Pharmacokinetics and safety profiles of beinaglutide injection, a recombinant human GLP-1, in adults with overweight/obesity: results from a phase I clinical trial.

Background: Beinaglutide, whose active ingredient is rhGLP-1, has been widely used as a pharmacological therapy for T2DM. We explored the safety and pharmacokinetics of beinaglutide in Chinese overweight/obese volunteers to lay a foundation for clinical applications of beinaglutide as an anti-obesity drug. Methods: An open-label, single center, multiple ascending dose phase I clinical trial was conducted in 16 overweight/obese Chinese volunteers. The plasma concentrations of beinaglutide were determined by a validated ELISA method and the pharmacokinetic parameters were estimated via non-compartmental analysis methods. Adverse events were also recorded. Results: Beinaglutide sequentially multiple dosing (three times daily) at different doses were generally well tolerated, without serious AEs leading to discontinuation of the trial. After multiple subcutaneous injections of different doses (0.1, 0.14 and 0.2 mg), the average blood concentration of beinaglutide with or without baseline correction showed a similar trend among different dose groups on different study days. After reaching the peak concentration around 15 min, it began to decrease, and the median of Tmax and Tmax,adj was 10-15 min. The exposure in vivo increased in proportion to the dosage increment, demonstrating linear pharmacokinetic characteristics. There were no statistically significant differences in the main PK parameters and no accumulation of beinaglutide after multiple dosing. After multiple subcutaneous injections, a gender difference was observed, while no differences in BMI were found under the grouping conditions. Conclusion: The safety profile and pharmacokinetic properties support further development and clinical applications of beinaglutide as an anti-obesity drug. Systematic Review Registration: [https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000BPEI&selectaction=Edit&uid=U00050YQ&ts=2&cx=wy0ioj].

Breastfeeding duration and nutritional status of infants and toddlers in Spain. LAyDI study (PAPenRed).

INTRODUCTION: Breastfeeding appears to protect the onset of obesity in infants. The aim is to know whether breastfeeding duration is associated with the risk of obesity in infants and toddlers aged 12 and 24 months. MATERIAL AND METHODS: Prospective longitudinal study in a cohort of children born in Spain between April 2017 and March 2018 (LAyDI study) in the paediatric primary care system conducted in the framework of the PAPenRed research network. Analysis of breastfeeding duration (group 1: fewer than 6 months; group: more than 6 months) and its association with anthropometric variables. RESULTS: A total of 1495 patients attended the 12 months preventive child health visit and 1073 patients the 24 months visit. We found a statistically significant association between breastfeeding duration and weight-for-age, BMI-for-age and weight-for-length/height at 12 and 24 months; breastfeeding duration of less than 6 months was significantly associated with overweight and obesity (based on BMI-for-age and weight-for-length/height) at ages 12 and 24 months. Maternal pre-pregnancy BMI acted as a modifier on the association between breastfeeding duration and overweight and obesity (based on BMI-for-age). CONCLUSIONS: A breastfeeding duration of less than 6 months is associated with a higher percentage of overweight and obesity at ages 12 and 24 months, although maternal pre-pregnancy BMI modifies this relationship at 24 months.

Recurrence quantification analysis of uterine vectormyometriogram reveals differences between normal weight and overweight parturient women.

OBJECTIVE: This study aims to use Recurrence Quantification Analysis (RQA) of uterine vectormyometriogram (VMG) created from the slow wave (SW) and high wave (HW) bands of electrohysterogram (EHG) signals and assess the directionality of the EHG activity (horizontal or X, vertical or Y) in normal-weight (NW) and overweight (OW) women during the first stage of labor. APPROACH: The study involved 41 parturient women (NW=21 and OW=20) during the first stage of labor, all of whom were attended at the Gynecology and Obstetrics Hospital of the Maternal and Child Institute of the State of Mexico (IMIEM) in Toluca, Mexico. Twenty-minute EHG signals were analyzed in horizontal and vertical directions. Linear and nonlinear indices such as dominant frequency (Dom), Sample Entropy (SampEn), and RQA measures of VMG were computed for SW and HW bands. MAIN RESULTS: Significant differences in SampEn and Dom were observed in the SW band between NW and OW in both X and Y directions, indicating more regular dynamics of electrical uterine activity and a higher dominant frequency in normal-weight parturient women compared to overweight women. Additionally, the RQA indices calculated from the VMG of SW were consistent and revealed that NW women exhibit more regular dynamics compared to OW women. SIGNIFICANCE: The study demonstrates that RQA of VMG signals and EHG directionality differentiate uterine activity between NW and OW women during the first stage of labor. These findings suggest that the uterine vector may become more periodic, predictable, and stable in normal-weight women compared to overweight women. This highlights the importance of tailored clinical strategies for managing labor in overweight women to improve maternal and infant outcomes. .

