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Integrating remote high-intensity interval training into multi-component obesity treatment for adolescents: Impacts on body composition, fitness, and lifestyle 将远程高强度间歇训练纳入青少年多成分肥胖治疗:对身体成分、健康和生活方式的影响
Pub Date : 2025-04-26 DOI: 10.1016/j.obpill.2025.100176
Fábio de Freitas , Mariana R. Zago , Maria Ângela Antônio , Maria Ângela Bellomo Brandão , António Videira-Silva

Background

This study aimed to analyze the effects of a three-month remote High-Intensity Interval Training (HIIT) program as an adjunct to a multi-component clinical obesity treatment on body composition, physical fitness, movement behaviors, and nutritional habits in adolescents with obesity.

Methods

This study was designed as a non-randomized controlled trial involving a total of 100 adolescents with obesity (BMI z-score ≥2), aged 12–17, divided into a control group (CG, receiving only standard care, i.e., medical and nutritional guidance, n = 50), and an experimental group (EG, exposed to a remote HIIT program four times/week (∼20 min/session) for 3 months, additionally to standard care, n = 50). Intervention effect was analyzed based on adherence (presence in ≥80 % of sessions). Anthropometrics, body composition, and physical fitness data were assessed at baseline and at the end of the intervention. Changes in body composition and physical fitness were the primary outcomes, while movement behaviors and nutritional habits were considered secondary outcomes.

Results

Six participants were excluded from the analysis due to missing post-intervention assessments. Among the 44 (88 %) adolescents who completed the 3-month assessments, 28 were included in the adherents’ group (AG) and 16 in non-adherents (non-AG). BMI z-score significantly decreased over time (β = −0.08, p = 0.001), with the AG showing a more significant reduction than non-AG (β = −0.3, p < 0.001) and CG (β = −0.29, p < 0.001). Flexibility (β = 3.5, p < 0.001) and Core strength improved (β = 2.9, p = 0.002), with no differences between the AG and non-AG. Water consumption also increased (β = 0.2, p = 0.022), but only in the AG.

Conclusion

The remote HIIT program was effective in improving body composition and physical fitness in adolescents with obesity. These findings highlight the potential of remote exercise interventions as a feasible and beneficial strategy within multi-component obesity treatments.
本研究旨在分析为期三个月的远程高强度间歇训练(HIIT)计划作为多成分临床肥胖治疗的辅助手段,对肥胖青少年的身体成分、体能、运动行为和营养习惯的影响。方法本研究设计为一项非随机对照试验,共涉及100名12-17岁的肥胖青少年(BMI z-score≥2),分为对照组(CG,仅接受标准治疗,即医疗和营养指导,n = 50)和实验组(EG,每周接受4次远程HIIT计划(~ 20分钟/次),持续3个月,另外接受标准治疗,n = 50)。根据依从性(≥80%的疗程)分析干预效果。在基线和干预结束时评估人体测量学、身体成分和身体健康数据。身体组成和身体健康的变化是主要结果,而运动行为和营养习惯被认为是次要结果。结果6名受试者因缺少干预后评估而被排除在分析之外。在完成3个月评估的44名(88%)青少年中,28名被纳入依从组(AG), 16名被纳入非依从组(non-AG)。BMI z-score随时间显著下降(β = - 0.08, p = 0.001), AG组比非AG组下降更显著(β = - 0.3, p <;0.001)和CG (β = - 0.29, p <;0.001)。灵活性(β = 3.5, p <;0.001)和核心强度提高(β = 2.9, p = 0.002), AG和非AG之间无差异。水分消耗也增加(β = 0.2, p = 0.022),但仅在AG中增加。结论远程HIIT训练能有效改善青少年肥胖患者的身体组成和体质。这些发现强调了远程运动干预在多组分肥胖治疗中作为一种可行且有益的策略的潜力。
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引用次数: 0
Characterizing obesity: A qualitative study 表征肥胖:一项定性研究
Pub Date : 2025-04-02 DOI: 10.1016/j.obpill.2025.100174
Tim Bober , Flor Cameron , Lane Alexander , J.G. Luiggi-Hernandez , David Rometo , Linda-Marie Lavenburg , Haley Grant , Emily Klawson , Autumn R. Boyer , Kathleen M. McTigue , Julie Gouveia-Pisano , Avani Patel , Lisa Tarasenko , Jannette Escobar , Allison Brenner , Scott M. Vouri , Feng Dai , Megan E. Hamm

Background

The prevalence of obesity among US adults has risen over the past several decades. In addition to bariatric surgery and behavioral weight management, several effective anti-obesity medications have emerged in the last ten years and become increasingly available. The goal of this qualitative study is to explore the perspectives of people with obesity (PwO), health professionals (HPs), and payors on obesity management and treatments.

