Obesity Facts最新文献

Introduction: Strategies to address suboptimal weight loss after Roux-en-Y gastric bypass (RYGB) can be developed if at-risk patients are identified in advance. This study aimed to build a pre-surgery prediction nomogram for early prediction of insufficient weight loss (IWL) or weight regain (WR) after bariatric surgery in Chinese patients.

Methods: In this retrospective study, 187 patients with obesity and type 2 diabetes who underwent laparoscopic RYGB were followed yearly for 3 years. Suboptimal weight loss included IWL and WR. IWL was defined as a total weight loss percentage of <25% at 1 year postoperatively, and WR was defined as a maximum weight loss percentage of >20% at 3 years postoperatively. Multivariate logistic regression was performed to identify independent predictors and to establish a nomogram to predict the occurrence of suboptimal weight loss.

Results: Multivariate logistic regression revealed that male sex (OR 4.268, 95% CI: 1.413-12.890), body mass index (OR 0.816, 95% CI: 0.705-0.946), and glycated hemoglobin (OR 1.493, 95% CI: 1.049-2.126) were independent predictors of IWL/WR. The AUC value of the nomogram constructed from the above three factors was 0.781. The Hosmer-Lemeshow test showed that the model had a good fit (p = 0.143). The calibration curve of the nomogram is close to an ideal diagonal line. Furthermore, the decision curve analysis demonstrated the good net benefits of the model.

Conclusions: A nomogram based on pre-surgery factors was developed to predict postoperative IWL/WR. This provides a convenient and useful tool for predicting suboptimal weight loss before surgery.

Introduction: Adjustable intragastric balloon (aIGB), known as a novel minimally invasive therapy for obesity, provides a sustained alternative for weight loss. Weight loss is achieved by implanting a balloon into the patient's stomach, with the volume of the balloon being adjustable through the injection or extraction of physiological saline. Its key distinction from other intragastric balloons lies in post-implantation volume control. Currently, the efficacy and safety of aIGB have not been well described.

Methods: MEDLINE, Embase, and the Cochrane Library were searched for relevant articles. Efficacy and safety of aIGB were evaluated by total body weight loss (TWL) after treatment and severe adverse events.

Results: A total of 12 eligible studies with 4,981 patients were included. The average inserting time was 9.9 months, and the pooled mean TWL was 16.4% (95% CI: 0.153-0.175, I2 = 91.2%). The pooled prevalence of patients choosing upward balloon adjustment was 34.2% (95% CI: 0.220-0.485, I2 = 96.5), and all reported additional weight loss with a mean of 6.3 (4.8-9.3) kg. The pooled prevalence of patients choosing downward balloon adjustment was 9.2% (95% CI: 0.065-0.119, I2 = 73.9%), and the pooled prevalence of alleviating intolerance in these patients was 90.8% (95% CI: 0.817-0.974, I2 = 53.4%). The pooled prevalence of intolerance and early removal within 3 months was 5.7% (95% CI: 0.035-0.078, I2 = 79.8%), and the pooled prevalence of stomach ulcer was 1.1% (95% CI: 0.008-0.014, I2 = 5.1%). There was no obvious publication bias detected for these outcomes. Leave-one-out and subgroup analysis demonstrated the results were statistically reliable.

Conclusion: aIGB has the ability of significant and sustained weight loss and can effectively manage both intolerance and weight loss plateaus by adjusting the balloon volume during treatment.

Introduction: The frequency of obesity and possible correlations with characteristics and outcome of inflammatory bowel disease (IBD) are undefined. Primary aim was to assess the body mass index (BMI) distribution in IBD patients in follow-up. Secondary aim was to compare clinical characteristics and course of IBD in normal weight versus overweight or obese patients.

Methods: Adult IBD patients in regular follow-up were prospectively enrolled and BMI was recorded during outpatient visits. Comparisons were assessed by the Student t-test, Mann-Whitney U test and Chi-square test, as appropriate.

