Overweight Women Research Articles

Resting energy expenditure in women with polycystic ovary syndrome.

Is resting energy expenditure (REE) altered in women with polycystic ovary syndrome (PCOS)? Women with PCOS have a reduction in REE, when corrected for fat-free mass, independent of PCOS clinical phenotypes and BMI categories. Obesity is an important issue in women with PCOS, in terms of frequency and pathophysiological implications. It has been hypothesized that obesity may be favoured by alterations in REE, but the studies have been limited and conflicting. This case-control study was a comparison of 266 women with PCOS and 51 healthy controls, recruited in the Verona 3P study from 2010 to 2021. Women with PCOS diagnosed by the Rotterdam criteria, with normal thyroid function and no interfering medications, were referred to the outpatient clinic of a tertiary care centre of endocrinology and metabolism for a measurement of REE. Healthy controls were recruited in the same period and submitted to the same procedure. In all subjects, REE was measured by indirect calorimetry and serum androgens were measured by LC-MS/MS. In women with PCOS, insulin sensitivity was assessed using the hyperinsulinemic-euglycemic clamp. REE was similar in women with PCOS and controls. However, REE corrected for fat-free mass (REE/FFM) was significantly lower in women with PCOS than in controls (31.8 ± 4.0 vs 35.4 ± 3.9kcal/kgFFM·day, P < 0.001). REE/FFM did not differ between normal-weight, overweight, or obese women with PCOS, and each of these subgroups showed lower REE/FFM values than controls. Reduced REE/FFM values were found in each phenotype of the syndrome. In multiple regression analysis, REE/FFM was independently associated with age and PCOS status, but not with fat mass. In PCOS women, REE/FFM was independently and directly associated with ovarian follicle number. Limitations of the study are the cross-sectional design, which limits the causal inference of the results, and the unavailability of precise information about lifestyle factors, which may be potential confounders. Further prospective studies are needed to establish the importance of this phenomenon in contributing to the weight excess of PCOS. A reduction of REE could potentially favour weight gain in women with PCOS and possibly contribute to the altered metabolic profile typical of this condition, even counteracting the therapeutic strategies aimed to reduce excess body fat in these women. Nevertheless, the presence of this abnormality in both obese/overweight and normal-weight patients suggests that other factors must play a role in this phenomenon. This work was supported by academic grants to PM from the University of Verona (FUR 2010-2022). All authors declare no conflict of interest. N/A.

The effect of mindfulness-based stress reduction on caregiving in romantic relationships of overweight women: A quasi-experimental design

The effect of mindfulness-based stress reduction on caregiving in romantic relationships of overweight women: A quasi-experimental design

Analysis of early-pregnancy metabolome in early- and late-onset gestational diabetes reveals distinct associations with maternal overweight.

It is not known whether the early-pregnancy metabolome differs in patients with early- vs late-onset gestational diabetes mellitus (GDM) stratified by maternal overweight. The aims of this study were to analyse correlations between early-pregnancy metabolites and maternal glycaemic and anthropometric characteristics, and to identify early-pregnancy metabolomic alterations that characterise lean women (BMI <25 kg/m2) and women with overweight (BMI ≥25 kg/m2) with early-onset GDM (E-GDM) or late-onset GDM (L-GDM). We performed a nested case-control study within the population-based prospective Early Diagnosis of Diabetes in Pregnancy cohort, comprising 210 participants with GDM (126 early-onset, 84 late-onset) and 209 normoglycaemic control participants matched according to maternal age, BMI class and primiparity. Maternal weight, height and waist circumference were measured at 8-14 weeks' gestation. A 2 h 75 g OGTT was performed at 12-16 weeks' gestation (OGTT1), and women with normal results underwent repeat testing at 24-28 weeks' gestation (OGTT2). Comprehensive metabolomic profiling of fasting serum samples, collected at OGTT1, was performed by untargeted ultra-HPLC-MS. Linear models were applied to study correlations between early-pregnancy metabolites and maternal glucose concentrations during OGTT1, fasting insulin, HOMA-IR, BMI and waist circumference. Early-pregnancy metabolomic features for GDM subtypes (participants stratified by maternal overweight and gestational timepoint at GDM onset) were studied using linear and multivariate models. The false discovery rate was controlled using the Benjamini-Hochberg method. In the total cohort (n=419), the clearest correlation patterns were observed between (1) maternal glucose concentrations and long-chain fatty acids and medium- and long-chain acylcarnitines; (2) maternal BMI and/or waist circumference and long-chain fatty acids, medium- and long-chain acylcarnitines, phospholipids, and aromatic and branched-chain amino acids; and (3) HOMA-IR and/or fasting insulin and L-tyrosine, certain long-chain fatty acids and phospholipids (q<0.001). Univariate analyses of GDM subtypes revealed significant differences (q<0.05) for seven non-glucose metabolites only in overweight women with E-GDM compared with control participants: linolenic acid, oleic acid, docosapentaenoic acid, docosatetraenoic acid and lysophosphatidylcholine 20:4/0:0 abundances were higher, whereas levels of specific phosphatidylcholines (P-16:0/18:2 and 15:0/18:2) were lower. However, multivariate analyses exploring the early-pregnancy metabolome of GDM subtypes showed differential clustering of acylcarnitines and long-chain fatty acids between normal-weight and overweight women with E- and L-GDM. GDM subtypes show distinct early-pregnancy metabolomic features that correlate with maternal glycaemic and anthropometric characteristics. The patterns identified suggest early-pregnancy disturbances of maternal lipid metabolism, with most alterations observed in overweight women with E-GDM. Our findings highlight the importance of maternal adiposity as the primary target for prevention and treatment.

