Current Obesity Reports最新文献

Objective: The purpose of this study is to evaluate the additional effect of exercise to intermittent fasting (IF) on body composition and cardiometabolic health in adults with overweight/obesity.

Method: Relevant studies were identified through a systematic search across five databases. A random-effects meta-analysis was conducted on outcomes including body composition and cardiometabolic health markers, to compare the effect of combining IF with exercise against IF alone. The certainty of the evidence was evaluated using the GRADE approach, while the quality of the included studies was assessed using the revised Cochrane risk-of-bias tool and the TESTEX scale.

Result: In total, twelve studies including 616 participants (Age: 40 ± 9 years; BMI: 33.6 ± 4.8 kg/m²; 87.3% female) were included in this systematic review and meta-analysis. The combined intervention was more effective, leading to greater reductions in fat mass (-0.93 kg [95% CI: -1.69, -0.18]) and waist circumference (-2.51 cm [95% CI: -3.70, -1.32]) when compared to IF alone. Cardiometabolic health parameters also showed greater improvements, with decreased insulin (-3.1uIU/ml [95%CI: -4.25; -1.95]), HOMA-IR (-0.57 [95%CI: -0.83; -0.31]), LDL (-10.67 mg/dl [95%CI: -20; -1.35]), resting heart rate (-2.68 bpm [95%CI: -4.71; -0.64]), along with enhanced cardiorespiratory fitness (VO_{2 max}:1.92 ml/kg/min [95%CI: 0.32; 3.52]). For the remaining outcome variables, no statistically meaningful differences emerged between the groups.

Conclusion: The potential benefits of incorporating exercise into IF for adults with overweight/obesity, particularly in terms of body composition, glycemic control, and cardiorespiratory fitness, appear promising. Nevertheless, given the limited amount of data, future investigations are essential to strengthen the evidence base and investigate the influence of specific exercise and IF types in enhancing treatment outcomes. Registry and registry number for systematic reviews or meta-analyses: CRD42024550753.

Purpose of review: The current review aims to summarize the rapidly evolving literature on selected technology-based interventions for obesity in adults. Research on mobile health applications, social media-based interventions, and telemedicine are discussed. Recommendations for the application of the most promising technologies and combination treatments will be reviewed.

Recent findings: Connection with healthcare professionals to facilitate self-management skills and behavioral adherence is likely to be most effective. Mobile health applications are effective for engagement with self-monitoring behaviors and may result in limited weight loss in the short term. Social media-based interventions similarly show promise, although combating misinformation remains critical. Telemedicine videoconferencing is likely to be highly effective for patients who desire this modality of treatment delivery. Evidence-based behavioral weight management interventions that may be scaled via telehealth show promise. Shifting focus from the magnitude of weight loss to the impact of technology-based interventions on gains in health and mobility may serve patients well in the long-term.

Purpose of review: The global incidence of obesity has risen dramatically in recent decades, with consequent detrimental health effects. Extensive studies have demonstrated that obesity significantly affects the risk, prognosis, and progression of various cancers, including multiple myeloma (MM). As an established modifiable risk factor for both MM and its precursor stages -monoclonal gammopathy of unknown significance (MGUS) and smoldering MM (SMM)- the association between obesity and disease onset has become a compelling area of research. This review presents a comprehensive overview of the current epidemiological evidence linking obesity to MM, emphasizing its role in disease pathogenesis and patient outcomes. It also offers insights into the molecular mechanisms underlying this deleterious association, and discusses therapeutic strategies targeting obesity-driven contributions to MM.

Recent findings: Emerging epidemiological evidence suggests that obesity not only influences MM development but also alters its biological behavior, impacting myelomagenesis, and clinical outcomes. Biologically, multiple pathways exist through which adipose tissue may drive MM onset and progression. Obesity fosters a state of chronic inflammation, where dysfunctional adipocytes and fat-infiltrating immune cells release proinflammatory cytokines, growth factors, adipokines, and fatty acids, contributing to the proliferation and expansion of MM. Additionally, communications between MM cells and adipocytes within the bone marrow are crucial in MM biology. Collectively, the discoveries described in this review underscore the necessity for broader preclinical and clinical investigations to better characterize the complex interplay between obesity and MM, and to determine whether lifestyle interventions can impact MM incidence and clinical outcomes, particularly in high-risk populations.

