Underweight Adults Research Articles

Prevalence of cardiometabolic diseases in underweight: a nationwide cross-sectional study.

This study aimed to estimate the nationwide prevalence of cardiometabolic diseases (CMDs) among adults with underweight in the US general population. Using data from the National Health and Nutrition Examination Survey (1999-2020), we estimated the age-standardized prevalence of dyslipidemia, hypertension, diabetes, chronic kidney disease, cardiovascular disease, and the presence of 0 or at least 2 CMDs. Multivariable Poisson regressions were used to compare CMD prevalence between subgroups, adjusting for age, sex, and race/ethnicity. Among the 855 adults with underweight included, the weighted mean age was 40.8 years, with 68.1% being women and 70.4% non-Hispanic White. The estimated prevalence rates were 23.4% for dyslipidemia (95% CI, 19.4%-27.5%), 15.6% for hypertension (95% CI, 13.3%-17.8%), 2.5% for diabetes (95% CI, 1.5%-3.5%), 7.9% for chronic kidney disease (95% CI, 6.9%-8.8%), and 6.1% for cardiovascular disease (95% CI, 4.3%-7.9%). The prevalence of having 0 and at least 2 CMDs was 50.6% (95% CI, 44.1%-57.0%) and 12.3% (95% CI, 8.1%-16.4%), respectively. Non-Hispanic Black adults had significantly higher prevalence of diabetes (adjusted prevalence ratio, 3.35; 95% CI, 1.35-8.30) compared to non-Hispanic White adults. In conclusion, approximately half of the underweight adults had at least one CMD, and 12.3% had at least two CMDs. Prevention and management of CMDs in underweight adults are critical yet neglected public health challenges.

A cross-sectional study in adiponectin, glucose metabolism, and body composition in cystic fibrosis.

We hypothesized that the insulin-sensitizing adipokine adiponectin (ADP) is upregulated in cystic fibrosis (CF) related diabetes (CFRD) and underweight adults with CF. We aimed to assess correlations between glucose metabolism, body composition and ADP in CF. We performed a cross-sectional study among adults with CF at the Copenhagen CF Center. The study included a fasting level of ADP, an oral glucose tolerance test (OGTT), and a dual energy-x-ray absorptiometry scan. In total, 115 patients were included of whom 104 had an OGTT performed. Glucose intolerance was not correlated with ADP in multivariable analysis, while increased hepatic insulin resistance (i.e., HOMA-IR) was correlated with reduced ADP levels. ADP declined by 4% (eβ 0.96, 95% CI: 0.94, 0.98), 5% (eβ 0.95, 95% CI: 0.93, 0.98), 9% (eβ 0.91, 95% CI: 0.87, 0.95), and 83% (eβ 0.17, 95% CI: 0.08, 0.37) for each one unit (kg/m2) increase in body mass index, fat mass index, muscle mass index, and bone mineral content index, respectively. In CF, ADP was negatively correlated with hepatic insulin resistance as well as low fat, muscle, and bone mass, but not with glucose intolerance. This suggests that malnutrition leads to higher ADP levels in CF.

Body Mass Index as a Determinant of Lower Limb Function and Community Well-Being in Older Adults: Analysis of 2020 National Older Korean Survey Data.

This epidemiological research investigated the relationship between body mass index (BMI) and lower limb function and community well-being among the older population (≥65 years old) in South Korea. Using the 2020 National Survey of Older Koreans (N = 10 097; Mage = 73.6 ± 6.63; MBMI = 23.6 ± 2.61), the study identified underweight (2.3%), normal (72.8%), and obese (24.9%) groups. Findings revealed significant associations between BMI and lower limb function, with underweight individuals facing greater physical challenges (P < .05-.01). Underweight participants were also found to live farther from key community locations, possibly reflecting social and environmental factors (P < .01) and expressed higher dissatisfaction with community environments (Ps < .05-.01). The study emphasizes the need for tailored community planning and health care strategies, focusing on the unique needs of the underweight older adults, considering South Korea's rapidly increasing older population.

Unlocking the potential: exploring the impact of dolutegravir treatment on body mass index improvement in underweight adults with HIV in Malawi.

