Journal of Obesity & Metabolic Syndrome最新文献

Background: While cognitive behavioral therapy (CBT) is the first-line treatment for bulimia nervosa (BN), standardizing treatment approaches may create differences in acceptability and efficacy between Wester and non-Western countries.

Methods: The retrospective cohort study investigated the feasibility and effectiveness of psychological therapies for BN in a Korean population. A total of 227 Korean patients with BN from a university hospital were included. Of these, 125 received CBT for binge eating based on the addictive appetite model, while 102 received specialist supportive clinical management for BN (SSCM for BN). Both therapies were accompanied by motivational enhancement therapy to enhance adherence. We conducted a mixed analysis of variance to examine the effects of two psychotherapies.

Results: There were main effects of time, with decreases in BN behaviors at post-treatment showing small effects (η² ranged from 0.02 to 0.19) and decreases in eating disorder psychopathology showing moderate effects (η² ranged from 0.27 to 0.54). The SSCM for BN group attended more sessions (27.3%; 15.66±14.08 sessions) than the CBT for binge eating group (39.7%; 10.86±11.80 sessions), while the dropout rate did not significantly differ between groups. In the regression analyses, the number of treatment sessions was associated with an increased likelihood of full remission (odds ratio, 1.119; P=0.003).

Conclusion: Both therapies were effective in reducing BN pathology in Korean patients with BN. The results suggest the need for personalization in the treatment of BN to enhance acceptability and efficacy, particularly in ethnic minorities.

Obesity promotes carcinogenesis through interlocking metabolic, inflammatory, immune, and hormonal pathways. We narratively synthesize recent meta-analyses and selected cohort studies that examine adiposity-principally body mass index (BMI) and waist circumference-in relation to cancer incidence. Across the 13 cancers designated by the U.S. National Cancer Institute as obesity-associated, risk elevations are generally consistent, though magnitudes vary by histology (e.g., esophageal adenocarcinoma vs. squamous cell carcinoma), anatomic subsite (gastric cardia vs. non-cardia), sex or menopausal status, and adiposity metric, with central adiposity often revealing additional risk beyond BMI. Evidence is mixed for several sites (e.g., pancreas and thyroid), and emerging but less established signals are noted for oral cavity, melanoma, bladder, non-Hodgkin lymphoma, and leukemia. We also review prevention data: observational studies and select trials suggest that intentional weight loss-via lifestyle interventions, pharmacotherapy (including glucagon-like peptide-1 receptor agonists), or bariatric surgery-can reduce overall or site-specific cancer incidence, although estimates are heterogeneous and causal certainty is limited. Taken together, biologic plausibility and convergent epidemiology support obesity as a modifiable cancer risk factor. Future studies are warranted using standardized exposure definitions, consistent stratification, and rigorous control of confounding to improve comparability. Adequately powered, long-term randomized or quasi-experimental studies may further refine effect sizes and inform precision prevention for obesity-related cancers.

Background: Given the challenges associated with direct insulin measurements, several surrogate markers combining both anthropometric data and laboratory tests (such as glucose and lipid levels) have been developed. This study aims to assess the diagnostic accuracy of the following indices: triglyceride-glucose (TyG) index, TyG index adjusted for body mass index (TyG-BMI), TyG index adjusted for waist circumference (TyG-WC), and TyG index adjusted for waist-to-height ratio (TyG-WHtR), for detecting metabolic syndrome (MetS) in the pediatric population, in comparison with conventional parameters.

Methods: We retrospectively analyzed data from 746 children and adolescents (372 female/374 male) categorized into groups based on BMI z-score. Insulin resistance (IR) surrogates were calculated as: homeostasis model assessment of insulin resistance (HOMA-IR), TyG, TyG-BMI, TyG-WC, and TyG-WHtR. MetS was defined by the presence of at least three of the following components: BMI z-score ≥2 standard deviation and/or WC/height ratio ≥0.5; fasting blood glucose >100 mg/dL and/or pathological HOMA-IR; dyslipidemia; and hypertension.

Results: The overall prevalence of MetS was 15.01% (112/746), occurring exclusively in children with obesity or overweight (P=0.004). The third quartile (Q3) was identified as the optimal cut-off point for the TyG indices (TyG, 8.1; TyG-BMI, 231.54; TyG-WC, 734.03; and TyG-WHtR, 4.73). The areas under the receiver operating characteristic curves (AUCs) of TyG, TyG-BMI, TyG-WC, and TyG-WHtR were 0.801 (P<0.001), 0.840 (P<0.001), 0.832 (P<0.001), and 0.816 (P<0.001) respectively, comparable to the AUC of HOMA-IR, which was 0.866 (P<0.001).

Conclusion: The TyG, TyG-BMI, TyG-WC, and TyG-WHtR indices demonstrated promising predictive value for MetS in children with overweight or obesity. These markers can effectively identify high-risk individuals and offer a cost-effective alternative to direct assessment of insulin sensitivity.

