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No therapy has been shown to reduce the risk of major adverse cardiovascular events (MACE) and death in patients with obstructive sleep apnea (OSA). The authors sought to investigate the long-term relationship between metabolic surgery and incident MACE in patients with OSA and obesity. Adult patients with a body mass index 35 to 70 kg/m2 and moderate-to-severe OSA at a U.S. health system (2004-2018) were identified. Baseline characteristics of patients who underwent metabolic surgery were balanced with a nonsurgical control group using overlap-weighting methods. Multivariable Cox regression analysis estimated time-to-incident MACE. Follow-up ended in September 2022. A total of 13,657 patients (7,496 [54.9%] men; mean age 52.0 ± 12.4 years; median body mass index 41.0 kg/m2 [Q1-Q3: 37.6-46.2 kg/m2]), including 970 patients in the metabolic surgery group and 12,687 patients in the nonsurgical group, with a median follow-up of 5.3 years (Q1-Q3: 3.1-8.4 years) were analyzed. The mean between-group difference in body weight at 10 years was 26.6 kg (95% CI: 25.6-27.6 kg) or 19.3% (95% CI: 18.6%-19.9%). The 10-year cumulative incidence of MACE was 27.0% (95% CI: 21.6%-32.0%) in the metabolic surgery group and 35.6% (95% CI: 33.8%-37.4%) in the nonsurgical group (adjusted HR: 0.58 [95% CI: 0.48-0.71]; P < 0.001). The 10-year cumulative incidence of all-cause mortality was 9.1% (95% CI: 5.7%-12.4%) in the metabolic surgery group and 12.5% (95% CI: 11.2%-13.8%) in the nonsurgical group (adjusted HR: 0.63 [95% CI: 0.45-0.89]; P = 0.009). Among patients with moderate-to-severe OSA and obesity, metabolic surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident MACE and death. [ABSTRACT FROM AUTHOR]

Given the heightened risk of postoperative complications associated with obesity, delaying total hip arthroplasty (THA) in patients who have a body mass index (BMI) > 40 to maximize preoperative weight loss has been advocated by professional societies and orthopaedic surgeons. While the benefits of this strategy are not well-understood, previous studies have suggested that a 5% reduction in weight or BMI may be associated with reduced complications after THA. We identified 613 patients who underwent primary THA in a single institution during a 7-year period and who had a BMI >40 recorded from 9 to 12 months prior to surgery. Subjects were stratified into 3 cohorts based on whether their baseline BMI decreased by >5% (147 patients, 24%), was unchanged (± 5%) (336 patients, 55%), or increased by >5% (130 patients, 21%) on the day of surgery. The frequency of 90-days Hip Society and Centers for Medicare & Medicaid Services complications was compared between these cohorts. There were significant baseline differences between the cohorts with respect to baseline American Society of Anesthesiologists class (P <.001) and hemoglobin A1C (P =.011), which were accounted for in a multivariate regression analysis. In univariate analysis, there was a lower incidence of readmission (P =.025) and total complications (P =.005) in the increased BMI cohort. The overall complication rate was 18.4% in the decreased BMI cohort, 17.6% in the unchanged cohort, and 6.2% in the increased cohort. However, multivariable regression analysis controlling for potential confounders did not find that preoperative change in BMI was associated with differences in 90-days complications between cohorts (P >.05). Patients who have a BMI >40 and achieved a clinically significant (>5%) BMI reduction prior to THA did not have a lower risk of 90-days complications or readmissions. Thus, delaying THA in these patients to encourage weight loss may result in restricting access to a beneficial surgery without an appreciable safety benefit. [ABSTRACT FROM AUTHOR]

The very-low calorie ketogenic diet (VLCKD) is recommended as an effective dietary approach for the management of obesity. This study investigated changes in circulating biomarkers of redox homeostasis induced by a multiphase VLCKD in obese individuals. A total of 40 obese subjects were prescribed a multiphasic VLCKD for eleven weeks. Anthropometric measurements, body composition parameters, calorimetric measures, and standard laboratory markers of glucose and lipid metabolism were evaluated at baseline (T 0) and at the end of the dietary intervention (T 1). Additionally, circulating markers of oxidative damage and antioxidant status were analyzed in serum and erythrocytes. Compared to T 0 , at T 1 the multiphase VLCKD induced significant weight loss and reduction of waist circumference, with beneficial effects on body composition parameters and the glucose/lipid biochemical profile. Moreover, a decrease in serum markers of oxidative damage was reported at T 1 , while no changes in serum markers of antioxidant status and in erythrocyte redox markers were observed. In addition, a significant association was found between variations in anthropometric measurements, body composition, glucose metabolism parameters, and changes in circulating markers of oxidative damage. Regression models showed that variation in lipofuscin was significant predictor of changes in body mass index, fat mass, visceral adiposity, and insulin sensitivity. In conclusion, this study demonstrated that the multiphase VLCKD improves serum redox balance by reducing markers of oxidative damage in obese individuals, highlighting the interplay between adiposity, glucose metabolism, and redox homeostasis in the pathogenesis of obesity. Furthermore, these data provide a rationale for future investigations aimed at testing serum lipofuscin as a reliable redox marker in obesity. [Display omitted] • Multiphase very-low calorie ketogenic diet (VLCKD) is promising for obesity • Multiphase VLCKD induces beneficial changes in serum markers of redox balance • Serum parameters of oxidative damage are reduced by multiphase VLCKD • Multiphase VLCKD-induced redox changes associate with weight and fat mass loss • Serum lipofuscin may be suggested as a reliable biomarker in obesity [ABSTRACT FROM AUTHOR]

In a national cohort of Veterans, weight change was compared between participants in a US Department of Veterans Affairs (VA) behavioral weight management program (MOVE!) and matched non-participants, and between high-intensity and low-intensity participants. Retrospective cohort study of Veterans with 1 + MOVE! visits in 2008–2017 were matched to MOVE! non-participants via sequential stratification. Percent weight change up to two years after MOVE! initiation of participants and non-participants was modeled using generalized additive mixed models, and 1-year weight change of high-intensity or low-intensity participants was also compared. MOVE! participants (n = 499,696) and non-participant controls (n = 1,336,172) were well-matched, with an average age of 56 years and average BMI of 35. MOVE! participants lost 1.4 % at 12 months and 1.2 % at 24 months, which was 0.89 % points (95 % CI: 0.83–0.96) more at 12 months than non-participants and 0.55 % points (95 % CI: 0.41–0.68) more at 24 months. 9.1 % of MOVE! participants had high-intensity use in one year, and they had 2.38 % point (95 % CI: 2.25–2.52) greater weight loss than low-intensity participation at 12 months (2.8 % vs 0.4 %). Participation in VA's system-wide behavioral weight management program (MOVE!) was associated with modest weight loss, suggesting that program modifications are needed to increase Veteran engagement and program effectiveness. Future research should further explore how variations in program delivery and the use of newer anti-obesity medications may impact the program's effectiveness. • Over 20 years, MOVE! program users had greater weight loss than non-users. • The 9 % of users with greater participation experienced greater weight loss. • Research is needed to more effectively engage Veterans to participate in MOVE!. [ABSTRACT FROM AUTHOR]

Interleukin-27 (IL-27), a potential mediator linking obesity to inflammatory diseases, is considered an important candidate for regulating obesity. The present study evaluated the relationship of IL-27 with obesity and insulin resistance (IR) and further investigated the changes in IL-27 levels after weight loss. The study analyzed 405 participants, of whom 62 with overweight or obesity completed one year of lifestyle intervention. The body compositions, including percent of body fat (PBF), visceral fat area (VFA), skeletal muscle mass (SMM), and visceral fat area to skeletal muscle mass ratio (VSR), were assessed using the bioelectrical impedance analysis method. Serum IL-27 levels were measured using the enzyme-linked immunosorbent assay (ELISA). IL-27 levels increased significantly with the increase in body mass index (BMI) (P < 0.001). Moreover, IL-27 levels were positively correlated with PBF, VFA, and VSR. Homeostatic model assessment for insulin resistance (HOMA-IR), the inverse of hepatic insulin sensitivity (1/HISI), adipose tissue insulin resistance (Adipo-IR), and homeostasis model assessment-adiponectin (HOMA-AD) increased significantly with each quartile of IL-27 levels (all P < 0.001). IL-27 levels significantly decreased after weight loss (P < 0.001). IL-27 was positively correlated with obesity, HOMA-IR, 1/HISI, Adipo-IR, and HOMA-AD. IL-27 levels significantly decreased after weight loss. • We used body composition to assess obesity to avoid the limitations of body mass index (BMI). • Interleukin-27 (IL-27) levels increased significantly with the increase in BMI, percent body fat, visceral fat area (VFA), and the ratio of VFA to skeletal muscle mass. • We initially found that IL-27 was positively correlated with homeostatic model assessment for insulin resistance (HOMA-IR), the inverse of hepatic insulin sensitivity (1/HISI), adipose tissue insulin resistance (Adipo-IR), and homeostasis model assessment-adiponectin (HOMA-AD). • IL-27 levels showed a significant decrease after weight loss. [ABSTRACT FROM AUTHOR]

Mobile health applications (mHealth apps) are increasingly being used in weight loss interventions. However, evidence on the effects of such interventions on diet quality and their correlation with weight loss is lacking. The objective of this study was to examine whether changes in the diet quality of adults with prediabetes followed the use of an mHealth-enabled lifestyle intervention, compared with those who did not, and whether these changes correlated with weight loss. A secondary analysis of a 6-month randomized controlled trial Diabetes Lifestyle Intervention using Technology Empowerment (D'LITE) was conducted, with participants recruited from October 2017 to September 2019. Community-dwelling adults (n = 148) in Singapore diagnosed with prediabetes and body mass index (BMI) ≥23 were included in this study. Participants were randomized to receive either a 6-month mHealth-enabled lifestyle intervention program (diet and physical activity) or standard care dietary advice. Dietary data were collected in the form of 2-day food records at baseline, 3, and 6 months. Changes in Alternate Healthy Eating Index-2010 (AHEI-2010) scores and food groups (servings/day), calculated from the dietary data, and correlation between changes in AHEI-2010 and weight loss at 3 and 6 months, were examined. Between-group comparisons of continuous variables and within-participants variation were performed using longitudinal mixed-effect models, intention-to-treat principles. The models included treatment groups, time (baseline, 3 months, and 6 months), and covariates (age, sex, and BMI), as well as the group × time interactions, as fixed variables and within-participant variation in outcome values as random variable. The random intercept for participants accounted for the dependence of repeated measures. A likelihood ratio test was also conducted to test random effect variance. Spearman correlation test was used to examine correlation between changes in AHEI-2010 scores and weight loss. There was a significant improvement in overall diet quality as ascertained by the AHEI-2010, by 6.2 points (95% confidence interval [CI], 3.8–8.7; P < 0.001) in the intervention group as compared with the control. The participants in the intervention group had a significantly greater reduction in intake of sugar-sweetened beverages (SSB) by 0.5 servings/day (95% CI, −0.8, −0.2; P < 0.001) and sodium by 726 mg/day (95% CI, −983, −468; P <.001), compared with those receiving standard care. At 3 and 6 months, a significant decrease in SSB (0.8 servings/day; 0.7 servings/day, respectively) and sodium (297 mg/day; 296 mg/day, respectively) intakes were reported compared with baseline intakes. Small positive correlations (r = 0.2; P < 0.05) were observed between changes in AHEI-2010 scores from baseline and percentage weight loss at 3 and 6 months. For adults with prediabetes in Singapore, diet quality can be improved with an mHealth-enabled lifestyle intervention program. A small positive correlation exists between AHEI-2010 scores and weight loss. [ABSTRACT FROM AUTHOR]

