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OBJECTIVES: The objectives of this study were to 1) examine the prevalence of prescription medication use overall and 2) examine the association between weight promoting medication (WPM) use by therapeutic class and weight status among a nationally representative sample of the children and adolescents in the United States. This study also further investigated antidepressant medication use among this population. METHODS: This cross-sectional study used data from the National Health and Nutrition Examination Survey from 2013 to 2018. Children and adolescents ages 2 to 19 years were included in this study. RESULTS: Of the 68,057,468 derived participants (34,507,154 [50.7%] male; 33,564,059 [49.3%] aged 2–10 years; 34,905,058 [51.3%] non-Hispanic White), 14,895,618 (22.2%) used a prescription medication in the prior 30 days, 21.7% (3,235,323) of which were considered weight promoting. There was no significant difference between weight status and WPM use for overall prescription medication use. Nevertheless, for overall antidepressant medication use, those with obesity were less likely to be prescribed antidepressant WPM when compared to those with normal weight (adjusted odds ratios 0.4; 95% confidence interval 0.2–0.7). CONCLUSIONS: These findings suggest that although there was no significant association between WPM use and weight status overall when examining the association by therapeutic class, most children with obesity were not using antidepressant WPM. This is reassuring and potentially an active attempt at avoiding the use of medications that have an exacerbating effect on weight gain. When choosing antidepressant medications, providers, parents, and patients consider the WPM effects and appropriately choose a medication best suited to the child’s health status.

Social and interpersonal context are associated with the onset and persistence of psychiatric disorders. We compared the effects of short-term interpersonal psychotherapy (IPT) on weight loss, binge eating behaviors, and depressive symptoms against cognitive-behavioral therapy (CBT), health education (HE), and behavioral weight loss (BWL).We searched until May 28th, 2022 following databases: PubMed, CINAHL, Science Direct, Web of Science, EMBASE, and Scopus. Articles on parallel randomized clinical trials were included. Outcomes were body mass index (BMI), binge days (bulimic episode), and depressive symptoms. These outcomes were self-reported or measured with specific scales (BMI) or instrument (depressive symptoms).The initial search retrieved 820 articles, a total of 10 studies met the eligibility criteria, and seven were included in the meta-analysis. Participants with overweight/obesity were women (62-100 %), aged between 11 and 50 years. There was a trivial to small effect on BMI favoring IPT over other interventions (standardized mean difference [SMD] = -0.10; 95%CI: -0.27 to 0.07, ISmall number of studies, the discrepancy in age cohorts, and racial diversity. Psychotherapeutic protocols and assessment tools had to be adapted across studies.Patients with overweight/obesity and depression had some benefit from IPT when compared with other interventions. In view of existing evidence, an IPT program adapted to obesity could help to achieve reliable and long-term effects.

Summary Background & aims ESPEN guidelines advocate that energy needs of critically ill patients with COVID 19 should be assessed using indirect calorimetry, if safely available. This study described energy needs of intubated patients with COVID-19 and explores whether neuromuscular blockade administration (NMBAs) is associated with altered energy expenditure. Methods Resting energy expenditure (REE) and respiratory exchange rate (RER) evaluated among critically ill intubated COVID-19 patients until 28th day of intensive care unit stay (ICU–S) by indirect calorimetry. Paralysed patients were defined as those with drug induced paralysis using cicatracurium, for at least 3 days during their ICU-S. Results 34 adult COVID 19 patients (59.8% male, 35.2% obese) requiring mechanical ventilation were assessed prospectively. REE measurements suggest a gradual increase of energy needs post 3rd day of ICU-S in both patients without obesity (non ob) ((from 17.8 kcal/kgr up to 29.3 kcal/kgr actual body weight (AcBW) during 28th day of ICU-S, p = 0.011)) and patients with obesity (ob) ((from 18.1 kcal/kgr up to 30.1 kcal/kgr adjusted body weight (AjBW) during 28th day of ICU-S, p = 0.021)). NMBAs use was accompanied by a significant drop in REE, especially during first 7 days of hospitalization, both in non ob (22.9 vs 17.9 kcal/kgr AcBW, p = 0.014) and ob patients (22.5 vs 19.5 kcal/kgr ABW, p = 0.027). Conclusion We identified the energy needs of COVID-19 intubated patients and highlighted a significant increase beyond the 1st week in the ICU. Administration of NMBAs should be considered, as it may impact resting energy expenditure.

This study identified the trajectories of organized youth sports over 9 years in youths aged 9-18 years and examined whether the trajectories predicted physical activity, sedentary behavior, and obesity in midlife.Self-reported organized youth sports trajectories were identified for participants between 1980 and 1989 (N=3,474). Accelerometer-derived physical activity was quantified for participants (n=1,349) in 2018-2020. Sociodemographic, physical activity, and TV viewing data were collected through questionnaires either at baselines or follow-up. Adult BMI was calculated to clarify obesity. Associations of organized youth sports trajectories with adult physical activity, sedentary behavior, and obesity were evaluated using mixture models, which were stratified by sex and conducted in 2022.Three organized youth sports trajectories were identified for boys and girls (sustained high-sports participation, 12.0%/7.5%; sustained moderate-sports participation, 14.0%/13.3%; and low-sports/nonparticipation, 74.0%/79.2%). Boys sustaining both moderate- and high-sports participation had higher levels of adult self-reported physical activity (β=0.59, p=0.007; β=0.69, p0.001) than low-sports/nonparticipating boys. Girls sustaining both moderate- and high-sports participation accumulated more total physical activity (β=113.4, p=0.009; β=144.3, p=0.002), moderate-to-vigorous physical activity (β=7.86, p=0.016; β=14.01, p0.001), step counts (β=1,020, p=0.003; β=1,045, p=0.005), and self-reported physical activity (β=0.79, p0001; β=0.63, p=0.003) in midlife than their low-sports/nonparticipating counterparts. Girls sustaining moderate-sports participation accumulated more light-intensity physical activity (β=19.79, p=0.012) and less sedentary time (β= -27.65, p=0.002), and those sustaining high-sports participation had lower obesity prevalence (OR=0.41, p=0.009) 40 years later than low-sports/nonparticipating girls.Sustained participation in organized youth sports is independently predictive of physical activity patterns, sedentary time, and obesity in midlife, especially in girls, thus contributing to the development of a healthy and active lifestyle across the life course.

Individual lifestyle targets have been associated with weight loss outcomes, yet few studies have examined associations of one's total lifestyle with weight loss maintenance. We aimed to examine the relationship between lifestyle patterns and weight loss outcomes in weight loss maintainers and regainers. We hypothesized that higher adherence to a broader healthy lifestyle favors maintenance (over regain). This is a cross-sectional analysis of 470 adults (62% women) with a history of overweight/obesity and significant weight loss 12 months before study entry. Participants were classified as maintainers (current weight ≤90% maximum weight) or regainers. They were asked to fill in a series of questionnaires on demographics and lifestyle habits (dietary intake and eating behaviors through two 24-hour recalls, physical activity, and sleep). A total Mediterranean Lifestyle Index (total-MLI, range 0-13) was generated by summing up ratings in the lifestyle domain quartiles (diet quality, physical activity, and sleep habits) and dietary behaviors (seasonal food and vegetable intake, intake of traditional foods, responsibility for food preparation, conviviality). Maintainers scored higher in the total-MLI than regainers (6.93 ± 2.31 vs 5.78 ± 2.49, P.001). Adherence to the total-MLI was associated with 28% higher odds for weight loss maintenance (per unit increment) in linear analyses. Being in the highest total-MLI quartile was associated with 5.27 (95% CI, 2.77-10.02) odds for maintenance. Higher adherence to a comprehensive Mediterranean lifestyle pattern was associated with higher odds for weight loss maintenance. Our findings suggest that even modest shifts toward a healthier living may contribute to favorable weight loss outcomes.

The nutritional status of people infected with Human T-Cell Leukemia Virus type 1 (HTLV-1) is rarely studied. Malnutrition affects the immune system, but the consequences of this remain unknown in HTLV-1 infection. This study aimed to analyze the nutritional status, food intake, and ability to adhere to dietary counseling in people with symptomatic HTLV-1 infection.This was a longitudinal, prospective, observational study in which the nutritional status of people with symptomatic HTLV-1 was monitored between June 2016 and August 2019 at a referral center. At the baseline (day 0) and last stage (day 90) anthropometric, bioimpedance, and dietary assessments were performed.In total, 71 participants with symptomatic HTLV-1 infection were enrolled, the majority (43, 60.6%) of whom were female. The mean age was 59.2 (±11.1) years. Participants were often overweight or obese (40, 56.3%) had a BMI above 25 kg/mA high proportion of participants were overweight or obese. Adherence to dietary counseling was low, and its success was limited in improving dietary diversity/nutritional status. Loss to follow-up was a limitation of this study.

