Obesity Research Articles

Background: Obesity is a well-established risk factor for atrial fibrillation (AF) and adverse cardiovascular outcomes. Glucagon-Like Peptide 1 receptor agonists (GLP-1 RAs), initially developed for glycemic control, have shown promise in reducing cardiovascular risk independent of diabetes. However, their effect on arrhythmic and cardiovascular outcomes in non-diabetic obese populations remains poorly defined. Research Question: In obese adults without diabetes, does GLP-1 RA therapy reduce the 1-year incidence of atrial fibrillation, mortality, heart failure, and major adverse cardiovascular events (MACE) compared to standard care? Methods: We utilized the TriNetX US Collaborative Network to identify adults ≥18 years with obesity and no history of diabetes from 2014–2022. Patients initiating GLP-1 RAs formed the treatment cohort. Controls were patients with obesity and no GLP-1 RA exposure. One-to-one propensity score matching (n=118,781 per group) was performed on demographics, cardiovascular comorbidities, and medication use. Outcomes were assessed at 1 year, excluding patients with pre-existing conditions. The primary outcome was incident AF while secondary outcomes were all-cause mortality, heart failure (HF), and three-point major adverse cardiovascular events (3P-MACE: acute MI, stroke, cardiac arrest). Results: GLP-1 RA use was associated with significant reductions across all endpoints: Atrial Fibrillation: 0.4% vs 0.7% (RR 0.605 [95% CI 0.542–0.675]; HR 0.563 [95% CI 0.504–0.628]; p<0.001); Mortality: 0.2% vs 1.0%, (RR 0.203 [95% CI 0.177–0.232]; HR 0.190 [95% CI 0.165–0.218]; p<0.001); Heart Failure: 0.6% vs 1.2% (RR 0.479 [95% CI 0.438–0.525]; HR 0.446 [95% CI 0.407–0.489]; p<0.001); 3P-MACE: 0.4% vs 0.9% (RR 0.429 [95% CI 0.384–0.480]; HR 0.399 [95% CI 0.357–0.446]; p<0.001). Kaplan-Meier survival curves confirmed significantly higher event-free survival in the GLP-1 RA cohort for all endpoints. No increase in AF subtypes (paroxysmal, persistent, chronic) was observed. Propensity-matching yielded well-balanced cohorts across age, sex, race, comorbidities, and medication exposure. Conclusion: Among obese adults without diabetes, GLP-1 RA was associated with a substantial reduction in new-onset AF, all-cause mortality, HF, and MACE at one year. These findings support a potential role for GLP-1 RAs in primary cardiovascular prevention in obesity, beyond their metabolic benefits, and underscore the need for dedicated randomized controlled trials.

Introduction: Overweight and obesity are associated with chronic low-grade inflammation, and exercise has been shown to lower levels of inflammatory markers. In this study, we examined the relationship between various exercise intensities and systemic inflammatory levels in overweight and obese adults using a nationally representative database of the United States population. Methods: Analysis was performed on 4,385 adults aged 18 years and older with a BMI of 25 or higher from the 2017-2018 National Health and Nutrition Examination Survey (NHANES), by comparing participant self-reported physical activity categorized as mild/moderate (M/M) and vigorous (V). Systemic inflammation was assessed using high-sensitivity C-reactive protein levels (CRP) and Systemic Inflammatory Index (SII). SII was calculated using platelet count, neutrophil, and lymphocyte count. Chi square and multivariable logistic regression were performed. Result: CRP was normal in 68.3% of people reporting V physical activity compared with 54.2% of people with M/M physical activity (p = 0.00). Similarly, 54.3% of people with V physical activity had lower SII compared with 43.7% of participants with M/M physical activity (p = 0.00). While controlling for sex, age group, race, and medical comorbidity, V physical activity was associated with lower odds of having elevated CRP (OR: 0.60, P = 0.00, 95% CI 0.42 –0.73) and SII (OR: 0.70, P = 0.00, 95% CI 0.56 – 0.90). Males (P = 0.00) have lower odds for elevated CRP and SII. Increasing comorbidity was associated with a higher odd of elevated CRP whereas was not significantly associated with SII. Non-Hispanic white males had higher odds of elevated SII. However, race was not significantly associated with CRP. Conclusion: For overweight and obese adults, the intensity of exercise matters. Compared with moderate/mild physical activity, vigorous physical activity is associated with lower systemic inflammatory markers, namely CRP and SII.

