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Obesity is a worsening global epidemic that is detrimentally affecting women’s reproductive health. Being obese not only decreases fertility, but also increases miscarriage rates and other pregnancy complications. Perhaps even more significant is the increasing evidence demonstrating associations between maternal obesity and long-term risks of obesity and metabolic disturbances in the offspring.
The mechanisms mediating the effects of obesity on early pregnancy are likely multifactorial, involving oocyte quality, embryo competence, endometrial receptivity, and fetal development. Early pregnancy is a critical time that strongly influences the fate of the pregnancy as well as the health of the next generation.
Fetal macrosomia, defined as birth weight >4,000 grams at any gestational age, is an important consideration for management of delivery, especially when complicated by preexisting and gestational diabetes, maternal obesity, post-term gestation, and history of macrosomia in prior pregnancy. While no exact measurement of fetal weight exists, fetal biometry is used to calculate an estimated fetal weight (EFW) when assessing for suspected macrosomia. When macrosomia is suspected, consideration of both fetal/neonatal and maternal morbidity must be considered when counseling patients on timing and mode of delivery. Fetal risks of macrosomia include shoulder dystocia and subsequent birth trauma, including clavicular fracture, brachial plexus injury, and complications related to hypoxia and impaired oxygenation during prolonged delivery. Maternal risks involve increased need for cesarean delivery, severe perineal lacerations, and postpartum hemorrhage. While most vaginal deliveries of pregnancies suspected to be affected by fetal macrosomia are uncomplicated and do not involve shoulder dystocia, scheduled cesarean deliveries may be beneficial in individuals with EFW of 4,500 grams or more with diabetes or individuals with EFW of 5,000 grams or more without diabetes.
The Brazilian Worker’s Food Program (WFP) is a public policy initiative that focuses on nutritional assistance for low-income formal workers (less than five minimum wages). Currently, it serves more than 25 million formal workers (around 54%). This systematic review aimed to assess the nutritional quality of meals offered and/or consumed by beneficiaries of the WFP. Observational studies conducted with workers from companies registered in the programme were eligible, with no restrictions on the period of publication. The nutritional quality was assessed according to the guidelines of the programme (Normative Ordinance No. 66/2006). Twenty cross-sectional studies and one cohort study met the inclusion criteria. Most of the participants were male, from manufacturing industries, and their average age was 35.0 years. The results of the analysis showed that fibre, sodium, calories, and proteins were the nutrients that most exceeded the recommended amounts, whereas carbohydrate was the nutrient that had the least amount. The results showed that the nutritional quality of the food offered to or consumed by workers did not fully meet the required guidelines and, in some companies, did not promote an adequate and healthy diet. The WFP has great potential and needs to be reformulated to make it a programme that contributes to strengthening the realisation of the human right to adequate food.
Dietary guidelines often combine plant and animal protein intake recommendations, yet evidence suggests they may have distinct associations with health. This study aimed to examine relationships between animal and plant protein intake, using different classification approaches, and diet quality and obesity. Plant and animal protein contents of foods reported by 7637 participants (≥ 19 years) during the 2011–2012 National Nutrition and Physical Activity Survey were estimated using Australian food composition databases. Usual animal, plant and total protein intakes were estimated using Multiple Source Methods. Diet quality was assessed using the 2013-Dietary Guidelines Index (DGI), and obesity measures included BMI and waist circumference (WC). Multiple linear and logistic regressions were performed and adjusted for potential confounders. Plant and animal protein intakes were positively associated with DGI scores (plant protein: men, β = 0·74 (95 % CI: 0·64, 0·85); women, β = 0·78 (0·67, 0·89); animal protein: men, β = 0·15 (0·12, 0·18); women, β = 0·26 (0·22, 0·29)). These associations were consistent when examining high-quality plant protein (high-protein-containing plant-based foods with comparable nutritional values to animal proteins) and non-dairy animal protein intakes. Plant protein intake was inversely associated with BMI and WC in men but not women. Animal protein intake was positively associated with BMI in both sexes and WC in men only. Men’s plant protein intake was inversely associated with obesity (OR = 0·97 (0·96, 0·99)) and central obesity (OR = 0·97 (0·95, 0·98)). Further studies are needed to examine the influence of different animal protein sources by accounting for energy intake and sex-specific associations.