Sarcopenic obesity (SO) associates a decrease in lean body mass (LBM) with an excessive increase in fat mass (FM). A number of diagnostic methods, definitions criteria, and thresholds have been proposed for SO resulting in markedly discordant prevalence estimates in populations with obesity. In this study, we first assessed several previously described SO diagnostic criteria and their limitations, and then we propose an innovative approach for identifying SO.Data were from a cross-sectional study of a cohort of overweight/obese patients who underwent clinical, laboratory, and body composition assessments by dual-energy X-ray absorptiometry (DXA). We performed unsupervised machine learning through clustering analysis to discriminate lean and fat compartments, and multivariate logistic regressions which provided prognostic variables applied on sex-specific models for SO diagnosis evaluation based on a training dataset (80% of total sample, n = 1165). The predicted models were validated by random forest (RF) machine learning algorithm in the validation dataset (20% of total sample, n = 262).Data from 1427 subjects were analyzed, 79.8% women, mean (±s.d.) age 45.0 (±12.9) years, grade III obesity (BMI over 40 kg/mCurrent diagnostic criteria for SO result in widely discrepant prevalence values leading to diagnosis uncertainty. We developed and validated diagnostic criteria based on body composition phenotypes, specifically for overweight/obese subjects, which identified patients at risk of cardio-metabolic complications. This approach may improve the identification of sarcopenia in subjects with obesity.

Many studies have investigated the effects of soy isoflavones on weight control, but few have focused on the role of equol, a gut-derived metabolite of daidzein with greater bioavailability than other soy isoflavones.This study examined the association of equol production with obesity and explored the mediating roles of equol-related gut microbiota and microbial carnitine metabolites.This 6.6-y prospective study included 2958 Chinese adults (2011 females and 947 males) aged 60.6 ± 6.0 y (mean ± SD) at baseline. Urinary equol and isoflavones were measured using HPLC-tandem MS. BMI, percentage fat mass (%FM), and serum triglycerides (TGs) were assessed every 3 y. Metagenomics sequencing and assessment of carnitine metabolites in feces were performed in a subsample of 897 participants.Urinary equol, but not daidzein and genistein, was independently and inversely associated with the obesity-related indicators of BMI, %FM, and a biomarker (TGs). Equol producers (EPs) had lower odds of adiposity conditions and a reduced risk of 6.6-y obesity progression than non-EPs among total participants. Gut microbial analyses indicated that EPs had higher microbiome species richness (P = 3.42 × 10-5) and significantly different β-diversity of gut microbiota compared with the non-EP group (P = 0.001), with 20 of 162 species differing significantly. EPs (compared with non-EPs) had higher abundances of Alistipes senegalensis and Coprococcus catus but lower abundances of Ruminococcus gnavus (false discovery rate 0.05). Among the 7 determined fecal acylcarnitine metabolites, palmitoylcarnitine, oleylcarnitine 18:1, and stearylcarnitine were inversely associated with EPs but positively correlated with obesity conditions and progression. Path analyses indicated that the beneficial association between equol and obesity might be mediated by gut microbiota and decreased production of 3 acylcarnitines in feces.This study suggests a beneficial association between equol and obesity, mediated by the gut microbiome and acylcarnitines, in adults.This trial was registered at clinicaltrials.gov as NCT03179657.

It has been widely demonstrated that there are a broad range of individual responses to all weight management regimens, often masked by reports of the mean. Identifying features of responders and non-responders to weight loss regimens enables a more tailored approach to the provision of weight management advice. Low-carbohydrate diets are currently popular, and anecdote suggests that males are more successful at losing weight using this approach. This is feasible given the physiological and socio-psychological differences between the genders. We analysed the extent and variation in weight change for males and females separately through a systematic search for all low-carbohydrate diet trials published since 1985. Very few studies compared weight loss outcomes by gender and, of those that did, most lacked supporting data. The majority of studies reported no gender difference but when a gender difference was found, males were more frequently reported as losing more weight than females on a low-carbohydrate diet. The lack of gender stratification in weight loss trials is concerning, as there are a range of gender-based factors that affect weight loss outcomes. This study highlights the importance of examining weight change for males and females separately, since as failure to do so may mask any potential differences, which, if detected, could assist with better weight loss outcomes.

Some studies have shown that famine exposure during adolescence can increase cardiovascular disease and diabetes susceptibility in later life. The association between famine exposure in adolescence and overweight/obesity and abdominal obesity in adulthood has been inconsistent. Based on previous studies, we hypothesized that famine exposure in adolescence increases the risk of overweight/obesity and abdominal obesity in adulthood. Eight databases, including PubMed, Embase, Cochrane Library, and Web of Science, were searched from their inception until November 2021. We initially identified 3982 records and finally included 7 articles after screening. The included articles were of moderate to high quality, containing 16 estimates of overweight/obesity and 3 estimates of abdominal obesity. Pooled odds ratios (ORs) with 95% CIs were used to estimate the association between them. The random effects model was adopted as the pooling method. There was a significant association between famine exposure in adolescence and overweight/obesity in adulthood (OR, 1.17; 95% CI, 1.02-1.33). Adolescents exposed to famine had a greater risk of abdominal obesity in adulthood than their unexposed counterparts (OR, 1.35; 95% CI, 1.03-1.76). These results were more pronounced in females than in males. In summary, our meta-analysis indicates that famine exposure during adolescence increases the risk of overweight/obesity and abdominal obesity in adulthood. This suggests that we need to pay timely attention to the nutritional status of adolescents to prevent adverse health consequences of malnutrition. More high-quality studies are needed to confirm these conclusions, given the limitations of this study.

Ageing brings alterations in body composition, as skeletal muscle gradually declines and accumulation of adipose tissue accompanies it. Although sarcopenia (S) and obesity (O) were separately reported to be associated with frailty and poor physical performance, whether they bring more detrimental or favorable effect when they coexist (i.e. sarcopenic obesity; SO) is an issue needs clarification. We aimed to study the associations of SO and S alone with frailty and poor physical performance, by using probable S definition.This was a retrospective, cross-sectional study including community dwelling older adults who were ≥60 years old and admitted to the outpatient clinic of a tertiary hospital between 2012 and 2020. We measured handgrip strength via hand dynamometer and defined decreased muscle strength as probable S. We performed bioimpedance analysis to evaluate body composition and used fat percentile method to define obesity. We assessed nutritional status via Mini-Nutritional Assessment-Short Form, frailty via FRAIL scale, and physical performance via Timed Up and Go (TUG) test. We examined the associations of four body phenotypes, i.e. non-S non-O, SO, S alone and O alone with frailty and impaired TUG in univariate and multivariate analyses (Model 1). We further performed a head to head analysis of SO vs S to see if one of them was associated more with frailty and impaired TUG (Model 2).There were 1366 older adults included in the study (mean age: 74.6 ± 6.9; 68.3% female). The prevalences of non-S non-O, S alone, SO and O alone were 53.5, 7.5, 2.8 and 36.2%, respectively. Multivariate analysis adjusted for age, gender and nutritional status revealed that both SO and S alone were independently associated with frailty and impaired TUG, with SO demonstrating lower odds than S alone (OR = 5.9 and 6.05 for frailty, and 3.9 and 4.4 for TUG, respectively). Head-to-head comparison between SO and S alone in Model 2 showed that two groups did not demonstrate significant difference in terms of the frailty and impaired TUG risk.Although SO and S groups demonstrated similar risks, obesity accompanying sarcopenia might show a favorable trend in terms of frailty and poor physical performance, compared to sarcopenia alone. Longitudinal studies are needed to reveal whether an obesity paradox exists for frailty and physical performance in older adults.

The association between obesity severity and duration with the transition from metabolically healthy obese/overweight (MHO) phenotype to metabolically unhealthy obese (MUO) phenotype is not well understood.This study includes the Tehran Lipid and Glucose Study participants who were initially classed as MHO. Cumulative excess weight (CEW) and cumulative excess waist circumference (CEWC) scores, which represent the accumulation of body mass index and waist circumference deviations from expected values over time (kg/mOver 15 years of follow-up in TLGS, general and central obesity accumulation was associated with the increased transition from MHO to MUO among women participants. More research with a larger sample size is needed to confirm and explain why the results are different for men and women.

Excess weight is a major health problem. Aims of this study were to determine the prevalence rates of overweight and obesity, and to compare their associations with cardiometabolic and renal risk factors between obese and non-obese populations, and between overweight and non-overweight populations.Cross-sectional observational study conducted in Primary Care. Population-based random sample: 6,588 study subjects between 18 and 102 years of age (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of overweight and obesity were calculated, and their associations with cardiometabolic and renal variables were assessed by bivariate and multivariate analysis.The age- and sex-adjusted prevalence rates of overweight and obesity were 36.0% (42.1% in men; 33.1% in women) and 25.0% (26.2% in men; 24.5% in women), respectively. These prevalences increased with age, and were higher in men than in women. Fifty-two percent (95%CI: 50.0-53.9) of the overweight population and 62.3% (95%CI: 60.1-64.5) of the obese population had a high or very high cardiovascular risk. Abdominal obesity, physical inactivity, prediabetes, hypertension, hypertriglyceridemia, and low HDL-C were independently associated with both entities. Furthermore, diabetes was independently associated with overweight and hypercholesterolemia with obesity.The prevalence of overweight and obesity was 61.0% (68.4% in men and 59.0% in women). More than half of the overweight population and nearly two-thirds of the obese population had a high cardiovascular risk. Hyperglycemia, physical inactivity, hypertension, hypercholesterolemia, low HDL-C, and hypertriglyceridemia were independently associated with overweight and obesity.

