Roux-en-Y gastric bypass (RYGB) surgery is known to improve lipid profiles in individuals with obesity, but the degree of improvement varies. Emerging evidence suggests a role for sphingolipids in modulating cholesterol metabolism. This study investigated the relationship between plasma sphingolipid changes and cholesterol improvements in women with obesity and Type 2 diabetes mellitus (T2DM) following RYGB. Patients from the SURMetaGIT study were evaluated before and 3 months after surgery. Biochemical and sphingolipid analyses, anthropometric measures, and body composition were assessed. A nonhierarchical cluster analysis assessed distinct phenotypes in response to cholesterol after surgery. The p value from multiple comparison tests was adjusted using the false discovery rate (FDR) method. A metabolite fold change [log2 (postoperative mean/preoperative mean)] of 1.2 and an adjusted p value < 5% were considered statistically significant. A linear regression model was used to investigate the relationship between sphingolipids and cholesterol levels. Finally, a binary logistic regression model was developed to identify the predictive value of specific discriminative sphingolipids in the lipid improvement after RYGB. Distinct sphingolipid remodeling patterns were observed, with specific sphingolipids, including Cer(d18:1/24:0), SM(d18:1/22:0), and SM(d18:1/24:0), presenting a strong positive correlation with cholesterol levels, independent of weight loss and T2DM remission. The binary logistic regression showed preoperative Cer(d18:1/24:0) could be the strongest candidate predictor of plasma lipid improvement after surgery (accuracy of 78%; AUC 0.87). These findings suggest that specific sphingolipids, notably preoperative Cer(d18:1/24:0), seemed to have a potential role in predicting cholesterol improvement after RYGB. External validation in independent cohorts is warranted before clinical applicability can be established. Trial Registration: ClinicalTrials.gov identifier: NCT01251016.
BACKGROUND:The relationship between knowledge, attitudes and beliefs (KAB) is complex and reciprocal. Although KAB are internal constructs, they collectively influence behaviour without necessarily determining it. In obesity management, understanding healthcare professionals' (HCPs') KAB about adult obesity is crucial. However, comprehensive and valid outcome measurement instruments (OMIs) are necessary to accurately reflect their perspectives. OBJECTIVE:This scoping review aimed to identify and evaluate published OMIs that assess HCPs' KAB about adult obesity, utilising the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) framework. METHODS:Following the COSMIN methodology and the five-stage scoping review framework proposed by Arksey and O'Malley, and refined by Levac and Colquhoun, reviewers searched six databases-Embase, Medline, Web of Science, PsycINFO, CINAHL and Google Scholar-for studies published from 1 January 1991 to 1 May 2025. Inclusion criteria required studies to focus on HCPs' KAB, OMI development, psychometric evaluation or application in relation to adult obesity. Two reviewers screened the literature and assessed methodological quality using the COSMIN Risk of Bias checklist, and evidence quality was graded with a modified GRADE approach. RESULTS:A total of 9213 records were identified, 45 articles were evaluated for full-text eligibility, and 4 articles were selected for final review. According to COSMIN criteria, the methodological quality of these studies was deemed inadequate. None demonstrated sufficient content validity, with common limitations including unrepresentative samples of HCPs' and poorly defined constructs. As per the COSMIN 'stop rule'," no further psychometric evaluations were conducted. CONCLUSION:There is a significant gap in the availability of rigorously developed instruments for assessing HCPs' KAB about adult obesity. There is a clear need for more contemporary and reliable OMIs that adhere to quality standards, such as those outlined in the COSMIN framework.
Weight cycling (WC), characterized by repeated weight loss and regain, has been associated with adverse health effects, though evidence remains inconsistent. The aim of this review is evaluating WC protocols used in rodent studies, with a particular focus on how variations in experimental design and cycle periodization influence metabolic outcomes. All included studies were conducted in C57BL/6 mice, with protocols alternating between normocaloric and hypercaloric diets, in a variety of protocols, mainly in the periodization of cycles, diet composition, and sex of the animals. Despite evidence suggesting greater resistance to metabolic disorders associated with WC, studies in females are still scarce. Frequent cycling was associated with worsened metabolic outcomes, whereas prolonged weight-loss phases did not reverse obesity-induced alterations. Common findings included increased feed efficiency, loss of lean mass, persistent insulin resistance, and impaired glucose tolerance, alongside adipose tissue remodeling and low-grade inflammation. Divergent results appeared in relation to inflammation and lipid deposition in peripheral tissues. Collectively, the need for more standardized, sex-inclusive experimental designs will improve mechanistic insight and translational relevance.