We present for the first-time efficacy and tolerability of GLP-1-RA (Semaglutide) in Smith-Kingsmore syndrome (SKS). SKS is a rare genetic disorder characterized by intellectual disability, macrocephaly, seizures and distinctive facial features due to MTOR gene mutation. We present a 22-year-old woman with mosaic SKS and severe obesity (Body Mass Index ≥40 kg/m²), treated with semaglutide. She achieved a 9 kg (7.44%) weight loss over 12 months without adverse effects.This case highlights semaglutide's potential in managing obesity in SKS patients, emphasizing the need for further research in this rare genetic disorder. • Smith-Kingsmore syndrome (SKS) is a rare genetic disorder due to MTOR gene mutation. • Obesity has been sporadically reported among SKS individuals. • The use of GLP-1 analogs has never been described in SKS individuals. • Semaglutide emerges as a promising therapeutic for obesity in mTORopathies. • Digestive tolerance was excellent and no side effects have been observed. [ABSTRACT FROM AUTHOR]

Obesity represents a major obstacle for controlling hypertension, the leading risk factor for cardiovascular mortality. The purpose of this study was to determine the long-term effects of bariatric surgery on hypertension control and remission. We conducted a randomized clinical trial with subjects with obesity grade 1 or 2 plus hypertension using at least 2 medications. We excluded subjects with previous cardiovascular events and poorly controlled type 2 diabetes. Subjects were assigned to Roux-en-Y gastric bypass (RYGB) combined with medical therapy (MT) or MT alone. We reassessed the original primary outcome (reduction of at least 30% of the total antihypertensive medications while maintaining blood pressure levels <140/90 mm Hg) at 5 years. The main analysis followed the intention-to-treat principle. A total of 100 subjects were included (76% women, age 43.8 ± 9.2 years, body mass index: 36.9 ± 2.7 kg/m2). At 5 years, body mass index was 36.40 kg/m2 (95% CI: 35.28-37.52 kg/m2) for MT and 28.01 kg/m2 (95% CI: 26.95-29.08 kg/m2) for RYGB (P < 0.001). Compared with MT, RYGB promoted a significantly higher rate of number of medications reduction (80.7% vs 13.7%; relative risk: 5.91; 95% CI: 2.58-13.52; P < 0.001) and the mean number of antihypertensive medications was 2.97 (95% CI: 2.33-3.60) for MT and 0.80 (95% CI: 0.51-1.09) for RYGB (P < 0.001). The rates of hypertension remission were 2.4% vs 46.9% (relative risk: 19.66; 95% CI: 2.74-141.09; P < 0.001). Sensitivity analysis considering only completed cases revealed consistent results. Interestingly, the rate of apparent resistant hypertension was lower after RYGB (0% vs 15.2%). Bariatric surgery represents an effective and durable strategy to control hypertension and related polypharmacy in subjects with obesity. (GAstric bypass to Treat obEse Patients With steAdy hYpertension [GATEWAY]; NCT01784848) [Display omitted] [ABSTRACT FROM AUTHOR]

Metabolic and bariatric surgery (MBS) is a very effective weight loss intervention, although does not invariably reverses the obesity status. Our aim was to evaluate whether despite successful weight loss after MBS, persistence of obesity at time of conception still carries additional risks of adverse perinatal pregnancy outcomes. Retrospective study comparing pregnancy outcomes of women previously submitted to MBS with a preconception (PC) body mass index BMI < 30 kg/m2 or PC BMI ≥ 30 kg/m2. Eighty pregnancies (n = 80) were included, 49 from women with a PC BMI < 30 kg/m2 and 31 with a PC BMI ≥ 30 kg/m2. Gestational weight gain was significantly lower (9.72 ± 7.10 vs. 13.81 ± 7.16 respectively; p = 0.01) and neonatal intensive care unit admissions were significantly higher (5% vs. 0% respectively; p = 0.02) in women with PC BMI ≥ 30 kg/m2 as compared to those with PC BMI < 30 kg/m2. There were no statistically significant differences in gestational diabetes, anemia, fetal growth restriction, prematurity rate, mode of delivery or birth weight between groups. Perinatal outcomes of pregnancies after MBS may be significantly influenced by PC BMI. The benefits of MBS induced weight loss on obesity-associated adverse pregnancy outcomes can be maximized if the obesity status can be reverted before pregnancy. [ABSTRACT FROM AUTHOR]

Considering the lack of a standardized definition for weight recurrence (W R), the prevalence and predictors of W R remain inconsistent. The prospective study was conducted on 1939 individuals who underwent bariatric surgery;66.8% underwent sleeve gastrectomy (SG), 33.2%, underwent gastric bypass (GB)[of them 87% one-anastomosis gastric bypass (OAGB), and 13% Rue and Y gastric bypass (RYGB)]. During a follow-up of 72 months, the prevalence of W R ranged from 13.5% to 35.5% according to five different definitions. The generalized estimated equation method was used to assess weight changes, excess weight loss (EWL%), and body composition (fat mass (FM), fat-free mass (FFM)and FFM loss/weight loss% (FFML/WL%)) by a bioelectrical impedance analyzer. Stepwise logistic regression models were applied to determine the independent predictors of W R. Among 1939 participants followed up for 72 months, W R definitions were applied to 650 patients (75.4% females) with an average BMI of 44.3 ± 5.4 kg/m2,491 (75.5%) and 159 (24.5%) of whom underwent SG and GB, respectively. W R group had relatively higher weights and FM and lower EWL%. A W R turning point was observed at 24 months post-surgery (Ptime before & after 24 months<0.001). The most significant risk factors for W R included SG (in all W R definitions), a younger age (in four out of five definitions), and a higher baseline BMI (in three out of five definitions). The prevalence and predictors of W R varied greatly depending on the definition applied. The prominent risk factors of W R included SG, younger age, and a higher baseline BMI. [ABSTRACT FROM AUTHOR]

The causes for failure of metabolic improvement and inadequate weight loss after metabolic surgery (MS) in Chinese patients with type 2 diabetes (T2D) have not been fully elucidated. The effect of insulin resistance (IR) on the outcome of T2D, hypertension, hyperlipidemia, and obesity after MS in Chinese patients with T2D and a body mass index (BMI) of 25–32.5 kg/m2 warrants further study. Patients with T2D and a BMI of 25–32.5 kg/m2 who underwent MS between July 2019 and June 2021 were included. University hospital, China. IR levels were evaluated with the glucose disposal rate (GDR). Improvement of T2D, hypertension, and hyperlipidemia was assessed with the composite triple endpoint (CTEP), and weight loss was assessed with the percent of total weight loss (%TWL). Partial correlation analysis, binary logistic regression analysis, multiple linear regression analysis, receiver operating characteristic curve (ROC) analysis, and subgroup analysis were used to analyze the relationship between the CTEP, %TWL at 1 year postoperative, and GDR preoperative. This study analyzed the data of 51 patients with T2D and a BMI of 25–32.5 kg/m2 (30 men and 21 women) with a mean preoperative GDR of 3.72 ± 1.48 mg/kg/min. Partial correlation coefficients between CTEP, %TWL, and GDR were.303 (P =.041) and.449 (P =.001), respectively. The preoperative GDR was significantly positively correlated with CTEP (OR = 1.610, P =.024) and %TWL (β = 1.38, P =.003). The preoperative GDR predicted cutoff values of 4.36 and 5.35 mg/kg/min for CTEP attainment and %TWL ≥ 20%, respectively. IR levels predicted metabolic improvement and weight loss 1 year after MS in Chinese patients with T2D and a BMI of 25–32.5 kg/m2. • Insulin resistance levels were evaluated by calculating GDR with the HEC. • Insulin secretion was measured using the OGTT model. • GDR predicted metabolic improvement and weight loss one year after MS in Chinese T2D patients with a BMI of 25-32.5 kg/m2. [ABSTRACT FROM AUTHOR]

The anti-obesity effect of milk intake has been suggested via a variety of designed studies, but findings of obesity interventions for Korean adults are scarcely reported. The study aimed to investigate the anti-obesity effect of cow milk in Korean adults with an 8-wk randomized intervention. A total of 121 adults overweight aged 19 to 60 yr old were randomly assigned to 1 of the 2 groups: milk or control. During the intervention, both groups were encouraged 500 kcal of restriction a day, and the milk group consumed 200 mL of milk twice a day; the same energy intake as the control group, including milk intake, was recommended for 8 wk. We detected no significant differences in body weight (BW) and body mass index (BMI) between the milk and control groups during the 8-wk intervention, although the changes in BW and BMI of those within the milk group were significant. High-density lipoprotein cholesterol levels and serum calcium levels increased significantly in the milk group compared with the control group. Calcium, phosphorus, vitamin A, and riboflavin intakes increased significantly, when compared with the control. In conclusion, 8-wk milk consumption had no effect on weight loss and BMI change but improved some blood biomarkers and nutrient intake in Korean adults who were overweight. To evaluate the effect of milk on obesity reduction, well-designed, long-term, and large-scale studies are needed. [ABSTRACT FROM AUTHOR]

