Pub Date : 2026-01-01Epub Date: 2026-02-16DOI: 10.1016/j.jacl.2025.06.016
Jeremy McNaught DO
BACKGROUND
Obesity is an increasingly common, multifactorial condition with significant consequences for patients and the healthcare system. Obesity represents a major modifiable risk factor for cardiovascular disease, type 2 diabetes and metabolic syndrome. Understanding of the pathways and mechanisms involved in the development of obesity will allow for further advancement in treatment modalities.
SOURCES OF MATERIAL
Evidence was drawn from current peer-reviewed literature addressing the pathophysiology of obesity identified via PubMed searches.
ABSTRACT OF FINDINGS
Obesity results from impaired energy homeostasis and chronic positive energy balance. The etiology of the positive energy balance is often a complex interplay of genetic, environmental, neurohormonal, and psychosocial factors. This paper discusses the pathophysiology of obesity. Topics included in this discussion are the genetics of obesity, the process of energy regulation and metabolism of adipose tissue. Also discussed is how visceral obesity is especially harmful, as it promotes insulin resistance, altered lipid metabolism, and inflammation.
CONCLUSION
Understanding the underlying pathophysiology of obesity is crucial for making advances in treating this condition with a more individualized approach.
{"title":"Pathophysiology of obesity","authors":"Jeremy McNaught DO","doi":"10.1016/j.jacl.2025.06.016","DOIUrl":"10.1016/j.jacl.2025.06.016","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Obesity is an increasingly common, multifactorial condition with significant consequences for patients and the healthcare system. Obesity represents a major modifiable risk factor for cardiovascular disease, type 2 diabetes and metabolic syndrome. Understanding of the pathways and mechanisms involved in the development of obesity will allow for further advancement in treatment modalities.</div></div><div><h3>SOURCES OF MATERIAL</h3><div>Evidence was drawn from current peer-reviewed literature addressing the pathophysiology of obesity identified via PubMed searches.</div></div><div><h3>ABSTRACT OF FINDINGS</h3><div>Obesity results from impaired energy homeostasis and chronic positive energy balance. The etiology of the positive energy balance is often a complex interplay of genetic, environmental, neurohormonal, and psychosocial factors. This paper discusses the pathophysiology of obesity. Topics included in this discussion are the genetics of obesity, the process of energy regulation and metabolism of adipose tissue. Also discussed is how visceral obesity is especially harmful, as it promotes insulin resistance, altered lipid metabolism, and inflammation.</div></div><div><h3>CONCLUSION</h3><div>Understanding the underlying pathophysiology of obesity is crucial for making advances in treating this condition with a more individualized approach.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 21-25"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-02-16DOI: 10.1016/j.jacl.2025.08.022
Matthew J. Landry PhD, RDN , Zohaib Bagha MD
BACKGROUND
Lifestyle modification remains the cornerstone of obesity management, serving as an essential component of all treatment plans, even in an era of effective pharmacotherapy.
SOURCES OF MATERIAL
This review examines the key elements of lifestyle interventions, their mechanisms of action, implementation strategies, and challenges in clinical practice. It additionally discusses the evolving role of lifestyle modification when integrated alongside new pharmaceutical advances, particularly glucagon-like peptide-1 receptor agonists, and how these combined approaches may optimize outcomes in obesity treatment.
ABSTRACT OF FINDINGS
Effective implementation of lifestyle modification requires a multidisciplinary approach, incorporating exercise counseling, medical nutrition therapy, and behavioral change strategies to address the complex nature of obesity. Nutritional approaches, including various evidence-based dietary patterns, function by creating energy deficits and altering metabolic pathways that influence weight regulation. Physical activity complements dietary interventions by increasing energy expenditure, improving body composition, and enhancing metabolic health. Studies have demonstrated benefits of physical activity for both weight loss and maintenance. Behavioral change techniques are critical for developing sustainable habits, overcoming psychological barriers, and facilitating long-term adherence to lifestyle modifications.
CONCLUSION
Despite evidence supporting lifestyle modification, challenges limit its use within obesity care, including poor long-term adherence, limited access to specialized facilities and professionals, and inadequate reimbursement for these clinical services.
