IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity

Pub Date : 2024-08-28 DOI: 10.1002/oby.24107

Emily Benjamin Finn, Caroline V. Keller, Marissa A. Gowey, Mary Savoye, Stephanie Samuels, Abby F. Fleisch, Victoria W. Rogers, Margaret Grey, Laura J. Damschroder, Amy Beck, Mona Sharifi

Objective

The increasing prevalence of and inequities in childhood obesity demand improved access to effective treatment. The SmartMoves curriculum used in Bright Bodies, a proven-effective, intensive health behavior and lifestyle treatment (IHBLT), was disseminated to ≥30 US sites from 2003 to 2018. We aimed to identify barriers to and facilitators of IHBLT implementation/sustainment.

Methods

We surveyed and interviewed key informants about experiences acquiring/implementing SmartMoves. In parallel, we analyzed and then integrated survey findings and themes from interviews using the constant comparative method.

Results

Participants from 16 sites (53%) completed surveys, and 12 participants at 10 sites completed interviews. The 11 sites (63%) that implemented SmartMoves varied in both use of training opportunities/materials and fidelity to program components. In interviews, demand for obesity programming, organizational priorities, and partnerships facilitated implementation. Seven sites discontinued SmartMoves prior to the COVID-19 pandemic. Funding insecurity and insufficient staffing emerged as dominant barriers to implementation/sustainment discussed by all interviewees, and some also noted participants' competing demands and the program's fit with population as challenges.

Conclusions

System- and organizational-level barriers impeded sustainment of an evidence-based IHBLT program. Adequate funding could enable sufficient staffing and training to promote fidelity to the intervention's core functions and adaptation to fit local populations/context.

目的：儿童肥胖症的发病率和不公平现象日益增加，这就要求提高有效治疗的可及性。从 2003 年到 2018 年，"光明身体 "中使用的 SmartMoves 课程被推广到≥30 个美国站点，这是一种行之有效的强化健康行为和生活方式疗法（IHBLT）。我们旨在确定实施/维持 IHBLT 的障碍和促进因素：我们就获取/实施 SmartMoves 的经验对关键信息提供者进行了调查和访谈。同时，我们使用恒定比较法对调查结果和访谈主题进行了分析和整合：16 个站点（53%）的参与者完成了调查，10 个站点的 12 名参与者完成了访谈。在实施 "智能运动 "的 11 个地点（占 63%）中，培训机会/材料的使用和计划内容的忠实度各不相同。在访谈中，对肥胖症计划的需求、组织优先事项和合作伙伴关系促进了计划的实施。在 COVID-19 大流行之前，有七个地点停止了 SmartMoves 计划。资金不安全和人员不足是所有受访者讨论的实施/持续性的主要障碍，一些受访者还指出，参与者的竞争性需求和计划与人群的契合度也是挑战：系统和组织层面的障碍阻碍了以证据为基础的 IHBLT 计划的持续开展。充足的资金可以保证足够的人员配备和培训，以促进忠实于干预的核心功能，并根据当地人口/环境进行调整。

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引用次数: 0

GLP-1 therapy increases visceral adipose tissue metabolic activity: lessons from a randomized controlled trial in obstructive sleep apnea GLP-1 疗法可增加内脏脂肪组织的代谢活动：阻塞性睡眠呼吸暂停随机对照试验的启示。

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity

Pub Date : 2024-08-22 DOI: 10.1002/oby.24126

Cliona O'Donnell, Odhrán Ryan, Andrew E. Hogan, Desmond Killick, Shane Crilly, Jonathan D. Dodd, David J. Murphy, Silke Ryan, Donal O'Shea

Objective

Glucagon-like peptide-1 (GLP-1) analogues are currently the most widely used pharmacotherapies for weight loss. Their primary mechanism of action is attributed to reduction in energy intake. Data from murine studies also support an additional impact of those agents on energy homeostasis through upregulation of visceral adipose tissue (VAT) metabolic activity, but this remains uncertain in humans.