Methods

This was a 3-group interview study using a qualitative description approach with a target sample size of 40 PwO, 30 HPs who provide care to PwO (10 primary care providers; 10 providers specializing in obesity medicine; and 10 nurse practitioners, physician assistants, or dieticians/nutritionists), and 10 payors. PwO were eligible if they had a Body Mass Index (BMI) ≥30 kg/m2 using self-reported height and weight and the National Institutes of Health (NIH) BMI calculator and were recruited via an online research registry. Health professionals and payors were recruited via direct contact from the research team and sponsor's professional networks in the United States.

Results

A total of 38 PwO, 30 HPs, and 6 payors were interviewed, with PwO interviews occurring from October 2023 to March 2024 and HP/payor interviews occurring from November 2023 to May 2024. The majority of participants in each group accepted the idea of obesity as a chronic disease and that discussing obesity and weight management was important in medical contexts; however, they also acknowledged that stigma around obesity negatively impacted PwO health and health care. All participants described a treatment landscape beginning with lifestyle interventions followed by pharmaceutical or surgical treatment options.

Conclusion

This qualitative study of people with obesity, health professionals, and payors demonstrated current views of addressing and treating obesity in clinical settings. These findings could spur person-centered, less stigmatizing methods to craft plans for weight management.
在过去的几十年里,美国成年人中肥胖的患病率一直在上升。除了减肥手术和行为体重管理之外,在过去十年中出现了几种有效的抗肥胖药物,并且越来越容易获得。本定性研究的目的是探讨肥胖患者(pvo)、健康专业人员(HPs)和付款人对肥胖管理和治疗的看法。方法采用定性描述方法进行三组访谈研究,目标样本量为40名PwO, 30名为PwO提供护理的HPs(10名初级保健提供者;10家肥胖症专业医疗机构;10名执业护士,医师助理,或营养师/营养学家)和10名付款人。如果他们的身体质量指数(BMI)≥30 kg/m2,使用自我报告的身高和体重和美国国立卫生研究院(NIH) BMI计算器,并通过在线研究注册中心招募,则符合条件。卫生专业人员和付款人通过直接联系从研究团队和赞助商在美国的专业网络中招募。结果共访谈了38名ppo、30名HP和6名支付方,其中ppo访谈时间为2023年10月至2024年3月,HP/支付方访谈时间为2023年11月至2024年5月。每组的大多数参与者都认为肥胖是一种慢性疾病,讨论肥胖和体重管理在医学环境中很重要;然而,他们也承认,肥胖带来的耻辱对女性的健康和医疗保健产生了负面影响。所有参与者都描述了一种治疗方案,从生活方式干预开始,然后是药物或手术治疗方案。结论:这项对肥胖患者、卫生专业人员和付款人的定性研究显示了目前在临床环境中解决和治疗肥胖的观点。这些发现可能会刺激以人为本、不那么污名化的方法来制定体重管理计划。
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引用次数: 0
Chronicity of obesity and the importance of early treatment to reduce cardiometabolic risk and improve body composition 肥胖的慢性性和早期治疗对降低心脏代谢风险和改善身体成分的重要性
Pub Date : 2025-04-02 DOI: 10.1016/j.obpill.2025.100175
Sandra Christensen , Christina Nelson

Background

Obesity is a chronic disease that affects millions of adults and children globally. Obesity is particularly prevalent in the US and is associated with adiposity-related complications, such as cardiovascular disease, hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, cancer, and reduced quality of life. The Obesity Medicine Association's 4 pillars of obesity treatment are nutrition therapy, physical activity, behavioral counseling, and medical interventions, the latter of which includes pharmacotherapy, complication management, and bariatric procedures. Long-term obesity treatment using these treatment modalities guides chronic disease management to achieve sustained weight reduction, improved health outcomes, and improved quality of life.

Methods

In this narrative review, we focus on obesity as a chronic disease and the importance of chronic disease management. We also review body composition changes that occur with obesity and the goals of obesity treatment as they relate to body composition. Finally, obesity treatment modalities and recommendations are discussed.

Results

Individuals with pre-obesity, which is a state of early obesity, often progress to obesity. Further, individuals with obesity attempting weight reduction frequently reduce weight and experience subsequent weight recurrence, highlighting the chronic nature of obesity. Pathophysiologic factors such as the location and degree of adiposity, as well as the health of adipose tissue, impact the risk factors, outcomes, and treatment options for patients with obesity. Treatment modalities and appointment frequency can be personalized to individualize treatment and maximize adiposity reduction and preservation of lean body mass.