{"title":"Lifestyle management approaches for obesity","authors":"Matthew J. Landry PhD, RDN , Zohaib Bagha MD","doi":"10.1016/j.jacl.2025.08.022","DOIUrl":"10.1016/j.jacl.2025.08.022","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Lifestyle modification remains the cornerstone of obesity management, serving as an essential component of all treatment plans, even in an era of effective pharmacotherapy.</div></div><div><h3>SOURCES OF MATERIAL</h3><div>This review examines the key elements of lifestyle interventions, their mechanisms of action, implementation strategies, and challenges in clinical practice. It additionally discusses the evolving role of lifestyle modification when integrated alongside new pharmaceutical advances, particularly glucagon-like peptide-1 receptor agonists, and how these combined approaches may optimize outcomes in obesity treatment.</div></div><div><h3>ABSTRACT OF FINDINGS</h3><div>Effective implementation of lifestyle modification requires a multidisciplinary approach, incorporating exercise counseling, medical nutrition therapy, and behavioral change strategies to address the complex nature of obesity. Nutritional approaches, including various evidence-based dietary patterns, function by creating energy deficits and altering metabolic pathways that influence weight regulation. Physical activity complements dietary interventions by increasing energy expenditure, improving body composition, and enhancing metabolic health. Studies have demonstrated benefits of physical activity for both weight loss and maintenance. Behavioral change techniques are critical for developing sustainable habits, overcoming psychological barriers, and facilitating long-term adherence to lifestyle modifications.</div></div><div><h3>CONCLUSION</h3><div>Despite evidence supporting lifestyle modification, challenges limit its use within obesity care, including poor long-term adherence, limited access to specialized facilities and professionals, and inadequate reimbursement for these clinical services.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 38-54"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-22DOI: 10.1016/j.jacl.2025.10.054
Jee Ah Kim MD, PhD, Min-Seung Park MD, PhD, Eun Hye Cho MD, PhD, Min-Jung Kwon MD, PhD, Hyosoon Park MD, PhD, Hee-Yeon Woo MD, PhD
BACKGROUND
Discordance between apolipoprotein B (apoB) and low-density lipoprotein cholesterol (LDL-C) levels is frequently observed in individuals with metabolic disorders and may contribute to underestimated cardiovascular risk. Population-based data on LDL-C discordance in East Asians, particularly in metabolically healthy individuals, remain limited.
OBJECTIVE
We aimed to investigate the distribution of apoB relative to LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) levels and assess the prevalence and determinants of apoB–LDL-C discordance.
METHODS
We analyzed data from 411,125 Korean adults who underwent health checkups between 2011 and 2023. Participants with a history of cardiovascular disease or lipid-lowering therapy were excluded from the study. ApoB–LDL-C (and apoB–non-HDL-C) discordance was quantified using residuals from a linear regression model. Individuals were classified as discordant-high (residuals > 75th percentile), discordant-low (residuals < 25th percentile), or concordant (residuals between the 25th and 75th percentiles). Subgroup analyses were performed for metabolic status, obesity phenotype, and lifestyle or family risk factors.
RESULTS
Substantial variability in apoB levels was observed at each LDL-C and non-HDL-C level. ApoB–LDL-C discordance patterns between apoB and non-HDL-C were similar to those observed with apoB and LDL-C, though with smaller residual differences. Discordance was most pronounced in metabolically unhealthy obese individuals, followed by metabolically unhealthy lean individuals, and metabolically healthy individuals (P < .001), indicating that metabolic health is a stronger determinant of discordance than obesity.
CONCLUSIONS
ApoB–LDL-C discordance is common, even among metabolically healthy individuals, and is primarily driven by metabolic dysfunction rather than by obesity. ApoB measurements should be included in routine cardiovascular risk assessments.
