Greater Weight Loss Research Articles

Impact of weight loss after treatment on survival outcomes of overweight and obese patients with early‑stage endometrial cancer.

Despite the fact that obesity is the main risk factor for endometrial cancer, there is limited evidence regarding the effects of body weight change on overweight and obese women treated for early-stage endometrial can its impact on cancer outcomes. A retrospective cohort study was performed including all overweight and obese patients with early-stage type-I endometrial cancer that were treated at the Insular University Hospital of Las Palmas (Las Palmas de Gran Canaria, Spain) between January 2007 and December 2019. Body weight change at 12 months of treatment was evaluated, as well as its impact on cancer outcomes. Weight loss ≥5% was independently evaluated regarding its impact on survival. A total of 526 women were studied, of which 152 (28.90%) were overweight (BMI ≥25 and <30) and 374 (71.10%) were obese (BMI ≥30). The median follow-up was 76.17 months, during which time 77 (14.64%) women died. In the survivor group, body weight at initial diagnosis was 86.4±17.9 kg compared with 84.6±16.4 kg 1 year after treatment, which corresponded to a significant mean weight loss of 1.47 kg (P<0.001). However, in the group of non-survivors, body weight at initial diagnosis was 84.7±15.7 kg compared with 84.7±14.6 kg 1 year after treatment, which demonstrated a non-significant mean weight loss of 0.63 kg (P=0.180). When comparing between the patients who maintained or gained ≥5% weight and those who lost ≥5% weight, there were no significant differences taking into account the whole cohort and follow-up time; however, when adjusting for the period between 32 and 98 months, survival was significantly higher in those patients that lost ≥5% of their initial body weight (P=0.025; log-rank test). Based on the final univariate and cer and multivariate analyses, body weight change at 12 months was not indicated to be a factor significantly affecting overall survival; adjusted hazard ratio was 1.01 (95% CI 0.97-1.05, P=0.723). In conclusion, even if greater weight loss is observed in patients with endometrial cancer that survive the disease, no significant impact on survival outcomes is observed based on multivariate analysis.

IBC-Oxford University2023_BJSPoster_3Mini-Gastric Bypass, One Anastomosis Gastric Bypass, Tailored Biliopancreatic, Bypass vs. Weight Loss

Abstract Introduction Studies of different Bariatric procedures have resulted in conflicting findings on the effects of the surgery on daily Dietary Food Choices (DFCs.) Some suggest a pure volume effect, others report changes in type and preferences and still others suggest the effects change over time. The Biliopancreatic Limb (BPL) length in the One Anastomosis Gastric Bypass (OAGB), Mini-Gastric Bypass-Original Technique (MGB-OT) version, includes a "tailored" BPL length. The purpose of this study was to investigate the relationship between BPL length and DFCs in patients undergoing MGB-OT. The primary hypothesis was that the changes in dietary habits and food choices would be related to the BPL length in the MGB-OT. Methods Data from a long term online patient survey including MGB-OT patients were collected including basic demographics, MGB-OT BPL length, patient reported DFCs and weight loss classes. Linear regression modelling was used to assess the relative association between BPL length with various mean patient reported DFCs and a composite model of Food Choices. Results 286 patients had responses for evaluation. Patients with BPL lengths of 3 to 9 ft (92-274cm) were selected. As reported in prior publications, patient reported mean weight loss classes varied linearly related to BPL length. The mean "Bad" Food Choices (BFC) declined from 5.7/day to 2.0/day. The mean composite "Bad" food choices declined from a mean of 2,070 DFCs per year to an estimated 745. There was a strong linear relation between BPL length and the decline in mean "Bad" daily food choices. (y=-0.3x-3, R2 = 0.7, p&amp;lt;0.05.) Conclusions The present study of mean patient reported DFC outcomes following a "Tailored" BPL length in the MGB-OT version of the OAGB declined substantially. The patient dietary food choices for fried foods, sugar sweetened beverages, processed meats and junk foods all declined. These changes were linearly related to the Bilio-pancreatic limb length. In cases of the MGB-OT a longer Bilio-pancreatic Limb Length was associated with greater weight loss and a greater improvement in daily Dietary Food Choices. If confirmed by other studies the possibility of tailoring the power of a bariatric operation based upon BPL length seems like an important advancement in bariatric surgery.

