The burden of disease attributable to excess body fat (EBF) in type 2 diabetes mellitus (T2DM) may be underestimated due to problems correlating BMI with body fat. The aim of this study is to compare the population attributable fraction (PAF) of EBF in T2DM assessed with various parameters.

Prevalence study based on the baseline visit of the IBERICAN study. Mixed unconditional logistic regression models were used to estimate the risk of T2DM for the various categories of BMI, of the estimation of EBF according to the CUN-BAE (Clínica Universidad de Navarra-Body Adiposity Estimator) and of waist circumference (WC), stratifying by sex. The PAF was calculated for each of the EBF estimates.

A total of 7752 patients from IBERICAN study were eligible, of them 1536 (19.8 %) achieved T2DM criterion, The prevalence of diabetes was higher in men, in those with a lower level of education, and in those who reported a low level of physical activity. Subjects with diabetes were older, had a higher BMI, a higher CUN-BAE-estimated body fat percentage (eBFP) and a higher waist circumference. One in three cases T2DM risk was attributed to elevated BMI, whereas in the CUN-BAE case it was attributed to 9 out of 10 men and 2 out of 3 women. One out of two cases of T2DM in women, and less in men, was attributed to an excess WC.

The burden of disease attributable to EBF in the case of T2DM may be underestimated. Therefore, EBF should be used, together with BMI, WC -especially in women-, and the CUN-BAE to better estimate the risk of T2DM and to adapt dietary or lifestyle recommendations in daily clinical practice.

IntroductionTraditional obesity measures including body mass index, waist circumference, waist-to-hip ratio, and waist-to-height ratio have limitations. The primary objective of this study was to identify and review the validity of non-traditional obesity measures, using measures of total body fat as the reference standard, that have been used across multiple life stages. MethodsWe conducted a systematic review and searched MEDLINE, Embase, and PsycINFO. We included observational studies published from 2013 to October 2023 among "the general population" for any life stage that reported the validity of non-traditional obesity measures compared to total body fat reference standards. Separate meta-analyses were performed to pool correlation coefficients and mean differences for non-traditional obesity measures that were evaluated at multiple life stages. ResultsA total of 123 studies were included, and 55 validated non-traditional obesity measures were identified. Of these, 13 were evaluated at multiple life stages. Two-dimensional (2D) digital imaging technologies, three-dimensional (3D) body scanners, relative fat mass (RFM), and mid-upper arm circumference had high or moderate validity (pooled correlation coefficient >0.70). Pooled mean differences were small (<6%) between total body fat percentage from reference standards and from RFM, 2D digital imaging technologies, 3D body scanners, and the body adiposity index. Heterogeneity (I2) was >75% in most meta-analyses. ConclusionNumerous validated non-traditional obesity measures were identified; relatively few were evaluated at multiple life stages and did not consider health risks associated with adiposity. More research is needed to define valid obesity measures across all life stages that assess health and adiposity.

The aim of this study was to investigate the association of wrist circumference (WrC) and neck circumferences (NC) with Insulin Resistance (IR) in obese and overweight children and adolescents.

This cross-sectional study included 227 overweight and obese children. Anthropometric indices such as NC and WrC were measured. Laboratory parameters such as fasting blood glucose (FBS) and insulin were measured after 12 h of overnight fasting. IR was determined by Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) using formula and HOMA-IR ≥ 2.6 defined as IR. The predictive power of NC and WrC for IR was assessed using receiver operating characteristic (ROC) analyses and the area under ROC curve (AUC) > 0.65 were considered as highly accurate tests.

Among the 227 included samples, 52.4% were girls, and 67.4% were classified as obese. IR was detected in 48.5% of the participants without a significant association with gender (48.8% in girls and 48.1% in boys) and weight status (43.2% in overweight and 51% in obese). The AUCs of WrC and NC in detecting IR were 0.78 (95% CI: 0.72-0.84) and 0.72 (95% CI: 0.65-0.78) in overweight and obese children respectively. The Chi-square test shows that the AUC of WrC in predicting IR was statistically higher than NC (Chi-square: 4.47, P: 0.03).

Our findings showed that WrC and NC are two useful indices for predicting IR in overweight and obese children and adolescents. Therefore they could be used as a clinical indicators of IR in children and adolescents.

The Body Rounds Index (BRI) is an anthropometric indicator specifically developed to evaluate an individual's obesity level, particularly emphasizing central or abdominal obesity. This study aimed to explore the relationship between BRI and all-cause mortality in older U.S. adults. The research sample comprised individuals aged 65 and older from the National Health and Nutrition Examination Survey (NHANES), eligible for mortality analyses between 1999 and 2018. We utilized Cox regression analyses, restricted cubic spline (RCS), threshold effects analysis, Kaplan-Meier curves, and subgroup analyses were conducted to assess how the BRI correlates with all-cause mortality among older adults in the U.S. To further ensure the robustness of our findings, we conducted sensitivity analyses. Among 5371 U.S. older adults (age ≥ 65), with an average age of 72.45 (standard deviation [SD]:5.65) years, 2884 (60%) were women. During the follow-up period, there were 2781 deaths from all causes among the 5371 participants. After adjusting for all covariates, a U-shaped association was identified between BRI and the all cause mortality. Compared to a BRI of less than 4.457, a BRI between 4.457 and 5.538 was associated with a 19% reduction in the likelihood of mortality from any cause (HR = 0.81, 95% CI = 0.69-0.95). A BRI between 5.538 and 6.888 was linked to a 8% reduction in mortality risk (HR = 0.92, 95% CI = 0.79-1.07), while a BRI exceeding 6.888 showed a 1% increase in this risk (HR = 1.01, 95% CI = 0.87-1.17). RCS analysis indicated a U-shaped relationship between BRI and all-cause mortality. The turning point was located at 4.546, with correlations observed both before and after this point. This NHANES-based study highlights the U-shaped relationship between BRI and all-cause mortality among U.S. older adults, suggesting that the BRI has predictive value for mortality outcomes. The findings offer compelling support for utilizing BRI as a non-invasive mortality risk screening tool.