The role of impulsivity and binge eating in outpatients with overweight or obesity: an EEG temporal discounting study.

BACKGROUND: Binge eating (BE) is associated with a range of cognitive control deficits related to impulsivity, including lower response inhibition, preference for immediate gratification, and maladaptive decision-making. The aim was to investigate whether impulsivity and BE may interact with the decision process and underlying brain activity in outpatients with overweight or obesity who are starting a treatment to achieve weight loss. METHODS: A sample of 26 treatment-seeking outpatients with overweight or obesity was evaluated for impulsivity, BE, and temporal discounting rates. Impulsivity was measured with the Barratt Impulsiveness Scale (BIS-11), according to which two groups were composed: high BIS and low BIS; BE was assessed with the eating disorders module of the Structured Clinical Interview for DSM5-Research Version, according to which two groups were composed: with (BE group) or without BE (NBE group). Changes in subjective value of rewards were measured with the Temporal Discounting Task (TDt) where participants had to choice between sooner but smaller vs. later but larger monetary rewards. These choices were made in two differently delayed conditions ("Now" and "Not-now"). Brain rhythms were recorded through high-density electroencephalogram (hd-EEG) during the TDt. RESULTS: Patients with BE reported more impulsive tendencies and perceived sooner rewards as more gratifying when both options were delayed (Not-now condition, p = 0.02). The reward choice in the TDt was accompanied by a general EEG alpha band desynchronization in parietal areas observed without differences between experimental conditions and patients groups. No effects were observed within the Now condition or in the other EEG bands. CONCLUSIONS: The tendency to favor immediate rewards may constitute an obstacle to adhering to treatment plans and achieving weight loss goals for outpatients with overweight or obesity. Clinicians are therefore encouraged to include psychological factors, such as impulsivity and dysfunctional eating behaviors, when designing weight loss programs. By addressing these psychological aspects, clinicians can better support patients in overcoming barriers to adherence and achieving sustainable weight loss. TRIAL REGISTRATION: This study was approved by the Ethics Committee of the Department of Psychological, Health, and Territorial Sciences of the University G. d'Annunzio of Chieti-Pescara (Prot. n. 254 of 03/14/2017).

Utility of anthropometry in defining overweight and obesity in urban South Indian children.

Introduction: Waist-based indicators of obesity are being used to detect central obesity and are predictive for metabolic syndrome (MS). The aim of the study is to assess the basic anthropometric indices in children, to determine the prevalence of overweight and obesity, and to determine the association between various waist-based measurements and body mass index (BMI). Methodology: A cross-sectional study was conducted among children aged 10 to 15 years attending government corporation schools in Chennai. Basic anthropometric measurements were taken. BMI, waist circumference/height ratio (WHtR), and waist circumference/hip circumference ratio (WHR) were calculated. The percentiles (Indian reference cutoffs) were determined for waist circumference (WC) and BMI. The prevalence of overweight and obesity was determined and compared to waist-based parameters. Results: Of 820 children, males constituted 47.1%. Stunting was seen in 9.8% and 7.8% were underweight. 8.2% had BMI less than the 3rd percentile. The prevalence of overweight and obese children was 9% and 3.2%, respectively, with female predominance. The majority had WC less than the 5th percentile. The prevalence of children under risk for MS based on WC >70th percentile was 4.5% and based on WHtR >0.5 was 8.2%. A significant association was identified between all waist-based anthropometric measurements to detect children at risk for MS and overweight/obese children as per BMI category. WHtR >0.5 was an indicator of overweight/obese children in logistic regression analysis. Conclusion: Early identification of children at risk of MS would require a combination of BMI to detect general obesity and waist-based anthropometric measurements to identify central obesity.

Association between adiposity and iron status in women of reproductive age: data from the UK National Diet and Nutrition Survey 2008-2019 (NDNS).