Background: The pathogenesis of nonalcoholic fatty liver disease (NAFLD) is multifactorial. Fibroblast growth factor-21 (FGF-21) has been proposed to be associated with NAFLD, but data on its circulating levels in patients with NAFLD are to date conflicting.

Aims: The synthesis and comparison of data on circulating FGF-21 between patients with NAFLD and controls without NAFLD.

Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library and Scopus, complemented by hand-searching. Forty-four observational studies with overall 15,563 participants (9548 controls and 6015 NAFLD patients) were included in the study.

Results: Circulating FGF-21 was higher in patients with NAFLD compared to controls (standardized mean difference [SMD]: 0.61; 95% confidence interval [CI]: 0.44, 0.77; p < 0.00001). Subgroup analysis showed higher FGF-21 levels in patients with nonalcoholic steatohepatitis (NASH) compared to controls (SMD: 1.30; 95% CI: 0.35, 2.24; p = 0.007), but not between hepatic steatosis and controls, or hepatic steatosis and NASH. Furthermore, the findings were more robust in the subgroup of studies with NASH-related cirrhosis than those without them (p = 0.0004). Sensitivity analysis further supported the findings. Heterogeneity was high in all comparisons. Meta-regression analyses showed that FGF-21 SMD between NAFLD patients and controls was positively associated with the rate of patients with type 2 diabetes mellitus per study, and this could explain 49.2% of the heterogeneity among studies.

Conclusions: Circulating FGF-21 levels were higher in NAFLD patients than controls, which may be possibly attributed to those with advanced disease (NASH and related cirrhosis).  Circulating fibroblast growth factor-21 levels were higher in patients with nonalcoholic fatty liver disease compared to controls. This is primarily attributed to the higher levels observed in patients with advanced disease (steatohepatitis and related cirrhosis).

Purpose of review: This review synthesizes current knowledge on Normal Weight Obesity (NWO), a condition characterized by excess body fat despite having a normal Body Mass Index (BMI). It highlights recent findings on diagnostic methods, pathophysiological mechanisms, and health implications associated with NWO.

Recent findings: Individuals with NWO have an increased risk of developing chronic inflammation, cardiometabolic disorders, insulin resistance, and sarcopenia. Genetic factors, including polymorphisms in IL-6, IL-1Ra, IL-15Ra, and MTHFR genes, play a significant role in determining susceptibility. Lifestyle behaviors, reduced physical activity and frequent intake of ultra-processed foods, further elevate metabolic risks. Advanced diagnostic techniques, particularly Dual-Energy X-ray Absorptiometry (DXA), are essential for accurate identification of NWO, as traditional BMI measurements fail to adequately detect this phenotype. Recognition and management of NWO require shifting from BMI-based classifications to detailed body composition analyses. Incorporating DXA into clinical practice is essential for accurately identifying individuals at metabolic risk. Further research should develop targeted strategies for preventing and treating this specific obesity phenotype.

Purpose of review: Lipedema is an abnormal accumulation of adipose tissue, predominantly observed in women, characterised by symmetrical fat deposition and tactile sensitivity in the extremities, affecting both sides of the body. This condition can lead to significant pain, impairing daily activities and causing substantial discomfort.

Recent findings: While the etiology of the disease is not yet fully understood, genetic predisposition, hormonal fluctuations, a stressful lifestyle, as well as traumatic events are considered potential triggers. Lipedema remains a condition with low diagnostic awareness as well as is frequently misdiagnosed as obesity or lymphedema. While obesity is a risk factor for lipedema, the abnormal fat deposition characteristic of the disease can occur across a wide spectrum of body weights, from underweight to overweight individuals. Specific patterns of adipose tissue distribution may be associated with signs of inflammation as well as heightened pain perception, as well as individuals with eating disorders, such as anorexia, may additionally be affected. Ketogenic diets have emerged as a promising therapeutic option for lipedema. Characterized by low carbohydrate as well as high fat content, ketogenic diets facilitate metabolic improvements by reducing insulin resistance as well as supporting weight loss. Furthermore, they may mitigate tissue damage associated with lipedema by decreasing inflammation as well as oxidative stress levels.Nevertheless, current scientific data regarding the mechanisms of action as well as therapeutic efficacy of ketogenic diets are limited, necessitating further research to expand their clinical application.

