Combating obesity in Southeast Asia countries:current status and the way forward

Obesity is gaining prominence as a serious public health challenge in the Southeast Asia(SEA)region,with an alarming rate of increase in its prevalence.Countries in the region have shown commitment to curbing the rise of obesity by establishing policies,strategies,and action plans.This paper summarises the current situation and strategies undertaken to combat obesity and related chronic diseases.Although a range of policies and strate-gies have been developed,including national nutrition action plans,community intervention programmes,fiscal measures,nutrition labelling to promote healthier choices,countries in the region are struggling to make signifi-cant progress toward halting the scourge of obesity.It is imperative to strengthen existing health systems with a paradigm shift from a focus on"sick care"to and enhancing nutrition initiatives to support obesity prevention.A comprehensive and coordinated approach is essential,one that emphasises high-level coordination across all lev-els of government and multiple sectors,and a unified plan rather than fragmented initiatives.For strategies to be effective and sustainable,they must address the fundamental environmental determinants of poor dietary choices and nutritional inequalities.A more holistic approach is clearly needed to improve the entire food environment,which in SEA countries must include the multitude of eating places where large segments of the population"eat out"everyday to meet their energy and nutrient needs.There is a recognised need for more comprehensive measures to promote healthy eating among school children and ensure a supportive environment for lifelong healthy habits.This paper calls for a whole-of-government,whole-of-society approach that combines changes to the fundamental food environment and accompanied by systematic monitoring and surveillance systems to achieve long-lasting health outcomes.

The 10th China Obesity Science Conference Held in Beijing

The 10th China Obesity Science Conference was held in Beijing from May 10th to 11th, 2024. Experts from authoritative institutions such as the National Health Commission, the Chinese Center for Disease Control and Prevention, and the China Institute of Sports Science gathered to discuss on the topics including obesity prevalence trends.

The Prevalence of Overweight/Obesity and Related Comorbidities among HIV-Positive and HIV-Negative Patients Attending the Same Clinics in Gaborone, Botswana

Context: Antiretroviral therapy (ART) helps restore the health status of people living with HIV (PLHIV). Likewise, it increases the risk of overweight/obesity and related comorbidities among the recipients. In countries like Botswana where ±84% of PLHIV is on ART, the paucity of data comparing overweight/obesity between HIV-positive on ART and HIV-negative patients may impede clinical and policy decision-making. This study sought to estimate and compare: i) the prevalence of overweight/obesity between HIV-positive on ART and HIV-negative patients;ii) the prevalence of hypertension (HTN), diabetes mellitus (DM)/coronary heart disease (CHD) between HIV-positive patients on ART and HIV-negative patients attending same outpatient departments of general clinics in Gaborone, Botswana. Patients and Methods: Five hundred eighty-one (581) outpatients were recruited in four major clinics of Gaborone, Botswana, between June and July 2019;294 or 51% of them were HIV-negative and 287 or 49% were HIV-positive on ART. The prevalence of overweight/obesity and of HTN and DM/CHD were calculated and examined using stratified analysis. Subgroups were compared using Chi-square analysis with Yates correction or Fisher exact test and t-student test for continuous data. Results: Major findings after stratification of the study population by HIV status were: i) the prevalence of all categories of (BMI), including overweight/obesity, were comparable between HIV-negative-patients and HIV-positive. In fact, there were 24 (8.0%) cases of underweight among HIV-negative-Patients and 15(5%) cases among HIV-positive patients, p = 0.2;145 (49%) HIV-negative-patients and 128 (45%) HIV-positive, p = 0.07 cases of normal weight;72 (25%) HIV-negative-patients and 87 (30%) HIV-positive, p = 0.08, were overweight;53 (18%) HIV-negative-patients and 57 (20%) HIV-positive, p = 0.12, were obese;125 (43%) HIV-negative patients and 144 (50%) HIV-positive, p=0.06 were overweight/obese;ii) the prevalence of HTN and DM/CHD among HIV-positive-patients were significantly lower (p < 0.05) compared to HIV-negative patients: There were 32 (10.9%) cases of HTN among HIV-negative patients compared to 18 (6.3%) cases of HTN among HIV-positive patients, p = 0.001;32 (11%) cases of DM/CHD HIV-negative patients compared to 4 (1.4%) cases of DM/CHD among HIV-positive patients, p = 0.001. Conclusion: the prevalence of overweight/obesity observed between HIV-negative and HIV-positive patients may suggest that the two groups shared the same exposure factors. That HTN and DM/CHD prevalence was lower among HIV-positive compared to HIV-negative patients, is possibly due to interplay factors of ART, HIV or the host population. Further studies are, however, recommended for clarifications.