Overweight and obesity are major risk factors for heart failure (HF), contributing to its development through metabolic, neurohormonal, haemodynamic, and inflammatory alterations. While overweight/obesity increases the risk of developing HF, its impact on patient outcomes remains complex. The "obesity paradox" suggests that a higher BMI may be associated with improved survival in patients with established HF. However, recent GLP-1 receptor agonist (GLP-1 RA) trials suggest that intentional weight loss positively influences outcomes in overweight/obese patients with HF. This seemingly contradictory evidence highlights the need for a deeper understanding of the mechanisms linking adiposity to HF outcomes. A more precise characterization of adiposity phenotypes using alternative and accurate measures of pathological fat accumulation is crucial in identifying individuals who may benefit most from anti-obesity treatments. In this context, recent research underscores the role of epicardial adipose tissue (EAT) in HF pathophysiology, as it directly influences cardiac function and structure through inflammatory, metabolic, and mechanical effects. This narrative review summarises current evidence on the impact of weight loss on HF outcomes, focusing on recent GLP-1 RA trial results. Additionally, it highlights epidemiological and molecular data supporting EAT as a novel adiposity measure that might allow refining patient selection for pharmacological weight-loss treatments. Finally, it emphasizes the need for future research to identify causal pathways linking alternative measures of visceral fat accumulation to HF outcomes. These efforts will be essential in optimizing the benefits of novel weight-loss treatments, ensuring effective and individualized therapeutic strategies for overweight or obese patients with HF.

Obesity is a major risk factor for heart failure with preserved ejection fraction (HFpEF) and contributes through multiple pathophysiological pathways, including systemic inflammation, neurohormonal activation, and mechanical inhibition. The treatment of obesity has shown significant potential for improving HFpEF outcomes. Sodium-glucose cotransporter 2 inhibitors have emerged as effective treatments for improving symptoms and quality of life in patients with HFpEF while aiding in weight control. Furthermore, a recent demonstration of the clinical benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in HFpEF showed promising results in reducing weight loss, and improving symptoms and clinical outcomes. In this review article, we discuss the association between HFpEF and obesity, the emerging role of GLP-1 RAs, and future directions for medical therapies targeting obesity-associated HFpEF.

Although visceral adiposity increases cardiovascular risk in the general population, the obesity paradox has been reported in critically ill patients. However, evidence for its prognostic role in patients undergoing coronary artery bypass grafting (CABG) is limited. This study evaluated the prognostic implications of visceral adiposity in patients who underwent CABG using computed tomography-based measurement of visceral fat.

A total of 2810 patients who underwent CABG from 2007 to 2017 were analyzed. The study population was classified into 3 groups according to visceral fat area index (VFAI) tertiles. VFAI was calculated as visceral fat area (cm2)/height2 (m2) at the L3 level. The primary outcome was all-cause mortality during follow-up.

Patients in the low VFAI group (lowest tertile) were younger and had a lower body mass index and less subcutaneous fat than those in the high VFAI group (highest tertile). During a median 8.7-year follow-up, VFAI was significantly associated with the risk of mortality in restricted cubic spline curve analysis (HR, 0.94 per 10 increases; 95%CI, 0.91-0.97; P<.001). Patients in the low VFAI group had a higher incidence of long-term mortality than those in the intermediate and high VFAI groups (T1 36.1%, T2 27.2%, and T3 29.1%; T1 vs T2; adjusted HR, 1.36; 95%CI, 1.15-1.61; P<.001; T1 vs T3; adjusted HR, 1.37; 95%CI, 1.16-1.62; P<.001). Similar results were obtained after inverse probability treatment-weighting analysis.

Low visceral adiposity was associated with an increased risk of long-term mortality in patients who underwent CABG.

Gallstones are a prevalent condition that can lead to significant morbidity and healthcare costs. Relative fat mass (RFM), as a potential marker of body fat distribution, may offer insights beyond traditional metrics like body mass index (BMI) and waist circumference. This study aims to investigate the association between RFM and gallstone prevalence in the U.S. population.

The study cohort comprised 6,881 participants obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2017 and 2020. Participants were stratified into quartiles (Q1-Q4) based on their RFM. To evaluate the associations, multivariable logistic regression analyses were employed to assess odds ratios (OR) for gallstone risk across different quartiles of RFM. Additionally, restricted cubic spline analysis was conducted to ascertain the relationship trend while subgroup analyses examined interactions based on age, sex, race, education level, and lifestyle factors.

The analysis revealed significant associations for participants within the higher RFM quartiles (Q3 and Q4), with ORs of 2.58 (95% CI: 1.65, 4.04) and 6.30 (95% CI: 3.63, 10.93), respectively, compared to Q1. The findings consistently indicated that RFM, particularly in Q4, is a strong predictor of gallstone risk, demonstrating superior predictive performance relative to waist circumference and BMI, as evidenced by an AUC of 0.702.

Elevated RFM is a noteworthy predictor of gallstone risk in the studied population, suggesting its potential utility in clinical risk assessment frameworks. Future research should focus on elucidating the underlying mechanisms driving this association and exploring RFM's applicability as a pragmatic tool in clinical practice for gallstone risk stratification.

