Vitamin D status of pregnant women with obesity in the UK and its association with pregnancy outcomes: a secondary analysis of the UK Pregnancies Better Eating and Activity Trial (UPBEAT) study.

Prenatal vitamin D deficiency is widely reported and may affect perinatal outcomes. In this secondary analysis of the UK Pregnancies Better Eating and Activity Trial, we examined vitamin D status and its relationship with selected pregnancy outcomes in women with obesity (BMI ≥ 30 kg/m2) from multi-ethnic inner-city settings in the UK. Determinants of vitamin D status at a mean of 17 ± 1 weeks' gestation were assessed using multivariable linear regression and reported as percent differences in serum 25-hydroxyvitamin D (25(OH)D). Associations between 25(OH)D and clinical outcomes were examined using logistic regression. Among 1089 participants, 67 % had 25(OH)D < 50 nmol/l and 26 % had concentrations < 25 nmol/l. In fully adjusted models accounting for socio-demographic and anthropometric characteristics, 25(OH)D was lower among women of Black (% difference = -33; 95 % CI: -39, -27), Asian (% difference = -43; 95 % CI: -51, -35) and other non-White (% difference = -26; 95 % CI: -35, -14) ethnicity compared with women of White ethnicity (n 1086; P < 0·001 for all). In unadjusted analysis, risk of gestational diabetes was greater in women with 25(OH)D < 25 nmol/l compared with ≥ 50 nmol/l (OR = 1·58; 95 % CI: 1·09, 2·31), but the magnitude of effect estimates was attenuated in the multivariable model (OR = 1·33; 95 % CI: 0·88, 2·00). There were no associations between 25(OH)D and risk of preeclampsia, preterm birth or small for gestational age or large-for-gestational-age delivery. These findings demonstrate low 25(OH)D among pregnant women with obesity and highlight ethnic disparities in vitamin D status in the UK. However, evidence for a greater risk of adverse perinatal outcomes among women with vitamin D deficiency was limited.

The Modeled Cost-Effectiveness of a Prevention Program Targeting Both Eating Disorders and High BMI.

OBJECTIVE: Prevention programs for eating disorders (EDs) and high body index mass (BMI) have the potential to reduce the onset of these interconnected public health concerns. However, it remains unclear whether routine implementation of such programs would be cost-effective. This study aims to determine the cost-effectiveness of an intervention that aims to prevent both ED and high BMI. METHOD: A Markov model was developed to evaluate the incremental cost-effectiveness of a targeted school-based program, Healthy Weight, that aims to prevent both EDs and high BMI among Australian adolescents with body image concerns (aged 15-18 years), versus a "no intervention" comparator. A cost-utility analysis was conducted from a "healthcare and education" sector perspective with costs (measured in 2019 Australian dollars) and health impacts modeled over the lifetime of the target population. An incremental cost-effectiveness ratio (ICER), expressed as cost per health-adjusted life year (HALY) gained, was calculated. Sensitivity analyses were done to test model assumptions. RESULTS: The mean intervention cost and HALYs gained were AUD$2.13 million (95% CI, AUD$1.83-2.43 million) and 146 (95% CI, 90-209), respectively. With healthcare cost-savings (AUD$3.97 million) included, the intervention was predicted to be cost-saving (AUD$1.83 million; 95% CI, AUD$0.51-3.21 million). Primary findings were robust to extensive sensitivity analyses. DISCUSSION: The Healthy Weight intervention is likely to represent good value-for-money. To ensure the successful implementation of this program at the population level, further research on its feasibility and acceptability among schools and the wider community is required.

Associations of polymetabolic risk of high maternal pre-pregnancy body mass index with pregnancy complications, birth outcomes, and early childhood neurodevelopment: findings from two pregnancy cohorts.

