Long-term changes in eating-related problems and quality of life in children with overweight and obesity attending a 10-week lifestyle camp.

BACKGROUND: Eating-related problems (e.g., binge eating (BE)) and impaired quality of life (QoL) is more prevalent in children with overweight and obesity. This study aimed to investigate changes in self-reported overeating (OE), BE, and QoL in children with overweight or obesity attending multicomponent 10-week lifestyle camps with a 52-weeks follow-up. Additionally, the study sought to investigate whether self-reported OE/BE before camp was associated with changes in QoL. METHODS: Children aged 7 to 14-years could attend camp if they had overweight/obesity, were lonely, unhappy, or had social or family-related problems. In this study only children with overweight and obesity were included (n:185). OE, BE, and QoL were measured using self-reported questionnaires. RESULTS: In total, 38 % of the children reported regular BE at baseline. Regular OE, occasional BE, and occasional OE was reported by 14 %, 13 %, and 11 %, respectively, while 24 % reported no eating-related problems. The relative risk of experiencing eating-related problems decreased at 10-weeks compared to baseline. Additionally, the probability of regular OE (RR 0.12 (95 % CI 0.04;0.38) (X2 = 8.44, p = 0.004)) and regular BE (RR 0.01 (95 % CI 0.00;0.11) (X2 = 9.91, p = 0.002)) remained lower at 52-weeks relative to baseline. All QoL dimensions improved after camp, and the presence of self-reported OE and regular BE at baseline was significantly associated with lower QoL at baseline, 10 and 52-weeks. CONCLUSION: Children self-reporting OE and BE may be a particular vulnerable group that needs more support from camp staff and healthcare professionals to improve QoL. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov with ID: NCT04522921.

Review of impacts of using body mass index as a screening tool in school children: A scoping review.

Body mass index (BMI) is used to screen for under- or overweight. However, it is unknown whether BMI-screening in school children reduces the incidence of overweight and obesity. We aimed to summarise the knowledge on positive and negative consequences on BMI and weight-related perceptions and behaviours of BMI-screening followed by an intervention to prevent and/or address obesity. We performed a systematic literature search, April 2023, using the PubMed, ScienceDirect and Google Scholar databases. We included randomised controlled trials and observational studies, including children aged 6 to 18 years and examining BMI-screening in a school setting. The primary outcome measures were BMI and weight status. Secondary outcome measures were weight-related perceptions and behaviours. Three studies met the inclusion criteria; two randomised controlled trials and one observational study. All studies used BMI-screening followed by sending report cards to the parents. None of the studies found a change in BMI z-scores in school children. Screening could cause transitory body-dissatisfaction and increase peer weight talk, yet potentially reduce problematic weight behaviours like skipping meals or excessive dieting. Reporting BMI to parents may influence their perception of their children's weight status, but does not change behaviour. The sparse evidence available suggested that BMI screening followed by sending report cards to parents does not change BMI z-scores among children in primary, middle and high school. Studies using appropriate evidence-based weight management interventions as a follow-up are lacking. Such studies may improve future prevention, detection and treatment of weight-related issues.

The younger the better: importance of age in treatment of childhood obesity.

Children living with obesity are prevalent worldwide. It is an established finding that many children who start a lifestyle intervention tend to leave prematurely. The aim of this study was to identify characteristics in children with obesity who prematurely leave a lifestyle intervention. The cohort study includes children living with obesity aged 4-17, treated in a Danish family-centered lifestyle intervention between 2014 and 2017. Data were collected from patient records. BMI-SDS was calculated using an external Danish reference population and multivariable regression analysis was used to answer the research question. Of the 159 children included, 64 children who left the intervention within the first 1.5 years were older compared to those who stayed in the intervention (10.2 years ± 2.9 vs 11.5 years ± 3.1, p = 0.005). Older participants (> 66.6th percentile) had a shorter treatment duration (489 days) compared to the youngest (190 days 95% CI: 60; 320, p = 0.005) and middle third (224 days 95% CI: 89; 358, p = 0.001). Additionally, an inverse association was found between duration of treatment and age at baseline (-31 days, 95% CI (-50; -13), p = 0.001).   Conclusion: The risk of leaving a lifestyle intervention prematurely was primarily dependent on the age of the participants, emphasizing the importance of including children early in lifestyle interventions. What is Known: • Lifestyle interventions for childhood obesity that are shorter in duration often lead to short-term weight reductions only. Limited knowledge exists on why some children prematurely leave these interventions. What is New: • This study observes a solid inverse correlation and association between age and time spent in the interventions, when treating childhood obesity. We hereby suggest age as an important determinant for the adherence to lifestyle interventions and emphasize the importance of treatment early in life.