This paper extends current knowledge about inequality of opportunity in body mass in Australia. Drawing on 2013 and 2017 Household, Income, and Labour Dynamics in Australia survey data, our empirical strategy comprises of mean-based and unconditional quantile regression techniques. We find that inequality of opportunity accounts for a non-trivial share of body mass inequality. Our results based on waist-to-height ratio reveal estimates of 10%-14%, which are much larger than previously published estimates based on body mass index (BMI). Our estimates are lower-bound values based on 13 observable circumstance variables. Relaxing the homogeneity assumption, for instance, increases estimates by 1.7-3 percentage points. Applying the Shapley-Shorrocks decomposition procedure, age and parents' socio-economic status are identified as leading circumstance factors. This finding is refined when quantiles of the body mass distribution are evaluated. Age's role is diminished at the clinically risky upper quantiles. By contrast, parents' socio-economic status is the single most important circumstance factor at the upper quantiles. Investigating by gender groups, inequality of opportunity is greater among women than men, with parents' socio-economic status playing a critical role in this disparity. Taking a life course perspective, circumstances' influence shows weakening over time, while effort is more impactful at later life stages. Overall, our findings underscore that anti-obesity campaigns should tackle early life social inequality, in addition to empowering personal responsibility later in life.

Obesity is a global health issue which has been widely accepted as an aging related pathogenesis. α-Klotho is a protein involved in aging process, mineral metabolism, insulin sensitivity, and the pathogenesis of various age-related diseases. Adiposity correlates with lower soluble α-Klotho, but the role of fat distribution and inflammation remains unclear. The body roundness index (BRI) refines central adiposity assessment beyond BMI. Herein, We aimed to investigate the relationship of BRI, inflammation and serum level of soluble α-Klotho.

We conducted a cross-sectional analysis of 9,958 U.S. adults (40-79 years) from the 2007-2016 NHANES. We examined association between BRI and serum α-Klotho (SαKl) levels, controlling for demographic, socioeconomic, lifestyle, and clinical factors. We also assessed whether inflammatory markers mediated the BRI-SαKl relationship.

BRI was inversely associated with SαKl levels (P < 0.05). A significant sex interaction was found (P < 0.001), while BRI was positively correlated with multiple proinflammatory markers, which were all inversely related to SαKl levels. Mediation analyses showed inflammatory markers accounted for 20.5% (WBC), 18.0% (neutrophils), and 12.3% (platelets) of the BRI-SαKl association.

More severe central adiposity measured by BRI was related to lower SαKl, which may partly be attributed to inflammation. These findings underscore the importance of fat distribution and inflammation in obesity-related aging and may guide interventions to preserve SαKl levels. Longitudinal studies are needed to confirm causality and inform future strategies.

The impact of body mass index (BMI) on cardiovascular risk in rheumatoid arthritis (RA) is unclear. RA characteristics may influence the association between BMI and risk. Disease activity, which predicts cardiovascular risk, is associated with obesity only among anticitrullinated antibody (ACPA)-positive patients. Biologics alter body composition and mitigate cardiovascular risk in RA. We explored the association of BMI with cardiovascular risk and whether this varied across ACPA status and biologic use.

We evaluated 3982 patients from an international observational cohort. Outcomes included (a) first major adverse cardiovascular event (MACE) encompassing myocardial infarction, stroke or cardiovascular death; and (b) all events comprising MACE, angina, revascularisation, transient ischaemic attack, peripheral arterial disease and heart failure. Multivariable Cox models stratified by centre risk evaluated the impact of BMI, ACPA, biologics and their two- and three-way interactions on outcomes.

We recorded 192 MACE and 319 total events. No main effects of BMI, ACPA or biologics were observed. A three-way interaction between them on MACE (p-interaction<0.001) and all events (p-interaction=0.028) was noted. Among ACPA negative patients, BMI was inversely associated with MACE (HR 0.38 (95% CI 0.25 to 0.57)) and all events (HR 0.67 (0.49 to 0.92)) in biologic users but not non-users (p-for-interaction <0.001 and 0.012). Among ACPA-positive patients, BMI was associated with MACE (HR 1.04 [1.01-1.07]) and all events (HR 1.03 (1.00 to 1.06)) independently of biologic use.

BMI is inversely associated with cardiovascular risk only among ACPA-negative biologic users. In contrast, BMI is associated with cardiovascular risk in ACPA-positive patients independently of biologic use.

Sleep health is influenced by sex, gender, and age, with various sleep disorders exhibiting different prevalence rates and clinical presentations among different demographic groups. This retrospective study investigated sex and age differences in a diverse cohort of patients referred to an Italian sleep center for comprehensive sleep evaluations over a four-year period. Medical records of 909 consecutive patients who underwent overnight video-polysomnography between January 2014 and December 2017 were reviewed. Socio-demographic, anthropometric, clinical, and sleep-related data were extracted and compared between male and female patients across different age groups. Our analyses revealed disparities in the access to sleep evaluations, socio-demographic characteristics and lifestyle habits between males and females across age groups. Comorbidities varied, with cardiovascular diseases more prevalent in males, while thyroid disorders, rheumatologic conditions, and psychiatric disorders more common in females. Female patients also reported higher rates of psychotropic medications use at admission. Males had higher rates of obstructive sleep apnea, while females, particularly in middle and older age groups, exhibited more insomnia disorder and restless legs syndrome. Notably, the co-occurrence of multiple sleep disorders was observed, particularly among older individuals and female patients. Our findings emphasize the importance of considering sex and age differences in diagnosing and managing sleep disorders. Tailored approaches are necessary to optimize sleep health and overall well-being, particularly in aging populations, where sleep disturbances often coexist with other chronic conditions. Further research is warranted to elucidate the complex interplay between sex, gender, and age to promote sleep equity and improve patient care.

