Baseline Obesity Research Articles

Psychological attributes and eating behaviors in 5- to 12-year-old children during periods of stress.

The objective of this study was to investigate the association between psychological attributes and obesogenic behaviors in children during the period of COVID-19 pandemic-induced stress. This observational study collected data from caregivers of 5- to 12-year-old children from three diverse groups assessing sociodemographic, economic, and perceived stress, along with the Strengths and Difficulties Questionnaire (SDQ) and the Family Eating and Activity Habits Questionnaire, revised (FEAHQ-R), in October 2020 and June 2021. The outcome measures were SDQ and FEAHQ-R scores. The SDQ subscales were compared with US child norms. Linear mixed models were used to examine the association between the SDQ subscales and FEAHQ-R domains, adjusting for socioeconomic covariates. A total of 361 families (496 children) completed the SDQ and FEAHQ-R. The SDQ subscale scores were higher than those of age/gender norms (p = 0.006-<0.001). Eating style (p < 0.001) and food stimulus exposure scores (p = 0.005-0.01) were associated with the SDQ subscales, but not satiety response. Perceived stress was a significant covariate (p < 0.01). The baseline obesity status of the children was not statistically significant. Psychological stress is associated with higher hedonic behavior in children. Food stimulus exposure and leisure access can be targeted for intervention during periods of prolongedstress.

Association between higher glucose levels and reduced survival in patients with non-small cell lung cancer treated with immune checkpoint inhibitors

BackgroundObesity and hypercholesterolemia have been associated with better responses to ICIs in NSCLC, while type 2 diabetes (T2D) has been associated with a worse response. However, the association between glucose levels and outcomes remains unknown. This study investigated the impact of mean baseline glucose levels, T2D, dyslipidemia, and obesity on overall survival (OS) in NSCLC patients undergoing ICI therapy. MethodsA multicenter retrospective cohort study was conducted using data from three medical centers, with locally advanced or metastatic NSCLC patients receiving ICI, regardless of treatment line or concurrent therapy. Random venous glucose levels within 4 weeks prior to ICI initiation, BMI, history of dyslipidemia, and T2D, along with OS, were assessed. Patients with BMI < 18.5 were excluded. ResultsAmong 438 patients, those with the highest quartile of baseline glucose levels had significantly shorter OS compared to those in the lowest quartile (HR, 1.53; 95 % CI, 1.08 – 2.15; p-value = 0.016). This association remind consistent after adjusting for steroid use, diabetes, performance status and glucose-lowering medication use. These effects were consistently observed in subsets of patients treated with ICI monotherapy and with PD-L1 TPS ≥ 1 %. ConclusionHigher mean baseline glucose levels correlated with shorter survival in patients with NSCLC treated with ICIs. The divergent effects of individual metabolic syndrome components on ICI response in patients with NSCLC underscore the complexity of metabolic influences on treatment outcomes.

Accounting for time-varying exposures and covariates in the relationship between obesity and diabetes: analysis using parametric g-formula

BackgroundPrevious studies investigating the association between obesity and diabetes often did not consider the role of time-varying covariates affected by previous obesity status. This study quantified the association between obesity...

Effect of a Multifactorial Weight Loss Intervention on HDL Cholesterol Efflux Capacity and Immunosenescence: A Randomized Controlled Trial

Objective Life expectancy and obesity prevalence are increasing worldwide, leading to an increase in the prevalence of cardiovascular disease. High-density lipoprotein (HDL) functionality and immunosenescence play key roles in cardiovascular disease, longevity, and quality of aging. Both molecular hallmarks of aging are impacted by obesity and metabolic syndrome and can be modulated by lifestyle. We aimed to evaluate the effect of a lifestyle intervention focused on an energy-reduced Mediterranean diet (erMedDiet), physical activity (PA), and behavioral support on HDL cholesterol efflux capacity (CEC) and immunosenescence. Method CEC and immunosenescent T cells were determined in 60 participants from the control group (CG) and 56 from the intervention group (IG) of the PREDIMED-Plus trial at baseline and after 1 and 3 years of follow-up. PREDIMED-Plus is a randomized, controlled, parallel-group trial with an IG of erMedDiet, PA promotion, and behavioral support for weight loss and a CG of usual primary care advice. The sample included 116 volunteers from the PREDIMED-Plus-IMDEA subsample of the PREDIMED-Plus trial. Men aged 55 to 75 years and women aged 60 to 75 years with a body mass index between 27 and 40 kg/m2 and metabolic syndrome were included. Results Participants within the IG had significantly improved CEC (2.42% and 10.69% after 1 and 3 years of follow-up) and a decreased in senescent T cell profile (−3.32% ± 12.54% and −6.74% ± 11.2%, p < 0.001, after 1 and 3 years of follow-up). Baseline obesity status impacted the response to the intervention. Conclusions A weight loss intervention program with erMedDiet and PA ameliorated senescence markers.