BACKGROUND: Overweight/obesity and iron deficiency are highly prevalent in women of reproductive age (WRA), impacting on women's health. Obesity is a risk factor for nutritional deficiencies but its association with iron deficiency is unclear. OBJECTIVE: To determine the association between adiposity and markers of iron status and iron deficiency prevalence in WRA. METHODS: This cross-sectional study analyzed the National Diet and Nutrition Survey (NDNS, 2008-2019) data, focusing on women aged 18-49y with BMI ≥18.5 kg/m2. Prevalence of anemia, Iron Deficiency Anemia (IDA), and Iron Deficiency (ID) were analyzed. Ferritin was adjusted for C-reactive protein. Iron status was assessed across high and low BMI, waist circumference (WC), waist-to-height (WHtR), and waist-to-hip ratio (WHR). Chi2, linear and logistic regression were performed adjusting for covariates. RESULTS: Among 1,098 WRA, 496 normal weight and 602 overweight/obesity, prevalence rates were: anemia 9.2% and IDA 6.8%. Anemia was more prevalent in those with higher WHtR and WHR (11.9% vs 5.9% and 16.7% vs 6.5%, both p<0.001). WRA with increased WC, WHtR, and WHR had higher IDA prevalence than those with lower adiposity. (8.5% vs 4.3%, p=0.005; 9.4% vs 3.3%, p<0.001; 12.1% vs 4.9%, p<0.001). ID prevalence was 49.7% (ferritin cut-off 30 µg/L) and 19.6% (ferritin cut-off 15 µg/L), showing similar rates across adiposity groups. ID prevalence defined by soluble transferrin receptor (sTfR) was higher in women with increased WHR (p=0.001). Higher WHR predicted ID categorized by sTfR (aOR 2.104, p=0.004), and WHtR and WHR predicted anemia and IDA (anemia: WHtR aOR 2.006 p=0.036; WHR aOR 4.489 p<0.001; IDA: WHtR: aOR 2.942, p=0.012; WHR aOR 4.142, p<0.001). CONCLUSIONS: At least one in five WRA in the UK are iron deficient, highlighting the need to revise current policies. Greater central adiposity was strongly associated with impaired iron status and the development of anemia, IDA, and ID.

Comparison of Weight Loss Effects among Overweight/Obese Adults: A Network Meta-Analysis of Mediterranean, Low Carbohydrate, and Low-Fat Diets.

BACKGROUND & AIMS: Eating patterns significantly impact the weight loss process. This study aimed to investigate the influence of primary eating patterns on weight loss measures in overweight and obese adults using network meta-analysis. METHODS: We systematically searched PubMed, Scopus, Web of Science (WOS), and Google Scholar until May 2, 2023. Our network meta-analysis followed the PRISMA extension guidelines for Comparing Mediterranean, low carbohydrate and low fat diet effects on weight loss among overweight/obese adults. We conducted a Frequentist random-effects network meta-analysis. Summary effects were presented as mean differences (MD) along with corresponding standard deviations (SD). P-scores were used for treatment ranking within the network. RESULTS: Initial literature searches yielded 1574 citations. Ultimately, 1004 participants from 7 RCTs (or 9 trials) met inclusion criteria. All diets resulted in weight loss. Comparatively, the low-carbohydrate diet exhibited a significant decrease in weight loss compared to the Mediterranean diet (MD = -2.70 kg, 95% CI: -4.65, -0.75). Indirect evidence revealed that both the low-carbohydrate diet (MD = -6.31 kg, 95% CI: -11.23, -1.39) and the low-fat diet (MD = -5.61 kg, 95% CI: -10.61, -0.61) significantly reduced weight among overweight/obese adults compared to the standard hypolipemic diet. Rankings indicated the low-carbohydrate diet as the most effective dietary intervention for enhancing weight loss (P-score = 0.8994) and reducing body fat (P-score = 0.7060). CONCLUSIONS: Overall, a low-carb diet appears to be among the most effective approaches for weight loss and body fat reduction. However, it's essential to consider that its efficacy may vary based on factors such as age, gender, genetics, and lifestyle habits.

Letrozole co-treatment in an antagonist protocol for overweight women undergoing IVF treatment: a retrospective study.