BACKGROUND: A substantial proportion of maternal pregnancy complications, adverse birth outcomes and neurodevelopmental delay in children may be attributable to high maternal pre-pregnancy Body Mass Index (BMI). However, BMI alone is insufficient for the identification of all at-risk mothers and children as many women with non-obesity(< 30 kg/m2) or normal weight(18.5-24.99 kg/m2) and their children may suffer from adversities. Evidence suggests that BMI-related metabolic changes during pregnancy may predict adverse mother-child outcomes better than maternal anthropometric BMI. METHODS: In a cohort of 425 mother-child dyads, we identified maternal BMI-defined metabolome based on associations of 95 metabolic measures measured three times during pregnancy with maternal pre-pregnancy BMI. We then examined whether maternal BMI-defined metabolome performed better than anthropometric BMI in predicting gestational diabetes, hypertensive disorders, gestational weight gain (GWG), Caesarian section delivery, child gestational age and weight at birth, preterm birth, admission to neonatal intensive care unit (NICU), and childhood neurodevelopment. Based on metabolic measures with the highest contributions to BMI-defined metabolome, including inflammatory and glycolysis-related measures, fatty acids, fluid balance, ketone bodies, lipids and amino acids, we created a set of maternal high BMI-related polymetabolic risk scores (PMRSs), and in an independent replication cohort of 489 mother-child dyads tested their performance in predicting the same set of mother-child outcomes in comparison to anthropometric BMI. RESULTS: BMI-defined metabolome predicted all of the studied mother-child outcomes and improved their prediction over anthropometric BMI, except for gestational hypertension and GWG. BMI-related PMRSs predicted gestational diabetes, preeclampsia, Caesarian section delivery, admission to NICU, lower gestational age at birth, lower cognitive development score of the child, and improved their prediction over anthropometric BMI. BMI-related PMRSs predicted gestational diabetes, preeclampsia, Caesarean section delivery, NICU admission and child's lower gestational age at birth even at the levels of maternal non-obesity and normal weight. CONCLUSIONS: Maternal BMI-defined metabolome improves the prediction of pregnancy complications, birth outcomes, and neurodevelopment in children over anthropometric BMI. The novel, BMI-related PMRSs generated based on the BMI-defined metabolome have the potential to become biomarkers identifying at-risk mothers and their children for timely targeted interventions even at the level of maternal non-obesity and normal weight.

Spatial and temporal patterns of disease burden attributable to high BMI in Belt and Road Initiative countries, 1990-2019.

OBJECTIVE: This study aimed to analyse the spatial and temporal patterns of disease burden attributed to high BMI (DB-hBMI) from 1990 to 2019 in Belt and Road Initiative (BRI) countries, in light of increasing hBMI prevalence worldwide. DESIGN: The study was a secondary analysis of Global Burden of Disease 2019 (GBD 2019) that analysed (using Joinpoint regression analysis) numbers and the age-standardised rate of mortality and disability-adjusted life years (DALY) of hBMI-induced diseases and their trends from 1990 to 2019 and in the final decade. SETTING: GBD 2019 study data for BRI countries were categorised by country, age, gender and disease. PARTICIPANTS: GBD 2019 data were used to analyse DB-hBMI in BRI countries. RESULTS: In 2019, China, India and Russia reported the highest mortality and DALY among BRI countries. From 1990 to 2019, the age-standardised DALY increased in Southeast Asia and South Asia, whereas many European countries saw declines. Notably, Bangladesh, Nepal and Vietnam showed the steepest increases, with average annual percentage change (AAPC) values of 4·42 %, 4·19 % and 4·28 %, respectively (all P < 0·05). In contrast, Israel, Slovenia and Poland experienced significant reductions, with AAPC values of -1·70 %, -1·63 % and -1·58 %, respectively (all P < 0·05). The most rapid increases among males were seen in Vietnam, Nepal and Bangladesh, while Jordan, Poland and Slovenia recorded the fastest declines among females. Across most BRI countries, the burden of diabetes and kidney diseases related to hBMI showed a significant uptrend. CONCLUSION: DB-hBMI varies significantly by region, age, gender and disease type across BRI countries. It can pose a substantial threat to public health.

How are overweight and obesity associated with reinforcement learning deficits? A systematic review.

Reinforcement learning (RL) refers to the ability to learn stimulus-response or response-outcome associations relevant to the acquisition of behavioral repertoire and adaptation to the environment. Research data from correlational and case-control studies have shown that obesity is associated with impairments in RL. The aim of the present study was to systematically review how obesity and overweight are associated with RL performance. More specifically, the relationship between high body mass index (BMI) and task performance was explored through the analysis of specific RL processes associated with different physiological, computational, and behavioral manifestations. Our systematic analyses indicate that obesity might be associated with impairments in the use of aversive outcomes to change ongoing behavior, as revealed by results involving instrumental negative reinforcement and extinction/reversal learning, but further research needs to be conducted to confirm this association. Hypotheses regarding how obesity might be associated with altered RL were discussed.

The Impact of a Lifestyle Intervention on Cardiometabolic Risk Factors among Postpartum Hispanic Women with Overweight and Obesity in a Randomized Controlled Trial (Proyecto Mamá).