Conclusions

Early and lifelong treatment is critical for maintaining lean body mass as well as preventing weight recurrence and increased adiposity. Obesity treatment should reduce adiposity, preserve lean muscle, and maintain bone health. Weight-reduction maintenance that can be sustained long-term is also a critical component of chronic disease management.
背景:肥胖是一种影响全球数百万成人和儿童的慢性疾病。肥胖在美国尤为普遍,并与肥胖相关的并发症有关,如心血管疾病、高血压、2型糖尿病、血脂异常、阻塞性睡眠呼吸暂停、癌症和生活质量下降。肥胖医学协会的肥胖治疗的四大支柱是营养治疗、体育活动、行为咨询和医疗干预,后者包括药物治疗、并发症管理和减肥程序。使用这些治疗方式的长期肥胖治疗指导慢性疾病管理,以实现持续的体重减轻,改善健康结果和提高生活质量。方法在这篇叙述性综述中,我们关注肥胖作为一种慢性疾病以及慢性疾病管理的重要性。我们还回顾了肥胖引起的身体成分变化以及肥胖治疗的目标,因为它们与身体成分有关。最后,讨论了肥胖的治疗方式和建议。结果前期肥胖的个体,即早期肥胖的一种状态,往往会发展为肥胖。此外,试图减肥的肥胖患者经常会体重减轻,随后体重复发,这突出了肥胖的慢性本质。病理生理因素,如肥胖的位置和程度,以及脂肪组织的健康状况,影响肥胖患者的危险因素、结局和治疗方案。治疗方式和预约频率可以个性化治疗,最大限度地减少肥胖和保持瘦体重。结论早期和终身治疗是维持瘦体重、防止体重复发和肥胖增加的关键。肥胖治疗应减少脂肪,保持瘦肌肉,保持骨骼健康。能够长期持续的减肥维持也是慢性病管理的关键组成部分。
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引用次数: 0
Obesity management in primary care: A joint clinical perspective and expert review from the Obesity Medicine Association (OMA) and the American College of Osteopathic Family Physicians (ACOFP) - 2025 初级保健中的肥胖管理:肥胖医学协会(OMA)和美国骨科家庭医生学会(ACOFP)联合临床观点和专家评论- 2025
Pub Date : 2025-03-17 DOI: 10.1016/j.obpill.2025.100172
Nicholas Pennings , Catherine Varney , Shaun Hines , Bernadette Riley , Patricia Happel , Samir Patel , Harold Edward Bays

Background

This collaboration from the Obesity Medicine Association (OMA) and the American College of Osteopathic Family Physicians (ACOFP) examines obesity management from a primary care perspective.

Methods

This joint perspective is based upon scientific evidence, clinical experience of the authors, and peer review by the OMA and ACOFP leadership. The goal is to identify and answer sentinel questions about obesity management from a primary care perspective, utilizing evidence-based publications, and guided by expert clinical experience.

Results

Obesity is a disease that contributes to both biomechanical complications and the most common cardiometabolic abnormalities encountered in primary care. Barriers that impede optimal care of patients with obesity in primary care include failure to recognize obesity as a disease, lack of accurate diagnosis, insufficient access to obesity treatment resources, inadequate training, insufficient time, lack of adequate reimbursement and the adverse impact of bias, stigma, and discrimination.