OBJECTIVES:(a) To describe studies that evaluated sarcopenic obesity (SO) in people with HIV (PWH); (b) to summarize the methods and diagnostic criteria used to define SO in PWH; and (c) to estimate the overall prevalence of SO in this population. DESIGN:Scoping review conducted according to established methodological frameworks and reported following PRISMA-ScR recommendations. SETTING AND PARTICIPANTS:Original observational studies conducted in clinical or research settings involving adults (≥ 18 years) with HIV that explicitly applied diagnostic criteria for SO were included. METHODS:Studies were identified through searches in 12 electronic databases from inception to August 2024, without language restrictions. The scoping review followed five stages: identification of the research question, identification and selection of relevant studies, data extraction, and synthesis of findings. Diagnostic approaches for SO included body composition assessed by dual-energy X-ray absorptiometry (DXA) or computed tomography (CT), anthropometric measures such as body mass index (BMI), and functional assessments including handgrip strength and the Short Physical Performance Battery (SPPB). An exploratory random-effects meta-analysis was performed to estimate the overall prevalence of SO in PWH. RESULTS:Three observational studies were included, two from Italy and one from the United States, comprising 2873 participants, predominantly male (n = 2174 [76%]). Mean age ranged from 47 to 52 years, and mean duration of HIV diagnosis and antiretroviral therapy exceeded 10 years. Seven distinct diagnostic criteria for SO were identified, with DXA being the most frequently used method. The prevalence of SO ranged from 0.76% to 20.8%, and the pooled overall prevalence was 8.18%. CONCLUSIONS AND IMPLICATIONS:SO remains insufficiently explored among PWH. The wide variability in diagnostic criteria and assessment methods contributes to inconsistent prevalence estimates, underscoring the need for standardized, population-specific diagnostic approaches.
AIMS:Increased waist-hip ratio (WHR) increases free fatty acid (FFA) flux, contributing to dysglycemia and dyslipidemia in Europeans. We examined these phenomena in non-Europeans, a group with higher prevalence of metabolic disease. METHODS:We undertook sex-stratified analyses of WHR, body composition, HbA1c, lipids and total FFA in people without diabetes (Males: 153,613, Females: 193,574) of European (E, N = 333,465), African (A, N = 2040), African American (AA, N = 2808), South Asian (SA, N = 5121), East Asian (EA, N = 1374), Asian-Pacific Islander (API, N = 570) and Latin American 1 (LA-1, Puerto Rican and Dominican, N = 1400) and Latin American 2 (LA-2, Mexican and Mexican American, N = 409) ancestry as defined by genetic data in the UK Biobank. Sex-matched Es were the comparator group for all analyses. RESULTS:After adjustment for WHR, socioeconomic status, smoking, alcohol use, physical activity and menopause status in females, all groups except LA-2 males had significantly higher HbA1c (p < 2E - 3). Increased FFA and dyslipidemia was only seen in EA and API males but not females. SA males and females had dyslipidemia with no increase in FFA. A and AA males and females had lower FFA and improved lipids, while no significant differences were seen in lipid parameters amongst LA-1 males and females and LA-2 females compared to Es. CONCLUSIONS:Dysglycemia is seen in most non-E ancestries after adjustment for WHR and does not always associate with increased FFA and dyslipidemia. This indicates that factors beyond body composition and lipid flux may contribute to metabolic disease in non-Es.