Gut-muscle communication links FGF19 levels to the loss of lean muscle mass following rapid weight loss

ObjectiveOptimal weight loss involves decreasing adipose tissue while preserving lean muscle mass. Identifying molecular mediators that preserve lean muscle mass is therefore a clinically important goal. We have shown that circulating, postprandial FGF19 levels are lower in patients with obesity and decrease further with comorbidities such as type 2 diabetes and MASLD. Preclinical studies have shown that FGF15 (mouse ortholog of human FGF19) is necessary to protect against lean muscle mass loss following metabolic surgery-induced weight loss in a mouse model of diet-induced obesity. We evaluated if non-surgical weight loss interventions also lead to increased systemic levels of FGF19 and whether FGF19 levels are predictive of lean muscle mass following rapid weight loss in human subjects with obesity. Research design and methodsWeight loss was induced in 176 subjects with obesity via a very low-energy diet, VLED (800 kcal/d) in the form of total liquid meal replacement for 3-4 months. We measured plasma FGF19 levels at baseline and following VLED-induced weight loss. Multiple linear regression was performed to assess if FGF19 levels were predictive of lean mass at baseline (obesity) and following VLED. ResultsPostprandial levels of FGF19 increased significantly following VLED-weight loss. Multiple linear regression analysis showed that baseline (obesity) FGF19 levels, but not post VLED FGF19 levels, significantly predicted the percent of lean muscle mass after VLED-induced weight loss, while controlling for age, sex, and the baseline percent lean mass. ConclusionThese data identify gut-muscle communication and FGF19 as a potentially important mediator of the preservation of lean muscle mass during rapid weight loss.

Chemotherapy and Metabolic Syndrome: A Comprehensive Review of Molecular Pathways and Clinical Outcomes.

Cancer therapies, notably chemotherapy, have significantly improved survival rates and quality of life for many patients. However, chemotherapy's cytotoxic effects also impact normal cells, leading to adverse effects, including metabolic disturbances. This paper explores the link between chemotherapy and metabolic syndrome, a cluster of metabolic abnormalities that increase the risk of cardiovascular diseases and type 2 diabetes. Understanding the predictors, such as specific chemotherapy regimens, patient characteristics, comorbid conditions, lifestyle factors, and genetic variations, is crucial for formulating personalized care plans and preventive strategies. Research indicates that older age, female gender, pre-existing diabetes, and baseline obesity are significant predictors of metabolic syndrome in cancer patients. Chemotherapy-induced molecular changes, including insulin resistance, dyslipidemia, chronic inflammation, oxidative stress, and tissue fibrosis, contribute to the development of this syndrome. Effective management strategies require a multidisciplinary approach, incorporating lifestyle interventions, pharmacological treatments, and regular monitoring. This paper underscores the importance of personalized medicine in mitigating the risks associated with metabolic syndrome and improving long-term health outcomes for cancer survivors. Future research directions include longitudinal studies to track metabolic health over time, mechanistic studies to uncover the molecular pathways involved, and the development of integrative therapies. By adopting comprehensive care models, healthcare providers can enhance the overall quality of life for cancer survivors, addressing both cancer and metabolic health challenges.

Predictors of patient satisfaction in the surgical treatment of cervical spondylotic myelopathy.