Prevalence and Factors Associated with Overweight and Obesity among Public Secondary School Teachers in Parakou, Benin, in 2021

Introduction: Overweight and obesity represent a public health problem in Africa due to the epidemiological transition. The objectives of this work were to determine the prevalence of overweight and obesity and to identify associated factors among public secondary school teachers in Parakou, Benin in 2021. Methods: We conducted a descriptive and analytical cross-sectional study. Teachers working in public secondary schools in Parakou during the 2020-2021 academic year, present at work and who gave their written informed consent, were included. A two-stage random sampling was carried out. Data were collected during an individual interview using a questionnaire followed by the measurement of anthropometric parameters and blood pressure. Overweight and obesity were defined by a body mass index ≥ 25 kg/m2. Multivariable logistic regression was performed to identify associated factors. Results: A sample of 325 teachers, including 88.6% of men, was recruited with an average age of 36.2 ± 6.8 years. The prevalence of overweight and obesity was 43.7% (95% CI [38.1%-44.8%]). It increased significantly with income (p Conclusion: The results show a high prevalence of overweight and obesity. Actions are necessary to prevent overweight and obesity among secondary school teachers in Parakou, in Benin.

Association of Serum Folate and Vitamin B_(12) Concentrations with Obesity in Chinese Children and Adolescents

Objective This study aimed to evaluate the associations of serum folate and/or vitamin B12 concentrations with obesity among Chinese children and adolescents.Methods A cross-sectional study was conducted including 3,079 Chinese children and adolescents,aged 6 to 17 years,from Jiangsu,China.Anthropometric indices,such as,children's body mass index(BMI),BMI z-scores,waist circumference,and waist-to-height ratio were utilized.Multivariable linear regression and generalized additive models were used to investigate the associations of serum folate and vitamin B12 levels with anthropometric indices and odds of obesity.Results We observed that serum vitamin B12 concentrations were inversely associated with all anthropometric indices and the odds of general obesity[odds ratio(OR)=0.68;95%confidence interval(CI)=0.59,0.78]and abdominal obesity(OR=0.68;95%CI=0.60,0.77).When compared to participants with both serum vitamin levels in the two middle quartiles,those with both serum folate and vitamin B12 levels in the highest quartile were less prone to general(OR=0.31,95%CI=0.19,0.50)or abdominal obesity(OR=0.46,95%CI=0.31,0.67).Conversely,participants with vitamin B12 levels in the lowest quartile alongside folate levels in the highest quartile had higher odds of abdominal obesity(OR=2.06,95%CI=1.09,3.91).Conclusion Higher serum vitamin B12 concentrations,but not serum folate concentrations,were associated with lower odds of childhood obesity.Children and adolescents with high levels of vitamin B12 and folate were less likely to be obese.