Weight loss was supposed to help with decreasing risk of premature mortality. However, results on this topic remain debatable and limited by study design.The present study aimed to investigate the association between weight loss and all-cause mortality among US adults with overweight or obesity in a national cohort study by using propensity score matching (PSM) analysis.A total of 5486 pairs of participants were matched in the National Health and Nutrition Examination Survey (NHANES, 2003-2015) after PSM. Hazard ratios (95% confidence intervals) (HRs (95% CIs)) were employed to evaluate the association between weight loss indicated by long-term weight loss (LTWL) and all-cause mortality by using Cox proportional hazards regression models.During a median follow-up of 6.8 years, 674 participants died from all-cause mortality. In each PSM match, compared with participants with LTWL 5%, the HRs (95% CIs) for participants with LTWL of 5-9.9% (2877 pairs), 10-14.9% (1315 pairs), and ≥ 15% (1294 pairs) were 1.18 (0.83-1.68) (P = 0.366), 1.65 (1.17-2.34) (P = 0.005), and 1.91 (1.21-3.00) (P = 0.006), respectively. The significant increased risk of all-cause mortality for LTWL ≥ 15% remained among male, female, participants aged ≥ 65 years, without weight loss intention, with non-communicable diseases, and without exceeding estimated energy requirement.Weight loss especially for being ≥ 15% should be cautious for US adults with overweight or obesity.

The circadian clock gene brain and muscle Arnt-like protein-1 (BMAL1) regulates energy metabolism, adipocyte proliferation and differentiation, glucose metabolism, and other functions. This study aimed to examine the association of potential polymorphisms in BMAL1 with obesity among Chinese youth.A total of 2973 participants were included in this study. According to the body mass index obesity standard of China, 208 subjects were defined as experiencing general obesity. According to the waist-to-hip ratio obesity standard, 335 participants were defined as experiencing central obesity. Four single nucleotide polymorphisms (SNPs) (rs9633835, rs6486121, rs7107287, and rs12364562) were genotyped using TaqMan probe techniques.There was no significant difference in the either genotypic or allelic frequencies between the non-general and general obesity groups, while a positive association was observed between BMAL1 rs6486121 variant and central obesity risk (CC＋CT vs. TT: OR:2.139, 95% CI:1.164-3.930; P = 0.014) after adjusting for covariates. Stratification analyses revealed significant associations with central obesity risk for rs6486121 polymorphism in women according to the additive model (CC vs. CT vs. TT: OR：1.409; 95 % CI: 1.029-1.930; P = 0.032). Haplotype analysis showed that only paired haplotypes, including rs9633835G with rs6486121T, had a significant effect on central obesity with OR (95%CI) was 1.035 (1.011-1.060) and P = 0.004.our findings suggest that BMAL1 polymorphisms are significantly associated with central obesity and sex-specific genetic effects on BMAL1-mediated genetic susceptibility to obesity.

Objectives Cardiorespiratory fitness (CRF) has been inversely associated with risk of cardiometabolic diseases. However, there are no studies comparing the independent associations of CRF scaled by body size and composition using different approaches with cardiometabolic risk factors between children and adults. We therefore investigated these associations in children and adults using same measures for CRF and cardiometabolic risk factors. Design Cross-sectional. Methods A total of 352 children (47.2 % girls) and 572 men were included in the study. Peak oxygen uptake (V̇O2peak) was measured during a maximal exercise test on a cycle ergometer and was scaled by total body mass (BM−1), total fat free mass (FFM−1), and allometrically modelled BM, FFM, and stature. Insulin, glucose, triglycerides, HDL cholesterol, and LDL cholesterol were assessed from fasting blood samples and systolic and diastolic blood pressure were measured. HOMA-IR and continuous metabolic risk score were computed. Results V̇O2peak scaled by BM−1 was inversely associated with insulin, HOMA-IR, triglycerides, diastolic blood pressure, the cardiometabolic risk score and the number of cardiometabolic risk factors in children and adults. However, these associations attenuated remarkably when V̇O2peak was scaled by total FFM or allometrically modelled BM, FFM, or stature. V̇O2peak was consistently and positively associated with HDL cholesterol in children and adults irrespective of the scaling approach. Conclusions The inverse associations of CRF with cardiometabolic risk factors among children and adults attenuated remarkably when body size and composition were appropriately controlled for. However, the positive association between CRF and HDL cholesterol was consistent irrespective of the scaling approach. peerReviewed

The perioperative and postoperative concern in percutaneous nephrolithotomy (PNL) is bleeding. Disease-related conditions (such as stone size, stone HU, tract number, and diameter) affecting this situation were determined. To determine independent risk factors that may affect the amount of hemorrhage in PNL.A total of 308 adult patients (211 men, 97 women) undergoing the PNL procedure were included in the study. Renal anatomy and stone size were evaluated using non-contrast thin-section computed tomography (NCCT). NCCT was used to assess Hounsfield unit (HU) values of kidney stones, presence of atheroma plaque and obesity. The difference between preoperative hemoglobin (Hgb) values and postoperative 1st day Hgb values was recorded. This variation was evaluated for the effect of gender, age, atherosclerotic vein disease, urine pH and density, leukocyte count, lymphocyte count, neutrophil count (NEU), platelet count, mean platelet volume (MPV), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), stone volume, HU, and obesity.The mean Hgb variation was identified as 2.1 (standard deviation: 1.6). There were positive, significant, and weak correlations between the Hgb variation with NEU (P=0.019), MPV (P=0.000), NLR (P=0.005), stone volume (P=0.041) and HU (P=0.024) values. There was a negative significant and weak correlation between Hgb variation and PLT (P=0.022). No effects at significant levels were identified for gender (P=0.078), presence of atheroma plaque (P=0.949), obesity (P=0.869), age (P=0.686), urine pH (P=0.746), urine density (P=0.421), and PLR (P=0.855) on Hgb variations.In addition to HU and stone volume, NEU count, MPV, NLR and PLT count may be used as independent risk factors to predict blood loss during PNL.

Betaine supplementation has been shown to enhance hepatic lipid metabolism in obese mice and improve exercise performance in healthy populations. We examined effects of betaine supplementation, alone or in combination with treadmill exercise, on the metabolic consequences of high fat diet (HFD)-induced obesity in mice.Male C57BL/6 J mice were fed chow or HFD. After 15 weeks, HFD mice were split into: HFD, HFD with betaine (1.5% w/v), HFD with treadmill exercise, and HFD with both betaine and exercise (15 m/min for 45min, 6 days/week; n = 12/group) for 10 weeks. Compared to HFD mice, body weight was significantly reduced in exercise and exercise-betaine mice, but not in mice given betaine alone. Similarly, adiposity was reduced by exercise but not by betaine alone. HFD-induced glucose intolerance was slightly improved by exercise, but not with betaine alone. Significantly greater benefits were observed in exercise-betaine mice, compared to exercise alone, such that GTT-outcomes were similar to controls. This was associated with reduced insulin levels during ipGTT, suggesting enhanced insulin sensitivity. Modest benefits were observed in fatty acid metabolism genes in skeletal muscle, whilst limited effects were observed in the liver. HFD-induced increases in hepatic Mpc1 (mitochondrial pyruvate carrier 1) were normalized by all treatments, suggesting potential links to altered glucose metabolism.Our data show that drinking 1.5% betaine was sufficient to augment metabolic benefits of exercise in obese mice. These processes appear to be facilitated by altered glucose metabolism, with limited effects on hepatic lipid metabolism.