Introduction: Obesity is a cardinal national health concern firmly linked to cardiovascular disease and a primary driver of hypertension (HTN) through mechanisms such as neurohormonal, metabolic, and renal alterations and dysfunction. Stratified analyses of HTN-related mortality in obese adults by demographic and geographic categorization are limited. In this study, we analyze these HTN-related mortality trends in obese adults aged 25 years and older in the United States from 1999 to 2023. Methods: Data from death certificates of adults aged ≥ 25 years from the CDC WONDER database from 1999 to 2023 were analyzed using ICD-10 codes related to HTN (I10-I15) as the underlying cause of death and obesity (E66) as a contributing cause of death. Results were stratified by year, along with demographic and regional classifications. Age-adjusted mortality rates (AAMR) were quantified per 100,000 persons by standardizing crude mortality rates (CMR) with 95% confidence intervals (95%CI). Annual percent change (APC) and average annual percent change (AAPC) were calculated using Joinpoint regression software. Statistical significance was set at P<0.05. Results: HTN-related mortality in obese adults caused a total of 82,079 deaths from 1999 to 2023, mainly in the decedent’s home (56.59%). Overall AAMR increased from 0.45 in 1999 to 2.75 in 2023 (AAPC: 7.24; 95%CI: 6.80 to 7.92). In terms of age groups, adults aged 55-64 years had the highest average CMR, while those aged 75-84 years had the highest rate of increase (AAPC: 9.20; 95%CI: 8.67 to 9.84). Men, in comparison to women, had higher average AAMR along with a higher rate of increase (AAPC: 8.38; 95%CI: 8.04 to 8.97). Racially, non-Hispanic (NH) Black/African Americans had the highest average AAMR, and NH Whites had the highest rate of increase (AAPC: 8.25; 95%CI: 8.01 to 8.70). The South had the highest average AAMR, and the Midwest had the highest rate of increase (AAPC: 8.60; 95%CI: 8.06 to 9.54). States in the top 90th percentile of deaths included California, Florida, New York, Ohio, and Texas. From 1999 to 2020, urban areas had higher average AAMR, though rural areas had a higher rate of increase (AAPC: 10.02; 95%CI: 9.52 to 10.72). Conclusion: HTN-related mortality in obese adults aged 25 and older has increased from 1999 to 2023, with marked demographic and geographic disparities. Increased focus on obesity awareness and management is crucial to lessen future mortality, especially in at-risk groups.