{"title":"Associations of metabolic health and obesity with apolipoprotein B and low-density lipoprotein cholesterol discordance in a large Korean cohort","authors":"Jee Ah Kim MD, PhD, Min-Seung Park MD, PhD, Eun Hye Cho MD, PhD, Min-Jung Kwon MD, PhD, Hyosoon Park MD, PhD, Hee-Yeon Woo MD, PhD","doi":"10.1016/j.jacl.2025.10.054","DOIUrl":"10.1016/j.jacl.2025.10.054","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Discordance between apolipoprotein B (apoB) and low-density lipoprotein cholesterol (LDL-C) levels is frequently observed in individuals with metabolic disorders and may contribute to underestimated cardiovascular risk. Population-based data on LDL-C discordance in East Asians, particularly in metabolically healthy individuals, remain limited.</div></div><div><h3>OBJECTIVE</h3><div>We aimed to investigate the distribution of apoB relative to LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) levels and assess the prevalence and determinants of apoB–LDL-C discordance.</div></div><div><h3>METHODS</h3><div>We analyzed data from 411,125 Korean adults who underwent health checkups between 2011 and 2023. Participants with a history of cardiovascular disease or lipid-lowering therapy were excluded from the study. ApoB–LDL-C (and apoB–non-HDL-C) discordance was quantified using residuals from a linear regression model. Individuals were classified as discordant-high (residuals > 75th percentile), discordant-low (residuals < 25th percentile), or concordant (residuals between the 25th and 75th percentiles). Subgroup analyses were performed for metabolic status, obesity phenotype, and lifestyle or family risk factors.</div></div><div><h3>RESULTS</h3><div>Substantial variability in apoB levels was observed at each LDL-C and non-HDL-C level. ApoB–LDL-C discordance patterns between apoB and non-HDL-C were similar to those observed with apoB and LDL-C, though with smaller residual differences. Discordance was most pronounced in metabolically unhealthy obese individuals, followed by metabolically unhealthy lean individuals, and metabolically healthy individuals (<em>P</em> < .001), indicating that metabolic health is a stronger determinant of discordance than obesity.</div></div><div><h3>CONCLUSIONS</h3><div>ApoB–LDL-C discordance is common, even among metabolically healthy individuals, and is primarily driven by metabolic dysfunction rather than by obesity. ApoB measurements should be included in routine cardiovascular risk assessments.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 123-134"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-02-16DOI: 10.1016/j.jacl.2025.09.026
Merle Myerson MD, EdD, FACC, FNLA
{"title":"Obesity: A multi-disciplinary approach to understanding and managing a 21st century epidemic","authors":"Merle Myerson MD, EdD, FACC, FNLA","doi":"10.1016/j.jacl.2025.09.026","DOIUrl":"10.1016/j.jacl.2025.09.026","url":null,"abstract":"","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 1-2"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent evidence suggests that visit-to-visit low-density lipoprotein cholesterol (LDL-C) variability—a measure of intraindividual lipid fluctuation over time—may independently influence cardiovascular risk. This study evaluated the impact of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) and inclisiran on LDL-C variability compared to standard lipid-lowering therapy (LLT) in a real-world population of very high-risk patients.
METHODS
We conducted a longitudinal, observational study including 618 patients at very high cardiovascular risk, treated at a single tertiary center. Patients were stratified into 3 groups: standard LLT (statins ± ezetimibe), PCSK9i, or inclisiran. LDL-C variability was assessed at 4 follow-up time points using both SD and coefficient of variation (CV), excluding the first lipid measurement to minimize early response bias. High variability was defined as SD or CV above the population median. Major adverse cardiovascular events (MACE) were collected as exploratory outcomes.
RESULTS
Patients receiving PCSK9i or inclisiran had significantly lower LDL-C variability compared to those on standard LLT (mean SD: 8.2 and 8.5 vs 20.5 mg/dL; P < .001; mean CV: 0.17 and 0.16 vs 0.31; P < .001). High variability in both SD and CV was observed in 77.3% of patients on standard LLT, but only in 17.2% and 17.1% of patients on PCSK9i and inclisiran, respectively. MACE incidence was higher in patients with high variability (12.5% vs 6.1%, P = .012). Multivariate analysis confirmed that treatment with PCSK9i or inclisiran was independently associated with lower LDL-C variability.
CONCLUSIONS
In patients at very high cardiovascular risk, PCSK9i and inclisiran therapies are associated with significantly lower visit-to-visit LDL-C variability compared to standard statin-based regimens. These findings support the importance of not only achieving LDL-C targets but also maintaining lipid stability over time, which may contribute to improved cardiovascular outcomes.