IBC-Oxford University2023_BJSPoster_4Biliopancreatic Limb Length and Patient Satisfaction One Anastomosis Gastric Bypass (Mini-Gastric Bypass-Original Technique)

Abstract Introduction Daily Food Choices (DFCs) in obesity and Bariatric Surgery (BS) are critical components of patient’s health. The Biliopancreatic Limb (BPL) length in the Mini-Gastric Bypass-Original Technique (MGB-OT) version of the One Anastomosis Gastric Bypass (OAGB) includes a “Tailored" BPLL designed to change the outcome of the operation related to patient needs. The purpose of this study was to investigate the relationship between the impact of the MGB-OT and the "Tailored" BPL length, on weight loss and patient-reported DFCs. The primary hypothesis was that the MGB-OT would be associated with major changes in both DFCs and weight loss and that the “Tailored" BPL length would be associated with both DFCs and weight loss. Methods Data from an online patient survey of MGB-OT patients were collected including basic demographics, BPL length, pre and post-operative DFCs and weight loss. Linear regression modelling was used to quantitate the relative association between MGB-OT and the "Tailored" BPL length with DFCs and weight loss. Results 377 patients had complete responses for evaluation; 72% of patients were female, mean age 48+/-15 range 24-80 years; mean BPL length was 2.0+/-0.3m range 0.9-2.7m, mean preop weight was 131.0+/-24.2 range 86.3-222.5kg, mean post weight was 82.6+/-20.0 range 47.2-193.0, mean weight loss 48.4+/-19.2 range 6.4-119.4 and Percent Total Weight Loss (%TWL) was 36.9%+/-8.0% range 6.4%-53.7%. 90.8% of patients reported %TWL greater than 20%. As reported elsewhere, various measures of weight loss varied linearly related to BPL length. The mean DFCs of Meat, Sugar-Sweetened Beverages and Fatty Foods (Meat, SSBs and FFs respectively) were all higher before MGB-OT and declined post-op. The mean “Bad” Food Choices (Bad DFCs = DFCs Meat+SSBs+FFs) declined from mean of 8.6+/-0.9 to 5.0+/0.7 a Delta “Bad” DFCs of 3.6+/-0.9. Daily DFCs of Fresh Fruit and Vegetables (FFVs) increased, Delta FFVs 1.2+/-0.1. The Delta All DFCs, (Delta Bad+FFVs) was 4.8+/-1.0/day with an estimated Delta of 1,757 “Yearly” Food Choices (YFCs.) The estimated Yearly “Bad” food choices declined from 2,070 YFCs to an estimated 745. Finally, there was a strong linear relation between BPL length and the decline in mean “Bad” daily food choices. Conclusions The present study demonstrates that patients report major weight loss following a “Tailored" BPL length in the MGB-OT. Patients also reported declines in “Bad” DFCs (meat, FFs &amp; SSBs) and improvements in FFVs. Yearly projections of these changes suggest both an improvement in quality and a decrease in caloric intake of hundreds of thousands of calories per year. Both these were linearly related to Biliopancreatic limb length. A longer Biliopancreatic Limb Length was associated with greater weight loss and a greater improvement in patient-reported Daily Food Choices.

IBC-Oxford University2023_BJSOral_3Tailored Bilio-Pancreatic Limb Length and Haemoglobin A1c Levels 10 years following Mini-Gastric Bypass Original Technique of One Anastomosis Gastric Bypass

Abstract Introduction The need for or the ideal length of the Biliopancreatic Bypass limb (BPL) length is a controversial topic. The Mini Gastric Bypass original technique (MGB-OT) version of the One Anastomosis Gastric Bypass (OAGB) includes a “Tailored” BPL length. This study aimed to investigate the 1 to 10-year outcomes of the “Tailored’ BPL length in patients undergoing MGB-OT in diabetic patients with Class III obesity. Methods The study is a retrospective chart review of 114 patients who underwent the Mini Gastric Bypass original technique (MGB-OT) with a tailored Biliopancreatic Limb length as described by Rutledge et al. These cases were performed between June 2008 and December 2009. The study investigated the relationship between the length of the BPLL and glycaemic control, primarily as measured by the change in (Delta) HbA1c levels, in morbidly obese diabetic patients undergoing the MGB-OT. The mean BPL length in the study was 185 cms, with a range of 120-350 cms. The study analysed preoperative, post-operative, and Delta HbA1c levels as the primary outcomes. The critical outcome goal for the study was HbA1c levels of less than 7%, which is a commonly used target for glycaemic control in diabetic patients. Results Only 89 of 114 (78%) patients completed the 10-year follow-up. The mean preoperative HbA1c was 9.2+/-1.6 (range 6.8-14.7). Longer BPL length were selected for patients based on a variety of patient factors including the patient’s preoperative HbA1c levels. Patients with longer BPL length had greater weight loss (R2 0.8.) The mean HbA1c levels were 5.50+/-0.36, 5.65+/-0.35, and 5.82+/-0.41 at 1, 5, and 10 years post-op. 100% of patients evaluated at 1 and 5 years had HbA1c levels below 7%, and only 1 out of 89 patients at 10 years had HbA1c levels above 7%. The correlation between BPL length and the 10-year Delta HbA1c was high, with a correlation coefficient (r) of 0.8. The Delta HbA1c was significantly greater in the patients with BPL length &amp;gt; 150 cm (3.99 +/- 1.87 vs 2.08 +/- 0.71 in the BP150 patients difference 1.91, SEM 0.40, 95% CI 1.12 to 2.69, P &amp;lt; 0.0001) i.e., longer BPL length (&amp;gt; 150cms) had significantly greater Delta HbA1c than 150 cm BPL length. Conclusions The study suggests that individualized tailoring of the biliopancreatic limb length in the OAGB procedure can potentially lead to a combination of excellent weight loss and near-complete normalization of HbA1c levels for up to 10 years. However, this a small and incomplete study and the optimal length may vary based on individual patient factors. Further research is needed to confirm these findings and establish standardized guidelines for determining the appropriate BPL length. Overall, the study highlights the importance and potential value of continued research and individualized treatment approaches for patients with obesity and diabetes.