BACKGROUND: Overweight women undergoing IVF treatment have lower success rates. Letrozole, an aromatase inhibitor, has been used as an adjunct for IVF treatment, but its specific effects in overweight women have not been investigated. This study was to explore the effects of letrozole co-treatment in an antagonist protocol for overweight infertile women undergoing IVF treatment. METHODS: This retrospective cohort study included overweight infertile women who underwent IVF/ICSI treatment and fresh embryo transfer (ET), with or without letrozole co-treatment in an antagonist protocol, from 2007 to 2021 at Shanghai Ninth People's Hospital (Shanghai, China). A total of 704 overweight infertile women were included: 585 women were in the antagonist group, and 119 women were in the letrozole co-treatment group. The primary outcome was the live birth rate after fresh ET. Propensity score-based patient-matching was employed to balance the covariates between the groups. Multivariate logistic regression analysis was also performed to estimate odds ratio (OR) and 95% confidence interval (CI) for association of letrozole co-treatment and the live birth outcome. RESULTS: Letrozole co-treatment induced significant changes in hormonal profile on the trigger day. The letrozole group exhibited a decrease in the total number of follicles compared to the antagonist group, but a higher proportion of large follicles at oocyte retrieval (P < 0.05). The quantity and quality of embryos were comparable between the two groups (P > 0.05). The letrozole co-treatment group had a significantly higher live birth rate than the control group (38.7% vs. 22.6%, P = 0.026). With multivariate logistic regression analysis, letrozole co-treatment was associated with higher odds of live birth after adjusting for potential confounding factors (adjusted OR = 2.00, 95% CI = 1.17-3.39, P = 0.011). Letrozole presented no significant associations with obstetrical or neonatal complications (P > 0.05). CONCLUSION: Letrozole co-treatment in an antagonist protocol may offer potential benefits for overweight infertile women undergoing IVF treatment. Further research is warranted to validate these findings and explore the broader implications for letrozole co-treatment.

Newborn DNA methylation age differentiates long-term weight trajectories: the Boston Birth Cohort.

BACKGROUND: Gestational age (GEAA) estimated by newborn DNA methylation (GAmAge) is associated with maternal prenatal exposures and immediate birth outcomes. However, the association of GAmAge with long-term overweight or obesity (OWO) trajectories is yet to be determined. METHODS: GAmAge was calculated for 831 children from a US predominantly urban, low-income, multi-ethnic birth cohort based on cord blood DNA methylation profile using Illumina EPIC array. Repeated anthropometric measurements aligned with pediatric primary care schedule allowed us to calculate body-mass-index percentiles (BMIPCT) at specific age and to define long-term weight trajectories from birth to 18 years. RESULTS: GAmAge was associated with BMIPCT trajectories, defined by 4 groups: stable (consistent OWO: "early OWO"; constant normal weight: "NW") or non-stable (OWO by year 1 of follow-up: "late OWO"; OWO by year 6 of follow-up: "NW to very late OWO"). GAmAge differentiated between the group with consistently normal BMIPCT pattern and the non-stable groups with late and very late OWO development. Such differentiation was observed in the age periods of birth to 1year, 3years, 6years, 10years, and 14years (p < 0.05 for all). The findings persisted after adjusting for GEAA, maternal smoking, delivery method, and child's sex in multivariate models. Birth weight was a mediator for the GAmAge effect on OWO status for specific groups at multiple age periods. CONCLUSIONS: GAmAge is associated with BMIPCT trajectories from birth to age 18 years, independent of GEAA and birth weight. If further confirmed, GAmAge may serve as an early biomarker for predicting BMI trajectory to inform early risk assessment and prevention of OWO. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03228875).

Effectiveness and safety of acupuncture modalities for overweight and obesity treatment: a systematic review and network meta-analysis of RCTs.

Introduction: The effectiveness and safety of acupuncture in the treatment of obesity have not been assessed. This poses a challenge for clinicians who choose to use acupuncture in the treatment of obesity, as they are unable to prioritize this approach based on outcome variables. Methods: In May 2024, a literature search of five databases was conducted. Only randomized controlled trials evaluating body weight (BW), body mass index, waist circumference (WC), and adverse events in patients with a body mass index (BMI) of 25 or higher for various acupuncture modalities were included. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials, version 2. Pairwise meta-analysis (PMA) and Bayesian network meta-analysis (NMA) were performed using a random effects model for quantitative synthesis. Results: Fourteen studies (n = 868) were included. The included studies evaluated the following acupuncture modalities: electroacupuncture (EA) (N = 6), laser acupuncture (LA) (N = 2), auricular acupuncture (AA) (N = 5), and manual acupuncture (MA) (N = 3). The PMA found that adding EA to usual care (UC), compared to UC alone, reduced BW (MD = 2.46, 95% CI = 1.12 to 3.80, I 2 = 58%, REM, N = 3, n = 157). The NMA of BW showed the following effect sizes for UC alone versus each acupuncture modality combined with UC: LA (MD = 2.09, 95% CI = 0.04 to 3.86), EA (MD = 2.04, 95% CI = 0.88 to 3.50), AA (MD = 1.69, 95% CI = -0.11 to 3.58), and MA (MD = 1.02, 95% CI = -0.82 to 2.94). The probability of each modality being the optimal treatment was evaluated using the surface under the cumulative ranking curve. EA was the most efficacious for BW and BMI, while LA was the most efficacious for WC. Discussion: EA and LA can effectively complement clinical obesity management. The number of included studies was limited, and publication bias may have occurred, necessitating a cautious interpretation of the results. Furthermore, most studies lasted between six and 12 weeks. Future clinical studies of acupuncture for obesity should include longer follow-up periods. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387788, identifier CRD42023387788.

