Obesity Reviews最新文献

Background and aims: The global rise in dementia, including early-onset cases, imposes a growing burden on patients and caregivers. While midlife obesity is a recognized risk factor, the role of body weight fluctuation in dementia and cognitive decline remains uncertain. This systematic review and meta-analysis examined the association between weight variability and the risk of dementia, including Alzheimer's disease, vascular dementia, and cognitive decline.

Methods: We systematically searched PubMed, Scopus, Web of Science, and PsycINFO, supplemented by manual searches, up to July 2024. Pooled hazard ratios (HRs) were estimated through pairwise meta-analysis, with subgroup analyses conducted to explore heterogeneity. Additionally, the quality of the included studies and the certainty of the evidence were assessed using the "Risk of Bias in Non-randomized Studies of Interventions" (ROBINS-I) tool and the GRADE Tool, respectively.

Results: Sixteen studies met the inclusion criteria. Compared with the lowest levels of weight fluctuation, the highest levels were associated with an increased risk of all-cause dementia (HR 1.40, 95% CI 1.29-1.52), Alzheimer's disease (HR 1.33, 95% CI 1.21-1.45), and vascular dementia (HR 1.39, 95% CI 1.16-1.67). No significant association was observed with cognitive decline. No clear source of heterogeneity was identified.

Conclusion: High body weight fluctuation is associated with an elevated risk of dementia, particularly Alzheimer's disease and vascular dementia. These findings highlight weight stability as a potential target for dementia prevention strategies. Further high-quality studies are warranted to clarify underlying mechanisms and long-term implications.

Introduction: We examined the cross-sectional association of BMI with limitations in instrumental (IADL) and basic (ADL) activities of daily living in surveys from middle- and high-income countries in 2015-2018; we also compared changes in these associations from 2002-2006 to 2015-2018.

Methods: Data at the 2015-2018 wave were available on 152,856 participants aged ≥ 50 years in seven nationally representative surveys from middle- (Mexico, India, and China) and high-income (the United States, SHARE-European countries, Israel, the United Kingdom, and Korea) countries. BMI was measured or self-reported, and disability in IADL and ADL was defined as limitations in at least one out of five items, respectively.

Results: The prevalence of underweight in men/women ranged from 0.5/1.5 (UK) to 23.4%/20.6% (India), and that of obesity from 0.7/1.5 (Korea) to 35.6%/37.6% (US), respectively. Meta-analyses showed underweight to be associated with a higher odds ratio (95% CI) of IADL (men, 1.78[1.26, 2.52]; women 2.07[1.38, 3.10]) and ADL (men, 1.89[1.22, 2.91]; women 1.72[1.16, 2.53]) disability. Obesity was associated with lower IADL limitations among men (0.80 [0.67-0.96]) but not among women (1.18 [0.94-1.49]), and with higher ADL (men, 1.38 [1.14, 1.65]; women, 1.59 [1.37, 1.84]). Associations of underweight with IADL and ADL, and obesity with ADL were stronger in high-income countries. The association of BMI categories with IADL/ADL was similar in the 2002-2006 data, although the prevalence of obesity was higher in 2015-2018.

Conclusion: Both underweight and obesity are associated with higher IADL and ADL disability; the stronger associations in high-income countries require further research.

Obesity represents a significant threat to global public health, with an estimated 16% of adults worldwide (2022) being classified as people with obesity, with a body mass index of 30 or more. Bariatric surgery is regarded as the most effective treatment option for people with obesity, with the three main types of bariatric surgery being gastric bypass or Roux-en-Y gastric bypass, laparoscopic gastric band, and laparoscopic sleeve gastrectomy. Drug bioavailability after oral administration is affected by several factors including properties of the drug itself, formulation properties, and anatomical and physiological factors. Procedures such as gastric bypass and laparoscopic sleeve gastrectomy result in significant anatomical and physiological alterations thought to profoundly influence oral drug bioavailability postoperatively. Consequently, following bariatric surgery, there is a risk of subtherapeutic drug levels leading to treatment failure, or the risk of potential toxicity if levels are elevated. In this review, previously unexamined aspects such as the impact of the "very low-calorie diet" (VLCD) initiated prior to surgery on anatomical parameters and subsequent pharmacokinetic changes, are explored. This review also highlights alterations in hepatic and renal volume that are expected to have a significant impact on renal and hepatic clearance. A clearer understanding of the effect of physiological alterations and weight loss on drug performance after surgery would support more evidence-based medicines optimization in this frequently complex patient group.