The introduction of dolutegravir (DTG) in treating HIV has shown enhanced efficacy and tolerability. This study examined changes in weight gain and body mass index (BMI) at 6- and 12-months after post-initiating antiretroviral therapy (ART), comparing people living with HIV (PLHIV) on DTG-based regimens with those on non-DTG-based regimens in Malawi. Retrospective cohort data from 40 public health facilities in Malawi were used, including adult ART patients (aged ≥ 15 years) from January 2017 to March 2020. The primary outcomes were BMI changes/transitions, with secondary outcomes focused on estimating the proportion of mean weight gain > 10% post-ART initiation and BMI category transitions. Descriptive statistics and binomial regression were used to estimate the unadjusted and adjusted relative risks (RR) of weight gain of more than ( >) 10%. The study included 3,520 adult ART patients with baseline weight after ART initiation, predominantly female (62.7%) and aged 25-49 (61.1%), with a median age of 33 years (interquartile range (IQR), 23-42 years). These findings highlight the influence of age, ART history, and current regimen on weight gain. After 12months follow up, compared to those aged 15-24 years, individuals aged 25-49 had an Adjusted RR (ARR) of 0.5 (95% Confidence Interval (CI): 0.35-0.70), suggesting a 50% reduced likelihood of > 10% weight gain after post-ART initiation. Similarly, those aged 50 + had an ARR of 0.33 (95% CI: 0.20-0.58), indicating a 67% decreased likelihood compared to the youngest age group 15-24 years. This study highlights the positive impact of DTG-based regimens, revealing significant transitions from underweight to normal BMI categories at 6- and 12-months post-initiation. This study provides insights into weight gain patterns in patients on DTG-based regimens compared with those on non-DTG regimens. Younger individuals (15-24 years) exhibited higher odds of weight gain, suggesting a need for increased surveillance in this age group. These findings contribute to the understanding DTG's potential effects on weight gain, aiding clinical decision making. Further research is required to comprehensively understand the underlying mechanisms and long-term implications of weight gain in patients receiving DTG-based regimens.

Comparing the Prevalence of Sleep Disorders Among Underweight, Normal, Overweight, and Obese Adults in Riyadh, Saudi Arabia.

Background Sleep disorders are prevalent worldwide and can have a negative impact on physical and psychological well-being. Numerous studies have explored the reciprocal connection between obesity and sleep disorders. This study aimed to compare the prevalence of sleep disorders among underweight, normal, overweight, and obese adults in Riyadh, Saudi Arabia. Methods This cross-sectional study was conducted on 378 adults visiting primary healthcare centers in Riyadh, Saudi Arabia, from August to November 2022. Data werecollected using a self-administered questionnaire that included a section for demographic data and the SLEEP-50 questionnaire in both English and Arabic languages. Results Most of the participants were aged between 25 and 34 years (37.6%), 79.1% were females and 59.5% were either overweight or obese.Most participants (78.3%) had at least one sleep disorder, with narcolepsy being the most frequent disorder (65.1%), and 23% had two combined sleep disorders. Obese and overweight patients were significantly more likely to have sleep disorders (p=0.011), and obese patients were more likely to have all sleep disorders (p=0.049). Conclusion The prevalence of sleep disorders, namely narcolepsy and insomnia, is high among adults in Riyadh, Saudi Arabia. Moreover, sleep disorders are significantly associated with obesity. Evaluation and management of sleep disorders in clinical settings among patient with overweight or obese is important to improve their quality of life and to prevent physical and psychological complications.

