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• Cumulative unpredictable mild stress (CUMS) induced depressive phenotype and memory deficit. • Depressed rats showed downregulation of the serotoninergic system. • Deep brain stimulation (DBS) of medial forebrain bundle alleviated depressive-like symptoms. • DBS upregulated serotoninergic innervation of the medial prefrontal cortex. • Stimulation of serotoninergic pathway in medial forebrain bundle may reverse depressive-like phenotype. The aim of the study is to understand the rationale behind the application of deep brain stimulation (DBS) in the treatment of depression. Male Wistar rats, rendered depressive with chronic unpredictable mild stress (CUMS) were implanted with electrode in the lateral hypothalamus-medial forebrain bundle (LH-MFB) and subjected to deep brain stimulation (DBS) for 4 h each day for 14 days. DBS rats, as well as controls, were screened for a range of parameters indicative of depressive state. Symptomatic features noticed in CUMS rats like the memory deficit, anhedonia, reduction in body weight and 5-hydroxytryptamine (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) levels in mPFC and elevated plasma corticosterone were reversed in rats subjected to DBS. DBS arrested CUMS induced degeneration of 5-HT cells in interfascicular region of dorsal raphe nucleus (DRif) and fibers in LH-MFB and induced dendritic proliferation in mPFC neurons. MFB is known to serve as a major conduit for the DRif-mPFC serotoninergic pathway. While the density of serotonin fibers in the LH-MFB circuit was reduced in CUMS, it was upregulated in DBS-treated rats. Furthermore, microinjection of 5-HT1A receptor antagonist, WAY100635 into mPFC countered the positive effects of DBS like the antidepressant and memory-enhancing action. In this background, we suggest that DBS at LH-MFB may exercise positive effect in depressive rats via upregulation of the serotoninergic system. While these data drawn from the experiments on rat provide meaningful clues, we suggest that further studies aimed at understanding the usefulness of DBS at LH-MFB in humans may be rewarding. [ABSTRACT FROM AUTHOR]

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]

• Moderate-intensity exercise did not prevent significant body weight gain in mice. • Female mice experienced enhanced dopamine signaling with aerobic exercise. • Male high-fat fed mice did not show enhanced endpoints with aerobic exercise. Obesity continues to rise in prevalence and financial burden despite strong evidence linking it to an increased risk of developing several chronic diseases. Dopamine response and receptor density are shown to decrease under conditions of obesity. However, it is unclear if this could be a potential mechanism for treatment without drugs that have a potential for abuse. Therefore, the aim of this study was to investigate whether moderate-intensity exercise could reduce body weight gain and the associated decreases in dopamine signaling observed with high-fat diet-induced adiposity. We hypothesized that exercise would attenuate body weight gain and diet-induced inflammation in high-fat (HF)-fed mice, resulting in dopamine signaling (release and reuptake rate) comparable to sedentary, low-fat (LF)-fed counterparts. This hypothesis was tested using a mouse model of diet-induced obesity (DIO) and fast-scan cyclic voltammetry to measure evoked dopamine release and reuptake rates. Although the exercise protocol employed in this study was not sufficient to prevent significant body weight gain, there was an enhancement of dopamine signaling observed in female mice fed a HF diet that underwent treadmill running. Additionally, aerobic treadmill exercise enhanced the sensitivity to amphetamine (AMPH) in this same group of exercised, HF-fed females. The estrous cycle might influence the ability of exercise to enhance dopamine signaling in females, an effect not observed in male groups. Further research into females by estrous cycle phase, in addition to determining the optimal intensity and duration of aerobic exercise, are logical next steps. [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]

• Fat mass during weight maintenance is independent of usual weight loss in athletes. • Athletes used to a higher degree of weight loss consumed more protein and less fat. • Athletes with a higher degree of weight loss seem to favor fat-free mass sparing. • Sex influences the negative relationship between fat intake and usual weight loss. • Food reward is not altered in athletes used to higher degrees of weight variations. Weight variations are common in sporting life, with important inter-individual variability in the degree of an athlete's habitual weight loss. As a part of the WAVE study (NCT04107545), the main objective of this preliminary study was to determine whether the habitual degree of weight loss was associated with anthropometric, body composition, nutritional or psychometric profiles during a period of weight maintenance in athletes accustomed to weight variations. We hypothesized that athletes accustomed to a higher habitual degree of weight loss may have a higher body weight and body fat mass, and may present a more controlled diet regimen and cognitive restriction than athletes with a lower habitual degree of weight loss. During a period of weight maintenance, 62 athletes (24.0 ± 5.3 years; 26 women) completed anthropometry and body composition measurements, a 48-hours food diary and self-reported questionnaires to determine their weight variation practice, nutritional profile and mood state. Athletes were stratified within inter- and intra-quartile groups according to their habitual degree of weight loss. Athletes with a higher habitual degree of weight loss were those who consumed more protein (P <.001) and less fat (P =.01) as a proportion of total energy compared with those losing less weight, without any difference in body composition between the groups. The rapid weight loss score was significantly higher in individuals losing more weight (P <.001) and no difference was observed for the mood state profile. The present results suggest a potential control of nutritional regulation during a period of weight maintenance in order to spare fat-free mass and favor fat mass loss in athletes who are routinely losing more weight. Fat-free mass may be the main nutritional driver due to low body fat mass in athletes, which may limit the "catch-up fat" phenomenon commonly observed in nonathletic population. Athletes used to weight variations (N = 62) were enrolled in a stable body weight period for physical and psychological measurements. The habitual degree of weight loss does not seem associated with body weight or composition nor the profile of mood state and food preferences. However, athletes used to a higher degree of weight loss consumed more relative protein and less relative fat than those losing less weight. This may suggest potential conscious control of nutritional regulation in order to spare fat-free mass and favor fat mass loss in those athletes losing more weight. %WL, usual degree of weight loss; BW, body weight; FFM, fat-free mass; FM, fat mass; RWLQ, rapid weight loss questionnaire. [Display omitted] [ABSTRACT FROM AUTHOR]

Investigate the influence of physical readiness tests (PRTs) on eating behaviors among US Navy Sailors. Focused ethnography using interviews and military policies. Three US Naval installations. Active-duty enlisted Sailors (n = 32). Eating behaviors. Authors analyzed data iteratively with data collection using domain, taxonomy, and thematic analysis to identify culturally relevant codes, domains, and themes. Five themes corresponded with PRT timing and Sailors' perceived ability to meet standards: (1) maintain usual eating habits, (2) get ready and switch it up, (3) make weight—damage control, (4) return to baseline—PRT is over, and (5) eat whatever—PRT is canceled. In contrast to the PRT policy's goal for Sailors to maintain standards and a healthy lifestyle, many Sailors modified their usual eating behaviors to pass the test. Changes in eating behaviors during PRT cycles highlight a culture of getting ready vs staying ready, suggesting many Sailors do not eat a nutrient-dense diet to maintain the minimum physical fitness and body composition standards. There is a need for nutrition education for healthy weight maintenance, weight gain prevention, and healthy weight loss among military personnel. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is strongly associated with obesity. While the relationship between weight reduction and apnea-hypopnea index improvement has been documented, to our knowledge, it has not been quantified adequately. Therefore, this study aimed to quantify the relationship between weight reduction and AHI change. A systematic literature search was performed using meta-analyses (PRISMA) guidelines for studies reporting AHI and weight loss in people with obesity/overweight and OSA between 2000 and 2023. A linear and quadratic model (weighted by treatment arm sample size) predicted percent change from baseline AHI against mean percent change from baseline weight. The quadratic term was statistically significant (P < 0.05), so the quadratic model (with 95 % prediction interval) was used. The literature search identified 27 studies/32 treatment arms: 15 using bariatric surgery and lifestyle intervention each and 2 using pharmacological interventions. Included studies were ≥3 months with weight intervention and participants had AHI ≥15/h. Weight reduction in people with OSA and obesity was associated with improvements in the severity of OSA. BMI reduction of 20 % was associated with AHI reduction of 57 %, while further weight reduction beyond 20 % in BMI was associated with a smaller effect on AHI. As the prediction intervals are relatively wide, a precise relationship could not be conclusively established. The degree of AHI index improvement was associated with the magnitude of weight reduction. The model suggests that with progress in weight reduction beyond 20 %, the incremental decrease in BMI appeared to translate to a smaller additional effect on AHI. • Weight reduction in patients with obesity and OSA was associated with reduced apnea-hypopnea index. • The degree of apnea-hypopnea index improvement was associated with the magnitude of weight reduction. • A BMI reduction of 20 % was associated with an apnea-hypopnea index reduction of 57 %. [ABSTRACT FROM AUTHOR]