Results: In the 300 IBD patients enrolled (150 Crohn's disease [CD], 150 ulcerative colitis [UC]), BMI distribution included: 16 (5.3%) underweight, 170 (56.7%) normal weight, 92 (30.7%) overweight, 22 (7.3%) obese patients. For the secondary aim, the 16 underweight patients were excluded, thus leaving 284 patients for the analysis (141 [49.6%] CD; 143 [50.4%] UC). Among these, 114 (40.2%) were overweight/obese and 170 (59.8%) normal weight. CD group included 89 (63.1%) normal weight and 52 (36.9%) overweight/obese patients. Perianal disease and refractoriness to biologics were more frequent in overweight/obese than normal weight CD patients (9 [10.1%] vs. 12 [23%], p = 0.03; 0 [0%] vs. 4 [23.4%], p = 0.01). In UC group, there were 81 (56.6%) normal weight and 62 (63.4%) overweight or obese patients.

Conclusion: In IBD patients in follow-up, the proportion of underweight patients is low. Overweight and obese CD patients showed a higher frequency of perianal disease and refractoriness to biologics. BMI may influence phenotype and responsiveness to biologics in CD.

Introduction: The aim of this study was to investigate the impact of the COVID-19 pandemic on psychosocial well-being in adolescents with obesity compared to those with type 1 diabetes.

Methods: As part of the German KICK-COVID Study, adolescents aged 12-21 with overweight or obesity from the German/Austrian Adiposity Follow-up Registry (APV) completed well-being, anxiety, and depression questionnaires (WHO-5, GAD-7, PHQ-9) during routine visits amidst the COVID-19 pandemic. By multivariable linear regression models, adjusted for age, gender, and immigration background, the association between psychosocial distress, anthropometrics, and cardiometabolic risk factors was analyzed. Data were compared to those of youth with type 1 diabetes from the German/Austrian Diabetes Follow-up Registry (DPV) and normative values from the general population. Additionally, a mediation analysis examined the impact of loneliness on mental health through media consumption.

Results: From June 2021 to September 2023, 235 adolescents from 6 German and 1 Austrian pediatric obesity centers were enrolled. Results were compared to 235 age- and gender-matched participants from the DPV registry (54.04% males; mean age 15.21 ± 1.66 years) and normative values. Youth with type 1 diabetes were more anxious about their health risk, but distress factors were more pronounced in the APV group (p < 0.001). Girls from the APV group showed higher mental distress than boys across all applied questionnaires, but not for age, BMI-SDS, and migration background as predictors. Perception of loneliness correlated with poorer mental health outcomes, but it was not associated to media consumption. Comparisons with normative values revealed significantly higher depression and anxiety scores (p < 0.001) and lower well-being scores in the APV group (p < 0.01).

Conclusions: Youth with obesity and diabetes experienced significant psychosocial distress during the COVID-19 pandemic. Disease-specific differences were observed on the level of single items: Adolescents with type 1 diabetes expressed heightened concern about their health risks, while those with obesity reported lower self-esteem, increased suicidal thoughts, and fluctuating appetite. Female gender appeared to pose an additional risk factor. Media consumption was notably higher in the APV cohort. Healthcare providers should be vigilant regarding psychological comorbidities in youth with chronic conditions, particularly during periods of heightened stress.

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.

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: The abdominal volume index (AVI), a novel anthropometric index that reflects abdominal obesity, has been related to atherosclerosis. We sought to investigate the association of AVI with the severity and burden of asymptomatic intracranial arterial stenosis (aICAS) in a rural Chinese population.

Methods: The population-based cross-sectional study included 1,994 participants who were aged ≥40 years and living in Kongcun Town, Pingyin County, Shandong, and who had no history of clinical stroke or transient ischemic attack. We detected aICAS by combining transcranial Doppler ultrasound with magnetic resonance angiography. We used multiple logistic regression models to investigate the association between AVI and aICAS.