Study of peak expiratory flow rate in male and female young adults with respect to their weight status

Background: Young adults are more attracted toward fast food, alcohol, and sedentary lifestyles. Previous study shows that peak expiratory flow rate (PEFR) correlates better with height in males and weight in females. Body mass index (BMI) is one of the main factor that affect PEFR values. PEFR, a pulmonary function test is routinely used to confirm the diagnosis of the respiratory disease. Aim and Objectives: This study was conducted to evaluate PEFR values in male and female young adults in underweight, normal, overweight, and obese categories of weight status. Materials and Methods: The study was conducted in four groups. 40 participants in each group, includes males (20) and female (20) young adults. The groups were divided according to BMI values, underweight (&lt;18.5), normal (18.5–24.9), overweight (25–29.9), and obese (&gt;30). Data were taken and calculated 2 h post lunch after relaxing for 15 min in the afternoon. In the sitting position, at the same time of the day, PEFR values were measured using Wright’s Peak Flow Meter. Results: We found significantly high PEFR values in males as compare to females in the category of underweight (&lt;0.01), normal (&lt;0.05) and overweight (&lt;0.05). The study also shows positive correlation between BMI and PEFR in underweight male and females, normal males, overweight females, and obese females, which is statistically non-significant, except in obese males. Conclusion: We concluded that male have high PEFR values than female as there are differences in their body build-up and low PEFR values in underweight and obese young adults as they have low body fat and reduced expansion of lungs, respectively.

Normative value of deep neck flexors muscle strength measurement using pressure biofeedback unit and sphygmomanometer: An observational study

PurposeTo find out the normative value of deep neck flexor muscles strength using pressure biofeedback unit and sphygmomanometer. MethodsThe healthy individuals both male and female aged between 18 and 25 years were recruited by stratified random sampling method from a tertiary hospital. The procedure is performed with the patient in supine lying with the neck in a neutral position. To check strength, pressure biofeedback unit and sphygmomanometer were placed under occiput and ask the individual to do the movement is genteelly and slowly as a head nodding action (chin tuck). The performance was scored via the pressure level that patient achieves 3 repetitions for 10 s hold and interval timing for 10 s. And the pressure biofeedback unit and sphygmomanometer inflated with 40 mmHg and took three reading respectively. ResultOur result shows, in decreased of deep neck cervical flexor muscle Strength with age group 21 (20–22) in normal adult and underweight with age group 21 (19–23) and with BMI 21 (20.1–22.4) and 16.6 (16.1–17.6) respectively. In our study, the deep neck flexor strength of overweight adults with age group 22 (21–23) and with BMI 27.8 (25.9–29.4) is stronger is than the normal and underweight adults. ConclusionThe study concluded that the maximal Deep neck cervical flexor strength of overweight Adults is stronger than normal and underweight Adults. The difference is maintained in all age groups. The maximal Deep neck cervical flexor strength, for flexion is developed at neutral position of neck.

Determining Gender-Based Differences in Retinal and Choroidal Thickness in Underweight Individuals via Swept-Source Optical Coherence Tomography.

Despite improvements in reducing hunger in recent years, undernutrition remains a global public health problem. This study utilizes the swept-source optical coherence tomography (SS-OCT) technique to assess changes in retinal and choroidal thickness in underweight subjects. Ophthalmic examinations were conducted on all adults participating in this cross-sectional research. Depending on their body mass index (BMI), the participants were divided into two groups: the underweight group and the normal group. The study included the right eyes of the underweight adults and an equal number of age- and gender-matched normal-weight subjects. The retinal thickness showed no significant difference between the underweight and normal groups (P > 0.05 for all). In males, the retina of the center and inner ring in the underweight group was significantly thinner than that in the normal group, while no such results were found in females. The choroid in the underweight group was significantly thinner compared to that in the normal group (all P < 0.05). Being underweight may affect choroidal thickness in both males and females. In comparison with underweight females, underweight males may experience more retinal damage. These findings contribute to a better understanding of the pathogenesis underlying specific ocular diseases in malnourished individuals.

