Obesity Facts最新文献

Introduction: Body Mass Index (BMI) ≥ 50 kg/m2 is more challenging for the bariatric surgeon, because of a thicker abdominal wall, more visceral fat, and hepatomegaly by liver steatosis. This study aims to give an overview of 5-year outcomes after OAGB and RYGB in these patients in terms of weight loss, remission of comorbidities, and complications.

Methods: This retrospective single-center cohort study focused on patients with BMI ≥ 50 kg/m2 undergoing OAGB or RYGB between 2015 and 2017 at a non-academic teaching hospital in the Netherlands. A 1:1 propensity-score matched (PSM) comparison was conducted.

Results: In total, 158 patients underwent OAGB and 32 patients RYGB. After performing a 1:1 PSM, we obtained two nearly identical cohorts of 28 patients. Follow-up data after five years was available in 79% of the patients after OAGB and 82% of the patients after RYGB. Both procedures resulted in equal weight loss, remission of comorbidities, and short-term complications. More minor mid-term complications were seen after OAGB (50% versus 18%; p=0.011) due to reflux complaints (50% versus 7%; p<0.001). The number of patients with major mid-term complications did not differ (7% after OAGB versus 14% after RYGB; p=0.388). The only major complication after OAGB was conversion to RYGB due to reflux in 7.1% of the patients. In contrast, major complications following RYGB were more diverse.

Conclusion: Both procedures resulted in similar weight loss, remission of comorbidities, short-term complications, and major mid-term complications; making OAGB a suitable alternative to RYGB for patients with a BMI > 50 kg/m2.

Introduction: Omentin (intelectin-1) is an adipokine produced by the stromal vascular fraction of visceral adipose tissue and has been positively associated with insulin sensitivity. The underlying mechanism of action, however, is largely unknown. It has been described that omentin may increase insulin sensitivity and glucose uptake of adipocytes, but effects on other insulin-sensitive tissues such as skeletal muscle are unexplored. We therefore investigated effects of omentin on insulin sensitivity and metabolism of primary human myotubes.

Methods: Primary human myotubes were treated with 0.5 or 2 µg/mL omentin and subsequently protein detection, glucose uptake assay, lactate assay and lipidomics analysis were performed.

Results: Omentin did not affect skeletal muscle insulin signaling, as assessed by basal and insulin-stimulated phosphorylation of IRS1 and AKT. Omentin increased basal, but not insulin-stimulated glucose uptake. While increased glycolytic activity was confirmed by elevated lactate release after omentin treatment, effects on cellular lipid composition were limited to an increase in total triacylglycerol concentration. Increased glucose uptake by omentin was counteracted by addition of extracellular lactotransferrin, which can bind to omentin.

Conclusions: Overall, increased basal glucose uptake in skeletal muscle cells suggests differential effects of omentin on insulin-sensitive tissues. Moreover, an involvement of lactotransferrin in omentin's mechanism of action may partially explain contradictory results of epidemiological studies on the role of omentin in different diseases.

Introduction: The prevalence of overweight and obesity has increased in the last decades, posing significant health and economic impacts globally. These conditions are related to several non-communicable diseases, including cardiovascular disease, type II diabetes and cancer. This study estimated the disease burden and healthcare costs associated with overweight and obesity in the adult population in mainland Portugal, in 2018.

Method: Burden of disease was measured in disability-adjusted life years (DALY) following Global Burden of Disease (GBD) methodology. DALY were calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). The analyses included morbidity, mortality and related costs directly related to overweight and obesity, as well as the attributable morbidity, mortality and related costs of of 25 selected diseases related to obesity (DrO). A prevalence-based cost analysis was conducted a from the perspective of the public National Health Service, including costs related to inpatient, outpatient care and pharmacological treatment.

Results: In 2018, total DALY amounted to 260,943, with 75% due to premature death (196,438 YLL) and 25% due to disability (64,505 YLD). The economic burden of overweight and obesity was estimated at approximately € 1,148 million. Of these, approximately € 13.3 million (1%) were costs related to the treatment of obesity, and the remaining were costs of DrO attributed to overweight and obesity. Outpatient care corresponded to 43% of total costs, pharmacological treatment 38%, and inpatient care 19%. Cardiovascular and cerebrovascular diseases were the largest contributor to total costs (38%), followed by type II diabetes (34%).

Conclusion: Overweight and obesity incur a large disease and economic burden to the public healthcare sector, representing approximately 0.6% of the country´s gross domestic product and 5.8% of public health expenditures.