We evaluate the 18F-fluorodeoxyglucose positron emission tomography (PET) standardized uptake value (SUV) by PET/computed tomography (CT) scans in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in patients with and without gout. Additionally, we investigate whether glucose uptake in these tissues predicts the progression of chronic kidney disease (CKD).

We used International Classification of Diseases, Tenth Revision codes from the University of California San Diego patient database to identify patients with gout and controls, forming a cohort of individuals who underwent PET/CT scans. The mean VAT and SAT maximum SUV (SUVmax) were measured using PET/CT scans and adjusted for potential confounders using inverse probability of weighting analysis. We also employed multivariable linear regression to analyze changes in estimated glomerular filtration rate (eGFR) after PET/CT scans.

The study included 221 patients, with 120 diagnosed with gout. After the inverse probability of weighting adjustment, the mean VAT and SAT SUVmax were higher in patients with gout (mean VAT SUVmax: β = 0.09, 95% confidence interval [CI] 0.04-0.15; mean SAT SUVmax: β = 0.06, 95% CI 0.01-0.12). Additionally, in patients with gout with CKD stage ≥3, higher mean VAT and SAT SUVmax were associated with decreased eGFR in the 5 years following PET/CT scans (mean VAT SUVmax: β = -1.76, 95% CI -3.50 to -0.01; mean SAT SUVmax: β = -2.97, 95% CI -5.61 to -0.32).

Elevated glucose uptake-associated metabolic activity in both VAT and SAT was observed in patients with gout, which may contribute to CKD progression among patients with both gout and CKD.

Obesity is a worldwide health problem with a rapidly rising incidence. In organ transplantation, increasing numbers of patients with obesity accumulate on waiting lists and undergo surgery. Obesity is in general conceptualized as a chronic inflammatory disease, potentially impacting alloimmune response and graft function. Here, we summarize our current understanding of cellular and molecular mechanisms that control obesity-associated adipose tissue inflammation and provide insights into mechanisms affecting transplant outcomes, emphasizing on the beneficial effects of weight loss on alloimmune responses.

This study investigated the correlation between body mass index (BMI), bioelectrical impedance analysis (BIA)-derived specific body compositions, and the obesity paradox, with a focus on sex differences in non-smallcell lung cancer (NSCLC).

This study is a multicenter prospective cohort. Association with survival was determined using Cox proportional hazard regression analysis. The mediating effect of systemic inflammation on the association between body composition and survival rate was determined using mediation analysis.

Fat mass had a strong positive correlation with BMI, but a weak positive correlation with other BIA-derived body compositions. Obese, overweight, and normal weight patients had significantly longer median survival than patients with BMI <18.5 ([23.2 versus 18.5 versus 17.5 versus 15.8] months, P < 0.001). Increased BMI and BIA-derived body composition indicators were associated with decreased all-cause mortality. Multivariable-adjusted analysis demonstrated that BMI, fat mass (FM), fat-free mass, muscle mass, bone mass, protein mass, total body water, extracellular water, and intracellular water were independent protective factors affecting the prognosis of patients with NSCLC. A difference in body compositions performance in the prognostic assessment of the different sexes was observed. Fat-related body compositions exhibited a significant obesity paradox in females compared to in males. Systemic inflammation played a crucial role in the relationship between body compositions and disease prognosis, with a mediating effect on body fat in males (31%) and females (19.7%).

The obesity paradox exists among patients with NSCLC and is not influenced by specific body compositions. In addition, this paradox is notably more common in female patients.

Registration number: ChiCTR1800020329.

We aimed to investigate the association between sleep apnea and incident dementia (dementia of the Alzheimer type [DAT] and vascular dementia) and whether differences in the effects of sleep apnea on dementia depend on sex. Furthermore, we sought to determine whether obesity affects the sex-specific relationship between sleep apnea and dementia.

We used de-identified data on patients with sleep apnea and a control group aged ≥ 50 years from the Korean National Health Insurance Service. After propensity score matching to balance age and sex between the patient and control groups, 30,111 individuals with sleep apnea (patient group) and 121,528 individuals without sleep apnea (control group) were included. To investigate the impact of sleep apnea on the development of dementia, we used Cox proportional hazards regression after controlling for potential confounders.

Sleep apnea was predictive of developing DAT in both women (hazard ratio [HR] = 1.30, 95% confidence interval [CI] 1.16-1.44, p < 0.001) and men (HR = 1.13, 95% CI 1.03-1.24, p = 0.012). The adverse effects of sleep apnea on DAT were more prominent in women than in men (p = 0.015 for sleep apnea×sex). Furthermore, obesity affected the sex-specific relationship between sleep apnea and DAT. Specifically, the adverse effects of obese sleep apnea on the DAT were more pronounced in women than in men (p = 0.002 for obese sleep apnea×sex). In contrast, there were no differences in the effects of non-obese sleep apnea on DAT between women and men (p = 0.667 for non-obese sleep apnea×sex).

Our results highlight sex differences in the adverse effects of sleep apnea on DAT. Furthermore, these results suggest that sex-specific strategies for controlling sleep apnea are necessary to prevent DAT.