Carbonic anhydrase 2 mediates anti-obesity effects of black tea as thermogenic activator

Obesity is a metabolic disorder due to over-accumulation of adipose tissue and ultimately becomes a“disease”.Brown adipose tissue(BAT)thermogenesis and white adipose tissue(WAT)browning emerge as a potential strategy of anti-obesity by dissipating energy as heat.However,drugs based on adipose tissue thermogenesis have not been successfully approved yet.In current study,we found that black tea extract(BTE)obtained by patentauthorized manufacturing process prevented body weight gain as novel thermogenic activator with reduction of adiposity,improvement of adipose distribution,and glucose metabolism improvement in diet-induced obesity mice.Mechanismly,anti-obesity effect of BTE depends on promoting BAT thermogenesis and WAT browning with upregulation of uncoupling protein 1(UCP1),especially visceral adipose tissue(VAT)with browning resistance.Specifically,utilizing in silico approach of network pharmacology and molecular docking,we identified carbonic anhydrase 2(CA2)in nitrogen metabolism as anti-obesity target of BTE and further elucidated that protein kinase B(AKT)signaling pathway linked CA2 and UCP1.Meanwhile gut microbiota regulation may prompt the CA2-dependent thermogenesis activation.Our findings demonstrated anti-obesity effect of BTE as thermogenic activator through CA2-mediated BAT thermogenesis and WAT browning via CA2-AKT-UCP1 signaling pathway,which could be developed as promising anti-obesity agent with good safety and efficacy.

Female Infertility and Obesity across the United States—A Geographic Cross-Sectional Analysis

This cross-sectional study investigates a connection between female infertility and obesity across various regions of the United States, utilizing data from the NIH’s “All of Us” Researcher Workbench. Analysis suggested that the Southern region exhibited the highest percentage of concurrently infertile and obese females at 32.3%, in contrast to the lowest in the Western region at 28.7%. The findings underscore the significant regional disparities in obesity-related infertility, particularly in medically underserved areas where healthcare access is limited. The study highlights the urgent need for targeted public health interventions, particularly in the Southern United States, to address the rising prevalence of obesity and its impact on infertility. Further, these results advocate for enhanced public health education and policies aimed at improving healthcare accessibility, with the goal of mitigating the adverse effects of obesity on reproductive health.

Insights into the interplay between gut microbiota and lipid metabolism in the obesity management of canines and felines

Obesity is a prevalent chronic disease that has significant negative impacts on humans and our companion animals,including dogs and cats.Obesity occurs with multiple comorbidities,such as diabetes,hypertension,heart disease and osteoarthritis in dogs and cats.A direct link between lipid metabolism dysregulation and obesity-associated diseases has been implicated.However,the understanding of such pathophysiology in companion animals is lim-ited.This review aims to address the role of lipid metabolism in various metabolic disorders associated with obesity,emphasizing the involvement of the gut microbiota.Furthermore,we also discuss the management of obesity,including approaches like nutritional interventions,thus providing novel insights into obesity prevention and treatment for canines and felines.

Mechanism of Wendan decoction in preventing obesity by regulating multiple signal pathway networks based on gene promoter methylation

Objective:To investigate the potential mechanism of Wendan decoction in obesity by screening target genes with promoter region methylation changes and constructing a multiple signaling pathways network based on promoter methylation.Methods:The methylation degree of Itgad,Col8a1,Adra2b,Jund,Rab2a,Wnt8b,Fzd9,B4galt7,Pik3cd,Creb1,Stard8,and Mmp1 in the abdominal adipose tissue of obese rats was determined using the Agena MassARRAY system.Western blot was performed to assess protein expression levels.Target genes were identified based on the methylation degree in the promoter region and protein expression.Enrichment analysis of signaling pathways was conducted to identify relevant target genes and obtain a multiple signaling pathway network associated with obesity.Core and terminal effector molecules in the pathway networks were selected as research targets for reverse transcription-polymerase chain reaction(RT-PCR)analysis.Results:Four genes(Adra2b,Creb1,Itgad,and Pik3cd)showed a degree of promoter methylation consistent with their respective protein expression levels.Among them,Adra2b,Creb1,and Pik3cd expression increased,while that of Itgad decreased.Enrichment analysis revealed that Creb1 and Pik3cd were involved in 6 signaling pathways related to obesity:tumor necrosis factor(TNF)signaling pathway,growth hormone synthesis/secretion and action,adenosine 5'-monophosphate-activated protein kinase(AMPK)signaling pathway,relaxin signaling pathway,cyclic nucleotide(cAMP)signaling pathway,and phosphatidylinositol 3-kinase/protein kinase B(PI3K/Akt)signaling pathway.Subsequently,a multiple signaling pathways network was constructed based on promoter methylation.Key molecules including protein kinase B(AKT),mechanistic target of rapamycin complex 1(mTORC1),and unc-51 like autophagy activating kinase 1(ULK1),as well as terminal effector molecules interleukin-1β(IL-1β),interleukin-6(IL-6),and chemokine(C-X-C motif)ligand 2(CXCL2)were selected as research targets.Wendan decoction decreased the expressions of AKT,mTORC1,IL-1β,IL-6,and CXCL2 while up-regulating ULK1 expression.Conclusion:The mechanism of Wendan decoction in preventing obesity involves the regulation of multiple signaling pathways through the control of Creb1 and Pik3cd gene promoter methylation.However,the associated multi-path gene regulation mechanism in preventing obesity is complex.Thus,further exploration is needed to elucidate the role of methylation changes in this mechanism.

