Sex differences in the associations of sleep-wake characteristics and rest-activity circadian rhythm with specific obesity types among Hong Kong community-dwelling older adults.

BACKGROUND: Sex differences exist in sleep characteristics, circadian rhythm and body composition but the evidence on their associations with obesity risk remains unclear. We aimed to examine sex differences in the associations of sleep-wake cycle and rest-activity circadian rhythm with specific obesity types among aged Chinese population. METHODS: This report pooled data from 2 population-based surveys conducted during 4/2018-9/2018 and 7/2019-9/2020. All participants wore actigraphy on wrists for 7 days to measure their objective sleep patterns and rest-activity circadian rhythm. We measured participants' anthropometric data, and obtained their body weight, body fat percentage(fat%), visceral fat rating, muscle mass by calibrated bioelectrical impedance analysis device. Hand-grip strength was assessed by Jamar Hydraulic hand dynamometer. Multinomial logistic regression was performed to assess the odds ratio(OR) and 95% confidence intervals(95%CI). RESULTS: We recruited 206 male and 134 female older adults with complete actigraphy data, with obesity prevalence of 36.9% and 31.3%, respectively. Male participants who had delayed sleep-wake cycle(i.e.,sleep-onset-time and wake-up time) was associated with higher risk of obesity(late sleep-onset-time:OR=5.28, 95%CI=2.00-13.94), and the results remained consistent for different types of obesity. Males with late M10(i.e., most active 10-hours) onset had higher adipose outcomes with an adjusted OR of 2.92(fat%:95%CI=1.10-7.71; visceral fat:95%CI=1.12-7.61). Among female participants, those with lower relative amplitude were associated with higher BMI and lower hand-grip strength. CONCLUSIONS: This study revealed that circadian rhythm fragmentation was associated with obesity and muscle loss. Promoting good sleep quality and maintaining robust circadian rhythm and physical activity can prevent poor muscle strength among older adults.

Hidden Obesity.

This communication proposes the term "hidden obesity" to describe normal weight obesity, or increased adiposity without a corresponding increase in body mass index. It uses the concept of hidden hunger to craft semantics which will generate greater attention to this condition from all stake-holders, including policymakers and planners. The article describes simple tools which can be used to suspect and confirm the diagnosis of hidden obesity. This phenotype is very commonly seen in the south Asian population.

Estratificação de risco dos pacientes na fila de espera para cirurgia bariátrica no Hospital do Servidor Público Municipal para elaboração de pontuação do Protocolo de Gravidade SOS (Score de Obesidade do Servidor) / Risk stratification of patients on the waiting list for bariatric surgery at the Hospital do Servidor Público Municipal to prepare a score for the SOS Severity Protocol (Server Obesity Score)

A obesidade é confirmada como um dos principais fatores de risco de doenças cardiovasculares, diabetes mellitus e doença renal crônica, entre outros. Na projeção para os próximos 12 anos, o Brasil terá 41% de sua população adulta com obesidade, segundo a nova edição do Atlas Mundial da Obesidade 2023. O número é confirmado para 2035 a partir das tendências projetadas na prevalência de obesidade. Para os adultos, o crescimento será de 2,8% por ano, enquanto nas crianças, fator mais preocupante, o crescimento anual será de 4,4%. O objetivo deste estudo é a estratificação de risco dos pacientes que estão aguardando cirurgia bariátrica pelo HSPM (Hospital do Servidor Público Municipal), através do protocolo SOS (Score de Obesidade do Servidor), ao definir critérios de gravidade e priorização desses pacientes, correlacionando a obesidade ao grau de disfunções orgânicas dos mesmos. Em nosso serviço o tempo na fila de espera para a cirurgia bariátrica gira em torno de 6 a 7 anos, para todos os pacientes, não levando em consideração as comorbidades e riscos destes indivíduos, e no Brasil não há até hoje nenhum protocolo de priorização por comorbidades descrito para a cirurgia bariátrica. Foi realizada a estratificação de gravidade dos pacientes que aguardam pela cirurgia bariátrica no HSPM, com elaboração de pontuação de risco alto (maior ou igual que cinco pontos: prioridade vermelha), médio (3 a 4 pontos: prioridade amarela) e baixo (0 a 2 pontos: prioridade verde), através do protocolo SOS (Score de Obesidade do Servidor). Palavras-chave: Cirurgia bariátrica. Obesidade. Listas de espera. Priorização. Manejo de Obesidade.