OBJECTIVE:The aim of the study was to describe the prevalence of comorbidities in patients with severe obesity in Poland and to assess the relationship between the diagnosis of chronic diseases and total weight lost after bariatric surgery in 1 year observation. PATIENTS AND METHODS:The current study is a retrospective analysis that included medical records of 601 patients with data on body weight before and 1 year after bariatric surgery. The total weight loss was calculated as the difference between the initial body weight and body weight after 1 year, divided by the initial body weight, multiplied by 100. The total weight loss was calculated separately for body weight at admission for the surgery (%WL) and maximum recorded body weight (%maxWL). Data on history of all recorded in medical documentation chronic diseases were used. The associations between the presence of chronic diseases at baseline and total weight loss were assessed using multivariable linear regression. RESULTS:Hypertension was the most common chronic disease (71.2%). Patients with hypertension, metabolic syndrome, and chronic obstructive pulmonary disease (COPD) had significantly higher %WL and %maxWL, while those with osteoarthritis and gastroesophageal reflux disease (GERD) had lower %WL and %maxWL. After adjusting for age, sex, and initial body mass index (BMI), the presence of metabolic syndrome and COPD was positively associated with %WL (respectively, beta = 2.405; 95% CI: 0.195-4.615 and beta = 6.522; 95% CI: 1.094-11.951) and with %maxWL (respectively, beta = 2.389; 95% CI: 0.249-4.528 and beta = 6.281; 95% CI: 1.038-11.524). All other diseases and total number of comorbidities were not related to total weight loss. CONCLUSION:Among patients undergoing bariatric surgery, obesity-related comorbidities were highly prevalent at baseline and did not adversely affect postoperative weight loss. Specifically, the presence of metabolic syndrome and COPD was independently associated with a greater 1-year total weight loss.
INTRODUCTION:Experimental studies have demonstrated that obesity increases salt sensitivity, defined as the blood pressure (BP) response to salt intake; however, its relevance within real-world lifestyle modification settings remains uncertain. This study aimed to investigate the cross-sectional and longitudinal associations between daily salt intake and BP according to obesity status. METHODS:This observational study analyzed data from adult men with hypertension who participated in a remote lifestyle modification program. Daily salt intake was estimated from urinary sodium excretion using a validated self-monitoring device and expressed as equivalent sodium chloride (NaCl) (g/day), and home systolic blood pressure (SBP) was recorded. A cross-sectional analysis compared SBP among the tertiles of salt intake at baseline. Longitudinal analysis was used to compare SBP reduction among the tertiles of salt intake reduction over 3 months. These analyses were adjusted for potential confounders and stratified by obesity, defined as body mass index ≥ 25 kg/m2. RESULTS:A total of 1095 participants were included (median age, 57 years; obese, 67.2%). At baseline, higher daily salt intake was associated with higher SBP in the obesity group (lowest tertile, estimated mean; 130.7 mmHg [95% confidence interval 129.2 to 132.3]; middle tertile, 132.2 [130.7 to 133.8]; highest tertile, 133.2 [131.6 to 134.7]; p = 0.028), but not in the nonobese group (p = 0.174). After 3 months, a greater reduction in salt intake was associated with a greater SBP decrease in the obese group (lowest tertile, estimated mean -2.5 [-3.5 to -1.4] mmHg; middle tertile, -3.5 [-4.5 to -2.4] mmHg; highest tertile, -5.2 [-6.3 to -4.1] mmHg; p < 0.001) but not in the nonobese group (p = 0.335). CONCLUSION:These findings suggest that, in real-world lifestyle modification settings, changes in salt intake are associated with changes in BP among adult men with obesity, highlighting the clinical relevance of salt sensitivity for tailored BP management.
OBJECTIVE:This study aimed to investigate the associations of body mass index (BMI), television viewing time, and their combination with the risk of Type 2 diabetes among Japanese individuals using data from a large Japanese prospective cohort study. METHODS:This prospective cohort study included 23,604 Japanese participants (9,284 males and 14,320 females) aged 40-79 years. Baseline data were collected between 1988 and 1990 using a self-administered questionnaire. In the 5-year follow-up survey, Type 2 diabetes was identified through self-reported physician diagnoses. We used a logistic regression model to analyze the associations of BMI and television viewing time, and their combination with the risk of Type 2 diabetes. RESULTS:During the 5-year follow-up, 5.9% of participants developed incident Type 2 diabetes. BMI and prolonged TV viewing time were independently associated with an increased risk of developing Type 2 diabetes. Individuals with obesity (BMI ≥ 30 kg/m2) who viewed TV for ≥ 7 h had a twentyfold increase in diabetes risk (odds ratio: 21.42, 95% confidence interval: 7.23-63.49) compared with those with normal BMI (18.5-24.9 kg/m2) who viewed TV for ≤ 3 h, indicating a significant interaction. CONCLUSIONS:Our study underscores the importance of addressing obesity and sedentary behavior to mitigate Type 2 diabetes risk.