Conclusions

Family physicians are often the first line of treatment in the healthcare setting. This affords early intervention opportunities to prevent and/or treat overweight and/or obesity. Patient care is enhanced when primary care clinicians recognize the risks and benefits of anti-obesity medications and bariatric procedures, as well as long-term follow-up. Practical tools regarding the 4 pillars of nutrition therapy, physical activity, behavior modification, and medical interventions (anti-obesity medications and bariatric surgery) may assist primary care clinicians improve the health and lives of patients living with obesity.
肥胖医学协会(OMA)和美国骨科家庭医生学会(ACOFP)的合作从初级保健的角度研究了肥胖管理。方法本联合观点基于科学证据、作者临床经验以及OMA和ACOFP领导的同行评议。目标是从初级保健的角度,利用基于证据的出版物,并在专家临床经验的指导下,识别和回答有关肥胖管理的哨兵问题。结果肥胖是一种导致生物力学并发症和初级保健中最常见的心脏代谢异常的疾病。阻碍在初级保健中对肥胖患者进行最佳护理的障碍包括:未能认识到肥胖是一种疾病、缺乏准确的诊断、无法获得肥胖治疗资源、培训不足、时间不足、缺乏足够的报销以及偏见、污名和歧视的不利影响。结论家庭医生往往是医疗机构治疗的第一线。这为预防和/或治疗超重和/或肥胖提供了早期干预机会。当初级保健临床医生认识到抗肥胖药物和减肥手术以及长期随访的风险和益处时,患者护理得到加强。关于营养治疗、体育活动、行为矫正和医疗干预(抗肥胖药物和减肥手术)这四大支柱的实用工具可以帮助初级保健临床医生改善肥胖患者的健康和生活。
{"title":"Obesity management in primary care: A joint clinical perspective and expert review from the Obesity Medicine Association (OMA) and the American College of Osteopathic Family Physicians (ACOFP) - 2025","authors":"Nicholas Pennings ,&nbsp;Catherine Varney ,&nbsp;Shaun Hines ,&nbsp;Bernadette Riley ,&nbsp;Patricia Happel ,&nbsp;Samir Patel ,&nbsp;Harold Edward Bays","doi":"10.1016/j.obpill.2025.100172","DOIUrl":"10.1016/j.obpill.2025.100172","url":null,"abstract":"<div><h3>Background</h3><div>This collaboration from the Obesity Medicine Association (OMA) and the American College of Osteopathic Family Physicians (ACOFP) examines obesity management from a primary care perspective.</div></div><div><h3>Methods</h3><div>This joint perspective is based upon scientific evidence, clinical experience of the authors, and peer review by the OMA and ACOFP leadership. The goal is to identify and answer sentinel questions about obesity management from a primary care perspective, utilizing evidence-based publications, and guided by expert clinical experience.</div></div><div><h3>Results</h3><div>Obesity is a disease that contributes to both biomechanical complications and the most common cardiometabolic abnormalities encountered in primary care. Barriers that impede optimal care of patients with obesity in primary care include failure to recognize obesity as a disease, lack of accurate diagnosis, insufficient access to obesity treatment resources, inadequate training, insufficient time, lack of adequate reimbursement and the adverse impact of bias, stigma, and discrimination.</div></div><div><h3>Conclusions</h3><div>Family physicians are often the first line of treatment in the healthcare setting. This affords early intervention opportunities to prevent and/or treat overweight and/or obesity. Patient care is enhanced when primary care clinicians recognize the risks and benefits of anti-obesity medications and bariatric procedures, as well as long-term follow-up. Practical tools regarding the 4 pillars of nutrition therapy, physical activity, behavior modification, and medical interventions (anti-obesity medications and bariatric surgery) may assist primary care clinicians improve the health and lives of patients living with obesity.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"14 ","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The association between hepatic steatosis, vitamin D status, and insulin resistance in adolescents with obesity 肥胖青少年肝脂肪变性、维生素D水平和胰岛素抵抗之间的关系
Pub Date : 2025-03-17 DOI: 10.1016/j.obpill.2025.100173
Emir Tas , Amanda Flint , Ingrid Libman , Radhika Muzumdar , Xiawei Ou , David K. Williams , Elisabet Børsheim , Eva C. Diaz

Introduction

Epidemiological studies suggest an inverse relationship between circulating 25-hydroxy-vitamin D [25(OH)D] levels and insulin resistance (IR), yet interventional studies have yielded inconsistent findings. This study examined the relationship between changes in vitamin D status and markers of IR in adolescents, with a focus on the modifying effect of liver fat.

Methods

A post-hoc analysis was performed using data from 44 adolescents participating in a 6-month observational study evaluating biomarkers of hepatosteatosis. Participants were categorized into two groups based on vitamin D status at the end of the observation period: those whose vitamin D levels increased or remained sufficient (VDI, n = 22) and those whose levels decreased or remained insufficient/deficient (VDD, n = 22). Liver fat percentage was measured using magnetic resonance imaging (MRI) fat-fraction, and IR was assessed using the updated Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR) and the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL).

Results

Across the cohort, liver fat was positively associated with HOMA2-IR (β = 0.08, p = 0.023). The association between changes in vitamin D status and HOMA2-IR trajectories was modified by liver fat but only in Hispanic adolescents (β = −0.18, p < 0.001). Among Hispanic adolescents in the VDD group, HOMA-IR worsened, particularly at higher levels of liver fat. In non-Hispanic adolescents, HOMA-IR increased in the VDD group (β = 0.65, p = 0.033) compared to the VDI group, independent of baseline liver fat. Across the cohort, changes in vitamin D status interacted with liver fat to influence TG/HDL trajectories (β = 0.20, p = 0.034).

