Obese Population Research Articles

Association of systemic immunity-inflammation index with type 2 diabetes and insulin resistance in NHANES 2005–2018

Although the interplay between inflammation and diabetes is increasingly recognized, it is unclear whether the systemic immunity-inflammation index (SII), as a biomarker of systemic inflammatory response, is associated with type 2 diabetes (T2D) and insulin resistance (IR). This cross-sectional study was performed in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018, and finally enrolled 17,017 participants. To explore the relationship between SII and T2D and IR, a series of statistical analyses were conducted including weighted multivariate linear regression, logistic regression, and subgroup analysis. The fully adjusted multivariate linear regression revealed a positive correlation between SII and fasting plasma glucose (β = 0.13, 95% CI: 0.01, 0.24), fasting serum insulin (β = 12.90, 95% CI: 6.77, 19.04), and homeostasis model assessment of insulin resistance (β = 0.68, 95% CI: 0.25, 1.10). A per-SD increase in SII was found to be associated with a 4% increase in the odds of T2D, and a 5% increase in the odds of IR. The trend was significant across all SII quartile groups. Subgroup analysis revealed a stronger positive association existed between SII and T2D and IR in female, younger, and obese populations. SII was positively associated with the risk of T2D and IR, indicating that reducing SII levels may help prevent these conditions in the general population.

Retrospective Study on Short-Term Reverse Cardiac Remodeling in Obese Patients Undergoing Sleeve Gastrectomy

Severe obesity is closely associated with an increased risk of comorbidities and alterations in cardiac structure and function. The primary objective of this study was to investigate cardiovascular (CV) risk factors and ventricular remodeling in individuals from an obese population eligible for bariatric surgery. The secondary objective was to evaluate changes in anthropometric, clinical laboratory, and echocardiographic measurements 12 weeks after surgery compared to baseline values. This retrospective observational cohort study involved patients from a single specialized bariatric surgery center. A total of 35 patients were included (mean age 41.5 ± 10.3 years; BMI 43.4 ± 6.6 kg/m2), of whom 34.2% had a family history of coronary artery disease (CAD), 5.7% had a prior history of CAD, 8 had essential hypertension, 11.4% had dyslipidemia, 20% were smokers, and 8.6% were former smokers. Approximately 57% of the patients exhibited concentric left ventricular remodeling, and 14% had grade I diastolic dysfunction. At 12 weeks post-surgery, with an average weight loss of 25 kg and a mean BMI reduction of 8.5 kg/m2, 14% of the patients still exhibited concentric left ventricular remodeling, and about 11% had grade I diastolic dysfunction. Bariatric surgery contributes to the improvement of cardiac function and structure over time as a result of significant weight loss.

Long-Term Cardiovascular Disease Outcomes Following Bariatric Surgery

IntroductionThe long-term cardiovascular benefits of bariatric surgery remain unclear. We aimed to analyze the association between bariatric surgery and cardiovascular disease outcomes. MethodsThe Maryland Health Services Cost Review Commission database (2015-2022) was queried for patients aged 15 to 84 y with obesity. Bariatric surgery patients were matched with nonsurgical patients using propensity score matching. Primary outcomes included all-cause mortality, new-onset heart failure (HF), myocardial infarction (MI), and ischemic stroke. A subgroup analysis of outcomes based on age, sex, diabetes, and smoking status was performed. ResultsA total of 222,700 patients met the inclusion criteria. 104,855 (47.09%) bariatric and 117,845 (52.90%) nonsurgical patients were analyzed. Bariatric surgery was associated with reduced risk of all-cause mortality 12.1 versus 15.7 per 1000 person-years (hazard ratio [HR] = 0.77, 95% confidence interval [CI] = 0.73-0.79, P < 0.001), HF (HR = 0.63, 95% CI = 0.69-0.67, P < 0.001), MI (HR = 0.69, 95% CI = 0.63-0.74, P < 0.001), and stroke (HR = 0.75, 95% CI = 0.69-0.80, P < 0.001). The association between bariatric surgery in the obese population and the improvement in cardiovascular outcomes was significantly pronounced in the pre-existing diabetes mellitus (DM) group compared to the non-DM group in terms of all-cause mortality, HF, and MI (adjusted HR = 0.59, 0.62, 0.59 respectively, P < 0.05). Bariatric surgery was also associated with a statistically significant reduction in all-cause mortality, MI, and stroke in smokers compared to nonsmokers (adjusted HR = 0.61, 0.59, 0.59 respectively, P < 0.05). ConclusionsOur study demonstrates a statistically significant association between bariatric surgery and improvement in long-term cardiovascular outcomes and reduction in all-cause mortality in the obese population following bariatric surgery.