Association between quality of life and emotional overeating - a cross-sectional study in Danish children attending a multicomponent lifestyle camp.

Emotional eating seems to emerge during the transition from childhood to adulthood; however, limited research has explored the association between emotional overeating and quality of life (QoL) in children with overweight and obesity. Therefore, the aim of this study was to examine the association between QoL and emotional overeating in a Danish sample of children with overweight and obesity. The present cross-sectional study is based on baseline questionnaire data from a nonrandomized controlled trial. Children attending a 10-week multicomponent lifestyle camp from October 2020 to March 2022 was invited to participate. Multiple linear regressions were used to examine if QoL was associated with emotional overeating before starting camp. In total, 229 children were included, and 45 children were excluded due to missing data, leaving 184 children in this study. The children had a mean age of 11.8 years (SD ± 1.38), with 60.9% girls and 39.1% boys, and the majority (94.6%) had overweight or obesity defined by a Body Mass Index Standard Deviation Score (BMI-SDS) > 1 SD. On average, children with a high tendency of emotional overeating had a 13.7 (95% CI 18.9; 8.5, p < 0.01) lower QoL score compared to children with a low tendency of emotional overeating.  Conclusions: This study shows that children with a high tendency of emotional overeating have lower quality of life, compared to children with a lower tendency of emotional overeating. Due to study limitations, the findings should be supported by further research. (Trial registration: clinicaltrials.gov with ID: NCT04522921). What is Known: • Emotional eating seems to emerge during the transition from childhood to adulthood. • Limited research has explored the association between quality of life and emotional overeating in children with overweight and obesity. What is New: • Children with a high tendency of emotional overeating had a lower quality of life compared to children with a lower tendency of emotional overeating. • Emotional overeating was negatively associated with quality of life in children with overweight and obesity.

The impact of age and obesity on outcomes among patients hospitalized with COVID-19 in Denmark: A nationwide cohort study.

Purpose: Obesity may alter the severity of infection with Coronavirus disease 2019 (COVID-19). Age may impact the association between body weight and severity of COVID-19 in patients with obesity. The aim of the study was to examine the association between obesity and severity of infection in a Danish cohort hospitalized with COVID-19 in the initial wave of the pandemic. Patients and methods: Based on data from the nationwide, clinical database: COVID-DK, risks of intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and mortality were compared among patients with and without obesity. Interaction with age was examined and we used Inverse Probability of Treatment Weighting regression for confounder adjustment. Results: Among 524 patients, 142 (27%) were admitted to the ICU, 112 (21%) required IMV, and 109 (21%) died. Compared to COVID-19 patients without obesity, patients with obesity displayed a non-significant increased risk of ICU admission (Relative Risk [RR] 1.19, 95% Confidence Interval [CI] 0.88; 1.60), IMV (RR 1.23, CI 0.86; 1.75) and mortality (RR 1.21, CI 0.84; 1.75). COVID-19 patients with obesity, <60 years had highly increased risk of ICU admission (RR 1.92, CI 1.14; 3.24) and IMV (RR 1.95, CI 1.09; 3.49). Conclusions: In hospitalized COVID-19 patients, obesity conferred an approximately 20% increased risk for ICU admission, IMV, and death, although these relationships did not reach statistical significance. COVID-19 patients with obesity and <60 years had an almost doubled risk of ICU admission and IMV.

Perceptions, behaviours and potential barriers to effective obesity care. Results from the ACTION-DK study.