• Weight Reduction: Cinnamon supplementation significantly reduces body weight in women with PCOS. • Improved Insulin Resistance: Cinnamon helps lower insulin resistance, as indicated by decreased HOMA-IR scores. • Lower Fasting Blood Sugar: Cinnamon intake significantly reduces fasting blood sugar levels. • Cholesterol Benefits: Cinnamon supplementation lowers total cholesterol and LDL levels. Polycystic Ovary Syndrome (PCOS) is a hormonal disorder in women associated with increased cardiovascular risk. Cinnamon, a Chinese herbal medicine, is known for its anti-inflammatory and insulin-sensitizing properties, making it a potential therapeutic agent for PCOS-related cardiovascular complications. This systematic review and meta -analysis aimed to assess the impact of cinnamon supplementation on cardiovascular risk markers in women diagnosed with PCOS. Twelve randomized controlled trials (RCTs) were included in the analysis. The primary outcomes assessed were body weight, insulin resistance measured by Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and fasting blood sugar (FBS). The meta -analysis revealed a statistically significant effect of cinnamon on reducing weight. Under the random-effects model, the pooled weighted mean difference (WMD) was −0.47 kg (95 % CI: −0.80 to −0.15, p < 0.001; I2 = 0.0 %). There was also a beneficial impact on insulin resistance, with reduced HOMA-IR scores following cinnamon supplementation (SMD=0.5015, 95 % CI: 0.2496 to 0.7533, p < 0.0001). Additionally, there was a significant improvement in FBS levels (pooled WMD: −7.72 mg/dL, 95 % CI: −12.33 to −3.12, p < 0.001; I2 = 91.3 %). The meta -analysis indicated a tendency towards reduced total cholesterol (WMD: −11.12 mg/dL, 95 % CI: −19.06 to −3.18, p = 0.01; I2 = 0.0 %) and LDL levels (WMD: −11.11 mg/dL, 95 % CI: −18.22 to −4.00, p < 0.01; I2 = 0.0 %) following cinnamon intervention. Substantial heterogeneity was observed among the studies, indicating the need for further research with larger sample sizes and standardized methodologies. Cinnamon supplementation demonstrates promising effects on body weight, blood sugar, total cholesterol, LDL, and insulin resistance in women with PCOS, indicating its potential in mitigating cardiovascular risk factors associated with this condition. [ABSTRACT FROM AUTHOR]

Both overweight/obesity and a Western lifestyle are associated with a poorer prognosis in women with breast cancer. The primary aim of this analysis was to examine the effect of a telephone-delivered lifestyle intervention program on reducing body weight and waist circumference, decreasing cardiovascular risk factors and improving lifestyle. Data is derived from an open-label, randomized, controlled phase III study that evaluated two chemotherapy regimens and the impact of a 2-year lifestyle intervention on disease-free survival and secondary outcomes in women with intermediate-risk to high-risk breast cancer. Initially, 2292 women with a body mass index (BMI) between 24 and 40 kg/m2 were randomized into one of two arms of the lifestyle intervention study. After accounting for dropout, 1785 participants remained: 776 in the intervention group (IG) who received a telephone-delivered lifestyle intervention supported by mailed materials, and 1009 in the low-level intervention group (LLIG) who received only mailed educational materials with general recommendations for a healthy lifestyle. Body weight, waist circumference, dietary intake, physical activity, and cardiovascular disease risk parameters were measured repeatedly throughout the intervention and a subsequent 2-year follow-up period. Linear mixed models for repeated measures were used to assess differences in study outcomes between the LLIG and IG at each measured time point. IG participants showed a mean weight loss of −2.7 kg (kg) (versus +0.4 kg, LLIG) at 6 months, −2.8 kg (vs. +0.8 kg, LLIG) at 12 months and −1.8 kg at 24 months (versus +0.9 kg, LLIG). Significant between-group differences for weight loss and reduced waist circumference were observed at all time points until the end of the lifestyle intervention (all p-values < 0.0001), including post-intervention. Reduced energy intake and a higher alternate healthy eating index (AHEI) score in the IG was detected during the lifestyle intervention (AHEI at 24 months: IG 49.1% versus LLIG 42.0%, p < 0.001). Modest significant improvements in several cardiovascular risk factors were observed during the intervention, including fasting plasma glucose, HbA1c, systolic and diastolic blood pressure, and lipids. A mainly telephone-delivered lifestyle intervention program can reduce body weight and waist circumference, improve diet quality, and decrease cardiometabolic risk in women with overweight/obesity and newly diagnosed, human epidermal growth factor receptor 2 (HER2)/neu-negative, intermediate-risk to high-risk breast cancer. Weight loss, reduced waist circumference and improved dietary patterns were maintained for up to two years post-intervention. The protocol was registered under the EU Clinical Trials Register, https://www.clinicaltrialsregister.eu/ , identifier: 2008-005453-38. • Lifestyle intervention leads to healthy weight loss in breast cancer survivors. • Telephone-delivered lifestyle counseling promotes a healthier eating pattern. • Lifestyle intervention in breast cancer survivors can reduce cardiometabolic risk. • Effects of a 2-year lifestyle intervention are partly retained for another 2 years. [ABSTRACT FROM AUTHOR]

Obesity is a polygenic multifactorial disease. Recent genome-wide association studies have identified several common loci associated with obesity-related phenotypes. Bariatric surgery (BS) is the most effective long-term treatment for patients with severe obesity. The huge variability in BS outcomes between patients suggests a moderating effect of several factors, including the genetic architecture of the patients. To examine the role of a genetic risk score (GRS) based on 7 polymorphisms in 5 obesity-candidate genes (FTO , MC4R , SIRT1 , LEP , and LEPR) on weight loss after BS. University hospital in Spain. We evaluated a cohort of 104 patients with severe obesity submitted to BS (Roux-en-Y gastric bypass or sleeve gastrectomy) followed up for >60 months (lost to follow-up, 19.23%). A GRS was calculated for each patient, considering the number of carried risk alleles for the analyzed genes. During the postoperative period, the percentage of excess weight loss total weight loss and changes in body mass index were evaluated. Generalized estimating equation models were used for the prospective analysis of the variation of these variables in relation to the GRS. The longitudinal model showed a significant effect of the GRS on the percentage of excess weight loss (P = 1.5 × 10–5), percentage of total weight loss (P = 3.1 × 10–8), and change in body mass index (P = 7.8 × 10–16) over time. Individuals with a low GRS seemed to experience better outcomes at 24 and 60 months after surgery than those with a higher GRS. The use of the GRS in considering the polygenic nature of obesity seems to be a useful tool to better understand the outcome of patients with obesity after BS. • This study contributes to understand how the biological background, among other factors, impact in the outcomes after bariatric surgery. • The use of genetic risk scores considering risk conferred by different genetic variants, could help to understand the evolution on weight loss of obese patients after surgery. [ABSTRACT FROM AUTHOR]

Sex of patients with knee osteoarthritis (KOA) may impact changes in thigh muscle composition during weight loss, the most well-known disease-modifying intervention. We investigated longitudinal sex-based changes in thigh muscle quality during weight loss in participants with KOA. Using Osteoarthritis Initiative (OAI) cohort data, we included females and males with baseline radiographic KOA who experienced > 5 % reduction in Body Mass Index (BMI) over four years. Using a previously validated deep-learning algorithm, we measured Magnetic Resonance Imaging (MRI)-derived biomarkers of thigh muscles at baseline and year-4. Outcomes were the intra- and inter-muscular adipose tissue (Intra-MAT and Inter-MAT) and contractile percentage of thigh muscles between females and males. The analysis adjusted for potential confounders, such as demographics, risk factors, BMI change, physical activity, diet, and KOA status. A retrospective selection of available thigh MRIs from KOA participants who also had a 4-year weight loss (>5 % of BMI) yielded a sample comprising 313 thighs (192 females and 121 males). Female and male participants exhibited a comparable degree of weight loss (females: −9.72 ± 4.38, males: −8.83 ± 3.64, P-value=0.060). However, the changes in thigh muscle quality were less beneficial for females compared to males, as shown by a less degree of longitudinal decrease in Intra-MAT (change difference,95 %CI: 783.44 mm2/4-year, 505.70 to 1061.19, P-value<0.001) and longitudinal increase in contractile percentage (change difference,95 %CI: −3.9 %/4-year, −6.5 to −1.4, P-value=0.019). In participants with KOA and 4-year weight loss, the longitudinal changes in thigh muscle quality were overall beneficial but to a less degree in females compared to males. Further research is warranted to investigate the underlying mechanisms and develop sex-specific interventions to optimize muscle quality during weight loss. [ABSTRACT FROM AUTHOR]

The depletion of visceral and subcutaneous adipose tissue (AT) during chemotherapy significantly correlates with diminished overall survival and progression-free survival. Despite its clinical significance, the intricate molecular mechanisms governing this AT loss and its chemotherapy-triggered initiation remain poorly understood. Notably, the evaluation of AT remodeling in most clinical trials has predominantly relied on computerized tomography scans or bioimpedance, with molecular studies often conducted using animal or in vitro models. To address this knowledge gap, a comprehensive narrative review was conducted. The findings underscore that chemotherapy serves as a key factor in inducing AT loss, exacerbating cachexia, a paraneoplastic syndrome that significantly compromises patient quality of life and survival. The mechanism driving AT loss appears intricately linked to alterations in AT metabolic remodeling, marked by heightened lipolysis and fatty acid oxidation, coupled with diminished lipogenesis. However, adipocyte stem cells' lost ability to divide due to chemotherapy also appears to be at the root of the loss of AT. Notably, chemotherapy seems to deactivate the mitochondrial antioxidant system by reducing key regulatory enzymes responsible for neutralizing reactive oxygen species (ROS), thereby impeding lipogenesis. Despite FDG-PET evidence of AT browning, no molecular evidence of thermogenesis was reported. Prospective investigations unraveling the molecular mechanisms modulated in AT by chemotherapy, along with therapeutic strategies aimed at preventing AT loss, promise to refine treatment paradigms and enhance patient outcomes. • Clinical and preclinical studies suggest that chemotherapy promotes body weight loss targeting adipose tissue. • Increased lipolysis and decreased de novo lipogenesis is a mark of cisplatin and doxorubicin treatment in animal models. • Adipose tissue loss is related to thermogenesis and mitochondrial biogenesis post doxorubicin treatment in animal models. • Irinotecan plus 5-fluoracil reduce antioxidant defences in adipose tissue of animal models. [ABSTRACT FROM AUTHOR]