Novel subtype of obesity influencing the outcomes of sleeve gastrectomy:Familial aggregation of obesity

BACKGROUND Differences in the preoperative characteristics and weight loss outcomes after sleeve gastrectomy(SG)between patients with familial aggregation of obesity(FAO)and patients with sporadic obesity(SO)have not been elucidated.AIM To explore the impact of SG on weight loss and the alleviation of obesity-related comorbidities in individuals with FAO.METHODS A total of 193 patients with obesity who underwent SG were selected.Patients with FAO/SO were matched 1:1 by propensity score matching and were categorized into 4 groups based on the number of first-degree relatives with obesity(1 SO vs 1FAO,2SO vs 2FAO).The baseline characteristics,weight loss outcomes,prevalence of obesity-related comorbidities and incidence of major surgeryrelated complications were compared between groups.RESULTS We defined FAO as the presence of two or more first-degree relatives with obesity.Patients with FAO did not initially show significant differences in baseline data,short-term postoperative weight loss,or obesity-related comorbidities when compared to patients with SO preoperatively.However,distinctions between the two groups became evident at the two-year mark,with statistically significant differences in both percentage of total weight loss(P=0.006)and percentage of excess weight loss(P<0.001).The FAO group exhibited weaker remission of type 2 diabetes mellitus(T2DM)(P=0.031),hyperlipidemia(P=0.012),and non-alcoholic fatty liver disease(NAFLD)(P=0.003)as well as a lower incidence of acid reflux(P=0.038).CONCLUSION FAO patients is associated with decreased mid-to-long-term weight loss outcomes;the alleviation of T2DM,hyperlipidemia and NAFLD;and decreased incidence of acid reflux postoperatively.

Pediatric flexible flatfoot: Does obesity influence the outcomes of arthroereisis?

BACKGROUND Childhood obesity has emerged in the last decades as an important public health problem worldwide.Although relationships between obesity and flatfoot have been shown,no studies have investigated the influence of obesity on arthroereisis outcomes.AIM To evaluate correlations between childhood overweight/obesity and clinical and radiographic outcomes after subtalar arthroereisis with self-locking implants.METHODS This retrospective study included one hundred and sixty-nine pediatric patients(10-14 years old)who underwent subtalar arthroereisis(PEEK PitStop®device)for severe flexible flatfoot.Exclusion criteria were additional procedures,revision of previous corrective surgeries,rigid flatfoot with severe deformity,and neurologi-cal or post-traumatic flatfoot.Preoperative/postoperative European Foot and Ankle Society(EFAS)and visual analogue scale(VAS)scores were determined;radiographic assessment was conducted on weight-bearing foot X-rays:Kite angle,first metatarsal-talus angle,Meary angle,calcaneal pitch angle and lateral talo-calcaneal angle were analyzed.RESULTS EFAS and VAS scores improved post-operatively in the whole population.Only seven cases with complications were reported.Radiographic assessment revealed an improvement in all angles.Statistical analysis demonstrated that the impact of obesity was significant on arthroereisis outcomes:Relationships were reported between BMI and postoperative EFAS/VAS scores,postoperative calcaneal pitch angle,Kite angle,Meary angle and talo-first meta-tarsal angle.CONCLUSION Although arthroereisis represents a very effective and valid treatment for flatfoot both in normal weight and obese children,obesity significantly influences clinical and radiographic outcomes of arthroereisis,and obese children tend to perceive more pain and discomfort.