背景：最近的证据表明，每次就诊的低密度脂蛋白胆固醇（LDL-C）变异性——一种衡量个体内部脂质随时间波动的指标——可能独立影响心血管风险。本研究评估了与标准降脂治疗（LLT）相比，蛋白转化酶枯草杆菌素/酮素9型抑制剂（PCSK9i）和inclisiran对现实世界高危患者LDL-C变异性的影响。方法：我们进行了一项纵向观察性研究，包括618名在单一三级中心治疗的心血管风险极高的患者。患者分为3组：标准LLT（他汀类药物±依折替米贝）、PCSK9i或inclisiran。在4个随访时间点使用SD和变异系数（CV）评估LDL-C变异性，排除第一次脂质测量以减少早期反应偏差。高变异性定义为SD或CV高于总体中位数。收集主要不良心血管事件（MACE）作为探索性结果。结果：与接受标准LLT治疗的患者相比，接受PCSK9i或inclisiran治疗的患者LDL-C变异性显著降低（平均SD: 8.2和8.5 vs. 20.5 mg/dL; P < 0.001；平均CV: 0.17和0.16 vs. 0.31; P < 0.001）。在标准LLT治疗的患者中，77.3%的SD和CV具有高度可变性，而在PCSK9i和inclisiran治疗的患者中，SD和CV分别只有17.2%和17.1%。高变异性患者的MACE发生率更高（12.5%比6.1%,P = 0.012）。多因素分析证实，PCSK9i或inclisiran治疗与较低的LDL-C变异性独立相关。结论：在心血管风险极高的患者中，与标准的他汀类药物治疗方案相比，PCSK9i和inclisiran治疗与更低的访间LDL-C变异性相关。这些发现支持不仅达到LDL-C目标，而且随着时间的推移保持脂质稳定的重要性，这可能有助于改善心血管结果。
{"title":"Reduction of visit-to-visit LDL-C intraindividual variability in patients treated with PCSK9 inhibitors and inclisiran vs standard lipid-lowering therapy","authors":"Arturo Cesaro MD, PhD , Vincenzo Acerbo MD , Francesco Scialla MD , Andrea Zito MD , Gennaro Porcelli MD , Domenico Panico MD , Giovanni Argenziano MD , Demetrio Iaria MD , Maria Grazia Monaco PharmD , Vincenzo De Sio MD , Felice Gragnano MD, PhD , Michele Golino MD, PhD , Massimiliano Ruscica PharmD, PhD , Stefano Carugo MD , Alberto Corsini PharmD, PhD , Paolo Calabrò MD, PhD","doi":"10.1016/j.jacl.2025.10.066","DOIUrl":"10.1016/j.jacl.2025.10.066","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Recent evidence suggests that visit-to-visit low-density lipoprotein cholesterol (LDL-C) variability—a measure of intraindividual lipid fluctuation over time—may independently influence cardiovascular risk. This study evaluated the impact of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) and inclisiran on LDL-C variability compared to standard lipid-lowering therapy (LLT) in a real-world population of very high-risk patients.</div></div><div><h3>METHODS</h3><div>We conducted a longitudinal, observational study including 618 patients at very high cardiovascular risk, treated at a single tertiary center. Patients were stratified into 3 groups: standard LLT (statins ± ezetimibe), PCSK9i, or inclisiran. LDL-C variability was assessed at 4 follow-up time points using both SD and coefficient of variation (CV), excluding the first lipid measurement to minimize early response bias. High variability was defined as SD or CV above the population median. Major adverse cardiovascular events (MACE) were collected as exploratory outcomes.</div></div><div><h3>RESULTS</h3><div>Patients receiving PCSK9i or inclisiran had significantly lower LDL-C variability compared to those on standard LLT (mean SD: 8.2 and 8.5 vs 20.5 mg/dL; <em>P</em> < .001; mean CV: 0.17 and 0.16 vs 0.31; <em>P</em> < .001). High variability in both SD and CV was observed in 77.3% of patients on standard LLT, but only in 17.2% and 17.1% of patients on PCSK9i and inclisiran, respectively. MACE incidence was higher in patients with high variability (12.5% vs 6.1%, <em>P</em> = .012). Multivariate analysis confirmed that treatment with PCSK9i or inclisiran was independently associated with lower LDL-C variability.</div></div><div><h3>CONCLUSIONS</h3><div>In patients at very high cardiovascular risk, PCSK9i and inclisiran therapies are associated with significantly lower visit-to-visit LDL-C variability compared to standard statin-based regimens. These findings support the importance of not only achieving LDL-C targets but also maintaining lipid stability over time, which may contribute to improved cardiovascular outcomes.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 66-74"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-02-16DOI: 10.1016/j.jacl.2025.09.023
Bradley L. Smith PharmD, BCACP, AAHIVP , Alexandria May PharmD, BCPS , Falak Lalani PharmD , Salman Hasham PharmD , Allison A. Presnell PharmD, BCACP, BC-ADM, CPP
BACKGROUND
Obesity is a chronic, multifactorial disease associated with significant metabolic, physical, and psychosocial complications. Although advances in pharmacologic therapy—particularly glucagon-like peptide-1 (GLP-1)–based agents—have expanded treatment options, challenges persist in the effective management of obesity.
SOURCES OF MATERIAL
This paper reviews current literature, including clinical trial data, national guidelines, and recent policy updates, to identify key barriers to optimal obesity management. Primary sources include studies and reviews published between 2021 and 2025, as well as data from the Centers for Medicare & Medicaid Services (CMS), the U.S. Food and Drug Administration (FDA), and the World Health Organization (WHO).
ABSTRACT FINDINGS
There are 4 major challenges in obesity management highlighted in this paper: (1) determining which healthcare providers should prescribe and manage obesity pharmacotherapy, (2) the necessity for lifelong treatment to sustain benefits from pharmacotherapy, (3) inconsistent third-party reimbursement that limits patient access, and (4) drug shortages compounded by high demand and direct-to-consumer (DTC) marketing. GLP-1–based agents demonstrate substantial weight reduction but require ongoing therapy to maintain outcomes. Reimbursement barriers persist across Medicaid, Medicare, and commercial plans, while drug shortages and compounded formulations pose safety and ethical concerns.
