International Journal of Obesity最新文献

Objectives: Obesity and type 2 diabetes (T2D) are associated with altered secretion of enteroendocrine hormones, including the glucagon-like peptide-1 (GLP-1). The mechanisms underlying this dysregulation remain poorly understood, partly due to the rarity of enteroendocrine cells (EECs) and technical difficulties in humans. Our aim was to generate an in vitro human jejunal enteroids (HJEs) derived from individuals with obesity and T2D as a simplified intestinal epithelium in a controlled environment, in order to explore GLP-1 secretion in metabolic diseases.

Subjects and methods: HJEs were obtained from jejunum fragments sampled during gastric bypass surgery in individuals with severe obesity and normoglycemia (Ob, n = 12), prediabetes (ObPreD, n = 12), or T2D (ObD, n = 10). HJEs were characterized through gene and protein expression analyses and immunofluorescence. To promote the EEC lineage, HJEs were treated with the Notch pathway inhibitor DAPT. Active GLP-1 secretion was assessed by ELISA.

Results: HJEs were successfully generated whatever the metabolic group Ob, ObPreD, ObD, exhibiting epithelial cell lineages and expressing critical genes involved in GLP-1 cell lineage, biosynthesis, and secretion. HJEs secreted active GLP-1 in response to both low and high glucose concentrations, regardless of subject metabolic status. However, HJEs from individuals with severe obesity and T2D exhibited a reduced capacity to release GLP-1 in response to high glucose concentrations compared to those from individuals with severe obesity or with obesity and prediabetes.

Conclusions: HJEs represent a robust human-derived model to investigate EEC function and GLP-1 secretion in metabolic diseases. While HJEs retain functional GLP-1-producing cells, their secretory capacity is impaired in the presence of T2D, confirming functional endocrine alterations. These findings support the use of HJEs in preclinical studies targeting enteroendocrine dysfunction.

Obesity is a complex disease that requires evidence-based treatments to be effectively managed. Despite extant literature detailing the benefits of treatment options currently available, there is a disconnect between established research and public discourse on the treatment of obesity. Due to the recent surge in popularity of highly efficacious incretin-based therapies, more patients are becoming aware of available treatment options and approaching healthcare providers to engage in conversations regarding weight management. Here, we provide details regarding patient preferences on certain terms related to weight management, and guidance for healthcare providers counseling patients through an obesity diagnosis. Given the evidence that individuals with obesity may have misunderstandings regarding the disease of obesity and the role of treatment options, we provide guidance on these complex topics. The authors of this perspective include researchers, clinicians, and a patient. The guidance provided herein is based on available literature, experience in clinical settings, and lived experience.

Background: The relationship between childhood maltreatment (CM) and obesity is nuanced, and recent evidence suggests stronger associations between CM and obesity-related traits in females compared to males. This study aims to validate and extend these findings in a large sample from the German National Cohort (NAKO).

Methods: The NAKO is a population-based cohort study including 204,744 adults. For the present analyses, 151,143 individuals (74,596 female) were included. CM was assessed using the Childhood Trauma Screener (CTS). From the CTS, an overall severity score (CTS sum score), a cumulative CM score (number of CM subtypes with at least moderate severity), and five CTS subtypes were considered as exposures. Obesity-related traits included anthropometric (height, weight, body mass index [BMI], waist circumference [WC]) and body fat markers (relative fat mass [rFM], subcutaneous [SAT], visceral adipose tissue [VAT]). Sex-stratified linear and logistic regression models were adjusted for age, education, and examination center to associate CTS-based scores with obesity-related traits.

Results: Associations of the CTS sum score with weight, BMI, WC, rFM, and SAT were stronger in females compared to males, while similar associations were observed for VAT. In both sexes, most obesity-related traits exhibited dose-response relationships with increasing numbers of CM subtypes. Compared to unexposed females, females with exposure to ≥3 CM subtypes had a higher risk for obesity (i.e., BMI ≥ 30 kg/m²; OR = 1.56; 95% CI: 1.43, 1.71) and high WC (i.e., WC ≥ 88 cm; OR = 1.39; 95% CI: 1.29, 1.50). In males, exposure to ≥3 CM subtypes was also associated with increased obesity risk (OR = 1.51; 95% CI: 1.32, 1.72) and high WC (i.e., WC ≥ 102 cm; OR = 1.31; 95% CI: 1.18, 1.44). Physical and emotional abuse exhibited the strongest average associations and were associated with the most outcomes.

Conclusion: Associations of CM exposure with adult anthropometric and body fat markers are stronger in females compared to males.