Drawing lines in the sand: The growing threat of obesity in type 1 diabetes

In this editorial,we comment on the article by Zeng et al published in the recent issue of the World Journal of Diabetes in 2024.We focus on the epidemiological,pathophysiological,and clinical interplay between obesity and type 1 diabetes mellitus(T1DM).Overweight and obesity represent a growing threat for modern societies and people with T1DM could not be an exception to this rule.Chronic exogenous insulin administration,genetic and epigenetic factors,and psy-chosocial and behavioral parameters,along with the modern way of life that incorporates unhealthy eating patterns and physical inactivity,set the stage for the increasing obesity rates in T1DM.As our knowledge of the underlying mechanisms that lead to the development of obesity and hyperglycemia expands,it becomes clear that there are overlap zones in the pathophysiology of the two main types of diabetes.Stereotypes regarding strict dividing lines between“autoimmune”and“metabolic”phenotypes increase the risk of trapping physicians into ineffective therapeutic approaches,instead of individualized diabetes care.In this context,the use of adjuncts to insulin therapy that have the potential to alleviate cardiorenal risk and decrease body weight can reduce the burden of obesity in patients with T1DM.

In-hospital outcomes in COVID-19 patients with non-alcoholic fatty liver disease by severity of obesity:Insights from national inpatient sample 2020

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular diseases independently of other risk factors.However,data on its effect on cardiovascular outcomes in coronavirus disease 2019(COVID-19)hospitalizations with varied obesity levels is scarce.Clinical management and patient care depend on understanding COVID-19 admission results in NAFLD patients with varying obesity levels.AIM To study the in-hospital outcomes in COVID-19 patients with NAFLD by severity of obesity.METHODS COVID-19 hospitalizations with NAFLD were identified using International Classification of Disease-10 CM codes in the 2020 National Inpatient Sample database.Overweight and Obesity Classes Ⅰ,Ⅱ,and Ⅲ(body mass index 30-40)were compared.Major adverse cardiac and cerebrovascular events(MACCE)(all-cause mortality,acute myocardial infarction,cardiac arrest,and stroke)were compared between groups.Multivariable regression analyses adjusted for sociodemographic,hospitalization features,and comorbidities.RESULTS Our analysis comprised 13260 hospitalizations,7.3% of which were overweight,24.3% Class Ⅰ,24.1% Class Ⅱ,and 44.3% Class Ⅲ.Class Ⅲ obesity includes younger patients,blacks,females,diabetics,and hypertensive patients.On multivariable logistic analysis,Class Ⅲ obese patients had higher risks of MACCE,inpatient mortality,and respiratory failure than Class Ⅰ obese patients.Class Ⅱ obesity showed increased risks of MACCE,inpatient mortality,and respiratory failure than Class I,but not significantly.All obesity classes had non-significant risks of MACCE,inpatient mortality,and respiratory failure compared to the overweight group.CONCLUSION Class Ⅲ obese NAFLD COVID-19 patients had a greater risk of adverse outcomes than class Ⅰ.Using the overweight group as the reference,unfavorable outcomes were not significantly different.Morbid obesity had a greater risk of MACCE regardless of the referent group(overweight or Class Ⅰ obese)compared to overweight NAFLD patients admitted with COVID-19.