• Collaborative Optimization of Simplified Sections of steel/aluminum vehicle body. • Simplified Section was translated into Complex Section under Constraints of Sectional Mechanical Properties. • Optimization method for complex sections controlled by proportional vectors was established. A multi-level matching transformation and optimization design method for complex sections of thin-walled structures in steel/aluminum vehicle body skeleton was proposed. The problems of lengthy body performance numerical analysis and low optimization efficiency were solved by the rapid collaborative optimization of simplified cross-sections and performance of the body skeleton. A complex cross-sections shape library of thin-walled structures in steel/aluminum body skeleton and formulas for solving section mechanical properties were established, which overcame the difficulty of translating simplified cross-sections of thin-walled structures in steel/aluminum body skeleton to actual complex sections. A precise optimization method for complex cross-sections of thin-walled structure controlled by proportional vectors was established, which solved the defect that it was difficult to precisely control the arbitrary change of complex cross-section shape, and provided a new way for lightweight optimization design of complex cross-sections. The proposed method achieved the rapid collaborative design of steel/aluminum body thin-walled structure with complex cross-sections and body skeleton performance through multi-level progressive cross-section matching transformation and optimization. A body skeleton model with actual complex cross-sections was established, and compared with the initial simplified structure, the weight reduction ratio of the body skeleton was up to 6.9 %, and the performance indicators of the body skeleton fully met the design requirements, which verified the effectiveness of the proposed method. [ABSTRACT FROM AUTHOR]

The objective of this narrative review is to advocate for improved comprehensive care of patients with obesity and infertility. Persons with an increased body mass index have less successful reproductive outcomes, and recently, new medications to treat neuroendocrine hormone imbalances are producing meaningful weight loss akin to surgical interventions. For the first time, obesity is publicly being recognized as a disease. These medications contain the newest generation of glucagon-like peptide 1 receptor agonists and deserve our attention for several reasons: regardless of body mass index, many patients will be using them; it is necessary to understand the mode of action, side effects, and implications for anesthetic procedures and pregnancy; and it is important to evaluate when they could be used to improve health outcomes and/or access to fertility care. [ABSTRACT FROM AUTHOR]

Weight loss before conception is recommended for women with overweight or obesity to improve fertility outcomes, but evidence supporting this recommendation is mixed. To examine the effectiveness of weight loss interventions using lifestyle modification and/or medication in women with overweight or obesity on pregnancy, live birth, and miscarriage. An electronic search of MEDLINE, Embase, Cochrane Library, including Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature was conducted through July 6, 2022, via Wiley. Randomized controlled trials examining weight loss interventions through lifestyle and/or medication in women with overweight or obesity planning pregnancy were included. Random-effects meta-analysis was conducted, reporting the risk ratio (RR) for each outcome. Subgroup analyses were conducted by intervention type, type of control group, fertility treatment, intervention length, and body mass index (BMI). Clinical pregnancy, live birth, and miscarriage events. A narrative review and meta-analysis were possible for 16 studies for pregnancy (n = 3,588), 13 for live birth (n = 3,329), and 11 for miscarriage (n = 3,248). Women randomized and exposed to a weight loss intervention were more likely to become pregnant (RR = 1.24, 95% CI 1.07–1.44; I2 = 59%) but not to have live birth (RR = 1.19, 95% CI 0.97–1.45; I2 = 69%) or miscarriage (RR = 1.17, 95% CI 0.79–1.74; I2 = 31%) compared with women in control groups. Subgroup analyses revealed women randomized to weight loss interventions lasting 12 weeks or fewer (n = 9, RR = 1.43; 95% CI 1.13–1.83) and women with a BMI ≥ 35 kg/m2 (n = 7, RR = 1.54; 95% CI, 1.18–2.02) were more likely to become pregnant compared with women in the control groups. Miscarriage was higher in intervention groups who underwent fertility treatment (n = 8, RR 1.45; 95% CI 1.07–1.96). Pregnancy rates were higher in women undergoing preconception weight loss interventions with no impact on live birth or miscarriage rates. Findings do not support one-size-fits-all recommendation for weight loss through lifestyle modification and/or medication in women with overweight or obesity immediately before conception to improve live birth or miscarriage outcomes. [ABSTRACT FROM AUTHOR]

Esculentin-2CHa(1–30) (‟ESC") has been reported as a potent anti-diabetic peptide with little toxicity. However, its very short plasma residence time severely limits the therapeutic efficacy. To address this issue, we genetically engineered a fusion protein of tandem trimeric ESC with an albumin binding domain (ABD) and a fusion partner, SUMO (named ‟SUMO-3×ESC-ABD"). The SUMO-3×ESC-ABD, successfully produced from E. coli , showed low cellular and hemolytic toxicity while displaying potent activities for the amelioration of hyperglycemia as well as non-alcoholic fatty liver disease (NAFLD) in vitro. In animal studies, the estimated plasma half-life of SUMO-3×ESC-ABD was markedly longer (427-fold) than that of the ESC peptide. In virtue of the extended plasma residence, the SUMO-3×ESC-ABD could produce significant anti-hyperglycemic effects that lasted for >2 days, while both the ESC or ESC-ABD peptides elicited little effects. Further, twice-weekly treatment for 10 weeks, the SUMO-3×ESC-ABD displayed significant improvement in blood glucose control with a reduction in body weight. Most importantly, a significant improvement in the conditions of NAFLD was observed in the SUMO-3×ESC-ABD-treated mice. Along the systemic effects (by improved glucose tolerance and body weight reduction), direct inhibition of the hepatocyte lipid uptake was suggested as the major mechanism of the anti-NAFLD effects. Overall, this study demonstrated the utility of the long-acting SUMO-3×ESC-ABD as a potent drug candidate for the treatment of NAFLD. [Display omitted] [ABSTRACT FROM AUTHOR]

The efficacy of medium-chain triglycerides (MCTs) for weight management and mitigating metabolic disorders among individuals with overweight and obesity remains a topic of ongoing discussion. Notably, there is a gap in the distinction between pure MCTs and medium-long-chain triglycerides (MLCTs). This meta-analysis investigates the efficacy of MCTs on weight loss and glucolipid metabolism in these populations, explicitly evaluating the differential effects of pure MCTs and MLCTs. We performed a random-effects meta-analysis on relevant studies examining weight loss and glucolipid parameters, incorporating a subgroup analysis conducted based on intervention types, pure MCTs versus MLCTs. Our findings revealed diets enriched with MCTs are more effective in achieving weight reduction (WMD: −1.53%; 95% CI: −2.44, −0.63; p < 0.01), particularly those containing pure MCTs (WMD: −1.62%; 95% CI: −2.78, −0.46; p < 0.01), compared to long-chain fatty acids (LCTs) enriched diets. However, our subgroup analysis indicates that an MLCTs-enriched diet did not significantly reduce weight loss. Additionally, MCTs-enriched diets were associated with significant reductions in blood triglyceride levels and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) scores, compared to LCTs-enriched diets. Hence, the authors recommend incorporating pure MCTs in dietary interventions for individuals with overweight and obesity, particularly those with comorbidities such as dyslipidemia and impaired glucose metabolism. [ABSTRACT FROM AUTHOR]

Sleeve gastrectomy (SG) is the most commonly performed weight loss operation, and its 2 most common complications are postoperative reflux and weight recurrence. There is limited evidence to guide decision-making in treating these conditions. To determine the efficacy of conversion of SG to Roux-en-Y gastric bypass (RYGB) for GERD management and weight loss. Forty-one hospitals in Michigan. We conducted a retrospective cohort study examining patients who underwent conversion of SG to RYGB from 2014 to 2022. The primary outcomes were changes in GERD-HRQL scores, anti-reflux medication use, and weight from baseline to 1 year after conversion. Secondary outcomes included 30-day postoperative complications and resource utilization. Among 2133 patients undergoing conversion, 279 (13%) patients had baseline and 1-year GERD-HRQL survey data and anti-reflux medication data. GERD-HRQL scores decreased significantly from 24.6 to 6.6 (P <.01). Among these, 207 patients (74%) required anti-reflux medication at baseline, with only 76 patients (27%) requiring anti-reflux medication at 1 year postoperatively (P <.01). Of the 380 patients (18%) with weight loss data, mean weight decreased by 68.4lbs, with a 24.3% decline in total body weight and 51.5% decline in excess body weight. In terms of 30-day complications, 308 (14%) patients experienced any complication and 89 (4%) experienced a serious complication, but there were no leaks, perforations, or deaths. Three-hundred and fifty-five (17%) patients presented to the emergency department and 64 (3%) patients underwent reoperation. This study represents the largest reported experience with conversion from SG to RYGB. We found that conversion to RYGB is associated with significant improvement in GERD symptoms, reduction in anti-reflux medication use, and significant weight loss and is therefore an effective treatment for GERD and weight regain after SG. However, the risks and benefits of conversion surgery should be carefully considered, especially in patients with significant comorbidity burden. • Conversion of SG to RYGB is associated with significantly improved GERD symptoms. • Conversion procedures are associated with significant weight loss. • Conversion is safe but has higher 30-day complication rates than primary RYGB. • Comorbidity burden should be considered when discussing conversion of SG to RYGB. [ABSTRACT FROM AUTHOR]