The Visceral Obesity Index (VAI) is utilized as a metric employed to assess the distribution of abdominal adipose tissue as well as the functional status of adipose tissue. Nevertheless, the interplay between VAI and persistent pain has yet to be investigated. This cross-sectional analysis investigated the relationship between VAI and persistent pain among 1357 American adults from NHANES data. A logarithmic transformation of VAI was performed to adjust for skewness. Following the adjustment for relevant variables, logistic regression analysis showed a noteworthy association between VAI and chronic pain, suggesting that higher VAI values may be linked to an increased prevalence of persistent pain. Curve fitting analysis revealed a nonlinear correlation, with a breakpoint at a VAI value of 0.18. For VAI values below this threshold, each unit increase was notably correlated with an elevated prevalence of persistent pain, while increases in VAI beyond this threshold did not show a significant impact on chronic pain prevalence. Subgroup analyses indicated that the VAI may serve as a relatively independent risk factor for persistent pain. These findings highlight the possibility of incorporating abdominal adipose modification into pain management approaches and emphasize the critical importance of monitoring visceral fat accumulation to better identify patients more susceptible to chronic pain.

This research explored the effects of 2-hydroxyfluorene exposure on the incidence of cardiovascular diseases (CVDs), particularly examining the mediating role of the lipid accumulation product (LAP) index. Utilizing data from the National Health and Nutrition Examination Survey spanning 2005 to 2018, this analysis evaluated the impact of 2-hydroxyfluorene on CVDs prevalence employing a variety of statistical methods. Logistic regression was applied to investigate relationships within polycyclic aromatic hydrocarbon mixtures, complemented by Bayesian Kernel Machine Regression. Additionally, a mediation analysis explored the influence of the LAP index in moderating the effects of 2-hydroxyfluorene on CVDs prevalence. The research also detailed the link between 2-hydroxyfluorene exposure and specific CVDs such as congestive heart failure, myocardial infarction, angina pectoris, and coronary heart disease, including their mediated impacts. Involving 3653 participants, the study detected a robust positive correlation between 2-hydroxyfluorene exposure and overall CVD risk (OR [95%CI] = 393.5173 [23.6978-6534.5979], P < .0001). This association extended to the prevalence of specific types of CVDs. The LAP index served as a mediator in the connection between 2-hydroxyfluorene exposure and the prevalence of total CVD, congestive heart failure, myocardial infarction, coronary heart disease, and stroke, with mediation percentages of 12%, 10%, 100%, 5%, and 9%, respectively. These results underscore a significant link between 2-hydroxyfluorene exposure and increased prevalence of CVDs, with the LAP index playing a crucial mediating role.

Our study aimed to investigate the association between the relative fat mass (RFM) and gallstones in adults.

Information obtained from the National Health and Nutrition Examination Survey (NHANES) 2017-2023 was utilized to examine the correlation between RFM and gallstones based on weighted multivariable regression analysis, smoothing curve fitting, and threshold effect analyses. Using subgroup analysis and interaction tests, we investigated whether this association remained consistent across different populations. We evaluated the effectiveness of RFM and Body Mass Index (BMI) in detecting gallstones through receiver operating characteristic (ROC) analysis and by calculating the area under the curve (AUC).

The study involved 7618 participants in total. RFM mean was 30.74 ± 5.68. Based on the fully adjusted model, gallstone prevalence was positively associated with RFM (OR = 1.09; 95% CI: 1.07-1.11; p < 0.001), with a 9% increase for each unit increase in RFM. This correlation was particularly evident among individuals under the age of 40 and among females. Smoothing curve fitting revealed a nonlinear association between RFM and the occurrence of gallstones, with an inflection point identified at 19.8. Additionally, ROC analysis showed that RFM (AUC = 0.674) outperformed BMI (AUC = 0.634) as a predictor of gallstone formation.

Higher RFM was associated with higher gallstone prevalence. RFM may be a more useful tool for gallstone prediction than BMI in the general population. Gallstones may be alleviated or improved by RFM management at an early age.

Not applicable.

A major problem that affects women of reproductive age globally is sterility. A new statistic called Relative Fat Mass (RFM) provides an accurate representation of the percentage of total body fat in people. This study aims to investigate the relationship between RFM and sterility in fertility-age American women.

This study employed a cross-sectional design using data collected from NHANES between 2013 and 2018. The association between RFM and sterility was investigated using logistic regression analysis, controlling for a number of variables. The results were more resilient when RFM was transformed into a four-category variable in order to further examine the patterns of the association between different RFM levels and sterility. The dose-response association between RFM and sterility was illustrated using restricted cubic spline (RCS) analysis. Sensitivity and subgroup analyses were also conducted to assess the robustness and consistency of the results.

This study included 3,197 women aged 18-45, consisting of 2,854 non-sterile participants and 343 sterile participants. First, in the fully adjusted model, RFM and the prevalence of sterility had a positive correlation (OR = 1.05, 95% CI = 1.01-1.09). When converting RFM from a continuous to a categorical variable, the prevalence of sterility was significantly greater in the highest quartile than in the lowest quartile (OR = 2.59, 95% CI = 1.40-4.82). Furthermore, RFM and sterility prevalence were found to be positively linearly correlated by RCS analysis, with sterility rates sharply increasing as RFM levels rose. The positive correlation between RFM and the frequency of sterility was shown to be constant throughout various populations, according to subgroup analysis across stratified parameters. Finally, sensitivity analysis further confirmed the reliability and consistency of the study's findings.

A representative sample of American women of reproductive age showed a positively correlation between RFM and the prevalence of sterility. RFM may help identify women at risk for sterility, and waist circumference management could potentially help lower the risk of sterility.