Methods

Here, we present data from a proof-of-concept study on 30 individuals with obstructive sleep apnea and obesity who were randomized to a GLP-1 therapy-based weight loss regimen, continuous positive airway pressure, or a combination of both for 24 weeks. At baseline and study completion, 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) was performed to evaluate VAT metabolic activity, expressed as VAT target to background ratio.

Results

Treatment with GLP-1, but not with continuous positive airway pressure, was associated with a significant increase in VAT target to background ratio. There was a strong correlation between the increase in VAT metabolic activity and the degree of weight loss.

Conclusions

These data support the hypothesis that upregulation of VAT metabolic activity by GLP-1 contributes to its weight loss action in humans, and this subject warrants further detailed investigation.

目的：胰高血糖素样肽-1（GLP-1）类似物是目前最广泛使用的减肥药物疗法。它们的主要作用机制是减少能量摄入。方法：在此，我们展示了一项概念验证研究的数据，研究对象是 30 名患有阻塞性睡眠呼吸暂停和肥胖症的患者，他们被随机分配到以 GLP-1 疗法为基础的减肥方案、持续气道正压疗法或两者相结合的减肥方案中，为期 24 周。在基线和研究结束时，进行了18F-氟脱氧葡萄糖（18F-FDG）正电子发射断层扫描（PET-CT），以评估增值血管瘤的代谢活动，用增值血管瘤目标与背景的比率表示：结果：GLP-1（而非持续气道正压）治疗可显著提高增值毛细血管目标与背景比率。VAT代谢活性的增加与体重减轻程度之间存在很强的相关性：这些数据支持这样的假设，即 GLP-1 对增值血管代谢活性的上调有助于其在人体中的减肥作用。

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引用次数: 0

Association between transitions in metabolic health and colorectal cancer across categories of body size phenotype: a prospective cohort study 不同体型表型的代谢健康状况变化与结直肠癌之间的关系：一项前瞻性队列研究。

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity

Pub Date : 2024-08-22 DOI: 10.1002/oby.24122

Qian Liu, Fei Si, Yuntao Wu, Jing Yu

Objective

We aimed to investigate the associations of changes in metabolic health across categories of body size phenotype with the risk of colorectal cancer in a community-based prospective cohort.

Methods

In the current study, a total of 70,987 participants were included. Changes in metabolic health across categories of body size phenotype were assessed between the health examination for the first time in the years 2006 through 2009 and a 2010/2011 health examination. A multivariate Cox proportional hazards model was used to assess the associations of changes in metabolic health across body size phenotype categories with risk of colorectal cancer.

Results

During the median follow-up time of 11.04 years, 428 (0.60%) participants developed colorectal cancer. Compared with metabolically healthy normal-weight (MHNW) participants who remained MH, the risk of colorectal cancer was increased by 144% (95% CI: 1.21–4.95) for participants with metabolically healthy obesity (MHO) who converted to a metabolically unhealthy (MU) phenotype. Participants who were MU at baseline were still at increased risk of colorectal cancer, regardless of obesity status.

Conclusions

The MHO phenotype was a dynamic status over time, and converting to MU during follow-up and being initially MU were associated with having an increased risk of colorectal cancer, regardless of degree of obesity and body size phenotype.

目的我们旨在研究社区前瞻性队列中不同体型表型的代谢健康变化与结直肠癌风险之间的关系：本研究共纳入 70,987 名参与者。评估了 2006 年至 2009 年首次健康检查与 2010/2011 年健康检查之间不同体型表型类别的代谢健康变化。采用多变量考克斯比例危险模型评估了不同体型表型类别的代谢健康变化与结直肠癌风险的关系：中位随访时间为 11.04 年，期间有 428 人（0.60%）罹患结直肠癌。与代谢健康的正常体重（MHNW）参与者相比，代谢健康的肥胖（MHO）参与者转为代谢不健康（MU）表型后，患结直肠癌的风险增加了144%（95% CI：1.21-4.95）。无论肥胖状况如何，基线值为 MU 的参与者罹患结直肠癌的风险仍然增加：MHO表型是一种随时间变化的动态状态，无论肥胖程度和体型表型如何，在随访期间转变为MU和最初为MU都与结直肠癌风险增加有关。