Obesity and nonalcoholic fatty liver disease (NAFLD) are an increasing health care burden worldwide. Weight loss is currently the best option to alleviate NAFLD and is efficiently achieved by bariatric surgery. Presence of NAFLD seems to be predictive for postoperative weight loss. To date, only few predictive factors for postbariatric weight loss (age, diabetes, psychiatric disorders) are established. Since liver fibrosis is the pathogenic driver for the progression of liver disease, we investigated its role in predicting postoperative weight loss. This study focuses on the correlation between fibrosis stage and weight loss. University and university-affiliated cooperation, Germany. We used a prospective, single-center cohort study including 164 patients who underwent bariatric surgery with simultaneous liver biopsies. Liver fibrosis was determined histologically according to Kleiner score and noninvasively by APRI and FIB-4 score. Percentage of total body weight loss was calculated at 1-year follow up visit. Thirty-two patients were found without fibrosis, whereas 91 patients showed mild fibrosis (F1), 37 significant fibrosis (F2), and only 4 patients presented advanced fibrosis (F3) at the time of bariatric surgery. Weight loss was similar across different degrees of fibrosis stage. Accordingly, linear regression analysis did not identify predictors of weight loss among fibrosis scores. In multivariable analysis, age and presence of diabetes showed the strongest predictive value. Baseline presence of fibrosis was not associated with postoperative weight loss, while age and diabetes were independent predictors of weight loss. Bariatric surgery should be applied independently of the fibrosis stage. • Stage of hepatic fibrosis does not predict postbariatric weight-loss results. • Therefore, stage of hepatic fibrosis should not influence the indication for metabolic surgery. • Age and presence of Type 2 diabetes mellitus have negative impact on postbariatric weight-loss. [ABSTRACT FROM AUTHOR]

Diamond/Cu–Sn–Ti composites as potential super-hard abrasive products were prepared in this work by spark plasma sintering at 1223 K. The effects of Ti content on the wettability, interfacial reaction layer thickness, and wear resistance of the bulk composite changes were systematically studied. The results revealed that when the Ti content was below 5 wt%, completely uncoated and partially coated diamond grains were still observed, indicating insufficient wettability, and the interfacial reaction layer appeared to be thin. When the Ti content was 5 wt%, all diamond grains were completely coated, and a continuous and stable interfacial reaction layer composed of TiC has been generated, in which the thickness reached a peak value of 1.72 μm. However, when the Ti content exceeded 5 wt%, the formation of brittle Cu 41 Sn 11 phases was observed, which led to inferior wear resistance. The minimum weight loss was obtained at 5 wt% Ti content. Meanwhile, through FIB-TEM, confirmed that the interfacial reaction layer was mainly composed of continuous TiC layer adjacent to diamond and discontinuous TiC layer in the filler metal, and constitute the formation of a high strength metallurgical interfacial bonding layer. [ABSTRACT FROM AUTHOR]

• Increased calcium intake reduces serum advanced glycation end products (AGEs). • AGEs/soluble receptor for AGEs (sRAGE) ratio also decreases after intervention. • ΔAGEs and ΔAGEs/sRAGE ratio are associated with a poorer metabolic profile. • ΔAGEs/ ΔsRAGE ratio is a better metabolic status marker than ΔAGEs and ΔsRAGE. The effect of calcium (Ca) on glycation markers is unknown. We hypothesized that increased Ca intake from skimmed milk associated with an energy-restricted diet intake will reduce glycation markers. This reduction will be associated with a greater improvement in markers of metabolic control in adults with type 2 diabetes, overweight, and low habitual Ca intake (<600 mg/d). In this secondary data analysis based on a crossover clinical trial, 14 adults were allocated into 2 groups: high calcium (shake containing 700 mg Ca/day) or low calcium (shake with 6.4 mg Ca/day), for 12 consecutive weeks per session. Energy-restricted diets were also prescribed (−500 kcal/d, 800 mg of dietary Ca/d) to all participants. Advanced glycation end products (AGEs), soluble receptor for AGEs (sRAGE), glycemic control, and lipid profile were assessed at baseline and after 12 weeks. High-calcium serum AGE concentrations and AGE/sRAGE ratio were lower at the end of the study. ΔAGE and ΔAGE/sRAGE ratio were both positively associated with Δtriglycerides, Δtotal cholesterol, Δtriglyceride-glucose index and variations, and Δvisceral adiposity index. ΔAGE/sRAGE was positively associated with Δfructosamine and Δhigh-density lipoprotein-cholesterol, and negatively associated with male sex. Consumption of approximately 1200 mg/day of calcium (3 servings of skim milk) reduced serum AGEs concentrations and the AGE/sRAGE ratio in individuals with diabetes. In general, positive changes in glycation markers are associated with lipid profile, insulin resistance, and adiposity markers worsening. ΔAGEs/ΔsRAGE ratio seems to be a better marker of metabolic status than ΔAGEs and ΔsRAGE alone. Registered in ClinicalTrials.gov (NCT02377076). Consumption of 1200 mg/day of calcium reduces serum AGE concentrations and the AGEs/sRAGE ratio, demonstrating a potential antiglycation effect of skimmed milk in individuals with type 2 diabetes, excess body weight, and low habitual calcium intake. Negative changes on glycation markers are associated with a better metabolic profile. Created with Adobe Photoshop CS6, using vectors freely distributed by Flaticom.com. Abbreviations: AGE, advanced glycation end products; sRAGE, soluble receptor for AGE. [Display omitted] [ABSTRACT FROM AUTHOR]

The glucagon-like peptide-1 receptor agonist, semaglutide, improved health status and reduced body weight in patients with obesity-related heart failure (HF) with preserved ejection fraction (HFpEF) in the STEP-HFpEF (Semaglutide Treatment Effect in People with Obesity and HFpEF) program. Whether benefits were due to mechanical unloading or effects on HF pathobiology is uncertain. This study sought to determine if semaglutide 2.4 mg reduced N-terminal pro–B-type natriuretic peptide (NT-proBNP) in patients with obesity-related HFpEF and compare treatment responses by baseline NT-proBNP. This was a prespecified secondary analysis of pooled data from 2 double-blind, placebo-controlled, randomized trials (STEP-HFpEF [Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity] and STEP-HFpEF DM [Research Study to Look at How Well Semaglutide Works in People Living With Heart Failure, Obesity and Type 2 Diabetes]) testing effects of semaglutide in patients with obesity-related HFpEF. The main outcomes were change in NT-proBNP at 52 weeks and change in the dual primary endpoints of Kansas City Cardiomyopathy Questionnaire Clinical Summary Score and body weight by baseline NT-proBNP. In total, 1,145 patients were randomized. Semaglutide compared with placebo reduced NT-proBNP at 52 weeks (estimated treatment ratio: 0.82; 95% CI: 0.74-0.91; P = 0.0002). Improvements in health status were more pronounced in those with higher vs lower baseline NT-proBNP (estimated difference: tertile 1: 4.5 points, 95% CI: 0.8–8.2; tertile 2: 6.2 points, 95% CI: 2.4-10.0; tertile 3: 11.9 points, 95% CI: 8.1-15.7; P interaction = 0.02; baseline NT-proBNP as a continuous variable: P interaction = 0.004). Reductions in body weight were consistent across baseline NT-proBNP levels (P interaction = 0.21). In patients with obesity-related HFpEF, semaglutide reduced NT-proBNP. Participants with higher baseline NT-proBNP had a similar degree of weight loss but experienced larger reductions in HF-related symptoms and physical limitations with semaglutide than those with lower NT-proBNP. [Display omitted] [ABSTRACT FROM AUTHOR]

The study aimed to investigate the effect of the circadian timing program (SİZAP) developed for evening-chronotype individuals with obesity on obesity management and sleep quality. This single-site, randomized controlled trial with an experimental research design was registered in ClinicalTrials.gov. It was reported in accordance with the "Consolidated Standards of Reporting Trials" (CONSORT) randomized controlled trial guidelines. The study sample consisted of 38 evening-chronotype individuals with first-degree obesity, with 19 individuals in each study group. The intervention group's sleep hygiene training was conducted and their lifestyle changes were ensured through SİZAP. The control group followed their normal daily lifestyle. No intervention was made in terms of the dietary practices of both groups. Study data were collected using the personal information form, the anthropometric measurement form, the Horne and Ostberg Morning and Evening Questionnaire (MEQ), the Impact of weight on quality of life–lite (IWQOL-lite), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the sleep diary, and the data tracked via the website and smart bracelets. It was determined that the participants in the SİZAP group had a statistically significant decrease in the anthropometric measurements and daytime sleepiness (p < 0.05). The sleep quality scores and the scores of the bodily functions sub-dimension of the quality of life scale were significantly better in the intervention group than in the control group (p < 0.05). It was found that SİZAP is effective in obesity management in evening-chronotype individuals and increases weight loss success and sleep quality. • Circadian misalignment and late timing of food intake reduce weight loss success. • Evening-chronotype individuals with obesity are less successful in adapting to weight loss treatments. • Circadian timing program according to chronotypes can be applied in obesity management. • Circadian timing program support weight loss in evening-chronotype individuals with obesity. • Circadian timing program contribute to improvement of sleep quality in evening-chronotype individuals with obesity. [ABSTRACT FROM AUTHOR]