CONCLUSION
Effective obesity management requires a coordinated, multidisciplinary approach supported by equitable insurance coverage and regulatory oversight. Providers must balance pharmacotherapy with behavioral and lifestyle interventions and educate patients on the risks of unapproved or compounded products. Addressing these systemic challenges will be essential to ensure sustained, safe, and accessible care for individuals with obesity.
{"title":"Challenges in the management of obesity","authors":"Bradley L. Smith PharmD, BCACP, AAHIVP , Alexandria May PharmD, BCPS , Falak Lalani PharmD , Salman Hasham PharmD , Allison A. Presnell PharmD, BCACP, BC-ADM, CPP","doi":"10.1016/j.jacl.2025.09.023","DOIUrl":"10.1016/j.jacl.2025.09.023","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Obesity is a chronic, multifactorial disease associated with significant metabolic, physical, and psychosocial complications. Although advances in pharmacologic therapy—particularly glucagon-like peptide-1 (GLP-1)–based agents—have expanded treatment options, challenges persist in the effective management of obesity.</div></div><div><h3>SOURCES OF MATERIAL</h3><div>This paper reviews current literature, including clinical trial data, national guidelines, and recent policy updates, to identify key barriers to optimal obesity management. Primary sources include studies and reviews published between 2021 and 2025, as well as data from the Centers for Medicare & Medicaid Services (CMS), the U.S. Food and Drug Administration (FDA), and the World Health Organization (WHO).</div></div><div><h3>ABSTRACT FINDINGS</h3><div>There are 4 major challenges in obesity management highlighted in this paper: (1) determining which healthcare providers should prescribe and manage obesity pharmacotherapy, (2) the necessity for lifelong treatment to sustain benefits from pharmacotherapy, (3) inconsistent third-party reimbursement that limits patient access, and (4) drug shortages compounded by high demand and direct-to-consumer (DTC) marketing. GLP-1–based agents demonstrate substantial weight reduction but require ongoing therapy to maintain outcomes. Reimbursement barriers persist across Medicaid, Medicare, and commercial plans, while drug shortages and compounded formulations pose safety and ethical concerns.</div></div><div><h3>CONCLUSION</h3><div>Effective obesity management requires a coordinated, multidisciplinary approach supported by equitable insurance coverage and regulatory oversight. Providers must balance pharmacotherapy with behavioral and lifestyle interventions and educate patients on the risks of unapproved or compounded products. Addressing these systemic challenges will be essential to ensure sustained, safe, and accessible care for individuals with obesity.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 126-134"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lifestyle modification through diet and exercise remains the first-line therapy for obesity; however, long-term success is limited for many individuals. Metabolic and bariatric surgery (MBS) has emerged as the most effective intervention for durable weight loss and obesity-related comorbidity reduction.
OBJECTIVE
To assess the efficacy, safety, and clinical significance of the effect of MBS in the management of obesity.
METHODS
Data from recent clinical trials and advances in surgical and endoscopic techniques were reviewed, with an emphasis on durability of weight loss, resolution of comorbidities, cardiovascular outcomes, and procedural risk profiles.
RESULTS
MBS consistently achieves superior and sustained weight loss compared with nonsurgical strategies. Substantial improvements, and in many cases resolution, of obesity-associated comorbidities—including type 2 diabetes, hypertension, and dyslipidemia—have been observed. Additionally, MBS significantly reduces major adverse cardiovascular events, particularly myocardial infarction and stroke. Advances in minimally invasive MBS and endoscopic techniques have improved safety and reduced perioperative risk. Nonetheless, both short- and long-term complications may occur. Indications for MBS differ between adult and pediatric populations, requiring individualized evaluation and selection.
CONCLUSION
MBS is an effective long-term treatment for obesity, offering durable weight reduction and meaningful improvements in metabolic and cardiovascular health. Although not without potential adverse events, evolving surgical and endoscopic approaches have enhanced safety and broadened applicability. These findings underscore the importance of incorporating MBS into shared decision-making and highlight its critical role within a comprehensive, evidence-based strategy for obesity management.