Association of obstructive sleep apnea with bone metabolism in older adults: a hospital-based study

PurposeObstructive sleep apnea (OSA) significantly affects patients’ quality of life; however, the mechanisms, such as its effects on bone mineral density (BMD) and bone turnover marker (BTM) expression, remain unclear. In this study, we investigated the relationships among OSA, BMD, and (BTMs) in older adults.MethodsThis retrospective study enrolled 260 participants (114 women; 44.5%). Data of an established system (Alice NightOne) were used to diagnose OSA and analyze nocturnal hypoxia. Participants were divided into four groups according to respiratory event index (REI) (control, < 5 times/hour; mild OSA, 5–15 times/hour; moderate OSA 15–30 times/hour; severe OSA ≥ 30 times/hour). BMD were mesured by dual-energy x-ray absorptiometry. BTMs including bone specific alkaline phosphatase (BALP), tartrate-resistant acid phosphatase 5b (TRAP-5b) were collected.ResultsPatients with OSA had higher BMD at first lumbar vertebra, left and right femur than those without (all p < 0.05). REI was positively correlated with BMD at the first lumbar vertebra (r = 0.181, p = 0.006), left femur (r = 0.160, p = 0.014), and right femur (r = 0.243, p < 0.001). In participants with body mass index (BMI) of 18–24 kg/m2 (N = 96), the correlation between REI and BMD at the left femur(r = 0.251, p = 0.019) and right femur (r = 0.258, p = 0.018) remained. Multiple regression analysis showed that OSA was significantly associated with osteoporosis (p = 0.034, 95% confidence interval, 0.092–0.100, odds ratio, 0.092). MSaO2 was positively correlated with TRAP5b (r = 0.560, p = 0.007). In participants with a BMI of ≥ 24 kg/m2(N = 164), MSaO2 was negatively correlated with BALP (r = −0.331, p = 0.034). No significant association between REI and BMD was observed.ConclusionsOSA and hypoxia were associated with higher BMD in older adults in BMI of 18–24 kg/m2 but not in participants with a BMI of ≥ 24 kg/m2. This study suggests a negative association between OSA and osteoporosis in non-overweight and obese population. BMI played an important role. The study’s findings could help exploration mechanisms of osteoporosis and promoting its treatment.

Validity of Fasting Plasma Glucose in Reference to HbA1c for the Detection of Diabetes in an Overweight and Obese Population in Sri Lanka

Validity of Fasting Plasma Glucose in Reference to HbA1c for the Detection of Diabetes in an Overweight and Obese Population in Sri Lanka

Association of body mass index with pathologic agreement of preoperative and postoperative tumor grade in endometrial cancer.