Results: Of the 1,994 participants, 146 were diagnosed with aICAS, including 51 with mild aICAS and 95 with moderate-to-severe aICAS. Controlling for confounding factors, a greater AVI was significantly associated with an adjusted odds ratio (OR) (95% confidence interval [CI]) of 1.08 (1.02-1.14) for having aICAS, 1.11 (1.04-1.18) for moderate-to-severe aICAS, and 1.12 (1.01-1.23) for multiple moderate-to-severe aICAS. We detected a statistical interaction of AVI with hypertension on aICAS (p for interaction = 0.011). Stratified analysis by hypertension showed a significantly independent association between AVI and aICAS in participants with hypertension (upper versus lower tertile of AVI: OR = 2.90; 95% CI: 1.65-5.10, p < 0.001) but not in those without hypertension.

Conclusion: A greater AVI is independently associated with aICAS, especially among individuals with hypertension. Moreover, AVI may help to identify both the severity and burden of aICAS.

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Introduction: Simple obesity is an increasingly prevalent chronic condition. While electroacupuncture (EA) has demonstrated potential in addressing this issue, its effectiveness may be hindered by insufficient continuous stimulation and challenges related to patient adherence. This study aimed to compare the efficacy of EA alone versus EA combined with press needles in the treatment of simple obesity and to explore the underlying mechanisms contributing to weight loss.

Methods: Eighty simple obese patients with a body mass index (BMI) ≥25.0 kg/m2 were divided into two groups: the observation group (treated with EA combined with press needles) and the control group (treated with EA alone). The efficacy of the treatments was evaluated by monitoring obesity indicators. Additionally, obesity rat models were established through a high-fat diet (HFD), and rats were randomly assigned to three groups: obesity control group (no treatment), EA group, and EA combined with press needles group. Treatment outcomes were assessed by monitoring obesity indicators, examining adipose and liver cell morphology using staining techniques, and evaluating intestinal lymphatic vessel function through qRT-PCR, Western blot, and immunofluorescence analyses.

Results: The patients in the observation group exhibited significantly lower body weight (BW), BMI, body fat percentage (F%), abdominal circumference (A), waist circumference (WC), as well as serum levels of intestinal lymphatic function-related factors such as VEGF-C, delta-like ligand 4 (DLL4), and adrenomedullin (ADM) compared to the control group. Similarly, compared to EA group, EA combined with press needles significantly decreased obesity indexes, serum intestinal lymphatic function-related factors, and improved lymphatic vessel function in obese rats. Mechanistically, the VEGF-C/VEGFR-3/PI3K/AKT signaling pathway was inhibited by EA combined with press needles intervention.

Conclusion: The combined therapy of EA with press needles had shown significantly superior efficacy in treating simple obesity compared to EA treatment alone. It achieved this by modulating the VEGF-C/VEGFR-3/PI3K/AKT signaling pathway, improving lymphatic vessel structure and function, and ultimately inhibiting obesity.

Introduction: Specialized lifestyle programmes for patients undergoing metabolic-bariatric surgery (MBS) are provided to facilitate adjustment and adherence to a healthy lifestyle after surgery. However, pre-programme food and health literacy in MBS patients is often unknown. In the general population, approximately three-quarters of people exhibit sufficient health literacy. This study aimed to examine food and health literacy of patients awaiting MBS and to identify patient-specific factors associated with these literacies.

Methods: Patients awaiting MBS completed questionnaires on food literacy (Self-Perceived Food Literacy scale) and health literacy (European Health Literacy Survey Questionnaire-16) at the start of a preoperative lifestyle programme. Linear and logistic regression analyses were used to identify associations between multiple variables and preoperative food and health literacy.

Results: Among 216 patients, the preoperative mean food literacy score was 3.49 ± 0.44, on a five-point scale. Furthermore, 96.3% of patients showed sufficient health literacy, with scores of 13 or more out of 16. Patients with sufficient health literacy had higher food literacy scores (β 0.508; 95% CI: 0.208-0.809, p < 0.001).

Conclusion: This study among people living with obesity awaiting MBS suggests that food literacy is comparable, and health literacy is higher than in the general population. These findings emphasize the complexity of the aetiology of obesity due to factors that extend beyond food and health literacy.