Under pressure-exploring partner changes, physiological responses and telomere dynamics in northern gannets across varying breeding conditions.

Life history theory predicts trade-offs between reproduction and survival in species like the northern gannet (Morus bassanus). During breeding, demanding foraging conditions lead them to expand their foraging range and diversify their diet, increasing the risk of reproductive failure. Changing partners may enhance breeding success but lead to more physiological costs. To investigate the physiological costs of reproduction upon partner changes, we measured and compared 21 biomarkers related to telomere dynamics, oxidative stress, inflammation, hematology, nutritional status, and muscle damage. We used a longitudinal approach with gannets (n=38) over three contrasting years (2017, 2018 and 2019). Our results suggest that annual breeding conditions exert a greater influence on physiological changes than partnership status. Individuals that changed partner experienced greater short-term stress than retained partners. This transient increase in stress was marked by short-term increases in oxidative lipid damage, lower antioxidant capacity, signs of inflammation, and greater weight loss than individuals that retained partners. During favorable conditions, individuals that changed mates had stabilized telomere length, decreased antioxidant capacity, glucose concentration, and muscle damage, along with increased oxygen transport capacity. Conversely, unfavorable breeding conditions led to increased telomere attrition, stabilized antioxidant capacity, decreased inflammation susceptibility, diminished oxygen transport capacity, and increased muscle damage. In the cases where partners were retained, distinct physiological changes were observed depending on the year's conditions, yet the telomere dynamics remained consistent across both partnership status categories. During the favorable year, there was an increase in unsaturated fatty acids and oxygen transport capacity in the blood, coupled with a reduction in inflammation potential and protein catabolism. In contrast, during the unfavorable year in the retained mates, we observed an increase in oxidative DNA damage, antioxidant capacity, weight loss, but a decrease in inflammation susceptibility as observed in changed mates. Our study shows that behavioral flexibility such as mate switching can help seabirds cope with the challenges of food scarcity during reproduction, but these coping strategies may have a negative impact on physiological status at the individual level. In addition, the marked reduction in telomere length observed during harsh conditions, coupled with the stabilization of telomere length in favorable conditions, highlights the long-term physiological impact of annual breeding conditions on seabirds. These findings underscore the effect on their potential survival and fitness, emphasizing that the influence of annual breeding conditions is greater than that of partnership status.

Toll-interacting protein inhibits transforming growth factor beta signaling in mouse lung fibroblasts.

Variations in the Toll-interacting protein (TOLLIP) gene have been identified in genome-wide association studies to correlate with risk of disease, mortality, and response to N-acetylcysteine therapy in idiopathic pulmonary fibrosis. Although TOLLIP is known to modulate innate immune responses, its relevance in organ fibrogenesis remains unknown. Prior work in the literature suggests TOLLIP dampens transforming growth factor beta (TGFβ) signaling in human cell lines. In this study, we examined the role of TOLLIP in mouse lung fibroblast (MLF) responses to TGFβ and in the bleomycin model of experimental lung fibrosis using Tollip-/- mice. We hypothesize that if TOLLIP negatively regulates TGFβ signaling, then Tollip-/- mouse lung fibroblasts (MLFs) would have enhanced response to TGFβ treatment, and Tollip-/- mice would develop increased fibrosis following bleomycin challenge. Primary MLFs were stimulated with TGFβ (1 ng/mL) for 24 h. RNA was obtained to assess global transcriptional responses by RNA-seq and markers of myofibroblast transition by qPCR. Functional assessment of TGFβ-stimulated MLFs included cell migration by scratch assay, cell proliferation, and matrix invasion through Matrigel. In the invivo model of lung fibrosis, Tollip-/- mice and wild-type (WT) littermates were administered bleomycin intratracheally and assessed for fibrosis. We further examined TGFβ signaling invivo after bleomycin injury by SMAD2, ERK1/2, and TGFβR1 Western blot. In response to TGFβ treatment, both WT and Tollip-/- MLFs exhibited global transcriptional changes consistent with myofibroblast differentiation. However, Tollip-/- MLFs showed greater number of differentially expressed genes compared to WT MLFs and greater upregulation of Acta2 by qPCR. Functionally, Tollip-/- MLFs also exhibited increased migration and Matrigel invasiveness compared to WT. We found evidence of enhanced TGFβ signaling in Tollip-/- through SMAD2 invitro and invivo. Tollip-/- mice experienced lower survival using a standard weight-adjusted dosing without evidence of differences in fibrosis at Day 21. With adjustment of dosing for sex, no differences were observed in fibrosis at Day 21. However, Tollip-/- mice had greater weight loss and increased bronchoalveolar lavage fluid total protein during early resolution at Day 14 compared to WT without evidence of differences in acute lung injury at Day 7, suggesting impaired resolution of lung injury.