Although body mass index (BMI) is the most commonly used anthropometric measure to assess adiposity, alternative indices such as the waist-to-height ratio may better reflect the location and amount of ectopic fat as well as the weight of the skeleton.

The prognostic value of several alternative anthropometric measures was compared with that of BMI in 1116 patients with non-ischaemic heart failure with reduced ejection fraction (HFrEF) enrolled in DANISH. The association between anthropometric measures and all-cause death was adjusted for prognostic variables, including natriuretic peptides. Median follow-up was 9.5 years (25th-75th percentile, 7.9-10.9). Compared to patients with a BMI 18.5-24.9 kg/m2 (n = 363), those with a BMI ≥25 kg/m2 had a higher risk of all-cause and cardiovascular death, although this association was only statistically significant for a BMI ≥35 kg/m2 (n = 91) (all-cause death: hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.28-2.48; cardiovascular death: HR 2.46, 95% CI 1.69-3.58). Compared to a BMI 18.5-24.9 kg/m2, a BMI <18.5 kg/m2 (n = 24) was associated with a numerically, but not a significantly, higher risk of all-cause and cardiovascular death. Greater waist-to-height ratio (as an exemplar of indices not incorporating weight) was also associated with a higher risk of all-cause and cardiovascular death (HR for the highest vs. the lowest quintile: all-cause death: HR 2.11, 95% CI 1.53-2.92; cardiovascular death: HR 2.17, 95% CI 1.49-3.15).

In patients with non-ischaemic HFrEF, there was a clear association between greater adiposity and higher long-term mortality.

ClinicalTrials.gov NCT00542945.

Over the past 50 years, the incidence of obesity has gradually increased, necessitating investigation into the multifactorial contributors to this disease, including the gut microbiota. Bacteria within the human gut microbiome communicate using a density-dependent process known as quorum sensing (QS), in which autoinducer (AI) molecules (e.g., N-acyl-homoserine lactones [AHLs]) are produced to enable bacterial interactions and regulate gene expression.

We aimed to disrupt QS using quorum quenching (QQ) lactonases GcL and SsoPox, which cleave AHL signaling molecules in a taxa-specific manner based on differing enzyme affinities for different substrates. We hypothesized that QQ hinders signals from obesity-associated pathobionts, thereby slowing or preventing obesity.

In a murine model of diet-induced obesity, we observed GcL and SsoPox treatments have separate sex-dependent and dose-dependent effects on intestinal community composition and diversity. Notably, male mice given 2 mg/mL SsoPox exhibited significant changes in the relative abundances of gram-negative taxa, including Porphyromonadaceae, Akkermansiaceae, Muribaculaceae, and Bacteroidales (Kruskal-Wallis p < 0.001). Additionally, we used covariance matrix network analysis to model bacterial taxa co-occurrence due to QQ enzyme administration. There were more associations among taxa in control mice, particularly among gram-negative bacteria, whereas mice receiving SsoPox had the fewest associations.

Overall, our study establishes proof of concept that QQ is a targetable strategy for microbial control in vivo. Further characterization and dosage optimization of QQ enzymes are necessary to harness their therapeutic capability for the treatment of chronic microbial-associated diseases.

We investigated how adolescents' time allocation across daily activities influences their body mass index and well-being by paying explicit attention to gender and activities relevant to low- and middle-income countries (LMICs). We hypothesized that the inequitable domestic burden shouldered by girls adversely affects their health and well-being. Using data from three waves of the Young Lives Longitudinal Survey (2009, 2013, and 2016) tracking 1891 children aged 8, 12, and 15 from predominantly rural, low-income households from South India, we analyzed gendered time use patterns and their implications. Girls spent more time on caregiving, housework, and studying at home, while boys allocated more time to school, leisure, and sleep. Random effects models revealed that time spent on caregiving and housework increased the likelihood of being overweight or obese among girls, whereas leisure time reduced it. Time in school was positively associated with girl's thinness, as was time spent on sleep for both boys and girls. Gender moderated the effects of time spent on housework and unpaid economic tasks on thinness, reducing its likelihood for girls. Subjective well-being improved with time spent in school and studying for all adolescents. Fixed effects models revealed it worsened for girls engaged in paid work and boys engaged in leisure. Longer sleep hours improved boys' well-being. These findings underscore that gendered time use patterns, particularly girls' unequal burden of domestic responsibilities, contribute to their increased risk of overweight and obesity. Addressing these disparities is crucial for improving adolescents' health and well-being in resource-poor settings in LMICs.

This study aimed to investigate the association between A Body Shape Index (ABSI) and low back pain, with a focus on gender and age differences, using cross-sectional data from the NHANES database.

A total of 14,268 participants were included from four NHANES cycles (1999-2004 and 2009-2010). Low back pain was assessed based on self-reported pain over the past three months, and ABSI was calculated using waist circumference, height, and weight. Multivariate logistic regression models were used to evaluate the association between ABSI and low back pain, adjusting for potential confounders. Restricted cubic spline (RCS) analysis was conducted to assess non-linear relationships, and subgroup analyses were performed based on gender, age and BMI.

Higher ABSI was significantly associated with an increased risk of low back pain (OR for highest quartile = 1.27, 95% CI: 1.07-1.50, p = 0.008). RCS analysis indicated a linear relationship between ABSI and low back pain, with the risk significantly rising when ABSI exceeded 0.85. Subgroup analyses revealed that this association was more pronounced in males (OR = 25.89, 95% CI: 3.11-215.86, p = 0.004) and participants aged ≥ 60 years (OR = 11.11, 95% CI: 2.61-47.26, p = 0.002), while no significant association was observed in females.