The Association between GLP-1 Receptor-Based Agonists and the Incidence of Asthma in Patients with Type 2 Diabetes and/or Obesity:A Meta-Analysis

Objective Recent studies have indicated potential anti-inflammatory effects of glucagon-like peptide-1 receptor agonists(GLP-1RAs)on asthma,which is often comorbid with type 2 diabetes mellitus(T2DM)and obesity.Therefore,we conducted a meta-analysis to assess the association between the administration of glucagon-like peptide-1(GLP-1)receptor-based agonists and the incidence of asthma in patients with T2DM and/or obesity.Methods PubMed,Web of Science,Embase,the Cochrane Central Register of Controlled Trials,and Clinicaltrial.gov were systematically searched from inception to July 2023.Randomized controlled trials(RCTs)of GLP-1 receptor-based agonists(GLP-1RA,GLP-1 based dual and triple receptor agonist)with reports of asthma events were included.Outcomes were computed as risk ratios(RR)using a fixedeffects model.Results Overall,39 RCTs with a total of 85,755 participants were included.Compared to non-GLP-1 receptor-based agonist users,a trend of reduced risk of asthma was observed in patients with T2DM or obesity using GLP-1 receptor-based agonist treatments,although the difference was not statistically significant[RR=0.91,95%confidence interval(CI):0.68 to 1.24].Further Subgroup analyses indicated that the use of light-molecular-weight GLP-1RAs might be associated with a reduced the risk of asthma when compared with non-users(RR=0.65,95%CI:0.43 to 0.99,P=0.043).We also performed sensitivity analyses for participant characteristics,study design,drug structure,duration of action,and drug subtypes.However,no significant associations were observed.Conclusion Compared with non-users,a modest reduction in the incidence of asthma was observed in patients with T2DM or obesity using GLP-1 receptor-based agonist treatments.Further investigations are warranted to assess the association between GLP-1 receptor-based agonists and the risk of asthma.

Downregulation of the circadian clock gene period 2 aggravates prognosis in breast cancer patients with obesity

Background:Obese individuals diagnosed with breast cancer often experience a less favorable prognosis;however,the underlying mechanisms linking obesity to breast cancer outcomes remain elusive.This study aimed to identify and validate novel prognostic markers associated with breast cancer in patients with obesity.Methods:We conducted a reanalysis of gene expression profiles from normal-weight,overweight,and obese breast cancer patients to identify candidate genes.Subsequently,we validated the protein levels of these candidates using immunohistochemistry.Finally,we investigated the association between candidate genes and breast cancer prognosis at Tongji Hospital,utilizing data from an 8-year follow-up through the Kaplan-Meier method and univariate and multivariate Cox regression models.Results:The fold change of the circadian clock gene period 2(PER2),which exhibited a declining trend with increasing body mass index,was 0.76 in obese patients compared with normal-weight patients.The expression rates of PER2 protein were 44.7%,51.5%,and 61.3%in normal-weight,overweight,and obese patients,respectively.The 8-year recurrence-free survival rates were 75.9%,69.6%,and 64.1%,whereas the 8-year overall survival rates were 86.8%,83.0%,and 76.1%in normal-weight,overweight,and obese patients,respectively(P<0.05).Furthermore,the 8-year recurrence-free survival rates were 66.2%and 76.4%,and the 8-year overall survival rates were 79.9%and 86.3%in the low and high PER2 expression groups,respectively(P<0.05).The unadjusted hazard ratio for PER2 was 1.550(95%confidence interval,1.029–2.335),and the adjusted hazard ratio was 3.003(95%confidence interval,1.838–4.907).Conclusions:Our findings indicate that low PER2 expression serves as an independent risk factor for breast cancer prognosis and may contribute to the unfavorable outcomes observed in obese patients.

