Obesity Facts最新文献

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: 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.

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: Excess skin after bariatric metabolic surgery may negatively impact quality of life (QoL). Nevertheless, not every eligible patient undergoes body contouring surgery (BCS), which may be explained by differences in QoL. The objective of this study was to assess the differences in QoL between patients with and without a desire for BCS after bariatric metabolic surgery and to identify predictive factors that contribute to this desire.

Methods: Patients completed the BODY-Q and a question regarding any desire for BCS, 6 months and yearly after bariatric metabolic surgery. BODY-Q outcomes were compared between patients with and without a desire for BCS and corrected for excess skin.

Results: A total of 380 patients who completed 3 years of follow-up were included. Of these patients, 69.5% desired BCS. Patients who did not desire BCS demonstrated significantly higher QoL scores across all domains at every follow-up moment compared to patients who desired BCS (except physical functioning at 3 years). These associations were largely explained by the amount and burden of excess skin. Younger age was the only significant predictor for desiring BCS when correcting for excess skin.

Conclusion: Patients with a desire for BCS demonstrated significantly lower QoL compared to patients without a desire due to a high burden of excess skin, which emphasizes the need for effective treatments aiming to improve QoL such as BCS.

Introduction: Person-centred care (PCC) may hold promise for improved healthcare experiences and outcomes among patients living with obesity. A validated instrument to assess the delivery of PCC to patients living with obesity is, however, currently lacking. This study aimed to validate such an instrument. In this article, we describe the development and psychometric testing of the 40-item and 24-item short version of the Person-Centred Obesity Care (PCOC) instrument.

Methods: A total of 590 individuals living with obesity (BMI 33.4 ± 3.9) from a representative Dutch sample completed the 49-item PCOC instrument measuring the eight dimensions of PCC (patient preferences, physical comfort, coordination of care, emotional support, access to care, continuity and transition, information and education, and family and friends), and two measures of satisfaction with care. We performed confirmatory factor analyses to verify the factor structure of the instrument and examined its reliability and validity.

Results: Fit indicators of the first model with all 49 items showed that the model left room for improvement (comparative fit index [CFI] <0.90). A 40-item version was obtained with satisfactory-to-good fit (standardized root mean square residual [SRMR] = 0.05, root mean square error of approximation [RMSEA] = 0.06, CFI = 0.90). The instrument demonstrated good reliability, and the relationship between the PCOC and two indicators of satisfaction with care supported the validity of the scale. Shortening the instrument only further improved the fit indicators, resulting in the development of a 24-item short version (SRMR = 0.04, RMSEA = 0.05, CFI = 0.96), with similar results in terms of reliability and validity.

Conclusion: The 40-item PCOC instrument and the 24-item short version showed to be reliable and valid instruments for the assessment of PCC among patients living with obesity. Based on the results, the 40 and 24-item PCOC are promising tools that can be used by clinicians and researchers to explore PCC delivery for patients living with obesity.

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: Bariatric surgery effectively treats severe obesity; however, publicly funded bariatric surgery in Australia and New Zealand is limited. Bariatric surgeons play an important role in deciding individuals' suitability for surgery. This study explored Australian and New Zealand bariatric surgeons' views on barriers and enablers to bariatric surgery.

Methods: Sixteen bariatric surgeons and registrars across Australia and New Zealand were interviewed in 2023 about their opinions on barriers and enablers to bariatric surgery. Conventional qualitative content analysis was used to synthesise the data.

Results: Eight content categories originated from the analysis: (1) patient characteristics; (2) factors related to a patient's residential location; (3) economic factors; (4) lifestyle factors; (5) health-related factors; (6) surgery-related fears and concerns; (7) social factors; and (8) institutional and organisational factors. Surgical demand and supply issues were salient in discussions about the pre-operative process and patient (non)progression to surgery. Patients' financial circumstances were similarly emphasised. Societal values and norms, including gender stereotypes, were featured, and the role of close others was substantiated, with patients' families and friends considered both barriers and enablers to surgery.

Conclusion: Participants discussed more barriers than enablers to bariatric surgery. Their views generally aligned with the patient-based literature; however, the qualitative nature of the study allowed for the perceived reasons underlying the barriers and enablers to be explored. Findings offer potential avenues for modifying the pre-operative process to better support patients' needs and promote equity in access to surgery.