Inpatient hospital course and self-reported symptomatology in underweight adults with ARFID compared to age- and sex-matched controls with anorexia nervosa

ObjectiveAvoidant restrictive food intake disorder (ARFID) has similar prevalence to anorexia nervosa (AN) in adults, but research in this population is lacking. Although inpatient or residential treatment involving nutritional rehabilitation is increasingly recommended for malnourished individuals with ARFID, best practices remain poorly defined. Existing studies on self-reported symptomatology and treatment course and outcome are primarily in child and adolescent cohorts and demonstrate inconsistent findings. This study aimed to compare hospital course and self-reported symptomatology of underweight adult inpatients with ARFID and sex- and age-matched patients with AN.MethodUnderweight adult patients with ARFID or AN admitted to a specialized, hospital-based behavioral treatment program completed measures of body dissatisfaction, drive for thinness, bulimic symptoms, anxiety, depression, and personality traits. Demographic and treatment course data were abstracted from electronic medical records. Patients with ARFID (n = 69) were matched to those with AN (n = 69) based on sex and age.ResultsAdults with ARFID were closer to target weight at admission, but gained weight at a slower rate, were discharged at lower BMI, and were less likely to reach target weight by discharge than adults with AN. Patients with ARFID reported less weight and shape-related eating disorder, state anxiety, and depression symptoms and lower neuroticism.DiscussionAdults with ARFID progress through treatment more slowly and achieve less favorable weight outcomes by hospital discharge than patients with AN, but long-term outcomes are unclear. Describing clinical presentations and course of illness of adult ARFID may help inform treatment protocols.

Impact of Nutritional Status on Antibody Titer After Booster mRNA COVID-19 Vaccine Among Elderly Adults in Japan.

Published studies on mRNA coronavirus disease 2019 (COVID-19) vaccine effects focus on younger individuals, comprising the majority of the workforce. Studies in elderly adults are sparse. In total, 107 subjects were recruited (median age 78; interquartile range [IQR], 58.5-90.5; range, 35-105 years). Factors associated with antibody titer after the third mRNA COVID-19 vaccination were compared between 49 elderly (age ≥80; median, 94; IQR, 86-97; range, 80-105 years) and 58 younger (age ≤79; median, 61; IQR, 46-71; range, 35-79 years) adults. Among body mass index (BMI) categories, the group of underweight elderly adults had a lower antibody titer compared to those with normal weight (P < .01 after 1, 3, and 5 months). Elderly adults were less likely to maintain effective antibody titer (≥4160 AU/mL) compared to younger adults: 76% versus 98%, P < .001 after 1 month, and 45% versus 78%, P < .001 after 3 months. Elderly adults who maintained effective antibody titer for 5 months had a higher BMI (22.9 kg/m2 vs 20.1 kg/m2, P = .02), and were less likely to have underweight BMI (0% vs 31%, P = .02) compared to the subjects who failed to maintain effective antibody titer. These results highlight the impact of nutritional status and the deleterious effect of underweight BMI on antibody titer and its maintenance among elderly adults following booster mRNA COVID-19 vaccination.

Relationships between Bone Mineral Density and Antidepressant Use and Physical Activity in U.S. Adults

Introduction: Osteoporosis is a major public health concern that affects millions of people worldwide. It is a progressive disease characterized by low bone mass and deterioration of bone tissue, leading to an increased risk of fractures. Antidepressant use and physical activity have been suggested as potential modifiable factors that may affect bone mineral density (BMD). However, the relationship between these factors and BMD is not fully understood, and it is uncertain whether these relationships differ for males and females.&#x0D; Methods: Using data from the 2011-2018 National Health and Nutrition Examination Surveys, we examined BMD differences in groups among 7,254 adults. Analyses were first conducted by using the Anderson-Darling normality test, T-test, and the Wilcoxon rank-sum test, and then used multivariate linear regressions to investigate its potential associations between antidepressant use and physical activity along with other factors.&#x0D; Results: Excluding the underweight adults, there is significant difference in BMD between those with and without depression in the female group (p=0.03), but not in the male group (p=0.54). No significant difference was found between those who used and those who did not use antidepressants, in either group, female (p=0.96) and male (p=0.77). Antidepressant use and low-level physical activity intensity were associated with decreased BMD values (Mean [SD] = -0.0073 [0.0049]).&#x0D; Discussion: This study suggests that physical activity may be a potential modifiable factor that could help prevent osteoporosis, particularly in females. On the other hand, antidepressant use, and low-level physical activity may increase the risk of low BMD. These findings highlight the importance of lifestyle modifications in the prevention of negative impact of low BMD. Further studies are needed to explore the impact of different types of antidepressant use in BMD.