Gastroesophageal reflux disease (GERD) is a prevalent condition observed across various medical specialties, including gastroenterology, otorhinolaryngology, surgery, and primary care. Despite the routine prescription of proton pump inhibitors (PPIs), some patients fail to experience adequate symptom relief. This review delves into the multifactorial mechanisms of reflux, which extend beyond hydrochloric acid to include pepsin, bile acids and trypsin. These factors significantly contribute to mucosal injury in GERD and are influenced by dietary composition. Moreover, dietary patterns with anti-inflammatory properties, such as the Mediterranean and DASH (dietary approaches to stop hypertension) diets, have shown potential in GERD managing, particularly in the context of obesity–an important risk factor.
To examine the potential indirect effect of meal frequency on mortality via obesity indices.
Design:
Prospective cohort study
Setting:
Korean Genome and Epidemiology Study.
Participants:
This cohort study involved 148 438 South Korean adults aged 40 years and older.
Results:
Meal frequency at the baseline survey was assessed using a validated FFQ. Outcomes included all-cause mortality, cancer mortality and CVD mortality. Cox proportional hazards regression models were employed to examine the relationship between meal frequency and the risk of mortality. Mediation analyses were performed with changes in obesity indices (BMI and weight circumference (WC)) as mediators. In comparison to the three-time group, the once-per-day and four-times-per-day groups had a higher risk for all-cause mortality. The irregular frequency group had a higher risk for CVD mortality. Both once-per-day and four-times-per-day groups exhibited higher risks for cancer mortality. The effect of meal frequency on all-cause mortality was partially mediated by WC. For specific-cause mortality, similar mediation effects were found.
Conclusions:
The data suggests that three meals per day have a lower mortality and longer life expectancy compared with other meal frequencies. Increased waist circumference partially mediates this effect. These findings support the implementation of a strategy that addresses meal frequency and weight reduction together.
Obesity, a global health issue, is associated with numerous diseases and has been shown to affect male reproductive health by inducing endocrine hormonal changes, chronic inflammation, oxidative stress and epigenetic alterations in reproductive cells. This study investigates the impact of obesity on testicular gene expression across mice, monkeys and humans, identifying 730 conserved testis-specific genes. High-fat diet-induced obesity upregulates GNG5, INHA, MSH5, SLC30A8 and SLC7A4 in testes, suggesting their potential as regulatory targets in testicular damage associated with obesity. Single-cell analysis reveals species-conserved expression patterns of SLC7A4 in Sertoli cells and SLC30A8 in SPG cells. It also confirmed that SLC30A8 and SLC7A4 were significantly upregulated in the testes of spontaneously obese mice. The findings highlight the potential of these genes as regulatory targets in obesity-related testicular dysfunction, providing insights into male reproductive health impairments caused by obesity.
This chapter discusses the role of neuroanatomy in the development and maintenance of obesity. Similar to other addictive behaviors, alterations in dopaminergic and opioid pathways involved in food reward are important in obesity. The reward system, including the striatal nucleus accumbens, caudate nucleus, amygdala, anterior insula, and OFC, has been implicated in the development of obesity. Activation in these areas to food cues predicts food consumption, weight gain, and changes with weight loss. Interestingly, gut hormones can modulate the activation of these reward systems both at rest and in response to food stimuli. Surgical interventions for obesity have proven to be the most effective tool for treating obesity. However, if anatomical manipulations of the gut can alter the hedonic evaluation of food, then the gut-brain axis may be the most important target for future treatments of obesity. This chapter provides a comprehensive overview of the neuroanatomical basis of obesity and highlights the importance of understanding the reward system in the development and treatment of obesity.
This study examined the relationship between total body fat percentage (TBFP), trunk fat percentage (TFP), and urinary flow rate (UFR) using NHANES data (2011–2018) from 10 521 participants aged 18–59. Multivariable-adjusted regression models assessed associations between dual-energy X-ray absorptiometry-measured fat percentages and UFR. Results showed that increased TBFP and TFP were inversely associated with UFR (TBFP: β = −0·013, 95 % CI [–0·018, −0·007]; TFP: β = –0·014, 95 % CI [–0·018, −0·009]). Stratified analyses revealed gender differences: in males, higher TBFP and TFP correlated with lower UFR (TBFP: β = –0·011, 95 % CI [−0·019, −0·004]; TFP: β = –0·016, 95 % CI [−0·022, −0·009]), but this association was absent in males aged 18–35. In females, both TBFP and TFP were consistently linked to reduced UFR across all age groups (TBFP: β = −0·016, 95 % CI [−0·023, −0·008]; TFP: β = −0·012, 95 % CI [−0·019, −0·006]). These findings suggest that body and trunk fat accumulation negatively impact UFR, with stronger effects in females and age-dependent variations in males. Further research should explore mechanisms behind these disparities to guide targeted interventions.