INTRODUCTION: Maternal overweight or obesity has been associated with metabolic syndrome through 1 year postpartum, but it remains unknown whether a culturally-modified, motivationally-targeted, and individually-tailored Lifestyle Intervention could improve postpartum cardiometabolic health among Hispanic women with overweight or obesity. METHODS: Proyecto Mamá was a randomized controlled trial conducted in Western Massachusetts from 2014 to 2020 in which Hispanic women with overweight/obesity were randomized to a Lifestyle Intervention (LI) involving diet and exercise or to a comparison Health and Wellness Intervention (HW). Biomarkers of cardiovascular risk (i.e., lipids, C-reactive protein) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment [HOMA-IR], leptin, adiponectin) were measured at baseline (early pregnancy), mid-pregnancy, and 6 weeks, 6 months, and 12 months postpartum. Generalized linear mixed effect models were used to evaluate differences in the change in biomarkers over the course of postpartum follow-up time. RESULTS: In intent-to-treat analyses among eligible women (LI; n=51, HW; n=58) there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year; for example, the intervention effect for total cholesterol was 6.98 (SE: 6.36, p=0.27) and for HbA1c was -0.01 (SE: 0.4, p=0.85). In pooled analyses, regardless of intervention arm, women who participated in any vigorous activity had less of an increase in HbA1c (intervention effect = -0.17, SE: 0.05, p=0.002) compared to those with no vigorous activity, and similarly beneficial associations with other cardiovascular risk biomarkers (p<0.05). DISCUSSION: Women who participated in vigorous activity, regardless of their assigned intervention arm, had more favorable changes in biomarkers of insulin resistance.

Characterising the prevalence of overweight and obese status among adults with sickle cell disease.

Individuals with sickle cell disease (SCD) have historically been considered underweight. Despite increasing body mass index (BMI) in the general population, the prevalence of overweight and obese status remains unclear in the adult SCD population. Our primary aim was to determine the prevalence of overweight and obese status and to identify associations between BMI, demographic, and clinical characteristics. We conducted an analysis of abstracted electronic health record data and patient-reported outcomes from the Sickle Cell Disease Implementation Consortium registry; individuals aged 20-45 years were included. The median (interquartile range) BMI for the 1664 adults in this analysis was 23.9 (21.1-28) kg/m2 . In this cohort, 42.9% had a BMI of >25 kg/m2 (Centers for Disease Control and Prevention definition of overweight/obese). In multivariable analysis, higher odds of being overweight or obese were associated with female gender, older age, college education, private insurance, and hypertension diagnosis. Higher odds of a BMI of >25 kg/m2 were observed in individuals with HbSC or HbSß+ thalassaemia regardless of hydroxycarbamide (hydroxyurea) exposure (odds ratio [OR] 3.4, p < 0.0001) and HbSS or HbSß0 thalassaemia exposed to hydroxycarbamide (OR 1.6, p = 0.0003) compared to those with HbSS or HbSß0 thalassaemia with no hydroxycarbamide exposure. These data highlight the importance of early identification, prevention, and intervention for increasing BMI to reduce obesity-related complications that may impact SCD-related complications.

The global prevalence of overweight and obesity among nurses: A systematic review and meta-analyses.

BACKGROUND: Several studies have reported the prevalence of overweight and obesity in various countries but the global prevalence of nurses with overweight and obesity remains unclear. A consolidation of figures globally can help stakeholders worldwide improve workforce development and healthcare service delivery. OBJECTIVE: To investigate the global prevalence of overweight and obesity among nurses. DESIGN: Systematic review with meta-analysis. SETTING: 29 different countries across the WHO-classified geographical region. PARTICIPANTS: Nurses. METHODS: Eight electronic databases were searched for articles published from inception to January 2023. Two independent reviewers performed the article screening, methodological appraisal and data extraction. Methodological appraisal was conducted using Newcastle-Ottawa Scale (NOS). Inter-rater agreement was measured using Cohen's Kappa. Meta-analyses were conducted to pool the effect sizes on overweight, obesity and waist circumference using random effects model and adjusted using generalised linear mixed models and Hartung-Knapp method. Logit transformation was employed to stabilise the prevalence variance. Subgroup analyses were performed based on methodological quality and geographical regions. Heterogeneity was assessed using the I2 statistic. RESULTS: Among 10,587 studies, 83 studies representing 158,775 nurses across 29 countries were included. Based on BMI, the global prevalence of overweight and obesity were 31.2% (n = 55, 95% CI: 29%-33.5%; p < .01) and 16.3% (n = 76, 95% CI: 13.7%-19.3%, p < .01), respectively. Subgroup analyses indicated that the highest prevalence of overweight was in Eastern Mediterranean (n = 9, 37.2%, 95% CI: 33.1%-41.4%) and that of obesity was in South-East Asia (n = 5, 26.4%, 95% CI: 5.3%-69.9%). NOS classification, NOS scores, sample size and the year of data collected were not significant moderators. CONCLUSIONS: This review indicated the global prevalence of overweight and obesity among nurses along with the differences between regions. Healthcare organisations and policymakers should appreciate this increased risk and improve working conditions and environments for nurses to better maintain their metabolic health. PATIENT OR PUBLIC CONTRIBUTION: Not applicable as this is a systematic review. REGISTRATION: PROSPERO (ref: CRD42023403785) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=403785. TWEETABLE ABSTRACT: High prevalence of overweight and obesity among nurses worldwide.