The interaction between polyphenol intake and genes (MC4R, Cav-1, and Cry1) related to body homeostasis and cardiometabolic risk factors in overweight and obese women: a cross-sectional study.

Cardiovascular disease (CVD), which is an important global health challenge, is expanding. One of the main factors in the occurrence of CVD is a high genetic risk. The interaction between genetic risk in CVD and nutrition is debatable. Polyphenols are one of the important dietary components that may have a protective role in people who have a high genetic risk score (GRS) for cardiometabolic risk factors. This study, conducted in overweight and obese women, examines the interaction between polyphenol intake and specific genes (MC4r, Cav-1, and Cry1) related to maintaining body balance and their interaction with cardiometabolic risk factors. This cross-sectional study included 391 women who were overweight or obese, aged 18 to 48 years, with a body mass index (BMI) between 25 and 40 kg/m2. Body composition was measured using the InBody 770 scanner. Total dietary polyphenol intake (TDPI) was assessed with a validated 147-item food frequency questionnaire (FFQ), and polyphenol intakes were determined using the Phenol-Explorer database. Serum samples underwent biochemical tests. The Genetic Risk Score (GRS) was calculated based on the risk alleles of three genes: MC4r, Cav-1, and Cry1. The mean ± standard deviation (SD) age and BMI of women were 36.67 (9.1) years and 30.98 (3.9) kg/m2, respectively. The high GRS and high TDPI group had a significant negative interaction with fasting blood glucose (FBS) (p = 0.01). Individuals who had a high GRS and a high phenolic acid intake were found to have a significant negative interaction with Triglyceride (p = 0.04). Similarly, individuals with high GRS and a high intake of flavonoids had a significant negative interaction with TG (p < 0.01) and a significant positive interaction with High-density lipoprotein (HDL) (p = 0.01) in the adjusted model. According to our findings, those with a high GRS may have a protective effect on cardiometabolic risk factors by consuming high amounts of polyphenols. Further studies will be necessary in the future to validate this association.

Deficiency of Energy and Nutrient and Gender Differences among Chinese Adults: China Nutrition and Health Survey (2015-2017).

Half of Chinese adults face the double burden of overweight/obesity and micronutrient deficiencies, and nearly 40% of them are severely overweight/obese or have micronutrient deficiencies. This study used the data from China Nutrition and Health Survey (CNHS) from 2015 to 2017 to estimate the prevalence of inadequate dietary micronutrient intake (including vitamin A, vitamin B1, vitamin B2, vitamin C, cCalcium, iron and sodium) in Chinese adults and further determine the differences in micronutrient intake by gender, age and BMI. A total of 61,768 subjects were included in this study, of which 33,262 (54%) were female. The intake of energy and all macronutrients decreased with age, and the intake was higher in men than in women. Inadequate energy intake occurs in adults of all ages. In terms of nutrient intake, women had a higher rate of insufficient carbohydrate intake than men in all age groups. Inadequate protein intake was more common in women aged 18-49 years (60.9%) than in men. Compared with women, men had a higher rate of vitamin B2 intake. Insufficient vitamin B3 intake was more common in women aged 18-49 years (35.6%), men aged 65-79 years (39.7%) and men aged 80 years and above (47.9%). In all age groups, insufficient vitamin C intake is higher in women than in men-up to 85.8 percent in women aged 80 years old and above. Compared with men in the same age group, insufficient intake of calcium and iron is more obvious in women. Women have significantly higher rates of inadequate intake of calcium, iron and sodium than men. In the analysis of correlations between BMI or demographic data and micronutrient intakes, the likelihood of micronutrient intakes being insufficient was higher in the central and western regions in all age groups compared to the eastern regions. The risk of insufficient micronutrient intake was higher in obese men and women aged 18-49 years and 50-64 years. Underweight and overweight women in the 65-79 age group were more likely to have inadequate micronutrient intake. Obese women over 80 years of age were less likely to have inadequate micronutrient intake. No significant difference was found between urban and rural areas for each age group.