We aim to study association of BMI of EC patients, with the level of agreement between preoperative and postoperative tumor grade. A retrospective study. We included patients with EC diagnosed in an outpatient clinic which had surgical staging as in our division. We categorized patients into BMI categories according to the World Health Organization; (BMI < 18.5kg/m2), (BMI 18.5-24.9kg/m2), (BMI 25-29.9kg/m2), (BMI 30-34.9kg/m2), (BMI 35-39.9kg/m2), and (BMI ≥ 40kg/m2). We further dichotomized the study population for obesity, defined as BMI ≥ 30.0. We analyzed agreement between preoperative and postoperative tumor grade, stratified by patient's BMI. Overall, 623 women met study inclusion criteria, with a median age of 64 [interquartile range (IQR) 57-72]. Among the study cohort, the median BMI was 30.7 [IQR 25.6-38.8], with 330 (53.0%) patients being obese. EC grade 1 was diagnosed preoperatively in 353 (56.7%), grade 3 in 148 (23.8%), and grade 2 in 122 (19.6%). Endometrioid histology was diagnosed in 463 (74.3%), serous in 78 (12.5%), mixed histotype in 51 (8.2%), clear cell in 20 (3.2%) and carcinosarcoma in 11 (1.8%). In 68.7% (n = 428), there was no change in postoperative grade, and in 24.9% (n = 155), there was upgrading of tumor, and in 6.4% (n = 40), there was a tumor downgrade. There were 3 (0.5%) cases in which no tumor was found on final pathology. The rate of no change was higher in preoperative grade 3 (89.9%) vs. grades 1 (63.5%) and grade 2 (58.2%), p < .001). There was no difference in grading agreement when obese patients were compared to non-obese, p = .248. There was no difference in grading agreement when comparing the various BMI categories, with no change proportion ranging between 58.2% in BMI 30.0-34.9 mg/kg2 and 79.7% in BMI 35.0-39.9 mg/kg2, p = .104. ROC analysis of BMI as predictor of no-change yielded an area under the curve of 0.466 (95% confidence interval 0.418-0.515) with a maximal performance at a BMI of 33.8 mg/kg2. The agreement between preoperative and postoperative tumor grade among all patients was kappa = 0.517. The agreement did not differ when compared between obese patients (kappa = 0.456) and non-obese (kappa = 0.575). Our study found no significant association between BMI and the agreement between preoperative and postoperative tumor grading in EC.

Analysing premature cardiovascular disease mortality in the United States by obesity status and educational attainment

BackgroundIn the United States (US), premature cardiovascular disease (CVD) mortality rates (35–74 years) have exhibited increases in recent years, particularly in younger adults, and large differentials by educational attainment. This trend has occurred concurrently with high and increasing obesity prevalence, which also show significant differences by education. This study aims to jointly model premature CVD mortality trends in the US according to obesity status and educational attainment.MethodsWe used multiple cause of death data from the National Center for Health Statistics, obesity prevalence data from the National Health and Nutrition Examination Survey (NHANES), and educational attainment data from the American Community Survey and NHANES. We applied Bayes’ theorem to these data to calculate the conditional probability of premature CVD mortality given obesity status and educational attainment for 2003–2019. We then projected this conditional probability for 2020–2029 using the Lee-Carter model.ResultsThe probability of premature CVD mortality was greatest for obesity and low education (not graduated high school) and was substantially higher (females 6.7 times higher, males 5.9) compared with non-obesity and high education (Bachelor’s degree or higher) in 2019. There was a widening of the gap in premature CVD mortality from 2003 to 2019 between the obese and non-obese populations, which occurred at each education level and was projected to continue in 2020–2029, especially for males. The conditional probability of premature CVD death for obesity and middle education (finished high school but no Bachelor’s degree) increased substantially and was projected to surpass the level for non-obesity and low education in coming years for males and in younger age groups. At high education, the conditional probability of premature CVD death for the obese population was projected to increase to 2029, while for non-obesity it was projected to remain steady for females and fall for males; this projected widening is greatest at older age groups.ConclusionsThe findings demonstrate the public health challenge to reduce premature US CVD mortality posed by continued high obesity prevalence, especially for younger ages, lower education groups and males. The relative importance of obesity in influencing premature CVD mortality trends has risen partly due to the decline in CVD mortality attributable to other risk factors.

Sex differences in overweight and obese patients undergoing high-power short-duration pulmonary vein isolation for atrial fibrillation: an observational cohort study

Atrial fibrillation (AF) is the most common heart rhythm disorder worldwide. As treatment methods evolve, optimizing personalized therapy based on patient characteristics, such as sex, becomes crucial. This study investigates sex differences in high-power short-duration (HPSD) pulmonary vein isolation (PVI) in overweight and obese patients. We analyzed data from 189 overweight and obese patients who underwent HPSD PVI for AF, comparing demographic information, procedural details, outcomes, and complications between male and female patients. Our analysis revealed fewer women underwent PVI compared to men, with women typically older and showing more pronounced changes in the left atrial substrate. Despite these differences, the safety and efficacy of PVI were comparable between sexes, including in the BMI ≥ 30 kg/m2 subgroup and after age adjustment. The findings emphasize the need for early AF screening in women to prevent treatment delays and show that considering sex-specific differences in fat distribution can improve procedural outcomes. These insights support the need for tailored management strategies for AF in overweight and obese populations, addressing sex-specific risks and anatomical variations.