Patients with cervical spondylotic myelopathy (CSM) experience progressive neurological impairment. Surgical intervention is often pursued to halt neurological symptom progression and allow for recovery of function. In this paper, the authors explore predictors of patient satisfaction following surgical intervention for CSM. This is a retrospective review of prospectively collected data from the multicenter Quality Outcomes Database. Patients who underwent surgical intervention for CSM with a minimum follow-up of 2 years were included. Patient-reported satisfaction was defined as a North American Spine Society (NASS) satisfaction score of 1 or 2. Patient demographics, surgical parameters, and outcomes were assessed as related to patient satisfaction. Patient quality of life scores were measured at baseline and 24-month time points. Univariate regression analyses were performed using the chi-square test or Student t-test to assess patient satisfaction measures. Multivariate logistic regression analysis was conducted to assess for factors predictive of postoperative satisfaction at 24 months. A total of 1140 patients at 14 institutions with CSM who underwent surgical intervention were included, and 944 completed a patient satisfaction survey at 24 months postoperatively. The baseline modified Japanese Orthopaedic Association (mJOA) score was 12.0 ± 2.8. A total of 793 (84.0%) patients reported satisfaction (NASS score 1 or 2) after 2 years. Male and female patients reported similar satisfaction rates (female sex: 47.0% not satisfied vs 48.5% satisfied, p = 0.73). Black race was associated with less satisfaction (26.5% not satisfied vs 13.2% satisfied, p < 0.01). Baseline psychiatric comorbidities, obesity, and length of stay did not correlate with 24-month satisfaction. Crossing the cervicothoracic junction did not affect satisfactory scores (p = 0.19), and minimally invasive approaches were not associated with increased patient satisfaction (p = 0.14). Lower baseline numeric rating scale neck pain scores (5.03 vs 5.61, p = 0.04) and higher baseline mJOA scores (12.28 vs 11.66, p = 0.01) were associated with higher satisfaction rates. Surgical treatment of CSM results in a high rate of patient satisfaction (84.0%) at the 2-year follow-up. Patients with milder myelopathy report higher satisfaction rates, suggesting that intervention earlier in the disease process may result in greater long-term satisfaction.

Low CD4 counts predict excessive weight gains during first-line treatment for HIV.

Weight gain is common after antiretroviral initiation, especially among females, those of black race and lower baseline CD4, although this may potentially be due to lower baseline weight. Use of tenofovir disoproxil fumarate or efavirenz can suppress weight gain. Data were pooled from the ADVANCE (n = 1053), NAMSAL (n = 613) and WHRI001 (n = 536) trials investigating first-line regimen. Week 96 weight and body mass index (BMI) was stratified by baseline CD4. Multivariable models of weight change and incident obesity (BMI ≥30 kg/m2) were adjusted for baseline CD4, age, sex, tenofovir disoproxil fumarate, efavirenz, baseline BMI and trial. Participants across all treatment arms experienced weight gain from baseline to week 96, with baseline CD4 count, baseline HIV RNA, tenofovir alafenamide and dolutegravir use, and female sex significant predictors. Mean unadjusted weight change was highest with CD4 < 100 (+8.6 kg; SD = 8.2) and lowest with CD4 ≥ 350 (+3.0 kg; SD = 6.5). This weight gain in CD4 < 100 was highest for participants on tenofovir alafenamide-inclusive treatment, such that absolute weight at week 96 was highest in the CD4 < 100 group. Although not statistically significant, obesity rate (BMI ≥ 30 kg/m2) in those taking TAF/FTC + DTG with CD4 < 100 overtook that seen in CD4 ≥ 350, despite lower baseline obesity prevalence. The unadjusted findings were corroborated in multivariable longitudinal models. Participants with low CD4 may demonstrate significant 'overshoot' weight gain, in addition to 'return to health', with a trend towards increased risk of obesity when initiated on TAF/FTC + DTG. Use of tenofovir disoproxil fumarate and efavirenz were associated with smaller weight gains. Effective weight management strategies are needed, especially for individuals with low baseline CD4.