Background: The incidence of diabetes mellitus (DM) continues to rise and is one of the most prevalent and costly chronic diseases worldwide. Diabetes, obesity, and cardiovascular disease (CVD) are closely linked, with CVD being the leading cause of mortality in individuals with DM. Thus, treatment (tx) of obesity has become a cornerstone in the prevention and management of type T2DM and CVD. Novel incretin mimetics, such as VK2735, a long-acting dual agonist of the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) receptors, may positively impact the risk of CVD in adults with T2DM. Hypothesis: Capture of cardiometabolic (CM) parameters in studies with VK2735 will provide critical data to determine improvement in CM measures and may support the potential long term benefit on CVD-related outcomes. Methods: VANQUISH-2 is a Phase 3, 78-week randomized, double-blind, placebo-controlled, parallel arm study that will evaluate the weight loss efficacy, safety, tolerability, pharmacodynamic effects, and pharmacokinetics of VK2735 in adults who are obese or overweight with T2DM. Participants will be recruited from sites in U.S. and will be randomized to receive a weekly subcutaneous injection of placebo or VK2735 (7.5-, 12.5-, or 17.5-mg). The tx period at the final target dose for each group will be a minimum of 52 weeks. Participants will receive lifestyle counseling throughout the tx period and should participate in ≥150 of physical activity per week in addition to a balanced, hypocaloric diet. Key inclusion criteria are adults with BMI ≥27 kg/m2. Key exclusion criteria are current or past diagnosis of type 1 DM, severe hypertriglyceridemia, prior or planned surgical tx or endoscopic and/or device-based tx for obesity and eGFR <30mL/min/1.73m 2 . Results: The primary efficacy endpoint of the study is mean percent change in body weight from baseline to end of tx. Key secondary endpoints are percentage of participants that achieve ≥5%, ≥10%, ≥15% and ≥20% body weight reduction by end of tx. Assessed changes in T2DM and CM-related parameters will include HbA1c, BMI, waist circumference, blood pressure and lipid profile. Safety and tolerability will also be assessed. Pancreatitis, gallbladder and CV events will be adjudicated. Conclusions: VANQUISH-2 will provide the first Phase 3 efficacy and safety data, including CM parameters, of the dual GIP/GLP-1 receptor agonist VK2735 for weight loss in obese or overweight adults with T2DM.

Objective: To determine the effects of a ketogenic diet on LDL-C levels and other metabolic parameters and adverse events in adults with a BMI greater than 25 and type 2 diabetes mellitus. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. Studies were identified through thorough searches of PubMed, Cochrane, Google Scholar, EMBASE, HERDIN. Included studies compared a ketogenic diet (≤10% carbohydrates) to a non-ketogenic diet for at least 3 months duration in adults with a BMI ≥25 and type 2 diabetes. The primary outcome was LDL-C level. Risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool and GRADE guidelines. Results: Nine studies with a total of 658 participants were included. In the short term (3-4 months), ketogenic diets significantly reduced LDL-C compared to non-ketogenic diets (mean difference: -0.16 mmol/L, 95% CI -0.31, -0.00, p = 0.04). This effect was not significant at longer follow-up periods (6-8 months, 12 months, and 24 months). Common adverse effects included hypoglycemia, constipation, and gastrointestinal discomfort. Conclusion: Ketogenic diets may offer short-term benefits in reducing LDL-C in overweight and obese adults with type 2 diabetes. However, these effects diminish over time, and the diet may be associated with adverse events. Significant short-term improvements were observed in HDL-C, triglycerides (TG), and HbA1c in ketogenic groups compared to controls, with moderate effects diminishing over time. Notably, follow-up time was a significant moderator for HDL-C, showing stronger effects at later time points, while FBS showed a borderline significant relationship with follow-up Long-term studies evaluating a broader range of metabolic outcomes are needed.