Purpose of review: This review evaluates the comparative efficacy of bariatric surgery and pharmacological interventions targeting Glucagon-Like Peptide-1 (GLP-1) and Glucose-Dependent Insulinotropic Polypeptide (GIP) receptors. Recent advancements, including the FDA approval of Tirzepatide (Zepbound) for OSA, are critically analysed alongside existing literature, offering insights into physiological mechanisms, long-term outcomes, and patient selection criteria.

Recent findings: OSA is a chronic condition characterized by repetitive upper airway collapse during sleep, resulting in intermittent hypoxia and sleep fragmentation. With obesity being a primary risk factor, weight management has emerged as a key intervention in OSA treatment. Direct comparisons of bariatric surgery and GLP-1/GIP receptor agonists in treating OSA are limited due to a lack of randomised controlled trials. Observational studies suggest that bariatric surgery typically results in faster and more sustained weight loss, leading to better initial OSA improvement. In contrast, pharmacotherapy offers a non-invasive option for patients who cannot undergo surgery. Randomized trials comparing these treatment modalities are essential to refine treatment algorithms and enhance patient care. A multidisciplinary, patient-centered approach is crucial for ensuring long-term success and improving the quality of life for individuals with obesity-related OSA.

Purpose of review: We aimed to summarize research on disparities in obesity treatment outcomes, access, and utilization.

Recent findings: We identified disparities in treatment effectiveness by race/ethnicity, sex/gender, and disability status. There were equivocal results regarding whether outcomes varied by socioeconomic status (SES) and there was no evidence for a rural/urban disparity. A different pattern emerged for treatment access/utilization; disparities were identified across all groups, including race/ethnicity, SES, rurality, sex/gender/sexual and gender minority (SGM) status, and disability status. Little is known regarding how multiple marginalized identities may interact in relation to treatment outcomes or access/utilization. Future research should adopt an intersectional framework to understand the complex interactions between an individual's identities and obesity treatment effectiveness, access, and utilization. Moreover, the field should look beyond the individual-level, using a multi-level approach to identify barriers and strategies to promoting access to effective treatment across system/organizational and policy levels.

Purpose of review: The natural course of metabolic dysfunction-associated steatotic liver disease (MASLD) in the population with metabolically healthy obesity (MHO) has not been adequately explored. In the present narrative review, we summarize the evidence regarding the association between MHO and MASLD prevalence, incidence and progression.

Recent findings: Cross-sectional, population-based, cohort studies have shown an increased prevalence of hepatic steatosis and fibrosis in subjects with MHO compared with metabolically healthy non-obese individuals (MHNO). In large-scale longitudinal cohort studies among metabolically healthy subjects, increasing body mass index (BMI) has been found to be independently associated with an increased incidence of MASLD and progressive hepatic fibrosis over a mean follow-up period of 2.2-7.7 years. With regard to advanced MASLD, the prevalence of steatohepatitis and clinically significant liver fibrosis is lower in MHO compared with subjects with metabolically unhealthy obesity (MUO). The presence of MASLD has been proposed as a strong risk factor for metabolic health deterioration in MHO. Furthermore, subjects with MHO and MASLD display an elevated 10-year cardiovascular risk and a three-fold increased risk of incident diabetes compared with MHO without MASLD. MASLD may also predict the failure to convert from MUO to MHO after a weight loss intervention.

Purpose of review: This narrative review aimed to provide an overview of the current evidence on the impact of various nutritional strategies on body composition in people living with obesity (PLwO), with particular attention to fat mass (FM), fat-free mass (FFM), and fat distribution.

Recent findings: Obesity is increasingly linked to cardiometabolic complications, yet common diagnostic metrics such as body mass index (BMI) do not capture changes in FM or FFM. Recent studies highlight the variable effects of different dietary interventions on body compartments. High-protein and ketogenic diets are associated with greater preservation of FFM and reductions in visceral adipose tissue (VAT), while the Mediterranean diet shows promise for long-term adherence and improvements in metabolic health. Intermittent fasting and time-restricted eating demonstrate efficacy in FM reduction but present mixed results regarding FFM retention and sustainability. Dietary strategies exert diverse effects on body composition in PLwO, underscoring the importance of tailoring interventions to individual metabolic profiles and health goals. Personalized nutrition approaches that prioritize the preservation of lean mass and reduction of VAT, along with sustainable adherence, are critical for optimizing obesity management beyond weight loss alone.