The ABSI was associated with low back pain. This association was more prominent in males and older adults. Our findings suggest that ABSI may provide a more nuanced understanding of low back pain risk, particularly in populations with abdominal obesity. Further studies are needed to explore the underlying mechanisms and potential clinical applications of ABSI in low back pain risk assessment.

The cardiometabolic index (CMI) is a new comprehensive measure that reflects visceral obesity and metabolic function. This study aimed to examine associations between CMI and adult mortality from all causes and specific causes, as well as gender differences, using the National Health and Nutrition Examination Survey (NHANES) database.

We included 37,539 adult participants with complete data from the 1999-2018 NHANES database. We categorized the participants according to gender and constructed three models to investigate the relationship between CMI and the outcome variables. These were analyzed using Kaplan-Meier curve analysis, COX proportional risk models, and restricted cubic spline (RCS).

Baseline characteristics showed that among both male and female participants, those who died exhibited higher levels of CMI compared to those who survived. Kaplan-Meier curves showed an increasing trend in all-cause and specific mortality with increasing follow-up time. When CMI was categorized according to quartiles (Q1-Q4), the probability of survival was lower in the Q4 group compared to Q1. We found no gender differences between all three mortality rates. In COX regression analyses, all-cause, cardiovascular, and diabetes mortality were significantly higher in Q4 in the whole population and female participants, whereas no significant differences were identified among male participants. The RCS showed a nonlinear positive correlation in diabetes mortality for females and a linear positive correlation in all-cause and cardiovascular mortality. As for males, CMI was positively and nonlinearly associated with all-cause and diabetes mortality. Besides, there is no statistically significant correlation for males in cardiovascular mortality.

There were gender differences in the correlation between CMI and all-cause mortality, cardiovascular mortality, and diabetes mortality in the adult population. The findings indicated that adult females with elevated CMI levels were at an elevated risk of mortality from all causes, cardiovascular disease, and diabetes. At the same time, there were no significant associations in adult males.

The rising prevalence of obesity and its association with heart failure with preserved ejection fraction (HFpEF) highlight an urgent need for a diagnostic approach tailored to this population. Diagnosing HFpEF is hampered by the lack of a single non-invasive diagnostic criterion. While this makes a firm diagnosis of HFpEF already notoriously difficult in the general population, it is even more challenging in individuals with obesity. The challenges stem from a range of factors, including the use of body mass index as a conceptually suboptimal indicator of health risks associated with increased body mass, symptom overlap between HFpEF and obesity, limitations in physical examination, difficulties in electrocardiographic and echocardiographic evaluation, and reduced diagnostic sensitivity of natriuretic peptides in individuals with obesity. In this review, we examine these diagnostic challenges and propose a diagnostic algorithm specifically tailored to improve the accuracy and reliability of HFpEF diagnosis in this growing patient demographic.

Obesity and cardiometabolic disease often, but not always, coincide. Distinguishing subpopulations within which cardiometabolic risk diverges from the risk expected for a given body mass index (BMI) may facilitate precision prevention of cardiometabolic diseases. Accordingly, we performed unsupervised clustering in four European population-based cohorts (N ≈ 173,000). We detected five discordant profiles consisting of individuals with cardiometabolic biomarkers higher or lower than expected given their BMI, which generally increases disease risk, in total representing ~20% of the total population. Persons with discordant profiles differed from concordant individuals in prevalence and future risk of major adverse cardiovascular events (MACE) and type 2 diabetes. Subtle BMI-discordances in biomarkers affected disease risk. For instance, a 10% higher probability of having a discordant lipid profile was associated with a 5% higher risk of MACE (hazard ratio in women 1.05, 95% confidence interval 1.03, 1.06, P = 4.19 × 10-10; hazard ratio in men 1.05, 95% confidence interval 1.04, 1.06, P = 9.33 × 10-14). Multivariate prediction models for MACE and type 2 diabetes performed better when incorporating discordant profile information (likelihood ratio test P < 0.001). This enhancement represents an additional net benefit of 4-15 additional correct interventions and 37-135 additional unnecessary interventions correctly avoided for every 10,000 individuals tested.

Differences in breast cancer recurrence and survival occur by body size; the role of treatment differences in these disparities has been underexplored. Our objective was to evaluate differences in treatments received, patient experiences of care, and treatment decision-making processes among breast cancer survivors by body size.

We used data from the Share Thoughts on Breast Cancer study. Participants (n = 1198) completed a survey that included information on demographics, treatments received, quality of care, and decision-making. We used descriptive statistics to evaluate differences in survey response by BMI category, and multivariable-adjusted multinomial and logistic regression to examine associations of BMI with treatments received.

Those with higher BMI were more likely to be older, report fair/poor health, not have a college-level education, be non-white, not be insured, have an income under $50,000, be unemployed, and report a history of several chronic diseases. Although there were unadjusted associations, after adjustment, women with obesity were not significantly less likely to receive mastectomy [OR 0.79 (0.50, 1.26) and OR 0.66 (0.38, 1.16), for BMI 30-35 and 35+ kg/m2 respectively] or contralateral prophylactic mastectomy [OR 0.92 (0.59, 1.44) and OR 0.80 (0.46, 1.39)] than those without obesity. Similarly, we found no association of BMI with reconstructive surgery [OR 0.97 (0.58, 1.60) and OR 0.58 (0.30, 1.11)] after adjustment. Women with obesity were less likely to report that their breast cancer care was excellent or very good (p = 0.026).