Transportation Factors and Postoperative Attendance and Weight Loss Through 24 Months.

Transportation, access to follow-up care, and association with weight loss are understudied in the bariatric population. The objective of this study was to determine how transportation variables associate with postoperative attendance and weight loss through 24 months. Seven hundred eighty-seven patients (81.3% female; 59.1% White) who had primary surgery (48.6% gastric bypass) from 2015 to 2019 were included. Sidewalk coverage and number of bus stops from patients' homes, driving distance in miles and minutes from patients' homes to the nearest bus stop and the clinic were measured. Bivariate analyses were conducted with the transportation variables and attendance and %TWL at 2 or 3, 6, 12, and 24 months. One mixed multilevel model was conducted with dependent variable %TWL over 24 months with visits as the between-subjects factor and covariates: race, insurance, surgical procedure, and driving distance to the clinic in minutes, attendance, and %TWL over 24 months; an interaction between distance, attendance, and visits. There were no significant differences between the majority of the transportation variables and postoperative attendance or %TWL. Patients who had perfect attendance had improved %TWL at 12 months [t(534)=-1.92, p=0.056] and 24 months [t(393)=-2.69, p=0.008] compared to those who missed at least one appointment. Patients with perfect attendance and who had shorter driving times (under 20 min) to the clinic had greater weight loss through 24 months [F(10, 1607.50)=2.19, p=0.016)]. Overall, transportation factors were not associated with attendance and weight loss, with the exception of the interaction between shorter driving minutes to follow-up and perfect attendance.

Weight change in patients with new-onset type 2 diabetes mellitus and its association with remission: Comprehensive real-world data.

We aimed to investigate weight change in patients with new-onset type 2 diabetes mellitus and the association of weight loss on diabetes remission in Korean adults. We used the health examination database of the Korean National Health Insurance Service. Patients diagnosed with type 2 diabetes mellitus from 2009 to 2012 were enrolled and followed to 2017. The baseline body weight was measured at the health examination closest to the time the patient was enrolled, and the change was calculated by examining the weight measured at the subsequent examination within 2 years. Remission was defined as fasting blood glucose less than 126 mg/dl at two or more consecutive health examinations after stopping medication. In total, 114, 874 patients with new-onset type 2 diabetes mellitus were analysed. Of these, 23 156 (20.2%) lost more than 5% of their body weight, and 2429 (2.1%) achieved remission. The adjusted odds ratio for remission in the weight loss group was 2.56 (95% confidence interval 2.35-2.79) compared with the group with stable body weight. Sensitivity analysis according to the degree of weight change showed that the greater weight loss, the higher the likelihood of remission. In the subgroup analysis, the effects of weight loss on remission were significantly greater in subgroups of age <65 years, male sex and body mass index >25. Weight loss within the first 2 years of treating type 2 diabetes mellitus was associated with diabetes remission. Physicians should pay more attention to weight management in new-onset type 2 diabetes mellitus, particularly for young and obese individuals.

53 Change in Cerebral Metabolite Concentrations Following Bariatric Surgery

Objective:Obesity is associated with adverse effects on brain health, including increased risk for neurodegenerative diseases. Changes in cerebral metabolism may underlie or precede structural and functional brain changes. While bariatric surgery is known to be effective in inducing weight loss and improving obesity-related medical comorbidities, few studies have examined whether it may be able to improve brain metabolism. In the present study, we examined change in cerebral metabolite concentrations in participants with obesity who underwent bariatric surgery.Participants and Methods:35 patients with obesity (BMI &gt; 35 kg/m2) were recruited from a bariatric surgery candidate nutrition class. They completed single voxel 1H-proton magnetic resonance spectroscopy at baseline (pre-surgery) and within one year post-surgery. Spectra were obtained from a large medial frontal brain region. Tissue-corrected absolute concentrations for metabolites including choline-containing compounds (Cho), myo-inositol (mI), N-acetylaspartate (NAA), creatine (Cr), and glutamate and glutamine (Glx) were determined using Osprey. Paired t-tests were used to examine within-subject change in metabolite concentrations, and correlations were used to relate these changes to other health-related outcomes, including weight loss and glycemic control.Results:Bariatric surgery was associated with a reduction in cerebral Cho (f[34j = -3.79, p &lt; 0.001, d = -0.64) and mI (f[34] = -2.81, p &lt; 0.01, d = -0.47) concentrations. There were no significant changes in NAA, Glx, or Cr concentrations. Reductions in Cho were associated with greater weight loss (r = 0.40, p &lt; 0.05), and reductions in mI were associated with greater reductions in HbA1c (r = 0.44, p &lt; 0.05).Conclusions:Participants who underwent bariatric surgery exhibited reductions in cerebral Cho and mI concentrations, which were associated with improvements in weight loss and glycemic control. Given that elevated levels of Cho and mI have been implicated in neuroinflammation, reduction in these metabolites after bariatric surgery may reflect amelioration of obesity-related neuroinflammatory processes. As such, our results provide evidence that bariatric surgery may improve brain health and metabolism in individuals with obesity.

