Mitochondrial DNA mosaicism in normal human somatic cells.

Somatic cells accumulate genomic alterations with age; however, our understanding of mitochondrial DNA (mtDNA) mosaicism remains limited. Here we investigated the genomes of 2,096 clones derived from three cell types across 31 donors, identifying 6,451 mtDNA variants with heteroplasmy levels of ≳0.3%. While the majority of these variants were unique to individual clones, suggesting stochastic acquisition with age, 409 variants (6%) were shared across multiple embryonic lineages, indicating their origin from heteroplasmy in fertilized eggs. The mutational spectrum exhibited replication-strand bias, implicating mtDNA replication as a major mutational process. We evaluated the mtDNA mutation rate (5.0 × 10-8 per base pair) and a turnover frequency of 10-20 per year, which are fundamental components shaping the landscape of mtDNA mosaicism over a lifetime. The expansion of mtDNA-truncating mutations toward homoplasmy was substantially suppressed. Our findings provide comprehensive insights into the origins, dynamics and functional consequences of mtDNA mosaicism in human somatic cells.

Association between Homocysteine and Vitamin D Levels in Asymptomatic Korean Adults.

An increased homocysteine level is a risk factor for cardiovascular disease, venous thromboembolism, cerebrovascular disease, and chronic kidney disease. In addition, vitamin D deficiency is associated with coronary artery disease and metabolic disorders. The present study included data from 1375 adults (895 men and 480 women) with a mean age of 52.62 ± 9.94 years who visited the Health Promotion Center of the University Hospital in Gyeonggi-do, Republic of Korea from January 2018 to December 2022 for routine checkups that included assessments of their homocysteine and vitamin D levels. Homocysteine levels were positively associated with age, a history of hypertension, a history of diabetes, current smoking habits, and levels of low-density lipoprotein cholesterol, creatinine, uric acid, and high-sensitivity C-reactive protein. By contrast, vitamin D levels were negatively associated with serum levels of homocysteine after adjusting for covariates (ß = -0.033, p < 0.001). Additional long-term prospective studies are needed to elucidate the presence of a causal relationship between vitamin D status and serum levels of homocysteine in asymptomatic Korean adults. An intervention trial is warranted to determine whether the administration of vitamin D is helpful for the primary prevention of cardiovascular disease by lowering the homocysteine level in this population.

Sunflower seed extract supplementation reduces body fat in adults with obesity: A double-blind, randomized, placebo-controlled trial.

Obesity is an important public health problem and socioeconomic burden. We hypothesized that an intake of sunflower seed extract (SUN-CA) would decrease body fat and then investigated the effects and safety of SUN-CA intake on body fat in adults with obesity as an option for obesity treatment. In this double-blind, randomized, placebo-controlled study, 100 adults with body mass indices of 25 to 31.9 kg/m2 were assigned to groups that received SUN-CA (n = 50) or a placebo (n = 50) and received 1 tablet/day containing 500 mg of SUN-CA or the placebo over a 12-week period. The primary endpoint was the change in mass and percentage of body fat. The group that received SUN-CA daily showed decreases in body fat mass greater than those in the placebo group (-0.9 ± 1.8 kg vs. -0.1 ± 1.4 kg, P = .043). In addition, body weight, body mass index, and hip circumference improved after the intake of SUN-CA relative to the changes in the placebo group. There was no intergroup differences in the prevalence of adverse events. The accumulation of excess body fat improved through the intake of 500 mg/day of SUN-CA containing 100 mg of chlorogenic acids for 12 weeks in adults with obesity without causing serious adverse side effects. SUN-CA could be an effective and safe management option for obesity. The trial was registered at Clinical Research Information Service (CRIS: https://cris.nih.go.kr/cris/index/index.do) as KCT0005733.

Somatic evolution of marine transmissible leukemias in the common cockle, Cerastoderma edule.