The impact of paternal obesity and metabolic disease on semen quality and fertility outcomes is not fully appreciated. With increasing obesity rates, researchers have studied the intricate relationship between paternal body mass index, metabolic health, and male fertility. This systematic review identified 112 articles in the MEDLINE database between 2013 and 2023 that investigated the effects of body mass index, diabetes, metabolic syndrome, exercise, weight loss medication, or bariatric surgery on semen parameters, sperm quality, or fertility outcomes. This review suggests that obesity, diabetes, and metabolic syndrome have a negative impact on various parameters of male fertility, from semen quality to sperm deoxyribonucleic acid integrity. There is also mounting evidence that male obesity is correlated negatively with live births via both natural conception and assisted reproductive technologies. Lifestyle interventions, such as physical exercise, generally appear to improve male fertility markers; however, the type and intensity of exercise may play a crucial role. Pharmacologic treatments for weight loss, such as metformin and glucagon-like peptide 1 agonists, present a more complex picture, with studies suggesting both beneficial and detrimental effects on male reproductive health. Similarly, surgical interventions, such as gastric bypass surgery, show promise in improving hormonal imbalances but have mixed effects on semen parameters. Future research is needed to clarify these associations and inform clinical guidelines. In the interim, health practitioners should incorporate these insights into clinical practices, encouraging proactive lifestyle changes and providing targeted treatments to improve male reproductive health. [ABSTRACT FROM AUTHOR]

The purpose of this case report is to describe the use of tirzepatide, a glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist, in a patient with type 1 diabetes mellitus (T1DM) and obesity. A 23-year-old female with T1DM since the age of 10 years was referred to an endocrinology clinic for specialized diabetes care with a pharmacist owing to increasing insulin requirements and resistance. At baseline, the patient weighed 195 pounds (86.64 kg), which had increased significantly by approximately 40 pounds in the last year, and had a body mass index of 38 kg/m2 and hemoglobin A1c (HbA1c) level of 7.4%. She used hybrid closed loop insulin pump technology with continuous glucose monitoring in 100% automation mode. The patient used on average 55.4 units of basal insulin and 26.5 units of bolus per day (total daily dose, 81.9 units) with a time in range (TIR) of 31%. The patient was started on tirzepatide 2.5 mg weekly and titrated to 7.5 mg weekly with 4-week dose titrations. After 12 weeks, the patient's TIR had doubled to 61% with improvements in glucose variability, insulin requirements had decreased to 57.6 units per day, HbA1c had decreased to 6.9%, daily carbohydrates had decreased by approximately 24%, and weight had decreased to 188 pounds (-7 lbs). With additional studies , tirzepatide may be a safe and effective option for patients with T1DM and obesity to improve glycemic control, reduce insulin requirements, and promote weight loss. [ABSTRACT FROM AUTHOR]

Overweight and obesity are related to an increased risk of asthma. The effect of platycoside E (PE) on obesity-related asthma remains unknown. To mimic obesity-related asthma conditions in vivo , C57BL/6 mice were exposed to a high-fat diet (HFD) and challenged with ovalbumin (OVA). PE was administrated intraperitoneally during the OVA treatment. Body weight was measured at 8th week before PE treatment and after sacrificing the mice. Airway inflammation and airway hyperresponsiveness (AHR) were evaluated. Immunohistochemistry staining was performed to evaluate eosinophils. Histopathological changes were determined by HE staining. Cellular model of asthma was established using IL-13 in BEAS-2B cells. Levels of proinflammatory cytokines and oxidative stress indicators were measured by ELISA kits and commercial kits, respectively. Cell viability was detected by CCK-8 assays. IL-13 treatment led to inflammatory and oxidative damage in bronchial epithelial cells, which was relieved by PE. PE administration significantly reduced HFD-induced obesity and relieved AHR and airway inflammation in obese asthmatic mice. The expression of proinflammatory cytokines in BALF and lung tissues in obese asthmatic mice were reduced by PE. PE administration also reduced infiltration of eosinophils and inflammation scores in obese asthmatic mice. PE suppresses airway inflammation and AHR in obese asthmatic mice and serves as an effective option for treating obesity-related asthma. • IL-13 treatment induces inflammatory and oxidative damage in BEAS-2B cells. • PE treatment relieves the IL-13 induced inflammation and oxidative stress in BEAS-2B cells. • PE administration alleviates AHR and inflammation in obese asthmatic mice. • PE administration reduces the expression of proinflammatory cytokines in obese asthmatic mice. [ABSTRACT FROM AUTHOR]

Morbid obesity (MO) has been associated with increased risk of adverse events following procedures such as posterior lumbar fusion (PLF). While preemptive bariatric surgery (BS) has been considered for those with MO (body mass index [BMI] ≥35 kg/m2), not all undergoing such intervention have significant weight loss, and the impact of BS has been shown to correlate with weight loss after different related procedures. To examine outcomes following isolated single level PLF among patients with history of BS who subsequently did and did not transition out of the morbidly obese category. Retrospective case-control study. The PearlDiver 2010-Q1 2020 MSpine database was used to identify adult patients undergoing elective isolated PLF. Patients were excluded if they had a history of infection, neoplasm, or trauma in the 90-days prior to their PLF and if they were not active in the database for at least 90 days following their surgery. Three sub-cohorts were defined: 1) MO controls without a history of BS (-BS+MO), 2) patients with prior BS procedure who remained MO (+BS+MO), and 3) patients with prior BS who were no longer MO at the time of PLF (+BS-MO). Matched 1:1:1 populations were created for these three sub-cohorts based on age, sex and Elixhauser Comorbidity Index (ECI). Ninety-day adverse events and readmission rates were assessed and compared between the three sub-cohorts (-BS+MO, +BS+MO, +BS-MO). Univariable analyses and multivariable logistic regression were performed on the matched population to compare 90-day adverse events and readmission rates controlling for age, sex, and ECI. The current study identified PLF patients who were MO at the time of surgery but did not have a history of BS (-BS+MO, n=34,236), those who had BS and remained MO (+BS+MO, n=564), and those who had MS and were no longer MO (+BS-MO, n=209 which was only 27% of those who had BS). On multivariable analysis of the matched populations, those that had BS but remained MO (+BS+MO) were not at reduced odds of 90-day adverse events. However, those that had BS and were no longer MO (+BS-MO) were at reduced odds of 90-day any, severe, and minor adverse events (OR 0.41, 0.51, and 0.37, respectively with p<0.05 for all). Only 27% of those with a history of BS prior to PLF transitioned out of the MO category. Compared to those who were morbidly obese without BS, those who had BS were only at reduced risk of 90-day adverse events if they actually lost weight sufficient to drop out of morbidly obesity. These findings should be taken into account when counseling patients and interpreting prior studies. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate how depressive symptoms affect bodyweight change (gain and loss), and how this association is intertwined with other psychosocial and biomedical factors in the adult general population. In a population-based, prospective, observational single-center cohort study in the Rhine-Main-Region, Germany (Gutenberg Health Study GHS) with N = 12,220 participants, we analyzed baseline and five year follow-up data with logistic regressions separately for bodyweight gain and loss (vs. stable bodyweight). Overall, 19.8 % of participants gained bodyweight of at least 5 %. More female participants were affected than male participants (23.3 % vs. 16.6 %). Regarding weight loss, overall, 12.4 % lost >5 % of bodyweight; participants were more often female than male (13.0 % vs. 11.8 %). Depressive symptoms at baseline were associated with weight gain (OR = 1.03, 95 % CI = 1.02–1.05). In models controlling for psychosocial and biomedical factors, female gender, younger age, lower socioeconomic status and smoking cessation were associated with weight gain. In weight loss, there was no overall significant effect of depressive symptoms (OR = 1.01 [0.99; 1.03]). Weight loss was associated with female gender, diabetes, less physical activity, and higher BMI at baseline. Only in women, smoking and cancer were associated with weight loss. Depressive symptoms were assessed via self-report. Voluntary weight loss cannot be determined. Significant weight change frequently occurs in middle to old adulthood resulting from a complex interplay of psychosocial and biomedical factors. Associations with age, gender, somatic illness and health behavior (e.g. smoking cessation) provide important information for the prevention of unfavorable weight change. • Over 5 years, weight gain was more frequent than weight loss (19.8 % vs. 12.4 %). • Women had more weight change (gain and loss) than men. • Depression predicted weight gain more robustly than weight loss. • Exploring weight change in depression needs to differentiate gain and loss. [ABSTRACT FROM AUTHOR]

Bariatric interventions (BI, including surgical interventions) are effective in patients with massive obesity, i.e., a body mass index (BMI) > 40, and their number has steadily increased during the past decade. Yet, the stability of improvements in quality of life (QoL) in post-interventional patients is understudied and restricted to studies with small samples and short follow-ups. Patients with BI between 2004 and 2018 were identified in a health claims database and invited to fill in a survey, comprising sociodemographic and lifestyle information and psychometric scales. QoL was assessed with the Bariatric QoL (BQL) scale with lower scores denoting worse QoL. BMI and excess weight loss (EWL) were calculated for the time soon after intervention (EWL-T1) and when filling the survey (EWL-T2). The majority of n = 2151 patients were female (80.7 %), had a mean age of 54.5 years and a mean BMI of 34.8. The mean EWL-T1 was 79 % (EWL-T2: 64.6 %). The mean BQL score was 47.6 and decreased with BMI (18.5–24.9: 52.6 vs. > 40: 38.7), EWL-T2 (>66 %: 51.3 vs. <65 %: 42.1) and years since intervention (3–4: 48.2 vs > 8: 45.1, each p <.001). For EWL-T1, the association between higher EWLs and higher BQL scores was stronger in females than in males (p <.005); for EWL at T2, both sexes did not differ in this regard (p =.848). Among normal-weight persons, males scored significantly lower on the BQL than females (44.9 vs. 54.9). Post-interventional QoL improvements diminish over time and depend on the weight loss, with significant differences between men and women. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Outpatient management of pediatric obesity can be difficult, requiring a significant time commitment from both provider and patient. Multidisciplinary clinic-based programs have shown promising effects in reducing BMI during intervention, but whether these changes are sustained over time is not well studied. The purpose of this study was to determine the post-treatment outcomes of children seen in a multidisciplinary pediatric obesity clinic (MPOC). METHODS: A retrospective chart review was performed using the MPOC database, which included all clinic patients from January 2008 to August 2016 who attended a minimum of 2 visits (n = 472). The primary outcome was the absolute change in BMI Z-score (BMIZ) from the final intervention visit compared to 1- and 2-years post-intervention. Multivariate regression analysis was performed to characterize predictors of change in BMIZ. RESULTS: MPOC patients ranged in age from 3 to 18 years. Mean BMIZ decreased significantly during intervention (-0.13 ± 1.47, P < .001) and was maintained at 1- and 2-years post-intervention. In participants ages 3 to 5, BMIZ further decreased at 1 year post intervention (-0.27 ± 0.26, P < .001). Age at time of referral was the only significant predictor of change in BMIZ. CONCLUSIONS: Outpatient, multidisciplinary intervention for pediatric obesity was effective in reducing or stabilizing BMIZ during and beyond the intervention, particularly when patients were referred at an early age. Although primary prevention is the ideal management, multidisciplinary clinic intervention can be effective in the sustained treatment of pediatric obesity. [ABSTRACT FROM AUTHOR]