Impact of Obstructive Sleep Apnea on Outcomes after Anterior Cervical Discectomy and Fusion

Study Design. Retrospective Cohort Objective. To evaluate the impact of having a history of Obstructive Sleep Apnea (OSA) in patients undergoing anterior cervical discectomy and fusion (ACDF) on postoperative outcomes. Summary of Background Data. With an aging population and rates of obesity increasing, comorbidities that influence patient safety are increasingly common. One frequently overlooked comorbidity is OSA which affects nearly 24% of the population. Despite its prevalence, the impact of OSA on outcomes following ACDF is poorly understood. Methods. A retrospective analysis of patients &gt;18 years who underwent 1-4 level ACDF at an academic medical center from 2014-2020 was performed. Patient’s age, sex, BMI, CCI, hypertension, diabetes, and levels fused were propensity matched in a 3:1 fashion. Outcomes assessed included inpatient complications, 30 and 90-day ED visits, 30 and 90-day readmissions, reoperations, and one-year PROMs. Results. A total of 344 ACDF patients (86 OSA, 258 No OSA) were included. 30-day ED visits were higher among the OSA compared to the non-OSA group (5.85% vs 0%, P=0.001). Among ED visits, there were 2 patients with pneumonia, 1 with dysphagia, and 1 with extremity weakness, none of which warranted readmission. ED visits equalized in the 30–90-day window. There were no significant differences in inpatient complications, LOS, discharge disposition, readmissions, reoperations, and one-year PROMs. Conclusion. Patients with a history of OSA underwent ACDF without an increased risk of postoperative complications, readmissions, or reoperations and experienced a complication rate much lower than previously suggested by current literature. OSA patients experienced similar improvements in PROMs at 1-year follow-up. Surgeons should counsel OSA patients regarding the increased risk of 30-day ED visits. But overall, patients can expect safe and equivalent outcomes compared to non-OSA patients which lends support for safe outpatient surgery in this population.

Burden of Non-Communicable Disease and It’s Association with Weight Status: A Cross-Sectional Study in a Rural Community of Bangladesh

Background: Non-Communicable Diseases (NCDs) are now the leading causes of morbidity and mortality worldwide. Bangladesh has also experienced a rapid epidemiological shift from communicable diseases to non-communicable diseases due to growing urbanization and lifestyle alteration over the last few decades and this transition is also prominent in rural community of the country. Among all modifiable factors, overweight or obesity is the key risk factor for NCDs. This study aimed to determine the burden of NCD and its link to the body weight status of the rural population of Bangladesh. Materials and methods: This cross-sectional study was conducted in a village of Gomostapur Upazila under Chapainawabganj district from February to April 2024 among 135 people. The data were collected with face-to-face interview and Body Mass Index was measured. The data were compiled and tabulated according to key variables and analyzed with IBM SPSS 29.0.2. Results: Majority 44.5% of the study people belonged to age group 21-40 years. Among them 47.4% were male and 52.6% were female. Maximum respondents were of low-middle socioeconomic condition. Among them around 3/4th of the population was suffering from NCDs. Most of the respondents 24.4% had bone and joint pain followed by Hypertension, Asthma, COPD, Diabetes and Heart Disease at 20.7%, 17.0%, 14.1% and 10.4% respectively. Hypertension, Diabetes, Cardiovascular Disease, Stroke and Cancers were more prevalent in the older age group. Hypertension, Diabetes, Stroke and Bone-Joint Pain were seen more in female participants whereas male respondents had more prevalence of Asthma, COPD. Most of the study population had BMI above 25 kg/m2 and the study showed maximum NCDs were prevalent considerably in overweight and obese groups. Conclusion: The study revealed that, NCDs are highly prevalent among obese older rural population of Bangladesh while management, prevention, awareness and research are low. The integrated programs must be designed and implemented through a primary health care approach and high risk-group targeted interventions should be procurable to combat the rising burden of NCDs. IAHS Medical Journal Vol 7(1), June 2024; 74-79