The Physiology Of the WEight Reduced State (POWERS) study is a multi-center clinical trial designed to understand the physiological basis for observed variability in weight regain following intentional weight loss among US adults. The primary dependent variable is weight regain over one year following a 7% or greater supervised weight loss. The overarching design and study organization, along with rationale and history of the POWERS study and outcomes measures are described in accompanying papers. This paper provides the rationale for and description of biospecimens samples that will ultimately inform on the molecular and cellular basis of the physiological variability that contributes to the regulation of energy balance in the weight reduced state. Participants will be 205 healthy adults (n = 205), aged 25-59 years, with body mass index (BMI) 30- ≤ 40 kg/m². Biospecimens will be collected prior to weight loss (baseline, BL), immediately following weight loss via lifestyle intervention (T0), and then four (T4) and twelve (T12) months after weight loss. Blood will be collected in the fasting state and following a meal challenge designed to induce hormones related to satiety. Weight change from T0 to T12 will be the primary outcome variable. Biospecimens to be collected include plasma, serum, peripheral blood mononuclear cells (PBMCs), DNA, urine, feces, adipose and skeletal muscle tissue. All samples will be biobanked at each site. This manuscript describes the rationale for the biospecimens chosen to assess contributors to homeostatic mechanisms that drive observed variability of weight regain after weight loss.

Introduction: The global rise in maternal obesity presents a growing public health challenge, with significant implications for pregnancy outcomes. This study offers a comprehensive retrospective analysis of changes in Body Mass Index (BMI) among pregnant women during labor over four decades.

Material and methods: BMI data were retrospectively collected from 13,193 pregnant women divided into three cohorts: Group 0 (1986-1990), Group 1 (2009-2013), and Group 2 (2024).

Results: Mean BMI increased significantly from 23.75 kg/m² in Group 0 to 27.33 kg/m² in Group 2 (p < 0.001). The prevalence of obesity rose more than fivefold, from 4.87% to 25.76%. Regression analysis confirmed a linear and statistically significant upward trajectory across all groups.

Conclusions: The sustained increase in maternal BMI underscores the urgency of implementing targeted interventions, including preconception counseling and personalized antenatal care, to mitigate the adverse maternal and neonatal outcomes associated with elevated BMI.

Background: Candidates for metabolic bariatric surgery (MBS) experience significantly higher rates of mental disorders compared to the general population. While previous studies have primarily focused on a limited range of mental health conditions, this study expands the scope by studying a broader spectrum of psychopathological symptoms. Our aim was to map the psychopathological profile of candidates for MBS and to test whether individuals higher in general psychopathology exhibit a higher body mass index (BMI) and more severe eating disorder symptoms than those lower in general psychopathology.

Methods: A total of 222 candidates for MBS from the Dutch Obesity Clinic completed 16 questionnaires to generate a comprehensive psychopathological profile. Cluster analysis was applied to identify distinct groups based on general psychopathology. The clusters were compared on BMI and eating disorder psychopathology. A cross-sectional network approach was used to explore the complex interconnections between symptoms.

Results: Two clusters emerged: a high psychopathology profile (high PP; 29%) characterized by elevated scores on general psychopathology, and a low psychopathology profile (low PP; 71%) marked by healthier psychological functioning. The high PP cluster exhibited more severe eating disorder psychopathology than the low PP cluster, while the clusters did not differ in BMI. The symptom network revealed that general psychopathology is linked to eating disorder psychopathology through the bridge symptom 'eating concerns.'

Conclusions: Approximately one-third of the individuals presenting for MBS exhibit elevated, transdiagnostic psychopathology with complex connections between symptoms. Notably, BMI was not associated with the severity of symptoms. The symptom network analysis highlights that 'eating concerns' serve as a crucial bridge linking eating disorder symptoms and symptoms of emotional disorders. Future research should focus on the transdiagnostic nature of psychopathology associated with obesity and investigate its potential impact on treatment outcomes, such as weight loss and quality of life.

Background: Obesity represents a critical global health challenge, yet the neurocognitive distinctions in processing different rewards among individuals with overweight/obesity (OW/OB) remain poorly characterized. This meta-analysis aims to synthesize functional MRI evidence to delineate common and distinct neural abnormalities during processing of food or monetary reward cues in individuals with OW/OB compared to normal-weight (NW) controls.

Methods: Searches were conducted in Web of Science, PubMed, and PsycInfo to identify eligible citations from inception until May 2025. The review protocol was registered in PROSPERO (No. CRD42024595608). Data analyses were carried out using the Activation Likelihood Estimation (ALE) algorithm. MRIcroGL was used to show the results with MNI coordinates.