{"title":"Surgical and interventional approaches for the treatment of obesity","authors":"Lonnell Gant DNP, APRN, FNP-BC , Merle Myerson MD, EdD, FACC, FNLA","doi":"10.1016/j.jacl.2025.11.003","DOIUrl":"10.1016/j.jacl.2025.11.003","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Lifestyle modification through diet and exercise remains the first-line therapy for obesity; however, long-term success is limited for many individuals. Metabolic and bariatric surgery (MBS) has emerged as the most effective intervention for durable weight loss and obesity-related comorbidity reduction.</div></div><div><h3>OBJECTIVE</h3><div>To assess the efficacy, safety, and clinical significance of the effect of MBS in the management of obesity.</div></div><div><h3>METHODS</h3><div>Data from recent clinical trials and advances in surgical and endoscopic techniques were reviewed, with an emphasis on durability of weight loss, resolution of comorbidities, cardiovascular outcomes, and procedural risk profiles.</div></div><div><h3>RESULTS</h3><div>MBS consistently achieves superior and sustained weight loss compared with nonsurgical strategies. Substantial improvements, and in many cases resolution, of obesity-associated comorbidities—including type 2 diabetes, hypertension, and dyslipidemia—have been observed. Additionally, MBS significantly reduces major adverse cardiovascular events, particularly myocardial infarction and stroke. Advances in minimally invasive MBS and endoscopic techniques have improved safety and reduced perioperative risk. Nonetheless, both short- and long-term complications may occur. Indications for MBS differ between adult and pediatric populations, requiring individualized evaluation and selection.</div></div><div><h3>CONCLUSION</h3><div>MBS is an effective long-term treatment for obesity, offering durable weight reduction and meaningful improvements in metabolic and cardiovascular health. Although not without potential adverse events, evolving surgical and endoscopic approaches have enhanced safety and broadened applicability. These findings underscore the importance of incorporating MBS into shared decision-making and highlight its critical role within a comprehensive, evidence-based strategy for obesity management.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 55-64"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent cohort studies demonstrated that higher levels of serum remnant cholesterol (remnant-C) were a predictor of kidney outcomes in diabetes; however, these studies did not take into account triglycerides, highly correlated with remnant-C.
OBJECTIVE
This study aimed to elucidate whether serum remnant-C predicts kidney disease progression in people with diabetes when considering triglycerides.
METHODS
This was a retrospective cohort study of 5214 adults with type 2 diabetes, classified into 4 groups by median of remnant-C and triglycerides levels. Exposures were remnant-C and triglycerides, defined as their geometric means within individuals at baseline and during the follow-up period. The outcome was a composite of a ≥40% decrease in estimated glomerular filtration rate or the initiation of kidney replacement therapy. Hazard ratios (95% CI) were estimated by the multivariable Fine-Gray model treating death as a competing risk.
RESULTS
During the median follow-up period of 8.8 years, 1070 people reached the outcome. Hazard ratios (vs people with both below-median remnant-C and triglycerides) for the outcome were 1.21 (0.88-1.65), 1.48 (1.07-2.05), and 1.33 (1.13-1.58) in those with only above-median triglycerides, only above-median remnant-C, and both above-median remnant-C and triglycerides, respectively. When classifying participants by quartile of remnant-C, outcome hazards gradually increased from the first to fourth quartile. The association for triglycerides was similar, but weaker. By adjusting for both 4-category dummy variables for remnant-C and triglycerides, the gradual increase was observed only in remnant-C.
CONCLUSION
Remnant-C can predict kidney disease progression in type 2 diabetes, even considering triglycerides.