Abstract 4135712: Mortality and Cardiovascular Complications Associated with Weight Loss Drugs among Breast Cancer Females Under Cardiotoxic Therapies: A Real-World Populational Study in the United States

Background: Obesity is an adverse prognostic factor for breast cancer (BC). While liraglutide and semaglutide, derived from antidiabetic glucagon-like peptide-1 receptor agonists (GLP1RA), are established weight loss drugs known for their cardiovascular safety in the general obese population, their safety in BC patients undergoing cardiotoxic antineoplastic therapies remains less understood. Objective: To investigate the mortality and cardiovascular outcomes related to GLP1RA used for weight loss among the highly susceptible BC females. Methods: This retrospective cohort study was based on the TrinetX network, comprising real-time health records from over 60 US healthcare organizations. The study population included obese females (≥18 years old) who received at least three prescriptions of either exclusive GLP1RA (liraglutide or semaglutide) or non-GLP1RA weight loss drugs (phentermine, bupropion-naltrexone, orlistat) upon BC diagnosis between 01/01/2015 and 01/01/2022. The index date was the initiation of systemic anti-cancer treatment, including chemotherapy (anthracycline, taxane, or cyclophosphamide), and/or anti-HER2 agents (trastuzumab, pertuzumab, or lapatinib). We used 1:1 propensity score-matching (PSM) to balance demographics, BMI, comorbidities, concurrent medications for cardiovascular diseases and metabolic disorders, BC receptor status and prior treatment, and levels of serum cholesterol (LDL, HDL) and hemoglobin A1c. Cox regression models were applied to compute hazard ratios (HR) and 95% confidence intervals (CIs). Follow-up continued until 05/24/2024, or until adverse cardiovascular events or death occurred. Results: Among 380 PSM-balanced pairs, the GLP1RA group (mean age: 57.6±11) showed significantly lower risks of all-cause mortality (HR 0.593, 95% CI 0.457-0.77), acute heart failure (HR 0.496, 95% CI 0.286-0.859), angina pectoris (HR 0.566, 95% CI 0.343-0.936), and acute stroke (HR 0.661, 95% CI 0.46-0.951) than the non-GLP1RA group (mean age: 57.5±12). Otherwise, no significant difference was shown in acute myocardial infarction (HR 0.787, 95% CI 0.495-1.251), pulmonary hypertension (HR 0.777, 95% CI 0.55-1.099), or arrhythmias (HR 0.829, 95% CI 0.566-1.215). Conclusion: Compared to non-GLP1RA weight loss agents, GLP1RA offers better survival and cardiovascular protection for BC patients undergoing cardiotoxic therapies. Future studies are warranted to validate the safety of these weight loss drugs during the BC treatment continuum.

Evaluation of measurement properties of the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) instrument among Chinese overweight and obese populations

PurposeTo evaluate measurement properties of the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) instrument among Chinese overweight and obese populations.MethodsA representative sample of Chinese overweight and obese populations was recruited stratified by age, sex, residence and body mass index (BMI). Social-demographic characteristics, self-reported EQ-5D-5 L and IWQOL-Lite responses were collected through the online survey. Test-retest reliability was assessed using intraclass correlation coefficient (ICC) among a subgroup of the total sample. Structural validity was evaluated by confirmatory factor analysis (CFA). Convergent validity and known-group validity were examined using Spearman’s rank correlation and effect sizes, respectively.ResultsA total of 1000 respondents (48% female; mean age: 51.7 years; mean BMI: 27.4) were included in this study. Ceiling and floor effects of the IWQOL-Lite were 5.4% and 0.67%, respectively. The ICC between the two tests was 0.992 for IWQOL-Lite among the subgroup (N = 150). The results of the CFA suggested that the five-factor model had an acceptable structural validity (GFI = 0.894, CFI = 0.960, TLI = 0.957, RMSEA = 0.054 and SRMR = 0.033). The Spearman’s rank correlation (range: 0.413–0.611) indicated a satisfactory convergent validity. The effect sizes values of IWQOL-Lite total score and different dimensions were moderate.ConclusionsThe IWQOL-Lite has been demonstrated to have satisfactory validity and reliability in measuring the HRQoL of Chinese overweight and obese populations. Further research is needed to confirm the sensitivity and responsiveness.