Conclusions

The metabolic response to changes in vitamin D status in adolescents with IR may vary based on racial and ethnic differences and liver fat status. These findings underscore the importance of considering liver fat and racial/ethnic background in vitamin D and metabolic health studies. Future research with more extensive and diverse cohorts spanning the fatty liver disease spectrum is needed to clarify these relationships.
流行病学研究表明,循环25-羟基维生素D [25(OH)D]水平与胰岛素抵抗(IR)呈负相关,但介入性研究的结果不一致。本研究考察了青少年维生素D状态变化与IR标志物之间的关系,重点关注肝脏脂肪的调节作用。方法对44名青少年参与的一项为期6个月的观察性研究的数据进行事后分析,该研究评估了肝成骨病的生物标志物。根据观察结束时的维生素D状况,参与者被分为两组:维生素D水平增加或保持充足的(VDI, n = 22)和维生素D水平下降或仍然不足/缺乏的(VDD, n = 22)。使用磁共振成像(MRI)脂肪分数测量肝脏脂肪百分比,使用更新的胰岛素抵抗稳态模型评估(HOMA2-IR)和甘油三酯与高密度脂蛋白胆固醇比率(TG/HDL)评估IR。结果在整个队列中,肝脏脂肪与HOMA2-IR呈正相关(β = 0.08, p = 0.023)。肝脏脂肪改变了维生素D状态和HOMA2-IR轨迹之间的关系,但仅限于西班牙裔青少年(β = - 0.18, p <;0.001)。在VDD组的西班牙裔青少年中,HOMA-IR恶化,特别是在肝脏脂肪水平较高的情况下。在非西班牙裔青少年中,与VDI组相比,VDD组HOMA-IR升高(β = 0.65, p = 0.033),与基线肝脂肪无关。在整个队列中,维生素D状态的变化与肝脏脂肪相互作用,影响TG/HDL轨迹(β = 0.20, p = 0.034)。结论IR青少年对维生素D水平变化的代谢反应可能因种族、民族差异和肝脏脂肪状况而异。这些发现强调了在维生素D和代谢健康研究中考虑肝脏脂肪和种族/民族背景的重要性。未来的研究需要更广泛和多样化的跨越脂肪肝疾病谱系的队列来澄清这些关系。
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引用次数: 0
Cardiovascular safety of fixed-dose extended-release naltrexone/bupropion in clinical practice 临床应用纳曲酮/安非他酮定剂量缓释的心血管安全性
Pub Date : 2025-03-01 DOI: 10.1016/j.obpill.2025.100169
Michael Kyle , Dustin Burns , Catherine Rogers Murray , Heather Watson , Jeff Swaney , Samuel Spevack , Megan Leonhard , Michael Simon , Emma Moynihan , Kate L. Lapane , Shirley V. Wang , Craig L. Longo , Mary E. Ritchey , David D. Dore

Background

The fixed-dose extended-release combination of naltrexone/bupropion (NB-ER) is indicated to treat overweight and obesity in adults as an adjunct to a reduced-calorie diet and increased physical activity. This study compared the rate of major adverse cardiovascular events (MACE) and its components (nonfatal acute myocardial infarction [AMI], nonfatal stroke, and cardiovascular death) between patients initiating NB-ER and those initiating lorcaserin (removed from US market in 2020; included as active comparator to minimize possible confounding by indication) in routine clinical practice.

Methods

This was a retrospective cohort study with a new-user, active-comparator design. Patients initiating NB-ER or lorcaserin were identified using Arcadia Data Research electronic health records, including insurance claims (June 2012–February 2020). Incidence rate ratios were estimated, and adjusted hazard ratios (aHRs) with 95 % confidence intervals (CIs) were estimated using a propensity score (PS)-weighted Cox proportional hazard model in an intention-to-treat analysis.

Results

Patients initiating NB-ER (n = 12 475) or lorcaserin (n = 12 171) were followed for a mean observation period of 4.7 years. After PS weighting, baseline comorbidities, concomitant medications, lifestyle factors, and clinical measures were balanced between cohorts. MACE incidence was 0.77/1000 person-years for NB-ER and 1.03/1000 person-years for lorcaserin. Compared to lorcaserin, patients initiating NB-ER had statistically similar rates of MACE (aHR, 0.76; 95 % CI, 0.48–1.22), nonfatal AMI (aHR, 0.74; 95 % CI, 0.45–1.23), and nonfatal stroke (aHR, 1.05; 95 % CI, 0.34–3.22). No deaths were observed within 30 days of an AMI or stroke.