• Obesity is a major public health issue in pregnancy. • There is a direct correlation between the severity of obesity and perinatal morbidity. • Gestational weight gain is a key parameter to address during pregnancy. • The IOM recommendations appear too permissive, and new standards should be proposed. In 2009, the Institute of Medicine (IOM) issued recommendations for gestational weight gain (GWG) based on body mass index (BMI). Several studies have challenged those recommendations for women with obesity, considering them too liberal and advising more limited weight gain – or even weight loss – during pregnancy to improve maternal and neonatal outcomes. Our aim was to study how gestational weight gain in women with obesity impacted maternal and fetal complications in the Belgian population. We did this by comparing the results from two groups of patients with obesity: those who met the 2009 IOM standards and those who satisfied the stricter recommendations suggested by other authors. This is a retrospective cohort study using data collected at the Centre d'Epidémiologie Périnatale (CEpiP) from obese (BMI ≥ 30 kg/m2) pregnant women with live singleton deliveries between 2010 and 2019 in Wallonia-Brussels Federation (n = 65,314). Compared to obese patients whose GWG satisfied the IOM standards, those with GWG meeting the stricter recommendations had lower rates of gestational hypertension (7.1 % vs. 10.1 %; p = 0.0059), cesarean section (22.1 % vs. 26.3 %; p = 0.0074), and macrosomia (12.0 % vs. 17.7 %; p < 0.0001). There was no significant difference in the rate of preterm delivery (6.9 % vs 5.8 %; p = 0.12) or small-for-gestational-age births (7.2 % vs. 6.2 %; p = 0.16). Gestational weight gain below that currently recommended by the IOM appears beneficial to the health of mothers with obesity and their children. These data, from our population, further challenge the standards proposed since 2009. [ABSTRACT FROM AUTHOR]

Weight loss is reported with oral roflumilast, which is approved for chronic obstructive pulmonary disease (COPD). Recently, the drug has shown efficacy in psoriasis, a disease strongly linked to overweight/obesity. To describe the effects of oral roflumilast on body weight and cardio-metabolic parameters in patients with psoriasis. Posthoc analyses from the PSORRO study, where patients with moderate-to-severe plaque psoriasis were randomized 1:1 to oral roflumilast 500 μg once-daily or placebo for 12 weeks, followed by active, open-label treatment through week 24 in both groups. Changes in body weight, blood pressure, gastrointestinal symptoms, and laboratory tests were registered. No lifestyle or dietary interventions were applied. Forty-six patients were randomized. Baseline characteristics across groups were comparable; mean weight was 103.6 kg. In patients receiving roflumilast, median weight change was −2.6% and −4% at week 12 and 24, respectively. Corresponding numbers were 0.0% and 1.3% in patients initially allocated to placebo. Reduced appetite was more frequent with active therapy. No changes in blood pressure or laboratory tests were observed. Posthoc analyses and low numbers. Oral roflumilast induced weight loss and reduced appetite, which support the growing evidence of roflumilast as an attractive treatment alternative for patients with psoriasis. [ABSTRACT FROM AUTHOR]

Predictive weight loss models can help patients meet their expectations after bariatric surgery and assist physicians in responding to deviations from the predicted weight. A model published by Seyssel et al. appears to accurately predict postoperative body mass index. We aimed to demonstrate this model's performance in terms of rapid detection of insufficient weight loss (surgical nonresponse). Cantonal Hospital, Switzerland. We retrospectively analyzed weight and body mass index deviations at 2 years postoperatively, based on values predicted by the model of Seyssel et al. The primary outcome was the timing of detection of surgical nonresponse. The secondary outcome was how patients' weight loss expectations influenced their real weight loss. Between 2016 and 2019, 190 patients underwent Roux-en-Y gastric bypass. Of these patients, 36 were lost to follow-up and 154 were included in this study. At 24 months, 16 patients had surgical nonresponse, defined as a real weight of +1 standard deviation higher than that predicted. Among these patients, 44% had a weight of ≥+1 standard deviation higher than predicted at 3 months, and 63% at 12 months. The positive and negative predictive values at 12 months were 59% and 95%, respectively. Patients with a lower hypothetically wanted weight (38.5%) exhibited greater weight loss (P <.05). The predictive weight loss model of Seyssel et al. enables rapid detection of surgical nonresponse, allowing physicians to react as early as 3 months postsurgery. Patients' overestimation of postoperative weight loss was positively correlated with the actual weight loss achieved. • The Seyssel model has a very high specificity. • The model detects surgical nonresponse as soon as 3 months postoperatively. • Patients' overestimation of weight loss positively correlates with real weight loss. [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]

Glucagon-like peptide-1 (GLP-1) agonists have been successfully used in clinical practice for the treatment of diabetes and obesity, offering significant clinical benefits. However, concerns regarding their potential link to psychiatric side effects, like suicidal thoughts and behaviours (STB) have emerged. This narrative review investigates the complex interplay between GLP-1 agonists and STB, focusing on the biological stress induced by rapid weight loss, psychological and social consequences, similar mechanism with addiction, and the evaluative lens of the Bradford Hill criteria on causality. While GLP-1 agonists can contribute to substantial health improvements, they also introduce biological and psychological stressors. Disruptions in homeostasis from quick weight reduction can elevate cortisol and norepinephrine levels, heightening the risk for, or exacerbation of STB. Psychological factors, including unfulfilled expectations and identity changes after significant weight loss, compound these risks. Utilizing the Bradford Hill criteria reveals insufficient evidence for a direct causal link between GLP-1 agonists and STB. Yet, the indirect effects related to the metabolic and psychological disturbances associated with rapid weight loss call for a cautious approach. Used carefully in targeted populations GLP-1 agonists may even emerge as protective agents against STB. Therefore, it is crucial to monitor patients during the treatment and screen for preexisting mental health conditions. If detected, appropriate clinical management should be applied. Future studies should aim at optimizing dosing schedules to mitigate the adverse effects of rapid weight loss and further investigate GLP-1 agonists in possible STB prevention. [ABSTRACT FROM AUTHOR]

To test the hypothesis that weight loss following bariatric surgery is associated with a reduced risk of developing carpal tunnel syndrome (CTS) compared with obese patients who do not undergo bariatric surgery. We performed a cohort study using data from the Swedish nationwide healthcare registries. Patients aged 18–79 years who underwent bariatric surgery from 2006 to 2019 were propensity score (PS)–matched to up to 2 obese bariatric surgery-free patients ("unexposed patients"). Cox proportional hazard regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CIs) to compare the incidence of CTS among bariatric surgery patients to obese unexposed patients both overall and divided by subgroups of age, sex, bariatric surgery type, and duration of follow-up. In total, 40,619 bariatric surgery patients were PS-matched to 63,540 obese unexposed patients who did not undergo surgery. Bariatric surgery was not associated overall with CTS (HR 0.98, 95% CI 0.91–1.05). There was a 23% decreased risk of CTS incidence observed within >1–3 years after bariatric surgery (HR 0.77, 95% CI 0.68–0.88). Decreased CTS risks were observed among bariatric surgery patients aged 18–34 years (HR 0.87, 95% CI 0.74–1.01) and those who underwent sleeve gastrectomy (HR 0.81, 95% CI 0.63–1.03), but these risks did not reach significance level compared with obese unexposed patients. However, there was a 20% increased CTS risk after 6 years (HR 1.20, 95% CI 1.05–1.36). Our results suggest that marked weight does not have a lasting impact on the reduction of CTS incidence. [ABSTRACT FROM AUTHOR]

Large vessel vasculitis (LVV) affects mainly large arteries with giant cell arteritis (GCA) and Takayasu arteritis (TAK) being the two most frequent forms. Clinical symptoms can be non-specific, including headache, fatigue, weight loss, and change in vision. Untreated, LVV may also lead to serious complications such as blindness, aortic aneurysm and dissection. Therefore, rapid recognition of the disease leading to accurate diagnosis and appropriate treatment is essential. FDG-PET/CT imaging has emerged as a sensitive marker of active vascular inflammation and its use in the management of LVV is now integrated in guidelines. In this article, we will discuss the role of FDG-PET/CT for the diagnosis of LVV and monitoring of therapy, as well as review technical and interpretation parameters. [ABSTRACT FROM AUTHOR]

Neuroimaging studies have revealed alterations in habenular (Hb) structure and functional connectivity (FC) in psychiatric conditions. The Hb plays a particularly critical role in regulating negative emotions, which trigger excessive food intake and obesity. However, obesity and weight loss intervention (i.e., laparoscopic sleeve gastrectomy [LSG])–associated changes in Hb structure and FC have not been studied. We used voxel-based morphometry analysis to measure changes in gray matter volume (GMV) in the Hb in 56 patients with obesity at pre-LSG and 12 months post-LSG and in 78 normal-weight (NW) control participants. Then, we conducted Hb seed-based resting-state FC (RSFC) to examine obesity-related and LSG-induced alterations in RSFC. Finally, we used mediation analysis to characterize the interrelationships among Hb GMV, RSFC, and behaviors. Compared with NW participants, Hb GMV was smaller in patients at pre-LSG and increased at 12 months post-LSG to levels equivalent to that of NW; in addition, increases in Hb GMV were correlated with reduced body mass index (BMI). Compared with NW participants, pre-LSG patients showed greater RSFCs of the Hb–insula, Hb–precentral gyrus, and Hb–rolandic operculum and weaker RSFCs of the Hb–thalamus, Hb–hypothalamus, and Hb–caudate; LSG normalized these RSFCs. Decreased RSFC of the Hb-insula was correlated with reduced BMI, Yale Food Addiction Scale rating, and emotional eating; reduced hunger levels were correlated with increased RSFCs of the Hb–thalamus and Hb–hypothalamus; and reduced BMI and Yale Food Addiction Scale ratings were correlated with increased RSFCs of the Hb–thalamus and Hb–hypothalamus, respectively. The bidirectional relationships between Hb GMV and RSFC of the Hb–insula contributed to reduced BMI. These findings indicate that LSG increased Hb GMV and that its related improvement in RSFC of the Hb–insula may mediate long-term benefits of LSG for eating behaviors and weight loss. [ABSTRACT FROM AUTHOR]