Heart failure and cardiomyopathy mortality trends and disparities among obese populations: A 20-year United States study

Heart failure and cardiomyopathy mortality trends and disparities among obese populations: A 20-year United States study

The role of metformin in modulating cardiometabolic risk in obese pediatric populations with metabolic syndrome: A systematic review

Introduction: Obesity significantly increases the risk of developing cardiometabolic complications, which are precursors to cardiovascular diseases (CVD). In children and adolescents, metabolic dysfunctions such as insulin resistance, dyslipidemia, and hypertension are key contributors to early-onset cardiovascular risk. Metformin, a well-established antidiabetic agent, has shown potential benefits in addressing these metabolic imbalances. However, the long-term impact of metformin on cardiovascular outcomes in obese pediatric patients remains unclear. Aim: This systematic review aims to evaluate the effect of metformin on cardiometabolic parameters in obese children and adolescents with metabolic syndrome, focusing on insulin sensitivity, body mass index (BMI), blood pressure, and lipid profiles. Methods: A systematic review was conducted by searching databases including PubMed, Cochrane Library, Embase, and Web of Science. The inclusion criteria targeted randomized controlled trials (RCTs), cohort studies, systematic reviews, and meta-analyses published between 2004 and 2024. Pediatric patients aged 6-18 years with obesity and metabolic syndrome were included. The primary outcomes assessed were BMI, insulin sensitivity, lipid profiles, blood pressure, and cardiovascular outcomes. Results: A total of 23 studies, including 10 RCTs and 1 meta-analysis, were reviewed, involving 777 patients. Metformin demonstrated consistent improvements in insulin sensitivity and BMI in obese children and adolescents. Several studies reported modest reductions in BMI, improved insulin resistance, and better lipid profiles. However, variability in results was observed regarding long-term cardiovascular outcomes. While metformin reduced systolic blood pressure and carotid intimal-medial thickness (CIMT), the long-term impact on preventing major cardiovascular events remained inconclusive. Discussion: Metformin’s benefits on cardiometabolic risk factors in obese children are primarily attributed to its effects on insulin sensitivity, lipid metabolism, and inflammatory pathways. Its ability to activate AMP-activated protein kinase (AMPK) leads to improved metabolic profiles and reduced inflammation and is crucial for mitigating obesity-related cardiovascular risks. Despite these positive effects, the evidence for long-term prevention of cardiovascular events is limited and requires further exploration. Conclusions: Metformin offers significant short-term benefits in improving BMI, insulin sensitivity, and cardiometabolic parameters in obese children and adolescents. However, its long-term efficacy in preventing cardiovascular events remains uncertain. Further studies are necessary to establish its role in long-term cardiovascular protection in pediatric populations

Fatty liver index as an independent predictor of all-cause and disease-specific mortality.

This study aims to assess the prognostic value of the fatty liver index (FLI), a noninvasive tool for hepatic steatosis assessment, in predicting all-cause and disease-specific mortality. We linked data from the National Health and Nutrition Examination Survey III (1988-1994) with Public-Use Mortality Files, forming a cohort of 11 297 participants with a median follow-up period of 26.25 years. Cox proportional hazards models were used to evaluate the association between FLI and all-cause mortality, while Fine and Gray's models assessed the relationship between FLI and disease-specific mortality. The FLI ≥ 60 was independently associated with an increased risk of all-cause mortality (hazard ratio = 1.24, P < 0.001), as well as mortality from malignant neoplasms (hazard ratio = 1.18, P = 0.048), diabetes (hazard ratio = 2.62, P = 0.001), and cardiovascular diseases (CVDs) (hazard ratio = 1.18, P = 0.018), compared to FLI < 30. No significant associations were found with Alzheimer's disease, influenza and pneumonia, chronic lower respiratory diseases, or renal disorders. Subgroup analyses indicated that individuals who were females aged 40-60 (hazard ratio = 1.67, P = 0.003), non-overweight (hazard ratio = 1.75, P = 0.007), or without abdominal obesity (hazard ratio = 1.75, P = 0.007) exhibited a stronger association between FLI ≥ 60 and all-cause mortality. These findings support the prognostic value of the FLI for predicting mortality from all causes, malignant neoplasms, diabetes, and CVDs. Targeted attention is needed in postmenopausal women, non-overweight, and non-abdominally obese populations.