Background: GLP-1 receptor agonists (GLP-1 RAs) improve cardiovascular outcomes in patients with type 2 diabetes, but their effects in obese adults without diabetes remain unclear. Given rising GLP-1 RA use for weight management, understanding their cardiometabolic and arrhythmic impact in non-diabetic populations is critical. We evaluated cardiovascular, arrhythmia, and safety outcomes among obese, non-diabetic adults using real-world data. Methods: We queried the TriNetX Global Collaborative Network to identify adults (≥18 years) with obesity (ICD-10: E66) and no prior diagnosis of diabetes (E10–E13) or atrial fibrillation (AF; I48). Patients prescribed GLP-1 RAs (semaglutide, liraglutide, or dulaglutide) were propensity score–matched 1:1 to non-users based on demographics, comorbidities, and baseline labs. The index event was the first GLP-1 RA prescription, with 12-month follow-up. Outcomes included all-cause mortality, hospitalizations, myocardial infarction (MI), stroke, cardiac arrest, AF, heart failure (HF), cardiomegaly, pancreatitis, and new-onset hypertrophic cardiomyopathy (HCM). Kaplan-Meier survival curves and risk ratios (RR) were calculated. Results: After matching, 377,410 patients were included in each group. GLP-1 RA use was associated with a significantly lower risk of all-cause mortality (RR 0.30; HR 0.30; p<0.001), MI (HR 0.71; p<0.001), stroke (HR 0.70; p<0.001), cardiac arrest (HR 0.45; p<0.001), and hospitalization (RR 0.65; HR 0.62; p<0.001). GLP-1 users also showed lower progression to diabetes (RR 0.69; p=0.001). However, GLP-1 use was linked to increased risk of new-onset AF (HR 1.09; p=0.02), cardiomegaly (HR 1.29; p<0.001), and pancreatitis (HR 1.39; p<0.001). No significant difference was observed in incident HCM (HR 0.95; p=0.60). Conclusion: In this large, real-world cohort of obese, non-diabetic adults, GLP-1 RA use was associated with significant reductions in all-cause mortality, hospitalizations, and ischemic cardiovascular events. However, a modest increase in atrial fibrillation and pancreatitis was observed. These findings support the broader application of GLP-1 RAs in cardiovascular risk reduction among high-risk, non-diabetic populations. Study limitations include potential residual confounding and limited granularity regarding AF subtype and medication adherence. Prospective studies are needed to validate these observations and assess long-term safety.

Introduction: Obesity-related cardiovascular (CV) risk is a growing concern in India, even in the absence of diabetes. Lifestyle intervention strategies may play a role in improving cardiovascular risk in the Indian population. Research Question: Does a structured, multidisciplinary lifestyle intervention improve CV risk factors—including the Atherogenic Index of Plasma (AIP) and estimated 10-year cardiovascular risk using the Framingham Risk Score (FRS)—in metabolically at-risk individuals with obesity? Methods: This study involved 271 adults, aged 30 to 75 years, with obesity (BMI ≥ 25 kg/m^2 according to the WHO Asia Pacific Guidelines) and no history of heart disease. These individuals participated in a one-year online intensive lifestyle intervention program at an obesity management clinic in Pune, India, between 2021 and 2023. The intervention comprised a personalized plant-based diet, physical activity, stress management, and medical management. Baseline and endline assessments were conducted to measure anthropometric and biochemical parameters related to cardiovascular risk. Results: The mean age of the cohort was 48.1±9.1 years, with 73.1% being female. Initially, 25.5% and 27.3% of the participants were receiving pharmacological treatment for dyslipidemia and hypertension, respectively. Post-intervention, there was a statistically significant improvement in weight loss (-6.5%, p<0.005), with 14% of individuals transitioning to an overweight or normal BMI category. Notable improvements were observed in traditional risk factors: the prevalence of high triglycerides (≥150 mg/dl) decreased from 30% to 23.6%, high non-HDL cholesterol (≥130 mg/dl) from 67.2% to 60.5%, low HDL cholesterol in females (≤50 mg/dl) from 61.1% to 53.0%, and a high TG/HDL ratio (≥3) from 38.0% to 31.4% (p<0.05). Among non-traditional risk factors, the proportion of individuals with high-sensitivity C-reactive protein (hs-CRP >3 mg/L) decreased from 57.9% to 41.7% (p<0.05). The intervention led to a significant reduction in the AIP, with the percentage of individuals exceeding the risk threshold (>0.11) decreasing from 40.0% to 33.6%. Furthermore, the estimated 10-year cardiovascular risk, as assessed by the FRS, demonstrated a significant improvement (-7.6%, p<0.001). Conclusion: A one-year online lifestyle intervention significantly improved traditional and non-traditional CV risk factors, reducing AIP and FRS scores in obese Indian adults.