Prevalence and determinants of overweight or obesity among medical students over a 2-year observation.

Introduction: University students are a special population group characterized by changes in BMI values over the subsequent years of education, with an upward tendency to BMI. The presented study aims to evaluate the prevalence of overweight and obesity and their determinants in medical students during the 2-year follow-up observation. Materials and methods: We analyzed data collected from the first follow-up of the cohort study named "POLLEK" conducted among medical students at the Medical University of Silesia in Katowice. Students were followed at two points of time: in their inaugural year of studies (the academic year 2021/2022, T1, N = 427), and subsequently in their second year (the academic year 2022/2023, T2, N = 335). Results: In the initial year of evaluation, 371 individuals (86.9%) exhibited normal body weight, 47 (11.0%) were overweight, and 9 (2.1%) were classified as obese. Subsequent assessments during the second year revealed the following distribution: 277 students (84.2%) with normal body weight, 40 (12.2%) classified as overweight, and 12 (3.6%) identified as obese. In summary, regardless of the academic year, an increased risk of being overweight or obese was significantly associated with dissatisfaction with personal health, financial strain, and a diet abundant in animal products. Conclusion: The results of our study confirmed an increase in the prevalence of overweight or obesity among medical students during the 2-year follow-up observation. Significant determinants of overweight or obesity among medical students were: dissatisfaction with individual health status, male sex, financial deficiencies, and a diet abundant in meat consumption.

Individual Difference in the Capacity of Gut Microbiota to Ferment Four Complex Carbohydrates from Normal to Overweight People: An In Vitro Study.

Pectic polysaccharides can beneficially shape the human microbiota. However, individual variability in the microbial response, especially the response between normal-weight (NW) and overweight (OW) people, is rarely understood. Therefore, we performed batch fermentation using inulin (INU), commercial pectin (CP), and pectic polysaccharides extracted from goji berry (GPP) and raspberry (RPP) by microbiota from five normal-weight (NW) and five overweight (OW) donors. The degree of specificity of fiber was negatively correlated to its fermentable rate and microbial response. Meanwhile, we found that microbiota from OW donors had a stronger fiber-degrading capacity than NW donors. The result of correlation between individual basal microbiota and the fermentable rate indicated Dialister, Megamonas, Oscillospiraceae_NK4A214, Prevotella, Ruminococcus, and unidentified_Muribaculaceae may be the key bacteria. In summary, we highlighted a new perspective regarding the interactive relationship between different fibers and fecal microbiota from different donors that may be helpful to design fiber interventions for individuals with different microbiota.

Variations of Eating Behaviors Among Vietnamese Preschool Children and Their Association With Children's Anthropometric Z-Scores: Results From Analyses of the Children's Eating Behavior Questionnaire in 10 000 Children.

Eating behaviors, which are shaped during childhood, are one of the important factors influencing children's growth. This study aimed to investigate the variations in eating behaviors among Vietnamese preschool children aged 3 to 6 years using the Children Eating Behavior Questionnaire (CEBQ) and their association with anthropometric Z-scores. A cross-sectional study was conducted on 10 172 children from 36 to 72 months old, recruited from three different socioeconomic regions of Hanoi. Differentiation of eating behaviors between two sexes was observed across all age groups, but most obvious at 36 to 48 months of age. The subscales of emotional overeating (EOE), enjoyment of food (EF), and desire to drink (DD) were higher in 60- to 72-month age groups and vice versa for slowness in eating (SE) and emotional undereating (EUE) subscales. Analyses using the general linear model showed that CEBQ subscales were associated with anthropometric Z-scores in both girls and boys.