BACKGROUND/OBJECTIVE:Antibiotic exposure by 2 years is linked to increased childhood overweight/obesity risk, mainly in cross-sectional studies. Few longitudinal studies exist in high-risk populations, and none examined BMI trajectories up to 18 years. Our study is the first to investigate the association between early antibiotic exposure and BMI trajectories in a high allergy-risk cohort. METHODS:We analysed data from 428 participants in the Melbourne Atopy Cohort Study from birth to 18 years. Antibiotic use < 2 years was categorized as "ever versus never" and according to seven antibiotic classes. Number of courses (7 days) and the spectrum of antibiotics (broad versus narrow) were defined for each antibiotic class. Logistic regression models estimated associations between antibiotic use (any/specific), courses (0, 1, 2, and ≥ 3), and previously defined BMI trajectories from 4 weeks to 18 years: very low catch-up, low average, stable average (reference), average increasing to very high (AIVH), and persistently high (PH). RESULTS:We found consistent evidence of a relationship between antibiotic exposure by 2 years and increased risk of belonging to AIVH and PH trajectories, with magnitudes of effect differing by antibiotic spectrum and frequency. Notably, exposure to ≥ 3 courses of broad-spectrum antibiotic was associated with the AIVH (aOR = 3.36 [95% CI: 1.03, 10.87]) and PH trajectories (aOR = 3.29 [95% CI: 1.03, 10.53]). CONCLUSION:These findings may have important clinical implications, but further large-scale studies are required.
BACKGROUND AND AIMS:Reducing atherogenic lipoproteins to lower cardiovascular risk is a key objective in obesity treatment. Accurate lipoprotein measurements are essential for determining the need for therapy and guiding its management. To identify the best equation for estimating LDL cholesterol, LDL measured directly (LDL-D) is compared to LDL calculated using equations developed by Friedewald (LDL-F), Martin (LDL-M) and Sampson/NIH (LDL-S). This study also examines the change of LDL and apolipoprotein B levels during a multidisciplinary obesity treatment programme. METHODS:This retrospective observational study included 308 adult patients with obesity who participated in a single-centre, multidisciplinary treatment programme using meal replacement (Optifast-professional). This study employed Pearson's correlations, repeated-measures analyses of variance (ANOVA) and a paired t-test and also compared calculated values against desirable bias and total allowable error. RESULTS:The absolute values of LDL-M and LDL-S showed less bias and correlated better with LDL-D than LDL-F. All equations significantly underestimated absolute LDL values: LDL-F (mean -12.43 mg/dL, p < 0.001), LDL-M (mean -10.05 mg/dL, p < 0.001) and LDL-S (mean -9.49 mg/dL, p < 0.001). LDL-F also underestimated the change occurring during the programme (3.81 mg/dL; p = 0.017). All equations performed poorly against desirable bias and total allowable error. LDL-D, LDL-F, LDL-M, LDL-S and ApoB levels all decreased significantly, and these decreases remained significant after excluding patients taking lipid-lowering medications. CONCLUSIONS:LDL estimation equations systematically underestimated LDL in individuals with obesity. Among these, the Martin equation most accurately captured changes in LDL. Consequently, it appears to be the most suitable estimation method. However, direct measurement should remain the preferred method. The multidisciplinary meal replacement programme significantly reduced LDL cholesterol and ApoB.
BACKGROUND:Obesity is a major public health challenge, and its prevalence is increasing in most countries around the world and across all age groups. OBJECTIVE:This study aims to identify the correspondence and factors associated with the nutritional status of children aged 7-10 years and their parents/guardians registered in Family Health Units in a metropolitan region in southeastern Brazil. METHODS:Cross-sectional study with a convenience sample was carried out in 26 Family Health Units in four municipalities in the Metropolitan Region of Vitória/ES, between July and December/2021. An anthropometric examination was performed, and sociodemographic and lifestyle data were collected. Nutritional status was classified using body mass index (BMI). Multinominal logistic regression models were tested, adopting p < 0.05. RESULTS:Around 56.5% of children classified as obese had parents/guardians with obesity. A greater chance of being obese was observed in adults aged > 30 years (OR: 2.34; 95% CI: 1.35; 4.06), Black race/color (OR: 2.82; 95% CI: 1.25; 6.33), and self-perceived health as regular/poor/very poor (OR: 4.12; 95% CI: 2.28; 7.42). CONCLUSION:Children's nutritional status is only associated with that of their parents/guardians, especially when they have obesity. Higher age range, Black race/color, and worse self-perceived health were associated with obesity in adults. Public policies should be implemented to tackle obesity at all levels, including the promotion of adequate nutrition, self-care regarding health, and the encouragement of physical activity within the context of primary healthcare.