Transmissible cancers are malignant cell lineages that spread clonally between individuals. Several such cancers, termed bivalve transmissible neoplasia (BTN), induce leukemia-like disease in marine bivalves. This is the case of BTN lineages affecting the common cockle, Cerastoderma edule, which inhabits the Atlantic coasts of Europe and northwest Africa. To investigate the evolution of cockle BTN, we collected 6,854 cockles, diagnosed 390 BTN tumors, generated a reference genome and assessed genomic variation across 61 tumors. Our analyses confirmed the existence of two BTN lineages with hemocytic origins. Mitochondrial variation revealed mitochondrial capture and host co-infection events. Mutational analyses identified lineage-specific signatures, one of which likely reflects DNA alkylation. Cytogenetic and copy number analyses uncovered pervasive genomic instability, with whole-genome duplication, oncogene amplification and alkylation-repair suppression as likely drivers. Satellite DNA distributions suggested ancient clonal origins. Our study illuminates long-term cancer evolution under the sea and reveals tolerance of extreme instability in neoplastic genomes.

Associations between Dietary Patterns and Metabolic Syndrome: Findings of the Korean National Health and Nutrition Examination Survey.

Metabolic syndrome (MetS) is a multifactorial cluster of metabolic disorders related to cardiovascular disease and type 2 diabetes mellitus. Diet and dietary patterns are significant factors in the development and management of MetS. The associations between dietary patterns (i.e., high-carbohydrate [HCHO], high-fat [HF], and high-protein [HP] diets) and the prevalence of MetS in Koreans were examined using data from the Korean National Health and Nutrition Examination Survey, collected between 2018 and 2020. The study included data from 9069 participants (3777 men and 5292 women). The percentage of participants with MetS was significantly higher in the HCHO diet group than in the normal diet group in women. Women with HCHO diet were positively associated with elevated blood pressure and triglyceride levels based on a comparison with the normal diet group (p = 0.032 and p = 0.005, respectively). Men with an HF diet were negatively associated with elevated fasting glucose levels based on a comparison with the normal diet group (p = 0.014). Our findings showed that HCHO intake was strongly associated with a higher risk of MetS, especially elevated blood pressure and triglyceride levels in women, and an HF diet was negatively associated with elevated fasting glucose levels in men. Further prospective studies of the impact of dietary carbohydrate, fat, and protein proportions on metabolic health are needed. The optimal types and proportions of these dietary components, as well as the underlying mechanisms through which suboptimal proportions can lead to MetS, should also be investigated.

Widespread somatic L1 retrotransposition in normal colorectal epithelium.

Throughout an individual's lifetime, genomic alterations accumulate in somatic cells1-11. However, the mutational landscape induced by retrotransposition of long interspersed nuclear element-1 (L1), a widespread mobile element in the human genome12-14, is poorly understood in normal cells. Here we explored the whole-genome sequences of 899 single-cell clones established from three different cell types collected from 28 individuals. We identified 1,708 somatic L1 retrotransposition events that were enriched in colorectal epithelium and showed a positive relationship with age. Fingerprinting of source elements showed 34 retrotransposition-competent L1s. Multidimensional analysis demonstrated that (1) somatic L1 retrotranspositions occur from early embryogenesis at a substantial rate, (2) epigenetic on/off of a source element is preferentially determined in the early organogenesis stage, (3) retrotransposition-competent L1s with a lower population allele frequency have higher retrotransposition activity and (4) only a small fraction of L1 transcripts in the cytoplasm are finally retrotransposed in somatic cells. Analysis of matched cancers further suggested that somatic L1 retrotransposition rate is substantially increased during colorectal tumourigenesis. In summary, this study illustrates L1 retrotransposition-induced somatic mosaicism in normal cells and provides insights into the genomic and epigenomic regulation of transposable elements over the human lifetime.

Angstrom-Confined Electrochemical Synthesis of Sub-Unit-Cell Non-Van Der Waals 2D Metal Oxides.

Bottom-up electrochemical synthesis of atomically thin materials is desirable yet challenging, especially for non-van der Waals (non-vdW) materials. Thicknesses below a few nanometers have not been reported yet, posing the question how thin can non-vdW materials be electrochemically synthesized. This is important as materials with (sub-)unit-cell thickness often show remarkably different properties compared to their bulk form or thin films of several nanometers thickness. Here, a straightforward electrochemical method utilizing the angstrom-confinement of laminar reduced graphene oxide (rGO) nanochannels is introduced to obtain a centimeter-scale network of atomically thin (<4.3 Å) 2D-transition metal oxides (2D-TMO). The angstrom-confinement provides a thickness limitation, forcing sub-unit-cell growth of 2D-TMO with oxygen and metal vacancies. It is showcased that Cr2 O3 , a material without significant catalytic activity for the oxygen evolution reaction (OER) in bulk form, can be activated as a high-performing catalyst if synthesized in the 2D sub-unit-cell form. This method displays the high activity of sub-unit-cell form while retaining the stability of bulk form, promising to yield unexplored fundamental science and applications. It is shown that while retaining the advantages of bottom-up electrochemical synthesis, like simplicity, high yield, and mild conditions, the thickness of TMO can be limited to sub-unit-cell dimensions.