The quality of a mother's diet is important to ensure child growth and development and keep women healthy. This systematic review aimed to identify the outcomes of a carbohydrate-restricted diet during lactation. PubMed, EMBASE, Scopus, Web of Science, and LILACS were searched for studies published between 2012 and 2023; 16 studies were selected, all of them case reports or care series. The carbohydrate restriction described in the papers mainly was ketogenic, low-carb, low-carbohydrate and high-fat, and modified ketogenic diets. The main goal of women undertaking these diets was weight loss, with therapeutic purposes (monitored and supervised by health professionals) in only 2 cases: (1) ketogenic diet therapy for treatment of seizures in the infant and (2) to reduce symptoms of mother's gastroesophageal reflux. Most articles reported that lactating women were hospitalized, experiencing symptoms such as vomiting, muscle weakness, nausea, abdominal pain, general malaise, and fatigue. However, articles did not mention poor outcomes for the infants. Most of the studies in this review were published in the past 3 years, indicating a possible increase in cases of women practicing carbohydrate restriction during lactation for weight loss caused by body dissatisfaction. In conclusion, carbohydrate restriction during lactation may be harmful to the lactating woman and contribute to the state of lactational ketoacidosis, but infant outcomes are mainly a change in feeding patterns. Thus, education on food and nutrition is necessary for this population. Carbohydrate restriction during lactation may cause problems for both the mother and the child. There has been an increase in the number of cases of lactating women restricting carbohydrates for weight loss purposes because of dissatisfaction with their bodies. This could result in hospitalization. Ketogenic diet therapy, when assisted by specialized professionals and performed for therapeutic purposes, provides evidence for the potential treatment and control of convulsions in infants. [Display omitted] [ABSTRACT FROM AUTHOR]

Açaí seed extract (ASE) is obtained from Euterpe oleracea Mart. (açaí) plant (Amazon region) has high nutritional and functional value. ASE is rich in polyphenolic compounds, mainly proanthocyanidins. Proanthocyanidins can modulate the immune system and oxidative stress by inhibiting the toll-like receptor-4 (TLR-4)/myeloid differentiation primary response 88 (MyD88)/nuclear factor-κB (NF-κB) pathway. A great deal of evidence suggests that inflammatory cytokines and oxidative stress contribute to the pathogenesis of intestinal mucositis, and these events can lead to intestinal dysmotility. We hypothesized that ASE acts as an anti-inflammatory and antioxidant compound in intestinal mucositis induced by 5-fluorouracil (5-FU) through modulation of the TLR-4/MyD88/phosphatidylinositol-3-kinase α/mechanistic target of rapamycin/NF-κBp65 pathway. The animals were divided into linear 5-FU (450 mg/kg) and 5-FU + ASE (10, 30, and 100 mg/kg) groups. The weight loss of the animals was evaluated daily. Samples from duodenum, jejunum, and ileum were obtained for histopathological, biochemical, and functional analyses. ASE reduced weight loss, inflammatory parameters (interleukin-1β; tumor necrosis factor-α; myeloperoxidase activity) and the gene expression of mediators involved in the TLR-2/MyD88/NF-κB pathway. ASE prevented histopathological changes with beneficial effects on gastrointestinal transit delay, gastric emptying, and intestinal absorption/permeability. In conclusion, ASE protects the integrity of the intestinal epithelial barrier by inhibiting the TLR/MyD88/PI3K/mechanistic target of rapamycin/NF-κBp65 pathway. Açaí is a plant from the Amazon region that has a high nutritional and functional value. A polyphenol-rich açaí seed extract showed protective effects against inflammation and oxidative stress, improved histological lesion, and delayed gastric emptying induced by 5-fluorouracil in mice. These effects were observed through TLR-4/MyD88/PI3K/mTOR/NF-κBp65 signaling pathway. Abbreviations: 5-FU, 5-fluorouracil; ASE, açaí seed extract; mTOR, mechanistic target of rapamycin; MyD88, myeloid differentiation primary response 88; NF-κBp65, nuclear factor-κBp65; PI3K, phosphatidylinositol-3-kinase α; TLR-4, toll-like receptor 4. [Display omitted] [ABSTRACT FROM AUTHOR]

Obesity has significant repercussions for female reproductive health, including adverse effects on oocyte quality, fertility, embryo development and offspring health. Here, we showed that intermittent fasting (IF) has several notable effects on follicular development, oocyte development and maturation and offspring health in obese mice. IF treatment prevents obesity-associated germline-soma communication defects, mitochondrial dysfunction, oxidative damage, apoptosis, and spindle/chromosomal disruption. RNA-sequencing analysis of oocytes from normal diet (ND), high-fat diet (HFD), and HFD + IF mice indicated that IF treatment improved mitochondrial oxidative phosphorylation function and mRNA storage and translation, which was potentially mediated by the Smith-like family member 14 B (LSM14B). Knockdown of LSM14B by siRNA injection in oocytes from ND mice recapitulates all the translation, mitochondrial dysfunction and meiotic defect phenotypes of oocytes from HFD mice. Remarkably, the injection of Lsm14b mRNA into oocytes from HFD mice rescued the translation, mitochondrial dysfunction and meiotic defect phenotypes. These results demonstrated that dysfunction in the oocyte translation program is associated with obesity-induced meiotic defects, while IF treatment increased LSM14B expression and maternal mRNA translation and restored oocyte quality. This research has important implications for understanding the effects of obesity on female reproductive health and offers a potential nonpharmacological intervention to improve oocyte quality and fertility in obese individuals. [Display omitted] • Reproductive dysfunction associated with obesity is linked to oocyte oxidative stress. • Intermittent fasting improve oocyte maturation, embryo development and offspring health in maternal diet-induced obesity mice. • Intermittent fasting alleviates the oxidative stress and DNA damage in oocytes from high-fat diet induced obesity mice. • Intermittent fasting improving the mouse oocyte maturation through the restoration of the defective LSM14B function. [ABSTRACT FROM AUTHOR]

[Display omitted] • CC16 is an anti-inflammatory, immunomodulatory protein expressed in respiratory club cells. • Severe abdominal obesity and arterial hypertension robustly decrease serum CC16. • ACEi/ARBs, uricosurics and chronic heart failure robustly increase serum CC16. • Effects might be mediated by adipose tissue inflammation as well as RAAS and uric acid disturbance. • Findings indicate a complex interplay of the metabolic, respiratory and cardiovascular system. Clara cell 16-kDa protein (CC16) is an anti-inflammatory, immunomodulatory secreted pulmonary protein with reduced serum concentrations in obesity according to recent data. Studies focused solely on bodyweight, which does not properly reflect obesity-associated implications of the metabolic and reno-cardio-vascular system. The purpose of this study was therefore to examine CC16 in a broad physiological context considering cardio-metabolic comorbidities of primary pulmonary diseases. CC16 was quantified in serum samples in a subset of the FoCus (N = 497) and two weight loss intervention cohorts (N = 99) using ELISA. Correlation and general linear regression analyses were applied to assess CC16 effects of lifestyle, gut microbiota, disease occurrence and treatment strategies. Importance and intercorrelation of determinants were validated using random forest algorithms. CC16 A38G gene mutation, smoking and low microbial diversity significantly decreased CC16. Pre-menopausal female displayed lower CC16 compared to post-menopausal female and male participants. Biological age and uricosuric medications increased CC16 (all p < 0.01). Adjusted linear regression revealed CC16 lowering effects of high waist-to-hip ratio (est. −11.19 [−19.4; −2.97], p = 7.99 × 10−3), severe obesity (est. −2.58 [−4.33; −0.82], p = 4.14 × 10−3) and hypertension (est. −4.31 [−7.5; −1.12], p = 8.48 × 10−3). ACEi/ARB medication (p = 2.5 × 10−2) and chronic heart failure (est. 4.69 [1.37; 8.02], p = 5.91 × 10−3) presented increasing effects on CC16. Mild associations of CC16 were observed with blood pressure, HOMA-IR and NT-proBNP, but not manifest hyperlipidemia, type 2 diabetes, diet quality and dietary weight loss intervention. A role of metabolic and cardiovascular abnormalities in the regulation of CC16 and its modifiability by behavioral and pharmacological interventions is indicated. Alterations by ACEi/ARB and uricosurics could point towards regulatory axes comprising the renin-angiotensin-aldosterone system and purine metabolism. Findings altogether strengthen the importance of interactions among metabolism, heart and lungs. [ABSTRACT FROM AUTHOR]

Evidence from animal models and human studies clearly demonstrate that sodium-glucose cotransporter-2 (SGLT2) inhibitors have systemic and tissue-specific anti-inflammatory effects that may be independent of glycemic control and weight loss. SGLT2 inhibitors may achieve their anti-inflammatory effects through various mechanisms, including reduction of reactive oxygen species, inflammasome activation, intracellular sodium and calcium levels, circulating uric acid, and mitochondrial dysfunction. The direct and indirect mitigation of inflammatory pathways by SGLT2 inhibitors may partially explain their cardiac and renoprotective effects. However, this remains to be formally demonstrated in human studies. Inflammation plays an essential role and is a common feature in the pathogenesis of many chronic diseases. The exact mechanisms through which sodium-glucose cotransporter-2 (SGLT2) inhibitors achieve their much-acclaimed clinical benefits largely remain unknown. In this review, we detail the systemic and tissue- or organ-specific anti-inflammatory effects of SGLT2 inhibitors using evidence from animal and human studies. We discuss the potential pathways through which SGLT2 inhibitors exert their anti-inflammatory effects, including oxidative stress, mitochondrial, and inflammasome pathways. Finally, we highlight the need for further investigation of the extent of the contribution of the anti-inflammatory effects of SGLT2 inhibition to improvements in cardiometabolic and renal outcomes in clinical studies. [ABSTRACT FROM AUTHOR]