Sesamol Alleviated Lipotoxicity-Induced Dysfunction in MIN6 Cells via Facilitating Cellular Senescence Caused by Endoplasmic Reticulum Stress.

Obesity is found to be a significant risk factor for type 2 diabetes mellitus (T2DM), attributed to lipotoxicity-induced β-cell dysfunction. However, the specific mechanism involved in the process remains incompletely unclarified. The current study demonstrated lipotoxicity resulted in the activation of ER stress, which increased the protein level of TXNIP, thereby inducing senescence-assiciated dysfunction in MIN6 cells under high fat environment. And we also found sesamol, a natural functional component extracted from sesame, was able to alleviate senescence-associated β-cell dysfunction induced by lipotoxicity by inhibiting ER stress and TXNIP. Our findings provided novel insights into senescence-related T2DM and propose innovative therapeutic approaches for utilizing sesamol in the treatment of T2DM in the obese elderly population.

Cardiometabolic outcomes in patients with overweight and obesity undergoing weight loss trials : a network meta-analysis

Abstract Objective Cardiometabolic outcomes are intrinsically linked with obesity. According to a study by Jayedi A et al. a 5kg weight gain could increase CVD mortality and MI risk by 11% and 18% respectively, with most overweight and obese patient also suffering from cardiometabolic derangements. This network meta-analysis evaluates cardiometabolic effects bought about by glucagon-like peptide 1 receptor agonists (GLP-1 RA) and other weight loss drugs in an overweight and obese population. Methods Cochrane CENTRAL, Embase and Medline were searched for randomised clinical trials (RCTs) on GLP-1 RA and United States Food and Drug administration weight loss drugs. A network meta-analysis was performed, using risk ratios(RR) to compare the efficacy of the interventions against one another. Network diagrams and surface under the cumulative ranking curve analysis were generated for the following cardiometabolic outcomes ( LDL, HDL, TC, TG, HbA1c, FPG, SBP and DBP). Results Among the cardiometabolic outcomes analysed, the GLP-1RA’s consistently ranked on top, with tirzepatide followed by semaglutide and then liraglutide. In terms of glycaemic control, tirzepatide 15, 10 and 5mg ranked first in a dose dependent manner(SUCRA = 0.8480, 0.8410, 0.6725) followed by semaglutide1.7mg(SUCRA= 0.6232). Tirzepatide 15mg did not achieve statistical significance compared to semaglutide 1.0mg (MD: -0.77, 95%CI: -2.04 to 0.50) or liraglutide1.8mg (MD: -0.64, 95%CI: -1.68 to 0.41). In reducing blood pressure, tirzepatide exhibiting a dose dependent reduction with Tirzepatide 15mg, (SUCRA =0.9457),10mg(SUCRA=0.9069)and 5mg(SUCRA=0.8419) followed by semaglutide 1.7mg (SUCRA =0.7415) then liraglutide 1.8mg(SUCRA = 0.5521).Tirzepatide 15mg demonstrated statistical significance compared to semaglutide 1.0mg (MD: -3.53, 95%CI: -6.78 to -0.27) and liraglutide 3.0mg (MD: -3.47, 95%CI: -5.59 to -1.36). The GLP-1RA’s also exhibited superiority in lipid reduction for TC and TG, with tirzepatide reducing TC (SUCRA = 0.7867) and TG(SUCRA = 0.9843) followed by semaglutide 1.7 mg (SUCRA = 0.7796) for TC and tirzepatide 10 mg (SUCRA = 0.9018) for TG. Orlistat 120mg(SUCRA =0.8789) and 60mg(SUCRA= 0.8458) were superior in reducing LDL, with tirzepatide 15mg(SUCRA =0.7806) and then semaglutide 2.4mg(SUCRA=0.7260) coming in behind. Naltrexone 32mg/Bupropion 360mg(SUCRA = 0.8757) ranked first followed by tirzepatide(SUCRA=0.8593) in increasing HDL, however the increase was not statistically significant (MD: 0.00, 95%CI: -0.04 to 0.05). Conclusion GLP-1 RAs’ superiority in addressing cardiometabolic parameters that are often deranged in patients with overweight and obesity highlights the need for weight lost medication transitioning from one that decreases and suppresses appetite or prevent the absorption of lipids to one that targets the altered metabolic mileu of patients with overweight and obesity, highlighting the multipronged approach needed to treat this metabolic disease.