Laser-Induced Phase Transition and Patterning of hBN-Encapsulated MoTe2.

Transition metal dichalcogenides exhibit phase transitions through atomic migration when triggered by various stimuli, such as strain, doping, and annealing. However, since atomically thin 2D materials are easily damaged and evaporated from these strategies, studies on the crystal structure and composition of transformed 2D phases are limited. Here, the phase and composition change behavior of laser-irradiated molybdenum ditelluride (MoTe2 ) in various stacked geometry are investigated, and the stable laser-induced phase patterning in hexagonal boron nitride (hBN)-encapsulated MoTe2 is demonstrated. When air-exposed or single-side passivated 2H-MoTe2 are irradiated by a laser, MoTe2 is transformed into Te or Mo3 Te4 due to the highly accumulated heat and atomic evaporation. Conversely, hBN-encapsulated 2H-MoTe2 transformed into a 1T' phase without evaporation or structural degradation, enabling stable phase transitions in desired regions. The laser-induced phase transition shows layer number dependence; thinner MoTe2 has a higher phase transition temperature. From the stable phase patterning method, the low contact resistivity of 1.13 kΩ µm in 2H-MoTe2 field-effect transistors with 1T' contacts from the seamless heterophase junction geometry is achieved. This study paves an effective way to fabricate monolithic 2D electronic devices with laterally stitched phases and provides insights into phase and compositional changes in 2D materials.

Quasi-van der Waals Epitaxial Recrystallization of a Gold Thin Film into Crystallographically Aligned Single Crystals.

Heterointerfaces between two-dimensional (2D) materials and bulk metals determine the electrical and optical properties of their heterostructures. Although deposition of various metals on 2D materials has been studied, there is still a lack of studies on the interaction at the van der Waals (vdW) heterointerface between 2D materials and metals. Here, we report quasi-van der Waals (qvdW) epitaxial recrystallization of a gold thin film into crystallographically aligned single crystals by encapsulation annealing of a gold thin film with hexagonal boron nitride (hBN). When a polycrystalline gold thin film passivated with hBN was annealed, it was recrystallized into single gold crystals with a planar shape and crystallographic alignment with hBN due to a strong interaction between the gold film and hBN at the heterointerface. This reflects that a weak vdW force at the heterointerface is sufficiently strong to induce epitaxial recrystallization. Using this method, we fabricated a gold nanocrystal array with the same crystalline orientation and smooth top surface. Our work demonstrates a new method for epitaxial recrystallization of bulk crystals and provides a deep understanding of the interaction at the vdW heterointerface of 2D materials and metals.

Sarcopenia in community-dwelling older adults is associated with the diversity and composition of the gut microbiota.

Sarcopenia is a prognostic indicator of negative consequences in older adults, including physical disability, frailty, and mortality. Few studies have investigated the associations between sarcopenia and the gut microbiota. We sought such associations in community-dwelling older adults aged ≥60 years. Sarcopenia was defined as low muscle mass, plus reduced physical performance, and/or low skeletal muscle strength. 16S rRNA next-generation sequencing was used to identify the components of the gut microbiota in fecal samples from 27 older adults with sarcopenia and 33 without sarcopenia. Relationships between sarcopenia and the diversity and composition of the gut microbiota were analyzed. Diversities at the species level were detected between the sarcopenia and control groups (P = 0.049). The abundance of Prevotella and Prevotella copri was significantly lower (P = 0.021 and P = 0.018 respectively) and that of Parabacteroides sp. higher in the sarcopenia than the control group (P = 0.010). Linear discriminant analysis of effect size revealed differences in the microbiota composition between the two groups. Sarcopenia was related with the presence of Anaerotruncus and Phascolarctobacterium sp. and the absence of Prevotella sp. and Prevotella copri. Further research is warranted to clarify whether changes in the gut microbiota cause sarcopenia onset or development.

Fat-to-muscle Ratio: A New Indicator for Coronary Artery Disease in Healthy Adults.