Revisional bariatric surgery (RBS) for insufficient weight loss/weight regain or metabolic relapse is increasing worldwide. There is currently no large multinational, prospective data on 30-day morbidity and mortality of RBS. In this study, we aimed to evaluate the 30-day morbidity and mortality of RBS at participating centres. An international steering group was formed to oversee the study. The steering group members invited bariatric surgeons worldwide to participate in this study. Ethical approval was obtained at the lead centre. Data were collected prospectively on all consecutive RBS patients operated between 15th May 2021 to 31st December 2021. Revisions for complications were excluded. A total of 65 global centres submitted data on 750 patients. Sleeve gastrectomy (n = 369, 49.2 %) was the most common primary surgery for which revision was performed. Revisional procedures performed included Roux-en-Y gastric bypass (RYGB) in 41.1 % (n = 308) patients, One anastomosis gastric bypass (OAGB) in 19.3 % (n = 145), Sleeve Gastrectomy (SG) in 16.7 % (n = 125) and other procedures in 22.9 % (n = 172) patients. Indications for revision included weight regain in 615(81.8 %) patients, inadequate weight loss in 127(16.9 %), inadequate diabetes control in 47(6.3 %) and diabetes relapse in 27(3.6 %). 30-day complications were seen in 80(10.7 %) patients. Forty-nine (6.5 %) complications were Clavien Dindo grade 3 or higher. Two patients (0.3 %) died within 30 days of RBS. RBS for insufficient weight loss/weight regain or metabolic relapse is associated with 10.7 % morbidity and 0.3 % mortality. Sleeve gastrectomy is the most common primary procedure to undergo revisional bariatric surgery, while Roux-en-Y gastric bypass is the most commonly performed revision. [ABSTRACT FROM AUTHOR]

This study assessed whether the addition of continuous positive airway pressure (CPAP) during weight loss would enhance cardiometabolic health improvements in patients with obesity and Obstructive Sleep Apnoea (OSA). Patients with overweight or obesity, pre-diabetes and moderatesevere OSA were randomised to receive CPAP therapy with a weight loss programme (CPAP+WL) or a weight loss programme alone (WL alone). Primary outcome: 2-hour glucose assessed by an oral glucose tolerance test. Secondary outcomes: 24 hr blood pressure, body composition (DEXA) and fasting blood markers. 17 patients completed 3-month follow-up assessments (8 CPAP+WL and 9 WL alone). Overall, participants in both groups lost ∼12 kg which reduced polysomnography determined OSA severity by ∼45 %. In the CPAP+WL group, CPAP use (compliance 5.29 hrs/night) did not improve any outcome above WL alone. There was no improvement in 2-hour glucose in either group. However, in the pooled (n = 17) analysis there were overall improvements in most outcomes including insulin sensitivity (.000965 units, p =.008), sleep systolic BP (- 16.2 mmHg, p =.0003), sleep diastolic BP (−9.8 mmHg, p = 0.02), wake diastolic BP (- 4.3 mmHg, p =.03) and sleepiness (Epworth Sleepiness Score −3.2, p =.0003). In addition, there were reductions in glucose area under the curve (−230 units, p =.009), total (−0.86 mmol/L, p = 0.006) and LDL cholesterol (−0.58 mmol/L, p = 0.007), triglycerides (−0.75 mmol/L, p = 0.004), fat mass (−7.6 kg, p <.0001) and abdominal fat (−310 cm3, p <.0001). Weight loss reduced OSA and improved sleepiness and cardiometabolic health. These improvements were not further enhanced by using CPAP. Results suggest weight loss should be the primary focus of treatment for patients with OSA and 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]

Physical exercise is widely acknowledged for its health benefits, but its effectiveness in treating obesity remains contentious due to variability in response. Owing to the roles of glutamate in appetite regulation, food addiction, and impulsivity, this observational cohort-study evaluated medial prefrontal cortex (mPFC) glutamate as a predictor of variability in exercise response, specifically in terms of fat loss and muscle gain. Healthy non-exercising adult men (n = 21) underwent an 8-week supervised exercise program. Baseline glutamate levels in the mPFC were measured through magnetic resonance spectroscopy. For exercise-dependent changes in body composition (fat and muscle mass), basal metabolic rate (BMR), and blood metabolic biomarkers related to lipid and glucose metabolism, measurements were obtained through bioelectrical impedance and blood sample analyses, respectively. The exercise program resulted in significant improvements in body composition, including reductions in percentage body fat mass, body fat mass, and waist-to-hip ratio and an increase in mean muscle mass. Furthermore, BMR and metabolic indicators linked to glucose and lipids exhibited significant changes. Notably, lower baseline glutamate levels were associated with greater loss in percentage body fat mass (r = 0.482, p = 0.027), body fat mass (r = 0.441, p = 0.045), and increase in muscle mass (r = −0.409, p = 0.066, marginal) following the exercise program. These preliminary findings contribute to our understanding of the neurobiology of obesity and emphasize the significance of glutamate in regulating body composition. The results also highlight cortical glutamate as a potential predictor of exercise-induced fat loss and muscle gain. [ABSTRACT FROM AUTHOR]

Eating-related problems (e.g., binge eating (BE)) and impaired quality of life (QoL) is more prevalent in children with overweight and obesity. This study aimed to investigate changes in self-reported overeating (OE), BE, and QoL in children with overweight or obesity attending multicomponent 10-week lifestyle camps with a 52-weeks follow-up. Additionally, the study sought to investigate whether self-reported OE/BE before camp was associated with changes in QoL. Children aged 7 to 14-years could attend camp if they had overweight/obesity, were lonely, unhappy, or had social or family-related problems. In this study only children with overweight and obesity were included (n:185). OE, BE, and QoL were measured using self-reported questionnaires. In total, 38 % of the children reported regular BE at baseline. Regular OE, occasional BE, and occasional OE was reported by 14 %, 13 %, and 11 %, respectively, while 24 % reported no eating-related problems. The relative risk of experiencing eating-related problems decreased at 10-weeks compared to baseline. Additionally, the probability of regular OE (RR 0.12 (95 % CI 0.04;0.38) (X2 = 8.44, p = 0.004)) and regular BE (RR 0.01 (95 % CI 0.00;0.11) (X2 = 9.91, p = 0.002)) remained lower at 52-weeks relative to baseline. All QoL dimensions improved after camp, and the presence of self-reported OE and regular BE at baseline was significantly associated with lower QoL at baseline, 10 and 52-weeks. Children self-reporting OE and BE may be a particular vulnerable group that needs more support from camp staff and healthcare professionals to improve QoL. clinicaltrials.gov with ID: NCT04522921 [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) is a field of study that strives to replicate aspects of human intelligence into machines. Preventive cardiology, a subspeciality of cardiovascular (CV) medicine, aims to target and mitigate known risk factors for CV disease (CVD). AI's integration into preventive cardiology may introduce novel treatment interventions and AI-centered clinician assistive tools to reduce the risk of CVD. AI's role in nutrition, weight loss, physical activity, sleep hygiene, blood pressure, dyslipidemia, smoking, alcohol, recreational drugs, and mental health has been investigated. AI has immense potential to be used for the screening, detection, and monitoring of the mentioned risk factors. However, the current literature must be supplemented with future clinical trials to evaluate the capabilities of AI interventions for preventive cardiology. This review discusses present examples, potentials, and limitations of AI's role for the primary and secondary prevention of CVD. [ABSTRACT FROM AUTHOR]

The key step of the Global Leadership Initiative on Malnutrition (GLIM) is nutritional risk screening, while the most appropriate screening tool for colorectal cancer (CRC) patients is yet unknown. The GLIM diagnosis relies on weight loss information, and bias or even failure to recall patients' historical weight can cause misestimates of malnutrition. We aimed to compare the suitability of several screening tools in GLIM diagnosis, and establish machine learning (ML) models to predict malnutrition in CRC patients without weight loss information. This multicenter cohort study enrolled 4487 CRC patients. The capability of GLIM diagnoses combined with four screening tools in predicting survival probability was compared by Kaplan–Meier curves, and the most accurate one was selected as the malnutrition reference standard. Participants were randomly assigned to a training cohort (n = 3365) and a validation cohort (n = 1122). Several ML approaches were adopted to establish models for predicting malnutrition without weight loss data. We estimated feature importance and reserved the top 30% of variables for retraining simplified models. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were calculated to assess and compare model performance. NRS-2002 was the most suitable screening tool for GLIM diagnosis in CRC patients, with the highest hazard ratio (1.59; 95% CI, 1.43–1.77). A total of 2076 (46.3%) patients were malnourished diagnosed by GLIM combined with NRS-2002. The simplified random forest (RF) model outperformed other models with an AUC of 0.830 (95% CI, 0.805–0.854), and accuracy, sensitivity and specificity were 0.775, 0.835 and 0.742, respectively. We deployed an online application based on the simplified RF model to accurately estimate malnutrition probability in CRC patients without weight loss information (https://zzuwtt1998.shinyapps.io/dynnomapp/). Nutrition Risk Screening 2002 was the optimal initial nutritional risk screening tool in the GLIM process. The RF model outperformed other models, and an online prediction tool was developed to properly identify patients at high risk of malnutrition. [ABSTRACT FROM AUTHOR]

