Obesity Reviews最新文献

Background: Early-life exposures might negatively affect fetal and infant development, predisposing children to obesity. This study aimed to systematically identify and evaluate risk factors for childhood obesity in preconception, pregnancy, and infancy, and assess their potential for future prediction and prevention strategies.

Methods: This systematic review (PROSPERO, CRD42022355152) included longitudinal studies from selected electronic databases published between inception and August 17th, 2022, identifying maternal, paternal, or infant risk factors from preconception until infancy for childhood obesity between 2 and 18 years. Screening and data extraction were conducted using standardized forms. We assessed risk factor quality on modifiability and predictive power using a piloted criteria template from ILSI-Europe-Marker-Validation-Initiative.

Findings: We identified 172 publications from observational and five publications from intervention studies involving n = 1,879,971 children from 37, predominantly high-income, countries. Average reported childhood obesity prevalence was 11.1%. Pregnancy and infancy risk factors were mostly studied. We identified 59 potential risk factors; 23 were consistently associated. Strongest risk factors were: higher maternal prepregnancy weight (n = 28/31 publications with positive associations), higher gestational weight gain (n = 18/21), maternal smoking during pregnancy (n = 23/29), higher birth weight (n = 20/28), large-size-for-gestational-age-at-birth (n = 17/18), no breastfeeding (n = 20/31), and higher infant weight gain (n = 12/12). Level of evidence was generally moderate due to unreliable exposure measurement, short follow-up/loss to follow-up, and risk of confounding.

Interpretation: We identified seven early-life risk factors, which were strongly associated with childhood obesity, and can contribute to future prediction and prevention strategies. These findings support the implementation of prevention strategies targeting these risk factors from a clinical and population perspective, where possible integrated with implementation studies.

Rationale: The global rise in obesity presents a major public health challenge, commonly associated with an increased risk of noncommunicable diseases. Paradoxically, individuals with obesity, particularly older adults and those with comorbidities, are also at risk of malnutrition. This coexistence, driven by inadequate nutritional intake, chronic inflammation, and immune dysfunction, highlights the need to understand these overlapping health risks. Obesity complicates the identification and management of malnutrition. This review examines current screening and diagnostic methods for malnutrition in individuals with obesity.

Methods: A systematic scoping review was conducted following the Joanna Briggs Institute guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Literature was searched using a comprehensive strategy across the EBSCOhost database.

Results: From 2097 search results, 41 studies with 420,498 participants met the inclusion criteria. Three main methods for assessing malnutrition risk/nutritional status emerged: blood markers, malnutrition screening tools, and physical/etiologic assessments. The diagnostic criteria described were typically based on healthy weight reference values, lacking obesity-specific cutoff values. Only two studies introduced tools tailored to individuals with obesity: the Nutrition Health Outcomes Questionnaire and the Just a Nutritional Screening Tool.

Conclusion: Current malnutrition screening and diagnostic methods lack reliability, validity, and appropriate reference values for individuals with obesity. This limits their effectiveness in accurately identifying malnutrition risk in this population. Adjusting cutoff values for key indicators such as weight loss and muscle mass is vital to improve the accuracy of malnutrition diagnosis and ensure appropriate clinical management for individuals with obesity.

Very few studies exist examining the effects of mild traumatic brain injury (mTBI) in patients with obesity, which is notable given that mTBI represents ~80% of all recorded TBIs. Given that approximately 40% of US adults have an obese body mass index (with predictions that this proportion will continue to increase), it would be prudent to focus efforts on targeted treatments for this growing subpopulation of patients with TBI. Authors have postulated that higher preinjury inflammation, as observed in the patient with obesity, could lead to greater spikes in acute inflammation following traumatic brain injury and higher chances of prolonged inflammation. Evidence to support this hypothesis has emerged recently, but this body of research has limitations such as evaluating TBI outcomes at variable timepoints along with an underappreciation of the heterogeneity of TBI outcomes. Our goal was to identify gaps where future work is needed by synthesizing the state-of-the-science across these clinical variabilities. In this scoping review, we summarize the available literature across different TBI severities and time from injury before providing a brief summary of basic science evidence on the topic and opportunities for future research.

Introduction: Digital health interventions are effective for weight management and improving dietary intake, but studies in culturally and linguistically diverse (CALD) and Indigenous populations are limited. The aim of this systematic review is to evaluate the effectiveness of digital health interventions on body weight and dietary intake outcomes in CALD and Indigenous populations.

Methods: MEDLINE, Embase, Scopus, and Cochrane databases were searched on December 28, 2022 (PROSPERO: CRD42023394058). Inclusion criteria were randomized controlled trials (RCTs) conducted in high-income English-speaking countries with free-living adults ≥ 18 years. Trials had to report both weight and dietary outcomes, with ≥ 50% participants from CALD/Indigenous backgrounds or outcomes reported by race/ethnicity. Two reviewers independently screened records. Risk of bias was assessed using the Cochrane RoB 2 tool. Results were synthesized descriptively and presented in graphs and tables.

Results: From the 1984 records identified, nine RCTs were included, which involved a total of 2716 participants. Eight trials were conducted in the United States, and only one trial included Indigenous participants. Significant body weight changes occurred in three trials. Significant diet quality changes occurred in three trials. Most trials had high retention rates (≥ 80%) but low intervention adherence (< 50%). Risk of bias was low for most trials.

Conclusion: Limited evidence supports the effectiveness of digital health interventions for improving body weight and dietary intake outcomes in CALD and Indigenous populations. The predominance of US-based trials, female-dominated samples, and hybrid intervention designs limits generalizability. Future research should prioritize inclusive practices and standalone digital designs to establish effectiveness in these populations.

