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 conduct cost analysis (CA) and cost-effectiveness analysis (CEA) of Strong Hearts, Healthy Communities (SHHC) implemented in two randomized trials.

Methods

Women with obesity or women who were sedentary with overweight who were ≥ 40 years old from rural medically underserved towns were randomized to SHHC intervention or control. CA calculated total and per participant costs and opportunity costs. CEA compared incremental costs to incremental outcome changes. Quality-adjusted life year (QALY) CEA compared incremental costs and effectiveness of a national SHHC intervention for a hypothetical cohort of 2.2 million women.

Results

SHHC-1.0 resource cost was $775/participant and SHHC-2.0 was $747. The incremental cost-effectiveness ratio from the payer's perspective for SHHC-1.0 was $346/kg weight loss and $187 and $155 for SHHC-2.0 at 24 and 48 weeks, respectively. Over a 10-year horizon, to avert QALYs lost, SHHC-1.0 was estimated to cost $238,271 from the societal perspective and $62,646 from the health care sector perspective. For SHHC-2.0, the corresponding numbers were $214,257 and $67,747 at 24 weeks and $94,395 and $11,341 at 48 weeks.

Conclusions

SHHC-2.0 compared favorably to SHHC-1.0 and could be cost-effective for longer-term effects. Results can help guide policy makers' decisions on larger-scale community-based obesity and cardiovascular disease prevention interventions.

Trial Registration

ClinicalTrials.gov identifier NCT03059472

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

This study investigated the safety, tolerability, and preliminary efficacy of Sirona, a novel gastro-retentive, dual-network polymer for weight management.

Methods

This pilot trial comprised a randomized, parallel-group, double-blind, placebo-controlled (3:1 ratio), 12-week period, with a 12-week open-label extension (OLE), in participants with BMI of 30–40 kg/m². Primary endpoints were feasibility, tolerability, and safety; secondary endpoints included weight loss and dietary intake, tested using Hedge's g [95% CI] as a measure of effect size.

Results

Participants received Sirona (n = 29/38) or Placebo (n = 9/38) (mean [SD] age = 40.9 [8.4]; weight = 101.7 [12.9] kg; BMI = 35.6 [3.0]; 29/38 female and 23/38 White British). Dosing was well tolerated (RCT Sirona: 95.2 [11.0]%; RCT Placebo: 97.8 [3.5]%; RCT + OLE Sirona: 93.1 [13.0]%). No serious adverse events occurred. Of the adverse events, nausea was most prominent (74.8%), mostly graded mild (79.3%) and requiring no intervention (84.4%). Percentage total body weight loss was greater for Sirona compared to Placebo after 12 weeks (3.9 [3.0]% versus 1.0 [2.1]%, g = 0.96 [−1.81, −0.10]). Weight loss continued in the OLE (change from baseline = 4.4 [3.8]%). Dietary intake reduced from baseline after 12 weeks of treatment (−382.5 [519.3] kcal; Placebo = 93.5 [670.3] kcal, g = −0.8 [−1.7, 0.0]) and after 24 weeks (−338.2 [486.7] kcal, g = 0.7 [0.2, 1.1]).

Conclusions

Sirona was well tolerated, with mild, primarily gastrointestinal side effects. Reduced weight and dietary intake suggest Sirona is suitable as a nonpharmacological treatment for weight management.

Trial Registration

ISRCTN14083641 (https://doi.org/10.1186/ISRCTN14083641)

Objective

Severe obesity poses a major public health concern due to its links with cardiometabolic complications and mortality. Visceral adipose tissue (VAT) plays a key role in these processes through distinct molecular features. This study aimed to characterize the VAT proteome of individuals with severe obesity and investigate its association with serum metabolic biomarkers.

Methods

A cross-sectional analysis was performed for 46 individuals with severe obesity undergoing metabolic bariatric surgery and 17 healthy controls undergoing elective abdominal surgery. VAT proteomes were analyzed using liquid chromatography–tandem mass spectrometry (LC–MS/MS), and serum metabolites were quantified using nuclear magnetic resonance–based metabolomics.

Results

LC–MS/MS identified 22 differentially expressed proteins (FDR < 0.05) in VAT with 12 downregulated and 10 upregulated in severe obesity. Downregulated proteins included mitochondrial enzymes involved in substrate metabolism and mitochondrial transmembrane transport. Circulating glucose, valine, and isoleucine correlated negatively with VAT mitochondrial transmembrane and electron transport proteins. Upregulated proteins were associated with inflammation, immune activation, oxidative stress, cytoskeletal remodeling, and protein turnover.

Conclusions

These findings demonstrate significant molecular alterations in the VAT proteome associated with severe obesity, providing insights into the underlying mechanisms of metabolic disease. The differentially expressed proteins may serve as biomarkers or therapeutic targets for obesity-related complications.

Trial Registration: ClinicalTrials.gov identifiers: NCT00793143 and NCT01373892

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.