Sustained underweight in rural areas and emergence of overweight in urban Ethiopian women: a multivariate analysis of EDHS data 2000–2016

A growing body of evidence indicates the emergence of overweight/obesity in developing countries before the battle against undernutrition has been won. We conducted this study to quantify the reduction of underweight and the emergence of overweight among Ethiopian women from 2000 to 2016 and evaluate factors explaining the progress. We used the four Ethiopian Demographic and Health Surveys (2000–2016) to analyze body mass index (BMI) trends among women. Data from 43,815 non-pregnant, non-puerperal reproductive-age women was used to evaluate the linear change in BMI and changes in the percentage of overweight and underweight over time. Using multivariate decomposition analysis of change in underweight and overweight percentages, we identified sources of change in BMI in the past 16 years of the survey periods. The BMI of Ethiopian reproductive-age women increased by 0.88 kg/m2 from 2000 to 2016. The increment was pronounced in urban areas with 1.46 kg/m2. There has been a significant reduction in underweight women since 2000 (p-value < 0.001), and 87.62% of the changes were attributed to behavioral changes toward weight management. And there was a significant upswing in overweight women from 2000 to 2016 (p-value < 0.001) as well. A compositional change of factors including region, women’s age, women’s educational status, religion, type of place of residence, and use of contraceptives contributed to 57.51% of the observed increment in the percentage of overweight women. A relatively slow decrease in underweight and an increment in overweight have been observed. This progress can be disaggregated into persistent underweight in the rural and poorest, and swift development of overweight in the urban and richest communities. Targeted nutrition interventions for both underweight and overweight women are mandatory. Nutritional interventions in Ethiopia should focus on behavioral change to reduce hunger and malnutrition as well as to avert the emergence of overweight or obesity in the affected communities.

Dairy intake and cardiovascular diseases risk factors: a cross-sectional study on Iranian obese and overweight women

ObjectiveAtherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide. Dietary interventions can directly affect several ASCVD risk factors. This study aimed to assess an association between dairy consumption and the odds of ASCVD and its risk factors in women with overweight and obesity.MethodsThe present cross-sectional study was conducted on 390 Iranian women aged 18–48 years and body mass index (BMI) ≥ 25 kg/m². Dairy consumption was assessed using a 147-item food frequency questionnaire. Participants were divided into tertiles based on their dairy consumption with 130 (33.3%) women in each category.ResultsThe participants had an average age of 36.73 ± 9.18 years, and the mean BMI was 31.28 ± 4.30 kg/m2. In the unadjusted model, individuals in the third tertile of dairy consumption had 0.79 times lower odds of ASCVD compared to those in the first tertile (OR: 0.21; 95% Confidence Interval (CI): 0.11, 0.41; P-value = 0.001). Additionally, we observed a significant inverse relationship between higher dairy intake and adiposity markers, blood pressure, and Triglyceride glucose-body mass index (TyG-BMI).ConclusionThe study revealed a negative association between dairy intake and the risk of ASCVD but this association diminished after adjusting for confounding factors. It also found a negative association between dairy consumption with BMI, fat mass index, body fat, blood pressure, and TyG-BMI.

Leptin, Ghrelin, Irisin, Asprosin and Subfatin Changes in Obese Women: Effect of Exercise and Different Nutrition Types.

Background and Objectives: In this study, the effects of a six-week training program and various diets on subfatin, asprosin, irisin, leptin, ghrelin and the lipid profile were investigated in overweight women. Materials and Methods: A total of 78 women voluntarily participated in the study. Groups: The study was divided into eight groups: Healthy Control, Obese Control, Obese + Vegetarian, Obese + Ketogenic, Obese + Intermittent Fasting, Obese + Exercise + Vegetarian, Obese + Exercise + Ketogenic and Obese + Exercise + Intermittent Fasting. While there was no intervention in the healthy and obese control groups, the other groups followed predetermined exercise and diet programs for 6 weeks. Blood samples were taken from the participants in the research group twice (before and after the interventions). An autoanalyzer was used to determine the lipid profile in the blood samples taken, and the ELISA method was used to analyze other parameters. Results: Overall, a significant difference was found in the values of weight, BMI, subfatin, ghrelin, leptin, cholesterol, triglyceride, HDL and LDL as a result of the exercise and diet interventions (p < 0.05). There was no significant difference in asprosin and irisin values (p > 0.05). Conclusions: In conclusion, regular exercise and dietary interventions in obese women can regulate lipid profile, ghrelin, leptin and asprosin levels, and increasing irisin with exercise can activate lipid metabolism and support positive changes in lean mass.

The association between maternal obesity and fetomaternal outcomes in twin pregnancies.