China has dedicated significant efforts to preventing obesity, but the rising prevalence of overweight and obesity remains a pressing public health issue. Therefore, unique solutions are required to address this challenge in China. As a research priority, the food environment plays a pivotal role in addressing overweight and obesity. However, research on this topic in China lags behind that in other developed countries, and the conflicting global evidence on the association between the food environment and obesity cannot be directly applied to policymaking and intervention in China. In addition, the rapid advancement of digital technology has introduced complexities and uncertainties in the food environment. To address these challenges, we propose an alternative research framework through (a) dissecting the challenges associated with defining and measuring the food environment, (b) reorganising the relationship chains between the food environment and human diet/health and (c) taking into consideration digital platforms as crucial monitoring tools for studying the food environment. Our framework aims to unlock the potential of food environment research in the digital age, ultimately striving to tackle the overweight and obesity issues in China.
Obesity and its comorbidities (e.g. laminitis) are identified as major welfare issues among domestic equids in the United Kingdom (UK) and abroad. Weight-management typically focuses on restricting consumption (e.g. limiting pasture grazing), often facilitated through stabling. This leads to social isolation, prompting other welfare issues. Increased exercise may be a preferable solution for equine obesity, if viable. The aims of this study were to explore horse (Equus caballus) owner perceptions regarding the importance of exercise, and to investigate how exercise provision related to welfare outcomes. Data obtained via an online survey from 804 UK horse owners indicated that most respondents’ horses were managed in obesogenic conditions, and 40% were owner-reported as overweight/obese. Exercise-related variables (e.g. if a horse was ridden) correlated with physical health problems, including decreased reports of laminitis and Equine Metabolic Syndrome. Approximately 90% of respondents reported that barriers outside of their control substantially limited opportunities to provide human-led exercise (e.g. riding, lunging). Analysis of a hypothetical weight-management scenario found owners with horses at livery yards felt significantly less able to increase horses’ self-directed exercise (e.g. free movement in fields/pastures) than owners keeping horses on their own properties. These findings indicate that while increased exercise may improve welfare, owner knowledge is not the only barrier that must be overcome to implement this prospective solution. Both human-led and self-directed exercise appear limited by a lack of opportunities available to horses and humans. These results justify future investigations into alternative management strategies as potentially viable methods of increasing exercise to improve welfare.
Overweight and obesity are growing health concerns globally. Technological advances drive interest in smartphone applications as possible health behaviour interventions to promote lifestyle change in these conditions. This article critically appraises a Cochrane Review of 18 studies (2703 participants) of smartphone app interventions for overweight or obesity in adolescents and adults and considers its relevance to clinical practice and research. The review's results suggest that there may be minimal benefit to the use of smartphone apps, but the evidence is very uncertain, lacking high-quality, replicable studies.
Supplemental Nutrition Assistance Program (SNAP) makes an exception to its rules, which allows elderly and/or disabled individuals, their spouses, as well as homeless beneficiaries, to buy hot prepared food from restaurants if they live in a state that participates in the Restaurant Meals Program (RMP). Using the staggered countywide adoption timeline in California, coupled with a stacked difference-in-differences empirical strategy, I examine the intent-to-treat (ITT) nutritional effects of RMP on the elderly population. Overall, I find no evidence that obesity rates for the elderly are any different in counties with RMP versus those without RMP. I can statistically rule out moderate effects. Additional evidence from some of the early-adopting counties suggests that RMP is associated with a reduction in food insecurity among the elderly.
Glucagon-like peptide-1 (GLP-1) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) administration has been associated with neuroproliferative effects and modulatory effects in neuronal pathways. Herein, we conducted a comprehensive synthesis of the effects of GLP-1 and GLP-1 RAs on neurogenesis.