Ferritin, transferrin, and transferrin receptor in relation to metabolic obesity phenotypes: Findings from the China Health and Nutrition Survey.

Background: This study aimed to explore the relationship between iron markers and metabolic obesity phenotypes and the role of age. Methods: Data were from the China Health and Nutrition Survey 2009. Metabolic obesity phenotypes included metabolically healthy with normal weight (MHNW), metabolically unhealthy with normal weight (MUNW), metabolically healthy with overweight/obesity (MHO), and metabolically unhealthy with overweight/obesity (MUO). Iron markers including ferritin, transferrin, and soluble transferrin receptor were calculated as Log and quartered. The linear regression and multinomial logistic regression were used to explore the association of iron markers with age and metabolic obesity phenotypes, respectively. Results: Ferritin was linearly related with age, with ß (95% confidence interval, CI) of 0.029 (0.027 to 0.032) and -0.005 (-0.007 to -0.002) for women and men. Transferrin was negatively associated with age in both men and women (ß < -0.011). Furthermore, compared with participants in the quartile 1 ferritin group, those in the quartile 4 had increased odds of MUNW, MHO, and MUO, with odds ratio and 95% confidence interval (OR, 95% CI) of 3.06 (2.20 to 4.25), 1.66 (1.35 to 2.05), and 5.27 (4.17 to 6.66). Transferrin showed similar relationships with MUNW, MUO, and MHO; whereas transferrin receptor showed no significance. We also found joint associations of ferritin and transferrin with MUNW, MUO, and MHO. The interactive effect of ferritin and transferrin on MUO was significant (P = 0.015). Conclusion: Increased ferritin and transferrin were associated with MUNW, MHO, and MUO. Age should be considered when investigating iron.

Mendelian randomization study of obesity and type 2 diabetes in hospitalized COVID-19 patients.

BACKGROUND: Both obesity and type 2 diabetes (T2D) are reported to be highly enriched in hospitalized COVID-19 patients. Due to the close correlation between obesity and T2D, it is important to examine whether obesity and T2D are independently related to COVID-19 hospitalization. OBJECTIVE: To examine the causal effect of obesity and T2D in hospitalized COVID-19 patients using Mendelian randomization (MR). RESEARCH DESIGN AND METHODS: This two-sample MR analysis applied genetic markers of obesity identified in the genome wide association study (GWAS) by the GIANT Consortium as instrumental variables (IVs) of obesity; and genetic markers of T2D identified by the DIAGRAM Consortium as IVs of T2D. The MR analysis was performed in hospitalized COVID-19 patient by the COVID-19 Host Genetics Initiative using the MR-Base platform. RESULTS: All 3 classes of obesity (Class 1/2/3) were shown as the causal risk factors of COVID-19 hospitalization; however, T2D doesn't increase the risk of hospitalization or critically ill COVID-19 as an independent factor. CONCLUSIONS: Obesity, but not T2D, is a primary risk factor of COVID-19 hospitalization.

Efeitos da ingestão do suco de laranja Pera e suco de laranja Moro na microbiota intestinal e marcadores inflamatórios em indivíduos com obesidade / Effect of Pera and Moro orange juice consumption on the gut microbiota and inflammatory parameters in volunteers with obesity