The global prevalence of obesity and metabolic disorders presents a substantial public health issue, with projections indicating that, by 2035, approximately 54% of the worldwide adult population will be classified as having overweight or obesity. Exercise immunometabolism has developed as a field investigating the mechanistic interplay between physical activity and the reciprocal regulation of immune and metabolic processes. Central to this paradigm are myokines, cytokines secreted by skeletal muscle during contraction, mediating the systemic benefits of exercise. Myokine meteorin-like protein (Metrnl) has attracted scientific attention due to its multiple roles in health and disease, including both protective metabolic effects and potential involvement in cancer progression. This review synthesizes current knowledge on Metrnl as an exercise-responsive myokine, examining its molecular regulation and its modulation by various exercise modalities, with high-intensity and resistance training showing the most pronounced effects. We present evidence from both preclinical models and clinical studies of Metrnl's anti-inflammatory and metabolic actions across multiple organ systems, including its role in mediating muscle-adipose, muscle-pancreas, muscle-cardiovascular, muscle-liver, muscle-immune, and muscle-brain crosstalk. Preclinical research has demonstrated Metrnl's effects on glucose homeostasis, insulin sensitivity, adipose tissue browning, and cardiovascular function while attenuating inflammation, with clinical studies beginning to validate these findings in humans. Despite promising results, challenges remain in translating these insights into clinical practice, including variability in human responses and knowledge gaps regarding demographic influences. This review addresses these translational challenges and proposes future research directions to utilize the therapeutic potential of Metrnl in metabolic and inflammatory disorders.

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) improve outcomes in heart failure (HF) with preserved ejection fraction. Whether GLP-1 RA prevent new-onset HF in Type 2 diabetes or obesity requires further investigation.

Methods: We performed an updated meta-analysis of randomized placebo-controlled trials (RCT) of treatment with GLP-1 RA in participants without HF. The hazard ratio (HR) and 95% confidence intervals (95% CI) were extracted from the group without HF in each study. The primary outcome was time to first HF event (HF hospitalization or urgent visit for HF). The correlation between the effect of GLP-1 RA on HF events and the effects on HbA1c, weight and major atherosclerotic cardiovascular events (MACE) was also investigated. We also evaluated the heterogeneity of effect according to study characteristics.

Results: A total of 52,752 participants without HF from six RCTs were included. Treatment with GLP-1 RA (vs. placebo) decreased the risk of new-onset HF (HR = 0.77 [95% CI 0.65-0.93], p < 0.001) and the composite of HF events or cardiovascular death (HR = 0.82 [95% CI 0.76-0.89], p < 0.001). The effect of GLP-1 RA on HF events was independent of its effects on HbA1c or weight, but was correlated with its protective effects on MACE. The effects on HF prevention were more pronounced in studies restricted to patients with atherosclerotic cardiovascular disease and in trials with higher incidence rate of HF events.

Conclusion: Treatment with GLP-1 RA decreases the risk of new-onset HF in patients with Type 2 diabetes or obesity.

Although much research focuses on the effects of hyperglycemia during pregnancy on maternal and offspring health, this narrative review specifically centers on the role of insulin resistance (IR) in pregnancy complications and offspring long-term health. Although hyperglycemia and IR are closely intertwined, this review deliberately prioritizes IR as a distinct yet interconnected factor driving metabolic dysfunction. During pregnancy, IR naturally increases to support fetal development. However, when IR becomes excessive, it can lead to metabolic disturbances and placental dysfunction. These conditions elevate the risk of pregnancy complications, impair fetal development, and adversely affect the long-term metabolic and cognitive health of the offspring. This review explores key factors influencing pregnancy-related IR, including genetic predisposition, lifestyle, physiological adaptations, hormonal fluctuations, and gut microbiota dysbiosis. It further examines how these factors worsen maternal metabolic imbalances and contribute to adverse pregnancy outcomes, including gestational hyperglycemia and hypertensive disorders, as well as their effects on neonatal complications and the long-term health of the offspring. Notably, this review is one of the first to address the transgenerational inheritance of IR, highlighting potential mechanisms such as epigenetic modifications, mitochondrial dysfunction, and the vertical transmission of altered maternal microbiota. In addition, we outline various preventive and therapeutic strategies aimed at mitigating these issues. These strategies include lifestyle changes, pharmacological treatments, nutritional supplementation, and emerging therapies such as mitochondrial-derived peptides and adipokine inhibitors. This narrative review provides a focused perspective on how pregnancy-related IR influences maternal and offspring health, offering insights for future clinical management and research.