AIM: Weight bias, stigma and discrimination are pervasive in the health care system and society and may result in biased treatment of people living with obesity (PwO). We aimed to identify perceptions, attitudes and potential barriers that exist between people with obesity and health care professionals (HCPs) in Denmark. METHODS: The ACTION-DK survey was a cross-sectional, non-interventional, descriptive study conducted in Denmark. The cohort included 879 PwO (body mass index ≥30.0 kg/m2 ) based on self-reported height and body weight, and 100 HCPs from the primary and secondary sectors who frequently encountered PwO. RESULTS: Several discrepancies between PwO and HCPs were identified, including recognition of obesity as a chronic disease (PwO: 49% vs. HCPs: 84%) and whether PwO were responsible for their weight loss (PwO: 81% vs. HCPs: 17%). Among PwO, 46% were motivated to lose weight, but only 28% of HCPs shared this perception. Untimely initiation of obesity care consultations was also identified as a potential barrier to proper obesity care, as PwO waited 7 years, on average, from their initial decision to lose weight before having their first obesity care consultation. In addition, only 24% of PwO had a follow-up consultation after the initial obesity care discussion. Almost half of HCPs (46%) considered weight loss medication effective, but only 10% brought up this possibility during an obesity care discussion. CONCLUSIONS: Our findings suggest that it is pivotal to improve obesity care in Denmark by ensuring a better follow-up and alignment of the perceptions and attitudes toward obesity between PwO and HCPs.

Food addiction is strongly associated with type 2 diabetes.

BACKGROUND & AIMS: Individuals can develop an addiction-like attraction towards highly processed foods, which has led to the conceptualization of food addiction, a phenotype linked to obesity. In this study, we investigated whether food addiction is associated with type 2 diabetes (T2D). METHODS: 1699 adults from the general population and 1394 adults from a population with clinically verified mental disorder completed a cross-sectional survey including the Yale Food Addiction Scale 2.0. Logistic regression was employed to examine the association between food addiction and T2D, the latter operationalized via Danish registers. RESULTS: Food addiction was strongly associated with T2D in the general population (adjusted odds ratio (AOR) = 6.7) and among individuals with mental disorder (AOR = 2.4) in a dose-response-like manner. CONCLUSION: This is the first study to demonstrate a positive association between food addiction and T2D in a general population sample. Food addiction may be a promising target for prevention of T2D.

Association between Food, Beverages and Overweight/Obesity in Children and Adolescents-A Systematic Review and Meta-Analysis of Observational Studies.

A healthy diet is essential to prevent childhood obesity, however, adherence to a healthy diet is challenging. The aim of this study was to give a comprehensive overview of the literature investigaating associations between food and beverages and overweight/obesity in children and adolescents in order to identify dietary risk factors. A systematic search was performed in four databases and observational studies were included. Meta-analysis was performed using the random effect model. Sixty records met inclusion criteria and 14 different food or beverage categories were identified. A higher intake of sugar-sweetened beverages increased the odds of overweight/obesity by 1.20 (p < 0.05) (n = 26) and higher intake of fast food increased the odds of overweight/obesity by 1.17 (p < 0.05) (n = 24). Furthermore, higher intake of meat (OR 1.02, p < 0.05 (n:7)) and refined grains (OR 1.28, p < 0.05 (n:3)) was associated with an increased risk of overweight/obesity. In contrast, higher intake of whole grain (OR 0.86, p = 0.04 (n:5)) and more surprisingly sweet bakery (OR 0.59, p < 0.05 (n:3)) was associated with a decreased risk of overweight/obesity. In conclusion, a higher intake of sugar-sweetened beverages and a higher intake of fast food was identified as the primary dietary risk factors for overweight/obesity. Future research is needed to strengthen the generalizability of these results.

Patients' perspectives on screening for disordered eating among adolescents with type 1 diabetes.