Prevention of high body mass index and eating disorders: a systematic review and meta-analysis.

BACKGROUND: Eating disorders (EDs) and high body mass index (BMI) are two important public health issues with significant health and cost impacts. The aim of this systematic review and meta-analysis was to establish whether interventions are effective in preventing both issues. METHODS: Electronic databases were searched up to 10 May 2021. Studies were included if they were randomised or quasi-randomised controlled trials that evaluated a preventive intervention (regardless of its aim to prevent ED, high BMI or both) and reported both EDs and BMI-related outcomes. Both narrative synthesis and meta-analysis were used to synthesise the results. Publication bias was also investigated. RESULTS: Fifty-four studies were included for analysis. The primary aim of the studies was ED prevention (n = 23), high BMI prevention (n = 21) and both ED and high BMI prevention (n = 10). Meta-analysis results indicated that preventive interventions had a significant effect on several ED outcomes including dieting, shape and weight concerns, body dissatisfaction, negative affect, eating disorder symptoms and internalization, with effect sizes ranging from - 0.16 (95% CI - 0.27, - 0.06) to - 0.61 (95% CI - 0.29, - 0.04). Despite several studies that demonstrated positive impacts on BMI, there was no significant effect on BMI-related measures in the meta-analysis. The risk of publication bias was low for the majority of the pooled effect results. CONCLUSION: Preventive interventions were effective for either high BMI or EDs. However, there is limited evidence to show that current preventive interventions were effective in reducing both outcomes. Further research is necessary to explore the risk factors that are shared by these weight-related disorders as well as effective prevention interventions. LEVEL OF EVIDENCE: Level I: systematic review.

High body mass index is a significant risk factor for the progression and prognosis of imported COVID-19: a multicenter, retrospective cohort study.

BACKGROUND: Coronavirus disease 2019(COVID-19) has spread worldwide. The present study aimed to characterize the clinical features and outcomes of imported COVID-19 patients with high body mass index (BMI) and the independent association of BMI with disease severity. METHODS: In this retrospective cohort study, 455 imported COVID-19 patients were admitted and discharged in Zhejiang province by February 28, 2020. Epidemiological, demographic, clinical, laboratory, radiological, treatment, and outcome data were collected, analyzed and compared between patients with BMI ≥ 24and < 24. RESULTS: A total of 268 patients had BMI < 24, and 187 patients had BMI ≥ 24. Those with high BMI were mostly men, had a smoking history, fever, cough, and sputum than those with BMI < 24. A large number of patients with BMI ≥ 24 were diagnosed as severe/critical types. Some biochemical indicators were significantly elevated in patients with BMI ≥ 24. Also, acute liver injury was the most common complication in these patients. The median days from illness onset to severe acute respiratory syndrome coronavirus 2 detection, duration of hospitalization, and days from illness onset to discharge were significantly longer in patients with BMI ≥ 24 than those with BMI < 24. High BMI, exposure to Wuhan, any coexisting medical condition, high temperature, C-reactive protein (CRP), and increased lactate dehydrogenase (LDH) were independent risk factors for severe/critical COVID-19. After adjusting for age, sex and above factors, BMI was still independently associated with progression to severe/critical illness (P = 0.0040). Hemoglobin, alanine aminotransferase (ALT), CRP, and serum creatinine (Scr) were independent risk factors associated with high BMI. CONCLUSIONS: Contrasted with the imported COVID-19 patients with BMI < 24, high proportion of COVID-19 patients with BMI ≥ 24 in our study, especially those with elevated CRP and LDH, developed to severe type, with longer hospitalization duration and anti-virus course. Thus, high BMI is a risk factor for the progression and prognosis of imported COVID-19.

