Obesity最新文献

Objective

This study investigated the neural mechanisms underlying appetite dysregulation in female subjects with abdominal obesity (AO) by identifying functional connectivity (FC) and network-level differences between moderate appetite (MA) and strong appetite (SA) subtypes.

Methods

A total of 60 women with AO (30 MA, 30 SA) and 30 healthy controls (HCs) underwent resting-state fMRI. Independent component analysis was used to identify and examine FC within and functional network connectivity (FNC) between key resting-state networks, including those involved in cognitive and visual processing. Network alterations and correlations with obesity-related indicators were evaluated.

Results

Compared to HCs, both groups showed reduced FC in the default mode network (DMN) and visual network (VN), with SA additionally exhibiting decreased FC in the frontoparietal network (FPN) and lower angular gyrus FC than MA (p < 0.05, FDR-corrected). MA displayed increased DMN-left FPN (FPN_L) FNC (p < 0.001), while SA showed negative correlations between FC and BMI/appetite visual analog scale (VAS) scores in FPN and with body weight/BMI/appetite VAS in VN (p < 0.05). In HCs, DMN-FPN_L FNC positively correlated with BMI, a pattern that was not observed in MA.

Conclusion

Objective

This study aimed to estimate population-level effects on weight change of initiating/adhering to additional glucose-lowering medications in adults with type 2 diabetes prescribed metformin.

Methods

We conducted a target trial using electronic health record data from 22,601 patients (age 20 to < 80 years) prescribed metformin to determine initiation/adherence to dipeptidyl peptidase IV (DPP4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium-glucose cotransporter 2 (SGLT-2) inhibitors, long-acting insulin, or sulfonylureas. Inverse probability weighting of marginal structural models with standardization by baseline covariates was used to estimate population-level effects of initiating/adhering to different medications on average 24-month weight change.

Results

At 24 months, a mean −5.15 kg (95% CI −10.6, −1.36) and −6.71 kg (95% CI −8.38, −4.34) weight loss would be observed for initiation/adherence to GLP-1RAs and SGLT-2s respectively. At 6 months, weight loss for DPP4s would be observed (−0.89 kg, 95% CI −1.41, −0.32) though not at 12 or 24 months. Glimepiride would be associated with weight gain at 6 and 12 months (0.88 kg, 95% CI 0.44, 1.22; 1.01 kg, 95% CI 0.32, 1.51) but not at 24 months.

Conclusions

Initiation/adherence to GLP-1RAs and SGLT-2s over 24 months could result in average weight losses of 5.15 kg and 6.71 kg, respectively.

Objective

Obesity affects 42% of older adults, with rates continuing to rise. This a complex condition influenced by non-modifiable as well as modifiable risk factors. The disease can be treated through modifications to diet, physical activity, and behavior and more recently through antiobesity medications (AOMs) and surgery. Treatment must be tailored to individual needs due to age-related metabolic and physiological changes. This review aimed to identify the suitability of seven FDA-approved AOMs in the treatment of obesity in older adults.

Methods

A review of AOMs was performed, focusing on their efficacy in weight loss, side effects, and potential health risks in older adults. Studies were selected to later evaluate the overall suitability and safety of these medications.

Results

AOMs can improve cardiovascular outcomes, hypertension, hyperlipidemia, metabolic liver disease, obstructive sleep apnea, and chronic kidney disease. Weight loss in older adults using AOMs is associated with an increased risk of sarcopenia.

Conclusions

From a policy standpoint, ensuring coverage of AOMs for older adults is critical, as these medications help reduce obesity-related complications. However, increased participation in clinical trials is urgently needed to study the impact of quality of life and outcomes in older adults.

Objective

This study addressed the paucity of data exploring long-term effects of metabolic and bariatric surgery (MBS)-related weight loss on fitness.

Methods

Data from MBS patients (SURG; n = 82) and comparable non-surgery participants (NSURG; n = 88) were collected from a subset of a prospective trial, the Utah Obesity Study. Fitness was assessed through maximal and submaximal treadmill tests using a modified Bruce protocol. Submaximal exercise tests were performed preceding surgery at baseline and 11.5 years later. A subset (n = 97) of the 170 participants also performed maximal treadmill tests 2 and 6 years after baseline. Weight and BMI were recorded at each visit. Between-group treadmill time comparisons were adjusted for sex and weight.

Results

As expected, SURG had lower BMI and weight than NSURG at all follow-up visits (p < 0.0001). Treadmill time, adjusted for sex, baseline treadmill time, and weight over the 11.5-year period, was elevated in surgery compared to non-surgery groups at all follow-up visits (p < 0.01), but the fitness advantage gradually decreased over time.