Background: Coronary artery disease (CAD) is an important issue in public health. Previous studies have shown that the ratio of fat to muscle mass is a significant predictor of metabolic disease, and it is known to be associated with atherosclerosis. In this study, we evaluated the association between the fat-to-muscle ratio (FMR) and CAD in healthy adults. Methods: A total of 617 participants without diabetes mellitus, hypertension, known CAD, or stroke who visited the Health Promotion Center from 2009 to 2018 were included in this study. Computed tomography imaging and bioelectrical impedance analysis were used to ascertain the coronary artery calcium (CAC) score, degree of CAD, and FMR. Results: Univariate logistic regression analysis showed that old age, male sex, smoking history, creatinine, aspartate aminotransferase, gamma-glutamyl transferase, uric acid, total cholesterol, and low-density lipoprotein cholesterol were significantly associated with CAC. After adjusting for potential confounding covariates, the presence of CAC was independently associated with FMR (OR, 1.014; 95% CI, 1.002-1.026; p = 0.019. The association was maintained even after adjusting for body mass index and waist circumference (odds ratio, 1.019; 95% confidence interval, 1.004 -1.034; P = 0.012). Conclusion: In this study, a high FMR was significantly associated with CAC. A large-scale prospective study on the association with FMR and cardiovascular diseases is necessary to confirm this relationship.

Tumor hypoxia represses γδ T cell-mediated antitumor immunity against brain tumors.

The anatomic location and immunologic characteristics of brain tumors result in strong lymphocyte suppression. Consequently, conventional immunotherapies targeting CD8 T cells are ineffective against brain tumors. Tumor cells escape immunosurveillance by various mechanisms and tumor cell metabolism can affect the metabolic states and functions of tumor-infiltrating lymphocytes. Here, we discovered that brain tumor cells had a particularly high demand for oxygen, which affected γδ T cell-mediated antitumor immune responses but not those of conventional T cells. Specifically, tumor hypoxia activated the γδ T cell protein kinase A pathway at a transcriptional level, resulting in repression of the activatory receptor NKG2D. Alleviating tumor hypoxia reinvigorated NKG2D expression and the antitumor function of γδ T cells. These results reveal a hypoxia-mediated mechanism through which brain tumors and γδ T cells interact and emphasize the importance of γδ T cells for antitumor immunity against brain tumors.

Multilevel Latent Class Profile Analysis: An Application to Stage-Sequential Patterns of Alcohol Use in a Sample of Canadian Youth.

Recently, latent class analysis (LCA) and its variants have been proposed to identify subgroups of individuals who follow similar sequential patterns of latent class membership for longitudinal study. A primary assumption underlying the family of LCA is that individual observations are independent. In many applications, however, particularly in research on adolescent substance use, individuals are often dependent because of multilevel data structure, where the unit of observation (e.g., students) is nested in higher level units (e.g., schools). In this study, we propose multilevel latent class profile analysis (MLCPA), which will allow us to analyze the longitudinal data with a multilevel structure under the framework of LCA. We apply an MLCPA using data from the COMPASS study, a 9-year study funded by the Canadian Institutes of Health Research and Health Canada, in order to identify representative sequential drinking patterns of Canadian youth and investigate whether these sequential patterns vary across schools. The MLCPA identified three common student-level drinking behaviors: non-drinker, ever lifetime, and binge drinker. The sequence of drinking behaviors can be classified into one of three longitudinal sequential patterns: non-drinking stayer, light drinking advancer, and heavy drinking advancer. In addition, MLCPA uncovered two latent clusters (low-use school and high-use school) out of 64 schools in Ontario and Alberta based on the prevalences of sequential drinking patterns.

Development and Evaluation of an Algorithm-Corresponding Instrument for Nursing Simulation.

BACKGROUND: This study aimed to develop and validate an assessment instrument for students engaging with an algorithm-based simulation scenario addressing emergency measures for high-risk newborns with apnea in a neonatal intensive care unit. METHOD: The study was conducted in two phases of development and evaluation of the algorithm-corresponding instrument. One hundred sixty-nine senior nursing students from two universities in South Korea were evaluated using the developed instrument. RESULTS: The developed and validated instrument consisted of three dimensions (assessment points, nursing skills, and communication) measured through 13 items. The exploratory factor analysis revealed three factors of the instrument, and the confirmatory factor analysis demonstrated a better model fit for a three-factor instrument model than for other models. CONCLUSION: The developed algorithm-corresponding assessment instrument is suitable for assessing the clinical decision-making ability of nursing students in a simulation scenario. [J Nurs Educ. 2020;59(11):617-626.].