PURPOSE: People with type 1 diabetes have an increased risk of disordered eating (DE) and eating disorders (ED). Screening is recommended however little is known about patients' perspectives on screening questionnaires. This paper reports qualitative analyses of patients' perspectives on the questionnaire Diabetes Eating Problem Survey Revised (DEPS-R), including acceptability, attitudes, and cognitive understanding. RESEARCH DESIGN AND METHODS: 15 adolescents with type 1 diabetes between 11 and 18 years, were interviewed. A semi-structured format and a qualitative Interpretive Descriptive (ID) methodology was chosen. RESULTS: The analyses identified four themes: (1) The Questionnaire, (2) Reframing Diabetes Visits, (3) This is (not) for me, and (4) Out in the Open. The DEPS-R was completed with-in 5-10 min. with no technical difficulties. The questionnaire altered the diabetes visit for some, creating a new dialog, and time for self-reflection. Adolescents appreciated the direct approach in the questionnaire, and showed willingness to complete the questionnaire, when presented to them by a health care professional (HCP). One item in the DEPS-R proved difficult to understand for some participants. CONCLUSION: The study highlights DEPS-R as a clinically relevant screening questionnaire. Completing DEPS-R prior to a consultation opens the door to a consultation that invites the adolescent to address matters of eating behavior. Our findings suggest that systematic screening of DE/ED using the DEPS-R is both accepted and welcomed by adolescents with type 1 diabetes. Future research should focus on a potential update of selected items in DEPS-R. LEVEL OF EVIDENCE: V - qualitative study.

Effects of foods, beverages and macronutrients on BMI z-score and body composition in children and adolescents: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: A healthy diet is fundamental for healthy growth and for future disease prevention. However, scientific consensus on how to compose healthy diets for children has not been established. Therefore, a systematic review and meta-analysis was performed to investigate if an independent effect exists between foods, beverages or the composition of macronutrients and body composition in children and adolescents. METHODS: A systematic search was performed in four databases up to July 2021. A systematic review of randomized controlled studies (RCTs) and meta-analyses were carried out by extracting mean difference (MDs) and standard deviation (SD) and performed using the random effect model. RESULTS: Sixteen RCTs met inclusion criteria. Beyond dairy, sugar-sweetened beverages and macronutrient composition, no trials were identified for other food groups. Based on five RCTs (n:5), a higher-dairy diet was found to reduce body fat percentage - 0.47 [- 0.92, - 0.03] (p = 0.04). A higher-dairy diet was also found to increase lean body mass (kg) 0.34 [0.06, 0.62] (p = 0.02) (n:2), but did not affect BMI z-score - 0.05 [- 0.16, 0.06] (p = 0.39) (n:4). Substituting sugar-sweetened beverage with non-caloric beverages or flavored milk reduced body fat percentage (- 0.70 [- 0.78, - 0.62] (p < 0.001)) (n:3) but did not change BMI z-score (- 0.05 [- 0.20, 0.09] (p = 0.48)) (n:2). No significant effects were found between different macronutrient compositions and BMI z-score or body fat percentage. CONCLUSION: Changes in diet from low to higher-dairy consumption and from sugar-sweetened beverages to non-caloric beverages or flavored milk resulted in favorable changes in body composition among children and adolescents. Eligible studies investigating other foods are lacking. TRIAL REGISTRATION: PROSPERO registration number (CRD42020173201).

Participation in a multicomponent lifestyle intervention for people with obesity improves glycated hemoglobin (HbA1c).