Selenoprotein-p and insulin resistance in children and adolescents with obesity

BACKGROUND Insulin resistance and obesity present significant challenges in pediatric populations.Selenoprotein P1(SEPP1)serves as a biomarker for assessing selenium levels in the body.While its association with metabolic syndrome is established in adults,its relevance in children remains underexplored.AIM To ascertain SEPP1 blood levels in children and adolescents diagnosed with obesity and to assess its correlation with insulin resistance and adiposity indices.METHODS 170 children participated in this study,including 85 diagnosed with obesity and an equal number of healthy counterparts matched for age and sex.Each participant underwent a comprehensive medical evaluation,encompassing a detailed medical history,clinical examination,and anthropometric measurements like waist circumference and waist-to-height ratio.Furthermore,routine blood tests were conducted,including serum SEPP1,visceral adiposity index(VAI),and Homeostatic Model Assessment of Insulin Resistance(HOMA-IR)level.RESULTS Our findings revealed significantly lower serum SEPP1 levels in children with obesity compared to their healthy peers.Moreover,notable negative correlations were observed between serum SEPP1 levels and body mass index,VAI,and HOMA-IR.CONCLUSION The study suggests that SEPP1 could serve as a valuable predictor for insulin resistance among children and adolescents diagnosed with obesity.This highlights the potential utility of SEPP1 in pediatric metabolic health assessment and warrants further investigation.

Prevalence of obesity,determinants,and its association with hyperglycaemia among community dwelling older adolescents in India

BACKGROUND Globally,obesity and diabetes mellitus(DM)are emergent public health concerns in the adolescent population.India,home to the largest adolescent population and the second largest diabetes cohort is experiencing rapid but unplanned urbanization,with accompanying unhealthy nutritional transition,and sedentary lifestyle.AIM To determine prevalence and determinants of obesity and hyperglycaemia and their association among community-dwelling older adolescents(15-19 years)in India.METHODS This cross-sectional analysis from the national family health survey-5 included data of 258028 adolescents aged 15-19 across India(2019-2021).The survey employed stratified two-stage sampling,with systematic random sampling in rural and urban areas.Statistical analysis included descriptive statistics,bivariate,and multivariable logistic regression,employing generalized linear models.RESULTS The weighted prevalence of DM was 1.09%including 0.77%[95%confidence interval(CI):0.72-0.83]previously diagnosed and 0.32%(95%CI:0.29-0.35)newly diagnosed cases detected on survey screening.On adjusted analysis,increasing age,higher education levels,higher wealth index,and overweight/obesity were the factors significantly associated with presence of DM.Only 61%of the adolescents with previously diagnosed DM were on anti-diabetes treatment.The weighted prevalence of overweight/obesity among older adolescents was 6.9%with significantly higher odds in the male sex,having higher educational levels,urban residence,and those with a higher wealth index.CONCLUSION Nearly one in hundred older adolescents in India have diabetes,with one in three undiagnosed.Strengthening DM screening and treatment access among adolescents through public health programs is urgently warranted.

Epicardial adipose tissue in obesity with heart failure with preserved ejection fraction: Cardiovascular magnetic resonance biomarker study

BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evaluating HFpEF in obesity is crucial.Epicardial adipose tissue(EAT)has emerged as a valuable tool for validating prognostic biomarkers and guiding treatment targets.Hence,assessing EAT is of paramount importance.Cardiovascular magnetic resonance(CMR)imaging is acknowledged as the gold standard for analyzing cardiac function and mor-phology.We hope to use CMR to assess EAT as a bioimaging marker to evaluate HFpEF in obese patients.AIM To assess the diagnostic utility of CMR for evaluating heart failure with preserved ejection fraction[HFpEF;left ventricular(LV)ejection fraction≥50%]by measuring the epicardial adipose tissue(EAT)volumes and EAT mass in obese patients.METHODS Sixty-two obese patients were divided into two groups for a case-control study based on whether or not they had heart failure with HFpEF.The two groups were defined as HFpEF+and HFpEF-.LV geometry,global systolic function,EAT volumes and EAT mass of all subjects were obtained using cine magnetic resonance sequences.RESULTS Forty-five patients of HFpEF-group and seventeen patients of HFpEF+group were included.LV mass index(g/m2)of HFpEF+group was higher than HFpEF-group(P<0.05).In HFpEF+group,EAT volumes,EAT volume index,EAT mass,EAT mass index and the ratio of EAT/[left atrial(LA)left-right(LR)diameter]were higher compared to HFpEF-group(P<0.05).In multivariate analysis,Higher EAT/LA LR diameter ratio was associated with higher odds ratio of HFpEF.CONCLUSION EAT/LA LR diameter ratio is highly associated with HFpEF in obese patients.It is plausible that there may be utility in CMR for assessing obese patients for HFpEF using EAT/LA LR diameter ratio as a diagnostic biomarker.Further prospective studies,are needed to validate these proof-of-concept findings.