Background: BMI is widely used to assess adiposity and cardiometabolic risk, yet its utility varies by race/ethnicity. Alternative indices such as Body Roundness Index (BRI) and A Body Shape Index (ABSI) may offer improved risk stratification, but their utility remains unclear in the ethnically diverse U.S. population. Research Question: We evaluated associations of BMI, BRI, and ABSI with prevalent ASCVD and all-cause mortality, and determine whether these associations vary by race/ethnicity. Methods: Adults from the National Health and Nutrition Examination Survey cycles 2011-2018 (N = 21,294; weighted 226.4 million) were analyzed. BMI was categorized per WHO cutoffs (obesity ≥30 kg/m 2 , underweight <18.5 kg/m 2 , ≥27.5 kg/m 2 for obese Asian adults). BRI and ABSI were divided into quartiles, and the interquartile range was set as reference. Survey weighted regression models were employed to estimate the odds of prevalent ASCVD and the hazards of mortality. Subgroup analyses tested for racial/ethnic differences. Results: Obesity as defined by BMI, BRI, and ABSI were all associated with higher odds of ASCVD (aOR 1.58 [1.36-1.83]; 1.69 [1.43-1.99]; 1.66 [1.39-1.98] respectively). Underweight BMI was associated with increased mortality risk (aHR 3.18 [2.04-4.95]), while obesity showed no significant association. However, a high ABSI 1.41 [1.08-1.82] and low BRI 1.44 [1.04-1.98] were associated with mortality in the overall population. Subgroup analyses revealed significant ethnic differences that persisted after comprehensive multivariable adjustment (Figure). Among White adults, underweight BMI and high ABSI predicted mortality. In Asian adults, high BRI conferred greatest risk, while underweight BMI was inversely associated with mortality. In Black adults, higher BMI was associated with lower mortality, and a low BRI was associated with higher risk. For Hispanic adults, high ABSI was the only significant mortality predictor. Conclusion: Our findings suggest that BMI, BRI, and ABSI have differential predictive value for mortality across racial/ethnic groups. While BMI alone may underestimate risk, BRI and ABSI offer nuanced risk stratification, particularly in non-White populations. These results underscore the need for racial/ethnic conscious anthropometric risk assessments in clinical and public health settings.

Abstract Obesity in older adults presents a unique clinical paradox: while excess body weight is associated with adverse metabolic outcomes, modest overweight may offer protective benefits in terms of mortality and functional reserve—referred to as the “obesity paradox.” However, intentional weight loss in this population, although beneficial for managing comorbidities such as type 2 diabetes and cardiovascular disease, often results in unintended muscle loss, sarcopenia, and increased frailty. This review synthesizes the current literature on the obesity paradox in aging, exploring its biological underpinnings and clinical implications. The paper critically examines the risks and benefits of intentional weight loss and emphasizes the need for integrative strategies that promote fat reduction while preserving muscle mass. Dietary recommendations focus on adequate protein intake, vitamin D, omega-3 fatty acids, and polyphenol-rich foods to mitigate muscle catabolism. The role of resistance and aerobic exercise is also discussed as essential in counteracting sarcopenia and maintaining physical function. In addition, emerging evidence on the use of nutritional supplements and functional foods as adjunctive tools is explored. Practical clinical recommendations and future research directions are provided to guide safe and effective weight management in older adults. The review advocates for a shift from BMI-centered strategies to body composition–focused approaches that prioritize functional and metabolic health. Overall, this paper provides a comprehensive, evidence-based framework to help clinicians navigate the complex intersection of aging, obesity, and energy balance. In weight-loss programs for older adults, combining ≥ 1.0–1.5 g/kg/day of high-quality protein with structured resistance and aerobic training, vitamin D supplementation to maintain 25(OH)D ≥ 30 ng/mL, 1–2 g/day EPA + DHA, and polyphenol-rich foods (e.g., berries, green tea, extra-virgin olive oil, cruciferous vegetables) supports fat loss while preserving muscle function.

Obesity should be managed in older adults. However, challenges in this age group include multimorbidity, polypharmacy, limited mobility and sensation, and, in particular, sarcopenia, a natural consequence of aging exacerbated by weight loss. Lifestyle recommendations should emphasize adequate protein intake and exercise, particularly strength training, adapted to mobility. Antiobesity medications and metabolic-bariatric surgery are useful in select patients.