Introduction: Obesity is associated with compromised glucose metabolism. Hence, it is of interest to investigate if the lifestyle interventions used in the LIBRA-cohort, which aimed at not only weight loss, but also patient well-being, could also help obese patients improve glucose metabolism by evidence of reduced HbA1c. The aim of the study was to retrospectively investigate if patients who were referred to a lifestyle intervention for obesity, were able to alter HbA1c. Research design and methods: Patients with a BMI≥30 undergoing a 6-month lifestyle intervention, who also completed physical and mental health surveys and whose baseline and 6-month blood samples were available, were included in the analysis. For changes in HbA1c and body weight a clinically relevant change of 5≥mmom/mol and 5%≥, respectively, was chosen. Participants were divided into groups according to their baseline HbA1c level: "Diabetes": HbA1c of ≥6.5% (≥48 mmol/mol), "Prediabetes": HbA1c of 5.7% to 6.4% (39-47.99 mmol/mol) or "Normal" HbA1c <5.7% (<39 mmol/mol). Results: 180 patients met the stated inclusion criteria and these patients were divided into groups (median age (25th;75th quartile): Diabetes: n=47, age 54 (43;60), 51% women, Prediabetes: n=68, age 60 (50;66), 71% women and Normal: n=65, median age 61 (50;66), 85% women. Significant reductions were found in all three groups and specifically in the diabetes group HbA1c was reduced (mean [95%CI]) -5[-8;-2] mmol/mol from baseline to the end of the intervention. Furthermore, 35% of patients with prediabetes normalized their HbA1c (<39) and 30% patients with diabetes reduced their HbA1c <48. All groups had clinically relevant (≥5%) reductions in body weight (p<0.01). There was an association between body weight reduction and HbA1c reduction in the diabetes group (p<0.01). All groups reported improvements in physical health (p<0.01). Conclusion: In this retrospective cohort study, all patients achieved clinically relevant weight loss after participation in the lifestyle intervention and obese patients with diabetes achieved clinically relevant reductions in HbA1c after 6-months. More than 1/3 of patients with prediabetes normalized their HbA1c.

Epidemiological aspects of obesity and the metabolic syndrome.

The prevalence of obesity increases rapidly, in all ages and in all social classes. Epidemiological studies have documented that obesity have large long-term consequences, even in children, including development of metabolic syndrome and other obesity-associated comorbidities (i.e. diabetes mellitus type 2, cancer and cardiovascular diseases) which may largely impact the person's health, life expectancy, and quality of life. As summarised in this review, epidemiological studies add to our knowledge on comorbidities associated with obesity, the prognosis, and the prevalence of obesity over time.

Communication about weight-related issues with patients with obesity.

This review focuses on communication about weight-related issues with patients with obesity in general practice. Primary care providers still lack knowledge and tools to address and communicate about the topic of weight and weight-related issues - with focus on minimizing stigmatization and a person centered approach. A few communication tools on the topic have been developed but it seems that the use of those is limited, suggesting an urgent need for making a fast, easy and simple tool for the use in general practice.

Effects of sugar-sweetened soda on plasma saturated and monounsaturated fatty acids in individuals with obesity: A randomized study.

Background: High carbohydrate, i.e., sugars, intake potentially drives the liver into a lipogenic state leading to elevated plasma fatty acids. Excessive intake of saturated fat and sugar-sweetened soda induces liver fat accumulation, but studying the effect of high intake from sugar-sweetened soda on the de novo lipogenesis (DNL) fatty acids in long-term randomized trials is lacking. Objective: To study the effect of consuming 1 L/day of sugar-sweetened soda, semi-skimmed milk (milk), aspartame-sweetened soda or water over 24 weeks on DNL-derived fatty acids (i.e., palmitate (primary outcome) and other saturated and monounsaturated fatty acids), and markers of stearoyl-CoA desaturase activity (SCD1) in plasma phospholipids (PL), cholesteryl esters (CE), and triglycerides (TG). Design and methods: A randomized parallel study was conducted simultaneously at Aarhus University Hospital and Copenhagen University, Denmark, including (n = 41) individuals aged 20-50 years, with BMI of 26-40 kg/m2, and without diabetes. The groups consisted of 9 individuals in the sugar-sweetened soda, 10 in the milk, 11 in the aspartame-sweetened soda, and 11 in the water. The change at 24 weeks was assessed and compared across the groups using ANCOVA and mixed-effects models. Correlations of fatty acid changes with liver fat accumulation (magnetic resonance imaging) were explored. Results: After 24 weeks, the groups differed in palmitate proportions in PL, oleate in CE and PL, and palmitoleate and SCD1 in all fractions (p < 0.05). Compared with water, the relative proportion of palmitate in PL increased by approximately 1% during both sugar-sweetened soda (p = 0.011) and milk (p = 0.006), whereas oleate and palmitoleate increased only during sugar-sweetened soda (CE 2.77%, p < 0.001; PL 1.51%, p = 0.002 and CE 1.46%, PL 0.24%, TG 1.31%, all p < 0.001, respectively). Liver fat accumulation correlated consistently with changes in palmitoleate, whereas correlations with palmitate and oleate were inconsistent across lipid fractions. Conclusions: Although both sugar-sweetened soda and milk increased palmitate in PL, only excess intake of sugar-sweetened soda increased palmitoleate in all lipid fractions and correlated with liver fat. In contrast, isocaloric milk intake did not increase plasma monounsaturated fatty acids. Clinical trial registration: [https://clinicaltrials.gov/ct2/show/NCT00777647], identifier [NCT00777647].