Spinal epidural lipomatosis is abnormal accumulation of normal fat in the epidural space with weight loss suggested as first-line therapy in select symptomatic patients. However, moderate to large longitudinal studies establishing concordant changes between body mass index and epidural fat are lacking. The purpose of this study was to longitudinally assess this relationship. We performed an ancillary study of the Habitual Diet and Avocado Trial. Baseline and six-month abdominal MRIs were analyzed for 98 overweight or obese but otherwise healthy subjects. Dorsal epidural fat volumes in the lumbar spine were measured and correlated with changes in body mass index, changes in visceral fat volume, and demographic information. There was a linear relationship between body mass index changes and epidural fat volume changes with a one-point change in body mass index corresponding to a 45 mm3 change in dorsal epidural fat volume (p < 0.001, 95% CI 31.87 to 76.77) as well as between visceral fat volume changes and epidural fat volume changes (regression coefficient 0.51, p < 0.001, 95% CI 0.22 to 0.47). Age was inversely related with subjects older than 45.7 years tending to lose epidural fat (regression coefficient −0.22, p = 0.025, 95% CI -10.43 to −0.72). Changes in spinal dorsal epidural fat volume parallel changes in body mass index and visceral fat, supporting weight loss as initial treatment for uncomplicated obesity-associated spinal epidural lipomatosis. • A one-point BMI change corresponds linearly to a 45 mm3 dorsal epidural fat change. • This finding may be used to help develop evidence-based treatment guidelines for spinal epidural lipomatosis. • Unexpectedly, subjects older than 45.7 years lost epidural fat independent of BMI changes, warranting further investigation. [ABSTRACT FROM AUTHOR]

Le tissu adipeux est modifié en quantité et qualité au cours de l'obésité : hypertrophie des adipocytes, diminution de leur expansibilité et fibrose, productions de cytokines et adipokines proinflammatoires, infiltration inflammatoire par des macrophages pro-inflammatoires M1, des lymphocytes T. Ainsi, l'excès de tissu adipeux et l'obésité sont associés à une inflammation de bas grade qui peut aggraver les pathologies inflammatoires chroniques, impacter l'effet des traitements, l'apparition des comorbidités et le développement de la maladie à sa phase préclinique. L'obésité augmente le risque de développer une polyarthrite rhumatoïde (PR), un psoriasis, un rhumatisme psoriasique avec un effet dose dépendant du poids. C'est aussi un facteur de moins bonne réponse aux traitements en particulier aux anti-TNF. La perte de poids induite par la chirurgie bariatrique diminue le risque de psoriasis et de rhumatisme psoriasique, et améliore l'activité de la maladie et la rémission sous traitement dans la PR. Une perte de poids d'au moins 5 % avec un régime hypocalorique améliore la réponse thérapeutique aux traitements anti-TNF dans le rhumatisme psoriasique avec un effet dose dépendant de la perte de poids. Dans la PR, l'effet bénéfique de la perte de poids au cours d'un régime hypocalorique sur l'activité de la maladie est rapporté dans quelques études observationnelles mais n'a pas été démontré dans un essai randomisé contrôlé. Le dépistage et la prise en charge de l'obésité font partie des recommandations de la SFR sur l'alimentation des patients ayant un rhumatisme inflammatoire chronique et doivent bien sûr être associés aux autres facteurs modifiables, arrêt du tabac, qualité de l'alimentation, activité physique et lutte contre la sédentarité. Adipose tissue is altered in quantity and quality during obesity: hypertrophy of adipocytes, decrease in expandability and fibrosis, production of proinflammatory cytokines and adipokines, inflammatory infiltration by pro inflammatory macrophages M1, T lymphocytes. Thus, excess adipose tissue and obesity are associated with low-grade inflammation that can aggravate chronic inflammatory diseases, decrease the treatment efficacy, the development of comorbidities, and of the disease in its preclinical phase. Obesity increases the incidence of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis with a weight dose effect. It is also predictor of poorer response to treatments, in particular TNF inhibitors. Weight loss induced by bariatric surgery decreases the risk of psoriasis and psoriatic arthritis, and improves disease activity and remission in RA. A weight loss of at least 5% with a hypocaloric diet improves the response to TNF inhibitor in psoriatic arthritis with a dose-dependent effect of weight loss. In RA, the beneficial effect of weight loss during a hypocaloric diet on disease activity has been reported in a few observational studies but has not been demonstrated in a randomized controlled trial. Screening and management of obesity are part of the dietary recommendations of the French Society for Rheumatology in patients with chronic inflammatory rheumatic diseases and should of course be associated with others modifiable lifestyle factors such as smoking, quality of food, physical activity and sedentary lifestyle. [ABSTRACT FROM AUTHOR]

Αvaialble evidence regarding the effectiveness of intragastric injection of botulinum toxin in reducing anthropometric indices of subjects with obesity is conflicting. We evaluated the existing evidence and perform a meta-analysis to assess the efficacy of intragastric botulinum toxin in treating obesity. We identified published systematic reviews evaluating the efficacy of intragastric injection of botulinum toxin in patients with overweight or obesity and additionally performed a systematic literature search to retrieve randomized controlled trials on this topic. A random-effects meta-analysis was performed to synthesize the existing studies. A total of four systematic reviews were included in our overview of systematic reviews and six randomized controlled trials were included in our meta-analysis. Compared to placebo, intragastric injection of botulinum toxin was ineffective in reducing body weight and body mass index after the application of the Knapp-Hartung adjustment (MD = −2.41 kg, 95%CI = −5.21 to 0.38, I2 =59% and MD = −1.43 kg/m2, 95%CI = −3.04 to 0.18, I2 =62%, respectively). Moreover, treatment with intragastric injection with botulinum toxin was not superior to placebo in decreasing waist and hip circumference. Based on the available evidence, intragastric injection with botulinum toxin is an ineffective procedure in reducing body weight and body mass index when the Knapp-Hartung method was applied. [ABSTRACT FROM AUTHOR]

The effects of mindfulness-based interventions (MBIs) on anthropometrics remain obscure. This review quantitatively synthesizes the effects of MBIs on decreasing body mass index (BMI), waist circumference (WC), weight, and percent body fat (%BF). Seven databases, including CINAHL Plus with Full Text, PubMed, PsycINFO, Cochrane, Web of Science Core Collection, Embase, and Sociological Abstracts were searched; studies with a comparison group were selected. Random-effects models were then applied to estimate the pooled effects (Hedge's g), while exploratory moderation analyses with mixed-effects models were performed to explore potential moderators of MBIs on anthropometrics. The pooled effect size was −0.36 (p <.001) on BMI, −0.52 (p <.001) on WC, −1.20 (p <.004) on weight loss, and −0.43 (p =.389) on %BF. The long-term effects from baseline to follow-up and from post-intervention to follow-up were sustained on BMI (−0.37, p =.027; −.24, p =.065) and weight loss (−1.91, p =.027; −0.74, p =.011) respectively. For weight loss, adding mindful movement had greater effects than those without (−2.65 vs −0.39, p <.001). Our findings support the short-term MBI effects on BMI reduction, WC, weight, and %BF, and long-term effects on reducing BMI and weight. Future efforts should focus on sustaining effects on reducing WC and %BF. [ABSTRACT FROM AUTHOR]

Anatomical modifications implemented during bariatric surgery not only result in weight loss, but also lead to metabolic corrections that translate into better glycemia stability and improvement in cardiovascular and liver disorders. The logical extension of surgical indications beyond mere reduction of the body mass index (BMI) (i.e. patients with < 35 kg/m2) is a hot topic today in France and worldwide. Metabolic surgeries make use of multiple modalities (endoscopic, mini-invasive, invasive) that should be carried out by trained physicians and within the same type of multidisciplinary formation as that for bariatric surgery. The aim of this update is to describe the physiological mechanisms that result in the benefits of bariatric surgery, the various procedures currently available and the perspectives for this new field in visceral and digestive surgery. [ABSTRACT FROM AUTHOR]

Bariatric surgery (BS) leads to substantial weight loss accompanied by reversal of several obesity-related co-morbidities and reduced mortality. However, surgery is associated with risks and its nearly irreversible characteristic requires a clearly established pre- and postoperative clinical pathway. In France, this pathway relies on recommendations made by the High Authority of Health (Haute Autorité de santé (HAS)) in 2009; an update is awaited in 2023. BS should be proposed only after failure of well-conducted medical treatment and is intended for patients whose body mass index (BMI) is ≥ 40 kg/m2 or for those with BMI ≥ 35 kg/m2 who also have co-morbidities amenable to improvement, and in whom there are no contra-indications, particularly, those related to general anesthesia or psychological factors. The success and safety of surgical management requires preparation of the patient with regard to dietetic and nutritional counseling, and physical activity. The possibility of complications must be recognized and communicated, including, in view of the large variability of outcomes between individuals, the risk of failure and regain of weight. Prior to the operation, patients should be informed of and accept the program of postoperative clinical and laboratory follow-up, as well as the need for lifelong supplementation in micronutrients and the financial implications including what patients may have to pay out of their own pocket. Surgical management of obesity cannot replace the multidisciplinary medical management of severe obesity. The results obtained by BS are sustainable only if the patient adheres to the proposed modalities. New drugs such a GLP-1 analogues have opened encouraging perspectives as possible alternatives to BS in certain indications. [ABSTRACT FROM AUTHOR]

The outcomes of bariatric surgery, while often impressive, are not universally satisfactory; they vary from patient to patient and from operation to operation. Between 20–30% of patients experience suboptimal weight loss or substantial weight regain early in their postoperative course. Confronted with this chronic disease, and given that failures are difficult to manage, it is essential to better characterize obesity preoperatively, considering other metrics beyond just the body mass index (BMI), to select the best candidates for surgery and optimize the benefit/risk ratio. Based on the data of the most recent studies on bariatric surgery, our objective is to identify the predictive factors of weight loss as well as the risk factors of failure. Our analysis indicates that the choice of the surgical technique, age, initial BMI, ethnic origin, the presence of eating disorders and metabolic factors all have an impact on weight-loss outcomes after bariatric surgery. Thus, it is of major importance to carefully select patients during a preoperative multidisciplinary discussion in order to optimize weight loss and metabolic outcomes. [ABSTRACT FROM AUTHOR]