Conclusions

An initially dramatic fitness benefit achieved with weight loss in MBS patients gradually declined but remained higher than non-surgery counterparts beyond a decade. An emphasis on physical activity may help sustain improved fitness after bariatric surgery.

Objective

To estimate long-term weight change after initiation and adherence to commonly used antiseizure medications (ASMs) and examine differences in weight change across ASMs compared to topiramate.

Methods

We included 52,309 adult patients who initiated ASMs, applied a target trial emulation approach to control time-varying confounding and selection bias, and examined the long-term comparative effects on weight change after initiating and adhering to different ASMs at 6 and 12 months post initiation.

Results

The most commonly initiated ASM was topiramate (41.2%). In comparison to topiramate, we estimated higher 6-month weight change under initiation and adherence to levetiracetam 0.94 kg (95% CI 0.20, 1.64), lamotrigine 1.44 kg (0.74, 1.99), valproate 2.42 kg (1.71, 2.88), carbamazepine 1.32 kg (0.46, 2.16), and oxcarbazepine 1.74 kg (0.85, 2.71), with similar results at 12 months and in sensitivity and subgroup analyses. These results were driven mostly by weight loss with use of topiramate rather than weight gain with use of other ASMs. Results were similar though attenuated when accounting for medication initiation only.

Conclusions

Topiramate was associated with weight loss at 6 and 12 months under either initiation and subsequent adherence or initiation-only effects; other medications were associated with higher weight change. These results provided important information to help with decision-making regarding ASM initiation.

Objective

This study aimed to characterize the longitudinal trajectory of the body roundness index (BRI) in a multinational cohort and to investigate its association with cardiovascular disease (CVD) events.

Methods

We pooled individual-level data from three prospective cohort studies across the United States, the United Kingdom, and China, covering 2004 to 2019. The trajectory of BRI was determined using latent class growth mixed models, and the relationship between BRI trajectory and CVD risk was evaluated using Cox models.

Results

Three longitudinal BRI trajectories were characterized: inverse-U (7.2%), low-increasing (44.4%), and middle-increasing (48.4%). The risk of CVD in the middle-increasing group and the inverse-U group was 1.25 times (95% CI: 1.12–1.35) and 1.86 times (1.53–2.36) higher than that in the low-increasing group, respectively. The historical maximum BRI, area under the curve, and time-weighted BRI all showed a nonlinear risk of CVD in the dose–response relationship (p < 0.05). The effect of BRI growth rate on CVD decreased with age.

Conclusions

The BRI trajectories were significantly associated with CVD risk, independent of baseline BRI and BMI. This emphasizes the long-term and persistent effects of visceral fat accumulation and may provide a reference for personalized CVD risk assessment and early impact.

Objective

This study aimed to examine sex-stratified associations between meeting recommended sleep duration and adiposity in 10-year-old children.

Methods

Using the GUSTO cohort (51% boys, 10.2 ± 0.2 years), we evaluated the associations of meeting sleep duration recommendations (total daily sleep duration of ≥ 9 h, caregiver-reported and actigraphy) throughout the week with obesity and BMI z-scores (N = 638), glycoprotein acetyls (n = 436), fat mass measured by quantitative magnetic resonance (n = 528), and abdominal adipose tissue volumes measured by magnetic resonance imaging (N = 377). Multivariable linear and logistic regressions were used, adjusted for ethnicity and maternal education.

Results

Boys, but not girls, whose caregiver-reported sleep duration met recommendations throughout the entire week had a lower risk of obesity (BMIz > 2.0) (OR = 0.49, 95% CI 0.27–0.87), BMIz (0.34 ± 0.16 vs. 0.98 ± 0.12) (p = 0.001), glycoprotein acetyls levels (0.65 ± 0.01 mmol/L vs. 0.70 ± 0.01 mmol/L) (p < 0.001), total fat mass (8.77 ± 0.69 kg vs. 11.31 ± 0.51 kg) (p = 0.002), and deep subcutaneous (492 ± 86 mL vs. 729 ± 56 mL) (p = 0.014), superficial subcutaneous (651 ± 85 mL vs. 888 ± 55 mL) (p = 0.013), and visceral (415 ± 51 mL vs. 557 ± 33 mL) (p = 0.013) adipose tissue volumes.

Conclusions

Interventions to help children attain recommended sleep duration for weekdays and weekends may reduce abdominal and total adiposity, especially in boys.