Introduction: Neighborhood determinants of health have been documented in several populations, yet less is known about their role in pediatric obesity treatment. A systematic review of longitudinal studies examining associations between neighborhood environment features and changes in obesity and in lifestyle behaviors among children participating in obesity management interventions was conducted.

Methods: Searches were conducted in Medline, Embase, CINAHL, and Web of Science for peer-reviewed articles published in English from database inception until April 2025. We included studies of children with overweight/obesity at baseline, participating in multicomponent obesity management interventions, and with at least one pre- and one post-intervention measurement of obesity or lifestyle behaviors.

Results: Of the 27,310 records screened, six met inclusion criteria. Studies were conducted in the United States (n = 5) and United Kingdom (n = 1), with participants' age ranging from 6 to 18 years, and a total of 13,364 participants. Studies examined availability of parks (n = 3), supermarkets (n = 2), greenspaces (n = 1), walkability (n = 1), recreational facilities (n = 1), and neighborhood deprivation (n = 1). Residing in neighborhoods with more parks was associated with greater reductions in post-intervention body mass index in two studies. Inconsistent findings relating availability of supermarkets to changes in fruit and vegetable intake were reported. Residing in neighborhoods with more recreational facilities was associated with increases in objectively measured physical activity but not with self-reported screen time.

Conclusion: Findings among the few studies that examined neighborhood determinants of obesity management outcomes among children were inconsistent. Neighborhood resources that support physical activity (parks, recreational facilities) may be associated with better outcomes.

Cardiovascular-kidney-metabolic (CKM) syndrome is a complex interaction of cardiovascular diseases, chronic kidney disease (CKD), and metabolic disorders, with its global prevalence rising due to increasing obesity and metabolic risk factors. The convergence of these conditions significantly worsens patient outcomes, leading to higher morbidity and mortality rates. Key pathophysiological mechanisms underpinning CKM syndrome include insulin resistance, oxidative stress, inflammation, and vascular dysfunction, all of which are exacerbated by reduced nitric oxide (NO) bioavailability and associated signaling dysfunctions. In clinical practice, organic nitrate has been used as NO donors; however, issues such as tolerance, side effects, and endothelial damage limit their effectiveness. The inorganic nitrate-nitrite-NO pathway offers a promising alternative, as emerging evidence from animal and human studies suggests that enhancing this pathway can significantly improve the progression of metabolic disorders, cardiovascular diseases, and CKD. The potential mechanisms may lie in its ability to improve the core pathophysiological processes of CKM syndrome, including inflammation, oxidative stress, insulin resistance, and vascular dysfunction. This review synthesizes current preclinical and clinical studies, highlighting the effects of inorganic nitrate and nitrite in managing CKM syndrome and suggesting avenues for future exploration.

Smartphone application (app)-based interventions to prevent Type 2 diabetes (T2D) are becoming increasingly available. A thorough summary of their effectiveness is lacking. We synthesized evidence on the effectiveness of app-based interventions to prevent T2D targeting individuals with prediabetes. For this systematic review and meta-analysis, we searched Web of Science, Embase, Scopus, PubMed Central, and Medline between January 1, 2013, and January 31, 2024, to identify randomized controlled trials (RCTs) that assessed the effectiveness of app-based interventions to prevent T2D targeting individuals with prediabetes, published in English, without restrictions regarding the effectiveness outcome. We synthesized all outcomes graphically via effect directions and conducted meta-analyses for clinical outcomes, including the Risk of Bias 2 Tool. This study was prospectively registered with PROSPERO (CRD42023491693) and OSF (DOI 10.17605/OSF.IO/B89QP). Of 9703 articles, 18 RCTs were included in the systematic review, and 15 RCTs in the meta-analysis. We found statistically significant reductions in body weight (-1.35 kg, 95% CI: [-2.48; -0.23], N = 13 RCTs), body mass index (-0.53 kg/m², 95% CI: [-0.97; -0.09], N = 11 RCTs), and glycated hemoglobin (-0.08%, 95% CI: [-0.10; -0.05], N = 11 RCTs) and point estimates and/or effect directions predominantly suggesting improvements for additional outcomes. Stratified meta-analyses showed no statistically significant between-group differences and missing evidence for long-term effectiveness and equity-relevant subgroups. Our study shows that app-based interventions can improve outcomes (i.e., motivation, behavior, and clinical parameters) in individuals with prediabetes. The effect on clinical outcomes is small. Evidence on equity impacts, long-term effectiveness, and diabetes incidence is missing and remains to be investigated.

Women with a raised body mass index are likely to take longer to conceive and have poorer outcomes from fertility treatment. Furthermore, fertility clinics commonly require women to have body mass index < 30 kg/m² prior to treatment. Consequently, many women face the challenge of needing to lose weight to improve their chances of conception or to become eligible for fertility treatment. For these women, there is an additional pressure to lose weight quickly due to the diminishment in reproductive potential with advancing age. Synthetic glucagon-like peptide-1 receptor agonists have been shown to cause rapid weight loss in individuals with obesity, as well as reversing some of the metabolic dysfunction associated with obesity and polycystic ovarian syndrome. The potential effect of preconception glucagon-like peptide-1 receptor agonist therapy to increase the chance of pregnancy in women with obesity is an emerging area of research. If this treatment proves to be safe and effective, it could provide significant benefits for many overweight women facing infertility. This article summarizes our understanding of the effect of obesity and polycystic ovarian syndrome on fertility and the success of assisted reproductive techniques. It also describes the traditional treatments for obesity, the pharmacology of glucagon-like peptide-1 receptor agonists, and the evidence for glucagon-like peptide-1 receptor agonists in improving fertility and pregnancy outcomes in overweight women, as well as the potential safety and ethical issue.