Associations among body mass index, handgrip strength, and cognitive impairment in older men and women in India

BackgroundThis study examined the associations among body mass index (BMI), handgrip strength (HGS) and cognitive impairment among older adults in India. We also assessed whether these associations vary by gender. MethodsWe used data from baseline wave of the Longitudinal Aging Study in India (2017–18) with a sample of 31,464 adults age 60 and above. Cognitive impairment was assessed using different domains of cognition, including memory, orientation, arithmetic functioning, and visuospatial and constructional ability. We used multivariable logistic regression and interaction analyses to test the research hypotheses. ResultsOlder women had 2.25 times the odds of cognitive impairment than older men [AOR: 2.25; CI: 2.01–2.53]. The odds of cognitive impairment were 1.36 times among underweight older adults [AOR: 1.36; CI: 1.23–1.50], 0.72 times among overweight [AOR: 0.72; CI: 0.62–0.83], and 0.66 times among obese older adults [AOR: 0.66; CI: 0.51–0.84] compared to peers with normal BMI. Underweight women had 3.14 times the odds of being cognitively impaired [AOR: 3.14; CI: 2.67–3.68] compared to older men with normal BMI. Further, older men who were underweight and had a weak HGS had higher odds of cognitive impairment than older men with a normal BMI and strong HGS. Conversely, older women who were overweight or obese and had strong HGS reported lower odds of cognitive impairment than older women with normal BMI and strong HGS. ConclusionsThat the association between BMI and cognitive impairment differs between men and women and by HGS gives health care providers and practitioners additional information needed to identify groups of older adults most susceptible to cognitive impairment. In particular, gender specific policies and an assessment of HGS may be useful when crafting interventions to minimize the negative consequences of varying body types on later life cognitive function.

Variations in adult BMI among Indian men: a quantile regression analysis.

India has not only maintained its top position among countries with the largest number of underweight adults but has also jumped to a higher position among countries with largest increase in the proportion of overweight people in the last three decades. More studies focus on double burden of malnutrition among women than on men. This study uses the quantile regression model to analyse the covariates associated with low and high body mass index (BMI) primarily among men aged 20-54 years during 2015-2016 in India. Occupations that involve more manual work help in maintaining a normal BMI along with better education, dietary diversity, and less sedentary lifestyle. A gendered comparison of men and their spouses highlights the differences in the association of covariates with BMI for men and women. The results from this study will provide insights for behavioural change at an individual level and inputs for public health intervention for addressing ill health concerns arising from underweight, overweight, or obesity.

Comparison of Pulmonary Function, Respiratory Muscle Strength, and Diaphragm Thickness between Underweight and Normal Adults

Comparison of Pulmonary Function, Respiratory Muscle Strength, and Diaphragm Thickness between Underweight and Normal Adults

Impact of micro- and macronutrient status on the incidence of tuberculosis: An examination of an African cohort initiating antiretroviral therapy.

Macronutrient and micronutrient deficiencies are associated with tuberculosis (TB) incidence. However, evidence is limited on the impact of micronutrient (vitamins and minerals) supplementation among underweight individuals. We conducted a secondary data analysis of a randomised controlled trial of lipid nutritional supplements with and without high-dose vitamin and mineral supplementation (LNS-VM vs LNS) for underweight (Body Mass Index [BMI] <18.5 kg/m2) adults with human immunodeficiency virus (HIV) initiating antiretroviral therapy (ART) in Tanzania and Zambia (2011-2013). Incident TB disease diagnoses were extracted from trial records. We used multivariable Cox regression to estimate hazard ratios (HR) for the impact of receiving LNS-VM on TB incidence, and the dose-response relationship between baseline BMI and TB incidence. Overall, 263 (17%) of 1506 participants developed TB disease. After adjusting for age, sex, CD4 count, haemoglobin, and C-reactive protein, receiving LNS-VM was not associated with TB incidence (aHR [95%CI] = 0.93 [0.72-1.20]; p = 0.57) compared to LNS alone. There was strong evidence for an association between lower BMI and incident TB (aHR [95%CI]: 16-16.9kg/m2 = 1.15 [0.82-1.62] and <16kg/m2 = 1.70 [1.26-2.30] compared to 17-18.5kg/m2; linear trend p<0.01). There was strong evidence that the rate of developing TB was lower after initiating ART (p<0.01). In conclusion, the addition of micronutrient supplementation to LNS was not associated with lower TB incidence in this underweight ART-naive population.