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引用次数: 0

Newborn adiposity is associated with cord blood DNA methylation at IGF1R and KLF7 新生儿肥胖与脐带血中 IGF1R 和 KLF7 的 DNA 甲基化有关。

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity

Pub Date : 2024-08-20 DOI: 10.1002/oby.24109

Jami L. Josefson, Alan Kuang, Catherine Allard, Monica E. Bianco, William Lowe Jr., Denise M. Scholtens, Luigi Bouchard, Marie-France Hivert

Objective

This study aimed to identify whether cord blood DNA methylation at specific loci is associated with neonatal adiposity, a key risk factor for childhood obesity.

Methods

An epigenome-wide association study was conducted using the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study as a discovery sample. Linear regression models adjusted for maternal and offspring covariates and cell counts were used to analyze associations between neonatal adiposity as measured by sum of three skinfold thicknesses and cord blood DNA methylation. Assays were performed with Illumina EPIC arrays (791,359 CpG sites after quality control). Replication was performed in an independent cohort, Genetics of Glucose regulation in Gestation and Growth (Gen3G).

Results

In 2740 HAPO samples, significant associations were identified at 89 CpG sites after accounting for multiple testing (Bonferroni-adjusted p < 0.05). Replication analyses conducted in 139 Gen3G participants confirmed associations for seven CpG sites. These included IGF1R, which encodes a transmembrane receptor involved in cell growth and survival that binds insulin-like growth factor I and insulin, and KLF7, which encodes a regulator of cell proliferation and inhibitor of adipogenesis; both are key regulators of growth during fetal life.

Conclusions

These findings support epigenetic mechanisms in the developmental origins of neonatal adiposity and as potential biomarkers of metabolic disease risk.

目的：本研究旨在确定脐带血 DNA 甲基化是否与新生儿肥胖（儿童肥胖的关键风险因素）有关：本研究旨在确定脐带血DNA特定位点的甲基化是否与新生儿肥胖（儿童肥胖的关键风险因素）有关：以高血糖和不良妊娠结局（HAPO）研究为发现样本，进行了一项表观基因组关联研究。采用线性回归模型，对母体和后代协变量及细胞计数进行调整，分析新生儿脂肪含量（以三个皮褶厚度之和计）与脐带血DNA甲基化之间的关联。检测使用 Illumina EPIC 阵列（质控后有 791,359 个 CpG 位点）进行。在一个独立队列 "妊娠和生长过程中葡萄糖调节的遗传学（Genetics of Glucose regulation in Gestation and Growth，Gen3G）"中进行了复制：结果：在 2740 个 HAPO 样本中，经多重检验后发现 89 个 CpG 位点存在显著关联（Bonferroni-adjusted p 结论）：这些研究结果支持表观遗传机制在新生儿肥胖发育起源中的作用，并可作为代谢性疾病风险的潜在生物标志物。

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引用次数: 0

Gut-derived appetite hormones do not explain energy intake differences in humans following low-carbohydrate versus low-fat diets 源自肠道的食欲激素无法解释人类在低碳水化合物饮食和低脂肪饮食之间的能量摄入差异。

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity

Pub Date : 2024-08-07 DOI: 10.1002/oby.24104

Aaron Hengist, Christina M. Sciarrillo, Juen Guo, Mary Walter, Kevin D. Hall

Objective

The objective of this study was to explore how dietary macronutrient composition influences postprandial appetite hormone responses and subsequent energy intake.

Methods

A total of 20 adults (mean [SEM], age 30 [1] years, BMI 27.8 [1.3] kg/m², n = 8 with normal weight, n = 6 with overweight, n = 6 with obesity) consumed a low-fat (LF) diet (10% fat, 75% carbohydrate) and a low-carbohydrate (LC) diet (10% carbohydrate, 75% fat) for 2 weeks each in an inpatient randomized crossover design. At the end of each diet, participants consumed isocaloric macronutrient-representative breakfast test meals, and 6-h postprandial responses were measured. Ad libitum energy intake was measured for the rest of the day.