Effect of the Mediterranean diet on BMI and body composition: A preliminary pre-post intervention study in pediatric overweight patients.

Retrospective Study Comparing Predicted and Measured Resting Energy Expenditure in Burn Patients with Obesity.

Background/Objectives: The number of overweight and obese people has significantly increased in the world, and this phenomenon is referred to as globesity. Globally increasing obesity has become one of the major problems to be dealt with for countries, given obesity-related health problems, including nutrition-related noncommunicable diseases and some types of cancer, and the economic and social costs of obesity. Therefore, countries try to combat obesity through diverse strategies related to nutrition, physical activity, and education. In this regard, identifying the factors behind obesity is critical to making progress in the fight against obesity. Methods: This study explores the interplay amongst ICT (information and communication technologies) indicators, including Internet and mobile phone usage, unemployment, and adult obesity in the BRICS states from 1995 to 2022, using recently developed cointegration techniques and causality tests. Results: The outcomes of causality tests uncover an interaction between Internet and mobile phone usage, unemployment, and adult obesity. In addition, the cointegration coefficients reveal that Internet and mobile phone usage positively impact adult obesity, while unemployment has a negative effect on adult obesity. Conclusions: Our outcomes uncover that improper use of the Internet and mobile phones foster adult obesity, but proper utilization of the Internet and mobile phones can be effective instruments in combatting adult obesity through increasing the awareness of healthy lifestyles and online weight loss programs.

Incidence of Subclinical Hypothyroidism in Obese Adults and Its Metabolic Implications: A Prospective Cohort Study

Background: Obesity and hypothyroidism are two common clinical conditions that have been linked closely. Objective: To determine the status of thyroid function in primary obese adults. Methods: This cross-sectional study was conducted in the Department of Endocrinology, BMU from September 2022 to March 2025, enrolling 100 adults (aged 18-60 years) with obesity (BMI ≥25 kg/m²) and 50 adults (aged 18-60 years) with normal weight (BMI 18.5-22.9 kg/m²), all without known thyroid disorders. Secondary causes of obesity and conditions affecting thyroid function were excluded. Obesity parameters (body mass index, waist circumference, hip circumference, waist-hip ratio, waist-height ratio) were measured. Thyroid function tests, including free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), and anti-thyroid peroxidase antibody, were measured by chemiluminescent immunoassay. Results: The mean age of the obese and normal weight groups was 28.6 (8.5) years and 28.1 (8.8) years, respectively. Serum FT3 [3.2 (0.5) vs. 3.6 (0.4), pg/ml, p<0.001] and FT4 [1.1 (0.2) vs. 1.2 (0.2), ng/dl, p<0.001] levels were significantly lower while TSH [3.9 (3.3) vs. 1.6 (1.1), µIU/mL, p<0.001] levels were significantly higher in obese individuals compared to those of normal weight individuals. There was a significantly higher frequency of hypothyroidism (24% vs. 2% Total, 17% vs. 2% subclinical, and 7% vs. 0% overt, p=0.001) and anti-thyroid peroxidase antibody positivity (27% vs. 12%, p=0.037) in obese adults compared with normal weight adults. None of the participants had subclinical or overt thyrotoxicosis. Multiple linear regression revealed a significant negative correlation between FT4 and hip circumference (β = -2.266, 95% CI = -0.050 to -0.001). Conclusions: We found a significant association of hypothyroidism with obesity, irrespective of anti-thyroid peroxidase antibody status. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S38]