Obesity, a prevalent and multifactorial disease, is linked to a range of metabolic abnormalities, including insulin resistance, dyslipidemia, and chronic inflammation. These imbalances not only contribute to cardiometabolic diseases but also play a significant role in cancer pathogenesis. The rising prevalence of obesity underscores the need to investigate dietary strategies for effective weight management for individuals with overweight or obesity and cancer. This European Society for the Study of Obesity (EASO) position statement aimed to summarize current evidence on the role of obesity in cancer and to provide insights on the major nutritional interventions, including the Mediterranean diet (MedDiet), the ketogenic diet (KD), and the intermittent fasting (IF), that should be adopted to manage individuals with overweight or obesity and cancer. The MedDiet, characterized by high consumption of plant-based foods and moderate intake of olive oil, fish, and nuts, has been associated with a reduced cancer risk. The KD and the IF are emerging dietary interventions with potential benefits for weight loss and metabolic health. KD, by inducing ketosis, and IF, through periodic fasting cycles, may offer anticancer effects by modifying tumor metabolism and improving insulin sensitivity. Despite the promising results, current evidence on these dietary approaches in cancer management in individuals with overweight or obesity is limited and inconsistent, with challenges including variability in adherence and the need for personalized dietary plans.

Introduction: Overweight and obesity (OW/OB) are underdiagnosed. The primary aim was to assess whether a diagnosis of OW/OB recorded by a primary care physician (PCP) is associated with clinically significant weight loss, compared to a missed diagnosis. The secondary aim was to investigate the association between OW/OB diagnosis and patient attendance at dietary consultations.

Methods: This retrospective, observational cohort study was conducted using a nationwide healthcare database. The study included a random sample of 200,000 adults with BMI ≥25 kg/m2, recorded on a primary care visit, between 2014 and 2020. Patients with prior diagnosis of OW/OB or obesity-related complications were excluded. The independent variable was OW/OB diagnosis recorded by the PCP immediately after BMI measurement. The outcome variable was ≥5% weight loss at a second weight measurement within 9-15 months. Multivariate regression analysis was applied.

Results: Of the 200,000 people with OW/OB, 36,033 (18.0%) had a diagnosis of OW/OB, and 37,368 (18.7%) had a second body weight measurement, of which 7,635 (20.4%) lost ≥5% of their baseline body weight. The prescription rate of anti-obesity medication was 1.2% and did not differ between patients who achieved weight loss and those who did not. Those with a recorded diagnosis were 2.6 times more likely to visit a dietitian (odds ratio [OR] 2.57, 95% confidence interval [CI]: 2.56-2.64) and 2.5 times more likely to achieve weight loss (OR 2.53, 95% CI: 2.46-2.60). After adjusting for multiple confounders, including attendance at dietary consultation, people who received OW/OB diagnosis were 32% more likely to achieve weight loss (OR 1.32, 95% CI: 1.28-1.36, p < 0.001) compared to people with missed diagnosis.

Conclusions: Recording a diagnosis of obesity among relatively healthy people is associated with clinically significant weight loss at 1-year follow-up, independent of attendance at dietary consultation. Early obesity diagnosis is a significant opportunity to promote weight loss in the primary care setting and may affect weight trajectory.

Introduction: Stress predicts unhealthy eating, obesity, and metabolic deterioration, likely mediated by altered levels of appetite- and metabolism-regulating hormones. Yet, evidence regarding the association between long-term stress and levels of appetite-regulating hormones in humans is lacking.

Methods: We included 65 patients with obesity (44 women) to investigate the cross-sectional association of biological stress (scalp hair cortisol and cortisone) and psychological stress (Perceived Stress Scale) with overnight-fasted serum levels of the hormonal appetite regulators leptin, adiponectin, insulin, pancreatic polypeptide, gastric-inhibitory peptide, peptide tyrosine-tyrosine, cholecystokinin and agouti-related protein, adjusted for age, sex and body-mass-index.

Results: Hair cortisone and, in trend, hair cortisol were positively associated with cholecystokinin (p=0.003 and p=0.058, respectively). No other associations between stress measures and hormonal appetite regulators were observed.

Conclusion: Long-term biological stress, measured using scalp hair glucocorticoid levels, is associated with elevated levels of circulating cholecystokinin, indicating a link between long-term stress and hormonal appetite signaling.

Introduction: The relationship between obesity and dental caries in adults presents inconsistent findings in current literature, which necessitates further research to clarify this relationship. This study aimed to examine the association between obesity and dental caries in adults using a nationally representative sample.

Methods: This study employed data of US adults aged >20 years from the National Health and Nutrition Examination Survey (NHANES) pre-pandemic cycle. Obesity was defined using the waist-to-hip ratio (WHR), body mass index (BMI), and waist circumference. Dental caries were assessed using the Decayed, Missing, Filled Teeth (DMFT) scores.