Results

The LC meal resulted in greater mean postprandial plasma active glucagon-like peptide-1 (GLP-1; LC: 6.44 [0.78] pg/mL, LF: 2.46 [0.26] pg/mL; p < 0.0001), total glucose-dependent insulinotropic polypeptide (GIP; LC: 578 [60] pg/mL, LF: 319 [37] pg/mL; p = 0.0004), and peptide YY (PYY; LC: 65.6 [5.6] pg/mL, LF: 50.7 [3.8] pg/mL; p = 0.02), whereas total ghrelin (LC: 184 [25] pg/mL, LF: 261 [47] pg/mL; p = 0.0009), active ghrelin (LC: 91 [9] pg/mL, LF: 232 [28] pg/mL; p < 0.0001), and leptin (LC: 26.9 [6.5] ng/mL, LF: 35.2 [7.5] ng/mL; p = 0.01) were lower compared with LF. Participants ate more during LC at lunch (244 [85] kcal; p = 0.01) and dinner (193 [86] kcal; p = 0.04), increasing total subsequent energy intake for the day compared with LF (551 [103] kcal; p < 0.0001).

Conclusions

In the short term, endogenous gut-derived appetite hormones do not necessarily determine ad libitum energy intake.

研究目的本研究旨在探讨膳食宏量营养素组成如何影响餐后食欲激素反应及随后的能量摄入：共有 20 名成年人（平均[SEM]，年龄 30 [1] 岁，体重指数 27.8 [1.3] kg/m2，n = 8 名体重正常者，n = 6 名超重者，n = 6 名肥胖者）参加了为期 2 周的低脂（LF）饮食（10% 脂肪，75% 碳水化合物）和低碳水化合物（LC）饮食（10% 碳水化合物，75% 脂肪）住院随机交叉设计。在每种饮食法结束时，参与者食用等热量宏量营养素代表的早餐测试餐，并测量餐后 6 小时的反应。在一天的其余时间里，对自由摄入的能量进行测量：结果：低脂餐使餐后血浆中的平均活性胰高血糖素样肽-1（GLP-1；低脂餐：6.44 [0.78] pg/mL，低脂餐：2.46 [0.26] pg/mL；P 结论：低脂餐使餐后血浆中的平均活性胰高血糖素样肽-1（GLP-1）增加：在短期内，内源性肠源性食欲激素并不一定决定自由摄入的能量。

{"title":"Gut-derived appetite hormones do not explain energy intake differences in humans following low-carbohydrate versus low-fat diets","authors":"Aaron Hengist, Christina M. Sciarrillo, Juen Guo, Mary Walter, Kevin D. Hall","doi":"10.1002/oby.24104","DOIUrl":"10.1002/oby.24104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study was to explore how dietary macronutrient composition influences postprandial appetite hormone responses and subsequent energy intake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 20 adults (mean [SEM], age 30 [1] years, BMI 27.8 [1.3] kg/m<sup>2</sup>, <i>n</i> = 8 with normal weight, <i>n</i> = 6 with overweight, <i>n</i> = 6 with obesity) consumed a low-fat (LF) diet (10% fat, 75% carbohydrate) and a low-carbohydrate (LC) diet (10% carbohydrate, 75% fat) for 2 weeks each in an inpatient randomized crossover design. At the end of each diet, participants consumed isocaloric macronutrient-representative breakfast test meals, and 6-h postprandial responses were measured. Ad libitum energy intake was measured for the rest of the day.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The LC meal resulted in greater mean postprandial plasma active glucagon-like peptide-1 (GLP-1; LC: 6.44 [0.78] pg/mL, LF: 2.46 [0.26] pg/mL; <i>p</i> < 0.0001), total glucose-dependent insulinotropic polypeptide (GIP; LC: 578 [60] pg/mL, LF: 319 [37] pg/mL; <i>p</i> = 0.0004), and peptide YY (PYY; LC: 65.6 [5.6] pg/mL, LF: 50.7 [3.8] pg/mL; <i>p</i> = 0.02), whereas total ghrelin (LC: 184 [25] pg/mL, LF: 261 [47] pg/mL; <i>p</i> = 0.0009), active ghrelin (LC: 91 [9] pg/mL, LF: 232 [28] pg/mL; <i>p</i> < 0.0001), and leptin (LC: 26.9 [6.5] ng/mL, LF: 35.2 [7.5] ng/mL; <i>p</i> = 0.01) were lower compared with LF. Participants ate more during LC at lunch (244 [85] kcal; <i>p</i> = 0.01) and dinner (193 [86] kcal; <i>p</i> = 0.04), increasing total subsequent energy intake for the day compared with LF (551 [103] kcal; <i>p</i> < 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the short term, endogenous gut-derived appetite hormones do not necessarily determine ad libitum energy intake.</p>\u0000 \u0000 <div>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":215,"journal":{"name":"Obesity","volume":"32 9","pages":"1689-1698"},"PeriodicalIF":4.2,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.24104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141904069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Utilization of antiobesity medications within the Military Health System 军事卫生系统内抗肥胖药物的使用情况。