Improving Obesity Outcomes in an Academic Clinic: A Quality Improvement Study

Introduction: Obesity is a chronic disease that affects more than 40% of the population in the United States. The prevalence of severe obesity doubled in the past two decades. Primary care providers are usually the first to screen patients for obesity. According to a 2018 study. Only 55% of adults with obesity were reported to have received the diagnosis of obesity and less than a third of the patients followed up for an obesity-specific visit. The management of obesity is multifactorial with lifestyle modifications and pharmacological and psychological therapies. In our academic clinic, there was a gap in comprehensive satisfactory obesity counseling, which addresses lifestyle modifications and adjunctive pharmacological therapies. Addressing this gap with an obesity-specific visit helps clinicians to discuss available options to manage obesity. Improvement in body weight is linked with improved control of hypertension, diabetes, and heart disease leading to improved health outcomes. Aim: To improve obesity counseling rates and usage of standardized obesity templates in an academic clinic by 25% in 3 months. Method: We used the IHI model of improvement using the plan-do-study-act framework to test changes on a small scale and guide the quality improvement study. To better address our aim, we divided our QI project into 2 cycles. For PDSA-1, a thorough chart search for the last 3 months was done to calculate a baseline obesity counseling rate. A root-cause analysis was completed with multi-disciplinary input from faculty, clinic staff, and residents, and several existing barriers that preclude satisfactory obesity counseling were identified. Proposed interventions corresponding to each root cause were plotted on an impact effort matrix. Interventions with the least effort and the most impact were selected as proposed solutions. These included creating a short education session on obesity management and creating an obesity counseling template. Post-intervention, the obesity counseling rates and use of the template were recorded on a run chart. For PDSA-2, we introduced an obesity assessment and plan (A/P) template, with the goal to incorporate all aspects of obesity management, i.e., lifestyle modification, diet, exercise, and screening for disease related co-morbidities. Results: Satisfactory obesity counseling prior to intervention was 32%. The first PDSA cycle post-intervention showed an improvement in the obesity counseling rates to 56%. About 20% of the clinic notes for the counseled patients used the proposed template. About 8% of the counseled patients agreed to a separate obesity-specific visit. The second PDSA cycle showed 20.1% usage of the standardized A/P plan template. In the group that the template was used, there was 63.6% reduction in BMI; compared to 39.4% BMI reduction in group without template usage. (OR= 2.34, p=0.034. Next steps: We noted an overall improvement in the obesity counseling rates after our interventions. However, we noticed that the A/P template usage did not meet our goal of 25% usage. We will conduct multidisciplinary team meetings to understand measures that can be undertaken to improve usage of A/P template. Patients will also be encouraged to have an obesity-specific visit.

Incident diabetes among older Asian, Native Hawaiian, and Pacific Islander women with breast cancer.

The risk of diabetes among Asian, Native Hawaiian, and Pacific Islander (ANHPI) women after breast cancer is unclear. This study estimated the risk of incident type II diabetes in older ANHPI and older non-Hispanic White (NHW) women with breast cancer from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Medicare linked claims. A matched cohort of 7122 older ANHPI and 21 365 older NHW women with breast cancer were identified from SEER-Medicare between 2000 and 2017. To assess the risk of incident type II diabetes after breast cancer, hazard ratios (HRs) and 95% confidence intervals (95% CI) were estimated using the Cox proportional-hazards regression model. During the mean 8 years of follow-up, 9.3% of older women with breast cancer developed incident type II diabetes. In comparison with older NHW women, older ANHPI women without a known history of diabetes had an elevated risk of diabetes after breast cancer, with strong associations observed for Pacific Islander (HR = 3.09, 95% CI = 1.43 to 6.67), Vietnamese (HR = 2.12, 95% CI = 1.33 to 2.36), and Filipino (HR = 2.02, 95% CI = 1.57 to 2.59) women with breast cancer, adjusting for potential confounders. Among ANHPI women with breast cancer, more baseline comorbidities and obesity were risk factors for developing incident type II diabetes. ANHPI women diagnosed with breast cancer had an elevated risk of type II diabetes compared with older NHW women with breast cancer. Routine monitoring and management of diabetes are warranted in older ANHPI women with breast cancer.

Pangenomic analysis identifies correlations between Akkermansia species and subspecies and human health outcomes.