BACKGROUND:Severe obesity (body mass index [BMI] of 40 kg/m2 or higher) poses significant health risks. It reflects a multifaceted interplay of genetic, behavioral, and environmental factors, contributing to rising rates of metabolic diseases and reduced quality of life. This study aimed to examine the prevalence and risk factors of severe obesity among adults in the United States. METHODS:We analyzed data from the National Health and Nutrition Examination Survey (NHANES), a complex, multistage, cross-sectional survey, designed to collect health and nutritional data from a representative sample of the civilian noninstitutionalized U.S. POPULATION:A total of 6729 respondents from the 2017 to March 2020 cycle of NHANES were included in the analysis. Descriptive statistics were used to summarize the characteristics of the sample. Multivariable logistic regression models were utilized to study risk factors for severe obesity. All analyses accounted for the complex survey design of the NHANES. RESULTS:The weighted prevalence of severe obesity among adults was 9.4%, with a higher rate found in females, 11.9%, compared to males, 6.2%. Binary logistic regression analysis revealed that males had 39% lower odds of severe obesity compared to females (odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.32-1.14), though this was not statistically significant. Participants aged 31-40 years were more than twice as likely to have severe obesity compared to those aged 20-30 years (OR: 2.73, 95% CI: 1.07-6.96). Non-Hispanic Asians had significantly lower odds of severe obesity than Mexican Americans (OR: 0.06, 95% CI: 0.01-0.27). Arthritis nearly doubled the odds of severe obesity (OR: 1.94, 95% CI: 1.17-3.22), and high blood pressure showed the strongest relationship, increasing odds more than fourfold (OR: 4.42, 95% CI: 3.30-5.91). Marital status, health insurance, and income level showed no significant associations with severe obesity. These findings highlight the complex interplay of factors influencing severe obesity. CONCLUSION:In conclusion, the study highlights a significant prevalence of severe obesity among adults in the United States, particularly among females, individuals aged 31-40 years, and those with specific comorbid conditions such as high blood pressure and arthritis. Non-Hispanic Asians exhibited notably lower odds of severe obesity compared to other racial/ethnic groups, underscoring potential protective factors. The findings emphasize the multifactorial nature of severe obesity, driven by demographic, behavioral, and health-related factors, and underline the importance of tailored interventions to address this public health challenge.
OBJECTIVE:To estimate the prevalence of overweight at 36 months of age and that of persistent overweight in an Italian birth cohort and to identify factors related to an increased likelihood of having overweight. METHODS:The Italian NASCITA birth cohort was analysed. Children were classified in the underweight, normal or overweight range at 12, 24 and 36 months of age according to the World Health Organization percentiles, and the prevalence of overweight (≥ 85th centile) was estimated. Persistent overweight was defined as having overweight in all three assessments. To test the association between the chance of having overweight, and parental and child characteristics, healthy newborns with appropriate for gestational age birth weight were selected, and univariate and multivariate analyses were performed. RESULTS:The prevalence of overweight was 22.7% at 12 months of age and 21.2% at 36 months (chi square-for-trend = 1.5 and p = 0.21). In all, 8.8% of the children had persistent overweight. Overweight at 12 months (RR: 3.28 and 95% CI: 2.69-4.00) and a big appetite (RR: 2.00 and 95% CI: 1.59-2.52) were the main factors associated with greater likelihood of overweight at 36 months, while excessive appetite and frequency of interaction with electronic devices were the main determinants of persistent overweight. CONCLUSIONS:The body mass index status at 12 months greatly influenced that at 36 months. The increased risk of persistent overweight in children interacting with electronic devices suggests that extreme caution in allowing preschool children to use smartphone or tablets should be adopted. Furthermore, nutritional education of the entire family is essential to appropriately guide children's appetite.