BackgroundOverweight and obesity result from excessive fat accumulation and pose significant global health challenges linked to various diseases. Recent research suggests that gut microbiota, particularly dysbiosis, is vital in obesity development. Next-generation probiotics, especially Akkermansia muciniphila, alongside compounds found in green tea extract and konjac glucomannan, offer promise in obesity management by enhancing gut microbiota balance and metabolic function. This research investigates a unique supplement that integrates these elements, proposing that it will outperform lifestyle changes alone in improving anthropometric measures, body composition, metabolic metrics, blood pressure, and appetite among overweight or obese adults.MethodsThis study will include 72 overweight or obese patients, who will be randomly assigned to either the intervention or control group within a randomized, triple-blind controlled clinical trial. The intervention group will consume 2 g of beverage sachets containing pasteurized Akkermansia muciniphila, green tea extract, and konjac glucomannan three times daily. In comparison, the control group will take 2 g of microcrystalline cellulose three times daily for 8 weeks. Evaluations of anthropometry (body mass index, waist and hip circumference), body composition (fat mass, fat-free mass, total body water, etc.), appetite using a visual analogue scale, blood pressure, and biochemical parameters including fasting blood glucose (FBS), total cholesterol (TC), triglycerides (TG), low- and high-density lipoprotein (LDL and HDL) will be conducted.DiscussionThe results of this study will provide evidence for the synergistic effects of Akkermansia muciniphila combined with prebiotics in the management of obesity and its associated metabolic states.Trial registrationIranian Registry of Clinical Trials (IRCT20250222064807N2) (2025/03/26).Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09180-3.

BackgroundObesity has become a global health crisis and is in urgent need of effective, sustainable interventions. Although conventional approaches such as dietary modification and aerobic exercise demonstrate efficacy, long-term maintenance of weight loss is still challenging. Dance movement therapy (DMT) is emerging as a promising intervention, combining physical activity with psychological and social engagement to potentially enhance compliance and holistic health outcomes. However, existing studies on DMT for weight management are limited, with inconsistent results.Methods and analysisRandomized controlled trials (RCTs) and cohort studies comparing DMT and standard lifestyle interventions (e.g., diet/exercise counseling) in overweight or obese adults will be included. Literature searches will be conducted in PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang, and Cochrane Library. Two reviewers independently perform the processes of literature retrieval, screening, data extraction, and assessment of risk of bias. Risk of bias in included studies is evaluated using the revised Cochrane risk-of-bias tool (ROB 2) for RCTs and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-1) for non-RCTs. Review Manager (RevMan) was used for data pooling. Subgroup analysis, meta-regression, trial sequential analysis (TSA), and sensitivity analysis are conducted.Ethics and disseminationEthical approval is not required because this study is a secondary analysis of existing data. We will disseminate the findings through peer-reviewed publications.Systematic review registrationPROSPERO CRD42024614884Strengths and limitations of this study• This systematic review and meta-analysis employs a rigorous methodology and strict adherence to inclusion criteria.• The use of ROB 2 and ROBINS-1 ensures a robust evaluation of study quality.• The certainty of evidence may be limited by inconsistent study quality and small sample sizes of enrolled trials.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13643-025-02962-5.

Time-restricted eating (TRE) is an effective dietary strategy for reducing overweight, obesity, and related complications, offering flexibility to fit individual preferences. However, its effects vary depending on individual conditions, and to date insufficient research in human studies has been conducted to support its recommendation as a healthy eating approach. This study took the form of a systematic review and meta-analysis to evaluate the effects of TRE on overweight and obesity in adults and on metabolic risk factors, specifically cardiovascular diseases (CVDs) and non-alcoholic fatty liver disease (NAFLD), considering fasting window, a common intervention, intake management, and intervention duration. A literature search was conducted on October 10, 2024, using the Ovid MEDLINE, Cochrane CENTRAL, Embase, Web of Science, Scopus, and CINAHL databases. The study followed the PRISMA checklist and included 28 randomized controlled trials (RCTs) with 1648 participants. The outcomes analyzed included weight, waist circumference, fat mass, plasma lipids, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), fasting glucose, and fasting insulin. The meta-analysis showed large effect sizes (ESs) for weight (ES: -1.40, 95% CI: -2.33 to -0.48) and waist circumference (ES: -0.75, 95% CI: -0.93 to -0.56), and a moderate ES for fat mass (ES: -0.61, 95% CI: -0.98 to -0.24). A small effect was found for HOMA-IR (ES: -0.29, 95% CI: -0.48 to -0.10). While there was heterogeneity for weight and fat mass, the sensitivity analyses were robust. In contrast, the effects on plasma lipids, fasting glucose, and fasting insulin were inconclusive. TRE may ameliorate metabolic risk factors in adults with overweight and obesity, offering a flexible approach adaptable to individual lifestyles. However, reductions in weight and fat mass may depend on the individual conditions, and the medications taken by individuals may influence the outcomes. Furthermore, interventional studies on TRE remain insufficient, necessitating further experimental research, systematic reviews, and meta-analyses to better understand the effects of TRE. PROSPERO registration No. [CRD42024556381].