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity

Pub Date : 2024-08-01 DOI: 10.1002/oby.24097

Taylor Neuman, Richele Corrado, Amanda Banaag, Tracey Perez Koehlmoos

Objective

The prevalence of overweight and obesity among beneficiaries of the Military Health System (MHS) is 41.6% and 30.5%, respectively. This incurs significant medical, fiscal, and military readiness costs. It is not currently known how the utilization of antiobesity medications (AOMs) within the MHS compares with that in the Veterans Health Administration or the private sector. Our aim was to assess the utilization of AOMs within the MHS.

Methods

A cross-sectional study was conducted using data gathered from the MHS Data Repository and the inclusion of all adult TRICARE Prime and Plus beneficiaries ages 18 to 64 years who were prescribed at least one TRICARE-approved AOM during the years 2018 to 2022.

Results

The total study population included 4,414,127 beneficiaries, of whom 1,871,780 were active-duty service members. The utilization of AOMs among the eligible population was 0.56% (0.44% among active-duty personnel). Liraglutide was the most-prescribed AOM (36% of the total). Female sex, age greater than or equal to 30 but less than 60 years, and enlisted or warrant officer rank were all associated with statistically significant higher odds of receiving AOMs.

Conclusions

Comparable with the US private sector, the MHS significantly underutilizes AOMs, including among active-duty service members, despite coverage of AOMs since 2018.

目的：在军队医疗系统（MHS）的受益者中，超重和肥胖的发生率分别为 41.6% 和 30.5%。这造成了巨大的医疗、财政和军事准备成本。目前尚不清楚军事卫生系统与退伍军人卫生管理局或私营部门对抗肥胖药物（AOMs）的使用情况如何比较。我们的目的是评估医疗服务系统内抗肥胖药物的使用情况：我们利用从医疗服务部数据存储库收集的数据开展了一项横断面研究，并纳入了所有年龄在 18 至 64 岁之间、在 2018 年至 2022 年期间至少开具过一种 TRICARE 批准的 AOM 的成年 TRICARE Prime 和 Plus 受益人：研究对象包括 4,414,127 名受益人，其中 1,871,780 人为现役军人。在符合条件的人群中，AOM 的使用率为 0.56%（现役军人为 0.44%）。利拉鲁肽是处方量最大的 AOM（占总数的 36%）。女性性别、年龄大于或等于 30 岁但小于 60 岁以及士兵或准尉军衔都与接受 AOMs 的几率较高有显著的统计学关联：结论：与美国私营部门相比，尽管自 2018 年起 AOMs 已被纳入医保范围，但包括现役军人在内的医疗服务系统对 AOMs 的利用率明显偏低。

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引用次数: 0

Dopamine in the regulation of glucose and lipid metabolism: a narrative review 多巴胺在葡萄糖和脂质代谢调节中的作用：综述。

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity

Pub Date : 2024-07-30 DOI: 10.1002/oby.24068

Zhehong Li, Lifei Zheng, Jing Wang, Liang Wang, Yao Qi, Buhe Amin, Jinxia Zhu, Nengwei Zhang

Objective

Owing to the global obesity epidemic, understanding the regulatory mechanisms of glucose and lipid metabolism has become increasingly important. The dopaminergic system, including dopamine, dopamine receptors, dopamine transporters, and other components, is involved in numerous physiological and pathological processes. However, the mechanism of action of the dopaminergic system in glucose and lipid metabolism is poorly understood. In this review, we examine the role of the dopaminergic system in glucose and lipid metabolism.