Many unique clinical challenges accompany the diagnosis and treatment of cardiovascular disease (CVD) in people living with overweight/obesity. Similarly, physicians encounter numerous complicating factors when managing obesity among people with CVD. Diagnostic accuracy in CVD medicine can be hampered by the presence of obesity, and pharmacological treatments or cardiac procedures require careful adjustment to optimize efficacy. The obesity paradox concept remains a source of confusion within the clinical community that may cause important risk factors to go unaddressed, and body mass index is a misleading measure that cannot account for body composition (eg, lean mass). Lifestyle modifications that support weight loss require long-term commitment, but cardiac rehabilitation programs represent a potential opportunity for structured interventions, and bariatric surgery may reduce CVD risk factors in obesity and CVD. This review examines the key issues and considerations for physicians involved in the management of concurrent obesity and CVD. [Display omitted] • Obesity presents unique challenges to diagnosis and management of patients with known or suspected CVD. • Excess adiposity can impede the performance and reduce the accuracy of standard modalities for diagnosis of cardiovascular disease. • Weight reduction is an important adjunct to reduction of cardiovascular risk and management of CVD in obese patients, and when other measures are insufficient, bariatric surgery can improve outcomes. [ABSTRACT FROM AUTHOR]

Association of high body mass index (BMI) with longer survival has been reported in patients on immune checkpoint inhibitors (ICIs), but results are inconsistent. This 'obesity paradox' is potentially confounded by the effects of BMI change over time and of skeletal muscle depletion. We conducted a secondary analysis of a prospective cohort, including consecutive patients receiving ICI treatment for melanoma (n = 411) and non-small cell lung cancer (NSCLC) (n = 389) in routine care. In the univariable analysis of the entire population, overweight/obesity (BMI ≥ 25 kg/m2) was associated with longer survival (p < 0.01); however, this effect was limited to NSCLC (p < 0.01) and was absent in melanoma. Weight loss (WL) and reduced skeletal muscle mass were observed in patients within all BMI categories. WL was associated with shorter survival in multivariable analysis in both tumour sites (p < 0.01), and for NSCLC, BMI lost significance when WL was included (p = 0.13). In models further adjusted for CT-defined skeletal muscle mass, WL retained significance for both tumour types (p < 0.01), and reduced skeletal muscle only for NSCLC (p = 0.02) was associated with shorter survival. WL retained significance when biomarkers (lactate dehydrogenase enzyme, albumin and derived neutrophil to lymphocyte ratio) were added to the multivariable model. The so-called 'obesity paradox', counterintuitive association between high BMI and longer survival, vanished when controlling for confounders, such as type of cancer, and manifestations of depletion (WL and reduced skeletal muscle mass). • Association of high BMI with survival is eliminated when adjusted for confounders. • Association of high BMI with survival disappears when adjusted for weight loss. • Weight loss in NSCLC and melanoma is the predominant prognostic factor. • In patients with NSCLC, reduced skeletal muscle is an independent prognostic factor. [ABSTRACT FROM AUTHOR]

L'essor de la chirurgie bariatrique a entrainé une augmentation considérable de la demande de chirurgie des séquelles d'amaigrissement. Le bodylift inférieur consiste à retirer l'excédent cutanéo-graisseux abdominal résiduel et remettre en tension les surfaces. L'objectif de notre étude était d'évaluer les complications associées, ainsi que les conséquences de cette chirurgie sur la qualité de vie des patients. Une étude monocentrique rétrospective a été menée chez les patients opérés de bodylift inférieur entre 2010 et 2019 au CHU de Besançon. Nous avons recueilli les complications post-opératoires et étudié la satisfaction et qualité de vie des patients opérés à l'aide des questionnaires Body-QoL et SF-36. Cent quarante-trois patients ont été inclus avec un âge moyen de 41,2 ans. L'indice de masse corporelle moyen était de 26,6 kg/m2 avec un poids moyen de 73,8 kg et une perte de poids moyenne de 54,4 kg. Quarante et un patients (29,7 %) ont présenté au moins une complication. La majorité des complications étaient mineures, avec 16,8 % de désunions de cicatrice et 7 % des complications étaient majeures, imposant une reprise chirurgicale. Quatre-vingt-treize patients (65 %) ont répondu aux questionnaires de satisfaction avec une amélioration portant majoritairement sur les symptômes physiques et la vie sociale. Le bodylift inférieur est une intervention efficace, sécurisée, avec des complications majoritairement mineures, n'influençant pas la qualité de vie. La satisfaction des patients est élevée et il est ainsi justifié de poursuivre la proposition de cette intervention pour corriger les séquelles d'amaigrissement massif. The rise of bariatric surgery has led to a considerable increase in the demand for weight loss surgery. The lower body lift consists of removing the residual abdominal fat and skin excess and re-tensioning the surfaces. The objective of our study was to evaluate the associated complications, as well as the consequences of this surgery on the quality of life of the patients. A retrospective monocentric study was conducted in patients operated on for lower body lift between 2010 and 2019 at the University Hospital of Besançon. We collected postoperative complications and studied the satisfaction and quality of life of the operated patients using the Body-QoL and SF-36 questionnaires. One hundred forty-three patients were included with a mean age of 41.2 years. The mean body mass index was 26.6 kg/m2 with a mean weight of 73.8 kg and a mean weight loss of 54.4 kg. Forty-one patients (29.7%) had at least one complication. Most complications were minor, with 16.8% of scar disunions, and 7% of complications were major, requiring revision surgery. Ninety-three patients (65%) responded to the satisfaction questionnaires with improvement mostly in physical symptoms and social life. The lower body lift is an effective, safe procedure with mostly minor complications that do not influence quality of life. Patient satisfaction is high, and it is therefore justified to continue offering this procedure to correct the sequelae of massive weight loss. [ABSTRACT FROM AUTHOR]

Background: Little is known regarding the association between weight change and accelerated aging. Objectives: This study aimed to estimate the influence of weight change across adulthood on biological aging acceleration in middle-aged and older adults in the United States. Methods: We used data of 5553 adults (40-84 y) from the National Health and Nutrition Examination Survey 1999-2010. Weight change patterns (i.e., stable normal, maximal overweight, obese to nonobese, nonobese to obese, and stable obese) and absolute weight change groups across adulthood (i.e., from young to middle adulthood, young to late adulthood, and middle to late adulthood) were defined. A biological aging measure (i.e., phenotypic age acceleration [PhenoAgeAccel]) at late adulthood was calculated. Survey analysis procedures with the survey weights were performed. Results: Across adulthood, maximal overweight, nonobese to obese, and stable obesity were consistently associated with higher PhenoAgeAccel. For instance, from young to middle adulthood, compared with participants who had stable normal weight, participants experiencing maximal overweight, moving from the nonobese to obese, and maintaining obesity had 1.71 (standard error [SE], 0.21; P < 0.001), 3.62 (SE, 0.28; P < 0.001), and 6.61 (SE, 0.58; P < 0.001) higher PhenoAgeAccel values, respectively. From young to middle adulthood, relative to absolute weight loss or gain of <2.5 kg, weight loss of ≥2.5 kg was marginally associated with lower PhenoAgeAccel (P = 0.054), whereas an obese to nonobese pattern from middle to late adulthood was associated with higher PhenoAgeAccel (P < 0.001). Conclusions: Maximal overweight, nonobese to obese, and stable obesity across adulthood, as well as an obese to nonobese pattern from middle to late adulthood, were associated with accelerated biological aging. In contrast, weight loss from young to middle adulthood was associated with decelerated biological aging. The findings highlight the potential role of weight management across adulthood for aging. Monitoring weight fluctuation may help identify the population at high risk of accelerated aging. [ABSTRACT FROM AUTHOR]

Higher body mass index is associated with a higher incidence of colorectal cancer (CRC) but also with improved survival in metastatic CRC (mCRC). Whether weight change after mCRC diagnosis is associated with survival remains largely unknown. We analysed individual patient data for previously untreated patients enrolled in five phase 3 randomised trials conducted between 1998 and 2006. Weight measurements were prospectively collected at baseline and up to 59.4 months after diagnosis. We used stratified multivariable Cox models to assess the prognostic associations of weight loss with overall and progression-free survival, adjusting for other factors. The primary end-point was a difference in overall survival (OS) between populations with weight loss and stable or increasing weight. Data were available for 3504 patients. The median weight change at 3 months was −0.54% (IQR −3.9 ... +1.5%). We identified a linear trend of increasing risk of death associated with progressive weight loss. Unstratified median OS was 20.5, 18.0, and 11.9 months (p < 0.001) for stable weight or gain, <5% weight loss, and ≥5% weight loss at 3 months, respectively. Weight loss was associated with a higher risk of death (<5% loss: aHR 1.18 [1.06–1.30], p < 0.002; ≥5% loss: aHR 1.87 [1.67–2.1], p < 0.001) as compared to stable or increasing weight at 3 months post-baseline (reference), while adjusting for age, sex, performance, and a number of metastatic sites. Patients losing weight during systemic therapy for metastatic colorectal cancer have significantly shorter OS. The degree of weight loss is proportional to the observed increased risk of death and remains evident among underweight, normal weight, and obese individuals. On-treatment weight change could be used as an intermediate end-point. The creation and management of the database containing the individual patient data from the original randomised trials is supported by the Aide et Recherche en Cancérologie Digestive Foundation. • Weight loss is proportional to the risk of death among mCRC patients. • Weight loss ≥5% is associated with significantly shorter survival. • Median overall survival was 20.5 months if there was no weight loss. • Median overall survival was 11.9 months if ≥ 5% weight loss at 3 months. [ABSTRACT FROM AUTHOR]