The cost-effectiveness analysis of semaglutide for the treatment of adult and adolescent patients with overweight and obesity: a systematic review.

PURPOSE: The present study aimed to systematically collect and synthesize available cost-effectiveness studies of semaglutide in patients with obesity or overweight in comparison with other interventions. METHODS: We comprehensively searched multiple electronic databases to identify relevant literature. Studies were selected based on inclusion and exclusion criteria. The quality of studies was appraised using the "Consolidated Health Economic Evaluation Reporting Standards" (CHEERS) tool. This study is conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: Out of a total of 252 items, after review, 32 articles were fully reviewed, and, finally, 7 studies met inclusion and exclusion criteria. The discount rate was in the range of 1.5-3.5%. Studies included showed semaglutide offered more QALYs than anti-obesity drugs but because of higher cost, in some cases, ICER exceeds the willingness to pay threshold. Results show that semaglutide creates higher total cost compared to conventional interventions in patients with class I, II, and III obesities. Results show that in patients with class I obesity (BMI 33) lifestyle intervention (LI), endoscopic sleeve gastroplasty (ESG), Sleeve gastrectomy (SG), and semaglutide create $124,195; $126,732; $139,971; and $370,776, respectively. CONCLUSION: The current systematic review showed that semaglutide provides more QALYs and creates more costs in comparison with phentermine-topiramate, phentermine, and naltrexone-bupropion. Semaglutide may be cost-effective with substantial cost reduction. Semaglutide appears to be cost-effective versus diet and exercise (D&E) and liraglutide but it was not cost-effective versus sleeve gastrectomy, endoscopic sleeve gastroplasty, and gastric bypass.

Examining Food-Specific and General Inhibitory Control and Working Memory as Moderators of Relations Between Emotion Regulation Difficulties and Eating Pathology in Adults With Overweight/Obesity: A Preregistered, Cross-Sectional Study.

OBJECTIVE: Empirical research and theory support the interaction of executive functions (e.g., inhibitory control, working memory) and emotion regulation in guiding goal-oriented behavior; however, applications to eating pathology (e.g., binge eating) are limited. Such research is scant with adults with overweight/obesity (AwO/O), a population reporting high levels of binge eating, emotion regulation difficulties, and deficits in inhibitory control and working memory. We tested interactions between emotion regulation and executive functioning in relation to eating pathology in AwO/O while considering stimuli-specific deficits (e.g., food-specific deficits) in behavioral task performance. METHOD: AwO/O (N = 204; MBMI = 32.11; Mage = 38.30 [SD = 12.16]) completed a preregistered, online study assessing demographics and emotion regulation difficulties (Difficulties in Emotional Regulation Scale), inhibitory control (go/no-go task, food and general stimuli), working memory (N-Back Task, food and general stimuli), binge eating (Binge Eating Scale), and disordered eating (Eating Disorder Examination-Questionnaire). RESULTS: There was limited evidence of moderation in models examining food-specific and general inhibitory control and working memory, emotion regulation difficulties, and binge eating. Preliminary support was found for emotion regulation difficulties to be more strongly associated with more disordered eating in AwO/O reporting more food-specific and general working memory deficits. Consistent, positive associations between emotion regulation difficulties and eating pathology were observed. CONCLUSIONS: Among adults with AwO/O, emotion regulation difficulties are closely related to eating pathology, regardless of performance on working memory and inhibitory control tasks. Clinicians and researchers working with AwO/O may consider how emotion regulation difficulties and working memory deficits work together to influence disordered eating.

Efficacy of lifestyle interventions to treat pediatric obesity: A systematic review and multivariate meta-analysis of randomized controlled trials.