Optimal management of a displaced midshaft clavicle fracture remains controversial. This study assessed demographic factors, fracture pattern, and surgical technique as potential predictors of surgical complications. Smoking, diabetes, obesity, polytrauma, high-energy mechanism, inpatient status, transverse or comminuted fractures, and single-plating technique were hypothesized to be associated with an increased risk of complications following clavicle fracture open reduction internal fixation (ORIF).Consecutive patients with minimum 12-week follow-up from the trauma and sports medicine divisions at a single tertiary institution who presented with a midshaft clavicle fracture and underwent ORIF between 2007 and 2020 were retrospectively identified. Patient demographics, fracture pattern, plating technique, and postoperative complications were recorded. Postoperative complications were classified into major (reoperation) and minor (no reoperation) complications. Chi-squared statistics, Fisher's exact test, analysis of variance, Kruskal-Wallis test, and multivariate logistic regression modeling were utilized with a significance level set to P .05.One hundred ninety-eight patients (average = 39.5 ± 14.6 years) were identified with an average follow-up of 9.1 ± 10.7 months. The cohort consisted of 155 males (78.3%), 62 smokers (31.3%), and 12 diabetics (6.1%). Injury characteristics revealed 80 transverse fractures (40.4%), 87 oblique fractures (43.9%), and 31 Z-type fractures (15.7%). Seventy-nine patients (39.9%) underwent superior plating, 72 (36.4%) underwent anterior plating, and 47 (23.7%) underwent dual plating. Overall, postoperative complications occurred in 47 patients (23.7%), 29 minor (14.6%) and 18 major (9.1%). Major complications requiring reoperation were symptomatic hardware, nonunion, deep infection, wound dehiscence, and broken hardware. Minor complications consisted of sensory deficit or paresthesia beyond peri-incisional numbness, superficial infections, postoperative pain and/or stiffness, and delayed union. Smoking status (P = .008), obesity (P = .009), and transverse or Z-type fractures (P = .002) were significant prognostic factors for overall complication risk. Only manual labor was predictive of minor complications (P = .019). Transverse or Z-type fractures and single plating were predictive of major complications (P = .004 and P = .008, respectively). No reoperations occurred in patients who underwent dual plating. Smokers (P = .027) with transverse/Z-type fractures (P = .022) were at the highest risk of reoperation with single plating.The overall rate of complications following ORIF of displaced midshaft clavicle fracture was 27.3%, with 9.1% requiring reoperation. Given relatively high complication rates, in instances when nonoperative vs. operative management is equivocal, nonoperative management should be strongly considered in obese patients, smokers, and patients who present with transverse or Z-type fracture. If operative management is indicated, use of dual plating may decrease reoperation rates.

The best definition of the metabolic syndrome (MetSyn) remains controversial. The aim was to develop a latent variable measurement model for the MetSyn using primary care data.This retrospective case-control study was based on the data from the IQVIA Disease Analyzer (DA) database including a representative panel of general and internal medicine practices in Germany. 23,020 adult patients, who were newly diagnosed with ≥1 component of the MetSyn (cases; median age [IQR]: 60 [50-72] years; 54 % males) between January 2016 to December 2019, and 2,144 patients without any MetSyn component (controls; 48 [38-61] years; 45 % males) were included. MetSyn was modeled by ICD-10 codes (E66: obesity, I10: hypertension, E11: type 2 diabetes, E78: lipid disorders) and physiological measures (BMI, HbA1c, blood pressure, HDL-cholesterol, LDL-cholesterol, triglycerides).The covariance structure of the ICD codes and physiological measures could not be accounted for by a single MetSyn factor (root mean square error of approximation, RMSEA=0.085). Enrichment by another factor "Likelihood to Diagnose" significantly increased model fit with the observed data (RMSEA=0.054). "Likelihood to Diagnose" hardly correlated with MetSyn (r = 0.06), and was differentially associated with male sex, older age, and corresponding cardio- and cerebrovascular diseases. MetSyn showed the highest loading on four subordinate factors "hyperlipidemia" (0.70), "obesity" (0.66), "type 2 diabetes" (0.60), followed by "hypertension" (0.42). The ICD codes E66 and E78 were less indicative of these factors relative to BMI and triglycerides/HDL-cholesterol, respectively, whereas E11 and I10 were similarly indicative as their corresponding physiological measures.MetSyn was best indicated by BMI, triglycerides (an indirect marker of insulin sensitivity), HbA1c, and ICD-10 diagnosis E11 (type 2 diabetes). The factor "Likelihood to diagnose" probably constitutes a method factor of differential diagnosis systematically contributing to the common consistency of the MetSyn diagnosis in primary care.

Few studies have evaluated the correlation between the severity of cutaneous manifestations of chronic venous disease (CVD) of the lower limbs measured by the Clinical, Etiologic, Anatomic and Pathophysiologic classification (CEAP) and the Venous Clinical Severity Score (VCSS) combined, its risk factors, and venous reflux determined by Doppler ultrasonography. The purpose of this study was to compare the clinical severity assessed by CEAP and VCSS with known risk factors for CVD and the severity of venous reflux.A prospective study was carried out on 250 patients with CVD characterized as C2 to C6 according to the CEAP classification, who attended the departments of Dermatology and Vascular Medicine at the Hospital Privado Universitario de Córdoba from April 2013 to December 2014. Chi-square test, Kruskal-Wallis analysis and multivariate logistic regression analysis were performed to examine the relations between these variables.Risk factors significantly associated with clinical severity included older age, hypertension, obesity, sedentarism, history of soft tissue infection, deep vein thrombosis (DVT), previous ulcer, and family history of venous ulcer. Both scores showed a good correlation between clinical severity and the presence of superficial, deep or perforating venous reflux. Older age, male gender and a history of DVT were significant risk factors for venous reflux in patients with mild disease.In addition to venous reflux, modifiable risk factors such as obesity, sedentarism, and hypertension are associated with CVD severity. Mild cutaneous manifestations may accompany moderate to severe venous reflux, especially in middle-aged or older men with a history of DVT.

This study investigated whether health disparities exist among lesbian, gay, and bisexual individuals serving in the U.S. military by examining the associations of sexual orientation with mental, physical, and behavioral health among a population-based sample of service members and veterans.Sexual orientation and health outcomes were self-reported on the 2016 Millennium Cohort Study follow-up questionnaire (N=96,930). Health outcomes were assessed across 3 domains: mental health (post-traumatic stress disorder, depression, anxiety, binge eating, problematic anger), physical health (multiple somatic symptoms, physical functioning, BMI), and behavioral health (smoking, problem and risky drinking, insomnia). Adjusted logistic regression models conducted between 2019 and 2022 estimated the associations between sexual orientation and each health outcome.Lesbian, gay, and bisexual individuals (3.6% of the sample) were more likely to screen positive for post-traumatic stress disorder, depression, anxiety, binge eating, problematic anger, multiple somatic symptoms, and insomnia than heterosexual individuals. Gay/lesbian and bisexual women reported more adverse health outcomes (overweight and obesity, smoking, problem/risky drinking) than heterosexual women. Gay and bisexual men reported some adverse health outcomes (e.g., smoking and problem drinking) but better physical health (e.g., less overweight/obesity) than heterosexual men.Lesbian, gay, and bisexual service members reported poorer mental, physical, and behavioral health than heterosexual peers, most notably among gay/lesbian women and bisexual individuals. Findings suggest that lesbian, gay, and bisexual service members experience health disparities, despite many having equal eligibility for health care, highlighting the need for improved equity initiatives that promote cultural responsiveness, acceptance, and approaches to support the healthcare needs of lesbian, gay, and bisexual military members.

With increasing rates of obesity worldwide, a correlation between high body mass index (BMI) and postoperative morbidity after thyroid surgery remains unclear. Postoperative transient hypocalcemia is common after total thyroidectomy due to interruption of parathyroid function. This study examines the relationship between BMI and hypocalcemia after total thyroidectomy.A retrospective review of prospectively collected data for 1135 patients who underwent total thyroidectomy for cancer, multinodular goiter (MNG), or Graves' disease between June 2009 and November 2020 at a single institution was performed. BMI groups followed the World Health Organization classification. Hypocalcemia was defined as serum calcium ≤8 mg/dL. Calcium levels measured on postoperative day 0 and the following morning were compared between the BMI groups.Of 1135 total thyroidectomy patients, 85% were women. The mean age and standard deviation of patients was 49 (± 13) y, with most of Hispanic origin (64%). Overall, 41.5% of patients had cancer, 45% nontoxic MNG, 5.8% toxic MNG, and 12% Graves' disease. Stratified by BMI, 27% of patients were normal, 34% overweight, and 39% obese. Overall, overweight and obese patients experienced less transient hypocalcemia at both time points compared to normal patients postoperatively (P = 0.01 and P = 0.009). Furthermore, overweight and obese patients with Graves' disease experienced less transient hypocalcemia at both time points (P = 0.04 and P = 0.05). There was no statistical difference in other groups.A protective role of higher BMI or "obesity paradox" for postoperative hypocalcemia may exist in those obese patients after total thyroidectomy.

Despite the identification of obesity as a risk factor for higher rates of hospital and Intensive Care Unit (ICU) admissions and complications due to COVID-19, the association between obesity and mortality in critically ill COVID-19 patients remains controversial, and the nutritional risk is little considered. Hence, our study sought to evaluate the association between obesity, nutritional risk, and mortality in critically ill patients diagnosed with COVID-19.Retrospective study were condutcted including adult critically ill COVID-19 patients admitted to an ICU between April 2020 and March 2021. Clinical and laboratory data were collected from electronic medical records. Obesity was classified by body mass index ≥ 30 kg/mFrom 71 patients aged 59 (± 15) years, 71.8 % were male. The frequencies of obesity (58.7 %) and death (49.3 %) were high, but obesity was not associated with mortality. Based on mNUTRIC, 85.9 % of patients were at high nutritional risk, presenting a higher frequency of mortality than patients at low nutritional risk (50.8 % vs 40.0 %; p = 0.014). Multiple Cox Regression showed that for each unit increase in mNUTRIC score the probability of death almost doubled, regardless of the presence of obesity (HR = 1.74; p 0.001).A higher nutritional risk was positively associated with mortality in critically ill COVID-19 patients, regardless of obesity, showing the importance of early identification of nutritional risk for appropriate nutritional interventions in this population.