Results

The dopaminergic system regulates glucose and lipid metabolism through several mechanisms. It regulates various activities at the central level, including appetite control and decision-making, which contribute to regulating body weight and energy metabolism. In the pituitary gland, dopamine inhibits prolactin production and promotes insulin secretion through dopamine receptor 2. Furthermore, it can influence various physiological components in the peripheral system, such as pancreatic β cells, glucagon-like peptide-1, adipocytes, hepatocytes, and muscle, by regulating insulin and glucagon secretion, glucose uptake and use, and fatty acid metabolism.

Conclusions

The role of dopamine in regulating glucose and lipid metabolism has significant implications for the physiology and pathogenesis of disease. The potential therapeutic value of dopamine lies in its effects on metabolic disorders.

目的：由于全球肥胖症的流行，了解葡萄糖和脂质代谢的调节机制变得越来越重要。多巴胺能系统，包括多巴胺、多巴胺受体、多巴胺转运体和其他成分，参与了许多生理和病理过程。然而，人们对多巴胺能系统在葡萄糖和脂质代谢中的作用机制却知之甚少。在这篇综述中，我们研究了多巴胺能系统在葡萄糖和脂质代谢中的作用：多巴胺能系统通过多种机制调节葡萄糖和脂质代谢。它在中枢水平调节各种活动，包括食欲控制和决策，有助于调节体重和能量代谢。在垂体中，多巴胺可抑制催乳素分泌，并通过多巴胺受体 2 促进胰岛素分泌。此外，多巴胺还能通过调节胰岛素和胰高血糖素的分泌、葡萄糖的摄取和利用以及脂肪酸的代谢，影响胰腺β细胞、胰高血糖素样肽-1、脂肪细胞、肝细胞和肌肉等外周系统的各种生理成分：结论：多巴胺在调节葡萄糖和脂质代谢中的作用对疾病的生理和发病机制具有重要意义。多巴胺的潜在治疗价值在于其对代谢紊乱的影响。

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引用次数: 0

Trimester-specific rate of gestational weight loss or gain and birth size: differences by prepregnancy BMI 特定孕期的妊娠体重减轻或增加率与新生儿体型：孕前体重指数的差异。

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity

Pub Date : 2024-07-30 DOI: 10.1002/oby.24071

Janne Boone-Heinonen, Dang Dinh, Rachel Springer, Shuling Liu, Jean O'Malley, Natalie A. Rosenquist, Teresa Schmidt, Jonathan M. Snowden, Sarah-Truclinh Tran, Kimberly K. Vesco

Objective

The objective of this study was to estimate the effects of trimester-specific gestational weight gain (GWG) on small and large (compared with appropriate) for gestational age (i.e., SGA, LGA, and AGA) by prepregnancy BMI classifications.

Methods

We conducted a cohort study of pregnancies in a national network of community health care organizations, stratifying by prepregnancy BMI (n = 20,676 with normal weight; 19,156 with overweight; 11,647 with obesity class I; 5124 with obesity class II; and 3197 with obesity class III). SGA and LGA (vs. AGA) were modeled as a function of trimester 1, 2, or 3 GWG rate, previous trimester(s) GWG rate, and maternal characteristics using modified Poisson regression.

Results

GWG rates ranged from weight loss to substantial gains. GWG-LGA associations were strongest in trimester 1 (risk ratio [RR] range for 10th vs. 50th percentile GWG, across BMI categories: 0.60–0.73). GWG-SGA associations were strongest in lower BMI categories and in trimester 2; RRs were 1.62, 1.40, and 1.17 for prepregnancy normal weight, obesity class I, and obesity class III, respectively, with curvilinear associations for class II and III.