The prevalence of overweight and obese people worldwide has dramatically increased in the last decades and is yet to peak. At the same time and partly due to obesity and associated assisted reproduction, twinning rates showed a clear rise in the last years. Adverse fetomaternal outcomes are known to occur in singleton and twin pregnancies in overweight and obese women. However, the impact of the obesity levels as defined by the World Health Organization on the outcomes of twin pregnancies has not been thoroughly studied. Therefore, the purpose of this study is to examine how maternal overweight, and the level of obesity affect fetomaternal outcomes in twin pregnancies, hypothesizing a higher likelihood for adverse outcomes with overweight and each obesity level. This is a retrospective cohort study with 2,349 twin pregnancies that delivered at the Buergerhospital Frankfurt, Germany between 2005 and 2020. The mothers were divided into exposure groups depending on their pre-gestational body mass index; these were normal weight (reference group), overweight and obesity levels I, II, and III. A multivariate logistic regression analysis was performed to assess the influence of overweight and obesity on gestational diabetes mellitus, preeclampsia, postpartum hemorrhage, intrauterine fetal death, and a five-minutes Apgar score below seven. The adjusted odds ratio for gestational diabetes compared to normal weight mothers were 1.47, 2.79, 4.05, and 6.40 for overweight and obesity levels I, II and III respectively (p = 0.015 for overweight and p < 0.001 for each obesity level). Maternal BMI had a significant association with the risk of preeclampsia (OR 1.04, p = 0.028). Overweight and obesity did not affect the odds of postpartum hemorrhage, fetal demise, or a low Apgar score. While maternal overweight and obesity did not influence the fetal outcomes in twin pregnancies, they significantly increased the risk of gestational diabetes and preeclampsia, and that risk is incremental with increasing level of obesity.

A prospective cohort study of multimetal exposure and risk of gestational diabetes mellitus

The relationship between co-exposure to multiple metals and gestational diabetes mellitus (GDM) and the mechanisms involved are poorly understood. In this nested case-control study, 228 GDM cases and 456 matched controls were recruited, and biological samples were collected at 12–14 gestational weeks. The urinary concentrations of 10 metals and 8-hydroxydeoxyguanosine (8-OHdG) as well as the serum levels of malondialdehyde (MDA) and advanced glycation end products (AGEs) were determined to assess the association of metals with GDM risk and the mediating effects of oxidative stress. Urinary Ti concentration was significantly and positively associated with the risk of GDM (odds ratio [OR]:1.45, 95 % confidence interval [CI]: 1.12, 1.88), while Mn and Fe were negatively associated with GDM risk (OR: 0.67, 95 % CI: 0.50, 0.91 or OR: 0.61, 95 % CI: 0.47, 0.80, respectively). A significant negative association was observed between Mo and GDM risk, specifically in overweight and obese pregnant women. Bayesian kernel machine regression showed a significant negative joint effect of the mixture of 10 metals on GDM risk. The adjusted restricted cubic spline showed a protective role of Mn and Fe in GDM risk (P < 0.05). A significant negative association was observed between essential metals and GDM risk in quantile g-computation analysis (P < 0.05). Mediation analyses showed a mediating effect of MDA on the association between Ti and GDM risk, with a proportion of 8.7 % (P < 0.05), and significant direct and total effects on Ti, Mn, and Fe. This study identified Ti as a potential risk factor and Mn, Fe, and Mo as potential protective factors against GDM, as well as the mediating effect of lipid oxidation.

P-691 Effect of body mass index on early and late pregnancy loss in women with polycystic ovary syndrome undergoing in vitro fertilization and embryo transfer

Abstract Study question Are early and late pregnancy loss both affected by elevated body mass index (BMI) in women with polycystic ovary syndrome (PCOS) undergoing IVF-ET? Summary answer Late pregnancy loss but not early pregnancy loss was adversely affected by elevated BMI in women with PCOS undergoing IVF-ET. What is known already PCOS, the most common endocrine disorder in women of reproductive age, affects 5–18% of women. Obesity appears to be closely associated with PCOS. High BMI of the women with PCOS has been clearly associated with pregnancy loss. However, available data are limited for distinguishing between early and late pregnancy loss in PCOS women with different BMI and age. We performed a large cohort study of PCOS women conceived after IVF-ET to access the risk of early and late pregnancy loss. Study design, size, duration A retrospective cohort study of 3213 pregnancies after IVF-ET in women with PCOS from January 2015 to October 2022. Participants/materials, setting, methods The participants were the PCOS women with a positive human chorionic gonadotropin (hCG) after IVF-ET treatment in the reproductive centre of an university hospital. We studied early (≤12 weeks and biochemical pregnancy loss included) and late (&amp;gt;12 weeks) pregnancy loss in overweight group (BMI≥24 kg/m2) compared to normal group (BMI&amp;lt;24 kg/m2). Main results and the role of chance From 3213 PCOS women conceived after IVF-ET treatment, 1715 (53.4%) women were in overweight group and 1498 (46.6%) in normal group. Baseline characteristics age, primary infertility, pregnancy loss history, endometrial thickness, numbers and types of embryo transferred were not different between two groups. Overweight women had higher serum basal total testosterone and androstenedione levels. Early pregnancy loss (EPL) occurred in 24.2% (415) of overweight women with PCOS versus 21.6% (323) of those with normal weight (OR 1.16, 95% CI 0.98–1.37, P = 0.08). Rates of ELP were also comparable in both groups stratified by age. Overweight women had higher rates of late pregnancy loss (LPL) (6.6% in overweight group versus 3.3% in normal group, OR 2.11, 95% CI 1.50–3.00, P &amp;lt; 0.001). In subgroup analyses, young and advanced-age women with PCOS both had increased chances of LPL with elevated BMI. Logistic regression showed BMI was an independent risk factor of LPL considering age, androgen level, history of previous pregnancy loss, and infertility type. Limitations, reasons for caution Due to the retrospective study, records about gestation-related disease history and smoking were not complete and not shown. However, all patients with IVF-ET were asked to control gestation-related conditions suitable for pregnancy. Proportion of smoking was low and women who planned to conceive were advised to stop smoking before treatment. Wider implications of the findings This study enables physicians to counsel PCOS women undergoing IVF their risk of pregnancy loss more accurately based on personal characteristics. Trial registration number not applicable