Body mass index (BMI) cutoffs for morbidly obese patients otherwise indicated for total knee arthroplasty (TKA) have been widely proposed and implemented, though they remain controversial. Previous studies suggested that a 5% reduction in BMI may be associated with fewer postoperative complications. Thus, the purpose of this study was to determine whether a substantial reduction in preoperative BMI in morbidly obese patients improved 90-day outcomes after TKA. There were 1,270 patients who underwent primary TKA at a single institution and had a BMI > 40 recorded during the year prior to surgery. Patients were stratified into three cohorts based on whether their BMI within 3 months to 1 year preoperatively had decreased by ≥ 5% (228 patients [18%]); increased by ≥ 5% (310 [24%]); or remained unchanged (within 5%) (732 [58%]) on the day of surgery. There were several baseline differences between the cohorts with respect to medical comorbidities. The rate of 90-day complications and six-week patient-reported outcome measures were compared via univariate and multivariable analyses. On univariate analysis, individual and total complication rates were similar between the cohorts (P >.05). On multivariable logistic regression, the risk of complications was similar in patients who had decreased versus unchanged BMI (OR [odds ratio] 1.0; P =.898). However, there was a higher risk of complications in the increased BMI cohort compared to those patients who had an unchanged BMI (OR 1.5; P =.039). The six-week patient-reported outcome measures were similar between the cohorts. Patients who have a BMI > 40 who achieved a meaningful reduction in BMI prior to TKA did not have a lower rate of 90-day complications than those whose BMI remained unchanged. Furthermore, considering that nearly one in four patients experienced a significant increase in BMI while awaiting surgery, postponing TKA may actually be detrimental. [ABSTRACT FROM AUTHOR]

Large-scale, population-based investigations primarily investigating the association between body mass index (BMI) and cardiovascular disease (CVD) mortality among older and younger adults in the United States (U.S.) are lacking. To evaluate the relationship between BMI and CVD mortality in older (≥ 65 years) and younger (< 65 years) adults and to identify the nadir for CVD mortality. This cohort study used serial cross-sectional data from the 1997 to 2018 National Health Interview Survey (NHIS) linked with the National Death Index. NHIS is an annual nationally representative household interview survey of the civilian noninstitutionalized U.S. population. Residential units of the civilian noninstitutionalized population in the U.S. The target population for the NHIS is the civilian noninstitutionalized U.S. population at the time of the interview. We included all adults who had BMI data collected at 18 years and older and with mortality data being available. To minimize the risk of reverse causality, we excluded adults whose survival time was ≤ 2 years of follow-up after their initial BMI was recorded and those with prevalent cancer and/or CVD at baseline. We used the BMI record obtained in the year of the NHIS survey. Total CVD mortality used the NHIS data linked to the latest National Death Index data from the survey inception to December 31, 2019. We performed multivariable Cox proportional hazards regression models to estimate adjusted hazard ratios (aHRs) and 95 % confidence intervals (CIs). The study included 425,394 adults; the mean (SD) age was 44 (16.7) years. During a median follow-up period of 11 years, 12,089 CVD-related deaths occurred. In older adults, having overweight was associated with a lower risk of CVD mortality (aHR 0.92 [95 % CI, 0.87–0.97]); having class I obesity (1.04 [0.97–1.12]) and class II obesity (1.12 [1.00–1.26]) was not significantly associated with an increased CVD mortality; and having class III obesity was associated with an increased risk of CVD mortality (1.63 [1.35–1.98]), in comparison with adults who had a normal BMI. Yet, in younger adults, having overweight, class I, II, and III obesity was associated with a progressively higher risk of CVD mortality. The nadir for CVD mortality is 28.2 kg/m2 in older adults and 23.6 kg/m2 in younger adults. This U.S. population-based cohort study highlights the significance of considering age as a crucial factor when providing recommendations and delivering self-care educational initiatives for weight loss to reduce CVD mortality. [ABSTRACT FROM AUTHOR]

Cancer cachexia is a clinical condition characterized by recognizable "sickness behaviors" accompanied by loss of lean body tissue. The Global Leadership on Malnutrition (GLIM) has proposed phenotypic (unintentional weight loss, low body mass index and low muscle mass) and aetiologic (reduced food intake and inflammation or disease burden) diagnostic criteria. Recent work has suggested serum lactate dehydrogenase (LDH) might represent a 3rd aetiologic criteria. Little is known of its relationship with GLIM. A systematic review and meta-analysis of their comparative prognostic value and association was performed. A search of electronic databases (PubMed, Medline, Ovid, Cochrane) up to February 2023 was used to identify studies that compared the prognostic value of LDH and components of the GLIM criteria in cancer. An analysis of the relationship between LDH and the components of GLIM was undertaken where this data was available. RevMan 5.4.1 was used to perform a meta-analysis for each diagnostic criteria that had 3 or more studies which reported hazard ratios with a 95 per cent confidence interval for overall survival (OS). A total of 119 studies were reviewed. Advanced lung cancer was the most studied population. Included in the meta-analysis were 6 studies (n=2165) on LDH and weight loss, 17 studies (n=7540) on LDH and low BMI, 5 studies (n=758) on LDH and low muscle mass, 0 studies on LDH and food intake and 93 studies (n=32,190) on LDH and inflammation. There was a significant association between elevated serum LDH and each of low BMI (OR 1.39, 1.09 – 1.77; p=0.008), elevated NLR (OR 2.04, 1.57 – 2.65; p<0.00001) and elevated CRP (OR 2.58, 1.81 – 3.67; p<0.00001). There was no association between elevated serum LDH and low muscle mass. Only one study presented data on the association between LDH and unintentional weight loss. Elevated LDH showed a comparative OS (HR 1.86, 1.57 – 2.07; p<0.00001) to unintentional weight loss (HR 1.57, 1.23 – 1.99; p=0.0002) and had a similar OS (HR 2.00, 1.70 – 2.34; p<0.00001) to low BMI (HR 1.57, 1.29–2.90; p<0.0001). LDH also showed an OS (HR 2.25, 1.76 – 2.87; p<0.00001) congruous with low muscle mass (HR 1.93, 1.14 – 3.27; p=0.01) and again, LDH conferred as poor an OS (HR 1.77, 1.64–1.90; p<0.00001) as elevated NLR (HR 1.61, 1.48 – 1.77; p<0.00001) or CRP (HR 1.55, 1.43 – 1.69; p<0.00001). Current literature suggests elevated serum LDH is associated with inflammation in cancer (an aetiologic GLIM criterion), however more work is required to establish the relationship between LDH and the phenotypic components of GLIM. Additionally, elevated serum LDH appears to be a comparative prognosticator of overall survival in cancer when compared to the GLIM criteria. ● Cancer cachexia can be thought of as disease related inflammation with malnutrition. ● GLIM have outlined phenotypic and aetiologic diagnostic criteria. ● LDH was associated with systemic inflammation (aetiologic GLIM criterion) in cancer. ● LDH was as prognostic of overall survival in cancer as any GLIM criteria. ● LDH may represent a useful addition to the GLIM criteria. [ABSTRACT FROM AUTHOR]

The worldwide prevalence of individuals with an elevated body weight has increased steadily over the past five decades. Billions of research dollars have been invested to improve our understanding of the causes and consequences of having an elevated body weight. All this knowledge has, however, failed to influence populational body weight trajectories of most countries around the world. Research on the definition of "obesity" has also evolved. Body mass index (BMI), the most commonly used tool to make its diagnosis, has major limitations. In this review article, we will highlight evidence from observational studies, genetic association studies and randomized clinical trials that have shown the remarkable inter-individual differences in the way humans store energy as body fat. Increasing evidence also suggests that, as opposed to weight inclusive, lifestyle-based approaches, weight-centric approaches advising people to simply eat less and move more are not sustainable for most people for long-term weight loss and maintenance. It is time to recognize that this outdated approach may have produced more harm than good. On the basis of pathophysiological, genetic and clinical evidence presented in this review, we propose that it may be time to shift away from the traditional clinical approach, which is BMI-centric. Rather, emphasis should be placed on actionable lifestyle-related risk factors aiming at improving overall diet quality and increasing physical activity level in the general population. [Display omitted] • Body mass index, the most commonly used metric to diagnose obesity, has major limitations. • Several studies have highlighted the remarkable inter-individual differences in the way humans store energy as body fat. • Approaches advising people to eat less and move more are not sustainable for most people for long-term weight loss. • Emphasis should be placed on improving diet quality and increasing physical activity levels in the general population. • We highlight ten limitations of body mass index as a measure in medicine. [ABSTRACT FROM AUTHOR]

To develop and validate questionnaires to assess the behavioral, psychosocial, and environmental predictors of successful weight loss outcomes. Mixed method study. Questionnaires were developed using 5 steps: item generation by literature review and preexisting questionnaires, expert evaluation, pilot testing, factor analysis, and internal consistency. Adults with obesity recruited via web-based survey hyperlink. One hundred participants with a mean body mass index of 28.7 ± 4.4 kg/m2. The questionnaires were generated using 221 items. Establishing content, face and construct validity, and internal consistency. Content validity was analyzed using content validity index and content validity ratio, internal consistency through Cronbach α (CA), and structural validity by factor analysis via principal varimax rotation. All three questionnaires had good content validity. The Behavioral Predictor Questionnaire had good internal consistency (CA, 0.7) and excellent structural validity (69.7%). Psychosocial Predictors Questionnaire (CA, 0.8, 67.5%) and Environmental Predictors Questionnaire (CA: 0.8, 72.2%) had excellent internal consistency and structural validity. Questionnaires seem to be practical, valid, and reliable tools for baseline assessment of individual-specific factors related to weight loss success. [ABSTRACT FROM AUTHOR]

This prospective cohort study identifies a positive relationship between body mass index (BMI) and renal cell carcinoma (RCC) risk. It also undermines the obesity paradox by finding that weight change around the time of RCC diagnosis, and not low BMI itself, is associated with prognosis. To disentangle the "obesity paradox" in renal cell carcinoma (RCC), we examined associations of body mass index (BMI) and weight change with RCC risk and survival in the Health Professionals Follow-up Study (HPFS) and Nurses' Health Study (NHS) 1 and 2. We estimated cohort-specific and summary covariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for RCC incidence, as well as RCC-specific survival among cases in the pooled HPFS and NHS data. Cumulative average BMI was associated with a higher risk of total RCC (summary HR 2.16, 95% CI 1.77–2.63 for BMI ≥30 vs 18–<25 kg/m2; p trend <0.001) and fatal RCC (HR 2.03, 95% CI 1.37–3.01; p trend <0.001). Prediagnosis BMI was not associated with RCC death. However, first postdiagnosis BMI (HR 0.51, 95% CI 0.29–0.89; p trend 0.006) and prediagnosis to postdiagnosis weight change (HR 0.52, 95% CI 0.29–0.91; p trend 0.001) were significantly inversely associated with RCC death. These results support obesity as a risk factor for total and fatal RCC. They undermine the obesity paradox by suggesting that weight loss around diagnosis, and not low BMI itself, is associated with worse prognosis. We studied obesity in kidney cancer and found that obesity is associated with getting and dying from the disease. Body mass index at diagnosis is not an ideal factor for predicting prognosis, as patients who have lost weight are likely to have more aggressive cancer. [ABSTRACT FROM AUTHOR]