Development and usability of a Hands-On Assessment Tool for Child Health: The HATCH.

AIM: To develop a comprehensive, hands-on assessment tool for assessing health in children under five in underserved regions. DESIGN: Methodological study design and usability testing were used. SAMPLE: Eight nurses working at two health posts and 261 children under five living in the migrant villages participated in the study. MEASUREMENT: The developed tool was evaluated using 10 items of a questionnaire based on the honeycomb model of Morville (2004). Community nurses administered the questionnaire then followed with a focus group interview after completing a child health exam using the developed tool. Data were collected during July 2017. RESULTS: The Hands-on Assessment Tool for Child Health is composed of developmental screening, identification of risk factors and clinical signs, growth measurement, diagnostic tests and interpretation of each subdomain, and final impressions. Management strategies include parent education, resource networking, referral to a paediatrician, and follow-up plans. Usability testing revealed high scores on the facets "valuable," "useful," "desirable," and "findable." CONCLUSIONS: Considering the demand for hands-on tools in underserved regions, the developed tool can provide nurses with resources for competent management of child assessment, interpretation, and nurses' intervention strategies, fortified with clinical judgement processes.

Are There Differences in Hair Mineral Concentrations Between Metabolically Healthy and Unhealthy Obese Adults?

Obesity is a risk factor for metabolic syndrome, dyslipidemia, hypertension, insulin resistance, type 2 diabetes mellitus, and cardiovascular disease. However, obesity is not a homogenous state and not all subjects in an obese population are at an increased risk for metabolic abnormalities. Thus, obesity types can be subdivided into metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) according to metabolic status. Body minerals are important and are involved in various metabolic processes that may be related to obesity. Thus, this study determined whether hair mineral concentrations differ between MHO and MUO adults. The associations between metabolic risk factors and hair mineral concentrations were analyzed in 141 obese Korean adults (62 MHO subjects and 79 MUO subjects). The MUO subjects showed significantly higher triglyceride levels, systolic blood pressure, waist circumference and body mass index, lower high-density lipoprotein cholesterol levels, and greater insulin resistance as reflected by the homeostasis model assessment-insulin resistance (HOMA-IR) index compared with MHO subjects. No significant differences in hair mineral concentrations were detected between MHO and MUO adults. Hair iron and cobalt concentrations were significantly negatively correlated with blood pressure in subjects with MHO. In addition, hair zinc concentration was associated with decreased systolic blood pressure. The results of this study suggest that mineral status in obese adults may play a role in metabolic abnormalities. Further studies with a larger number of subjects are warranted to identify the nature of the relationship between hair mineral status and metabolic risk in MHO and MUO subjects.

The effects of repetitive transcranial magnetic stimulation on body weight and food consumption in obese adults: A randomized controlled study.

BACKGROUND: Although some studies have reported significant reductions in food cravings following the single-session of repetitive transcranial magnetic stimulation (rTMS), there is little research on the effects of multi-session of rTMS on food consumption and body weight in obese subjects. OBJECTIVE: We conducted 4-week randomized, sham-controlled, single-blind, parallel-group trial to examine the effect of rTMS on body weight in obese adults. METHODS: Forty-three obese patients (body mass index [BMI] ≥25 kg/m2) aged between 18 and 70 years were randomized to the sham or real treatment group (21 in the TMS group and 22 in the sham treatment group). A total of 8 sessions of rTMS targeting the left dorsolateral prefrontal cortex (DLPFC) was provided over a period of 4 weeks. The primary outcome measure was weight change in kilograms from baseline to 4 weeks. Secondary endpoints included changes in anthropometric measures, cardiovascular risk factors, food intake, and appetite. RESULTS: Participants in the rTMS group showed significantly greater weight loss from baseline following the 8 session of rTMS (-2.75 ±â€¯2.37 kg vs. 0.38 ±â€¯1.0 kg, p < 0.01). Consistent with weight loss, there was a significant reduction in fat mass and visceral adipose tissue at week 4 in the rTMS group compared with the control group (p < 0.01). After the 8 sessions of rTMS, the TMS group consumed fewer total kilocalories and carbohydrates per day than the control group (p < 0.05). CONCLUSIONS: 8 sessions of HF rTMS delivered to the left DLPFC were effective in inducing weight loss and decreasing food intake in obese patients. TRIAL REGISTRATION: Clinical trial registered with the Clinical Trials Registry at http://cris.cdc.go.kr (KCT0002548).