The aim of this study was to apply the European Society for Clinical Nutrition and Metabolism/European Association for the Study of Obesity (ESPEN/EASO) consensus to identify sarcopenic obesity (SO) in adults mid to long-term post-Roux-en-Y gastric bypass (RYGB) using both dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). Further, this approach was compared to accepted sarcopenia diagnostic criteria (Revised European Working Group on Sarcopenia in Older People [EWGSOP2] and Sarcopenia Definition and Outcomes Consortium [SDOC]).This cross-sectional study included adults ≥2 years post-RYGB surgery. Obesity was diagnosed by excess fat mass (FM) for all diagnostic criteria. Agreement was evaluated using Cohen's Kappa.We evaluated 186 participants (90.9% female, median age 43.9 years, 6.8 years post-surgery), of which 60.2% (BIA), and 83.3% (DXA) had excess FM. Low muscle strength was not identified using absolute handgrip strength. The prevalence of SO by BIA or DXA, respectively, was 7.9% (95%CI 3.9-12.5), and 23.0% (95%CI 17.1-30.3) [ESPEN/EASO SO consensus]; 0.7% (95%CI 0-2.0), and 3.3% (95%CI 0.7-5.9) [EWGSOP2]; and 27.0% (95%CI 19.7-34.2), and 30.3% (95%CI 23.0-37.5) [SDOC]. Agreement between the ESPEN/EASO SO consensus and other diagnostic criteria was none to slight using DXA: EWGSOP2 k = 0.19; 95% CI 0.04-0.34, or SDOC k = 0.16; 95% CI -0.01-0.32. Moderate agreement was observed within the ESPEN/EASO SO consensus for BIA and DXA (k = 0.43; 95% CI 0.26-0.60).This is the first study to explore the prevalence of SO using the ESPEN/EASO criteria. We identified a high but variable prevalence of SO in post-bariatric surgery patients (7.9-23.0%), depending on the body composition technique used; prevalence was higher using DXA. Little agreement was observed for the diagnosis of SO using the three diagnostic criteria. Future studies are needed to explore the relationship between SO identified by the ESPEN/EASO consensus and health status/outcomes.

This descriptive cross-sectional study aimed to examine the effects of the coronavirus disease-19 (COVID-19) pandemic on obesity, Internet addiction, and sleep quality in adolescents.In this study, data were collected from 395 healthy adolescents using a sociodemographic form, an Internet addiction scale, and a sleep quality scale. Descriptive statistics were analyzed as numbers, percentages, and mean values. The Wilcoxon test was performed to compare the mean body mass index (BMI), Internet addiction, and sleep quality scores of the participants before and after the COVID-19 pandemic. The differences were significant at a p value of0.05.The mean age of the participants was 15.04 ± 1.81 years, and 53% of them were female. The difference between the mean BMI scores of adolescents before and after the COVID-19 pandemic was significant (p0.01). The difference between the mean Internet addiction scale scores of the participants before and after the COVID-19 pandemic was significant (p0.01). The difference between the mean sleep quality scale scores before and after the COVID-19 pandemic was also significant (p0.01). Approximately 27.1% and 34.9% of the participants were obese before and after COVID-19, respectively.The obesity rate, BMI, and Internet addiction levels of children increased, whereas their sleep quality decreased after the COVID-19 pandemic.During the pandemic period, online trainings for parents should be organized on planning physical activities during closure periods, regulating the adolescents' sleep and eating habits.

Food processing changes the nature of foods, and it is growing globally due to its availability and affordability and its effects on the palatability of foods. Consumption of ultraprocessed foods (UPFs) may adversely affect weight gain. The purpose of the current study is to examine the association between UPFs consumption and adiposity among Iranian adults.A cross-sectional study was conducted on 1459 Iranian adults (≥19 years). Dietary intakes were assessed using a validated 136-item food frequency questionnaire (FFQ), and foods were classified based on the NOVA system. Overweight, obesity, and abdominal obesity were defined as body mass index (BMI) ≥25 and 30, ≥30, respectively, and waist circumference (WC) ≥91 for women and WC ≥ 89 for men. The odds of general and abdominal obesity across the quartiles of UPFs were assessed by binary logistic regression. UPFs consumption contributed to 20.17% of daily energy intake. After adjustment for potential confounders, UPFs consumption was not associated with general or abdominal obesity. However, in the fully adjusted model, men in the top quartile of UPFs were twice as likely to be overweight compared with those in the bottom quartile (OR = 2.06, 95% CI: 1.03, 4.10; P = 0.047). No association was found in women or stratified analysis by age.The present findings suggest a sex-specific association between UPFs consumption and overweight. UPFs consumption might be associated with an increased risk of overweight in men, but no such association was found in women. Future cohort studies are required to confirm these results.

The abdominal panniculectomy is a common procedure that patients choose to undergo for the purpose of restoring hygiene, reducing infection, and improving personal esthetic. A panniculectomy is often indicated after bariatric surgery, which defines a high-risk patient population. This study sought to better establish the association of known risk factors that can complicate the postoperative care of the panniculectomy patient, and whether or not bariatric surgery plays a role in the development of these complications.Patients that underwent a panniculectomy between 2010 and 2018 were identified in PearlDiver, a national insurance-claims database, and identified by CPT code 15,380. Patient demographics and associated medical problems were elucidated, and various complications were then identified. Descriptive statistics as well as a multivariate analysis were used to evaluate the association of risk factors and complications.A total of 8,282 panniculectomy patients were identified. Of these, 1,420 underwent bariatric weight loss surgery prior to their panniculectomy, whereas the remaining 6,869 underwent a panniculectomy alone. Obesity, tobacco use, and diabetes were significant in developing a surgical site infection, wound disruption, and the need to undergo reoperation. Charlson Comorbidity Index greater than one (CCI1), male gender, age greater than 60, COPD, and HTN identified as potential risk factors in developing various complications. Although patients with prior weight loss surgery had a history significant for prior comorbidities, the overall postoperative complication rate was decreased compared to those who did not undergo preoperative bariatric surgery.In the face of the obesity epidemic, the incidence of undergoing a panniculectomy has increased significantly, particularly following bariatric surgery. Identifying potential risk factors in this patient population could better help identify postoperative complications following a panniculectomy and perhaps allow for targeted intervention and medical optimization prior to surgery.

Cardiometabolic disease risk factors, including obesity, insulin resistance, high blood pressure, and dyslipidemia, are associated with elevated oxidative stress biomarkers like oxylipins. Increased adiposity by itself induces various isomers of this oxidized lipid family, while dietary polyphenols show benefits in its regulation. Previously, we showed that specific co-abundant microorganisms characterized the gut microbiota of Colombians and associated differentially with diet, lifestyle, obesity, and cardiometabolic health status, which led us to hypothesize that urinary oxylipins would reflect the intensity of oxidative metabolism linked to gut microbiota dysbiosis. Thus, we selected a convenience sample of 105 participants (age: 40.2 ± 11.9 years, 47.6% women), grouped according to microbiota, cardiometabolic health status, and body mass index (BMI); and evaluated 33 urinary oxylipins by HPLC-QqQ-MS/MS (e.g., isoprostanes, prostaglandins, and metabolites), paired with anthropometry and blood chemistry information and dietary antioxidants estimated from a 24-h food recall. In general, oxylipins did not show differences among individuals who differed in gut microbiota. While the unmetabolized oxylipin levels were not associated with BMI, the total content of oxylipin metabolites was highest in obese and cardiometabolically abnormal subjects (e.g., insulin resistant), mainly by prostaglandin-D (2,3-dinor-11β-PGF) and 15-F-IsoPs (2,3-dinor-15-F-IsoP and 2,3-dinor-15-epi-15-F-IsoP) metabolites. The total polyphenol intake in this cohort was 1070 ± 627 mg/day. After adjusting for body weight, the polyphenol intake was significantly higher in lean than overweight and showed an inverse association with dinor-oxylipin levels in principal component analysis. These results suggest that the 2,3-dinor-oxylipins could be more specific biomarkers associated with BMI than their parent oxylipins and that are sensitive to be regulated by dietary antioxidants., The authors thank the volunteers who agreed to participate in this study, the Colombian Ministry of science, technology, and innovation (Minciencias; grant number 832-2018), and Grupo Empresarial Nutresa. They also thank the Ibero-American Programme for Science, Technology and Development (CYTED) – Action 112RT0460 CORNUCOPIA network