223 Impact of Bump Feeding in Late Gestation on Reproductive Performance and Body Weight and Body Condition at Pre- and Post-Farrowing and at Weaning in Hyper Prolific Gilts

Abstract The study aimed to quantify the effect of increasing the feeding level during late gestation on reproductive performance, body weight (BW) and body condition (BC) at pre- and post-farrowing and at weaning in gilts. A total of 815 PIC Camborough X54 gilts were individually weighed at day 90 of gestation and assigned to two feeding levels in a randomized complete block design. Gilts received either 2.3 kg/d [4.95 Mcal/d of net energy (NE) and 11.5 g/d of standard ileal digestible lysine (SID Lys); CONTROL] or 3.1 kg/d (6.67 Mcal/d of NE and 15.5 g/d of SID Lys; BUMP) from 90 d until farrowing. Gilts were housed in group pens during gestation and feed was provided using a feed box setting. Feed contained 2.15 Mcal/kg of NE and 5 g/kg of SID Lys. Caliper information was individually collected at day 90 of gestation to assess BC. Caliper and BW measurements were collected pre-farrowing and at weaning and their difference was calculated. Additionally, post-farrowing 48 h BW was predicted using the following equation: Gilt 48h post-farrow BW = -20.81 + (0.98 × pre-farrow BW). Total born (TB), born alive (BA), stillborn (SB), and mummified (MM) were collected for each gilt at farrowing, and their percentage per litter was calculated and used for analysis. Data were analyzed using a general linear model considering gilt as the experimental unit. The model included treatment as fixed effect and gilt as random effect. Caliper or BW at 90 days of gestation were considered as covariable for BW and BC analysis, respectively. Alpha for determination of significance was 0.05 and trend were identified at 0.10. BUMP gilts were 7.5 and 7.4 kg heavier than CONTROL gilts at pre- and post-farrowing, respectively (P &amp;lt; 0.001; Table 1). The BW at weaning did not differ between treatments (P = 0.32); however, BUMP gilts lost 6.3 kg BW more than CONTROL gilts (P &amp;lt; 0.001; Table 1) during the lactation period. Regarding BC, caliper at pre-farrow was 0.3 units greater for BUMP gilts compared with CONTROL gilts (P &amp;lt; 0.001; Table 1). No differences were observed in caliper loss during the lactation period and at weaning between treatments (P &amp;gt; 0.05; Table 1). The BUMP gilts tended to have 0.5 more TB compared with CONTROL gilts (P = 0.054; Table 1). Nevertheless, TB is related to the early gestation period and embryo survivability. No differences were observed in BA, SB and MM between treatments (P &amp;gt; 0.05; Table 1). In summary, increasing the feeding level by 0.9 kg/d in late gestation resulted in increased gilt weight and caliper at pre-farrow, and greater weight loss during the lactation period. Although reproductive performance traits were not altered by treatments, these will be followed in subsequent parities.

Longitudinal Changes in Physical Function and Their Impact on Health Outcomes in COVID-19 Patients.

Coronavirus disease (COVID-19) is correlated with a variety of long-term sequelae that affect different aspects of health, including physical function. This study investigated the longitudinal changes in handgrip strength (HGS) over six months post-hospital discharge in COVID-19 patients and explores the associations between HGS, health-related quality of life, dyspnoea, exercise capacity, and body mass index (BMI). Adult COVID-19 patients were followed up at one, three, and six months after hospital discharge. HGS, BMI, exercise capacity, and health-related quality of life were assessed. Data from patients with HGS measurements at all three time points were analysed. Low HGS was prevalent one month post-discharge (35%). Participants with low HGS exhibited more severe disease (30.5% vs. 5.9% were admitted to the intensive care unit, p < 0.01), longer hospital stays (median [IQR] 21 [10.0; 40.5] vs. 12.0 [8.0; 20.0] days, p < 0.01), greater weight loss (-5.7 [-9.1; -0.6] vs. -3.2 [-5.7; -0.0] kg, p = 0.004), and reduced exercise capacity (6 min walking test [6 MWT], 95.7 [84.0; 102.0] vs. 100.0 [92.9; 105.0]% predicted, p = 0.007). Those with persistently low HGS (40% of the initial low HGS group) had worse exercise capacity (6-MWT 93.3 [78.3; 101.0] vs. 101.0 [95.0; 107.0]% predicted, p < 0.001), more dyspnoea (29.0% vs. 2.0% of participants, p < 0.001), poorer quality of life (visual analogue scale score, 75 [50; 75] vs. 85 [75; 95], p < 0.001), and higher rates of problems in various health dimensions. HGS at 1 month was the only significant predictor of HGS improvement from 1 month to 6 months (odds ratio [95% CI] 1.11 [1.03; 1.20], p = 0.008). This study highlights the prevalence of reduced physical function among COVID-19 survivors and emphasises the importance of early identification and intervention to optimise their long-term health. Monitoring HGS, a simple and reliable tool, can provide valuable insights into patients' overall physical function, aiding in tailored care and improved outcomes.