Obesity, kidney and metabolic bariatric surgery: a surgeon’s narrative review

Excess body weight impacts kidney function in individuals with severe obesity, primarily through metabolic alterations in adipocytes, especially in visceral adipose tissue. The relationship between persistent sterile inflammation associated with obesity and the progression of obesity-related kidney disease to chronic kidney disease (CKD) is an area of growing interest. The beneficial effects of weight loss on the prevention of kidney disease and the improvement of kidney function in individuals with obesity have been well documented. Currently, the most effective weight loss strategy is metabolic bariatric surgery (MBS), which has been proven to not only prevent the progression of CKD but also reverse it. However, awareness and understanding of the impact of obesity on the kidney should also extend to the severely obese population with clinically normal renal function. The purpose of this review is to outline the current knowledge on the pathophysiology of obesity-induced kidney damage, the effects of MBS on renal function in severely obese individuals with or without CKD, and provide the current evidence on perioperative management strategies for CKD patients, including diet and nutrition.

Individual and joint association of Life’s Essential 8 metrics with pre-sarcopenia among U.S. adults

BackgroundIn recent times, the American Heart Association has updated its approach to evaluating cardiovascular health (CVH) by replacing the previous “Life’s Simple 7” with the more demanding “Life’s Essential 8” (LE8). However, the impact of enhancing CVH on reducing the risk of pre-sarcopenia and the association of LE8 metrics with pre-sarcopenia remain unexplored.MethodsLE8 score was calculated among 9857 participants. Multivariable logistic regression was utilized to investigate the associations between LE8 and pre-sarcopenia. Additionally, the weighted quantile sum (WQS) model was employed to determine the combined and individual impact of LE8 metrics on pre-sarcopenia. To assess the indirect effects of peripheral immune responses on the relationships between cardiovascular health and pre-sarcopenia, mediation analyses were performed.ResultsIn this study, 827 participants had pre-sarcopenia. After accounting for potential confounding factors, the group with excellent cardiovascular health demonstrated an 83% lower risk of pre-sarcopenia compared to the poor cardiovascular health group (OR: 0.17, 95% CI: 0.11–0.27) and a 33% decreased risk of pre-sarcopenia for each 10-point increase in LE8 score (OR: 0.67, 95% CI: 0.62–0.73). Body mass index (BMI) and physical activity (PA) were the critical contributors that decreased the prevalence of pre-sarcopenia in the obese and non-obese populations, respectively.ConclusionsA negative association was found between LE8 score and pre-sarcopenia prevalence. Body mass index and physical activity are the primary contributors to the obese and non-obese populations, respectively.

The risk of depression, anxiety, and suicidal behavior in patients with obesity on glucagon like peptide-1 receptor agonist therapy.

This large community-based cohort study investigates the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), specifically Liraglutide and Semaglutide, on the risk of developing psychiatric conditions such as depression, anxiety, and suicidal behaviors in patients with obesity. Utilizing post-marketing data, this research compares patients prescribed GLP-1 RAs (cases) with those not taking these medications (controls). The analysis spanned data from January 1, 2015, to December 31, 2023. To minimize selection bias, we employed 1:1 propensity score matching to account for demographic factors such as age, sex, race, and comorbidities. After matching, the study included 162,253 case and control patients. This study showed a significant association between GLP-1 RA treatment and an 98% increased risk of any psychiatric disorders. Notably, patients on GLP-1 RAs exhibited a 195% higher risk of major depression, a 108% increased risk for anxiety, and a 106% elevated risk for suicidal behavior. These findings underscore the critical need for physicians to thoroughly assess patient history before prescribing GLP-1 RAs and highlight the urgent requirement for further prospective clinical trials to fully understand the implications of GLP-1 RA use on mental health in the obese patient population.