Obesity in Late-Life as a Protective Factor Against Dementia and Dementia-Related Mortality.

We estimated the conversion from cognitively normal to mild cognitive impairment (MCI) to probable dementia and death for underweight, normal, overweight, and obese older adults, where the timing of examinations is associated with the severity of dementia. We analyzed six waves of the National Health and Aging Trends Study (NHATS). Body mass (BMI) was computed from height and weight. Multi-state survival models (MSMs) examined misclassification probability, time-to-event ratios, and cognitive decline. Participants (n = 6078) were 77years old, 62% had overweight and/or obese BMI. After adjusting for the effects of cardiometabolic factors, age, sex, and race, obesity was protective against developing dementia (aHR=.44; 95%CI [.29-.67]) and dementia-related mortality (aHR=.63; 95%CI [.42-.95]). We found a negative relationship between obesity and dementia and dementia-related mortality, a finding that has been underreported in the literature. The continuing obesity epidemic might complicate the diagnosis and treatment of dementia.

The dietary inflammatory index is positively associated with insulin resistance in underweight and healthy weight adults.

The aim of this study was to explore the relationship between dietary inflammatory index (DII) and insulin resistance (IR) in underweight and healthy weight adults. This cross-sectional study involved 3205 participants from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. All dietary data used to calculate the DII were obtained based on the average of two 24-h dietary recall interviews. Participants were divided into an anti-inflammatory diet group and a pro-inflammatory diet group based on DII<0 and DII≥0, respectively. Fasting blood glucose and fasting insulin data used to calculate IR index (HOMA-IR) were from laboratory data in the NHANES database. According to the linear regression analysis results of DII and HOMA-IR, we found that there was a positive relationship between DII and IR. A positive association between DII and HOMA-IR was seen in the following groups after stratification: by age in 20-39-year olds, by sex in males, by race in Non-Hispanic Whites, by family history of diabetes in those without a family history of diabetes, by education level in those with high school education, by smoking status in current smokers and non-smokers, by hypertension in those with hypertension, by BMI in those with a BMI of 18.5-24.99, by hypertriglyceridemia (HTG) in those without HTG, by poverty impact ratio (PIR) in those with PIR≤1.3 and>1.3, and by physical activity in those with moderate recreational activities. In conclusion, in underweight and healthy weight adults, DII was positively correlated with the risk of IR.

Revised Case Finding Protocol for Dysglycemia in Chile: A Call for Action in Other Populations

ObjectiveGuidelines recommend case finding for dysglycemia (prediabetes and type 2 diabetes [T2D]) in adults or youth older than 10 years with overweight/obesity, but increased adiposity has not been associated with dysglycemia in some Hispanic populations. This study aims to determine the prevalence of dysglycemia in this population using simplified criteria independent of body mass index and age to request an oral glucose tolerance test (OGTT). MethodsCross-sectional retrospective analysis of medical records from a clinical center in Chile (2000-2007). OGTT was obtained from any patient with 1 cardiometabolic risk factor (CMRF) independent of age and body mass index. ResultsIn total, 4969 adults (mean age ± SD) 45.7 ± 15.9 years and 509 youths 16.6 ± 3.0 years were included. The prevalence (%, 95% CI) of prediabetes doubled that of T2D in youths (14.1%, 1.4-17.4 vs 6.3%, 4.5-8.7) and tripled it in adults (36.0%, 34.7-37.4 vs 10.7%, 9.8-11.5). In underweight and normal-weight adults, 22% (12.0-36.7) and 29.2% (26.4-32.1) had prediabetes, whereas 4.9% (1.3-16.1) and 8.8% (7.2-10.7) had T2D, respectively. In normal weight youths, 10.5% (6.7-15.9) and 2.9% (1.2-6.6) had prediabetes and T2D, respectively. In adults, but not in youths, most dysglycemia categories were related to overweight/obesity. ConclusionThis study supports a public health policy to identify more people at risk for cardiovascular disease by implementing a revised case finding protocol for dysglycemia using OGTT in even normal weight patients over 6 years of age when there is at least 1 CMRF. Reanalysis of case finding protocols for cardiometabolic risk in other populations is warranted.