Transcriptional and epigenetic changes after dietary and surgical weight loss interventions in an animal model of obesity.

Identifying determinants that can predict response to weight loss interventions is imperative for optimizing therapeutic benefit. We aimed to identify changes in DNA methylation and mRNA expression of a subset of target genes following dietary and surgical interventions in high-fat-diet (HFD)-induced obese rats. Forty-two adult Wistar Han male rats were divided into two groups: control rats (n = 7) and obese rats (n = 28), fed a HFD for 10 weeks (t10). Obese rats were randomly subdivided into five intervention groups (seven animals per group): (i) HFD; (ii) very-low-calorie diet (VLCD); (iii) sham surgery, and (iv) sleeve gastrectomy (SG). At week sixteen (t16), animals were sacrificed and tissue samples were collected to analyze changes in DNA methylation and mRNA expression of the selected genes. By type of intervention, the surgical procedures led to the greatest weight loss. Changes in methylation and/or expression of candidate genes occurred proportionally to the effectiveness of the weight loss interventions. Leptin expression, increased sixfold in the visceral fat of the obese rats, was partially normalized after all interventions. The expression of fatty acid synthase (FASN) and monocyte chemoattractant protein 1 (MCP-1) genes, which was reduced 0.5- and 0.15-fold, respectively, in the liver tissue of obese rats, were completely normalized after weight loss interventions, particularly after surgical interventions. The upregulation of FASN and MCP-1 gene expression was accompanied by a significant reduction in promoter methylation, up to 0.5-fold decrease in the case of the FASN (all intervention groups) and a 0.8-fold decrease in the case of the MCP-1 (SG group). Changes in tissue expression of specific genes involved in the pathophysiological mechanisms of obesity can be significantly attenuated following weight loss interventions, particularly surgery. Some of these genes are regulated by epigenetic mechanisms.

The effects of weight loss on health-related quality of life in obese women with PCOS and controls

BackgroundPolycystic ovary syndrome (PCOS) is a complicated endocrine disorder with widespread symptoms that reduce women’s quality of life. The adverse effect of associated obesity on this reduction is unclear, therefore the impact of weight loss on health-related quality of life (HRQOL) in obese women with PCOS is unknown. This study aimed to compare the impact of weight loss following a 24-week dietary intervention on HRQOL in obese women with and without PCOS.MethodsIn a 24-week hypocaloric LGI (low glycemic index) diet intervention study, 286 women were recruited (140 PCOS, 146 controls) and 216 participants (PCOS = 105, non-PCOS = 111) completed the study. HRQOL was assessed using the SF-36 questionnaire (Short Form Health Survey). Physical activity was measured using the short form of the International Physical Activity Questionnaire (IPAQ). Anthropometric assessments, dietary intake, physical activity levels, and HRQOL scores, according to the Iranian version of SF-36, were compared at baseline and 24 weeks with intervention.ResultsAt the end of the intervention, there was no significant difference in the percentages of weight loss between the two groups (PCOS: 6.29 ± 3.32% vs. non-PCOS: 7 ± 3.62%, p = 0.1). At baseline, women with PCOS had lower mean scores in aspects of physical function (PF), general health perception (GH), role limitation due to emotional problem (RE), vitality (VT), mental health (MH), physical (PCS) and mental component summary scales (MCS), compared to non-PCOS (P < 0.01). At 24 weeks, the percentage of improvement in HRQOL in the non-PCOS group was higher compared to the PCOS group but this difference didn’t reach statistical significance except for PCS. In both groups, greater weight loss was associated with further improvement in the physical aspects of HRQOL and vitality. In the non-PCOS group, with trivial exception, greater weight loss was associated with greater improvement in the mental aspects of HRQOL.ConclusionsBoth obese PCOS and non-PCOS women achieved nearly similar levels of improvement in HRQOL due to weight loss induced by a hypocaloric LGI diet.Trial registrationThis study is registered in the Iranian Randomized Clinical Trials Registry (IRCT, code: IRCT2016092129909N1).

Moderators of a Diet and Physical Activity Intervention: who Responds Best to Sequential vs. Simultaneous Approaches.