The aim of this study was to provide a quantitative synthesis of the effects of randomized controlled pediatric lifestyle interventions in treating obesity among 11-17-year-old children. We conducted a systematic review and meta-analysis on the randomized controlled trials, consisting of actual exercise training and nutrition education, published between January 2000 and August 2022. The initial search yielded 2598 articles, with eight articles meeting the inclusion criteria. The articles were analyzed using a multivariate random effects model. The primary outcome variables were body mass index (BMI), standardized BMI (BMIz), and waist circumference (WC). Our analyses showed that lifestyle interventions were efficacious in improving BMI (-1.77 kg/m2, 95% CI [-2.70, -0.83], p < 0.001), BMIz (-0.30, 95% CI [-0.45, -0.16], p < 0.001), and WC (-3.32 cm, 95% CI [-5.35, -1.29], p < 0.001) in children with overweight and obesity. In addition, moderation analyses suggested that the efficacy of the lifestyle interventions correlated positively with participants' weight status and was enhanced when an intervention was boosted with a longer intervention duration and higher frequency. In conclusion, the current evidence suggests that lifestyle interventions are efficacious in treating children with obesity. The available evidence further indicates that duration, frequency, along weight status, were moderating the effectiveness of these lifestyle interventions.

The usefulness of randomized trials of lifestyle interventions for overweight, obesity, or metabolic syndrome: A systematic review.

BACKGROUND: Randomized controlled trials (RCTs) widely considered the gold standard for evidence-based healthcare may be limited in their clinical usefulness in lifestyle interventions for adults with overweight, obesity, or metabolic syndrome. OBJECTIVE: In this systematic review of lifestyle intervention RCTs we delineated trial usefulness. METHODS: Following prospective registration in PROSPERO (CRD4202347896), we conducted a comprehensive search across Medline, Scopus, Web of Science, and the Cochrane Library databases, covering the period from inception to December 2023. RCTs involving dietary interventions, with or without physical activity, and with or without behavioural support were included. Two reviewers independently performed study selection and data extraction. Study usefulness was assessed using a multidimensional 14 item questionnaire. Percentage compliance with usefulness items was computed. RESULTS: Of 1175 records, 30 RCTs (12,841 participants) were included. Among these, 13 (43%) RCTs complied with half of the usefulness items and only 3 (10%) complied with two-thirds of the items. For each usefulness item individually: 30 (100%) reported the burden of the problem addressed, 15 (50%) contextualized the trial through a systematic review, 18 (60%) presented an informative trial with clinically meaningful outcomes evaluated at a stated statistical power, 17 (57%) had low risk of bias, 2 (7%) exhibited pragmatic features pertaining to the trial methodologies and outcomes relevant to real-world application.18 (60%) were patient centred with formal patient involvement, none (0%) demonstrated value for money, 17 (57%) were completed according to their feasibility assessment achieving at least 90% of the estimated sample size, and 30 (100%) reported at least one of five transparency or openness features. CONCLUSION: Only one in 10 lifestyle RCTs met two-thirds of the usefulness features. It is imperative to meet these criteria when devising future trials within the field of nutrition to reduce research waste.

Association between metabolically healthy obesity and carotid intima-media thickness in Korean adolescents with overweight and obesity.

PURPOSE: Data regarding the association between metabolically healthy obesity (MHO) and preclinical atherosclerosis in childhood are lacking. Carotid intima-media thickness (cIMT) is a noninvasive method used to assess cardiovascular risk. This study examined the relationships among cIMT, metabolic phenotypes, and cardiometabolic risk factors (CMRFs) in overweight and obese adolescents. METHODS: Anthropometric, biochemical, and cIMT data were collected. The study participants were categorized as MHO or metabolically unhealthy obesity (MUO) based on insulin resistance. CMRFs were assessed using blood pressure (BP); levels of triglycerides, high-density lipoprotein cholesterol (HDL-C), and fasting plasma glucose; or a diagnosis of diabetes mellitus. Differences in cIMT values were evaluated according to the metabolic phenotype and factors associated with cIMT. RESULTS: Among the 111 participants (80 boys, 72.1%), 23 (20.7%) were classified as MHO and 88 (79.3%) as MUO. The MHO group exhibited lower glycated hemoglobin and triglyceride levels and higher HDL-C levels compared to those exhibited by the MUO group (all P<0.01). The cIMT values did not differ significantly between the MHO and MUO groups. The high cIMT tertile group revealed higher systolic BP compared to that exhibited by the low cIMT tertile group (123.7±2.1 mmHg vs. 116.9±1.6 mmHg, P=0.028). Mean cIMT was positively correlated with age (ß=0.009) and body mass index (BMI) (ß=0.033) after adjusting for covariates (both P<0.05). CONCLUSION: In overweight and obese Korean adolescents, cIMT was associated with age and BMI but not with metabolic phenotype or CMRFs. Further research is warranted to determine the relationship between cIMT during adolescence and cardiovascular outcomes during adulthood.

