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Chapter 6 uses doctrinal analysis to ask what the word ‘disfigurement’ means, and whether we can justify treating disfigurement differently from the related concepts of appearance and obesity. It identifies significant gaps created by a law which only protects a small subset of people experiencing appearance disadvantage – those with severe disfigurements – and which excludes many of those disabled by social barriers because of other aesthetic differences, such as those experiencing hair loss, those whose bodies are differently sized or those with facial movement impairments (such as facial palsy or synkinesis). It doubts whether these inconsistencies and mixed messages can be justified. It also considers whether other protected characteristics – such as sex or age – can be drafted in to fill the gaps in legal protection, but concludes that this may amplify the inconsistencies within the law.
In Aotearoa New Zealand, approximately 1 in 3 adults and 1 in 8 children are classified as obese, with Māori and Pacific communities disproportionately affected(1). While maternal nutrition has been extensively studied, paternal impacts and the combined effect of both parents’ obesogenic environments on offspring health remain underexplored(2). The primary objective of this study is to characterise the metabolic phenotype of parent rats fed a High Fat High Sugar (HFHS) diet and investigate the birth characteristics of their offspring, from a factorial mating design.Eighty female and 40 male Sprague-Dawley rats were randomised to a standard chow diet (SD) (24% protein, 18% fat, 58% carbohydrates) or HFHS diet (Specialty Feeds SF23-120: 16% protein, 41% fat, 43% carbohydrates) for five weeks prior to mating. Females were then continued on their respective diets throughout pregnancy and lactation. Four mating combinations were established: SDmum-SDdad, SDmum-HFHSdad, HFHSmum-SDdad, and HFHSmum-HFHSdad. A subset of parents (n=38) underwent body composition assessments using dual-energy X-ray absorptiometry (DEXA). Additionally, a subgroup (n=23) was evaluated for metabolic profiles using Prometheon metabolic cages. Offspring birth weights and body lengths were recorded. The HFHS diet’s efficacy was confirmed in both male and female rats, with HFHS groups showing higher body weight (females: 327.1 g ± 19.7 vs. 288.2 g ± 20.1; males: 575.8 g ± 39.8 vs. 532.6 g ± 50.3; p < 0.05), greater fat percentage (females: 46.8% ± 5.6 vs. 29.2% ± 5.6; males: 40.5% ± 7.2 vs. 28.7% ± 6.8; p < 0.001), and a lower respiratory exchange ratio (RER) (females: 0.8108 ± 0.0275 vs. 0.8679 ± 0.0288; males: 0.8257 ± 0.0304 vs. 0.8759 ± 0.0266; p < 0.05) compared to the SD group. In male offspring, birth weights in HFHSmum-SDdad (6.3 g ± 0.9) and HFHSmum-HFHSdad (6.0 g ± 0.9) groups were significantly lower (p < 0.0001) than in SDmum-SDdad (6.980 g ± 0.7753) and SDmum-HFHSdad (7.0 g ± 0.7) groups. Birth weights were further reduced in HFHSmum-HFHSdad versus HFHSmum-SDdad (Mean Diff. = 0.3g; p < 0.05).Body lengths in HFHSmum-HFHSdad males were shorter (43.1 mm ± 3.2; p < 0.0001) compared to other groups (≥ 45.3 mm). Female offspring birth weights were lower in the HFHSmum-SDdad (5.8g ± 0.8) and HFHSmum-HFHSdad groups (5.8 g ± 0.9; p<0.0001) compared to the other groups (means ≥ 6.4g) but paternal HFHS diet had no additional effect on birth weight. As with males, body lengths in the HFHSmum-HFHSdad female offspring were significantly shorter (4 mm ± 3; p<0.0001) compared to all other groups (≥44mm). Parental HFHS diets synergistically reduce offspring birth length and weight, with stronger effects in males. These findings underscore the importance of inclusive dietary guidelines for both parents to reduce intergenerational obesity risk and support long-term health.