BACKGROUND:Obesity is a chronic, multifactorial disease associated with significant cardiometabolic, psychological, and socioeconomic consequences. Its complex etiology necessitates integrated, evidence-based management strategies beyond simple caloric restriction. OBJECTIVE:This narrative review aims to critically evaluate current and emerging weight management strategies, including lifestyle interventions, dietary patterns, behavioral approaches, pharmacotherapy, and bariatric procedures, with attention to efficacy, limitations, sustainability, and real-world applicability. METHODS:A structured literature search was conducted using PubMed, Scopus, ScienceDirect, and Google Scholar to identify relevant peer-reviewed articles on obesity management. Studies addressing dietary strategies, physical activity, behavioral therapy, antiobesity medications, and surgical or endoscopic interventions were included. Evidence was synthesized narratively, emphasizing comparative effectiveness, safety considerations, and long-term challenges. RESULTS:Lifestyle interventions remain the foundation of obesity management; however, long-term success is often limited by physiological adaptations, behavioral factors, and socioeconomic barriers. Among dietary approaches, differences in weight loss tend to diminish over time, highlighting adherence and sustainability as key determinants of success. Pharmacotherapy has advanced significantly, particularly with incretin-based agents such as GLP-1 receptor agonists and dual GIP/GLP-1 agonists, which produce substantial weight loss and cardiometabolic benefits but require ongoing use and may be limited by cost and tolerability. Bariatric surgery remains the most effective long-term intervention for severe obesity, while less invasive endoscopic procedures are expanding treatment options. Behavioral and psychological support plays a critical role in improving adherence across all interventions. CONCLUSION:Effective obesity management requires a personalized, multidisciplinary approach integrating sustainable lifestyle strategies with pharmacological or procedural therapies when appropriate. While recent therapeutic innovations have expanded treatment possibilities, long-term success depends on behavioral support, accessibility, and continued evaluation of safety and cost-effectiveness.
PURPOSE:MicroRNA (miRNA) profiling of visceral adipose tissue in Type-2 diabetes mellitus (T2DM) remains limited. We compared the expression of obesity-associated miRNAs in visceral fat from individuals with T2DM versus metabolically healthy obesity (MHO) and examined Raf kinase inhibitory protein (RKIP) as a candidate miR-543 target. METHODS:Visceral fat biopsies were obtained from adults with T2DM (n = 8) and MHO (n = 11). Thirteen miRNAs previously linked to obesity were quantified, and RKIP expression was evaluated at the mRNA level and by immunohistochemistry, including phosphorylated RKIP (pRKIP). RESULTS:Of the 13 miRNAs analyzed, miR-23a-3p and miR-543 were upregulated in T2DM (p = 0.032 and p = 0.009, respectively), whereas miR-320a-3p was downregulated (p = 0.009). RKIP mRNA levels did not differ between groups; however, in MHO adipocytes, RKIP mRNA correlated positively with miR-543 expression (r = 0.655, p = 0.034). Total RKIP protein was comparable between groups, while pRKIP was significantly higher in T2DM adipocytes (p = 0.012). CONCLUSIONS:Posttranscriptional regulation in visceral adipocytes differs between T2DM and MHO. Increased miR-543 and elevated pRKIP in T2DM suggest a rapid shift in regulatory signaling consistent with enhanced lipolysis and a proinflammatory milieu. Further studies are warranted to delineate the pRKIP-associated pathways in adipose tissue remodeling in T2DM.