Obesity is a complex and multifactorial chronic disease with genetic, environmental, physiological and behavioural determinants that requires long-term care. Obesity is associated with a broad range of complications including type 2 diabetes, cardiovascular disease, dyslipidaemia, metabolic associated fatty liver disease, reproductive hormonal abnormalities, sleep apnoea, depression, osteoarthritis and certain cancers. An algorithm has been developed (with PubMed and Medline searched for all relevant articles from 1 Jan 2000-1 Oct 2021) to (i) assist primary care physicians in treatment decisions for non-pregnant adults with obesity, and (ii) provide a practical clinical tool to guide the implementation of existing guidelines (summarised in Appendix 1) for the treatment of obesity in the Australian primary care setting. MAIN RECOMMENDATIONS AND CHANGES IN MANAGEMENT: Treatment pathways should be determined by a person's anthropometry (body mass index (BMI) and waist circumference (WC)) and the presence and severity of obesity-related complications. A target of 10-15% weight loss is recommended for people with BMI 30-40 kg/m

To examine the prevalence, distribution, and temporal trends of metabolic phenotypes that are jointly determined by obesity and metabolic health status among US adults, overall and in key population subgroups.A nationally representative sample of civilian, noninstitutionalized US adults aged 20 years and older from the National Health and Nutrition Examination Survey between 1999-2000 and 2017-2018 were included. Metabolic phenotypes were characterized jointly by body mass index and metabolic health: metabolically healthy underweight, normal weight, overweight, and obese (MH-OB); and metabolically unhealthy underweight, normal weight, overweight, and obese (MU-OB). Metabolic health was defined using the 2009 joint scientific statement for metabolic syndrome from the International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity as having 2 or less components (primary analysis) or no components (secondary analysis) of the following: waist circumference of 102 cm or greater in men and 88 cm or greater in women, fasting plasma glucose level of 100 mg/dL or greater, blood pressure of 130/85 mm Hg or greater, triglyceride level of 150 mg/dL or greater, and high-density lipoprotein cholesterol level of less than 40 mg/dL in men and less than 50 mg/dL in women.Of 19,941 adults, the mean age was 46.9 years; 10,005 (50.6%) were female. From 1999 to 2018, the prevalence in primary analysis declined from 33.2% (465465 of 1646) to 25.1% (454454 of 2058) (difference, -8.09%; 95% CI, -12.5% to -3.70%) for metabolically healthy normal weight, whereas it increased from 9.92% (178178 of 1646) to 14.1% (277277 of 2058) (difference, 4.17%; 95% CI, 1.13% to 7.21%) for MH-OB (both P.001 for trend). The prevalence of metabolically healthy underweight and overweight remained stable at about 1.62% (298298 of 19,94119,941) (95% CI, 1.38% to 1.89%; P=.34 for trend) and 22.2% (4,275 of 19,941) (95% CI, 21.4% to 23.0%; P=.14 for trend), respectively. The prevalence declined from 3.77% (72 of 1646) to 2.10% (68 of 2058) (difference, -1.67%; 95% CI, -3.22% to -0.12%; P=.006 for trend) for metabolically unhealthy normal weight, whereas it increased from 19.0% (343 of 1646) to 26.4% (574 of 2058) (difference, 7.41%; 95% CI, 2.67% to 12.2%; P.001 for trend) for MU-OB. The prevalence of metabolically unhealthy underweight and overweight remained stable at 0.06% (11 of 19,941) (95% CI, 0.03% to 0.15%; P=.84 for trend) and 11.2% (2528 of 19,941) (95% CI, 10.6% to 11.8%; P=.29 for trend), respectively. Persistent differences in the prevalence of metabolic phenotypes were identified across multiple sociodemographic subgroups. For example, the prevalence of MH-OB increased from 7.58% (53 of 754) to 12.0% (79 of 694) (P.001 for trend) for non-Hispanic Whites and 12.2% (60 of 567) to 18.4% (76 of 493) for Hispanics (P=.01 for trend) and remained stable at 22.6% (756 of 3,825) for non-Hispanic Blacks (P=.62 for trend and P=.05 for interaction). Results in secondary analyses revealed similar patterns.From 1999 to 2018, US adults experienced major increases in the prevalence of both MH-OB and MU-OB, largely due to decreases in MH-N. The prevalence of MU-OB increased across all subgroups, with higher values observed in older adults and those with lower education and income levels.

Adults with obesity are at higher risk for developing hypovitaminosis D. Some studies suggest that reduced levels of serum 25-hydroxyvitamin D (25(OH)D) may also be related to disorders in cardiometabolic parameters. However, because of the association between 25(OH)D and obesity, we hypothesized that body composition can be a confounding factor in the association of 25(OH)D with cardiometabolic parameters, and that 25(OH)D is inversely associated with body composition and cardiometabolic parameters and directly associated with fat intake. The aim of this study was to analyze the associations between 25(OH)D with body composition, fat intake, and cardiometabolic parameters in adults with obesity. This cross-sectional study consisted of 52 adults with obesity (61.53% female; 37.50 ± 6.88 years; body mass index [BMI]: 33.60 ± 2.89 kg/m

The joint effect of famine exposure and adulthood obesity on risk of dyslipidemia remains unclear. Thus, we aim to explore the joint effect of famine exposure and adulthood obesity on the risk of dyslipidemia, and the potential effect of adult general or abdominal obesity on the association between famine exposure and dyslipidemia.We conducted a community-based cohort study in 8880 subjects aged 40 years or older. Participants were divided into nonexposed, fetal-exposed, childhood-exposed, adolescent-exposed according to birth date. General obesity and abdominal obesity were defined according to body mass index (BMI: overweight≥24.0 kg/mCoexistence of early-life undernutrition and adulthood obesity was associated with a higher risk of dyslipidemia in later life.

"Sarcopenic obesity" refers to a condition of low muscle mass in the context of obesity, though may be difficult to assess in patients with cirrhosis who are acutely ill. We aimed to define sarcopenic visceral obesity (SVO) using CT-based skeletal muscle index (SMI) and visceral-to-subcutaneous adipose tissue ratio (VSR) to examine its association with post-transplant mortality. We analyzed 116 adult inpatients with cirrhosis who were urgently listed and transplanted between 1/2005 and 12/2017 at 4 North American transplant centers. SVO was defined as patients with sarcopenia (SMI50 cm

Treatment of chronic hypercapnic failure in COPD patients with home noninvasive ventilation (HNIV) remains unclear.To create a curated cohort of all COPD patients on HNIV in Catalonia, perform a cluster analysis, and evaluate mortality evolution.This study was a multicenter, observational study including all COPD patients on HNIV on 1st January of 2018. Patients were selected through the Catalan Health Service, and administrative and clinical data were obtained in the previous four years. Principal component analysis of mixed data and hierarchical clustering were performed to identify clusters of patients. Mortality was evaluated from 1 January 2018 until 31 December 2020.A total of 247 patients were enrolled. They were mostly male (78.1%), with a median (SD) age of 70.4 (9.4) years old. In 60%, 55% and 29% of patients, obesity, sleep apnea and heart failure coexisted, respectively. Cluster analysis identified four well-differentiated groups labeled for their clinical characteristics: (1) obese smokers, (2) very severe COPD, (3) sleep apnea and (4) older comorbid males. Patients belonging to Clusters (2) and (4) had a worse prognosis than patients in Clusters (1) and (3).A high heterogeneity in the prescription of HNIV was demonstrated. Cluster analysis identifies four different groups, of which only one had COPD as the main cause of ventilation, while the other three clusters showed a predominance of other comorbidities. This leads to different survival outcomes, including an overlapping phenotype of obesity-related disease and sleep apnea with better survival.

Growth abnormalities in childhood have been related to later cardiometabolic risks, but little is known about these associations in populations at high risk of type 2 diabetes.We examined the associations of patterns of growth, including weight and height at ages 1-59 months, with cardiometabolic risk factors at ages 5-16 years.We linked anthropometric data collected at ages 1-59 months to cardiometabolic data obtained from a longitudinal study in a southwestern American Indian population at high risk of diabetes. Analyses included 701 children with ≥1 follow-up examination at ages 5-16 years. We derived age- and sex-specific weight-for-height z-scores (WHZ) and height-for-age z-scores (HAZ) at ages 1-59 months. We selected the highest observed WHZ and the lowest observed HAZ at ages 1-59 months and analyzed associations of z-scores and categories of WHZ and HAZ with cardiometabolic outcomes at ages 5-16 years. We used linear mixed-effects models to account for repeated measures.Overweight/obesity (WHZ 2) at ages 1-59 months was significantly associated with increased BMI, fasting and 2-hour postload plasma glucose, fasting and 2-hour insulin, triglycerides, systolic blood pressure, diastolic blood pressure, and decreased HDL cholesterol at ages 5-16 years relative to normal weight (WHZ ≤1). For example, at ages 5-9 years, 2-hour glucose was 10.4 mg/dL higher (95% CI: 5.6-15.3 mg/dL) and fasting insulin was 4.29 μU/mL higher (95% CI: 2.96-5.71 μU/mL) in those with overweight/obesity in early childhood. Associations were attenuated and no longer significant when adjusted for concurrent BMI. A low height-for-age (HAZ-2) at ages 1-59 months was associated with 5.37 mg/dL lower HDL (95% CI: 2.57-8.17 mg/dL) and 27.5 μU/mL higher 2-hour insulin (95% CI: 3.41-57.6 μU/mL) at ages 10-16 years relative to an HAZ ≥0.In this American Indian population, findings suggest a strong contribution of overweight/obesity in early childhood to cardiometabolic risks in later childhood and adolescence, mediated through persistent overweight/obesity into later ages. Findings also suggest potential adverse effects of low height-for-age, which require confirmation.