Aim: Akkermansia are common members of the human gastrointestinal microbiota. The prevalence of these mucophilic bacteria, especially Akkermansia muciniphila (A. muciniphila), correlates with immunological and metabolic health. The genus Akkermansia in humans includes species with significantly larger genomes than A. muciniphila, leading us to postulate that this added genetic content may influence how they impact human metabolic and immunological health. Methods: We conducted a pangenomic analysis of 234 Akkermansia complete or near-complete genomes. We also used high-resolution species and subspecies assignments to reanalyze publicly available metagenomic datasets to determine if there are relationships between Akkermansia species and A. muciniphila clades with various disease outcomes. Results: Analysis of genome-wide average nucleotide identity, 16S rRNA gene identity, conservation of core Akkermansia genes, and analysis of the fatty acid composition of representative isolates support the partitioning of the genus Akkermansia into several species. In addition, A. muciniphila sensu stricto, the most prevalent Akkermansia species in humans, should be subdivided into two subspecies. For a pediatric cohort, we observed species-specific correlations between Akkermansia abundance with baseline obesity or after various interventions. For inflammatory bowel disease cohorts, we identified a decreased abundance of Akkermansia in patients with ulcerative colitis or Crohn's disease, which was species and subspecies-dependent. In patients undergoing immune checkpoint inhibitor therapies for non-small cell lung carcinoma, we observed a significant association between one A. muciniphila subspecies and survival outcomes. Conclusion: Our findings suggest that the prevalence of specific Akkermansia species and/or subspecies can be crucial in evaluating their association with human health, particularly in different disease contexts, and is an important consideration for their use as probiotics.

Prevalence of obesity and its impact on outcome in children diagnosed with cancer in Canada: A population-based study.

10517 Background: Childhood obesity can result in a variety of adverse health outcomes. Objectives were to describe the prevalence of obesity and determine the association between baseline obesity with event-free survival (EFS) and overall survival (OS) in children diagnosed with cancer in Canada. Methods: We conducted a retrospective cohort study using the Cancer in Young People in Canada database, a population-based surveillance program collecting data from all cancer patients &lt; 15 years old before 2015 and &lt; 19 years old after 2015. This study included all children with newly diagnosed cancer aged 2 to 18 years across Canada from 2001 to 2020. Obesity was defined as age and sex-adjusted body mass index ≥ 95th percentile. EFS was defined as the time from diagnosis to first event (relapse, progression, secondary malignancies, or death). Univariate and multivariable Cox proportional hazards models compared EFS and OS between patients with and without obesity. The prevalence of obesity was compared annually from diagnosis. All analyses were stratified by cancer categories. Results: A total of 11,291 patients were included (37.1% leukemias, 14.5% lymphomas, 21.8% central nervous system (CNS) tumors, 26.6% non-CNS solid tumors; median age: 7.6 years [interquartile range (IQR): 4.2-12.5] and median follow-up time: 4.7 years [IQR: 2.6-5.1]). At diagnosis, 10.5% were obese and the prevalence of obesity was significantly higher at 1 year (15.7%, p &lt; 0.001) and 2 years (20.1%, p &lt; 0.001) after diagnosis. The prevalence of obesity was higher in the leukemia and lymphoma cohort compared to other cancer categories (11.4% vs. 9.5%, p = 0.001). In multivariable models controlling for age at diagnosis, sex, ethnicity, income quintile, treatment era and cancer categories, obesity at diagnosis remained significantly associated with inferior EFS [adjusted HR (aHR) 1.16, 95% CI 1.02–1.32] and OS [aHR 1.29, 95% CI 1.11–1.49]. In children with acute lymphoblastic leukemia (ALL) (n = 3458, 82.5% of all leukemias), after adjusting for high-risk features such as age, white blood cell count and CNS status, obesity at diagnosis remained associated with inferior EFS [aHR 1.55, 95% CI 1.17–2.04] and OS [aHR 1.75, 95% CI 1.23–2.49]. In patients with CNS tumors, obesity at diagnosis was also associated with inferior EFS [aHR 1.38, 95% CI 1.09–1.76] and OS [aHR 1.47, 95% CI 1.13–1.91]. Obesity at diagnosis did not confer adverse outcomes in other cancer categories. Conclusions: In this population-based study of children with cancer, the prevalence of obesity was 11% at diagnosis and continued to increase in the following 2 years. Obesity at cancer diagnosis was independently associated with inferior survival across the entire cohort, especially in children with ALL and CNS tumors. Further studies are needed to better characterize the relationship between obesity and survival in children with cancer to inform future trial design.