O-217 Evaluating the impact of obesity on oocyte quality, using 2 main factors in cumulus cells (CC) and follicular fluid (FF) which reflect oocyte quality

Abstract Study question How obesity impacts oocyte quality through analysis of mtDNA expression in CC and levels of proteins BMP-15 and HSPG2 in FF? Summary answer There is correlation between increased BMI and lower levels of BMP15 and a decreased expression of mtDNA that reflect decreased oocyte quality in overweight women. What is known already Obesity impacts female health and impairs fertility. There is limited evidence suggesting that obesity impairs oocyte quality. BMP-15 (Bone morphogenetic protein 15) is a protein synthesized by oocyte, is a factor predicting quality of the oocyte and female fertility. Heparan sulfate proteoglycan 2 (HSPG2) is a protein secreted from granulosa cells and there are limited studies regarding the function of HSPG2 in reproduction including oocyte quality. BMP-15 and HSPG2 secreted to FF. Oocyte quality was demonstrated to be influenced by mtDNA (mitochondrial DNA) content in CC. Study design, size, duration Prospective observational cohort study performed between February 2022 until June 2022 in a single university-affiliated hospital. Total of 50 patients were enrolled. Participants/materials, setting, methods Women who underwent IVF or ICSI cycles were included. Exclusion criteria were patients older than 40 years, fertility preservation, unbalanced endocrine disorders and less than 4 follicles at the time of OPU (oocyte pick-up). Follicular fluid and cumulus cells were collected following OPU. mtDNA was assessed by quantitative real-time PCR. BMP-15 and HSPG2 were measured with ELISA method quantitatively. Lipid profile, hormonal profile and C-reactive protein were evaluated in blood and follicular fluid samples. Main results and the role of chance Patients were divided based on BMI, 28 patients with BMI &amp;lt; 25 (Group 1) and 22 with BMI &amp;gt; 25 (Group 2). A significant increase in BMP-15 in FF (38.8 ± 32.5 vs. 14.3 ± 10.8 ng/ml; p = 0.001) and mitochondrial DNA in CC (1.10 ± 0.3 vs. 0.87 ± 0.18 Fold change expression; p = 0.016) were found in group 1. Significantly higher CRP in blood (7.1 ± 5.4 vs. 3.4 ± 4.3; p = 0.015) and FF (5.2 ± 3.8 vs. 1.5 ± 1.6; p = 0.002) and LDL level in blood (91 ± 27 vs. 71 ± 22; p = 0.008) in group 2. HDL levels were significantly higher in group 1 in the blood (50 ± 12 vs. 62 ± 18; p = 0.015) and FF (20.9 ± 7.2 vs. 34 ± 26; p = 0.05). The fresh clinical pregnancy rate demonstrated a trend toward better results in group 1 (47.8% vs. 28.6%: p = 0.31), as well as in FET (69.2% vs. 53.8; P = 0.69). Limitations, reasons for caution Research included relatively small number of participants. We can’t report our cumulative pregnancy rate since not all frozen embryos were transferred yet. Wider implications of the findings Obesity is an increasing worldwide problem and impairs fertility outcome. Our study demonstrates decreased oocyte quality in the group of overweight women through 2 important markers BMP-15 and mtDNA. We recommend our patients to lose weight and improve their lifestyle in order to overcome those impaired quality markers. Trial registration number Not applicable

P-641 A prospective observational case series on the effects of a very low-calorie ketogenic diet (VLCKD) in overweight and obese infertile women