This study describes program implementation through a research-restaurant partnership and assesses participant satisfaction, program costs, and percent body weight changes. Participants (n = 60) in a virtual synchronous (n = 43) or virtual asynchronous (n = 17) 12-week plant-based nutrition program received restaurant vouchers. Class satisfaction data were collected weekly. Assessments were completed at baseline, 3 months, and 9 months, along with interviews (n = 13) between 3 and 9 months. The costing approach estimated costs per participant. Interviews were coded using a content analysis and constant comparative method. Participants rated the intervention favorably. Program costs were $198.63/participant, and participants' willingness to pay postintervention was $101.50 ± $63.90. Participants shared satisfaction with course content, the restaurant partnership, and suggestions for future delivery. No changes in participants' percent body weight were observed between 3 and 9 months (P = 0.98), indicating maintenance of 3-month weight loss. A research-restaurant partnership successfully implemented a nutrition program and generated positive feedback. With the lifting of coronavirus disease 2019 pandemic restrictions, future research can now test alternative implementation methods (in person vs online) in other restaurants. [ABSTRACT FROM AUTHOR]

The current study investigated effects of dietary amino acid (AA) availability on lactational body condition loss and metabolic status, in relation to reproductive parameters after weaning up to Day 8 post-ovulation. Primiparous sows (n = 35) were allocated to one of two lactation diets containing either low crude protein (CP, 140 g/kg) with a low percentage (8%) of slow protein in total protein (LL, n = 18) or high CP (180 g/kg) with a high (16%) percentage of slow protein (HH, n = 17). The HH diet was expected to improve AA utilization by supplying more AA, in a more gradual fashion. The diets did not affect sow body condition loss during lactation, while the HH diet tended to increase litter weight gain during the week 3 of lactation (Δ = 1.3 kg, P = 0.09). On Day 14 post-farrowing, HH diet led to higher plasma urea both pre-feeding and post-feeding (Δ = 2.3 mmol/L, P < 0.01, Δ = 2.4 mmol/L, P < 0.01, respectively), whilst plasma creatinine, NEFA and IGF-1 were similar. No dietary effects on reproductive parameters were found, however several relationships were found between body condition and reproductive parameters. Sows with higher body weight on Day 1 or Day 21 post-farrowing had greater follicle size on Day 3 post-weaning (β = 0.03 mm/kg, P < 0.01, β = 0.04 mm/kg, P < 0.01, respectively). At Day 8 post-ovulation, plasma progesterone concentration was negatively related to loin muscle loss (β = −0.67 ng/ml · mm−1, P = 0.02), backfat loss (β = −2.33 ng/ml · mm−1, P = 0.02), and estimated body fat loss (β = −0.67 ng/ml · mm−1, P = 0.02). Both plasma progesterone and the number of corpora lutea were positively related to the energy balance during lactation (β = 0.03 ng/ml · ME MJ−1, P = 0.01, β = 0.01 CL/ME MJ, P = 0.02, respectively). The conceptus size at Day 8 post-ovulation was negatively related to body weight loss (β = −0.01 mm/kg, P = 0.01), estimated body fat loss (β = −0.02 mm/kg, P = 0.03) and estimated body protein loss (β = −0.06 mm/kg, P = 0.04), and was positively related to the energy balance during lactation (β = 5.2*10−4 mm/ME MJ, P = 0.01). In conclusion, body protein and fat losses during lactation reduced subsequent plasma progesterone concentration and conceptus development at Day 8 post-ovulation. • Lactational body condition loss impairs conceptus development at Day 8 post-ovulation. • A higher body condition loss relates to a lower plasma P4 at Day 8 post-ovulation. • A higher body weight on Day 1 or 21 post-farrowing relates to a larger follicle size. [ABSTRACT FROM AUTHOR]

Physiological or pathological hypoperfusion of the placenta is one of the main causes of intrauterine growth restriction (IUGR) which poses a significant risk to the health of the fetus and newborn. Tadalafil, a 5-type phosphodiesterase inhibitor, has previously been found to improve the symptoms of IUGR in various clinical studies. Unfortunately, its clinical utility is hindered by its limited water solubility, rapid metabolism, and lack of specific distribution in target tissues rendering tadalafil unable to maintain long-term placental perfusion. In this study, iRGD-modified tadalafil-loaded liposomes (iRGD-lipo@Tad) featuring a size of approximately 480 nm were designed to rectify the shortcomings of tadalafil. The prepared iRGD-lipo@Tad exhibited superior stability, sustained drug release capacity, and low cytotoxicity. The fluorescence study, tissue slice study, and drug biodistribution study together demonstrated the placenta-anchored ability of iRGD-modified liposomes. This was achieved by a dual approach consisting of the iRGD-mediated placenta-targeting effect and special particle size-mediated placenta resident effect. The pharmacokinetic study revealed a significant improvement in the in vivo process of tadalafil encapsulated by the iRGD-modified liposomes. In comparison to the tadalafil solution, the peak plasma concentration of iRGD-lipo@Tad was significantly increased, and the area under the curve was increased by about 7.88 times. In the pharmacodynamic study, iRGD-lipo@Tad achieved a continuous and efficient improvement of placental blood perfusion. This was achieved by decreasing the ratio of plasma soluble fms-like tyrosine kinase to placental growth factor and increasing the levels of cyclic guanosine monophosphate and nitric oxide. Consequently, iRGD-lipo@Tad resulted in a significant increase in embryo weight and a reduction in the miscarriage rate of N-Nitro-L-arginine methyl ester-induced IUGR pregnant mice without detectable toxicity. In summary, the nanotechnology-assisted therapy strategy presented here not only overcomes the limitations of tadalafil in the clinical treatment of IUGR but also offers new avenues to address the treatment of other placenta-originated diseases. In this study, a kind of placenta-anchored liposome which has the iRGD-assisted placenta-targeting effect and special particle size-mediated placenta resident effect, have been designed for achieving continuous and efficient placental blood perfusion in the treatment of intrauterine growth restriction. [Display omitted] [ABSTRACT FROM AUTHOR]

This study evaluates the real-world impact of a lifestyle change program (LCP) on healthcare utilization in a large health system. Using electronic health record data from a large health system in northern California, U.S., LCP participant and propensity-score-matched nonparticipant outcomes were compared in the second year post-participation: (1) overall healthcare utilization and (2) utilization and medications related to cardiometabolic conditions and obesity. Adult LCP participants between 2010 and 2017 were identified and matched 1:1 with replacement to comparable nonparticipants. Participants without electronic health record activity in the 12–36 months before baseline, or with conditions or procedures associated with substantial weight change, were excluded. Statistical analysis and modeling were performed in 2021–22. Compared to matched nonparticipants, LCP participants in the 12–24 months post-baseline were more likely to have specialty-care visits (+4.7%, 95% CI +1.8%, +7.6%), electronic communications (8.6%, 95% CI +5.6%, +11.7%), and urgent-care visits (+6.5%, 95% CI +3.0%, 10.0%). Participants also had more office visits for cardiometabolic conditions and obesity (+1.72 visits/patient, 95% CI +1.05, +2.39). Compared with matched nonparticipants, LCP participation was associated with higher utilization of outpatient services post-participation. Additional research could assess whether this indicates an increase in preventive care that could lead to improved future outcomes. [ABSTRACT FROM AUTHOR]

Prescriptions and use of glucagon-like peptide-1 (GLP-1) receptor agonists are increasing dramatically, as indications are expanding from the treatment of diabetes mellitus to weight loss for people with obesity. As GLP-1 receptor agonists delay gastric emptying, perioperative healthcare practitioners could be concerned about an increased risk for pulmonary aspiration during general anaesthesia. We summarise relevant medical literature and provide evidence-based recommendations for perioperative care for people taking GLP-1 receptor agonists. GLP-1 receptor agonists delay gastric emptying; however, ongoing treatment attenuates this effect. The risk of aspiration during general anaesthesia is unknown. However, we advise caution in patients who recently commenced on GLP-1 receptor agonists. After over 12 weeks of treatment, standard fasting times likely suffice to manage the risk of pulmonary aspiration for most otherwise low-risk patients. [ABSTRACT FROM AUTHOR]

Glucagon-like peptide 1 (GLP-1) based therapies, including GLP-1 agonists, are currently in use for treatment of diabetes and obesity. However, several complications may occur with their use. This narrative review provides a focused evaluation of GLP-1 agonist therapy and associated complications for emergency clinicians. GLP-1 agonists potentiate insulin release and reduce gastric emptying and food intake. These agents have demonstrated significant improvements in glucose control in diabetics and weight loss in obese patients. The two most common agents include subcutaneous semaglutide (Ozempic, approved for type 2 diabetes, and Wegovy, approved for weight loss) and liraglutide (Saxenda, approved for weight loss, and Victoza, approved for type 2 diabetes), though an oral formulation of semaglutide is available (Rybelsus). While these drugs are associated with improved long-term outcomes, there are a variety of associated adverse events. The most common include gastrointestinal (GI) adverse events such as nausea, vomiting, diarrhea, and abdominal pain. Pancreatitis and biliary disease may also occur. Hypersensitivity including injection site reactions have been associated with use, with reports of anaphylaxis and other rashes. Renal adverse events are most commonly associated with severe GI losses. Hypoglycemia may occur when these agents are used with sulfonylureas or insulin. There is also an increased risk of diabetic retinopathy. Due to the current shortage and expense of these medications, many patients have attempted to obtain these medications from non-licensed and unregulated agents, which may be associated with increased risk of serious complications. An understanding of the indications for GLP-1 agonist use and associated adverse events can assist emergency clinicians. [ABSTRACT FROM AUTHOR]