A obesidade é uma doença complexa que está associada inflamação crônica de baixo grau que contribui para o desenvolvimento de diversos distúrbios metabólicos como a resistência à insulina e estudos recentes sugerem a influência da microbiota intestinal no desenvolvimento e manutenção da doença. Diversos estudos apontam para o benefício da ingestão de frutas e vegetais na prevenção e tratamento de doenças crônicas. O suco de laranja contém diversos compostos bioativos com ações anti-inflamatórias, antioxidantes com efeitos na composição da microbiota intestinal. Deste modo, o objetivo principal deste estudo foi avaliar os efeitos da ingestão do suco de laranja Pera e Moro sobre a composição da microbiota intestinal e de parâmetros inflamatórios em voluntários com obesidade e resistência à insulina. Foi realizado um ensaio clínico crossover com suplementação de suco de laranja (400ml/dia) por 15 dias com um período de washout de 40 dias. As análises de sangue, fezes, urina, composição corporal, consumo alimentar foram realizadas antes e após cada intervenção. A comparação entre os tratamentos foi realizada utilizando equações de estimativas generalizadas e adotou-se um nível de significância de 5%. Em relação à microbiota intestinal, em ambos os tratamentos, os dois filos mais abundantes foram Firmicutes e Actinobateria. Dos gêneros analisados, observou-se maior abundância de Bifidobacterium após a suplementação com o suco de laranja Moro. O suco de laranja Pera promoveu uma diminuição da zonulina e o suco de laranja Moro contribuiu para redução de citocinas inflamatórias, diminuição da pressão arterial e aumento nos níveis de acetato nas fezes. Após a separação dos voluntários por grau de obesidade, observamos que o suco de laranja Moro contribuiu para o aumento na abundância de Akkermansia, Alistipes, Bacteroides e Catenibacterium em indivíduos com obesidade grau 3. Além disso, em ambos os sucos encontramos redução da razão Firmicutes/Bacteroidetes e aumento da excreção de metabólitos de flavonoides após os tratamentos. Diante destes resultados, conclui-se que o suco de laranja Pera apresentou ações positivas sobre a permeabilidade intestinal e o suco de laranja Moro promoveu efeitos mais expressivos na modulação da inflamação associada à obesidade e da microbiota intestinal

Obesity is a complex disease that is associated with low-grade chronic inflammation, and it contributes to the development of several metabolic disorders such as insulin resistance, and recent studies suggest the influence of the intestinal microbiota in the development and maintenance of the disease. Several studies have suggested the benefit of fruits and vegetables consumption in the prevention and treatment of chronic diseases. The orange juice contains some bioactive compounds with anti-inflammatory and antioxidant actions with effects in the composition of the gut microbiota. Thus, the main objective of this study was to evaluate the effects of Pera and Moro orange juice consumption on the composition of the gut microbiota and inflammatory parameters in volunteers with obesity and insulin resistance. A crossover clinical trial was carried out with orange juice supplementation (400ml/day) for 15 days with a washout period of 40 days. Blood, feces, urine, body composition, food consumption were analyzed before and after each intervention. Comparison between treatments was performed using generalized estimating equations and a significance level of 5% was adopted. In relation to gut microbiota, in both treatments, the two most abundant phyla were Firmicutes and Actinobateria. In the analysis of bacterial genera, a greater abundance of Bifidobacterium was observed after supplementation with Moro orange juice. The Pera orange juice reduced zonulin and Moro orange juice contributed to a reduction on inflammatory cytokines, a decrease in blood pressure and an increase in acetate levels in the stool. After separating the volunteers by degree of obesity, we observed that Moro orange juice contributed to the increase in the abundance of Akkermansia, Alistipes, Bacteroides and Catenibacterium in individuals with grade 3 obesity. Furthermore, in both juices we found a reduction in the Firmicutes/Bacteroidetes ratio and increased excretion of flavonoid metabolites after treatments. Therefore, we concluded that Pera orange juice had positive actions on intestinal permeability and Moro orange juice promoted more expressive effects on the modulation of inflammation associated with obesity and on the intestinal microbiota

Tyramine exerts hypolipidemic and anti-obesity effects in vivo

Abstract Obesity and dyslipidemia are conditions often associated with cardiovascular risk, inflammation, oxidative stress, and death. Thus, a new approach has been highlighted to promote research and development of pharmacological tools derived from natural sources. Among the most widely studied groups of substances, polyphenols such as tyramine stand out. This study investigated hypolipidemic and anti-obesity properties of tyramine. Oral toxicity evaluation, models of dyslipidemia and obesity were used. To induce dyslipidemia, Poloxamer-407 (P-407) was administered intraperitoneally. In the hypercholesterolemic and obesity model, specific diet and oral tyramine were provided. After 24h of P-407 administration, tyramine 2 mg/kg (T2) decreased triglycerides (TG) (2057.0 ± 158.5 mg/dL vs. 2838 ± 168.3 mg/dL). After 48h, TG were decreased by T2 (453.0 ± 35.47 vs. 760.2 ± 41.86 mg/dL) and 4 mg/kg (T4) (605.8 ± 26.61 760.2 ± 41.86 mg/dL). T2 reduced total cholesterol (TC) after 24h (309.0 ± 11.17 mg/dL vs. 399.7 ± 15.7 mg/dL); After 48h, 1 mg/kg (T1) (220.5 ± 12.78 mg/dL), T2 (205.8 ± 7.1 mg/dL) and T4 (216.8 ± 12.79 mg/dL), compared to P-407 (275.5 ± 12.1 mg/dL). The treatment decreased thiobarbituric acid reactive substances and nitrite in liver, increased superoxide dismutase, reduced the diet-induced dyslipidemia, decreasing TC around 15%. Tyramine reduced body mass, glucose, and TC after hypercaloric feed. Treatment with 5 mg/L (0.46 ± 0.04 ng/dL) and 10 mg/L (0.44 ± 0.02 ng/dL) reduced plasma insulin (1.18 ± 0.23 ng/dL). Tyramine increased adiponectin at 5 mg/L (1.02 ± 0.02 vs. 0.83 ± 0.02 ng/mL) and 10mg/L (0.96 ± 0.04 ng/mL). In conclusion, tyramine has low toxicity in rodents, has antioxidant effect, reduces plasma triglycerides and cholesterol levels. However, further studies should be conducted in rodents and non-rodents to better understand the pharmacodynamic and pharmacokinetic properties of tyramine