Abstract Study question What is the compliance level of overweight/obese infertile patients to VLCKD? Is therapeutic adherence associated with weight loss and increased pregnancy rates? Summary answer Compliance level to VLCKD was surprisingly high. Participants experienced weight loss and pregnancy rates improved. What is known already Obesity and overweight are associated with infertility. They can adversely affect the hypothalamic-pituitary-gonadal axis, compromise oocyte quality and reduce endometrial receptivity. In addition, obesity exposes women at increased risk of obstetric complications. Although not always consistent, some evidence suggests a beneficial effect of diet in this setting, both for natural conception and in the context of ART. However, these studies also show low compliance, with many patients failing to lose enough weight to be clinically significant. VLCKD is a more aggressive approach to treating severe obesity and may represent a more effective option for these patients. Study design, size, duration This case-series prospective study has been performed at Unit of Obesity and Occupational medicine, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico Milano between May 2019 and September 2023 and involved 42 infertile women aged ≤ 40 years, affected by overweight-obesity (BMI 27.5-35), but without other relevant systemic pathologies. Participants/materials, setting, methods Treatment firstly included 3 months of VLCKD followed by 12 months of Low-Calorie Diet (LCD). The occurrence of any natural pregnancy led to the discontinuation of treatment. These cases were counted as successes. Throughout the study period, patients underwent regular dietary and anthropometric evaluations. Main results and the role of chance Of the 42 recruited patients, 36 adhered to the VLCKD. The median treatment duration was 5.5 months [Interquartile Range (IQR) 3-9]. The compliance rate was 86% (95% CI: 72-93%). A significant reduction in BMI was observed: at recruitment, patients had a median BMI of 36.6 [IQR 33.4-39.9], and at the end, it was 29.5 [IQR 27.3-32.7], with a weight loss of 19.9 kg [IQR 12.7-24.4]. Regarding pregnancy, 8 women (22%) achieved a natural pregnancy, while of the remaining 28 patients, 25 underwent ART treatments. Among these, 16 achieved pregnancy (13 by homologous cycles, two donor cycles, and one with ovulation induction). In total, 24 women achieved pregnancy. The intention-to-treat success rate was 57% (95% CI: 42-71%), and the protocol success rate was 67% (95% CI: 50-80%). Limitations, reasons for caution The case-series study design, by definition, does not require a control group and this could be considered a “weakness”. However, it should be noted that patients were likely to be highly motivated to lose weight and health-conscious, thus creating a sample group with distinctive characteristics. Wider implications of the findings The use of VLCKD in obese infertile women allows high compliance to be achieved. The probability of pregnancy also appears very promising. VLCKD could be considered as a first approach for the treatment of obese women who do not have contraindications to ketosis. Trial registration number not applicable

Longitudinal Exposure to Neighborhood Concentrated Poverty Contributes to Differences in Adiposity in Midlife Women.

Background: Neighborhood poverty is associated with adiposity in women, though longitudinal designs, annually collected residential histories, objectively collected anthropometric measures, and geographically diverse samples of midlife women remain limited. Objective: To investigate whether longitudinal exposure to neighborhood concentrated poverty is associated with differences in body mass index (BMI) and waist circumference (WC) among 2,328 midlife women (age 42-52 years at baseline) from 6 U.S. cities enrolled in the Study of Women's Health Across the Nation (SWAN) from 1996 to 2007. Methods: Residential addresses and adiposity measures were collected at approximately annual intervals from the baseline visit through a 10-year follow-up. We used census poverty data and local spatial statistics to identify hot-spots of high concentrated poverty areas and cold-spots of low concentrated poverty located within each SWAN site region, and used linear mixed-effect models to estimate percentage differences (95% confidence interval [CI]) in average BMI and WC levels between neighborhood concentrated poverty categories. Results: After adjusting for individual-level sociodemographics, health-related factors, and residential mobility, compared to residents of moderate concentrated poverty communities, women living in site-specific hot-spots of high concentrated poverty had 1.5% higher (95% CI: 0.6, 2.3) BMI and 1.3% higher (95% CI: 0.5, 2.0) WC levels, whereas women living in cold-spots of low concentrated poverty had 0.7% lower (95% CI: -1.2, -0.1) BMI and 0.3% lower (95% CI: -0.8, 0.2) WC. Site-stratified results remained in largely similar directions to overall estimates, despite wide CIs and small sample sizes. Conclusions: Longitudinal exposure to neighborhood concentrated poverty is associated with slightly higher BMI and WC among women across midlife.

A pilot study of Keto Prescribed+: A healthy thinking and eating educational program for African American women.

African American (AA) women have the highest prevalence of obesity in addition to health disparities in preventable diet-related diseases (i.e., diabetes, hypertension), which places them at increased risk for cardiovascular disease. The purpose of this pilot study was to assess the feasibility, acceptability, and preliminary effectiveness of the Keto Prescribed+ (KetoRx+) program on associated physical and psychosocial outcomes among this population. The KetoRx+ program is a healthy eating and thinking educational intervention. The program combined online and in-person community group sessions over 8 weeks. The Keto Prescribed+ was found to be feasible and acceptable with comments on ways to increase acceptability from participants completing program (n = 10). Physical outcomes changed showed an average decrease in weight of 10lbs (SD = 5), baseline average 226lbs. Waist-to-hip ratio and systolic blood pressure also trended down. Psychosocial outcomes showed improvement trends. The KetoRx+ program is feasible and acceptable for overweight or obese AA women. Preliminary efficacy was established for most physical and psychosocial outcomes. However, more research is needed to identify specific program components contributing to healthy lifestyle behavior change and to establish program efficacy and effectiveness. Culturally adapted community-based biopsychosocial interventions using ketogenic nutrition therapy may help improve cardiovascular health of adult AA women.