• A ketogenic diet intervention is beneficial for overweight/obese women with PCOS • Uric acid concentrations may affect weight loss during ketogenic diet interventions • With weight loss, some women with PCOS can resume menstruation Do overweight/obese women with PCOS with different uric acid concentrations show different effects after a ketogenic diet intervention? The study involved women with PCOS with a body mass index (BMI) of ≥24 kg/m2. Groups showing different uric acid concentrations were given ketogenic diet guidance for 12 weeks. Weight, BMI, body fat percentage, fasting blood glucose, triacylglyerols, total cholesterol, uric acid and other metabolism-related indexes were measured. After 12 weeks of the ketogenic diet intervention, body weight (hyperuricaemia group: P= 0.001; non-hyperuricaemia group: P <0.001), BMI (hyperuricaemia group: P = 0.025; non-hyperuricaemia group: P <0.001) and body fat percentage (hyperuricaemia group: P <0.001; non-hyperuricaemia group: P <0.001) were decreased in both groups. There was greater weight loss in the non-hyperuricaemia group (hyperuricaemia group 11.2±4.6 kg versus non-hyperuricaemia group 14.7±4.8 kg; P < 0.05). In the non-hyperuricaemia group, uric acid concentrations increased significantly after 6 weeks of the ketogenic diet intervention (week 0: 5.69±0.84 mg/dl versus week 6: 8.41 ± 2.33 mg/dl; P < 0.001) and reached the concentrations of the hyperuricaemia group (week 6: 9.37 ± 2.43 mg/dl; P > 0.05). A ketogenic diet intervention is beneficial for overweight/obese women with PCOS with different serum uric acid concentrations. Participants with normal basal uric acid concentrations showed a greater fluctuation of serum uric acid concentrations during the ketogenic diet intervention and had a greater weight loss. [ABSTRACT FROM AUTHOR]

Background and Aims: The positive association between mean systolic blood pressure (SBP) and body mass index (BMI) diminished or reversed over the past four decades. The primary aim of this study was to evaluate effects of BMI change on longitudinal SBP.Methods and Results: A total of 3638 participants who had annual health examination from 2015 to 2019 were included and matched by age and sex according to BMI levels. BMI and SBP were measured annually and their association were assessed by a linear mixed-effects regression model. The normal weight participants had a sustained weight gain as well as SBP increase during the study period (all Ptrend <0.001). The obese participants had a sustained weight loss but SBP did not decrease simultaneously. If BMI change was considered, the obese participants with BMI loss had a significant decrease of SBP during the study period (Ptrend = 0.0012). Mixed-effects models showed that weight gain was more influential on longitudinal SBP in the normal weight participants and weight loss was in the obese participants. The obese group with BMI loss had a decrease of SBP by 5.01 mmHg (95% confidence interval: 2.56 mmHg, 7.46 mmHg) compared to their counterparts with BMI maintenance from 2015 to 2019.Conclusions: The effect of weight change on longitudinal SBP was varied among BMI groups. With the increase of baseline BMI level, the positive effect of weight loss on SBP became greater and the negative effect of weight gain on SBP were attenuated. [ABSTRACT FROM AUTHOR]

Pediatric obesity is a primary public health concern, and designing effective programs for managing it is of the utmost importance. The objective of this study was to describe the protocol study of a three-arm, parallel, randomized controlled trial aimed at assessing the efficacy of a family-system-based intervention ("ENTREN-F" program) for managing childhood obesity, compared to the "ENTREN" program (no "F" - without specific family-system-based workshop) and a control group (behavioral monitoring). The ENTREN-F program was a multicomponent family-system-based intervention carried out by a multidisciplinary team in the primary health care setting. The program targeted children between 8 and 12 years with overweight and obesity (P ≥ 85th). Parents were actively involved in the process. The contents were designed using the Cognitive Behavioral Therapy (CBT) principles. The program comprised individual behavioral monitoring, a healthy habits workshop for children and their parents, a CBT workshop for children, and a family-system-based workshop for parents, enhancing parental management skills plus family functioning. The trial's primary outcomes included changes in child body mass index (BMI) z-scores, child's psychological well-being, and family functioning over six months. Secondary outcomes included changes in eating behavior, physical activity, self-esteem, parental distress, parental feeding practices, and parental modeling. To our knowledge, this is one of the few randomized controlled trials to assess the efficacy of a multicomponent program that considers health from a comprehensive perspective, trying to improve children's psychological well-being and family functioning besides weight loss. This study, therefore, addresses a gap in the literature. If found to be efficacious, it suggests a new potential health service for translation into National Primary Health Care services in Spain, one of the ten countries with the highest prevalence of obesity in Europe. [ABSTRACT FROM AUTHOR]

Background and Objectives: Weight loss is the mainstay of management for women with polycystic ovarian syndrome (PCOS). However, lifestyle and dietary modifications, and gastric banding have generally poor long-term efficacy. We aimed to investigate whether gastric bypass is equally efficacious in women with or without PCOS.Methods: We performed a matched case-control study of primary Roux-en-Y gastric bypass surgery in women with PCOS (cases, n = 30) compared to women without PCOS (controls, n = 60) matched for baseline age, body mass index (BMI) and presence or absence of type 2 diabetes (T2D). Data shown represent mean values.Results: At 24 months after surgery the 90 participants (age 36.1 years) experienced significant reductions in BMI (53.4 vs. 34.9 kg/m2, p < 0.0001), glycated haemoglobin (HbA1c) in 21 women with T2D (68.2 vs. 38.7 mmol/mol, p < 0.0001) and blood pressure (BP) in 29 women with hypertension (144/91 vs. 129/83 mmHg, p < 0.01), while obstructive sleep apnoea (OSA) resolved in 88.0% of the 25 affected patients. Women with PCOS compared to women without PCOS achieved equivalent reductions in percentage total weight loss (32.6% vs. 32.6% at 12 months and 34.8% vs. 36.1% at 24 months) and HbA1c (T2D subgroup; 38.3 vs. 41.6 mmol/mol at 12 months and 37.0 vs. 39.6 mmol/mol at 24 months) and comparable improvement in BP (hypertension subgroup) and resolution of OSA (87.5% vs. 88.2% at 24 months).Conclusion: In women with PCOS with morbid obesity, gastric bypass resulted in significant weight loss and metabolic outcomes similar to women without PCOS. [ABSTRACT FROM AUTHOR]

Background An under-explored strategy for increasing physical activity is the dietary treatment of obesity, but empirical evidence is lacking. Objectives We aimed to compare the effects of weight loss via severe as opposed to moderate energy restriction on physical activity over 36 mo. Methods A total of 101 postmenopausal female adults (45–65 y, BMI 30–40 kg/m2, <180 min/wk of structured exercise) were randomly assigned to either 12 mo of moderate energy restriction (25%–35% of energy requirement) with a food-based diet, or a severe intervention involving 4 mo of severe energy restriction (65%–75% of energy requirement) with a total meal replacement diet, followed by 8 mo of moderate energy restriction. Physical activity was encouraged, but no tailored or supervised exercise prescription was provided. Physical activity was assessed with an accelerometer worn for 7 d before baseline (0 mo) and 0.25, 1, 4, 6, 12, 24, and 36 mo after intervention commencement. Results Compared with the moderate group, the severe group exhibited greater mean: total volume of physical activity; duration of moderate-to-vigorous-intensity physical activity (MVPA); duration of light-intensity physical activity; step counts, as well as lower mean duration of sedentary time. All these differences (except step counts) were apparent at 6 mo [e.g. 1006 metabolic equivalent of task (MET)-min/wk; 95% CI: 564, 1449 MET-min/wk for total volume of physical activity], and some were also apparent at 4 and/or 12 mo. There were no differences between groups in the 2 other outcomes investigated (self-efficacy to regulate exercise; and proportion of participants meeting the WHO's 2020 Physical Activity Guidelines for MVPA). When the analyses were adjusted for weight at each time point, the differences between groups were either attenuated or abolished. Conclusions Among female adults with obesity, including a dietary component to reduce excess body weight—notably one involving severe energy restriction—could potentially enhance the effectiveness of physical activity interventions. This trial was registered at www.anzctr.org.au as ACTRN12612000651886. [ABSTRACT FROM AUTHOR]

There is controversial data on the impacts of bitter melon (Momordica charantia) supplementations on anthropometric indices. Thus, we aimed to clarify this role of bitter melon through a systematic review, and meta-analysis of the trials. All clinical trials conducted on the impact of bitter melon on anthropometric indices were published until August 2023 in PubMed, Web of Sciences, Scopus, Embase, and Cochrane Library web databases included. Overall, 10 studies with 448 individuals were included in the meta-analysis. Meta-analysis of 10 trials with 448 participants revealed no significant reductions in body weight (BW) (WMD: 0.04 Kg; 95 %CI: −0.16–0.25; P =0.651), body mass index (BMI) (WMD: −0.18 kg/m2; 95 %CI: −0.43–0.07; P =0.171), waist circumference (WC) (WMD: −0.95 cm; 95 % CI: −3.05–1.16; p =0.372), and percentage of body fat (PBF) (WMD: −0.99; 95 % CI: −2.33–0.35; p =0.141) following bitter melon supplementation. There was no significant impact of bitter melon supplementation on BW, BMI, WC, and PBF. More large-scale and high-quality RCTs are necessary to confirm these results. • 10 studies, with 448 participants were included in meta-analysis. • Melon supplementation did not decrease the effect on anthropometric indices. • Most of the included studies were of moderate quality. [ABSTRACT FROM AUTHOR]

Weight reduction is a standard recommendation for obstructive sleep apnea (OSA) treatment in people with obesity or overweight; however, weight loss can be challenging to achieve and maintain without bariatric surgery. Currently, no approved anti-obesity medication has demonstrated effectiveness in OSA management. This study is evaluating the efficacy and safety of tirzepatide for treatment of moderate to severe OSA in people with obesity. SURMOUNT-OSA, a randomized, placebo -controlled, 52-week phase 3 trial, is investigating the efficacy and safety of tirzepatide for treatment of moderate to severe OSA (apnea hypopnea- index ≥15 events/h) in participants with obesity (body mass index ≥30 kg/m2) and an established OSA diagnosis. SURMOUNT-OSA is made of 2 intervention-specific appendices (ISAs): ISA-1 includes participants with no current OSA treatment, and ISA-2 includes participants using positive airway pressure therapy. Overall, 469 participants have been randomized 1:1 to receive tirzepatide or placebo across the master protocol (ISA-1, n = 234; ISA-2, n = 235). All participants are also receiving lifestyle intervention for weight reduction. The primary endpoint for the individual ISAs is the difference in apnea hypopnea- index response, as measured by polysomnography, between tirzepatide and placebo arms at week 52. Secondary endpoints include sleep apnea-specific hypoxic burden, functional outcomes, and cardiometabolic biomarkers. The trial employs digital wearables, including home sleep testing to capture time to improvement and accelerometry for daily physical activity assessment, to evaluate exploratory outcomes. SURMOUNT-OSA brings a novel design to investigate if tirzepatide provides clinically meaningful improvement in obesity-related OSA by targeting the underlying etiology. Trial registration: ClinicalTrials.gov , NCT05412004 [ABSTRACT FROM AUTHOR]