The Effect of Obesity Class on the Energetics and Mechanics of Walking.

Higher mass-normalized net energy cost of walking (NetCw/kg) and mechanical pendular recovery are observed in obese compared to lean adults. This study aimed to investigate the effect of different classes of obesity on the energetics and mechanics of walking and to explore the relationships between body mass, NetCw/kg and gait mechanics by using principal component analysis (PCA). NetCw/kg and gait mechanics were computed in severely obese (SOG; n = 18, BMI = 40.1 ± 4.4 kg·m-2), moderately obese (MOG; n = 17, BMI = 32.2 ± 1.5 kg·m-2) and normal-weight (NWG; n = 13, BMI = 22.0 ± 1.5 kg·m-2) adults during five walking trials (0.56, 0.83, 1.11, 1.39, 1.67 m·s-1) on an instrumented treadmill. NetCw/kg was significantly higher in SOG compared to NWG (p = 0.019), with no significant difference between SOG and MOG (p = 0.14), nor between MOG and NWG (p = 0.27). Recovery was significantly higher in SOG than in NWG (p = 0.028), with no significant difference between SOG and MOG (p = 0.13), nor between MOG and NWG (p = 0.35). PCA models explained between 17.0% and 44.2% of the data variance. This study showed that: (1) obesity class influences the gait energetics and mechanics; (2) PCA was able to identify two components, showing that the obesity class is associated with lower walking efficiency and better pendulum-like characteristics.

Machine Learning to Identify Metabolic Subtypes of Obesity: A Multi-Center Study.

Background and objective: Clinical characteristics of obesity are heterogenous, but current classification for diagnosis is simply based on BMI or metabolic healthiness. The purpose of this study was to use machine learning to explore a more precise classification of obesity subgroups towards informing individualized therapy. Subjects and Methods: In a multi-center study (n=2495), we used unsupervised machine learning to cluster patients with obesity from Shanghai Tenth People's hospital (n=882, main cohort) based on three clinical variables (AUCs of glucose and of insulin during OGTT, and uric acid). Verification of the clustering was performed in three independent cohorts from external hospitals in China (n = 130, 137, and 289, respectively). Statistics of a healthy normal-weight cohort (n=1057) were measured as controls. Results: Machine learning revealed four stable metabolic different obese clusters on each cohort. Metabolic healthy obesity (MHO, 44% patients) was characterized by a relatively healthy-metabolic status with lowest incidents of comorbidities. Hypermetabolic obesity-hyperuricemia (HMO-U, 33% patients) was characterized by extremely high uric acid and a large increased incidence of hyperuricemia (adjusted odds ratio [AOR] 73.67 to MHO, 95%CI 35.46-153.06). Hypermetabolic obesity-hyperinsulinemia (HMO-I, 8% patients) was distinguished by overcompensated insulin secretion and a large increased incidence of polycystic ovary syndrome (AOR 14.44 to MHO, 95%CI 1.75-118.99). Hypometabolic obesity (LMO, 15% patients) was characterized by extremely high glucose, decompensated insulin secretion, and the worst glucolipid metabolism (diabetes: AOR 105.85 to MHO, 95%CI 42.00-266.74; metabolic syndrome: AOR 13.50 to MHO, 95%CI 7.34-24.83). The assignment of patients in the verification cohorts to the main model showed a mean accuracy of 0.941 in all clusters. Conclusion: Machine learning automatically identified four subtypes of obesity in terms of clinical characteristics on four independent patient cohorts. This proof-of-concept study provided evidence that precise diagnosis of obesity is feasible to potentially guide therapeutic planning and decisions for different subtypes of obesity. Clinical Trial Registration: www.ClinicalTrials.gov, NCT04282837.