The Antiobesity Effect and Safety of GLP-1 Receptor Agonist in Overweight/Obese Adolescents Without Diabetes Mellitus: A Systematic Review and Meta-Analysis.

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), particularly semaglutide, have become the leading anti-obesity drugs for adults, and a similar trend may follow in adolescents with its recent approval for this age group. However, there is a lack of comparative analysis on the weight loss effects and safety of GLP-1 RAs in obese or overweight pediatric and adolescent populations, especially those who are non-diabetic. This systematic review and meta-analysis aim to provide current evidence on the efficacy and safety of GLP-1 RAs as an anti-obesity treatment in obese or overweight non-diabetic pediatric and adolescent populations. METHOD:  We searched electronic databases from inception until January 2024 for randomized controlled trials (RCTs) that analyzed the weight loss effect of GLP-1 receptor agonists in adolescents with obesity or overweight without diabetes mellitus. Search results were screened, and eligible studies were included to perform a systematic review and meta-analysis using the Review Manager (RevMan) computer program Version 5.4.1 (The Cochrane Collaboration, 2020) with a random-effects model. The primary efficacy outcomes were changes in body weight, BMI, and BMI Z-score, while the secondary outcomes were the incidence of gastrointestinal adverse events, treatment discontinuation rate due to adverse events, and incidence of serious adverse events. The mean difference, odds ratio, and 95% confidence interval (CI) were used to present the meta-analysis results. Publication bias was visualized using a funnel plot. The quality of the studies was analyzed using Cochrane's Risk of Bias tool (RoB2). RESULTS: A total of seven RCTs with 576 adolescent participants were included in the analysis. GLP-1 RAs significantly achieved greater weight loss than placebo, with a mean difference of -4.98 kg (-8.49, -1.46), I² = 99%, p = 0.006. Subgroup analysis showed that semaglutide had the most pronounced anti-obesity effect (mean difference of -17.70 kg (-18.89, -16.51), p < 0.00001), compared to liraglutide (mean difference of -2.26 kg (-5.17, 0.65), I² = 99%, p = 0.13) and exenatide (mean difference of -3.17 kg (-4.45, -1.90), I² = 0%, p < 0.0001). Similar results were obtained for other efficacy parameters such as BMI and BMI z-score. However, GLP-1 RA was associated with more gastrointestinal adverse events (such as nausea and vomiting) than placebo (3.06 (2.12, 4.42), I² = 0%, p < 0.00001), with incidence comparable among all GLP-1 RAs in the subgroup analysis. The overall risk of bias among included studies was either of 'some concern' or 'high risk.' CONCLUSIONS: Our meta-analysis demonstrated that GLP-1 RAs had a superior anti-obesity effect compared to placebo or lifestyle modification in obese or overweight non-diabetic adolescents, particularly semaglutide, which had a more pronounced anti-obesity effect than liraglutide and exenatide, with tolerable gastrointestinal adverse effects.

Survival Analysis in Adult Heart Transplantation: Experience from a Brazilian Single Center.

INTRODUCTION: Heart transplantation is the gold standard for advanced heart failure treatment. This study examines the survival rates and risk factors for early mortality in adult heart transplant recipients at a Brazilian center. METHODS: This retrospective cohort study involved 255 adult heart transplant patients from a single center in Brazil. Data were collected from medical records and databases including three defined periods (2012-2015, 2016-2019, and 2020-2022). Statistical analysis employed Kaplan-Meier survival curves, Cox proportional hazards analysis for 30-day mortality risk factors, and Log-rank tests. RESULTS: The recipients were mostly male (74.9%), and the mean age was 46.6 years. Main causes of heart failure were idiopathic dilated cardiomyopathy (33.9%), Chagas cardiomyopathy (18%), and ischemic cardiomyopathy (14.3%). The study revealed an overall survival of 68.1% at one year, 58% at five years, and 40.8% at 10 years after heart transplantation. Survivalimproved significantly over time, combining the most recent periods (2016 to 2022) it was 73.2% in the first year and 63% in five years. The main risk factors for 30-day mortality were longer time on cardiopulmonary bypass, the initial period of transplants (2012 to 2015), older age of the donor, and nutritional status of the donor (overweight or obese). The main causes of death within 30 days post-transplant were infection and primary graft dysfunction. CONCLUSION: The survival analysis by period demonstrated that the increased surgical volume, coupled with the team's experience and modifications to the immunosuppression protocol, contributed to the improved early and mid-term outcomes.