Longitudinal relationship between body mass index and depressive symptoms among Chinese adults: The moderating roles of lifestyle factors and age

ObjectiveThis study aims to verify the moderating roles of lifestyle factors and age between body mass index (BMI), BMI trajectory and depressive symptoms of Chinese adults through a prospective design. MethodsThe participants who are 18 years old and above from the China Family Panel Studies (CFPS) were included in the 2016 baseline and 2018 follow-up research. BMI was calculated according to self-report weight (kilogram) and height (centimeter). Depressive symptoms were evaluated via the Center for Epidemiologic Studies Depression (CESD-20) scale. Inverse probability-of-censoring weighted estimation (IPCW) was used to check whether selection bias existed. Modified Poisson regression was performed to calculate prevalence and risk ratios as well as 95% confidence intervals. ResultsAfter adjustment, it was found that the positive associations of persistent underweight (RR = 1.154, P < 0.001) and normal weight → underweight (RR = 1.143, P < 0.001) with 2018 depressive symptoms were significant among middle-aged people, while the negative association of persistent overweight/obesity (RR = 0.972, P < 0.001) was significant in young adults. Notably, smoking moderated the relationship between baseline BMI and subsequent depressive symptoms (interaction P = 0.028). Also, exercise regularly and exercise duration weekly moderated the relationships of baseline BMI (interaction P = 0.004 and 0.015) and trajectories of BMI (interaction P = 0.008 and 0.011) with depressive symptoms among Chinese adults, respectively. ConclusionWeight management strategies for underweight and normal weight → underweight adults should pay attention to the role of exercise in maintaining normal weight and improving depressive symptoms.

Chrononutrition behavior during the COVID-19 pandemic and its relationship with body weight among college students.

Students in colleges are exposed to unhealthy lifestyles and poor dietary choices. They are at risk of being overweight, skipping meals, and developing eating disorders. However, there is a paucity of information on their chrononutrition behavior, which is very important, especially concerning the timing of food consumption across the day. Therefore, the present study aimed to investigate chrononutrition behavior and its potential association with body weight status among college students in Malaysia. This cross-sectional study was conducted on 409 college students aged above 18 in Malaysia. The chrononutrition behavior was assessed using the validated Chrononutrition Profile Questionnaire (CP-Q). The questionnaire was distributed using an online platform. Participants self-reported their body weight and height, and the Body Mass Index (BMI) was computed. Data were analyzed using the SPSS software. A total of 409 participants were recruited, with a mean age of 21.5 ± 2.2 years. The prevalence of underweight, normal, and overweight was 24.7, 49.4, and 25.9%, respectively. The chrononutrition behavior revealed that participants ate breakfast about four times/week (mean 4.27 ± 2.43 days), and only 135 (33.0%) consumed breakfast daily. The largest meal consumed was during lunch (75.8%), and the mean of snacking after the last meal was 3.23 ± 2.01 days. The prevalence of night eating was low, and most participants (70.9) did not wake up at night to eat. The frequency, however, was significantly higher in the underweight group compared to the normal weight group (p < 0.05). We observed a significant association between BMI and eating window, evening latency, evening eating, and night eating. It was found that the underweight had a poor eating window (p < 0.01), poor evening latency (p < 0.01), poor evening eating (p < 0.01), and poor night eating (p < 0.05) compared to those with normal and overweight BMI groups. In contrast to predictions, poor chrononutrition behavior was more likely to predict being underweight compared to normal (p < 0.05). Underweight young adults are more likely to have poor chrononutrition behavior. The results of the present study suggest that future nutrition education should also focus on the chrononutrition behavior of college students.