Conclusion

Patients initiating NB-ER compared with lorcaserin were not at an increased risk of MACE or its components. Conclusions from this study must be interpreted in the context of certain assumptions related to PS methodology and use of lorcaserin as an active comparator. Causal interpretations for the cardiovascular safety of NB-ER should be evaluated further in a prospective, randomized, blinded, controlled clinical trial.
纳曲酮/安非他酮(NB-ER)的固定剂量缓释组合被认为可以作为减少卡路里饮食和增加身体活动的辅助手段来治疗成人超重和肥胖。该研究比较了服用NB-ER和服用氯卡色林(将于2020年从美国市场撤出;作为主动比较者纳入常规临床实践,以尽量减少可能的混淆(指征)。方法采用回顾性队列研究,采用新用户、主动比较设计。使用阿卡迪亚数据研究公司的电子健康记录,包括保险索赔(2012年6月至2020年2月)确定服用NB-ER或氯卡塞林的患者。在意向治疗分析中,使用倾向评分(PS)加权Cox比例风险模型估计发病率比,并估计95%置信区间(CIs)的校正风险比(aHRs)。结果接受NB-ER治疗(n = 12 475)或氯卡色林治疗(n = 12 171)的患者平均随访4.7年。PS加权后,基线合并症、伴随用药、生活方式因素和临床措施在队列之间进行平衡。NB-ER的MACE发生率为0.77/1000人年,氯卡色林的MACE发生率为1.03/1000人年。与氯卡色林相比,启动NB-ER的患者MACE发生率具有统计学意义相似(aHR, 0.76;95% CI, 0.48-1.22),非致死性AMI (aHR, 0.74;95% CI, 0.45-1.23)和非致死性卒中(aHR, 1.05;95% ci, 0.34-3.22)。AMI或中风后30天内未观察到死亡。结论与氯卡色林相比,开始使用NB-ER的患者发生MACE或其成分的风险没有增加。本研究的结论必须在与PS方法和使用氯卡色林作为活性比较剂有关的某些假设的背景下进行解释。NB-ER心血管安全性的因果解释应在前瞻性、随机、盲法、对照临床试验中进一步评估。
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引用次数: 0
The effect of weight reduction on the diabetes foot: A scoping review and clinical implications 减肥对糖尿病足的影响:范围回顾和临床意义
Pub Date : 2025-03-01 DOI: 10.1016/j.obpill.2024.100152
Janine E. Roll Ahmed , John Veto , Derek Santos

Background

This scoping review aims to explore the literature available on rapid weight reduction (either via diet/exercise or bariatric surgery) on the diabetes foot.

Methods

A search strategy was developed using Population, Intervention, Comparison, Outcome (PICO). A search using all identified keywords and index terms was performed on Cumulated Index in Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), PubMed, International Clinical Trials Registry Platform (ICTRP) and Web of Science (WoS) databases as well as Proquest, and Cochrane systematic reviews. A search of grey literature was also performed on Google Scholar and Internet explorer. No restrictions were placed on the date of publication.

Results

There were few studies that explored the effects of weight reduction on the diabetes foot. Only 2 articles met the scoping review's inclusion criteria. These were a case study where the intervention was bariatric surgery and a case series study where the interventions were bariatric surgery or diet and exercise.

Conclusion

This scoping review has highlighted the lack of research in this area, raising opportunities for further research that focus on the effects of rapid weight reduction (either following bariatric surgery or weight reduction and diet) on the diabetes foot. Patients with diabetes mellitus should receive individualised pre and post weight reduction care to their feet, either by a podiatrist or multidisciplinary care team.
背景:本综述旨在探讨糖尿病足快速减肥(通过饮食/运动或减肥手术)的现有文献。方法采用人群、干预、比较、结果(PICO)方法进行检索。使用所有确定的关键词和索引词在护理和联合健康文献累积索引(CINAHL)、医学文献分析和在线检索系统(MEDLINE)、医学摘录数据库(EMBASE)、PubMed、国际临床试验注册平台(ICTRP)和科学网络(WoS)数据库以及Proquest和Cochrane系统综述中进行搜索。在b谷歌Scholar和Internet explorer上也进行了灰色文献搜索。对出版日期没有任何限制。结果很少有研究探讨减肥对糖尿病足的影响。只有2篇文章符合范围审查的纳入标准。这些是干预是减肥手术的案例研究和干预是减肥手术或饮食和运动的案例系列研究。结论:本综述强调了该领域研究的不足,为进一步研究快速减肥(减肥手术后或减肥加饮食)对糖尿病足的影响提供了机会。糖尿病患者应该接受个体化的减肥前后护理,由足科医生或多学科护理团队进行。
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引用次数: 0
Prevalence and association of MASLD in metabolically healthy young Asian Americans with obesity: A nationwide inpatient perspective (2019) 代谢健康的年轻亚裔美国人与肥胖的MASLD患病率及其相关性:全国住院患者视角(2019)
Pub Date : 2025-03-01 DOI: 10.1016/j.obpill.2025.100168
Ahmad Alhomaid , Sukhjinder Chauhan , Yamini Katamreddy , Avideep Sidhu , Praveena Sunkara , Rupak Desai

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease worldwide. Although the epidemiology of MASLD and its association with metabolically healthy obesity (MHO) is well-studied in the United States, data for Asian Americans with MHO is limited. We sought to evaluate the association of MASLD in young Asian American patients with MHO.

