Journal of Obesity & Metabolic Syndrome最新文献

Background: Bariatric surgery (BS) is an effective intervention for morbid obesity; however, it is often accompanied by undesirable muscle mass loss, which can negatively affect metabolic function and physical performance. Probiotics and resistance training have been studied discretely to address this complication. The present randomized controlled trial investigated the independent and combined effects of probiotic-enriched yogurt and resistance training on muscle preservation and related health outcomes in post-BS patients.

Methods: In this parallel, randomized controlled trial, 52 participants who had recently undergone BS and met the eligibility criteria were randomly assigned to one of four groups: group A (probiotic-enriched yogurt plus resistance training [FY+RT]), group B (probiotic-enriched yogurt [FY]), group C (resistance training [RT]), and group D (control), with 13 participants in each group. Anthropometric indices, body composition, functional performance, inflammatory and oxidative stress markers, lipid profile, and liver enzymes were measured at baseline and after a 12-week intervention.

Results: All participants completed the intervention. The FY+RT group showed the greatest preservation of muscle mass, with the smallest reductions in fat-free mass percentage (-2.32%, P=0.001) and skeletal muscle mass (-1.34 kg, P<0.001). This group also exhibited significant improvements in muscle strength, as measured by hand grip strength (P=0.038) and 30-second chair stand test repetitions (P<0.001).

Conclusion: The combination of probiotic-enriched yogurt and resistance training was the most effective strategy for preserving muscle mass and improving strength following BS. Further research is warranted to elucidate the underlying mechanisms and validate these findings.

Background: Current evidence concerning a link between metabolic phenotypes and their dynamic changes over time and the risk of cancer is limited. The present study aimed to assess the association between different metabolic health statuses and the risk of cancer occurrence among adult individuals.

Methods: This prospective cohort study enrolled 11,445 adults aged ≥18 years from the Tehran Lipid and Glucose Study and followed them for 18 years. We identified metabolic phenotypes based on the Joint Interim Statement. Accordingly, participants were divided into four groups: metabolically healthy normal weight/overweight (MHNW/OW), metabolically unhealthy normal weight (MUNW)/OW, metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO). Cox proportional hazards modeling was performed to assess the association between metabolic phenotype and the risk of cancer occurrence.

Results: The multivariable adjusted hazard ratio (HR) (95% confidence interval [CI]) for cancer risk in participants with the MUNW/OW phenotype was 1.37 (95% CI, 1.04 to 1.82) and that in those with the MUO phenotype was 1.84 (95% CI, 1.21 to 2.79) when compared to those with the MHNW/OW phenotype, respectively. More particularly, the risk of breast cancer was higher in women with the MHO phenotype (HR, 3.60; 95% CI, 1.34 to 9.60) as well as those with the MUO phenotype (HR, 4.69; 95% CI, 1.96 to 11.20) relative to those with the MHNW/OW phenotype. Ultimately, however, we found no relationship between phenotype transition and the risk of cancer occurrence.

Conclusion: Based on our findings, metabolically unhealthy phenotypes may be associated with a higher overall incidence of cancer. In addition, obesity, independent of metabolic status, was linked to an increased risk of breast cancer incidence. No association between the transition from a metabolically healthy to unhealthy phenotype and cancer risk was established.

Background: Reduced handgrip strength (HGS) is associated with adverse cardiometabolic outcomes. This study aimed to determine reference values for HGS among Korean youth and young adults and to evaluate their relationships with metabolic syndrome (MS).

Methods: We analyzed data from 9,024 individuals aged 10 to 29 years in the Korean National Health and Nutrition Examination Survey (2014-2019). The adjusted combined handgrip strength (aCHGS; the average of maximum values from the two hands divided by body weight) was used as the primary outcome variable. Percentile curves for aCHGS were generated using the LMS method and locally estimated scatterplot smoothing regression analysis, excluding outliers. Associations between aCHGS z-scores and MS were assessed.

Results: Percentile curves for aCHGS plateaued after 20 years in both sexes. At age 10 years, aCHGS was comparable between males and females. Males showed a marked rise in aCHGS after mid-adolescence, maintaining higher levels thereafter. The adjusted odds ratio for MS was 0.313 (95% confidence interval [CI], 0.276 to 0.354) using International Diabetes Federation (IDF) criteria and 0.348 (95% CI, 0.310 to 0.390) using modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. aCHGS z-scores demonstrated strong predictive power for MS (area under the curve, 0.802 for IDF and 0.776 for modified NCEP-ATP III criteria). The optimal aCHGS z-score cutoff values for predicting MS were -0.508 (IDF) and -0.519 (modified NCEP-ATP III).

Conclusion: We established age- and sex-specific aCHGS reference values among Korean youth and young adults, demonstrating effectiveness in predicting MS risk. These standards may serve as a practical clinical tool to identify individuals at increased risk of MS early in development.

Background: Insulin resistance is a central feature of type 2 diabetes mellitus (T2DM), which remains a major global health burden with limited therapies that directly address upstream molecular defects. Pyruvate dehydrogenase kinase 4 (PDK4), a regulator of glucose and lipid metabolism, has emerged as a promising therapeutic target. Here, we evaluated the metabolic effects of GM-10395, an orally available PDK4 inhibitor, in preclinical models of insulin resistance.

Methods: We evaluated the metabolic effects of GM-10395, an orally available PDK4 inhibitor, in preclinical models of insulin resistance. In alpha mouse liver 12 (AML12) hepatocytes, we assessed protein kinase B (AKT) phosphorylation, mitochondrial reactive oxygen species (ROS), and oxygen consumption rate (OCR). In vivo, long-term oral administration of GM-10395 (8 weeks in KKAy mice [n=6 per group] and 5 weeks in diet-induced obesity [DIO] mice [n=6 per group]) was evaluated for effects on glucose tolerance, glycosylated hemoglobin, lipid profiles, and liver histology.