Analysis of the Correlation Between Visceral Fat Area and Insulin Resistance in Patients with Type 2 Diabetes and Abdominal Obesity

Objective: To analyze the correlation between visceral fat area and insulin resistance index (HOMA-IR) in patients with type 2 diabetes mellitus (T2DM) and abdominal obesity and to provide a reference for screening and related research of such patients. Methods: Two hundred patients with T2DM admitted to Guandu People’s Hospital of Kunming were included. The study was carried out from October 2022 to December 2023. The patients were divided into three groups according to different abdominal visceral fat areas (VFA): Group A (n = 65) was less than 75cm2, Group B (n = 75) was 75-100 cm2, and Group C (n = 60) was greater than 100 cm2. The subjects in the three groups were all tested for glycated hemoglobin (HbA1c), fasting insulin (FINS), and fasting blood glucose (FPG). Height and weight were measured to calculate body mass index (BMI). The HOMA-IR and TYG (fasting triglyceride and glycemic index) were also calculated. Changes in the BMI, VFA, HOMA-IR, and TYG levels were observed in the three groups. Results: The VFA, BMI, HbA1c, FPG, FINS, HOMA-IR, and TYG of the patients all increased, with a more significant increase in the BMI, FINS, HOMA-IR, and TYG levels (P < 0.01). Multiple linear stepwise regression analyses used visceral fat area (VFA) as the dependent variable. The results showed that VFA was closely related to BMI, FINS, HOMA-IR, and TYG. Conclusion: Early reduction of VFA to reduce insulin resistance may be a better treatment and effective method for T2DM, providing powerful measures and new strategies for effective blood sugar control and early prevention in the treatment of metabolic diseases.

The Relationship Between Multiple Obesity Indices and Long-Term Prognosis in STEMI Patients:An Observational Cohort Study of 220 Cases

Objective:To investigate the association of body mass index(BMI),waist circumference(WC),and waist-to-height ratio(WHtR)with the long-term prognosis of ST-elevation myocardial infarction(STEMI)patients and to determine whether the combination of obesity indices can be used for risk stratification.Method:A multifactorial Cox regression analysis was performed using 3-year follow-up data from 220 STEMI patients to explore the relationship between obesity indicators and major adverse cardiovascular events(MACEs).The incidence of MACEs was also compared by combining BMI and WHtR.Results:WC was found to reduce the risk of MACEs within 25 months after myocardial infarction[hazard ratio(HR)=0.95,95%confidence interval(CI)=0.92-0.98,P<0.001].However,this effect was not significant beyond 25 months(HR=0.98,95%CI=0.97-1.07,P=0.49).Neither BMI nor WHtR were significantly associated with the risk of MACEs.The incidence of MACEs was highest in patients with low body weight(BMI<18.5 kg/m^(2))and WHtR>0.5,and lowest in obese patients(BMI≥28 kg/m^(2))with WHtR>0.5.Conclusions:BMI,WC,and WHtR were not significantly associated with the long-term prognosis of STEMI patients.However,the combination of BMI and WHtR can be useful for further stratifying patient risk.