The association between weight loss and long term development in quality-of-life among children living with obesity: a pragmatic descriptive intervention study.

BACKGROUND: Childhood obesity is associated with impaired Quality-of-Life (QoL), increased stigmatization and higher risk of development of depression compared to their peers. This report describes the long-term development in QoL for cohort of children with obesity after a sustainable weight reduction. METHODS: This pragmatic descriptive intervention study enrolled 120 children with obesity, age 5-17 years, in a multifactorial lifestyle intervention. The intervention was an across sectors collaboration between a department of pediatrics and community health care workers. QoL was assessed yearly throughout the intervention and evaluated by a 6-item Visual Analogue Scale (VAS). For analyzing changes in VAS, as function BMI-SDS, regression models were used, while ANOVA and Wilcoxon test were applied for normal and not-normal distributed data. 95% confidence interval not containing 0 and p-value < 0.05 was considered statistically significant. RESULTS: After 26.4 months (13.9 SD) an overall decrease in bullying (0.6 vs. 0.0 median) and motivation (10.0 vs. 9.6) was observed. QoL increased in children with a BMI-SDS reduction (0.65 (2.49 SD)) opposite children with no-change or increasing BMI-SDS who reported reduced QoL (-0.36 (1.55 SD) and -0.96 (2.27 SD)). A significant inverse relationship was observed for Joy of Life, QoL and body perception as a function of BMI-SDS per year. CONCLUSION: Weight reduction causes improvement in QoL for children with obesity and an inverse relationship for QoL and changing BMI-SDS / year was establish.

Association of Coronary Plaque With Low-Density Lipoprotein Cholesterol Levels and Rates of Cardiovascular Disease Events Among Symptomatic Adults.

Importance: Atherosclerosis burden and coronary artery calcium (CAC) are associated with the risk for atherosclerotic cardiovascular disease (ASCVD) events, with absence of plaque and CAC indicating low risk. Whether this is true in patients with elevated levels of low-density lipoprotein cholesterol (LDL-C) is not known. Specifically, a high prevalence of noncalcified plaque might signal high risk. Objective: To determine the prevalence of noncalcified and calcified plaque in symptomatic adults and assess its association with cardiovascular events across the LDL-C spectrum. Design, Setting, and Participants: This cohort study included symptomatic patients undergoing coronary computed tomographic angiography from January 1, 2008, to December 31, 2017, from the seminational Western Denmark Heart Registry. Follow-up was completed on July 6, 2018. Data were analyzed from April 2 to December 2, 2021. Exposures: Prevalence of calcified and noncalcified plaque according to LDL-C strata of less than 77, 77 to 112, 113 to 154, 155 to 189, and at least 190 mg/dL. Severity of coronary artery disease was categorized using CAC scores of 0, 1 to 99, and ≥100, where higher numbers indicate greater CAC burden. Main Outcomes and Measures: Atherosclerotic cardiovascular disease events (myocardial infarction and stroke) and death. Results: A total of 23 143 patients with a median age of 58 (IQR, 50-65) years (12 857 [55.6%] women) were included in the analysis. During median follow-up of 4.2 (IQR, 2.3-6.1) years, 1029 ASCVD and death events occurred. Across all LDL-C strata, absence of CAC was a prevalent finding (ranging from 438 of 948 [46.2%] in patients with LDL-C levels of at least 190 mg/dL to 4370 of 7964 [54.9%] in patients with LDL-C levels of 77-112 mg/dL) and associated with no detectable plaque in most patients, ranging from 338 of 438 (77.2%) in those with LDL-C levels of at least 190 mg/dL to 1067 of 1204 (88.6%) in those with LDL-C levels of less than 77 mg/dL. In all LDL-C groups, absence of CAC was associated with low rates of ASCVD and death (6.3 [95% CI, 5.6-7.0] per 1000 person-years), with increasing rates in patients with CAC scores of 1 to 99 (11.1 [95% CI, 10.0-12.5] per 1000 person-years) and CAC scores of at least 100 (21.9 [95% CI, 19.9-24.4] per 1000 person-years). Among those with CAC scores of 0, the event rate per 1000 person-years was 6.3 (95% CI, 5.6-7.0) in the overall population compared with 6.9 (95% CI, 4.0-11.9) in those with LDL-C levels of at least 190 mg/dL. Across all LDL-C strata, rates were similar and low in those with CAC scores of 0, regardless of whether they had no plaque or purely noncalcified plaque. Conclusions and Relevance: The findings of this cohort study suggest that in symptomatic patients with severely elevated LDL-C levels of at least 190 mg/dL who are universally considered to be at high risk by guidelines, absence of calcified and noncalcified plaque on coronary computed tomographic angiography was associated with low risk for ASCVD events. These results further suggest that atherosclerosis burden, including CAC, can be used to individualize treatment intensity in patients with severely elevated LDL-C levels.