Results: GM-10395 restored AKT phosphorylation, reduced ROS generation, and normalized OCR in palmitate-treated AML12 cells. In both KKAy and DIO mice, GM-10395 significantly improved glucose tolerance and reduced hepatic steatosis. Serum lipid analysis revealed reductions in low-density lipoprotein cholesterol and triglycerides, with histology confirming decreased lipid deposition. Enhanced insulin signaling, evidenced by increased phosphorylated AKT (pAKT)/total AKT (tAKT) ratios in liver, muscle, and adipose tissues, was consistently observed.

Conclusion: GM-10395 improves systemic glucose and lipid homeostasis by restoring insulin sensitivity via PDK4 inhibition. These results support GM-10395 as a promising oral therapeutic candidate for insulin resistance in T2DM.

Background: The gut microbiota plays a vital role in various physiological processes, including metabolism. Fecal microbiota transplantation (FMT) involves transferring fecal matter from a healthy donor to rebalance a patient's intestinal dysbiosis. The impact of FMT on metabolic syndrome (MetS) is subject to debate. This study assesses the effects of FMT on MetS when administered by rectal enema.

Methods: In a double-blind, randomized controlled trial, subjects with MetS were assigned to receive either FMT (n=8) or a sham intervention (n=10) via rectal enema. Participants were followed at 6 and 12 weeks. The primary outcome was changes in the homeostatic model assessment of insulin resistance (HOMA-IR). Secondary outcomes included fasting blood glucose (FBG), body mass index (BMI), inflammatory markers, and hepatic steatosis. The mean adjusted difference (MAD) and 95% confidence interval (CI) between groups were reported as treatment effects using a linear marginal model for repeated measures.

Results: The study included patients with a mean age of 50.4±10.7 years. Baseline BMI and HOMA-IR were similar between groups. Over 6 weeks, FMT significantly improved HOMA-IR (MAD, -1.63; 95% CI, -2.63 to -0.64; P=0.001). The FMT group also showed improvements in serum FBG and high-sensitivity C-reactive protein compared with levels in the sham group (P=0.044 and P=0.025, respectively). However, no significant changes in MetS-associated variables or liver steatosis were evident at 12 weeks. Stool microbiota analysis revealed a reduced relative abundance of Desulfovibrio, Bacteroides, and Parabacteroides after FMT.

Conclusion: FMT by rectal enema produced favorable changes in IR in patients with MetS. FMT may be an effective treatment for patients with metabolism-related diseases. Further research into the long-term benefits of the procedure is warranted.

The Korean Society for the Study of Obesity has published the 9th edition of its Clinical Practice Guidelines to provide updated, evidence-based recommendations for the management of overweight and obesity. Developed through a structured process of systematic literature review and expert consensus, these guidelines incorporate recent clinical evidence for obesity management. Key clinical questions were formulated using the Population, Intervention, Comparison, and Outcome framework and addressed through comprehensive evaluations of randomized controlled trials, cohort studies, systematic reviews, and existing guidelines. Major updates include the inclusion of the concept of clinical obesity, defined as excessive adiposity with tissue and organ dysfunction. The revised guidelines expand recommendations for pharmacologic treatments and introduce a new section on health functional foods. Emphasis is placed on early assessment of treatment response and individualized therapeutic adjustments to improve long-term outcomes. The guidelines also highlight the importance of recognizing obesity-related health conditions and ensuring equitable access to care. They promote shared decision-making and ethical prescribing practices to support a person-centered approach. All recommendations are evaluated using the Grading of Recommendations Assessment, Development and Evaluation system, which reflects the strength of evidence and the balance of expected benefits and harms. These updates are intended to assist healthcare providers in delivering personalized, evidence-informed care and underscore the evolving role of pharmacotherapy within risk-based obesity management strategies.

Background: Morbid obesity is a well-established risk factor for cardiovascular disease. Diastolic dysfunction, particularly in non-cardiac surgeries, has been associated with increased incidence of adverse cardiovascular events. This study aimed to evaluate the prevalence of diastolic dysfunction in morbidly obese patients undergoing bariatric surgery and to identify associated clinical risk factors using transesophageal echocardiography (TEE).

Methods: In this prospective observational study, 113 morbidly obese patients scheduled for bariatric surgery between April 2019 and January 2023 were enrolled. Diastolic function was assessed after anesthesia induction using TEE and categorized as normal or grade I, II, or III dysfunction based on the E/e' ratio. The primary study outcome was the prevalence of diastolic dysfunction, while secondary outcomes included identification of risk factors, development of a predictive score and evaluation of perioperative complications.

Results: Diastolic dysfunction was identified in 45.1% of patients (grade I: 21.2%; grade II: 19.5%; and grade III: 4.4%). Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01 to 1.08) and continuous positive airway pressure (CPAP) use for obstructive sleep apnea (OSA) (OR, 4.22; 95% CI, 1.02 to 17.55) were significantly associated with high-grade dysfunction (grades II-III). A predictive score demonstrated high diagnostic accuracy with a cutoff of >120 points. The score was calculated as (age×2)+(coronary artery disease×51)+(chronic kidney disease×102)+(OSA without CPAP×2)+(OSA with CPAP×63). Postoperative outcomes did not differ significantly between groups.

Conclusion: Diastolic dysfunction is prevalent among morbidly obese patients undergoing bariatric surgery. A predictive score exceeding 120 points may aid in identifying individuals at elevated risk.