Conclusions

Among people with prepregnancy obesity class II or III, GWG rate is associated with higher LGA risk in a dose-dependent manner, including understudied ranges of weight loss, but with weak associations with SGA.

研究目的本研究的目的是根据孕前体重指数（BMI）分类，估计特定孕期体重增加（GWG）对胎龄偏小和胎龄偏大（与适当胎龄相比）（即 SGA、LGA 和 AGA）的影响：我们对全国社区医疗机构网络中的孕妇进行了一项队列研究，按照孕前体重指数进行分层（正常体重 20676 人；超重 19156 人；肥胖 I 级 11647 人；肥胖 II 级 5124 人；肥胖 III 级 3197 人）。使用改良泊松回归法，将 SGA 和 LGA（与 AGA 相比）作为孕期 1、2 或 3 的 GWG 率、前三个孕期的 GWG 率和产妇特征的函数进行建模：GWG率从体重下降到大幅增加不等。GWG-LGA 的关联性在怀孕三个月中最强（不同 BMI 类别中，GWG 第 10 百分位数与第 50 百分位数的风险比 [RR] 范围为 0.60-0.73）：0.60-0.73).孕前体重正常、肥胖 I 级和肥胖 III 级的 GWG-SGA 相关性分别为 1.62、1.40 和 1.17，II 级和 III 级呈曲线相关：结论：在孕前肥胖等级为 II 级或 III 级的人群中，GWG 率与较高的 LGA 风险呈剂量依赖关系，其中包括未被充分研究的体重减轻范围，但与 SGA 的关系不大。

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引用次数: 0

A pediatric primary care practice-based obesity intervention to support families: a cluster-randomized clinical trial 以儿科初级保健实践为基础的肥胖干预，为家庭提供支持：分组随机临床试验。

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity

Pub Date : 2024-07-30 DOI: 10.1002/oby.24100

Lori Pbert, Sue Druker, Sybil Crawford, Christine Frisard, Jennifer Bram, Barbara Olendzki, Victoria Andersen, Jennifer Hazelton, Dante Simone, Michelle Trivedi, Grace Ryan, Kristin Schneider, Alan C. Geller

Objective

The American Academy of Pediatrics recommends that pediatric practices help families make lifestyle changes to improve BMI, but provider time and access to treatment are limited. This study compared the effectiveness of two pediatric practice-based referral interventions in reducing BMI.

Methods

In this cluster-randomized clinical trial, 20 pediatric primary care practices were randomized to telephonic coaching (Fitline Coaching) or mailed workbook (Fitline Workbook). Parents and their 8- to 12-year-old children with BMI ≥ 85th percentile completed assessments at baseline and at 6 and 12 months post baseline. Primary outcomes were 12-month BMI percentile and z score.

Results

A total of 501 children and their parents received Fitline Coaching (n = 243) or Fitline Workbook (n = 258); 26.8% had overweight, 55.4% had obesity, and 17.8% had severe obesity. Mean (SD) age was 10.5 (1.4), and 47.5% were female. BMI percentile improved in both groups; 12-month decline in continuous BMI z score was not statistically significant in either group. However, 20.8% of telephonic coaching participants and 12.4% of workbook participants achieved a clinically significant reduction of at least 0.25 in BMI z score, a significant between-group difference (p = 0.0415).

Conclusions

Both low-intensity interventions were acceptable and produced modest improvements in BMI percentile. One in five children in the telephonic coaching condition achieved clinically meaningful BMI z score improvements. However, more research is needed before such a program could be recommended for pediatric primary care practice.