{"title":"Remnant cholesterol and kidney disease progression in type 2 diabetes: A retrospective cohort study","authors":"Tomomi Mori MD, PhD , Yui Yamamoto MD, PhD , Ko Hanai MD, PhD , Yurika Yamashige MD , Hidekazu Murata MT , Tomohiro Shinozaki MPH, PhD , Tomoko Nakagami MD, PhD","doi":"10.1016/j.jacl.2025.10.075","DOIUrl":"10.1016/j.jacl.2025.10.075","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Recent cohort studies demonstrated that higher levels of serum remnant cholesterol (remnant-C) were a predictor of kidney outcomes in diabetes; however, these studies did not take into account triglycerides, highly correlated with remnant-C.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to elucidate whether serum remnant-C predicts kidney disease progression in people with diabetes when considering triglycerides.</div></div><div><h3>METHODS</h3><div>This was a retrospective cohort study of 5214 adults with type 2 diabetes, classified into 4 groups by median of remnant-C and triglycerides levels. Exposures were remnant-C and triglycerides, defined as their geometric means within individuals at baseline and during the follow-up period. The outcome was a composite of a ≥40% decrease in estimated glomerular filtration rate or the initiation of kidney replacement therapy. Hazard ratios (95% CI) were estimated by the multivariable Fine-Gray model treating death as a competing risk.</div></div><div><h3>RESULTS</h3><div>During the median follow-up period of 8.8 years, 1070 people reached the outcome. Hazard ratios (vs people with both below-median remnant-C and triglycerides) for the outcome were 1.21 (0.88-1.65), 1.48 (1.07-2.05), and 1.33 (1.13-1.58) in those with only above-median triglycerides, only above-median remnant-C, and both above-median remnant-C and triglycerides, respectively. When classifying participants by quartile of remnant-C, outcome hazards gradually increased from the first to fourth quartile. The association for triglycerides was similar, but weaker. By adjusting for both 4-category dummy variables for remnant-C and triglycerides, the gradual increase was observed only in remnant-C.</div></div><div><h3>CONCLUSION</h3><div>Remnant-C can predict kidney disease progression in type 2 diabetes, even considering triglycerides.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 135-144"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-21DOI: 10.1016/j.jacl.2025.10.063
Sebastian Holländer MD , Evelyn Marth MA , Philipp Robert Scherber MD, MHBA , Antonios Spiliotis MD, MSc , Ammar Al-Ali MD , Gereon Gäbelein MD , Matthias Glanemann MD
BACKGROUND/OBJECTIVES
The increasing incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) poses a major healthcare challenge. This condition is particularly prevalent in patients with obesity. Artichoke leaf extract (ALE) has known hepatoprotective, antioxidant, and lipid-lowering properties. While ALE has been studied for its impact on liver metabolism, its specific effectiveness in individuals with obesity and MASLD remains unclear. This study investigates the effectiveness of ALE in reducing liver steatosis in patients scheduled for bariatric surgery. To our knowledge, this is the first study to examine ALE's “antisteatotic” efficacy in this clinical context.
METHODS
Forty participating bariatric surgery candidates received either ALE or a placebo for 6 weeks before measurements. Steatosis was quantified using FibroScan (controlled attenuation parameter, CAP), and liver size was assessed via ultrasound. Secondary outcomes included serum laboratory parameters and body composition, measured through bioelectrical impedance analysis.
RESULTS
ALE intake significantly reduced CAP values and liver lobe diameters compared to placebo, indicating decreased steatosis and liver volume. Improvements were already evident after 3 weeks. In female participants, total and low-density lipoprotein cholesterol levels improved. However, transaminase levels—particularly aspartate aminotransferase—increased in the ALE group. Body composition improved, with reductions in fat mass percentage.
CONCLUSIONS
ALE effectively reduces liver steatosis and size and improves body composition in patients with obesity and MASLD. Unlike prior studies, we observed a significant transaminase increase, suggesting a distinct hepatic response in individuals with obesity. Further research is needed to evaluate ALE's metabolic and hepatic effects specifically in this population beyond the prebariatric setting.
{"title":"Artichoke leaf extract reduces steatosis and decreases liver size in prebariatric patients: A randomized placebo-controlled pilot trial—The “SteatoChoke-Study”","authors":"Sebastian Holländer MD , Evelyn Marth MA , Philipp Robert Scherber MD, MHBA , Antonios Spiliotis MD, MSc , Ammar Al-Ali MD , Gereon Gäbelein MD , Matthias Glanemann MD","doi":"10.1016/j.jacl.2025.10.063","DOIUrl":"10.1016/j.jacl.2025.10.063","url":null,"abstract":"<div><h3>BACKGROUND/OBJECTIVES</h3><div>The increasing incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) poses a major healthcare challenge. This condition is particularly prevalent in patients with obesity. Artichoke leaf extract (ALE) has known hepatoprotective, antioxidant, and lipid-lowering properties. While ALE has been studied for its impact on liver metabolism, its specific effectiveness in individuals with obesity and MASLD remains unclear. This study investigates the effectiveness of ALE in reducing liver steatosis in patients scheduled for bariatric surgery. To our knowledge, this is the first study to examine ALE's “antisteatotic” efficacy in this clinical context.</div></div><div><h3>METHODS</h3><div>Forty participating bariatric surgery candidates received either ALE or a placebo for 6 weeks before measurements. Steatosis was quantified using FibroScan (controlled attenuation parameter, CAP), and liver size was assessed via ultrasound. Secondary outcomes included serum laboratory parameters and body composition, measured through bioelectrical impedance analysis.</div></div><div><h3>RESULTS</h3><div>ALE intake significantly reduced CAP values and liver lobe diameters compared to placebo, indicating decreased steatosis and liver volume. Improvements were already evident after 3 weeks. In female participants, total and low-density lipoprotein cholesterol levels improved. However, transaminase levels—particularly aspartate aminotransferase—increased in the ALE group. Body composition improved, with reductions in fat mass percentage.</div></div><div><h3>CONCLUSIONS</h3><div>ALE effectively reduces liver steatosis and size and improves body composition in patients with obesity and MASLD. Unlike prior studies, we observed a significant transaminase increase, suggesting a distinct hepatic response in individuals with obesity. Further research is needed to evaluate ALE's metabolic and hepatic effects specifically in this population beyond the prebariatric setting.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 167-178"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145581967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-09-12DOI: 10.1016/j.jacl.2025.09.009
Mingjie Yin MD , Feipeng Cui MD , Xiaoyu Xu MS , Yuxin Yang MS , Shuohua Chen MS , Yanan Sun MD , Yanfeng Zhen MD , Hongjia Zhai MS , Shouling Wu MD , Hui Fang MD
BACKGROUND
This study, for the first time, stratified a larger sample size of participants according to the Framingham Risk Score and applied a fine-grained classification of non-high-density lipoprotein cholesterol (non-HDL-C) in 20 mg/dL increments, aiming to further analyze the associations of baseline non-HDL-C and its changes with atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality across different baseline risk populations.