Age-period-cohort analysis of kidney cancer deaths attributable to high body-mass index in China and U.S. adults.

BACKGROUND: Statistical data on burden of kidney cancer and the relavant risk factors are valuable for policy-making. This study aims to estimate kidney cancer deaths and high body-mass index (BMI) attributable to the deaths by gender and age group in China adults, compared with U.S. METHODS: We extracted kidney cancer data (1990-2017) about the age-standardized rates using the comparative risk assessment framework of the 2017 Global Burden of Disease study. We performed an age-period-cohort (APC) analysis to estimate trends of kidney cancer mortality attributable to high BMI. RESULTS: During 1990-2017, age-standardized mortality rate of kidney cancer was increasing in China but decreasing in U.S. The mortality attributable to high BMI in China showed a general increasing trend, while that in U.S. men was increasing and tended to be stable in women since 1995. APC analysis showed a similar pattern of age effect between China and U.S. adults, which substantially increased from 20 to 24 to 90-94 age group. Differently, the period effect rapidly increased in China than U.S. adults during 1990-2017. The cohort effect peaked in the earlier cohort born in 1902-1906 in China, and it declined consistently in U.S. with exception of 1902-1906 and 1907-1911 birth cohort. CONCLUSIONS: The kidney cancer deaths attributable to high BMI, and period effect have been generally increasing in China adults, compared with U.S. adults in which the trend tends to be stable in recent years. The rapid aging may also intensify the increasing trend of kidney cancer death in China. Effective measures should be conducted on body weight control and care for kidney cancer prevention.

Mortality trends of colorectal cancer among overweight patients at the global and national levels.

PURPOSE: Colorectal cancer (CRC) is a commonly diagnosed malignancy with highly heterogeneous incidence and mortality rates worldwide. High body mass index (BMI) is a well-defined risk factor for CRC. The mortality trends of CRC among patients who are overweight contributions at the global and national levels are largely unknown. METHOD: We collected data on CRC-related mortality attributable to high BMI from 1990 to 2017 from the Global Burden of Disease Study 2017 database. The annual average percentage change (AAPC) was used to quantify the CRC age-standardized mortality rate (ASMR) trends. RESULTS: Globally, approximately 896,040 CRC-related deaths occurred in 2017, among which 73,222 (8.2%; 54,193 in men and 19,029 in women) deaths were attributable to high BMI. The high-BMI-related CRC ASMR increased from 0.81 per 100,000 in 1990 to 0.93 per 100,000 in 2017, with an AAPC of 0.42 (95% CI 0.36, 0.49). The increasing trend was consistent among populations of different sexes and ages. A more pronounced increase was found in men and in regions with middle or low socio-demographic indexes. CONCLUSION: The increase in high-BMI-related CRC mortality suggests scarce attention to overweight in the current prevention strategies and highlights its priority in future prevention strategies for CRC.

Severe maternal morbidity in women with high BMI in IVF and unassisted singleton pregnancies.