Methods

This was a retrospective, matched cohort, database review of Asian American Individuals. After excluding adult hospitalizations with metabolic risk factors (hypertension, diabetes, or hyperlipidemia), we identified all National Inpatient Sample (2019) admissions with obesity (MHO) and MASLD using relevant ICD-10-CM codes. We matched (1:1) propensity scores for age, sex, household income, hospital location, and teaching status to obtain cohorts with and without obesity (MHO+) vs. (MHO-). Categorical and continuous data were compared using the Chi-square and Mann-Whitney U tests. The primary endpoint was the prevalence and adjusted multivariable odds/predictors of MASLD in (MHO+) vs. (MHO-) cohort.

Results

In the adjusted multivariate regression for demographics, and comorbidities, the (MHO+) cohort was associated with higher odds of admissions with MASLD (OR 4.07, 95%CI 2.02–8.19, p ​< ​0.001). In addition, among the (MHO+) cohort, higher rates of MASLD-related hospitalizations were observed in males (OR 8.40, p ​< ​0.001), females (OR 2.69, p ​= ​0.025), high-income quartiles (OR 10.51, p ​< ​0.001), no prior bariatric surgery (OR 4.07, p ​< ​0.001), non-tobacco users(OR 4.16, p ​< ​0.001), and non-hypothyroid patients (OR 4.00, p ​< ​0.001) compared to the (MHO-) cohort. There was no statistically significant difference in the groups with low-income quartiles, tobacco use disorder, and hypothyroidism.

Conclusion

This nationwide analysis demonstrates that (MHO+) is associated with a higher prevalence of MASLD. In the (MHO+) cohort, there was an association of MASLD with sex, high-income quartile, no prior bariatric surgery, non-tobacco use, and non-hypothyroidism. Further prospective multicenter studies are needed to evaluate the association of MASLD in (MHO+) patients with comorbid conditions.
背景:代谢功能障碍相关脂肪变性肝病(MASLD)是世界范围内慢性肝病的主要原因。尽管MASLD的流行病学及其与代谢健康型肥胖(MHO)的关系在美国得到了充分的研究,但关于MHO的亚裔美国人的数据有限。我们试图评估年轻亚裔美国人MHO患者与MASLD的关系。方法对亚裔美国人进行回顾性、匹配队列、数据库回顾。在排除了伴有代谢危险因素(高血压、糖尿病或高脂血症)的成人住院患者后,我们使用相关的ICD-10-CM代码确定了所有患有肥胖症(MHO)和MASLD的全国住院患者样本(2019)。我们将年龄、性别、家庭收入、医院位置和教学状况的倾向评分(1:1)进行匹配,以获得有肥胖和没有肥胖的队列(MHO+)和(MHO-)。分类数据和连续数据采用卡方检验和Mann-Whitney U检验进行比较。主要终点是(MHO+)与(MHO-)队列中MASLD的患病率和调整后的多变量赔率/预测因子。结果在人口统计学和合并症的调整多因素回归中,(MHO+)队列与MASLD入院几率较高相关(OR 4.07, 95%CI 2.02-8.19, p <;0.001)。此外,在(MHO+)队列中,男性与masld相关的住院率较高(OR 8.40, p <;0.001),女性(OR 2.69, p = 0.025),高收入四分位数(OR 10.51, p <;0.001),既往无减肥手术(OR 4.07, p <;0.001),非烟草使用者(OR 4.16, p <;0.001),非甲状腺功能减退患者(OR 4.00, p <;0.001),与(MHO-)队列相比。在低收入四分位数组、烟草使用障碍组和甲状腺功能减退组中,没有统计学上的显著差异。结论全国范围内的分析表明(MHO+)与MASLD的高患病率相关。在(MHO+)队列中,MASLD与性别、高收入四分位数、既往无减肥手术、非吸烟和非甲状腺功能减退有关。需要进一步的前瞻性多中心研究来评估MASLD在(MHO+)合并合并症患者中的相关性。
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引用次数: 0
Editorial: Exploring the nuances of obesity in Asian populations 社论:探索亚洲人群肥胖的细微差别
Pub Date : 2025-03-01 DOI: 10.1016/j.obpill.2024.100150
Harold Bays (Editor– in -Chief)
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引用次数: 0
Management and impact of obesity in Canada: A real-world survey of people with obesity and their physicians 加拿大肥胖的管理和影响:对肥胖患者及其医生的真实调查
Pub Date : 2025-02-28 DOI: 10.1016/j.obpill.2025.100171
Jennifer Glass , Sophie Carter , Esther Artime , Victoria Higgins , Lewis Harrison , Andrea Leith , David CW. Lau , Ian Patton , Jennifer L. Kuk