Maternal Overweight and Obesity and Their Effect on the Growth of the Newborn During the First Six Months of Life.

Maternal overweight and obesity during pregnancy have been shown to have multiple negative effects on the mother's health, which can even affect the infant's growth by increasing weight gain and altering various indicators, such as weight for age, length for age and weight for length. While breast milk on the other hand reduces these risks, and it's the best and most complete food for the newborn. It's a dynamic fluid capable of being modified to meet the needs of each stage of the newborn, but despite this capacity and the fact that maternal body mass index can have an impact on its components, through complex biological mechanisms, it manages to reduce the negative effects accumulated during pregnancy and even promotes a healthy state in the baby.In a country like Mexico, where overweight and obesity affect a large part of the population, it is important to study their causes and which could be the effect of this increased maternal overweight during pregnancy and lactation on newborns. Identify the alterations associated with increased maternal body mass index during pregnancy and breastfeeding on mothers' health and their possible effect on the growth of the newborn during the first six months of life. This was a prospective cohort study. Forty-two healthy binomials (mother and child), without problems during delivery and without serious illnesses during the breastfeeding period, were included. Maternal body mass index at the beginning of pregnancy allowed us to create two comparison groups between mothers: one with adequate weight, another with overweight or obesity. Follow-up was carried out once a month during the first six months of life, evaluating the somatometric development of mothers and children. All mothers completed the six-month period of exclusive breastfeeding. There were differences between both groups of women. The one that included overweight and obese women compared to the group of women with adequate weight had a higher number of pregnancies, abortions, plasma glucose levels in the third trimester of pregnancy, and a lower number of prenatal control visits and plasma platelet levels (all with p<0.05). Regarding the baby's growth, there was a difference between the weight for length classification at 60-, 120-, 150- and 180-day follow-ups.The group to which the mother was assigned with respect to her body mass index at the beginning of pregnancy (adequate weight group and overweight/obese group) was the only factor associated with the risk of the baby being overweight according to weight for lengthindicator at the 180-day follow-up, with an OR = 5.2 (95%CI 1.02-26.59). Maternal overweight and obesity during pregnancy have a negative effect on the mother's health and baby's weight gain in its weight-for-length classification during the first six months of life.Although breastfeeding has been shown to have a positive effect on the growth of the baby, exposure to a higher maternal body mass index during pregnancy triggers important metabolic alterations that promote the development of diseases.It is important to establish weight control guidelines in women who wish to become pregnant to reduce the negative effects on the mother and offspring.

Overweight in Adolescence and Young Adulthood in Association With Adult Cerebrovascular Disease: The NFBC1966 Study.

Risk factors for cerebrovascular disease in adulthood are well known. However, research on individuals' risk factors throughout their life span has been limited. This prospective cohort study aims to determine the effect of body mass index (BMI) and its changes in adolescence and young adulthood on early onset cerebrovascular disease. This study includes 10 491 people (5185 women) from the Northern Finland Birth Cohort 1966. Height, weight, and BMI were measured at ages 14 and 31 years. Sex- and age-specific BMI ranges were used to define overweight and obesity. Data on ischemic and hemorrhagic cerebrovascular diseases between ages 14 and 54 years were extracted from national hospital and death registers. Cox proportion hazard models (95% CI) were used to estimate associations between BMI or its changes and cerebrovascular disease, while adjusting for sex, smoking, educational level, BMI at the other time point, and age at menarche for women. Additionally, sex-BMI interactions were calculated. A total of 452 individuals (4.7%) experienced cerebrovascular disease during the follow-up. The risk of ischemic cerebrovascular disease was increased for overweight women at ages 14 years (hazard ratio [HR], 2.49 [95% CI, 1.44-4.31]) and 31 years (HR, 2.13 [95% CI, 1.14-3.97]), as well as for obese women at ages 14 years (HR, 1.87 [95% CI, 0.76-4.58) and 31 years (HR, 2.67 [95% CI, 1.26-5.65]), with normal weight as the reference. These results were independent of earlier or later BMI. Similar associations were not found among men. The risk of hemorrhagic cerebrovascular disease was increased at age 31 years both among obese women (HR, 3.49 [95% CI, 1.13-10.7) and obese men (HR, 5.75 [95% CI, 1.43-23.1). The risk of any cerebrovascular disease related to overweight at age 14 years was 2.09× higher among girls than boys (95% CI, 1.06-4.15). The risk of ischemic cerebrovascular disease related to obesity at age 31 years was 6.96× higher among women than men (95% CI, 1.36-35.7). Among women, being overweight in adolescence or young adulthood increases the risk of cerebrovascular disease, especially ischemic, independent of their earlier or later BMI.