The effect of obesity on pregnancy outcomes of patients with polycystic ovary syndrome (PCOS) undergoing assisted reproductive technology (ART) remains unclear. As such, a meta-analysis of recent studies was conducted to probe the effect of being overweight or obese on ART pregnancy outcomes in patients with PCOS. PubMed, Embase, MEDLINE, Scopus and Web of Science were searched from inception to 22 July 2023 without language restrictions. The main indicators were: live birth rate, clinical pregnancy rate, spontaneous abortion rate and multiple pregnancy rate. Ten studies were analysed, with a combined sample size of 247,845. Among patients with PCOS undergoing ART who were overweight or obese, the live birth rate, clinical pregnancy rate, implantation rate and number of retrieved oocytes were lower than in normal-weight patients with PCOS, and the spontaneous abortion rate was higher than in normal-weight patients with PCOS. Obese patients with PCOS undergoing ART had a lower multiple pregnancy rate and a lower number of mature oocytes compared with normal-weight patients with PCOS. The data showed that, among patients with PCOS, being overweight or obese has a negative effect on ART pregnancy outcomes. This meta-analysis may inform guidelines for pregnancy with ART, and encourage overweight or obese patients with PCOS to lose weight. [ABSTRACT FROM AUTHOR]

To compare the efficacy and safety of tirzepatide 5, 10 and 15 mg with subcutaneous semaglutide 0.5 mg as second-line treatment for adults with type 2 diabetes mellitus, after metformin monotherapy, using adjusted indirect treatment comparisons (aITCs). The aITCs were performed using the Bucher method to compare the relative efficacy and safety of tirzepatide 5, 10 and 15 mg versus semaglutide 0.5 mg via a common comparator (subcutaneous semaglutide 1.0 mg) based on trial results from SURPASS–2 (NCT03987919) and SUSTAIN 7 (NCT02648204). All tirzepatide doses showed statistically significantly greater reductions in glycated haemoglobin, body weight and body mass index from baseline to week 40, with a comparable adverse event (AE) profile and no statistically significant differences in the odds of gastrointestinal AEs versus semaglutide 0.5 mg. Furthermore, all tirzepatide doses showed greater odds of patients achieving HbA1c targets of ≤ 6.5 % (≤48 mmol/mol) and < 7.0 % (<53 mmol/mol) and weight loss targets of ≥ 5 % and ≥ 10 %, versus semaglutide 0.5 mg. In these aITCs, glycated haemoglobin and weight reductions were significantly greater for all tirzepatide doses versus semaglutide 0.5 mg with a comparable AE profile. These findings provide comparative effectiveness insights in the absence of a head-to-head clinical trial. [ABSTRACT FROM AUTHOR]

Although recent trials have shown benefits of weight loss and lifestyle interventions on obstructive sleep apnea (OSA) severity and comorbidities, the effect of these interventions on cardiorespiratory fitness (CRF) remains unknown. This study aimed to investigate the effects of an interdisciplinary weight loss and lifestyle intervention on CRF and self-reported physical fitness in adults with OSA. Eighty-nine men aged 18–65 years with moderate-to-severe OSA and a body mass index ≥25 kg/m2 were randomly assigned to a usual-care group or an 8-week interdisciplinary weight loss and lifestyle intervention. CRF was assessed through the 2-km walking test, and the International Fitness Scale (IFIS) was used to assess self-reported physical fitness. As compared with usual-care, the intervention group had greater improvements at intervention endpoint in objective CRF (6% reduction in 2-km walking test total time, mean between-group difference, −1.7 min; 95% confidence interval, −2.3 to −1.1), and self-reported overall physical fitness (18% increase in IFIS total score, mean between-group difference, 2.3; 95% CI 1.2 to 3.3). At 6 months after intervention, the intervention group also had greater improvements in both 2-km walking test total time (10% reduction) and IFIS total score (22% increase), with mean between-group differences of −2.5 (CI 95%, −3.1 to −1.8) and 3.0 (CI 95%, 1.8 to 4.1), respectively. An 8-week interdisciplinary weight loss and lifestyle intervention resulted in significant and sustainable improvements in CRF and self-reported physical fitness in men with overweight/obesity and moderate-to-severe OSA. ClinicalTrials.gov registration (NCT03851653) • An 8-week interdisciplinary weight loss and lifestyle intervention resulted in increased cardiorespiratory fitness (CRF). • An 8-week interdisciplinary weight loss and lifestyle intervention resulted in increased self-reported physical fitness. • Increased CRF and self-reported physical fitness were closely related to improvements in OSA severity and sleep outcomes. • Increased CRF and self-reported physical fitness were closely related to improvements in body weight and composition. • Increased CRF and self-reported physical fitness were closely related to reductions in neck, chest, and waist circumferences. [ABSTRACT FROM AUTHOR]

• The association between weight loss and subsequent functional decline is unclear. • Older individuals with ≥1 % weight loss were at risk of functional decline. • Monitoring weight change could identify older adults at risk of functional decline. The association between weight loss and subsequent functional decline is uncertain. The study aims to elucidate the association between weight loss over a year and subsequent functional decline requiring assistance in performing their activities of daily living in older individuals. The study used data from the publicly funded Long-Term Care Insurance service in Japan, which provides coverage for long-term care services for individuals unable to perform activities of daily living due to physical or cognitive impairment. The study enrolled people born in or before 1949, who underwent health checkups in both 2014 and 2015. The participants were followed from 2015 to the worsening of functional decline requiring long-term care services, death, or February 28, 2019, whichever occurred first. The risk of subsequent functional decline in each weight loss category was estimated using a Cox regression model adjusted for age, sex, baseline body mass index, smoking, and Charlson comorbidity index. We identified 67,452 eligible individuals from the database. The median follow-up period was 1,284 days. The hazard ratios (95 % confidence interval) of functional decline for -1 %, -2 %, -3 %, -4 %, and ≤-5% weight change compared to 0 % weight change were 1.17 (1.03−1.32), 1.26 (1.11−1.43), 1.29 (1.12−1.49), 1.61 (1.39−1.87), and 1.79 (1.58−1.99), respectively. Older people with weight loss of 1 % or more were at risk of functional decline. Close weight monitoring may serve as an easy and inexpensive means of identifying older individuals at risk of functional decline. [ABSTRACT FROM AUTHOR]

The quantity and quality of the adipose tissue is altered in obesity: hypertrophy of adipocytes, decrease in expandability, fibrosis, production of pro-inflammatory cytokines and adipokines, inflammatory infiltration by pro-inflammatory M1 macrophages and T lymphocytes. Excess adipose tissue and obesity are associated with low-grade inflammation that can aggravate chronic inflammatory diseases, decrease treatment efficacy, contribute to the development of comorbidities, and of the disease in its preclinical phase. Obesity increases the incidence of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis with a weight-dose effect. It is also a predictor of worse response to treatment, in particular TNF inhibitors. Weight loss induced by bariatric surgery decreases the risk of psoriasis and psoriatic arthritis and improves disease activity and remission in RA. A 5% weight loss through a low-calorie diet improves the response to TNF inhibitors in psoriatic arthritis, losing even more weight improves the response even more. In RA, the beneficial effect of weight loss from a low-calorie diet on disease activity has been reported in a few observational studies but has not been demonstrated in a randomized controlled trial. Screening and management of obesity are part of the dietary recommendations of the French Society for Rheumatology in patients with chronic inflammatory rheumatic diseases. Of course, this should be combined with other lifestyle modifications such as smoking cessation, higher food quality, increased physical activity and reduced sedentary behavior. [ABSTRACT FROM AUTHOR]

Frailty is a decline in the functioning of several body systems, accompanied by an increase in vulnerability to stressors. The condition is related to high risk of falls, hospitalizations, all-cause mortality, and disability, which poses challenges to public health. There is no consensus regarding frailty. Indeed, several validated instruments based on different conceptual approaches have been developed. Professionals face a challenge when attempting to make a clinical assessment that discriminates between low and high-risk groups. There is a scarcity of frailty assessment data for hospitalized older adults. Understanding aspects related to frailty in a hospital setting is essential to providing comprehensive care to these individuals. Investigate the association between frailty criteria at hospital admission and intra-hospital death in older patients. This is a longitudinal observational study of 170 older adults hospitalized in a public hospital of the Federal District, Brazil. Frailty and mortality were the independent and dependent variables, respectively. The former was assessed using the frailty phenotype, considering unintentional weight loss, exhaustion, muscle weakness, slow gait and low physical activity level, and participants were categorized as non-frail, pre-frail or frail. Intra-hospital mortality was collected in the healthcare electronic medical chart system (TrackCare). The older patients were categorized into two groups: those that were discharged and those that died. Data analysis was descriptive and using the chi-squared, Mann-Whitney U and simple and multiple logistic regression tests. Demographic (age and sex) and clinical data (number of medications and body mass index- BMI) were collected to adjust the analyses. 7.1% of the older adults hospitalized during the study period were non-frail, 34.1% pre-frail and 58.8% frail, and 7.1% died during their hospital stay. The group that died exhibited more frailty criteria (U=510.500; p=0.006) and more frequent muscle weakness (X²(1)=7.412; p=0.006) and slow gait (X²(1)=5.636; p=0.030). These individuals showed no differences in age, sex, education level, BMI and medications when compared to their discharged counterparts (p>0.05). In simple regression analyses, one more frailty criterion increased the likelihood of intra-hospital death by 110% (OR=2.100 [95% CI 1.201 – 3.673]). Adjusted multiple analyses did not change the simple regression results. Older adults with more frailty criteria exhibited a greater likelihood of intra-hospital death. The findings reveal the risk of intra-hospital death in hospitalized frail older patients and therefore, the need for multiprofessional monitoring of these individuals from the moment they are admitted. Understanding frailty in a hospital setting may contribute to the development of healthcare, screening, health indicator and prevention strategies aimed at improving care and prognosis for these individuals. [ABSTRACT FROM AUTHOR]