Does a Healthy Weight Body Mass Index at Onset of Idiopathic Intracranial Hypertension Change the Outcomes? A United Kingdom Prospective Cohort Study

ABSTRACT Idiopathic intracranial hypertension (IIH) predominantly affects reproductive-aged females with obesity. However, the prevalence and impact of a healthy weight body mass index (BMI) at disease presentation is not known. This study aimed to evaluate the visual and headache outcomes stratified by the presenting BMI. This was a longitudinal prospective cohort study (IIH Life) based on a tertiary neuro-ophthalmology IIH service, University Hospitals Birmingham NHS Trust, United Kingdom, recruiting consecutive patients living with IIH between 2012 and 2021. Those with a presenting BMI were included. The outcome measures included visual outcomes of LogMAR visual acuity, Humphrey visual field perimetric mean deviation (PMD), optical coherence tomography (OCT) measurements, and headache outcomes of frequency, severity, and Headache Impact Test-6 score. Three hundred seventy-five people with IIH and a documented baseline BMI. About 3.7% of the entire cohort had a healthy weight BMI at IIH presentation and 15.5% BMI < 30 kg/m2. The baseline PMD was worse in patients without obesity; however, OCT papilloedema measures were similar. The presence of obesity was associated with a small but significant greater worsening in visual acuity but slower macular ganglion cell layer loss. There was no impact on PMD or papilloedema prognosis related to baseline obesity. The headache outcomes showed heterogeneity, with worse baseline headache frequency in patients with obesity. No BMI group was associated with worse headache outcomes. Patients with a healthy weight BMI or those without obesity at baseline make up a small proportion of IIH patients. BMI at presentation does not appear to influence long-term visual or headache outcomes.

Obesity is a risk factor for poor response to treatment in early rheumatoid arthritis: a NORD-STAR study

ObjectiveThis report from the NORD-STAR (Nordic Rheumatic Diseases Strategy Trials and Registries) trial aimed to determine if obesity is associated with response to conventional and biological antirheumatic treatment in early...

Universal Free School Meals Policy and Childhood Obesity.

The Community Eligibility Provision (CEP), a universal free school meals policy, increases school meal participation by allowing schools in low-income areas to provide free breakfast and lunch to all students; however, its impact on obesity remains uncertain. The objective of this study is to estimate the association of CEP with child obesity. School obesity prevalence was calculated using BMI measurements collected annually between 2013 and 2019 from students in California public schools in grades 5, 7, and 9. To estimate the association of CEP with obesity, we used a difference-in-differences approach for staggered policy adoption with an outcome regression model conditional on covariates, weighted by student population size. The analysis included 3531 CEP-eligible schools using school-level obesity prevalence calculated from 3 546 803 BMI measurements. At baseline, on average, 72% of students identified as Hispanic, 11% identified as white, 7% identified as Black, and 80% were eligible for free or reduced-price meals. Baseline obesity prevalence was 25%. Schools that participated in CEP were associated with a 0.60-percentage-point net decrease in obesity prevalence after policy adoption (95% confidence interval: -1.07 to -0.14 percentage points, P = .01) compared with eligible, nonparticipating schools, corresponding with a 2.4% relative reduction, given baseline prevalence. Meals served increased during this period in CEP-participating schools only. In a balanced sample of California schools, CEP participation was associated with a modest net decrease in obesity prevalence compared with eligible, nonparticipating schools. These findings add to the growing literature revealing potential benefits of universal free school meals for children's well-being.

Response Types and Factors Associated with Response Types to Biologic Therapies in Patients with Moderate-to-Severe Plaque Psoriasis from Two Randomized Clinical Trials.