Methods:
We examined studies that investigate changes in neurogenesis mediated by GLP-1 and GLP-1 RA administration in both human and animal populations. Relevant articles were retrieved through OVID (MedLine, Embase, AMED, PsychINFO, JBI EBP Database), PubMed, and Web of Science from database inception to July 2nd. Primary studies investigating the role of GLP-1 and GLP-1 RAs on neurogenesis were included for analysis.
Results:
GLP-1 and GLP-1 RAs (i.e. exenatide, geniposide, liraglutide, lixisenatide, and semaglutide), increased neurogenesis within the dentate gyrus, hippocampus, olfactory bulb, and the medial striatum in animal models. Additionally, GLP-1 and GLP-1 RAs were associated with modulating changes in multiple apoptotic pathways and upregulating survival pathways.
Discussion:
GLP-1 and GLP-1 RAs are positively associated with neurogenesis. This effect may have translational implications insofar as disparate mental disorders that are characterised by neurogenesis defects (e.g. depressive disorders and neurocognitive disorders) may be benefitted by these agents.
India’s nutrition transition has led to an increased burden of overweight/obesity (body mass index of ≥23 kg/m2), driven by lifestyle factors like poor diet, inactivity, and substance use, prompting public health interventions. However, these interventions lack supporting evidence, especially in rural areas, hindering effective strategies for this population. To address this evidence gap, this study used cohort data (baseline: 2018–19, follow-up: 2022–23) from the Birbhum Population Project (West Bengal, India) to analyse lifestyle risk factors and their association with incidence and remission of overweight/obesity among adults aged ≥18 years (sample: 8,974). Modified Poisson regression model was employed to attain the study objective. From 2017–2018 to 2022–2023, the prevalence of overweight/obesity increased from 15.2% (95% CI: 14.1%–16.4%) to 21.0% (95% CI: 19.7%–22.3%) among men and from 24.1% (95% CI: 22.9%–25.2%) to 33.8% (95% CI: 32.5%–35.1%) among women. Overall, 23.0% (95% CI: 21.8%–24.3%) of adults experienced incidence of overweight/obesity, while 13.9% (95% CI: 12.4%–15.6%) experienced remission. Use of motor vehicles among unemployed participants was associated with incident overweight/obesity (relative risk or RR: 1.058; 95% CI: 1.023–1.095; P: 0.001). Vigorous activity at home (including gardening, yard work, and household chores) was linked to higher odds of recovering from overweight/obesity (RR: 1.065; 95% CI: 1.008–1.125; P: 0.025). Frequent tobacco use (often/daily vs. none) was inversely associated with remission of overweight-obesity (RR: 0.689; 95% CI: 0.484–0.980; P: 0.038), as was each 1 ml in alcohol consumption (RR: 0.995; 95% CI: 0.991–0.999; P: 0.022). Discouraging habitual motor vehicle use may help prevent overweight/obesity, while promoting home-based activities may aid remission, particularly for women who are at higher risk for overweight/obesity.
As obesity rates rise globally, addressing modifiable lifestyle factors, such as sleep, presents an opportunity for public health interventions. This review explores the growing evidence linking sleep duration, quality and timing with weight management and dietary behaviours throughout the life course. Observational studies associate short or irregular sleep with increased obesity risk, poor diet quality and metabolic disturbances. Plausible mechanisms include decreased physical activity, heightened hedonic and/or emotional eating, dysregulated appetite signals and circadian misalignment of metabolism, which contribute to a positive energy balance. Unravelling the bidirectional relationship between sleep and weight is challenging; poor sleep exacerbates weight gain, while obesity-related comorbidities such as obstructive sleep apnoea further impair sleep. Despite promising evidence from sleep-restriction studies showing increased energy intake, long-term randomised controlled trials (RCTs) examining interventions designed to improve sleep with weight management as an outcome are lacking. A handful of short-term interventions suggest benefits in reducing energy intake or improving dietary quality, but their effects on weight loss remain inconclusive. This review calls for robust, well-powered RCTs that integrate sleep, diet and physical activity interventions to evaluate the potential of sleep as a core component of obesity prevention and treatment strategies. Currently, there is insufficient evidence to support sleep-focused interventions as a mandatory element in clinical weight-management programmes.
To evaluate the association between dietary fibre intake and obesity in Japanese outpatients with type 2 diabetes, as well as the demographic and dietary factors influencing this association.
Design:
Cross-sectional study with nationwide registry data on Japanese type 2 diabetes outpatients (2014–2019). Diet was self-reported via a FFQ. Obesity was defined as BMI ≥ 25 kg/m2.