Effects of a new early municipality-based versus a geriatric team-based transitional care intervention on readmission and mortality among frail older patients - a randomised controlled trial.

Purpose Previous studies reported reduced risk of readmission, mortality and shorter length of hospital stay (LOS) among geriatric patients receiving an early (<24h), hospital-based geriatric team intervention after discharge. The objective of this study was to compare a novel, early municipality-based, nurse-led and general practitioner (GP)-supported transitional care intervention (TCI) to an established hospital-based TCI among frail, older, geriatric patients. Material and methods A randomised controlled trial was conducted within a single geriatric department and the adjacent municipality. Inclusion criteria: acutely admitted, frail patients 75+ years old. Eligible patients were randomly allocated (1:1) to the two TCIs. Primary outcome was 30-day unplanned readmission. Secondary outcomes were 90-day all-cause mortality and LOS. Stratified analysis according to type of dwelling was made. Odds ratios (OR) with 95% confidence intervals (CI), and number needed to treat (NNT) were reported. Results 3,103 patients (median age (IQR): 85 (80-90); 57% female) were included. Readmission rates were 22% in the municipality-based intervention (n=332/1,545), and 18% in the hospital-based intervention (n=276/1,558); OR was 1.27, 95% CI (1.06-1.52), p=0.008 and NNT=27. OR for cohabiting patients was 1.47, 95% CI (1.02-2.08); p=0.035. No significant difference was observed in mortality (22% vs. 21%; OR=1.05, 95% CI (0.89-1.25), p=0.577) or LOS (median (IQR): 6 (2-8) vs. 6 (2-8) days, p=0.1787). Conclusions The new municipality-based, nurse-led and GP-supported intervention was inferior to the hospital-based geriatric team intervention in preventing 30-day readmission among frail, geriatric patients. There was no significant difference between the two interventions in regard to 90-day mortality or LOS.

The Impact of Lifestyle, Diet and Physical Activity on Epigenetic Changes in the Offspring-A Systematic Review.