Given that low physical activity levels and poor dietary intake are co-occurring risk factors for chronic disease, there is a need for interventions that target both health behaviors, either sequentially or simultaneously. Little is known about participant characteristics that are associated with better or worse response to sequential and simultaneous interventions. The 12-month Counseling Advice for Lifestyle Management (CALM) randomized trial (N = 150; Mage = 55.3years) targeted these two behaviors either via a sequential approach - dietary advice first then exercise advice added ("Diet-First") or exercise advice first then dietary advice added ("Exercise-First") - or via a simultaneous approach. The objective was to examine demographic, clinical, and psychosocial moderators of intervention effects on 12-month change in (1) moderate-to-vigorous physical activity (MVPA), (2) fruit/vegetable intake, (3) caloric intake from saturated fat, and (4) weight. Hierarchical regressions first compared Diet-First to Exercise-First, followed by comparisons of these arms combined ("sequential") to the simultaneous arm. Older age, higher baseline BMI, and lower social support were associated with higher MVPA in Exercise-First vs. Diet-First, while lower tangible support was associated with higher fruit/vegetable intake in Exercise-First but not in Diet-First. Poor sleep was associated with higher levels of MVPA in the sequential arm than in the simultaneous arm. Lower vitality was associated with greater weight loss in the sequential arm than in the simultaneous arm, while the opposite was true for those who were not married. Identifying moderators of treatment response can allow the behavioral medicine field to enhance intervention efficacy by matching participant subgroups to their best-fitting interventions. NCT00131105.

Effect of heat treatment on precipitation behavior of second phase and property evolution of martensitic stainless steel

The microstructural optimization for 15–5PH stainless steel by heat treatment to enhance toughness and corrosion resistance were investigated. The results indicate that Cu-rich nanoparticles with a size of less than 30 nm are homogeneously dispersed within the matrix, exhibiting a K-S orientation relationship with the martensite matrix during the aging treatment. Additionally, reversed austenite is found to be distributed at the martensite lath boundaries, with the maximum content of 1.62% being observed at 550 °C. With increasing aging temperature, the dispersion strengthening effect caused by the precipitation of Cu-rich phases gradually weakens. After immersion in a 6% FeCl3 solution for 12 h, the greatest weight loss is observed in the 600 °C treated samples, followed by those treated at 450 °C, 550 °C, and 1050 °C.

Comparing self-reported energy intake using an online dietary tool with energy expenditure by an activity tracker

ObjectiveThe aim of this study was to compare self-reported total energy intake (TEI) collected using an online multiple-pass 24-h dietary recall tool (Intake24) with total energy expenditure (TEE) estimated from Fitbit Charge 2-improved algorithms in adults from the NoHoW trial (12-mo weight maintenance after free-living weight loss). MethodsBland–Altman plots were used to assess the level of agreement between TEI and TEE at baseline and after 12 mo. The ratio of TEI to TEE was also calculated. ResultsData from 1323 participants (71% female) was included in the analysis (mean ± SD: age 45 ± 12 y, body mass index 29.7 ± 5.4 kg/m2, initial weight loss 11.5 ± 6.5 kg). The TEI was lower than TEE on average by 33%, with limits of agreement ranging from –91% to +25%. Men, younger individuals, those with higher body mass index, those with the greater weight loss before enrollment, and those who gained weight during the study underestimated to a greater extent. ConclusionsThese findings contribute to the ongoing research examining the validity of technology-based dietary assessment tools.

Exhaled Breath Analysis Using Selected Ion Flow Tube Mass Spectrometry and Disease Severity in Heart Failure.

Exhaled breath volatile organic compounds (VOCs) are elevated in heart failure (HF). The ability of VOCs to predict long term cardiovascular mortality and morbidity has not been independently verified. In 55 patients admitted with acute decompensated heart failure (ADHF), we measured exhaled breath acetone and pentane levels upon admission and after 48 h of diuresis. In a separate cohort of 51 cardiac patients undergoing cardiopulmonary exercise testing (CPET), we measured exhaled breath acetone and pentane levels before and at peak exercise. In the ADHF cohort, admission acetone levels correlated with lower left ventricular ejection fraction (LVEF, r = -0.297, p = 0.035). Greater weight loss with diuretic therapy correlated with a greater reduction in both acetone levels (r = -0.398, p = 0.003) and pentane levels (r = -0.309, p = 0.021). In patients with above-median weight loss (≥4.5 kg), patients demonstrated significantly greater percentage reduction in acetone (59% reduction vs. 7% increase, p < 0.001) and pentane (23% reduction vs. 2% reduction, p = 0.008). In the CPET cohort, admission acetone and pentane levels correlated with higher VE/VCO2 (r = 0.39, p = 0.005), (r = 0.035, p = 0.014). However, there were no significant correlations between baseline or peak exercise acetone and pentane levels and peak VO2. In longitudinal follow-up with a median duration of 33 months, patients with elevated exhaled acetone and pentane levels experienced higher composite adverse events of death, ventricular assist device implantation, or orthotopic heart transplantation. In patients admitted with ADHF, higher exhaled breath acetone levels are associated with lower LVEF and poorer outcomes, and greater reductions in exhaled breath acetone and pentane tracked with greater weight loss. Exhaled acetone and pentane may be novel biomarkers in heart failure worthy of future investigation.