STUDY QUESTION: Is there a synergistic risk of severe maternal morbidity (SMM) in overweight/obese women who conceived by IVF compared to normal-weight women without IVF? SUMMARY ANSWER: SMM was more common in IVF pregnancies, and among overweight/obese women, but we did not detect a synergistic effect of both factors. WHAT IS KNOWN ALREADY: While much is known about the impact of overweight and obesity on success rates after IVF, there is less data on maternal health outcomes. STUDY DESIGN, SIZE, DURATION: This is a population-based cohort study of 114 409 singleton pregnancies with conceptions dating from 11 January 2013 until 10 January 2014 in Ontario, Canada. The data source was the Canadian Assisted Reproductive Technologies Register (CARTR Plus) linked with the Ontario birth registry (BORN Information System). PARTICIPANTS/MATERIALS, SETTING, METHODS: We included women who delivered at ≥20 weeks gestation, and excluded those younger than 18 years or with twin pregnancies. Women were classified according to the mode of conception (IVF or unassisted) and according to pre-pregnancy BMI (high BMI (≥25 kg/m2) or low-normal BMI (<25 kg/m2)). The main outcome was SMM, a composite of serious complications using International Classification of Diseases, 10th revision (ICD-10) codes. Secondary outcomes were gestational hypertension, pre-eclampsia, gestational diabetes and cesarean delivery. Adjusted risk ratios (aRR) with 95% CI were estimated using log binomial regression, adjusted for maternal age, parity, education, income and baseline maternal comorbidity. MAIN RESULTS AND THE ROLE OF CHANCE: Of 114 409 pregnancies, 1596 (1.4%) were IVF conceptions. Overall, 41.2% of the sample had high BMI, which was similar in IVF and non-IVF groups. We observed 674 SMM events (rate: 5.9 per 1000 deliveries). IVF was associated with an increased risk of SMM (rate 11.3/1000; aRR 1.89, 95% CI: 1.06-3.39). High BMI was modestly associated with SMM (rate 7.0/1000; aRR 1.23, 95% CI: 1.04-1.45) There was no interaction between the two factors (P = 0.22). We noted supra-additive effects of high BMI and IVF on the risk of pre-eclampsia and gestational diabetes, but not gestational hypertension or cesarean delivery. LIMITATIONS, REASONS FOR CAUTION: We were unable to assess outcomes according to reason for treatment. Type II error (beta ~25%) may affect our results. WIDER IMPLICATIONS OF THE FINDINGS: Our results support previous data indicating a greater risk of SMM in IVF pregnancies, and among women with high BMI. However, these factors do not interact. Overweight and obese women who seek treatment with IVF should be counseled about pregnancy risks. The decision to proceed with IVF should be based on clinical judgment after considering an individual's chance of success and risk of complications. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the Research Institute of the McGill University Health Centre (grant 6291) and also supported by the Trio Fertility (formerly Lifequest) Research Fund. The authors report no competing interests. TRIAL REGISTRATION NUMBER: Not applicable.

Exercise training during pregnancy reduces circulating insulin levels in overweight/obese women postpartum: secondary analysis of a randomised controlled trial (the ETIP trial).

BACKGROUND: The primary aim was to investigate if supervised exercise training during pregnancy could reduce postpartum weight retention (PPWR) three months after delivery in overweight and obese women. We also measured circulating markers of cardiometabolic health, body composition, blood pressure, and physical activity level. METHODS: This was a secondary analysis of a randomised controlled trial in which 91 women with BMI ≥ 28 kg/m2 were allocated 1:1 to an exercise program or a control group. Women in the exercise group were prescribed three weekly, supervised sessions of 35 min of moderate intensity walking/running followed by 25 min of resistance training. The control group received standard maternal care. Assessments were undertaken in early pregnancy, late pregnancy, and three months postpartum. PPWR was defined as postpartum body weight minus early pregnancy weight. RESULTS: Seventy women participated three months after delivery, and PPWR was -0.8 kg in the exercise group (n = 36) and -1.6 in the control group (n = 34) (95% CI, -1.83, 3.84, p = 0.54). Women in the exercise group had significantly lower circulating insulin concentration; 106.3 pmol/l compared to the control group; 141.4 pmol/l (95% CI, -62.78, -7.15, p = 0.01), and showed a tendency towards lower homeostatic measurement of insulin resistance (HOMA2-IR) (3.5 vs. 5.0, 95% CI, -2.89, 0.01, p = 0.05). No women in the exercise group compared to three women in the control group were diagnosed with type 2 diabetes postpartum (p = 0.19). Of the women in the exercise group, 46.4% reported of exercising regularly, compared to 25.0% in the control group (p = 0.16). CONCLUSIONS: Offering supervised exercise training during pregnancy among overweight/obese women did not affect PPWR three months after delivery, but reduced circulating insulin levels. This was probably due to a higher proportion of women being active postpartum in the exercise group. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT01243554 ), registration date: September 6, 2010.

Advanced dental maturity of Finnish 6- to 12-yr-old children is associated with high energy intake.

We studied the association of dental maturity with body mass index (BMI), energy intake, and macronutrient intake. A randomly selected subset (n = 148) of the Special Turku Coronary Risk Factor Intervention Project (STRIP) was invited to an oral follow-up study, and the 6- and 12-yr-examination data (n = 111, 60 boys) were used. Food records for four consecutive days and BMI values were extracted from the databank of the main STRIP project. The developmental stage of seven permanent mandibular teeth was assessed using panoramic radiographs. The resulting maturity scores were converted to dental age estimates. Three dental-maturity groups (delayed, average, and advanced) and two BMI groups [normal BMI (≤mean+1SD) and high BMI (>mean+1SD)] were formed. The dental age was higher than the chronological age by 0.6-0.8 yr. Maturity scores for girls were statistically significantly higher than for boys. The distribution of girls into dental-maturity groups at age 12 yr was different from that of the boys and there were more boys than girls among the high-BMI group. Children of the advanced dental-maturity group had a statistically significantly higher energy intake than children in the other groups. We conclude that advanced dental maturity is associated with higher energy intake.