Results: Most participants were categorized as individuals with obesity based on the WHR (74.5%) or BMI (72.7%). A significant difference in the DMFT scores and missing teeth was observed between individuals with normal weight and individuals with obesity. After adjusting for the sociodemographic variables, individuals with obesity had a 0.11 higher DMFT score (95% confidence interval [CI]: -0.01 to 0.23). A significant association was observed between the WHR and DMFT scores when age was excluded from the model, demonstrating a higher coefficient of 0.17 (95% CI: 0.05-0.30).

Conclusions: A positive association was observed between obesity and dental caries in the US adult population. However, age was found to be a confounding factor in this relationship. This study highlights the relationship between oral and general health, advocating healthcare providers for an integrated health promotion strategy, through comprehensive campaigns addressing obesity, diet, lifestyle, and dental health, aiming for raising awareness and a more effective public health strategy.

Introduction: This systematic scoping review aimed to synthesize existing research findings on the clinical manifestations in patients with nonalcoholic fatty liver disease (NAFLD) and sarcopenia.

Methods: Adhering to scoping review guidelines, we comprehensively searched five databases for literature on sarcopenia's clinical manifestations in NAFLD patients from December 2013 to December 2023, meticulously compiling and synthesizing the findings.

Results: A total of 312 articles were identified, with 9 studies included in the final review. Of these, 90% were cross-sectional investigations, with 70% from Asian cohorts. Comparative analysis between patients solely afflicted with NAFLD and those additionally experiencing sarcopenia revealed discernible trends. Individuals with both conditions tended to be older, have a higher body mass index, and show a higher prevalence among females, underscoring the influence of unhealthy lifestyles and obesity. Furthermore, comorbidities like metabolic syndrome, hypertension, and diabetes have been implicated in sarcopenia manifestation among NAFLD patients. Nonetheless, the lack of standardized diagnostic criteria and patterns poses an ongoing clinical challenge for this subgroup.

Conclusions: Our review highlights distinct clinical characteristics evident in NAFLD patients with sarcopenia. However, comprehensive investigations remain scarce, impeding accurate early detection and intervention. Future research should prioritize bridging these gaps and fostering enhanced clinical management strategies.

Introduction: Despite recent attempts to reach a consensus on the diagnostic criteria and treatment of dumping syndrome (DS) after bariatric surgery, many questions about the clinical applicability and significance of standardized provocation tests remain unanswered. The objective of this study was to retrospectively evaluate a mixed-meal-test (MMT) based on general nutritional recommendations after bariatric surgery and its clinical value in diagnosing DS.

Methods: The MMT contained 15.5 g of protein, 10 g of fat, 20.7 g of carbohydrates, and 3.1 g of dietary fiber, totaling 241 kcal. Symptoms based on the Sigstad Score, along with blood sugar, hematocrit, pulse rate, and blood pressure, were collected as primary readouts. The analysis included 58 MMTs from 56 patients who reported postprandial symptoms indicative of DS and were referred to the clinic by surgeons or general practitioners.

Results: Although all individuals reported significant symptoms at home, the MMT showed a positive symptom score (Sigstad Score ≥7) in only 16 cases (28%). Neither a heart rate increase >10 BPM nor the 3% hematocrit increase suggested as cut-offs for early DS by the consensus paper were associated with the Sigstad Score or individually reported symptoms. None of the participants had a postprandial glucose decrease below 50 mg/dL; one fell below 60 mg/dL and 14 fell below 70 mg/dL. A blood glucose decrease below 70 mg/dL was not associated with symptoms.

Conclusion: The MMT showed that only a minority of patients reported classical DS symptoms under controlled conditions. Changes in hematocrit, heart rate, and blood sugar decrease below 70 mg/dL did not help to predict symptoms in the individuals studied. The data, in the context of existing evidence, suggest that provocation tests have little value in clinical practice and that DS as a clinical entity after bariatric surgery should be reevaluated.

Background: Obesity, gestational diabetes mellitus (GDM) and bariatric metabolic surgery (BMS) are increasingly common conditions during pregnancy.

Summary: However, clinical knowledge regarding GDM that occurs after BMS remains full of uncertainties. Given its prevalence and potential consequences for the dyad pregnant and offspring, it is imperative to increase knowledge about GDM after BMS, define diagnostic criteria and consequently strategies capable of improving pregnancy outcomes.

Key messages: This paper aims to review GDM screening methods after BMS and gives insights regarding new paths of research on this paramount obstetric condition.