STUDY OF THE VALUE SPHERE OF OVERWEIGHT WOMEN

Background. According to statistics, the number of obese people is growing rapidly. Attitude to one's own weight, as well as a negative assessment of appearance by others, can negatively affect self-esteem, lead to psychological and emotional problems. Values are a fundamental component of personality. They will include concepts and beliefs that transcend specific situations and guide the choice or assessment of behavior or events (Schwartz S. H.). Taboos and stigma associated with excess weight can greatly affect the quality of life of women, limiting their social contacts, career opportunities and individual self-expression (Zenkov A. S.; Polskaya N.A., Yakubovskaya D.K.; Sayamov Yu.N.; Brewis A.; Dressler W. W.). The analysis of the value sphere will help to identify social, cultural beliefs and attitudes related to overweight in women. The purpose of our study was to determine the characteristics of the value sphere of overweight women. The sample consisted of two groups of 15 people. The first group included overweight women who turned to a psychologist or nutritionist with this problem. The second group includes women with a standard weight. Three diagnostic methods were used to study the features of the value sphere «The level of value and accessibility in various spheres of life» (E. B. Fantalova); «Portrait value questionnaire» (Sh. Schwartz); «Morphological test of life values» (V.F. Sopov L.V. Karpushina. The results of the study (without taking into account statistical processing data) showed that the value sphere of overweight women is characterized by a lower value-accessibility discrepancy index; higher values of stimulation, interpersonal conformity and universalism (in relation to other people and the environment); the importance of the value of spiritual satisfaction and the life sphere of hobbies is more developed.

Public Health Perspectives: Unveiling the Socio-Demographic Tapestry and Nutritional Wellness of Khatik Women in North-East Delhi

Introduction: The dietary intake pattern significantly impacts human health. Malnutrition remains a critical global issue,requiring comprehensive and on-going intervention efforts. Approximately one-third of the world's population faces some form of malnutrition, including underweight, overweight, or obesity. Proper nutrition is essential for individual health, particularly among women, emphasizing the importance of addressing nutritional needs effectively. This study investigates the relationship between nutritional status and socio-demographic/reproductive profiles of Khatik women in North East Delhi. Material and Methods: A cross-sectional investigation was carried out within the Khatik community of North East Delhi, involving data collection from 400 respondents. The current study examined the nutritional status using Body Mass Index (BMI) as a primary health indicator. Results: Results from the analysis indicated notable variations across BMI categories concerning age and reproductive variables. Specifically, as the age of the respondents increased, there was a greater likelihood of being overweight or obese. According to the study findings, overweight/obese women demonstrated a higher median (Median 21 IQR-19-22) consumption of full meals compared to both normal (Median 21, IQR-18-22) and underweight (Median 19, IQR-17-24) women. Similarly, underweight individuals (Median 3, IQR-2-5) exhibited a lower median intake of milk products compared to both normal weight (Median 4, IQR-3-6) and overweight (Median 4, IQR-3-6) respondents. Conclusion: The study reveals increasing overweight and obesity among Khatik women in Delhi, driven by factors like age, education, urban living, and economic status. Overweight or obese women tend to have more live births and conceptions compared to underweight and normal-weight women, highlighting disparities in reproductive outcomes across BMI categories.

Factors influencing participation and regular attendance in a program combining physical activity and nutritional advice for overweight and obese pregnant women

BackgroundEducational programs incorporating physical activity (PA) sessions and nutritional workshops have demonstrated potential benefits for overweight and obese pregnant women. However, participation in such programs remains challenging. This prospective study aimed to investigate the factors influencing participation and regular attendance, while examining changes in health behaviors, along with obstetric and neonatal outcomes.MethodsPregnant women with at 12–22 weeks’ gestation a BMI ≥ 25 kg/m2 were invited to join an educational program combining three nutritional workshops conducted in groups and 12 weekly PA sessions. They self-selected their participation into the program. Regardless of program uptake and regularity of attendance, the women’s PA levels, eating behaviors, and affectivity were assessed using validated questionnaires at 20–24 weeks, 32–34 weeks, and postpartum. A multivariable logistic regression model was used to determine the factors influencing participation.ResultsOf the 187 women enrolled in the study, 61.5% agreed to participate in the program. Of these, only 45% attended six or more sessions (regardless of the nature of sessions, i.e. nutritional workshops and/or PA sessions), while only 8.7% attended six or more PA sessions. Participation was associated with higher rates of problematic eating behaviors and lower PA levels at baseline, while regular attendance was mainly associated with higher household incomes. No significant difference was observed between participants and non-participants in terms of changes in eating behaviors, PA levels, or affectivity. However, at the 32–34 week visit, regular participants displayed a higher change in positive affectivity, but unexpectedly also in cognitive restraint, than non-regular participants, a difference that did not persist at postpartum.ConclusionThe educational program combining nutrition and PA was shown to be safe. Women facing challenges related to health behavior displayed a willingness to sign up for the program, but tailored interventions addressing their individual challenges are needed to improve attendance. Accordingly, four recommendations are proposed for the design of future interventions.Trial registrationClinicalTrials.gov; Identifier: NCT02701426; date of first registration: 08/03/2016.