METHODS
The study included 90,072 low-risk individuals, 77,499 primary prevention individuals, and 15,653 secondary prevention individuals. Using time-varying Cox proportional hazards regression models, we assessed the association of non-HDL-C levels with the risks of ASCVD and all-cause mortality across different baseline risk populations. Furthermore, based on non-HDL-C levels in 2 consecutive measurements, we evaluated the association of changes in non-HDL-C with the risks of ASCVD and all-cause mortality.
RESULTS
This study found that non-HDL-C levels below 140 mg/dL in low-risk populations, below 120 mg/dL in primary prevention populations, and below 100 mg/dL in secondary prevention populations were significantly associated with a reduced risk of ASCVD and all-cause mortality. Furthermore, sustained lower non-HDL-C was associated with a 43% reduced risk of ASCVD in low-risk populations and a 27% reduced risk in primary prevention populations, whereas in secondary prevention populations it corresponded to a 25% reduced risk of all-cause mortality.
CONCLUSIONS
As baseline risk levels increase, lower non-HDL-C levels are significantly associated with reduced risks of ASCVD and all-cause mortality. Moreover, sustained lower non-HDL-C levels are associated with a significant decrease in ASCVD and all-cause mortality risks across different baseline risk populations.
{"title":"Association of non-high-density lipoprotein cholesterol with atherosclerotic cardiovascular disease and all-cause mortality in Chinese populations with different baseline risks: A prospective cohort study","authors":"Mingjie Yin MD , Feipeng Cui MD , Xiaoyu Xu MS , Yuxin Yang MS , Shuohua Chen MS , Yanan Sun MD , Yanfeng Zhen MD , Hongjia Zhai MS , Shouling Wu MD , Hui Fang MD","doi":"10.1016/j.jacl.2025.09.009","DOIUrl":"10.1016/j.jacl.2025.09.009","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>This study, for the first time, stratified a larger sample size of participants according to the Framingham Risk Score and applied a fine-grained classification of non-high-density lipoprotein cholesterol (non-HDL-C) in 20 mg/dL increments, aiming to further analyze the associations of baseline non-HDL-C and its changes with atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality across different baseline risk populations.</div></div><div><h3>METHODS</h3><div>The study included 90,072 low-risk individuals, 77,499 primary prevention individuals, and 15,653 secondary prevention individuals. Using time-varying Cox proportional hazards regression models, we assessed the association of non-HDL-C levels with the risks of ASCVD and all-cause mortality across different baseline risk populations. Furthermore, based on non-HDL-C levels in 2 consecutive measurements, we evaluated the association of changes in non-HDL-C with the risks of ASCVD and all-cause mortality.</div></div><div><h3>RESULTS</h3><div>This study found that non-HDL-C levels below 140 mg/dL in low-risk populations, below 120 mg/dL in primary prevention populations, and below 100 mg/dL in secondary prevention populations were significantly associated with a reduced risk of ASCVD and all-cause mortality. Furthermore, sustained lower non-HDL-C was associated with a 43% reduced risk of ASCVD in low-risk populations and a 27% reduced risk in primary prevention populations, whereas in secondary prevention populations it corresponded to a 25% reduced risk of all-cause mortality.</div></div><div><h3>CONCLUSIONS</h3><div>As baseline risk levels increase, lower non-HDL-C levels are significantly associated with reduced risks of ASCVD and all-cause mortality. Moreover, sustained lower non-HDL-C levels are associated with a significant decrease in ASCVD and all-cause mortality risks across different baseline risk populations.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 112-122"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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