IFN-γ Limits Immunopathogenesis but Delays Fungal Clearance during Pneumocystis Pneumonia.

High levels of IFN-γ are produced in the lung during an adaptive immune response to Pneumocystis, but the effects of this prototypical Th1 cytokine on fungal clearance and immunopathogenesis have not been fully defined. Therefore, Pneumocystis-infected immunodeficient mice were immune reconstituted and administered control or anti-IFN-γ neutralizing Ab to determine how IFN-γ regulates the balance between host defense and immune-mediated lung injury. Mice treated with anti-IFN-γ demonstrated an initial worsening of Pneumocystis pneumonia-related immunopathogenesis, with greater weight loss, heightened lung inflammation, and more severe pulmonary function deficits than control mice. However, IFN-γ neutralization also enhanced macrophage phagocytosis of Pneumocystis and accelerated fungal clearance. When anti-IFN-γ-treated mice were also given IL-4 and IL-13 to promote a Th2-biased lung environment, the accelerated fungal clearance was preserved, but the severity of immunopathogenesis was reduced, and a more rapid recovery was observed. A direct suppressive effect of IFN-γ on macrophages was required but was not solely responsible for delayed fungal clearance, suggesting that IFN-γ acts through multiple mechanisms that likely include modulation of both macrophage and Th polarization. Enhanced Pneumocystis clearance in anti-IFN-γ-treated and IFN-γR-deficient mice was associated with significantly elevated IL-17+ CD4+ T cells and IL-17 protein in the lungs. Furthermore, neutralization of IL-17, but not IL-4, signaling blocked the accelerated fungal clearance observed in anti-IFN-γ-treated mice. Together, these data demonstrate that although IFN-γ delays fungal clearance by suppressing the lung Th17 response, it also serves an important regulatory role that limits immunopathogenesis and preserves pulmonary function.

Impact of social connectedness on weight loss outcomes in an online program.

Obesity is linked to many negative health consequences. While online behavioral weight loss programs (BWL) are an effective treatment for obesity, weight losses are modest. Social connectedness has been found to improve weight loss outcomes and previous findings suggests that it may be especially important for people of color. The present study investigated the impact of social connectedness (structural connectedness, or network size; relationship quality, and functional connectedness, or social support) on weight loss outcomes in an online BWL program and whether Black race or Hispanic ethnicity moderates the relationship between social connectedness and weight loss. Participants (N = 387) enrolled in a 16-week online BWL program and completed measures of social connectedness before treatment and had their weight measured. Individuals with less structural connectedness (smaller social networks) had greater weight losses. Further, higher levels of functional connectedness (affectionate support, positive support, and relationship quality) mediated the relationship between smaller network size and better weight loss outcomes. Black race / Hispanic ethnicity did not moderate the relationship between social connectedness and weight loss. These findings suggest that the quality of one's relationships, not the size of one's social network, is important for weight loss. Future studies may examine whether online BWL programs that build relationship quality and affectionate and positive support in participants' existing social networks improve overall weight loss outcomes.

Pathogenicity of a goose astrovirus 2 strain causing fatal gout in goslings

Gosling gout has posed a serious threat to the development of the China's goose industry since the outbreak in mainland China in 2016; goose astrovirus (GAstV) was identified as the culprit pathogen. Two genotypes of this virus have been identified: GAstV-1 and GAstV-2, of which GAstV-2 is the main epidemic strain. Our current understanding of the pathogenic mechanisms of GAstV-2 remains limited. To assess pathogenicity, 1-day-old goslings were inoculated with the GAstV-2 YC20 strain via the subcutaneous, intranasal, and oral infection routes. All the goslings showed typical gout symptoms, with those in the oral infection group exhibiting earlier and more severe clinical symptoms, the highest mortality rate, and greatest weight loss. The blood biochemical indicators, viral loads in cloacal swabs and all representative tissues, and serum antibody titers of all infection groups increased significantly, and no significant differences in these parameters were observed among the three infection groups. Histopathological studies showed that the livers, kidneys, and spleens were the main damaged organs, and the pathological changes in the oral group were more severe than those in the other groups. Further analysis revealed that hepatic sinuses narrowed or became occluded as early as 1 day post-inoculation; urate deposition occurred in the renal tubules at 2 days post-inoculation (dpi), followed by necrosis of renal tubular epithelial cells; and lymphocytic infiltration appeared in the splenic tissue at 5 dpi. These results further our understanding of the pathogenic mechanisms of GAstV-2 and provide a reference for future studies.