical care. Therefore, improving treatment adherence and identifying treatment barriers are necessary.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. Friedrich Steiner Street 5, Datteln 45711, Germany
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20
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Schwarz S, Mrosewski I, Silawal S, Schulze-Tanzil G. The interrelation of osteoarthritis and diabetes mellitus: considering the potential role of interleukin-10 and in vitro models for further analysis. Inflamm Res 2017; 67:285-300. [PMID: 29196771 DOI: 10.1007/s00011-017-1121-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 11/12/2017] [Accepted: 11/24/2017] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Today, not only the existence of an interrelation between obesity/adipositas and osteoarthritis (OA) but also the association of OA and diabetes mellitus (DM) are widely recognized. Nevertheless, shared influence factors facilitating OA development in DM patients still remain speculative up until now. To supplement the analysis of clinical data, appropriate in vitro models could help to identify shared pathogenetic pathways. Informative in vitro studies could later be complemented by in vivo data obtained from suitable animal models. MATERIALS AND METHODS Therefore, this detailed review of available literature was undertaken to discuss and compare the results of currently published in vitro studies focusing on the interrelation between OA, the metabolic syndrome and DM and to propose models to further study the molecular pathways. RESULTS The survey of literature presented here supports the hypothesis that the pathogenesis of OA in DM is based on imbalanced molecular pathways with a putative crucial role of antiinflammatory cytokines such as IL-10. CONCLUSION Future development of versatile micro-scaled in vitro models such as combining DM and OA on chip could allow the identification of common pathogenetic pathways and might help to develop novel therapeutic strategies.
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Affiliation(s)
- Silke Schwarz
- Department of Anatomy, Paracelsus Medical University, Prof. Ernst Nathan Str. 1, 90419, Nuremberg, Germany.,Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria
| | - Ingo Mrosewski
- MVZ Limbach Laboratories, Aroser Allee 84, 13407, Berlin, Germany
| | - Sandeep Silawal
- Department of Anatomy, Paracelsus Medical University, Prof. Ernst Nathan Str. 1, 90419, Nuremberg, Germany.,Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria
| | - Gundula Schulze-Tanzil
- Department of Anatomy, Paracelsus Medical University, Prof. Ernst Nathan Str. 1, 90419, Nuremberg, Germany. .,Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria.
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21
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Rabel M, Meisinger C, Peters A, Holle R, Laxy M. The longitudinal association between change in physical activity, weight, and health-related quality of life: Results from the population-based KORA S4/F4/FF4 cohort study. PLoS One 2017; 12:e0185205. [PMID: 28953956 PMCID: PMC5617179 DOI: 10.1371/journal.pone.0185205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 09/10/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Longitudinal evidence on the association between physical activity (PA) or weight and health-related quality of life (HRQL) is sparse and studies describe inconclusive results. The aim of this study was to examine longitudinal associations between change in PA and HRQL as between change in weight and HRQL respectively. METHODS Analyses are based on data from the KORA S4 cohort study (1999-2001; n = 4,261, mean age 49.0 ± 13.3 years) and the two follow-up examinations (F4: 2006-2008; FF4: 2013-2014). Information on PA was collected in standardized interviews. Weight was measured objectively. Mental and physical components of HRQL were assessed via the SF-12 questionnaire. First, change in HRQL was regressed on change in PA and weight. Second, hierarchical linear models were fitted, which allowed estimation of between-subject and within-subject effects. Analyses were adjusted for the covariates sex, baseline diseases, and education. RESULTS A change to a physically more active lifestyle is positively associated with physical and mental HRQL. Although weight gain is associated with impairments in physical HRQL, the data show an inverse relationship between weight gain and mental HRQL. The results were consistent for both the change score analyses and the hierarchical linear models. DISCUSSION Our findings stress the importance of interventions on PA/weight. Nonetheless, more research is needed to reveal the causal relationship between PA/weight and HRQL.
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Affiliation(s)
- Matthias Rabel
- Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
- Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München–German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München–German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München–German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München–German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München–German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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22
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Laxy M, Stark R, Peters A, Hauner H, Holle R, Teuner CM. The Non-Linear Relationship between BMI and Health Care Costs and the Resulting Cost Fraction Attributable to Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14090984. [PMID: 28867791 PMCID: PMC5615521 DOI: 10.3390/ijerph14090984] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 12/31/2022]
Abstract
This study aims to analyse the non-linear relationship between Body Mass Index (BMI) and direct health care costs, and to quantify the resulting cost fraction attributable to obesity in Germany. Five cross-sectional surveys of cohort studies in southern Germany were pooled, resulting in data of 6757 individuals (31–96 years old). Self-reported information on health care utilisation was used to estimate direct health care costs for the year 2011. The relationship between measured BMI and annual costs was analysed using generalised additive models, and the cost fraction attributable to obesity was calculated. We found a non-linear association of BMI and health care costs with a continuously increasing slope for increasing BMI without any clear threshold. Under the consideration of the non-linear BMI-cost relationship, a shift in the BMI distribution so that the BMI of each individual is lowered by one point is associated with a 2.1% reduction of mean direct costs in the population. If obesity was eliminated, and the BMI of all obese individuals were lowered to 29.9 kg/m2, this would reduce the mean direct costs by 4.0% in the population. Results show a non-linear relationship between BMI and health care costs, with very high costs for a few individuals with high BMI. This indicates that population-based interventions in combination with selective measures for very obese individuals might be the preferred strategy.
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Affiliation(s)
- Michael Laxy
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, 85764 Neuherberg, Germany.
- German Center for Diabetes Research, 85764 Neuherberg, Germany.
| | - Renée Stark
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, 85764 Neuherberg, Germany.
| | - Annette Peters
- German Center for Diabetes Research, 85764 Neuherberg, Germany.
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, 85764 Neuherberg, Germany.
| | - Hans Hauner
- Technische Universität München, Klinikum Rechts der Isar, Institute for Nutritional Medicine, 81675 Munich, Germany.
| | - Rolf Holle
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, 85764 Neuherberg, Germany.
- German Center for Diabetes Research, 85764 Neuherberg, Germany.
| | - Christina M Teuner
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, 85764 Neuherberg, Germany.
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