Community health needs assessment for a child health promotion program in Kyrgyzstan.

Despite over 10 years of support from government health programs and health organizations, children in migrant villages in Kyrgyzstan remain a public concern owing to high incidence rates of preventable diseases such as anemia. An effective community health promotion program is needed but there is a lack of knowledge of community barriers and health factors affecting children's health in these migrant villages. The purpose of this study was to conduct a community health needs assessment to develop strategies for a child health promotion program in these migrant villages. This study conducted using a mixed method that included literature review, reginal statistics, focus group and key person interviews, and a community survey. The analysis method was descriptive statistics for the questionnaires, and content analysis for the interviews. Results showed the following priorities for child health promotion: strengthening health care provider capacity, overcoming resource shortages, managing child health and preventable diseases, improving public hygiene, promoting a healthy lifestyle, and empowering school health. The strategies were identified: capacity building of health workers, increasing community participation and raising child health awareness, and supporting child health promotion services. These findings will help guide the implementation of a child health promotion program.

[Evaluation of a Community-based Child (Infants and Toddlers) Health Promotion Pilot Project in a Migrant Village in Kyrgyzstan]. / 키르키즈스탄 이주민 마을 지역사회기반 ì˜ìœ ì•„ 건강증진 ì˜ˆë¹„ì‚¬ì— í‰ê°€.

PURPOSE: Children in migrant villages in Kyrgyzstan have a high incidence of anemia and need effective health promotion programs. The purpose of this study was to evaluate a pilot study of a health promotion project for infants and toddlers based on community participation. METHODS: This was a retrospective study conducted to evaluate the effectiveness of the project. The project was carried out by nurses at a public health center, community health workers, and local residents in a migrant village. After the operational system of the project was established, health assessments, child-care education, provision of vouchers for iron supplements, and activities to improve residents' awareness were conducted during 6 months among 100 children, of whom 85 were finally analyzed. RESULTS: In international health projects, close cooperation of the project team with community residents and health workers is important. Access to the community-based program was feasible in the socially and economically poor migrant village, and improvements were shown in children's anemia and awareness of health care. CONCLUSION: By focusing on the effective aspects of this preliminary project, plans to utilize community health workers and promotion strategies can be added to the main project to improve health promotion among children in this area.

The effects of repetitive transcranial magnetic stimulation on eating behaviors and body weight in obesity: A randomized controlled study.

BACKGROUND: Although some studies have reported significant reductions in food cravings following repetitive transcranial magnetic stimulation (rTMS), none have examined changes in body weight. OBJECTIVE: We conducted 2-week randomized, sham-controlled, single-blind, parallel-group trial to examine the effect of rTMS on body weight in obese patients. METHODS: Sixty obese patients (body mass index [BMI] ≥25 kg/m2) aged between 18 and 65 years were recruited. A total of 4 sessions of rTMS targeting the left dorsolateral prefrontal cortex (DLPFC) was provided over a period of 2 weeks, with a follow-up assessment conducted two weeks after treatment had finished. The primary outcome measure was weight change in kilograms from baseline to 4 weeks. Secondary endpoints included changes in anthropometric measures, cardiovascular risk factors, food intake, and appetite. RESULTS: Of the 60 volunteers, 57 completed the 4-week follow-up (29 in the TMS group and 28 in the sham treatment group). Participants in the rTMS group showed significantly greater weight loss from baseline following the 4 session of rTMS (p = 0.002). Consistent with weight loss, there was a significant reduction in BMI, fat mass and VAT at week 4 in the rTMS group compared with the control group (p < 0.05). After the 4 sessions of rTMS, the TMS group consumed fewer total kilocalories per day than the control group (p < 0.01). CONCLUSIONS: rTMS delivered to the left DLPFC was effective in decreasing food intake and facilitating weight loss in obese patients. The results of this study suggest that rTMS could be an effective treatment option for obesity. TRIAL REGISTRATION: Clinical trial registered with the Clinical Trials Tegistry at https://cris.nih.go.kr (KCT0001455).