Kombucha is a fermented beverage rich in bioactive compounds. This beverage has demonstrated high antioxidant capacity in vitro and experimental animal studies. In this sense, this study aimed to evaluate the effect of daily consumption of green tea kombucha on oxidative stress and endothelial health in individuals with excess body weight. This is a randomized controlled clinical trial, lasting 10 weeks, during which the control group followed a healthy −500 kcal/d energy-restricted diet. In contrast, the kombucha group, in addition to the energy-restricted diet, consumed 200 ml of kombucha green tea daily. This study included men and women aged 18–45 years without chronic diseases. At the beginning and end of the study, fasting blood was collected, and colorimetric assays and immunoassay protocols evaluated markers of oxidative stress and endothelial health. Compared to the control group, kombucha consumption significantly reduced hydrogen peroxide (H2O2) levels (P = 0·007). Initial and final values were as follows: Control group (16·5 v. 15·09 µmol/ml; n 29) and Kombucha group (18·14 v. 14·67 µmol/ml; n 30). The other markers that were evaluated did not change after the kombucha consumption. In conclusion, daily consumption of 200 ml of green tea kombucha for 10 weeks reduces one pro-oxidant marker, without altering other markers of oxidative stress and endothelial health in individuals with excess body weight. Reducing a pro-oxidant marker suggests that kombucha is an antioxidant beverage with promising implications for human health. However, further studies are needed to elucidate other possible beneficial effects on health.
This chapter discusses sleep-disordered breathing (SDB), a highly prevalent condition that affects over 1 billion people worldwide, and the incidence of SDB is likely to increase in over the next decades. At first thought to be a moderate disruption in sleep, leading to snoring, intermittent awakenings and daytime sleepiness, SDB has now been shown to be strongly associated with severe health outcomes such as cardiovascular disease, stroke, pulmonary hypertension, and even death. Most of those with SDB suffer from obstructive sleep apnea resulting from upper airway obstruction during sleep, distinct from central sleep apnea in which the control of breathing in the brain is impaired. Diagnosis is primary made by polysomnography, with increasing application of lower cost and widely scalable home sleep apnea testing. In neuromuscular disease, SDB is more prevalent than in the general population. Treatment typically involves lifestyle management changes, CPAP therapy and noninvasive positive airway pressure ventilation. These and other treatment options, including dental appliances and surgical therapies, are presented.
Food insecurity (FIS) is a critical public health issue, particularly among older adults. This study investigates the association between FIS with diet quality and anthropometric indices in the US older adults. A cross-sectional analysis was conducted using NHANES data from 2017 to 2020, involving 2592 participants aged ≥ 60 years. FIS was assessed using the USDA Household Food Security Survey Module. Diet quality was assessed using the Healthy Eating Index (HEI)-2020 and adherence to Mediterranean diet (MedDiet) score. Anthropometric measures were calculated following standardised protocols. Multivariable logistic regression models, adjusted for demographic, socio-economic and behavioural factors examined the association between FIS and the higher quartile and tertile of anthropometric and diet quality indices, respectively. Of the participants, 27·4 % experienced FIS. FIS participants were younger and had lower education and income levels compared with FS individuals (P < 0·05). In the adjusted model, FIS was associated with lower adherence to both the Mediterranean Diet (OR: 0·48, 95 % CI: 0·31, 0·67) and HEI-2020 (OR: 0·61, 95 % CI: 0·37, 0·84), indicating poorer diet quality in older adults. In adjusted analyses, FIS was significantly associated with higher A Body Shape Index quartiles (Q3: OR: 1·44, 95 % CI: 1·06, 1·95; Q4: OR: 1·46, 95 % CI: 1·07, 2·01), the waist-to-hip ratio (Q4: OR: 1·44, 95 % CI: 1·01, 2·06) and the Conicity index (Q4: OR: 1·36, 95 % CI: 1·02, 1·81). FIS in older adults is associated with unfavourable diet quality and body composition patterns, particularly central obesity measures. Addressing FIS may mitigate health risks related to obesity and its complications.
This study investigated how the belief systems and interests of policy actors shaped their framing of the causes and solutions to obesity and how this influenced policy recommendations.
Design:
Submissions to the Select Committee on Obesity Epidemic in Australia (SCOEA) were collected, and actors were classified according to their interests in commercial and non-commercial groups. A framework grounded in social constructionism was used to code frames and underlying belief systems. The SCOEA report was analysed to identify the representative distribution of belief systems in recommendations.