BACKGROUND:Dietary supplements are commonly marketed for weight loss, yet contemporary national data remain limited on the prevalence of use, types of products used, and whether use is provider-recommended among U.S. adults with obesity. METHODS:We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2020. Participants included adults with obesity. They were asked about behaviors on dietary supplements for weight loss. We estimated survey-weighted prevalence overall and by survey cycle, assessed linear trends over time, and used survey-weighted multivariable logistic regression to examine associations with age, sex, race/ethnicity, education, and poverty-income ratio. Among users, we described whether supplement use was recommended by healthcare providers and summarized supplement categories. RESULTS:Among 27,116 adults with obesity, 1706 reported using dietary supplements for weight loss. The survey-weighted prevalence of weight-loss supplement use was 5.9% and varied across survey cycles (p for trend = 0.003). Compared with adults aged 20-39 years, odds of use were lower among those aged 40-59 years (adjusted odds ratio [aOR] 0.60, 95% CI 0.45-0.80) and ≥ 60 years (aOR 0.15, 95% CI 0.11-0.22). Females had higher odds of use than males (aOR 1.46, 95% CI 1.13-1.87). Education was positively associated with use, whereas poverty-income ratio was not significantly associated. The use differed by race/ethnicity, with non-Hispanic White adults having lower odds of use compared with Hispanic adults. Among users, 81% reported use without medical advice, and it was more common among males and younger adults. The most frequently used supplements included multivitamin-minerals (28.8%), botanical products (20.0%), and single vitamins (15.2%). CONCLUSIONS:Approximately 6% of U.S. adults with obesity reported using dietary supplements for weight loss, most without clinician recommendation and with significant demographic differences. Routine clinical assessment of supplement use and counseling regarding limited efficacy and potential safety concerns are warranted.
BACKGROUND:Overweight and obesity are defined by body mass index (BMI); however, this indicator does not address the wide variability that exists in metabolic health for a given BMI. This largely depends on adipose tissue functionality and location, with larger visceral depots elevating inflammation and cardiometabolic risk. The visceral adiposity index (VAI) provides a closer approach to adipose tissue functionality; however, there are limited studies addressing its ability to identify differences in metabolic health among young adults with excess weight. We evaluated whether low versus high VAI (L-VAI vs. H-VAI) groups differ in body composition, endocrine and metabolic indicators, and indices of metabolic risk and adipose tissue function. METHODS:Fifty-two healthy adult males with BMI ≥ 25 kg/m2 were evaluated in this cross-sectional study. Subjects were classified as L-VAI or H-VAI according to the VAI cutoff proposed for adipose tissue dysfunction (> 2.52). Weight, height, arterial blood pressure, body composition, and metabolic/endocrine parameters were compared in L-VAI versus H-VAI groups. RESULTS:Subjects in the H-VAI group (∼40%) showed greater truncal fat mass and lower adiponectin/leptin ratio (Ad/Lep), as well as greater indices of insulin resistance (HOMA-IR and triglyceride/glucose) and the metabolic syndrome severity score. Significant positive correlations were found between VAI and the cardiovascular risk and metabolic syndrome-related factors, plasminogen activator inhibitor-1 (PAI-1), uric acid, and HOMA-IR and an inverse association with adiponectin and Ad/Lep. CONCLUSIONS:Our observations indicate that VAI is a useful tool to assess cardiometabolic risk and adipose tissue functionality in young adult males with overweight and obesity.
AIMS:To explore the association of endocrine hormones and hypothalamic neuropeptides fluctuations within normal level with obesity in women of childbearing age. MATERIALS AND METHODS:Laboratory data of women in childbearing age with normal levels of endocrine hormones and hypothalamic neuropeptides in Heilongjiang Provincial Hospital between March 2022 and October 2022 were retrospectively collected. Included subjects were divided into obese group and normal weight group according to body mass index. RESULTS:80 subjects were included in final analysis, including 37 in the obese group and 43 in the normal weight group. Within the normal range, the levels of cortisol, adrenocorticotropic hormone, free triiodothyronine, free thyroxine, follicle-stimulating hormone, neuropeptide Y, and orexin were positively correlated with body mass index, while the levels of estradiol and oxytocin were negatively correlated with body mass index; the levels of adrenocorticotropic hormone, thyroid-stimulating hormone, neuropeptide Y, and orexin were positively correlated with triglycerides, while proopiomelanocortin level was negatively correlated with triglycerides; neuropeptide Y level was positively correlated with total cholesterol, and cortisol level was negatively correlated with high-density lipoprotein cholesterol. Elevated levels of neuropeptide Y and orexin were independent risk factors for obesity (OR = 1.123, 95% CI = 1.023-1.232, p = 0.015; OR = 4.004, 95% CI = 1.174-13.656, p = 0.027), while increase in oxytocin level was an independent protective factor (OR = 0.833; 95% CI = 0.697-0.995; p = 0.044). CONCLUSIONS:Among women of childbearing age, fluctuations in multiple endocrine hormones and hypothalamic neuropeptides within the normal range play a crucial role in regulating body weight and plasma lipids. Specifically, relatively higher levels of neuropeptide Y and orexin increase obesity risk, while elevated oxytocin levels reduce this risk. These identified biomarkers may offer candidates for subsequent mechanistic research and clinical interventions.