AIMS: This systematic review examines the association between maternal lifestyle, diet and physical activity, and epigenetic changes in the offspring. METHODS: A literature search was conducted using multiple science databases: PubMed, Embase and Cochrane Library, on 10 March 2021. RCT and Cohort studies in English or Scandinavian languages were included. Exposure variables included diet, lifestyle, meal patterns or physical activity. Studies using dietary supplements as exposure variables were excluded. Outcome variables included were DNA methylation, microRNA or histone changes in placenta, cord blood or offspring. Two independent authors screened, read and extracted data from the included papers. The Cochrane risk-of-bias tool for randomized trials (RoB2) and The Critical Appraisal Skills Program (CASP) Cohort Study Checklist were used to assess risk of bias in the included studies. A qualitative approach was employed due to heterogeneity of exposures and results of the studies. RESULTS: 16 studies and 3617 participants were included in the final analysis. The exposure variables included physical activity, carbohydrate, low glycemic index diet, added sugar, fat, Mediterranean diet and pro-inflammatory diet. The outcome variables identified were differences in DNA methylation and microRNA. Most studies described epigenetic changes in either placenta or cord blood. Genes reported to be methylated were GR, HSD2, IGF-2, PLAG1, MEG-3, H19 and RXRA. However, not all studies found epigenetic changes strong enough to pass multiple testing, and the study quality varied. CONCLUSION: Despite the variable quality of the included studies, the results in this review suggest that there may be an association between the mother's lifestyle, diet and level of physical activity during pregnancy and epigenetic changes in the offspring.

Mortality and readmission risk can be predicted by the record-based Multidimensional Prognostic Index: a cohort study of medical inpatients older than 75 years.

PURPOSE: To examine the predictive value of the record-based Multidimensional Prognostic Index (MPI) on mortality, readmission and length of hospital stay (LOS) among older medical inpatients. METHODS: A cohort of medical inpatients aged ≥ 75 years was rated using the record-based MPI to assess frailty retrospectively. 90-day and 1-year mortality hazard ratios (HRs) were calculated in a sex- and age-adjusted Cox proportional hazards model. 30-day readmission relative risk (RR) estimates were calculated in a binary regression model with mortality as a competing risk. Discrimination was expressed by the area under the receiver operating characteristic (ROC) curve. Median LOS was calculated using the non-parametric Kruskal-Wallis one-way ANOVA. RESULTS: In total, 1190 patients with a median age of 83 years were included. 50% were male. 335 patients (28%) were categorized as non-frail (MPI score 0.0-0.33), 522 (44%) moderately frail (MPI score 0.34-0.66) and 333 (28%) severely frail (MPI score 0.67-1.0). 90-day mortality HR was 7.4 (95% confidence interval (CI) 2.9-18.6, p < 0.001) for the moderately frail and 18.5 (95% CI 7.5-46.1, p < 0.001) for the severely frail compared with the non-frail. ROC area was 0.76 (95% CI 0.72-0.80). Similarly, 1-year mortality HR was 3.3 (95% CI 2.2-5.0, p < 0.001) for the moderately frail and 7.1 (95% CI 4.7-10.6, p < 0.001) for the severely frail. 30-day readmission RR was 2.1 (95% CI 1.5-2.9, p < 0.001) for the moderately frail and 1.8 (95% CI 1.3-2.6, p = 0.001) for the severely frail. LOS was significantly longer with increasing MPI score (p < 0.001). CONCLUSION: The record-based MPI assessed at discharge predicts dose-dependent post-discharge mortality and readmission risk and is associated with LOS in older medical inpatients.

Uric Acid Is Elevated in Children With Obesity and Decreases After Weight Loss.

Introduction: Childhood obesity is an increasing condition associated with continuous obesity into adulthood and development of comorbidities. Adult studies show an association between serum uric acid (SUA) levels and body mass index (BMI). The aim of this retro perspective exploratory study was to investigate SUA in obese children and adolescents and the effects of a subsequent weight reduction. Materials and Methods: One hundred and seventy-one children (age 4-18), with obesity (i.e. BMI-SDS of +2 or higher) were included in a multifactorial lifestyle intervention. The children participating were annually measured for anthropometrics, blood samples and DEXA-scans for up to 3 years. Eighty-nine children were included for follow-up analysis. Results: After a follow-up of 20.7 ± 9.4 months a reduction in BMI-SDS of -0.34 ± 0.53 (p < 0.01) was observed. SUA was found to be positively associated with changes in BMI-SDS. SUA levels decreased in the 65 children who lost weight during the trial, conversely, SUA increased in the 23 children who gained weight during the trial (p < 0.01 between groups). Conclusion: SUA was found to correlate with measures of obesity and for the first time, this intervention demonstrates a positive relationship between SUA and weight reduction in children with obesity.