Background: This study prospectively assessed the combined versus individual effects of reducing energy intake (EI) and increasing physical activity (PA) on body weight and composition in older adults with overweight/obesity and metabolic syndrome. The interaction between both exposures was likewise assessed.

Methods: A subsample of 1,110 participants (aged 55-75 years) from the Prevención con Dieta Mediterránea-Plus (PREDIMED-Plus) trial was followed for 1 year. The combined effects of 1-year changes in EI and PA on reduction of ≥5% in baseline body weight and total fat, and on ≥5% increments in lean mass were examined using dual-energy X-ray absorptiometry. Multivariate logistic regression models were used to assess the combined association. Multiplicative and additive interactions were tested.

Results: Participants who had reduced EI and increased PA over 1 year were significantly more likely to exhibit ≥5% reduction in body weight (odds ratio [OR], 3.24; 95% confidence interval [CI], 1.83 to 5.72) and fat mass (OR, 2.13; 95% CI, 1.23 to 3.69) and ≥5% increase in lean mass (OR, 2.46; 95% CI, 1.24 to 4.87) compared to those who had increased EI and reduced PA. A potential for biological, rather than statistical, interaction between PA and EI was found, with synergy index (>1): 1.08 (95% CI, 0.58 to 1.99) for beneficial changes in body weight, 1.88 (95% CI, 0.41 to 8.65) for fat mass, and 1.44 (95% CI, 0.43 to 4.88) for lean mass.

Conclusion: Encouraging an increase in PA with complementary nutritional education to reduce dietary EI may be more effective in managing body composition in older adults with overweight/obesity and metabolic syndrome than focusing on lifestyle behaviors alone.

Background: This study was conducted to examine the association of body mass index (BMI)-adjusted body cell mass (BCM; BCM_bmi) and lean body mass (LBM; LBM_bmi) with metabolic markers, metabolic syndrome (MetS), and insulin resistance (IR) in middle-aged and older Korean adults.

Methods: This cross-sectional study included 9,522 adults (4,456 males and 5,066 females) without a history of myocardial infarction, stroke, or cancer from the Ansan-Ansung Study of the Korean Genome and Epidemiology Study. Multivariable linear regression was conducted to evaluate the association of BCM_bmi and LBM_bmi with metabolic markers. Logistic regression analyses were conducted to evaluate the association of BCM_bmi and LBM_bmi with metabolic abnormalities, including MetS and IR. MetS diagnosis followed National Cholesterol Education Program Adult Treatment Panel III criteria, and IR was assessed using the homeostatic model assessment index of insulin resistance (HOMA-IR).

Results: BCM_bmi and LBM_bmi were negatively associated with fasting glucose, fasting insulin, HOMA-IR, triglycerides, alanine/aspartate aminotransferase, uric acid, and high-sensitivity C-reactive protein, while they were positively associated with high-density lipoprotein cholesterol. The magnitudes of regression coefficients were generally greater for BCM_bmi than for LBM_bmi. A total of 3,590 (37.7%) and 3,490 (36.7%) participants were categorized as having MetS and IR. Compared to the lowest tertile of BCM_bmi, the highest tertiles were associated with lower odds ratio of MetS (males: 0.36 [95% confidence interval, CI, 0.30 to 0.42], females: 0.23 [95% CI, 0.20 to 0.27]) and IR (males: 0.34 [95% CI, 0.30 to 0.40], females: 0.33 [95% CI, 0.28 to 0.38]), all with significant trends (P for trend <0.001).

Conclusion: The results suggest that BCM_bmi is independently associated with metabolic markers and demonstrate comparable predictive power to LBM_bmi for MetS and IR, particularly in males.

Amylin is a pancreatic peptide hormone that regulates blood glucose levels and appetite. This review outlines the physiological role of amylin and highlights recent clinical studies exploring its therapeutic potential in diabetes and obesity. Amylin lowers postprandial glucose levels by delaying gastric emptying and suppressing glucagon secretion, while promoting satiety via central nervous system pathways. Preclinical research has driven the development of long-acting amylin analogs with enhanced pharmacokinetics and reduced aggregation, resulting in significant weight loss and metabolic benefits in animal models. Clinically, the synthetic analog pramlintide has been shown to modestly improve glycemic control and induce weight loss in patients with diabetes. More recently, cagrilintide, a long-acting analog, has produced substantial weight reduction in individuals with obesity. Combination therapy with glucagon like peptide-1 receptor agonists has achieved synergistic effects, with weight loss exceeding 15%, positioning amylin analogs as a promising approach for treatment of diabesity-the co-existence of diabetes and obesity. This review summarizes recent advancements and discusses their implications for future therapeutic applications in diabesity management.