Obesity indicators and risk of mortality and functional health outcomes in Asian community-dwelling older adults: A systematic review and meta-analysis.

Disclosure: C. Tsai: None. J. Chan: None. J. Milks: None. A. Ferrebus: None. I. Hanna: None. S. Mahrokhian: None. A.J. Newman: None. S. Parisien-La Salle: None. I.R. Marques: None. K. Foote: None. R.Y. Kwong: None. M. Jerosch-Herold: None. A. Vaidya: None. J.M. Brown: None.Background: Adiposity has been linked to excess aldosterone production and mineralocorticoid receptor (MR) activation, implicating a mechanism of obesity-related cardiovascular disease. Cardiac fat, comprising epicardial and pericardial fat, is a recognized cardiovascular risk factor and has been linked to elevated aldosterone concentrations in overt primary aldosteronism (PA). We aimed to investigate the relationship between the spectrum of PA pathophysiology and cardiac fat in obese adults. Method: We here report a cross-sectional analysis of baseline data from a randomized trial of 71 participants with Stage 1-2 hypertension and obesity evaluating the impact of MR antagonist therapy on cardiac magnetic resonance imaging (MRI) endpoints. Prior to randomization, all participants were washed off of interfering medications and underwent comprehensive phenotyping of PA pathophysiology, including oral sodium suppression and saline suppression (SST) tests to assess renin-independent aldosterone production, as well as dexamethasone suppression and adrenocorticotropic hormone (ACTH) stimulation tests to assess ACTH-mediated aldosterone production. Additionally, 24-hour ambulatory blood pressure monitoring was performed. Cardiac fat was quantified from cardiac MRI studies using whole-heart short-axis cine stack imaging and was analyzed in relation to clinical parameters and aldosterone levels. Results: The mean age of participants was 55.4 years, and the mean BMI was 34.7 kg/m². Participants were divided into high and low cardiac fat groups based on the median value (217.6 ml). Participants in the high cardiac fat group exhibited significantly higher 24-hour ambulatory systolic blood pressure (122.2 vs 127.0 mmHg; P=0.022). High cardiac fat was associated with greater renin-independent aldosterone production, assessed via both post-SST aldosterone levels (12.2 vs. 8.94 ng/dL) and post-oral sodium suppression aldosterone levels (16.0 vs. 12.1 ng/dL), and with greater ACTH- dependent and ACTH-independent aldosterone production: post-ACTH aldosterone 44.0 vs. 33.0 ng/dL, post-dexamethasone aldosterone 16.8 vs. 11.8 ng/dL (global P=0.017). Repeated measures linear mixed models confirmed a significant continuous relationship of greater cardiac fat volume with greater renin-independent and ACTH-mediated aldosterone production, including after adjustment for age, sex, body mass index and 24-hour ambulatory blood pressure (global P=0.011). Conclusion: These findings demonstrate a highly prevalent spectrum of PA pathophysiology in obese hypertensive adults that is associated with greater cardiac fat, thereby implicating the role of aldosterone and MR activation with this metabolically active fat depot known to be related to adverse cardiometabolic outcomes.Presentation: Sunday, July 13, 2025