This study aimed to understand treatment response dynamics, including factors associated with favorable response, among patients with moderate-to-severe psoriasis who received guselkumab, adalimumab, or secukinumab. These post hoc analyses used data from the phaseIII clinical trials ECLIPSE and VOYAGE1, which were conducted between September 2021 and November 2022. On the basis of absolute Psoriasis Area and Severity Index (aPASI) scores, patients were divided into short-term response types (SRT1-6, based on week20-48 response) and long-term response types (LRT1-4, based on week52-252 response). Response types(RTs) were based on aPASI cutoffs deemed clinically relevant by the investigators; SRT1/LRT1 were the most favorable response types. Baseline characteristics were compared across RTs, and logistic regression analyses established factors associated with SRT1/LRT1. Overall, 1045, 662, and 272 patients were included in the ECLIPSE short-term, VOYAGE1 short-term, and VOYAGE1 long-term analyses, respectively. Mean age, body mass index (BMI), baseline aPASI score, and body surface area were lower in SRT1 than SRT6. In VOYAGE1, adalimumab treatment, high BMI, and current/former smoking status resulted in less favorable responses. In the VOYAGE1 long-term analysis, patients in LRT4had the highest baseline aPASI score, were older, and were more often obese compared with other LRT groups. Regression analyses showed that SRT1 (both treatments) in VOYAGE1 and ECLIPSE, and LRT1 (guselkumab group) in the VOYAGE1 long-term analysis, were associated with week16 aPASI response. In VOYAGE1, SRT1 was associated with psoriasis duration and smoking status. Early treatment response and baseline characteristics, including smoking, psoriasis duration, and obesity, may be associated with longer-term response to biologics. ECLIPSE: NCT03090100, VOYAGE1: NCT02207231.

The Effectiveness of Continuous Positive Airway Pressure for Treating Obstructive Sleep Apnoea in Pregnancy: A Systematic Review

(Aust N Z J Obstet Gynaecol 2023. 2023;63(3):290–300) Obstructive sleep apnea (OSA) is characterized by recurrent pauses in breathing during sleep due to upper airway collapse, resulting in decreased oxygen levels. OSA affects around 10.5% of parturients during early pregnancy and up to 30% at term. In pregnancy, OSA is associated with an increased risk for gestational hypertension, pre-eclampsia, and gestational diabetes. Infants born to mothers with OSA may have a lower birth weight and are at increased risk for premature delivery and neonatal intensive care unit admission. Baseline obesity increases the risk of OSA during pregnancy, with lifestyle modifications being the standard treatment, though their influence on maternal outcomes is limited. Continuous positive airway pressure (CPAP) is an effective OSA treatment; however, little research exists on the impact of CPAP on either maternal or fetal outcomes. This systematic review sought to investigate if the use of CPAP improved outcomes for pregnant women with or at risk of OSA.

Aspirin pharmacokinetics and pharmacodynamics through gestation

ObjectiveWe sought to describe the pharmacokinetics and pharmacodynamics of aspirin through pregnancy (first and third trimester), to identify covariates that significantly impact aspirin pharmacokinetics (PK) and to identify the relationship between aspirin pharmacokinetics and pharmacodynamics (PD). Study DesignThis is a prospective study of patients at high risk for preeclampsia recommended to take 81mg aspirin daily. This study involved three visits: baseline: 1st trimester (10-16’ weeks) 6-hour PK visit, done prior to initiation of aspirin; follow up-1: 2-4 weeks after aspirin initiation; Follow up-2: 3rd trimester 6-hour PK visit (28-32 weeks’). The following were assessed at each visit: weight/BMI, PFA-100 (Siemens), urinary thromboxane B2 (TX-B2), serum thromboxane B2 (TX-B2) and plasma salicylic acid. The PK visits consisted of blood work done at baseline (pre-dose), administration of 81mg non-enteric coated aspirin, and then plasma blood level of salicylic acid assessed at 30minutes and then hourly 1-6 hours after dose. Pearson correlation and multivariable regression were used to identify associations between parameters and identify relevant covariates. Log-adjusted values used for regression analysis. P<0.05 considered significant. ResultsNineteen participants were included with first trimester data, and 16 with third trimester data. There was no statistically significant change in mean PK parameters between the first and third trimester, although there was a trend to lower Cmax in the 3rd vs 1st trimester (p=0.08). In multivariable regression, baseline obesity and current BMI as a continuous measure were negatively associated with log-adjusted peak salicylic acid concentration (-0.28 (-0.46 - -0.11), p=0.003 and -0.02 (-0.03 - -0.009), p=0.001 respectively) and log-adjusted plasma salicylic acid area under the curve 0-6hr post-dose (AUC0-6) (-0.25 (-0.45 – 0.05), p=0.02, -0.04 (-0.07 - -0.01), p=0.008 respectively). There was a significant decrease in urinary thromboxane 2-4 weeks after aspirin initiation compared to baseline, which correlated with a concomitant increase in PFA-100 closure time. In multivariable regression model, there was a strong association between plasma salicylic acid concentration (area under the curve 0-6hrs post-dose) and urinary thromboxane (B=-3.12 (-5.38 - -1.04), p=0.006), and with urinary thromboxane suppression and platelet inhibition, PFA-100 (-0.23 (-0.31 - -0.14), p<0.001). With progressive thromboxane suppression, platelet inhibition (PFA-100 closure time) increased. Individual comorbidities including weight, hypertension, and diabetes, also impacted aspirin response. ConclusionWe have demonstrated the relationship between individual factors, plasma concentrations of salicylic acid, thromboxane suppression, and platelet inhibition at a single dose (81mg) of aspirin taken through pregnancy. Our findings suggest dose modification of aspirin in pregnancy may help to achieve the optimal response. Our results may be used to facilitate computational modeling to identify optimal dosing taking into consideration individual factors