Serum and Dietary Vitamin D in Individuals with Class II and III Obesity: Prevalence and Association with Metabolic Syndrome.

The association between vitamin D deficiency and metabolic syndrome (MS) in severe obesity is unclear and controversial. We analyzed serum and dietary vitamin D and their association with MS in 150 adults with class II and III obesity (BMI ≥ 35 kg/m2) from the DieTBra Trial (NCT02463435). MS parameters were high fasting blood glucose, low HDL cholesterol, high triglycerides, elevated waist circumference, and hypertension. Vitamin D deficiency was considered as a level < 20 ng/mL. We performed multivariate Poisson regression adjusted for sociodemographic and lifestyle variables. The prevalence of serum vitamin D deficiency was 13.3% (mean 29.9 ± 9.4 ng/mL) and dietary vitamin D median was 51.3 IU/day. There were no significant associations between vitamin D, serum, and diet and sociodemographic variables, lifestyle, and class of obesity. Serum vitamin D deficiency was associated with age ≥ 50 years (p = 0.034). After a fully adjusted multivariate Poisson regression, MS and its parameters were not associated with serum or dietary vitamin D, except for lower HDL, which was associated with serum vitamin D deficiency (PR = 0.71, 95% CI 0.52-0.97; p = 0.029). Severe obese individuals had a low prevalence of vitamin D deficiency, which was not associated with MS.

Can a data driven obesity classification system identify those at risk of severe COVID-19 in the UK Biobank cohort study?

COVID-19 is a disease that has been shown to have outcomes that vary by certain socio-demographic and socio-economic groups. It is increasingly important that an understanding of these outcomes should be derived not from the consideration of one aspect, but by a more multi-faceted understanding of the individual. In this study use is made of a recent obesity driven classification of participants in the United Kingdom Biobank (UKB) to identify trends in COVID-19 outcomes. This classification is informed by a recently created obesity systems map, and the COVID-19 outcomes are: undertaking a test, a positive test, hospitalisation and mortality. It is demonstrated that the classification is able to identify meaningful differentials in these outcomes. This more holistic approach is recommended for identification and prioritisation of COVID-19 risk and possible long-COVID determination.

Normal weight obesity and unaddressed cardiometabolic health risk-a narrative review.

Normal weight obesity (NWO) is defined as having a normal body mass index (BMI), but a high body fat mass. There is growing interest in individuals with NWO, which is an underdiagnosed and understudied group, because of their increased risk for cardiometabolic morbidity and mortality. In this review, we summarized the definition, prevalence, etiology, pathophysiology, and cardiovascular outcomes seen in NWO. We have also summarized the available literature on interventions for NWO. There is a wide variation in the body fat percent cutoffs used to diagnose excess body fat. Hence, the prevalence rates of NWO vary between different populations and studies. It is estimated that about 30 million Americans have NWO and the worldwide prevalence ranges from 4.5% to 22%. Genetics, diet, and physical activity are related to NWO. However, etiological factors are not clear. Changes in body composition, inflammation, oxidative stress are present in NWO in comparison to normal weight lean (NWL) who have a normal BMI and normal body fat amount. Furthermore, cardiometabolic changes are observed and some are subclinical. Thus, screening for NWO will enhance the primary prevention of cardiovascular disease. Due to the use of various body fat percent cutoffs and methods to measure body fat, it is challenging to compare between studies. Researchers working in this field should ideally work towards developing standard body fat percent cutoffs for diagnosing NWO. There are many gaps in the literature on NWO unlike for overt obesity and future studies should explore the etiology, molecular mechanisms, and adipose tissue changes of NWO as well as conduct well planned and executed randomized controlled trials testing dietary, physical, and behavioral interventions for NWO in both males and females of different racial and age groups.

Edmonton Obesity Staging System: an improvement by cardiopulmonary exercise testing.