Setting:
Clinics throughout Japan.
Participants:
1565 Japanese outpatients with type 2 diabetes (63·1 % men; age range 30–89 years).
Results:
Multivariate analysis revealed that a higher dietary fibre intake was associated with a lower risk of obesity in all participants (95 % CI = 0·439, 0·795, P trend = 0·002). Stratified analysis showed a significant inverse association between fibre intake and obesity in men and the older age groups (59–89 years), but not in women or the younger age group (30–58 years). In men, higher fibre intake was associated with healthier lifestyle behaviours, including increased physical activity (P < 0·001) and non-smoking (P < 0·001), with stronger associations compared with women. Vegetables, fruits and soyabeans/soya products were strongly correlated with fibre, while grains had a weak correlation. Folate was the micronutrient most strongly correlated with fibre.
Conclusion:
Higher fibre intake was associated with lower obesity risk, particularly in men and older age groups. These findings emphasise the need for targeted public health initiatives promoting the intake of diverse fibre-rich foods to effectively manage obesity. Further research is needed to understand sex- and age-specific factors in the fibre–obesity relationship in diverse populations.
A hospital-based cross-sectional study involving children aged 2–15 years attending the obesity clinic of a tertiary care hospital from January 2016 to March 2018 was carried out to study carotid intima media thickness (cIMT) and its association with cardiometabolic risk factors in children with overweight and obesity. Secondary objective was to compare children with elevated (EcIMT) and normal cIMT (NcIMT). Out of 223 patients enrolled for the study, 102 (45·7 %) had EcIMT. Mean cIMT of the study participants was 0·41 (sd 0·13) mm. Median alanine transaminase levels (27 v. 24, P= 0·006) and proportion of patients with fatty liver (63·7 % v. 48·8 %, P= 0·025) and ≥ 3 risk factors (80·4 % v. 66·1 %, P= 0·003) were higher in the EcIMT group compared with NcIMT group. Proportion of patients with hypercholesterolemia (36·4 % v. 16 %, P= 0·024), elevated LDL-cholesterol (38·6 % v. 16 %, P= 0·013), low HDL-cholesterol (40·9 % v. 20 %, P= 0·027) and dyslipidemia (84·1 % v. 58 %, P= 0·006) was higher in the pubertal EcIMT group and those with fatty liver (63·8 % v. 45·1 %, P= 0·034) was higher in the prepubertal EcIMT group compared with pubertal and prepubertal NcIMT groups, respectively. No significant correlations were observed between cIMT and various cardiometabolic parameters. Our finding of EcIMT in nearly half of the study participants including young children is very concerning as these children are at increased risk of atherosclerotic CVD in adulthood. Interventions starting at a young age are important when trajectories are likely to be more malleable and adverse cardiometabolic phenotypes and subclinical atherosclerosis are reversible.
Substantial changes resulting from the interaction of environmental and dietary factors contribute to an increased risk of obesity, while their specific associations with obesity remain unclear. We identified inflammation-related dietary patterns (DP) and explored their associations with obesity among urbanised Tibetan adults under significant environmental and dietary changes. Totally, 1826 subjects from the suburbs of Golmud City were enrolled in an open cohort study, of which 514 were followed up. Height, weight and waist circumference were used to define overweight and obesity. DP were derived using reduced rank regression with forty-one food groups as predictors and high-sensitivity C-reactive protein and prognostic nutritional index as inflammatory response variables. Altitude was classified as high or ultra-high. Two DP were extracted. DP-1 was characterised by having high consumptions of sugar-sweetened beverages, savoury snacks, and poultry and a low intake of tsamba. DP-2 had high intakes of poultry, pork, animal offal, and fruits and a low intake of butter tea. Participants in the highest tertiles (T3) of DP had increased risks of overweight and obesity (DP-1: OR = 1·37, 95 % CI 1·07, 1·77; DP-2: OR = 1·48, 95 % CI 1·18, 1·85) than those in the lowest tertiles (T1). Participants in T3 of DP-2 had an increased risk of central obesity (OR = 2·25, 95 % CI 1·49, 3·39) than those in T1. The positive association of DP-1 with overweight and obesity was only significant at high altitudes, while no similar effect was observed for DP-2. Inflammation-related DP were associated with increased risks of overweight and/or obesity.