Incidence density of hyperuricemia and association between metabolism-related predisposing risk factors and serum urate in Chinese adults: a cohort study.

Evidence regarding the association between metabolism-related indicators and serum urate (SU) is limited. We aimed to obtain the incidence density of hyperuricemia and to explore the association between metabolism-related predisposing risk factors and SU. A total of 48,979 Chinese adults from the Beijing Physical Examination Center were included in the study. The partial least squares path model was used to explore the relationship between SU and metabolism-related risk factors. The generalized additive model was used for smooth curve fitting, showing the sex-specific associations of SU at follow-up with baseline fasting blood glucose (FBG) concentrations and age. The incidence density of hyperuricemia was 78/1000 person-years. Baseline SU, age, sex, obesity, FBG, and lipid metabolism were significantly associated with SU at follow-up (all P values <0.05). Non-linear relationships were found between the baseline FBG concentrations and SU at follow-up, while U-shaped associations were observed between baseline age and SU at follow-up. The SU concentration is associated with several metabolism-related risk factors such as obesity and FBG. Recognition of these associations will aid in a deeper understanding of the multifaceted nature of SU regulation.

Guselkumab-Treated Patients with Plaque Psoriasis Who Achieved Complete Skin Clearance for ≥156 Consecutive Weeks: A Post-Hoc Analysis From the VOYAGE 1 Clinical Trial.

Treatment of moderate-to-severe plaque psoriasis with biologics, such as guselkumab, has demonstrated greater efficacy over traditional non-biologic treatments. However, given patient diversity, greater understanding of the relationship between patient characteristics, positive clinical outcomes, and long-term response to biologics is crucial for optimizing treatment choices. This post-hoc analysis of the 5-year VOYAGE1 clinical trial compares baseline characteristics of patients maintaining a Psoriasis Area and Severity Index (PASI) score of 0 at all visits for ≥156 consecutive weeks (PASI=0 group) with those that never achieve PASI=0 (comparator group), using descriptive statistics and a multiple logistic regression model. Guselkumab plasma trough concentrations in both response groups were assessed from Weeks 4-156. Of patients who started guselkumab treatment at Week 0 or at Week 16 after switching from placebo, 22.7% (112/494) maintained PASI = 0 for ≥156consecutive weeks. Numerical differences in baseline characteristics, including age, obesity, diabetes, PASI score, disease duration, smoking status, and psoriatic arthritis comorbidity, were identified between the PASI = 0 group and comparator group. Plasma guselkumab levels were consistently higher in the PASI = 0 group. Multiple logistic regression analysis revealed absence of diabetes, lower Dermatology Life Quality Index score at baseline, and higher Week 4 guselkumab plasma concentration as significantly (p<0.05) associated with the PASI = 0 group. A substantial (22.7%) number of guselkumab-treated patients in the VOYAGE 1 clinical trial maintained complete skin clearance for a consecutive period of ≥156 weeks. Factors associated with this outcome may suggest clinical benefits of holistic treatment approaches. NCT02207231.