Severe obesity is frequently accompanied by restricted joint mobility and chronic pain, both of which compromise quality of life and functional independence. Despite well-documented benefits of exercise in managing severe obesity, adherence remains low due to perceived physical limitations and discomfort. This study identified primary physical limitations faced by individuals with severe obesity and proposed evidence-based, accessible exercise modalities tailored to their needs. A systematic literature search was conducted using Scopus, PubMed, Web of Science, and Google Scholar. Search terms included combinations of 'obese,' 'severe obesity,' 'exercise,' 'training,' 'stability,' 'mobility,' and 'pain.' Ten studies examining effects of exercise interventions on mobility, stability, and pain in severely obese individuals were selected based on predefined inclusion criteria. Findings consistently indicated that low-impact exercise modalities such as yoga-based stretching, core training, and stabilization exercises using balance pads, chairs, and gym balls significantly improve mobility, enhance postural stability, and reduce musculoskeletal pain over intervention periods as short as 4 weeks. Interventions incorporating core muscle stretching and instability-based training were particularly effective in improving functional outcomes and balance control. This review highlights prevalent musculoskeletal and neuromuscular impairments associated with severe obesity and underscores the functional role of core musculature in mitigating these limitations. Based on synthesized evidence, we propose a set of low-complexity, high-accessibility exercise strategies feasible in both clinical and home-based settings. These recommendations provide a practical framework for improving physical function and reducing pain among individuals with severe obesity, supporting more sustainable engagement in physical activity.

Background: Social connections impact morbidity and mortality, yet their influence on waist circumference (WC) and potential gender differences remains unclear.

Methods: Prospective study of the Canadian Longitudinal Study on Aging (CLSA, 2011-2021) on changes in marital status, living arrangements, and social participation (baseline to follow-up 1) in relation to changes in WC (follow-up 1 to follow-up 2) used stratified, multivariable random coefficient regression with post-estimated predicted means. Sample sizes varied: 13,941 participants for marital and living arrangement transitions and 13,921 for changes in social participation.

Results: Mean WC declined over time in aging cisgender heterosexual women and men in Canada. We found genders-specific associations between changes in different social connections changes in mean WC. Among women, decreased social participation was significantly associated with changes in WC (0.47 cm; 95 confidence interval [CI], 0.11 to 0.83), compared to women with stable social participation. Among men, becoming divorced was significantly associated with changes in WC (1.45 cm; 95% CI, 0.14 to 2.75), compared to men remained partnered. Women who decreased their social participation had a predicted mean WC of 87.61 cm (95% CI, 87.14 to 88.09), and men who became divorced had a predicted mean WC of 100.54 cm (95% CI, 99.17 to 101.91). Results for living arrangement changes were not significant, though patterned appeared gendered. All social connection transitions were associated with clinically meaningful predicted mean WC, placing both women and men with altered connections in the 'high risk' category for poor health outcomes.

Conclusion: Decreased social participation increased WC among cisgender heterosexual women, whereas becoming divorced increased WC among cisgender heterosexual men in Canada.

Background: Serum ferritin is well known to be associated with chronic inflammation and insulin resistance. This study investigates urinary ferritin as a potential non-invasive biomarker for metabolic alterations and insulin resistance.

Methods: This study analyzed ferritin levels in urine samples from two independent cross-sectional cohorts: IRONMET-continuous glucose monitoring (CGM) (a middle-aged cohort, n=78) and Aging Imageomics (an aged cohort, n=47). Associations between urinary ferritin and clinical and biochemical parameters were assessed using correlation analyses. Untargeted plasma metabolomics was performed in the IRONMET-CGM cohort, and differentially abundant metabolites associated with urinary ferritin and ultrasensitive C-reactive protein were identified using linear models for microarray regression analysis.

Results: In the IRONMET-CGM cohort, urinary ferritin correlated positively with serum glucose, serum ferritin, and transferrin saturation and negatively with transferrin and total iron-binding capacity. In the Aging Imageomics cohort, urinary ferritin showed positive associations with serum glucose, fasting plasma insulin, low-density lipoprotein cholesterol, serum ferritin, right ankle diastolic blood pressure, and the percentage of mean arterial pressure of the right brachial pulse wave and a negative association with high-density lipoprotein cholesterol. Plasma metabolomics profiling revealed that urinary ferritin was positively associated with succinic acid, adipic acid and cis-4-decenoic acid concentrations, suggesting disruptions in fatty acid metabolism. In contrast, metabolites linked to elevated ultrasensitive C-reactive protein, including 3-hydroxyanthranilic acid and formyl-5-hydroxykynurenamine, were associated with the kynurenine pathway and systemic inflammation.

Conclusion: Urinary ferritin is a promising, non-invasive marker of iron metabolism disturbances and metabolic dysregulation. Its associations with glucose metabolism, lipid profiles, and distinct metabolomics signatures suggest potential utility for early detection of metabolic alterations.