We examined the interactive effects of copper (Cu) and overweight (overweight) and obesity on outcomes of burn patients. We posited that higher baseline Cu among burn patients with overweight or obesity will be associated with poor clinical outcomes vs. patients with a normal weight.A retrospective review was conducted on patients with ≥20% total burn surface area (TBSA) with an initial measurement of Cu. Patients were grouped by body mass index (BMI). The interactions between baseline Cu and BMI groups on multiple burn patient outcomes were examined in a series of multiple regression models.One-hundred-and-sixty patients met eligibility (age 43.9 ± 17.5, males 86.3%, normal weight:overweight:obesity = 53:38:69). BMI groups did not differ significantly on demographics, burn severity, or baseline biochemistry. Normal weight patients with higher baseline Cu had shorter ICU stay (ICUS), shorter length of stay (LOS), and had fewer operations (Ps0.05). In contrast, overweight and obese patients with higher baseline Cu had longer ICU stay (p = 0.001 and p = 0.034), LOS (p = 0.005 and p = 0.066), and increased operations (p = 0.001 and p = 0.067).Higher baseline Cu seems associated with adverse outcomes in overweight and obese burn patients. Further research is needed to confirm this association and explore the direction of causality.

Dysfunctional eating behaviors may be associated with weight gain and have a negative impact on obesity. Intuitive eating is a strategy that helps with changing eating behaviors. This study aimed to analyze the effects of intuitive eating alone or combined with nutritional guidelines on eating behaviors, weight, and body mass index (BMI), in individuals with obesity.This is a randomized clinical trial of 58 individuals (84.5% females and 84.5% candidates for bariatric surgery). The mean age was 40.5 years (SD = 9.1). The mean BMI was 48.3 kg/mCompared with the CG, the IEG and IEGDG did not differ in binge eating, cognitive restriction, emotional eating, and uncontrolled eating. Likewise, there were no significant differences in weight and BMI.Intuitive eating alone or in combination with nutritional guidelines did not alter the general domains of eating behaviors, weight, and BMI in individuals with obesity. We suggest further studies involving other health professionals, as well as evaluating the effects of intuitive eating using scales, in addition to eating behaviors.https://ensaiosclinicos.gov.br6, Identifier: RBR-7q9nj8.

Parenting style has been associated with children's weight-related outcomes and health behaviors, but this relationship may be confounded by genetic influences. Using a twin design to better control for genetics and shared home environments, this study aimed to estimate the longitudinal parental effects on obesity, smoking, and drinking in children and adolescents.Data were retrieved from the first two waves of the German Twin Family Panel. A total of 631 pairs of same-sex monozygotic twins were analyzed, including three birth cohorts aged 5, 11, and 17 years. Self-reported parenting styles were measured in five dimensions: emotional warmth, psychological control, negative communication, monitoring, and inconsistent parenting. Outcome variables included children's body mass index z-score (BMIz) and smoking and alcohol drinking frequency. The differencing method was used to examine the relationship between within-monozygotic pair differences in parenting styles and health outcomes, controlling for differences at baseline, genetic influences, and other shared characteristics between twins.Controlling for genetics, shared environmental effects, and body weight status at baseline, the twin who received harsher parenting in communication had lower BMI than their cotwin. Subgroup analyses found that negative communication had a stronger impact on the youngest cohort and female twins. Paternal parenting differentially relates to child weight compared to maternal parenting. No concurrent and long-lasting effects of paternal parenting on smoking and drinking were found.The twin study design is a unique epidemiological tool to measure the contribution of genetics as opposed to the environment, to a given health trait. This study found that negative communication was associated with lower BMI in German twin families. However, it failed to identify strong evidence for the causal link between other parenting dimensions and child's weight status and alcohol and tobacco use. More twin studies with objective measurements are warranted to understand the critical role of parenting, especially family communication, in predicting children's BMIs and their health behaviors across cultures.

Excess weight can cause structural and functional cardiac disorders. The presence of left ventricular hypertrophy in the obese patient is an independent predictor of cardiovascular morbidity and mortality. The major aim of the present study is to know the prevalence of cardiac morphofunctional disorders in obese patients, before and after weight loss due to bariatric surgery (BS).Prospective cohort study of 75 patients with obesity without known heart disease referred to gastric bypass. Anthropometric, analytical and echocardiographic parameters were measured before and after 6 and 12 months after BS.The study included 75 patients (66.6% women, mean age 39.3 [9.7] years and BMI 47.8 [7.1] kg/mOur results support the negative effect of obesity on cardiac geometry and function and the potential reversibility of these cardiac alterations after marked weight loss due to BS.

Which factors influence the success rate of egg donation programmes with imported vitrified oocytes?Observational longitudinal cohort study of 431 oocyte donation cycles conducted between January 2015 and February 2019. A total of 398 couples underwent an IVF cycle with imported donated vitrified eggs. All consecutive oocyte donation cycles conducted at the Centre for Reproductive Medicine of the European Hospital in Rome, Italy, were included.A univariable analysis was conducted. Among the demographic characteristics studied, body mass index (BMI) was significantly able to influence outcome. In 49% of unsuccessful cycles, men were overweight, compared with 39.4% in cycles with a positive beta-HCG test (P = 0.03). The relationship between female or donor BMI and treatment outcome, however, was not statistically significant. The day on which the embryo is transferred affects the outcome of the cycle: transferring on day 2 versus day 5 reduces the probability of clinical pregnancy. The relationship between male BMI classes and semen parameters was studied: obese men have a significantly lower sperm concentration than normal-weight men (P = 0.006 after Bonferroni correction). No statistically significant differences were found in semen volume (P = 0.722), sperm morphology (P = 0.100) and motility (P = 0.179) in obese men compared with normal weight men.In addition to the number of oocytes available after warming, male BMI, semen characteristics and blastocyst transfer are critical parameters able to influence the reproductive outcomes of egg donation programmes with imported vitrified oocytes.

The evidence for an association between obesity and increased carotid intima-media thickness (CIMT) and carotid stiffness (CS) in the young has been limited by methodological challenges related to study populations, measurements, methods of percentile derivation and comprehensiveness of obesity markers investigated. This nationwide general population study developed new CS and CIMT centiles in the young and used them to study associations with body mass index, waist circumference, waist-to-height-ratio, bioimpedance-derived absolute and relative fat mass, fat-free mass, subscapular skinfold thickness and blood pressure.In its 11-year follow-up, the KiGGS cohort, which is based on a nationally representative sample, included semi-automated state-of-the-art sonographic CIMT and CS measurements in 4,709 participants aged 14 to 28. Distensibility coefficient (DC), stiffness index β, Young's elastic modulus (YEM) and Peterson's elastic modulus (Ep) centiles were modelled by sex, age and height simultaneously.CS increased with age in both sexes, and young men had stiffer arteries than young women at all ages. All obesity measures at baseline and at follow-up, except for subscapular skinfold thickness, were positively associated with several CS parameters with moderate relative risks (RR), e.g. cross-sectional RR 2.23 (95% CI 1.26-3.93) for DC ≥ 90th percentile when waist circumference ≥90th percentile; RR 5.98 (3.38-10.56) for elevated DC associated with simultaneously elevated waist circumference and BP.These new state-of-the-art CS percentiles show consistent associations of obesity with CS in the young and support primary prevention efforts starting at a young age.

QRS prolongation is one of the most common findings in patients with underlying cardiac diseases. Recent studies have shown that QRS prolongation can be accompanied by obesity, hypertension, and hyperlipidemia, which are known risk factors for cardiovascular events. This study aimed to evaluate how obesity, hypertension, and hyperlipidemia could affect QRS duration.A total of 4033 eligible subjects aged between 35 and 70 years were included from the Persian Cohort Study in Mashhad. ECG intervals, blood pressures, lipid profile, and BMI measures were obtained at the time of enrolment. Multiple regression analysis was performed to assess the relationship between QRS duration and BMI, hypertension, and lipid profile.This study population consisted of 2047 females and 1986 males with a mean age of 46.05 ± 9.50 years. Higher BMI values and heart rate were observed in women (27.12 ± 4 and 74.66 ± 8.54; P 0.001), while height, weight, and QRS duration showed a significant increase in men (172.60 ± 7.18, 79.44 ± 12.55, and 97 ± 11.05; P 0.001). Except for total cholesterol (P = 0.317), blood pressures and lipid profile differed significantly among women and men (P 0.001). Furthermore, univariate analyses indicated that QRS duration was associated with age, sex, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), systolic blood pressure, diastolic blood pressure, categorical blood pressure, categorical BMI, and continuous BMI. On the backward multivariate model, TG, LDL, HDL, DBP, SBP, categorical blood pressure, categorical BMI, and continuous BMI were independently correlated with QRS duration.Hypertension, increased BMI, and high levels of LDL, TG, and lower HDL, as well-known risk factors of cardiovascular disease, were associated with prolonged QRS duration. These findings could be beneficial in future investigations regarding establishing the underlying heart problems.