BACKGROUND/OBJECTIVES: Different approaches are used to classify obesity severity. Beyond classical anthropometric measurements, the Edmonton Obesity Staging System (EOSS) considers medical, physical and psychological parameters. However, this method has some limitations, principally due to the absence of an objective measure for physical impairment. The aim of our study is thus to overcome this limitation suggesting a new functional parameter obtained by cardiopulmonary exercise testing (CPET), i.e., cardiorespiratory fitness (CRF), expressed as weight-adjusted peak oxygen consumption (VO2peak/kg). SUBJECTS/METHODS: This observational cross-sectional study conducted on a population of 843 patients affected by obesity finally enrolled 500 subjects. Every patient underwent clinical, anthropometric, biochemical assessment and CPET. First, participants have been classified according to standard EOSS in five stages. Second, patients were reclassified according to the new modified EOSS (EOSS-CRF) based on their age- and gender-appropriate VO2peak/kg percentiles as reported in the healthy normal-weight population of the FRIEND registry. RESULTS: VO2peak/kg was significantly different between standard EOSS classes 1 and 2 and classes 1 and 3 (ANCOVA p model = 0.004), whereas patients in classes 2 and 3 showed similar CRF. The EOSS-CRF classification varied in number of patients in each class compared to EOSS, particularly with a shift from class 2 to class 3. Moreover, CRF showed that physical impairment is less addressed by EOSS when compared to EOSS-CRF. CONCLUSIONS: The integration of EOSS with CRF allowed us to assign to each patient a severity index that considers not only clinical parameters, but also their functional impairment through a quantitative and prognostically important parameter (VO2peak/kg). This improvement of the staging system may also provide a better approach to identify individuals at increased risk of mortality leading to targeted therapeutic management and prognostic risk stratification for patients with obesity.

Circulating IL-6, clusterin and irisin in obese subjects with different grades of obesity: association with insulin resistance and sexual dimorphism.

OBJECTIVE: There are discrepancies about the relationship of IL-6, clusterin and irisin with obesity and obesity associated insulin resistance and also about their sexual dimorphism. This study aimed at evaluating the circulating levels of IL-6, clusterin and irisin in obese subjects of both sexes who had different grades of obesity and examining their sexual dimorphism and their association with insulin resistance. METHODS: This study included 176 non-diabetic subjects of both sexes who were classified according to their sex into two groups; the male and the female groups. The male group (88 men) was classified according to BMI into; group 1 (22 lean men), group 2 (22 class I obese men), group 3 (22 class II obese men) and group 4 (22 class III obese men). The female group (88 women) was classified according to BMI exactly as the male group. Metabolic parameters, IL-6, clusterin, and irisin levels were measured. Data were analyzed by ANOVA test, post hoc Tukey's test and independent t-test. Pearson correlation was used to assess the association between variables. RESULTS: In obese subjects of both sexes, circulating IL-6, clusterin and irisin levels were significantly elevated and positively correlated with HOMA-IR. Obese males showed significantly higher HOMA-IR, IL-6, clusterin and irisin levels than obese females. CONCLUSION: Obesity in both sexes, especially in males was associated with high levels of IL-6, clusterin and irisin and worsened the metabolic pattern. Circulating IL-6, clusterin and irisin may represent possible therapeutic targets for insulin resistance in obese subjects.

Circulating IL-6, clusterin and irisin in obese subjects with different grades of obesity: association with insulin resistance and sexual dimorphism

ABSTRACT Objective: There are discrepancies about the relationship of IL-6, clusterin and irisin with obesity and obesity associated insulin resistance and also about their sexual dimorphism. This study aimed at evaluating the circulating levels of IL-6, clusterin and irisin in obese subjects of both sexes who had different grades of obesity and examining their sexual dimorphism and their association with insulin resistance. Subjects and methods: This study included 176 non-diabetic subjects of both sexes who were classified according to their sex into two groups; the male and the female groups. The male group (88 men) was classified according to BMI into; group 1 (22 lean men), group 2 (22 class I obese men), group 3 (22 class II obese men) and group 4 (22 class III obese men). The female group (88 women) was classified according to BMI exactly as the male group. Metabolic parameters, IL-6, clusterin, and irisin levels were measured. Data were analyzed by ANOVA test, post hoc Tukey's test and independent t-test. Pearson correlation was used to assess the association between variables. Results: In obese subjects of both sexes, circulating IL-6, clusterin and irisin levels were significantly elevated and positively correlated with HOMA-IR. Obese males showed significantly higher HOMA-IR, IL-6, clusterin and irisin levels than obese females. Conclusion: Obesity in both sexes, especially in males was associated with high levels of IL-6, clusterin and irisin and worsened the metabolic pattern. Circulating IL-6, clusterin and irisin may represent possible therapeutic targets for insulin resistance in obese subjects.