Cementless TKA use as an alternative to cemented TKA in high BMI patients: A systematic review and meta-analysis.

Purpose: Obesity is prevalent, with nearly one-third of the world's population being classified as obese. In patients with high body mass index (BMI)/body mass undergoing total knee arthroplasty (TKA), there is an increase in strain placed on the implant fixation interfaces. As such, component fixation is a potential concern when performing TKA in the obese patient. To address the growing concerns around the longevity of implant fixation, some have advocated cementless over cemented fixation. However, there is no clear consensus on whether a cementless fixation has more favourable outcomes. The aim of this paper was to present a systematic review and meta-analysis of the existing evidence to establish if cementless TKA has a lower rate of aseptic loosening in high BMI patients when compared to cemented TKA procedures. Methods: A systematic review was performed, and the following databases Medical Literature Analysis and Retrieval System Online (1946 to date), PubMed (1966 to date) and Excerpta Medica Database (1974 to date) were searched. All studies comparing cementless to cemented TKA in patients with BMI > 30 were considered. Meta-analysis compared aseptic loosening and all-cause revision between cemented and uncemented implant use in BMI > 30 patients. Results: The search returned 91 articles in total; after duplicates were removed, the yield was 44 studies. Of the remaining studies that were assessed, three studies met the inclusion criteria for meta-analysis. The pooled odds ratio for all-cause revisions was 0.17 (95%, 0.08-0.36) in favour of uncemented implants (p < 0.01). The pooled odds ratio for aseptic loosening was 0.15 (95% confidence interval, 0.02-0.90) in favour of uncemented implants (p = 0.04). Conclusions: Meta-analysis demonstrated a significant decrease in all-cause revisions and revisions for aseptic loosening when using uncemented fixation in high BMI patients when compared to the use of cemented implants. Level of Evidence: The level of evidence is 1 for our systematic review.

Racial/Ethnic Differences in the Age-Varying Association Between Adherence to 8-5-2-1-0 Guidelines in Adolescents with High BMI.

PURPOSE: To examine the association between adherence to sleep, dietary, screen time, and physical activity (PA) (8-5-2-1-0) guidelines and risk of high body mass index (BMI ≥ 85 percentile) among U.S. adolescents and to assess for racial inequities and age-varying effects in these associations. METHODS: Data from the 2019 Youth Risk Behavior Surveillance System survey were used to conduct multivariable logistic regression models and moderation analysis by race/ethnicity and age using time-varying varying effect models (TVEM) and estimate associations of interest. RESULTS: Of the 13,518 adolescents aged ≥ 14 years, only 0.5% met all guidelines. Adolescents adhering to sleep guidelines had a 21% reduction in their odds of having a high BMI (OR 0.79, 95% CI 0.67-0.93). Those adhering to PA guidelines had a 34% reduction in their odds of having a high BMI (OR 0.66, 95% CI 0.56-0.79), and those adhering to screen time guidelines had a 17% reduction in their odds of having a high BMI (OR 0.83, 95% CI 0.72-0.95). TVEM showed associations between adherence to sleep and screen time guidelines with high BMI fluctuate and are at specific ages. TVEM revealed substantial racial/ethnic differences in the age-varying association between adherence to 8-5-2-1-0 guidelines and high BMI throughout adolescence. CONCLUSIONS: Associations between adherence to sleep and screen time guidelines and high BMI fluctuate with age, highlighting the need for nuanced interventions targeting 24-h movement guidelines (sleep, PA, and screen time) across adolescence, particularly given racial/ethnic disparities.

Global health impacts of high BMI: A 30-Year analysis of trends and disparities across regions and Demographics.