Setting:
Australia.
Participants:
None.
Results:
150 submissions were collected and analysed. 120 submitters were actors with non-commercial interests, including governments (n 13), non-government organisations (n 49), civil society groups and citizens (n 24) and academia (n 34). Thirty submitters were actors with commercial interests including food industry representatives (n 23) and health enterprises (n 7). Conflicting belief systems in the framing of obesity were identified among policy actors, particularly between commercial and non-commercial groups. Non-commercial actors framed obesity in biomedical, lifestyle and socio-ecological terms, whereas commercial actors exclusively framed obesity as an issue of individual choices and proposed behavioural change interventions. A broad range of belief systems expressed by the submitters was represented in the SCOEA final report.
Conclusion:
These findings illustrate how policy actors’ beliefs and interests shaped their frames and influenced the development of a key policy report. Policymakers seeking to advance obesity prevention policy must critically evaluate strategic framing by various actors and ensure that policy decisions are evidence-based and aligned with health, equity and ecological perspectives.
To identify trajectories of Indonesian children and adolescent’s BMI-z scores between 1993 and 2014, examine whether the pattern differs by sex and assess associations with host, agent and environmental factors.
Design:
Longitudinal data were from the Indonesian Family Life Survey with up to five measurements of height and weight. Group-based trajectory models investigated changes in BMI-z score across time; differences by sex were investigated using random effect (mixed) models. The association between the trajectories and host, agent and environmental factors were examined using multinomial logistic regression.
Setting:
Thirteen provinces in Indonesia.
Participants:
Indonesian children and adolescents aged 6–18 years (n 27 394 for BMI-z trajectories; n 8805 for risk factor analyses).
Results:
Mean BMI-z score increased from –0·743 sd in 1993 to –0·414 sd in 2014. Four distinct trajectory groups were estimated with mean BMI-z increasing more rapidly in the most recent time periods. One group (11·7 % of participants) had a mean BMI-z entirely within the moderately underweight range; two had trajectories in the normal range and one (5·6 %) had a mean BMI-z starting in the overweight range but within the obesity range by 2014. There were differences in trajectory groups by sex (P< 0·001). Those born in 2000s, frequent consumption of meat, fast foods, soft drinks and fried snacks, and living in urban areas were associated with rapid gain weight.
Conclusions:
These trajectories highlight the double burden of malnutrition and suggest that the prevalence of overweight and obesity is likely to increase substantially unless public health interventions are implemented.
Metabolic syndrome (MetS) is associated with deteriorated mental health and health-related quality of life (HRQOL). Curcumin and probiotics improved MetS, mental health and HRQOL. The present study aimed to investigate the effect of curcumin-probiotic (CurPro) co-supplementation in the form of drink powder on mental health and HRQOL in adults with overweight/obesity and MetS. A four-arm, randomised, double-blinded, placebo-controlled clinical trial with factorial design was conducted for adults with overweight/obesity and MetS (n 128). Participants were randomly allocated into four groups to receive one drink powder sachet containing 1 g curcumin, 109 colony-forming unit (CFU) probiotic (Lactobacillus acidophilus and Lactobacillus rhamnosus strains), CurPro (1 g curcumin and 109 CFU probiotic) or placebo along with a low-calorie diet. Participants were assessed for dietary intake, physical activity, mental health and HRQOL before and after the study. After 8 weeks of intervention, 104 participants finished the study. The CurPro intervention reduced stress (P = 0·001) and anxiety (P = 0·019) and improved general health (P = 0·024) and overall HRQOL (P = 0·011) scores of participants in comparison with the Placebo group. Results were NS for depression and HRQOL subdomains such as physical functioning, role limitations due to physical problems, bodily pain, vitality, social functioning and role limitations due to emotional problems. Curcumin-probiotics co-supplementation could improve the mental health and HRQOL of adults with overweight/obesity and MetS. Further investigations in various populations or with different dosages or durations are recommended.