Anti-obesity medications promote greater degrees of weight loss than lifestyle interventions alone. There is an important need to understand whether loss of skeletal muscle during pharmacologically induced weight loss is clinically significant due to its essential role in health and disease. Most randomized, placebo-controlled studies addressing this question report on fat-free or lean mass estimated from dual-energy x-ray absorptiometry or bioelectrical impedance without defining the composition of these components. Fat-free, lean, and skeletal muscle mass are not synonymous terms, and studies frequently fail to define lean mass, which may or may not include bone. Lack of standard preparatory procedures prior to measurement, differences in medications, doses, or intervention lengths, and inclusion of varied lifestyle modifications prevent reaching a consensus regarding the impact on skeletal muscle of pharmacologically induced weight loss. There is a critical need for greater precision and depth of understanding when selecting a measurement method and describing body compartments.

Background: This scoping review identified existing outcome measurement instruments (OMIs) for weight and body composition in children ≤ 1 year of age and how they are used in clinical trials. This information will improve outcome selection in future trials.

Methods: We searched the EMBASE, MEDLINE, CINAHL, and PsycINFO up to September 2023, previous reviews, and the TOPCHILD collaboration registry. Screening was conducted independently in duplicate. We included studies reporting trials including healthy, full-term infants ≤ 1 year of age reporting at least one weight, weight gain, and/or body composition OMI. Study and OMI characteristics were synthesized narratively.

Results: Seventy-two studies were included. Reported outcomes included weight (n = 71), changes in weight (n = 33), and body composition (n = 10). Six OMIs were used to measure infant weight, with undefined (n = 19) and electronic (n = 15) scales being the most common. Results for weight were mostly expressed as z scores relative to a population reference (n = 50). Five OMIs were used to assess infant weight gain, most frequently undefined weighing scales (n = 8) and electronic scales (n = 7), with results mostly expressed as changes in z scores relative to a population reference (n = 10). Eight body composition OMIs were identified; calipers (n = 5) and air displacement plethysmography (n = 3) were most commonly used. Body composition was predominantly presented as fat mass (FM) and fat-free mass (FFM) in kg (n = 5). OMIs were mostly administered in person by researchers, clinicians, or healthcare practitioners.

Conclusions: Given the heterogeneity identified in this review, research is needed to select standardized, feasible, and reliable OMIs for infant anthropometric outcomes in trials.

There are large evidence gaps for pregnant people, and research in pregnancy should be prioritized to ensure strong evidence to guide safe clinical practice. GLP-1 receptor agonist (GLP-1RA) research is a modern example that shows how pregnancy continues to preclude individuals from participating in and subsequently receiving potential benefits of research or understanding their important effects. In this article, we utilize GLP-1RAs to practically discuss prior ethical work on research in pregnancy, we specifically apply Miranda Waggoner and Anne Lyerly's framework of the protectionist ethic to the case of GLP-1RA research, and we consider risk as well as potential maternal and fetal benefit as they relate to GLP-1RAs. Finally, reproductive justice as an organizing theoretical framework offers many important insights into critically evaluating research, pregnancy, and GLP-1RAs and should be centered throughout research in pregnancy efforts. Strong ethical analyses, rooted in reproductive justice, are critical to informing clinical science in pregnant humans to narrow the evidence gaps, including with GLP-1RAs.

Introduction: To address the high prevalence and significant burden of overweight and obesity, surveillance through sentinel networks should be considered. The aim of this review is to identify the sentinel surveillance networks in relation to overweight and obesity and to describe their characteristics and methodology.

Methods: A scoping review was performed using MEDLINE (Ovid and PubMed), Web of Science (WoS), and Scopus, updated until November 2024, and included studies that identified sentinel networks specifically conducting surveillance for overweight and obesity, as well as networks that include these conditions as secondary variables. The main characteristics of each sentinel network and the variables related to overweight and obesity surveillance were recorded. A descriptive analysis was conducted.

Results: The search strategy retrieved 467 records, of which 40 fulfilled the inclusion criteria. Ten sentinel networks were identified, located in Europe (n = 5), Central America (n = 1), North America (n = 3), and Oceania (n = 1). Two were designed specifically for overweight and obesity surveillance. Eight used general practitioners or primary care physicians as their key informants; and of these, four utilized electronic medical records for recording information. One of the three sentinel networks that targeted children conducted surveillance through schools.

Conclusion: This review highlights sentinel networks as a valuable option to surveil overweight and obesity and offers a significant step forward towards the subsequent design of new sentinel networks that will address important public health problems such as overweight and obesity.