OBJECTIVE: This study explores the global disease burden associated with high Body Mass Index (BMI) from 1990 to 2021, using data from the Global Burden of Disease Study 2021 (GBD 2021). METHODS: We applied Joinpoint regression to assess trends in deaths and Disability-Adjusted Life Years (DALYs) and employed ARIMA models to project future BMI-related burdens. RESULTS: From 1990 to 2021, global deaths linked to high BMI surged by 153.97%, rising from 1.46 million to 3.71 million. DALYs increased by 167.57%, with the highest rises in North Africa, the Middle East, and South Asia. Women, particularly those aged 75 and above, experienced the most significant burden, with a faster rate of increase in disease burden compared to men post-2000. Future projections indicate a continued rise in BMI-related health impacts, particularly in low- and middle-income countries. CONCLUSIONS: The global disease burden attributable to high BMI is increasing rapidly, particularly in low- and middle-income regions. Targeted public health interventions, especially for women and the elderly, are crucial to addressing this growing health challenge.

Global burden and trends of leukemia attributable to high body mass index risk in adults over the past 30 years.

Background: High BMI (Body Mass Index) is a significant factor impacting health, with a clear link to an increased risk of leukemia. Research on this topic is limited. Understanding the epidemiological trends of leukemia attributable to high BMI risk is crucial for disease prevention and patient support. Methods: We obtained the data from the Global Burden of Disease Study, analyzing the ASR (age-standardized rates), including ASDR (age-standardized death rate) and age-standardized disability-adjusted life years (DALYs) rate, and estimated annual percentage change (EAPC) by gender, age, country, and region from 1990 to 2019. Results: In 2019, deaths and DALYs have significantly increased to 21.73 thousand and 584.09 thousand. The global age-standardized death and DALYs rates have slightly increased over the past 30 years (EAPCs: 0.34 and 0.29). Among four common leukemia subtypes, only CML (Chronic Myeloid Leukemia) exhibited a significant decrease in ASDR and age-standardized DALYs rate, with EAPC of -1.74 and -1.52. AML (Acute Myeloid Leukemia) showed the most pronounced upward trend in ASDR, with an EAPC of 1.34. These trends vary by gender, age, region, and national economic status. Older people have been at a significantly greater risk. Females globally have borne a higher burden. While males have shown an increasing trend. The regions experiencing the greatest growth in ASR were South Asia. The countries with the largest increases were Equatorial Guinea. However, It is worth noting that there may be variations among specific subtypes of leukemia. Regions with high Socio-demographic Index (SDI) have had the highest ASR, while low-middle SDI regions have shown the greatest increase in these rates. All ASRs values have been positively correlated with SDI, but there has been a turning point in medium to high SDI regions. Conclusions: Leukemia attributable to high BMI risk is gradually becoming a heavier burden globally. Different subtypes of leukemia have distinct temporal and regional patterns. This study's findings will provide information for analyzing the worldwide disease burden patterns and serve as a basis for disease prevention, developing suitable strategies for the modifiable risk factor.

Effect of High BMI on Human Bone Marrow-Derived Mesenchymal Stromal Cells.

Bone marrow-derived mesenchymal stromal cells (BMSCs) are attractive candidates in tissue engineering and regenerative medicine. Growing evidence has suggested that a high body mass index (BMI) can affect the properties of BMSCs, resulting in a reduced quality of the cells. However, the results are not consistent. Therefore, this study aimed to investigate the influences of high BMI on human BMSCs (hBMSCs). To avoid gender bias, BMSCs from females and males were studied independently. Finally, hBMSCs from 89 females and 152 males were separately divided into the normal BMI group (18.5 kg/m2 ≤ BMI < 25 kg/m2) and the high BMI group (BMI > 25 kg/m2). The cells were analyzed for the colony-forming potential; proliferation capacity; in vitro adipogenic, osteogenic, and chondrogenic differentiation potentials; and the expression of 32 common surface antigens. The results showed that high BMI did not change the number of colonies at passage 1 in females and males. In contrast, significantly reduced colony numbers at passage 4 (P4) were found in both female and male donors with high BMI. The doubling time of hBMSCs was comparable between the normal and the high BMI groups of females and males. Furthermore, the results of trilineage differentiation did not differ between the different BMI groups of males. In females, the high and the normal BMI groups also showed similar adipogenic and chondrogenic differentiation, while osteogenic differentiation was significantly enhanced in the high-BMI group. Regarding the expression of surface antigens, the expressions of CD200 and SSEA4 on hBMSCs were reduced in the high-BMI group of females and males, respectively. In conclusion, high BMI suppressed the clonogenicity of female and male hBMSCs at P4, improved the in vitro osteogenesis of female hBMSCs, and decreased the expressions of CD200 on hBMSCs in females and SSEA4 in males.