目的：美国儿科学会建议儿科诊所帮助家庭改变生活方式以改善体重指数（BMI），但提供者的时间和治疗机会有限。本研究比较了两种基于儿科实践的转诊干预措施在降低体重指数方面的效果：在这项分组随机临床试验中，20 家儿科初级保健诊所被随机分配到电话辅导（Fitline 辅导）或邮寄工作手册（Fitline 工作手册）。体重指数≥85百分位数的8至12岁儿童的家长及其子女在基线期及基线期后6个月和12个月时完成评估。主要结果是 12 个月的 BMI 百分位数和 z 分数：共有 501 名儿童及其家长接受了 Fitline 指导（人数 = 243）或 Fitline 工作手册（人数 = 258）；26.8% 的儿童超重，55.4% 的儿童肥胖，17.8% 的儿童严重肥胖。平均（标清）年龄为 10.5 (1.4)岁，47.5% 为女性。两组的 BMI 百分位数均有所改善；两组 12 个月连续 BMI z 分数的下降均无统计学意义。然而，20.8%的电话辅导参与者和12.4%的工作手册参与者的体重指数z值在临床上显著下降了至少0.25，组间差异显著（p = 0.0415）：结论：两种低强度干预都是可以接受的，并能适度改善 BMI 百分位数。在电话辅导条件下，每五名儿童中就有一人的 BMI z 分数得到了有临床意义的改善。然而，在推荐儿科初级保健实践使用此类计划之前，还需要进行更多的研究。

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引用次数: 0

Time-restricted eating affects human adipose tissue fat mobilization 限时进食会影响人体脂肪组织的脂肪动员。

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity

Pub Date : 2024-07-28 DOI: 10.1002/oby.24057

Carolina Zambrano, Elena González-Alvarado, Diego Salmerón, Francisco Javier Ruiz-Ojeda, Juan Luján, Frank A. J. L. Scheer, Marta Garaulet

Objective

Time-restricted eating (TRE), a dietary approach that confines food intake to specific time windows, has shown metabolic benefits. However, its impact on body weight loss remains inconclusive. The objective of this study was to investigate the influence of early TRE (eTRE) and delayed TRE (dTRE) on fat mobilization using human adipose tissue (AT) cultures.

Methods

Subcutaneous AT was collected from 21 participants with severe obesity. We assessed fat mobilization by measuring glycerol release in AT culture across four treatment conditions: control, eTRE, dTRE, and 24-h fasting.

Results

TRE had a significant impact on lipolysis (glycerol release [mean (SD)] in micromoles per hour per gram: control, 0.05 [0.003]; eTRE, 0.10 [0.006]; dTRE, 0.08 [0.005]; and fasting, 0.17 [0.008]; p < 0.0001). Both eTRE and dTRE increased lipolysis compared with the control group, with eTRE showing higher glycerol mobilization than dTRE during the overall 24-h time window, especially at the nighttime/habitual sleep episode (p < 0.0001). Further analysis of TRE based on fasting duration revealed that, independently of the time window, glycerol release increased with fasting duration (in micromoles per hour per gram: 8 h = 0.08 [0.001]; 12 h = 0.09 [0.008]; and 16 h of fasting = 0.12 [0.011]; p < 0.0001).

Conclusions

This study provides insights into the potential benefits of TRE on fat mobilization and may guide the design of future dietary strategies for weight management and metabolic health.

目的：限时进食（TRE）是一种将食物摄入限制在特定时间窗口内的饮食方法，对新陈代谢有好处。然而，它对体重减轻的影响仍无定论。本研究的目的是利用人体脂肪组织（AT）培养物研究早期限时进食（eTRE）和延迟限时进食（dTRE）对脂肪动员的影响：方法：从 21 名重度肥胖症患者身上采集皮下 AT。方法：我们从 21 名重度肥胖症患者的皮下脂肪组织中采集了脂肪组织，通过测量脂肪组织培养物在对照组、eTRE、dTRE 和 24 小时禁食四种处理条件下的甘油释放量来评估脂肪动员情况：结果：TRE 对脂肪分解有明显影响（甘油释放量[平均值（标度）]（单位：微摩尔/小时/克）：对照组，0.05 [0.003]；eTRE，0.10 [0.006]；dTRE，0.08 [0.005]；禁食，0.17 [0.008]；P 结论：TRE 对脂肪分解有明显影响（甘油释放量[平均值（标度）]（单位：微摩尔/小时/克）：这项研究揭示了 TRE 对脂肪动员的潜在益处，可指导未来体重管理和代谢健康饮食策略的设计。

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引用次数: 0

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