Background

Obesity is a chronic relapsing disease associated with multiple complications. This study described real-world demographic/clinical characteristics, including obesity-related complications (ORCs), prescribing rationale, and patient-reported outcome measures (PROMs) for adults living with obesity in Canada accessing treatment.

Methods

This was a cross-sectional survey of physicians and consulting people with obesity (PwO) in Canada with retrospective data capture in a real-world setting. Canadian data were drawn between July and November 2022 from the multinational Adelphi Real World Obesity Disease Specific Programme™. Consulting PwO were required to be on a weight management program and/or have a current body mass index of ≥30 kg/m2. Physicians completed questionnaires for the next 3–5 consecutive PwO seen in their routine clinical practice. A quota was applied for obesity management medication (OMM). PROMs including Work Productivity and Activity Impairment (WPAI) questionnaire were provided voluntarily by PwO. Analyses were descriptive.

Results

Overall, 50 physicians (35 general practitioners, 15 endocrinologists) and 199 PwO were analyzed. More than 85 % of PwO had ≥1 ORC. The most common ORCs were hypertension, dyslipidemia, depression, and type 2 diabetes, and one-quarter to one-half of ORCs were not optimally controlled. Approximately two-thirds of the cohort were employed full-time, almost half had private insurance, and almost 70 % were classified as high socio-economic status. Mean number of weight-reduction attempts over the past 3 years was 2.9. Pharmacological treatment for obesity was common among those with ORCs. A general trend towards greater work impairment among people with ORCs than for PwO without ORCs was observed.

Conclusions

Among PwO participating in our study, ORCs were common, often uncontrolled, and their presence impacted the likelihood of obesity treatment and possibly impaired work productivity. Medical treatment for obesity was often delayed until ORCs developed, suggesting that preventative healthcare measures are not the norm for PwO in Canada. A large proportion of PwO had high socioeconomic status, suggesting that PwO who access treatment may not be representative of the overall population of PwO in Canada.
背景:肥胖是一种伴有多种并发症的慢性复发性疾病。本研究描述了现实世界的人口统计学/临床特征,包括肥胖相关并发症(ORCs)、处方依据和患者报告的结果测量(PROMs),用于加拿大成年肥胖患者获得治疗。方法:这是一项横断面调查,调查对象是加拿大的医生和咨询肥胖患者(pvo),并在现实世界中收集回顾性数据。加拿大的数据是在2022年7月至11月期间从跨国公司阿德尔菲真实世界肥胖疾病特定计划™中提取的。咨询pw需要进行体重管理计划和/或当前体重指数≥30 kg/m2。医生在接下来的3-5个连续的临床实践中完成了问卷调查。对肥胖管理药物(OMM)实行配额。工作效率和活动障碍(WPAI)问卷由pvo自愿提供。分析是描述性的。结果共分析50名内科医生(全科医生35名,内分泌科医生15名)和199名PwO。85%以上的pvo患者ORC≥1。最常见的orc是高血压、血脂异常、抑郁症和2型糖尿病,四分之一到一半的orc没有得到最佳控制。大约三分之二的人有全职工作,几乎一半的人有私人保险,几乎70%的人被列为高社会经济地位。过去3年的平均减肥次数为2.9次。肥胖的药物治疗在ORCs患者中很常见。观察到有ORCs的人比没有ORCs的PwO有更大的工作障碍的总体趋势。在参与我们研究的pvo中,ORCs很常见,通常不受控制,它们的存在影响了肥胖治疗的可能性,并可能损害工作效率。肥胖的医疗治疗往往被推迟到ORCs发展,这表明预防性保健措施不是加拿大ppo的标准。很大一部分残疾妇女具有较高的社会经济地位,这表明获得治疗的残疾妇女可能不能代表加拿大残疾妇女的总体人口。
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引用次数: 0
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Obesity Pillars
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