Relación entre el patrón de consumo de alimentos y la composición corporal de estudiantes universitarios: estudio transversal / Relationship between pattern of food consumption and body composition in university students: a cross-sectional study

INTRODUCCIÓN: los jóvenes universitarios enfrentan diversas situaciones sociales que generan cambios en los estilos de vida. Estos están asociados a desequilibrios en la ingesta dietética, caracterizada por una gran densidad calórica, lo que produce sobrepeso. Al mismo tiempo, se conoce la relación entre los patrones de consumo y la composición corporal, pero existe un vacío en la población universitaria colombiana. Así pues, el objetivo de esta investigación fue determinar la relación del patrón de consumo de alimentos con la composición corporal en universitarios. MÉTODO: estudio observacional, descriptivo, de corte transversal con una muestra de 189 estudiantes. Se incluyeron variables sociodemográficas obtenidas por encuesta, variables de composición corporal derivadas de la bioimpedancia, y los grupos de alimentos y sus categorías por el método del recordatorio de 24 horas. Se realizó un modelo de regresión logística multinomial para explicar la composición corporal de acuerdo con el consumo de los grupos de alimentos. RESULTADOS: se obtuvieron asociaciones estadísticamente significativas entre el consumo de alimentos y la composición corporal para la grasa visceral y el consumo de huevos, carnes, embutidos y granos (p = 0,024), y para el consumo de azúcares con respecto a la masa ósea (p = 0,029) y la masa muscular (p = 0,013). El modelo de regresión múltiple mostró que el consumo de azúcar incrementa la probabilidad de tener grasa visceral (OR = 2,71) y la probabilidad de clasificar a una persona como obesa (OR = 2,55). El consumo de huevos, carnes, embutidos y granos favorece la clasificación de la grasa visceral como aceptable (OR = 0,14). El consumo de frutas y verduras incrementa la probabilidad de presentar un alto porcentaje de agua (OR = 5,41) y la clasificación del porcentaje de grasa como bajo (OR = 3,60). CONCLUSIONES: el consumo de frutas y verduras se corresponde con un porcentaje bajo de grasa; no obstante, su ingesta se vincula proporcionalmente con altos niveles de agua corporal. Se deben realizar estudios que establezcan asociaciones entre la composición corporal y el consumo de alimentos, teniendo en cuenta la ingesta específica que pueda establecer una correlación con mayor precisión

INTRODUCTION: young university students face a social dynamics that has generated complex lifestyles and, especially, an imbalance in the intake of macro and micronutrients, characterized by having a high caloric density intake, which results in significant excess of weight. It is unknown if these consumption patterns are related to body composition. This research aimed to determine the relationship between pattern of food consumption and body composition in university students. METHOD: an observational, descriptive, cross-sectional study with a sample of 189 students. Sociodemographic variables obtained by a survey, body composition variables obtained by bioimpedance, and food groups and their categories obtained via a 24-hour reminder method were included. A multinomial logistic regression model was performed to explain body composition according to consumption of food groups. RESULTS: statistically significant associations were obtained between food consumption and body composition for visceral fat and consumption of eggs, meats, sausages and grains (p = 0.024), and consumption of sugars with bone mass (p = 0.029) and muscle mass (p = 0.013). The multiple regression model showed that sugar consumption increases the risk of having visceral fat (OR = 2.71), and increases the probability of being classified as an obese person (OR = 2.55). Consumption of eggs, meats, sausages, and grains favors an acceptable percentage of visceral fat (OR = 0.14). The consumption of fruits and vegetables increases the risk of having a high percentage of water (OR = 5.41), and low fat percentage (OR = 3.60). CONCLUSIONS: the consumption of sugars seems to have a close relationship with variables of body composition such as visceral fat, bone mass, and muscle mass. The consumption of fruits and vegetables was related to a low percentage of fat; however, their consumption is proportionally related to high levels of body water. Studies to establish associations between body composition and food consumption should be carried out taking into account specific intakes in order to establish a more accurate association

Association of obesity indices with in-hospital and 1-year mortality following acute coronary syndrome.