INTRODUCTION:Various anthropometric and dietary indicators influence insulin resistance (IR), and lipid biomarkers may play a pivotal mediating role in these relationships. To investigate the mediating effects of lipid biomarkers on the relationships between anthropometric, dietary indicators, and IR, and the moderating role of sex in these associations. METHODS:A hospital-based cross-sectional study was conducted with 169 participants. Parallel mediation models assessed the mediating effects of lipid biomarkers (triglycerides, HDL, LDL, and total cholesterol) on the relationships between anthropometric (BMI, waist circumference, waist-to-hip ratio, and waist-to-height ratio) and dietary indicators (at least one starchy staple, at least one fruit, consumed all five recommended food groups (ALL-5), global dietary recommendations (GDR) score, and noncommunicable disease risk/protect scores) and IR. Moderated mediation analyses evaluated the moderating effect of sex. Statistical analyses were bootstrapped. RESULTS:The cumulative effect of lipid biomarkers fully mediated the relationship between WHtR and IR (Indirect Coef. = 0.65; 95% CI [0.02, 1.70]). TG significantly mediated the associations between WHR and IR (indirect Coef. = 0.55; 95% CI [0.11, 2.63]), BMI and IR (indirect Coef. = 0.76; 95% CI [0.17, 2.27]), and WC and IR (indirect Coef. = 0.72; 95% CI [0.04, 2.63]). Furthermore, LDL-C (Indirect Coef. = 1.99; 95% CI [0.24, 9.61]) and HDL-C (Indirect Coef. = 0.55; 95% CI [0.03, 2.57]) mediated the relationships of starchy staple and fruit intake with IR, respectively. Sex moderated the direct effect of WC on IR (interaction Coef. = 5.11, p = 0.002) but did not moderate the indirect pathways involving lipid biomarkers. CONCLUSIONS:These findings elucidate the intricate interplay between body composition, diet, lipid biomarkers, sex, and IR, providing insights for developing targeted prevention and intervention strategies to combat IR.
Introduction:Imagine a surgeon's critical decision: Should the gallbladder be removed now, along with the planned bariatric surgery, or risk the complication and necessity of a second surgery later? This clinical dilemma is central to treating morbidly obese patients, who face a high prevalence of gallstone disease exacerbated by rapid postoperative weight loss. The best approach to managing existing gallstones in bariatric candidates remains debated, with debate focusing on whether combining laparoscopic cholecystectomy (LC) with bariatric surgery is both safe and advantageous. In this pilot study, we provide randomized evidence to guide this decision. Methods:In this prospective randomized controlled pilot study, 58 morbidly obese patients with ultrasound-confirmed gallstones were randomly assigned to two groups: Group I (n = 30) received bariatric surgery and LC; Group II (n = 28) had bariatric surgery only, with LC delayed for symptoms. The primary outcomes were clearly defined as operative time, intraoperative complications, and postoperative morbidity, providing a focused measure of safety and efficacy. Secondary outcomes included hospital stay, pain, and follow-up gallstone symptoms. Results:Baseline demographics and comorbidities were similar across groups. Operative time was longer in Group I (98.93 ± 11.58 min) than in Group II (75.18 ± 11.26 min, p < 0.001). An extra port was used in 20% of Group I patients, compared with none in Group II (p = 0.012). No significant differences were observed in bleeding, bile leakage, postoperative complications, or hospital stay. Group I reported higher pain scores (p < 0.001). During follow-up, 79.3% of Group II developed symptomatic gallstones, requiring later cholecystectomy. Conclusion:Concomitant LC during bariatric surgery in morbidly obese patients with pre-existing gallstones is demonstrated to be safe and feasible, with acceptable increases in operative time and postoperative pain. The high rate (79.3%) of symptomatic gallstone development in patients who did not undergo concomitant cholecystectomy supports adopting routine concomitant LC to prevent future morbidity, thereby influencing clinical decision-making and standard practice. Trial Registration: ClinicalTrials.gov: NCT04567890.