Results: We systematically reviewed 26 studies with 1065 participants, comprising 6 monetary reward and 20 food reward studies. Overlapping reduced activation occurred in the left posterior cingulate cortex (PCC) and insula across both reward types; the left middle frontal gyrus (MFG) exhibited decreased activation in response to food reward cues, while it showed increased activation in response to monetary reward cues in individuals with OW/OB. During food-reward tasks, individuals with OW/OB exhibited increased activation in the bilateral caudate nucleus, hippocampus, anterior cingulate cortex (ACC), and medial prefrontal cortex, alongside decreased activation in amygdala responses. For monetary-reward tasks, increased activation was observed in the right lateral nucleus and hypothalamus, while decreased activation was observed in the right subthalamic nucleus (STN) and posterior ventral lateral nucleus.

Conclusion: Obesity represents a critical global health challenge, yet the neurocognitive distinctions in processing different rewards among individuals with OW/OB remain poorly characterized. Our findings reveal both dissociable and overlapping neural alterations during the processing of primary (food) versus secondary (monetary) rewards in OW/OB, implicating altered reward sensitivity, decision-making, and inhibitory control. The results underscore the necessity for reward-type-specific interventions targeting these neural mechanisms to address obesity-related dysregulation. Contrasts in brain activation during food and monetary reward processing between individuals with overweight/obesity (OW/OB) and normal weight (NW).

Background: Metabolic and bariatric surgery (MBS) is a highly effective treatment for patients with obesity, with increasing prevalence in France. However, some patients require revisional MBS (RMBS) due to suboptimal initial response, recurrent weight gain, and correction of technique-related complications. Understanding the prevalence and risks associated with RMBS is essential for optimizing patient care.

Objective: This study aims to assess the rate of RMBS in France and to delineate the associated complications and risk factors.

Setting: France.

Methods: Using national discharge data from 2016 to 2022, this observational study compared morbidity and mortality rates between primary and RMBS. Patient demographics, comorbidities, and procedural details were analyzed. Major complications within 90 days post-surgery were assessed using logistic regression models adjusted for potential confounders.

Results: Among 284,271 bariatric procedures analyzed, the revision rate was 12.8%. Patients undergoing RMBS were older, predominantly female, and had more comorbidities compared to those undergoing primary procedures. RMBS were associated with significantly higher rates of severe complications (OR 1.58, 95% CI 1.49-1.68, p < 0.001), particularly after gastric bypass (GB) (OR 2.70, 95% CI 2.27-3.20). Subgroup analyses showed increased morbidity following revisional sleeve gastrectomy compared to primary procedures.

Conclusions: This study highlights a notable rate of RMBS in France, with evolving trends towards more complex revisions. RMBS are associated with increased morbidity, emphasizing the need for careful patient selection and enhanced postoperative management. Further research into surgical techniques, long-term pharmacological interventions, and surgeon expertise is warranted to optimize outcomes in this population.

Background: Obesity is linked to adverse health effects, but paradoxically improves survival in heart failure (HF). Peak oxygen consumption (VO₂), a measure of exercise capacity, is a key prognostic indicator in HF. We examined the interaction between obesity and peak VO₂ in predicting survival in patients with HF with reduced ejection fraction (HFrEF).

Methods: We retrospectively reviewed 18,879 patients who underwent maximal cardiopulmonary exercise testing using the modified Bruce ramp protocol between 2012 and 2020. The inclusion criteria were left ventricular ejection fraction <40% and body mass index (BMI) > 18.5 kg/m². Patients were classified as those with normal weight (BMI: 18.5-22.9 kg/m²), overweight (23.0-24.9 kg/m²), or obesity (≥25.0 kg/m²) per 2020 Korean Society for the Study of Obesity guidelines.

Results: For the 819 included patients (292 with normal weight, 197 with overweight, 330 with obesity), median age was 59 (interquartile range [IQR]: 49-67) years, 75.2% were male, and the median BMI was 24.1 (IQR: 22.1-26.5) kg/m². Patients with obesity achieved the highest workload, peak VO₂, and exercise time (all P < 0.001). They also had lower all-cause mortality versus patients with normal weight (hazard ratio 0.46, 95% confidence interval 0.25-0.82, P = 0.009). In patients with obesity, elevated peak VO₂ was associated with a U-shaped mortality curve, unlike the linear relationship in other groups (P for interaction = 0.001).

Conclusions: Patients with obesity and HFrEF showed better survival, consistent with the obesity paradox. However, the U-shaped relationship between peak VO₂ and mortality in this group suggests the survival advantage may diminish at higher levels of exercise capacity, warranting further investigation.