BACKGROUND/OBJECTIVES: According to the "obesity paradox", adults with obesity have a survival advantage following acute coronary syndrome, compared with those without obesity. Previous studies focused on peripheral obesity and whether this advantage is conferred by central obesity is unknown. The objective of this study was to describe the association of peripheral and central obesity indices with risk of in-hospital and 1-year mortality following acute coronary syndrome (ACS). SUBJECTS/METHODS: Gulf COAST is a prospective ACS registry that enrolled 4044 patients age ≥18 years from January 2012 through January 2013, across 29 hospitals in four Middle Eastern countries. Associations of indices of peripheral obesity (body-mass index, [BMI]) and central obesity (waist circumference [WC] and waist-to-height ratio [WHtR]) with mortality following ACS were analyzed in logistic regression models (odds ratio, 95% CI) with and without adjustment for Global Registry of Acute Coronary Events risk score. RESULTS: Of 3882 patients analyzed (mean age: 60 years; 33.3% women [n = 1294]), the prevalence of obesity was 34.5% (BMI ≥ 30.0 kg/m2), 72.2% (WC ≥ 94.0 cm [men] or ≥80.0 cm [women]) and 90.0% (WHtR ≥ 0.5). In adjusted models, deciles of obesity indices showed higher risk of mortality at extreme versus intermediate deciles (U-shaped). When defined by conventional cut-offs, peripheral obesity (BMI ≥ 30.0 versus 18.5-29.9 kg/m2) showed inverse association with risk of in-hospital mortality (0.64; 95% CI, 0.42-0.99; P = 0.04; central obesity showed trend toward reduced mortality). In contrast, for risk of 1-year mortality, all indices showed inverse association. Obesity, defined by presence of all three indices, versus nonobesity showed inverse association with risk of 1-year mortality (0.52; 95% CI, 0.35-0.75; P = 0.001). Results were similar among men and women. CONCLUSION: The degree of obesity paradox following ACS depends on the obesity index and follow-up time. Obesity indices may aid in risk stratification of mortality following ACS.

Disability assessment in an Italian cohort of patients with obesity using an International Classification of Functioning, Disability and Health (ICF)-derived questionnaire.

BACKGROUND: Obesity is a clinical condition that contributes to the development of related disability in different areas (physical, psychological and social). Multidisciplinary treatment calls for specific instruments able to evaluate all related functional problems. We have developed a tool (an ICF-based assessment instrument, the ICF-OB schedule) to evaluate obesity-related disability, composed of an inventory of 71-items from the WHO International Classification of Functioning, Disability and Health (ICF). AIM: The aim of the present study was to validate this new tool for the definition of obesity-related disability. We also sought to examine the relationship between obesity disability, an index of multimorbidity (Cumulative Illness Rating Scale [CIRS]) and a well-validated score of perceived obesity-related disability (Italian Obesity Society Test for Obesity-Related Disability [TSD-OC]). DESIGN: Process validation of the ICF-OB schedule. SETTING: Baseline conditions of out- and in-patients. POPULATION: A large cohort of obese patients recruited from 9 multidisciplinary centers belonging to the Italian Obesity Society (SIO) network, which provide specialized obesity care. METHODS: A total of 353 patients (F: 70%, age: 50.2±12.7yrs, BMI: 41.4±8.3kg/m2) were enrolled between January 2017 and June 2018. The ICF-OB was used to define patients' functioning and disability profiles in order to set and appraise rehabilitation goals. RESULTS: We described the distribution of body functions (BF), body structures (BS) and activities and participations (A&P) categories and the agreement rates were significant for the majority of these. The ICF-OB was more often significantly associated, and with stronger coefficients, with patients' comorbidities as described by the CIRS rather than with Body Mass Index (BMI). The TSD-OC also presented a strong association with A&P indexes. CONCLUSIONS: The complexity of clinical condition, that generates disability in obesity might be well identified with the use of this new instrument that appear significant related to the perceived disability for each patients and also with their multimorbidity. CLINICAL REHABILITATION IMPACT: The ICF-OB shows great promise as a tool for goal setting in the rehabilitation of obese patients.