Binge-eating disorder (BED) is characterized by highly distressing episodes of loss-of-control over-eating. We have examined the use of repetitive transcranial magnetic stimulation (rTMS) for the treatment of people with BED and associated obesity. Such non-invasive brain stimulation (NIBS) techniques are used therapeutically in several psychiatric conditions and there is an associated scientific rationale.
Methods
Sixty participants were randomly allocated to receive 20 sessions of neuronavigated 10 Hz rTMS administered to the left dorsolateral prefrontal cortex (dlPFC) or sham treatment. Primary outcomes were the frequency of binge eating episodes (BEE) and the ‘urge to eat’ (craving) evaluated at baseline and end-of-treatment (8 weeks post-randomization). Secondary outcomes included body mass index (BMI), hunger, general and specific eating disorder psychopathology. Follow-up analyses were conducted for most outcomes at 16 weeks post-randomization. Multilevel models were used to evaluate group, time, and group-by-time interactions for the association between rTMS exposure and outcomes.
Results
The real rTMS group (compared with sham treatment), showed a significantly greater decrease in the number of BEE at the end of treatment (Estimated Mean [EM]: 2.41 95% CI: 1.84–3.15 versus EM: 1.45 95% CI: 1.05–1.99, p = 0.02), and at follow-up (EM: 3.79 95% CI: 3–4.78 versus EM: 2.45 95% CI: 1.88–3.17, p = 0.02; group × time interaction analysis p = 0.02). No group differences were found for other comparisons.
Conclusion
rTMS was associated with reduced BEE during and after treatment: it suggests rTMS is a promising intervention for BED.
Curcumin, a natural bioactive compound, is known to exert therapeutic effects on cancer and dysplasia. However, less is known about its effects on DNA damage and repair in obesity. Therefore, this study was to examine the novel role of curcumin in regulating DNA repair signalling using a high-fat diet (HFD)-induced obesity in mice. Male C57BL/6 mice were fed either a 60 % HFD or standard chow with curcumin (2·5 g/kg diet) for 8 weeks. We observed that curcumin alleviated weight gain, preserved glucose balance and enhanced liver fat accumulation and lipid profile in mice with obesity induced by an HFD. Curcumin enhanced the adipocyte-derived mesenchymal stem cell (ADMSC) population (Sca-1 + CD45-) and expression of phosphorylated checkpoint kinase1 (pCHK1), a DNA repair gene, in adipocytes isolated from adipose tissues of HFD-induced obesity in mice. Moreover, in human preadipocytes, treatment with 10 μM curcumin effectively reduced the mRNA levels of IL6 and CCL2 in a dose-dependent manner, while treatment with 100 μM H2O2 together with curcumin upregulated the levels of pCHK2 and total CHK2 protein and reduced level of γH2AX, a biomarker of DNA damage. In addition, curcumin inhibits preadipocyte-to-adipocyte differentiation. In conclusion, our data demonstrated that curcumin reduced the pro-inflammatory response and DNA damage in adipocytes, controlling weight gain in mice with HFD-induced obesity.
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.
This cross-sectional study aimed to investigate the correlation between magnesium consumption and periodontitis in different body mass index (BMI) and waist circumference (WC) groups. 8385 adults who participated in the National Health and Nutrition Examination Survey during 2009–2014 were included. The correlation between dietary magnesium intake and periodontitis was first tested for statistical significance by descriptive statistics and weighted binary logistic regression. Subgroup analysis and interaction tests were performed to investigate whether the association was stable in different BMI and WC groups. There was a statistical difference in magnesium intake between periodontitis and non-periodontitis populations. In model 3, participants with the highest magnesium consumption had an odds ratio of 0.72 (0.57-0.92) for periodontitis compared to those with the lowest magnesium consumption. However, in subgroup analysis, the relationship between magnesium intake and periodontitis remained significant only in the non-general obese (BMI ≤ 30 kg/m2) and non-abdominal obese populations (WC ≤ 102 cm in men and ≤ 88 cm in women). Dietary magnesium intake might decrease the periodontitis prevalence in the American population, and this beneficial periodontal health role of magnesium consumption might only be evident in non-general obese and non-abdominal obese populations.
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, 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 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.