Background No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. Methods The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. Findings 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7–9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46–0·99]), obesity (0·50 [0·34–0·74]) and invasive mechanical ventilation (0·42 [0·23–0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74–1·00]), at 5 months (0·74 [0·64–0·88]) to 1 year (0·75 [0·62–0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. Interpretation The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. Funding UK Research and Innovation and National Institute for Health Research.

Background : The coronavirus disease 2019 (COVID-19) is responsible for one of the largest public health crises the United States has seen to date. This study explores the outcomes of African American and non-African American COVID-19-positive patients hospitalized in rural Southwest Georgia to identify differences in morbidity and mortality between the groups. Methods : We performed a retrospective cohort analysis among adults aged ≥18 years admitted with COVID-19 between March 2, 2020 and June 17, 2020 at Phoebe Putney Health System. Data on demographics, comorbidities, presenting symptoms, and hospital course were obtained. Patients were divided into two groups: African Americans and non-African Americans. We examined differences in patient characteristics between groups using chi-square tests for categorical variables, t-test for parametric continuous variables, and Wilcoxon rank-sum tests for non-parametric continuous variables. Statistical Analysis Software (SAS) version 9.4 was used for statistical analysis. Results : Among 710 patients, median age was 63 years, 43.8% were males, and 83.3% were African Americans. African Americans had higher prevalence of obesity and hypertension, were more likely to present with fever, and present with longer duration of symptoms prior to presentation. In-hospital mortality was similar between the groups, as was need for mechanical ventilation, ICU care, and new dialysis. African Americans were more likely to be discharged home compared to non-African Americans. Conclusions : There was no difference in in-hospital mortality; however, African Americans had disproportionately higher hospitalizations, likely to significantly increase the morbidity burden in this population. Urgent measures are needed to address this profound racial disparity.

Metabolic syndrome, including obesity has been documented as a critical factor in male reproductive dysfunction with subsequent reduction in male fertility. The therapeutic potential of melatonin has been demonstrated against oxidative stress-induced pathologies. Therefore, the present study investigated the effects of melatonin on testicular dysfunction associated with high fat diet (FD)-induced obese rat model, and the possible involvement of peroxisome proliferator-activated receptor-γ (PPAR-γ). Adult male Wistar rats (n = 6/group) were used: control group received vehicle (normal saline), obese group received 40% FD, melatonin-treated group received melatonin (4 mg/kg), and obese plus melatonin group received melatonin and 40% FD and the treatment lasted for 12 weeks. High fat diet caused increased body weight and testicular triglyceride, total cholesterol, malondialdehyde, γ-glutamyl transferase, lactate production and lactate/pyruvate ratio as well as decreased glutathione/glutathione peroxidase, nitric oxide and PPAR-γ and circulating testosterone. Nevertheless, all these alterations were attenuated when supplemented with melatonin. Taken together, these results demonstrates that FD-induced obesity causes testicular dysfunction. In addition, the results suggest that melatonin supplementation protects against obesity-associated testicular dysfunction and this effect is accompanied by upregulation of PPAR-γ.

Previous studies have demonstrated stronger associations between metabolic alterations and neck circumference (NC) than with body mass index (BMI) or waist circumference (WC). However, most of these studies were performed in individuals presenting overweight or mild obesity.To determine which adiposity index among BMI, WC, NC and fat mass (FM) can best predict metabolic alterations in men and women presenting severe obesity.Anthropometric and plasma biochemical parameters were measured in 81 participants presenting severe obesity (19 men, 62 women; age: 44.5 ± 8.9 years; BMI: 43.5 ± 4.1 kg/mNC was positively correlated with fasting insulin concentrations, C-peptide concentrations and HOMA-IR values and negatively correlated with HDL-C concentrations. NC was the best predictor of glucose homeostasis indices and HDL-C concentrations in models also including sex, BMI, WC, and FM. The ROC curve analysis indicated that a NC ≥ 37.8 cm best predicted type 2 diabetes.NC seems a better predictor of insulin resistance and lower HDL-C concentrations in patients presenting severe obesity compared to other standard anthropometric indices, and particularly in women. The small sample size in men prevent us to draw clear conclusions. NC could be useful in targeting patients with metabolic alterations who could benefit from medical or surgical treatment of obesity.

Increased cardiac inflammation and oxidative stress are common features in obesity, and toll-like receptor (TLR)4 signaling is a key inflammatory pathway in this deleterious process. This study aimed to investigate whether berries could attenuate the detrimental effects of a high-fat, high-sucrose (HFHS) diet on the myocardium at the molecular level.Eight-week-old male C57BL/6 mice consumed a low-fat, low-sucrose (LFLS) diet alone or supplemented with 10% blackberry (BL), 10% raspberry (RB) or 10% blackberry + raspberry (BL + RB) for four weeks. Animals were then switched to a HFHS diet for 24 weeks with or without berry supplementation or maintained on a LFLS control diet without berry supplementation. Left ventricles of the heart were isolated for protein and mRNA analysis. Berry consumption, particularly BL + RB reduced NADPH-oxidase (NOX)1 and NOX2 and increased catalase (CAT) and superoxide dismutase (SOD)2, expression while BL and RB supplementation alone was less efficacious. Downstream TLR4 signaling was attenuated mostly by both RB and BL + RB supplementation, while NF-κB pathway was attenuated by BL + RB supplementation. Stress-activated protein kinase (SAPK)/Jun amino-terminal kinase (JNK) was also attenuated by BL + RB supplementation, and reduced TNF-α transcription and protein expression was observed only with BL + RB supplementation.The synergistic effects of BL + RB may reduce obesity-induced cardiac inflammation and oxidative stress to a greater extent than BL or RB alone.

American Indians (AI) or Alaska Natives, or in combination with another race, comprised 6.8 million individuals in 2010 and the population is expected to exceed 10 million in the current census. Diabetes is more common in AIs than in other races in the United States and is responsible for 69% of new onset end stage renal disease in AI patients. The incidence of obesity is also higher among AIs. As both diabetes and obesity make creating a successful autogenous vascular access more challenging, we reviewed our experience creating arteriovenous fistulas in AI patients.Our vascular access database was reviewed for consecutive new AI patients undergoing creation of a hemodialysis vascular access during a 10-year period. Each patient underwent ultrasound vessel mapping by the operating surgeon in addition to history and physical examination. The goal for initial cannulation was 4-6 weeks after access creation. Minimal AVF flow volume for cannulation was 500 mL/min with an outflow vein diameter of 6 mm.235 consecutive new AI patients were identified. All patients had an autogenous access constructed. The median age was 56 years (range, 15-89 years). Diabetes was present in 85% and 42% were female. Obesity was noted in 27% of the patients and 37% had previous vascular access operations. Primary patency at 12 and 24 months was 62% and 46%, respectively. Cumulative patency at 12 and 24 months was 96% and 94%, respectively. Female gender and previous access operations were associated with lower primary (P = 0.002 and 0.02, respectively) and cumulative patency (P = 0.01 and 0.04, respectively). Obesity was associated with lower cumulative access patency (P = 0.02). Overall, 74% of the access operations used the radial or ulnar artery for AVF inflow. Distal radial artery inflow AVFs were associated with longer patient survival (P = 0.01) and individuals with proximal radial inflow had longer survival when compared to brachial artery AVFs. Previous access operations were associated with shorter patient survival (P = 0.04).Safe and functional arteriovenous fistulas can be created for American Indians despite a higher prevalence of vascular access risk factors such as diabetes and obesity.

Endoscopic bariatric therapies are less-invasive alternatives to bariatric surgery, and endoscopic gastroplasty (ESG) represents the latest evolution. This study aims to compare weight loss, safety, and comorbidity resolution of ESG compared with laparoscopic sleeve gastrectomy (LSG).This was a propensity score-matched study of patients who underwent ESG or LSG. Primary outcome was weight loss at 6, 12, 24, and 36 months. A noninferiority margin of 10% total weight loss (%TWL) was used. Secondary outcomes were safety and comorbidity resolution.A 1:1 propensity score match yielded 3018 patient pairs. Average age and body mass index (BMI) were 34 ± 10 years and 33 ± 3 kg/mESG induces noninferior weight loss to LSG with similar comorbidity resolution and safety profiles.