We observed no differences in breast cancer treatments received by BMI after adjustment for key covariates in this study sample. Further research is necessary to determine why quality of care may be perceived as lower among women with obesity.

The 'Body Mass Index' (BMI) is an anachronistic and outdated ratio that is used as an internationally accepted diagnostic criterion for obesity, and to prioritise, stratify, and outcome-assess its management options. On an individual level, the BMI has the potential to mislead, including inaccuracies in cardiovascular risk assessment. Furthermore, the BMI places excessive emphasis on a reduction in overall body weight (rather than optimised body composition) and contributes towards a misunderstanding of the quiddity of obesity and a dispassionate societal perspective and response to the global obesity problem. The overall objective of this review is to provide an overview of obesity that transitions away from the BMI and towards a novel vista: viewing obesity from the perspective of the skeletal muscle (SM). We resurrect the SM as a tissue hidden in plain sight and provide an overview of the key role that the SM plays in influencing metabolic health and efficiency. We discuss the complex interlinks between the SM and the adipose tissue (AT) through key myokines and adipokines, and argue that rather than two separate tissues, the SM and AT should be considered as a single entity: the 'Adipo-Muscle Axis'. We discuss the vicious circle of sarcopenic obesity, in which aging- and obesity-related decline in SM mass contributes to a worsened metabolic status and insulin resistance, which in turn further compounds SM mass and function. We provide an overview of the approaches that can mitigate against the decline in SM mass in the context of negative energy balance, including the optimisation of dietary protein intake and resistance physical exercises, and of novel molecules in development that target the SM, which will play an important role in the future management of obesity. Finally, we argue that the Adipo-Muscle Ratio (AMR) would provide a more clinically meaningful descriptor and definition of obesity than the BMI and would help to shift our focus regarding its effective management away from merely inducing weight loss and towards optimising the AMR with proper attention to the maintenance and augmentation of SM mass and function.

Obesity is associated with excessive adipocyte-derived aldosterone secretion, independent of the classical renin-angiotensin-aldosterone cascade, and mineralocorticoid receptor antagonists may be more effective in patients with heart failure (HF) and obesity.

This study sought to examine the effects of the nonsteroidal mineralocorticoid receptor antagonist finerenone compared with placebo, according to body mass index (BMI) in FINEARTS-HF (FINerenone trial to investigate Efficacy and sAfety superioR to placebo in paTientS with Heart Failure).

A total of 6,001 patients with HF with NYHA functional class II, III, and IV, a left ventricular ejection fraction of ≥40%, evidence of structural heart disease, and elevated natriuretic peptide levels were randomized to finerenone or placebo. BMI (kg/m2) was examined using World Health Organization categories, namely, underweight/normal weight (<25.0 kg/m2; n = 1,306); overweight (25.0-29.9 kg/m2; n = 1,990); obesity class I (30.0-34.9 kg/m2; n = 1,546); obesity class II (35.0-39.9 kg/m2; n = 751); and obesity class III (≥40 kg/m2; n = 395). The primary outcome was cardiovascular death and total worsening HF events.

Data on baseline BMI were available for 5,988 patients (median: 29.2 kg/m2; Q1-Q3: 25.5-33.6 kg/m2). Compared with patients who were underweight/normal weight, those with obesity class II or III had a higher risk of the primary outcome (underweight/normal weight, reference; overweight, unadjusted rate ratio: 0.96 [95% CI: 0.81-1.15]; obesity class I: 1.04 [95% CI: 0.86-1.26]; obesity class II-III: 1.26 [95% CI: 1.03-1.54]). The effect of finerenone on the primary outcome did not vary by baseline BMI (underweight/normal weight, rate ratio: 0.80 [95% CI: 0.62-1.04]; overweight: 0.91 [95% CI: 0.72-1.15]; obesity class I: 0.92 [95% CI: 0.72-1.19]; obesity class II-III: 0.67 [95% CI: 0.50-0.89]; Pinteraction = 0.32). However, when BMI was examined as a continuous variable, the beneficial effect of finerenone seemed to be greater in those with a higher BMI (Pinteraction = 0.005). A similar pattern was observed for total worsening HF events. Consistent effects across baseline BMI were observed for cardiovascular and all-cause death and improvement in the Kansas City Cardiomyopathy Questionnaire scores.

In patients with HF with mildly reduced/preserved ejection fraction, the beneficial effects of finerenone on clinical events and symptoms were consistent, irrespective of BMI at baseline, possibly with a greater effect on the primary outcome in patients with higher BMI. (FINEARTS-HF [FINerenone trial to investigate Efficacy and sAfety superioR to placebo in paTientS with Heart Failure]; NCT04435626).

Background/Objectives: Metabolic syndrome (MetS) is a cluster of risk factors that significantly increase the risk of cardiovascular disease, including type 2 diabetes, etc. Assessing the predictive diagnostic power of anthropometric indicators for MetS is crucial for the early identification and prevention of related health issues. This study focuses on the Korean adult population while providing insights that may be applicable to broader global contexts. Therefore, this study aimed to compare the predictive diagnostic capabilities of various anthropometric indicators, including body mass index (BMI), waist-to-height ratio (WHtR), muscle mass-to-fat mass ratio (MFR), muscle mass-to-waist ratio (MWR), and body shape index (ABSI), in relation to MetS in Korean adults. Methods: Data from 13,725 participants of the Korea National Health and Nutrition Examination Survey (2008-2011) were analyzed. The diagnostic power of each indicator was assessed using the receiver operating characteristic (ROC) curve analysis, and the area under the curve (AUC) values were compared. Participants were classified into normal (NG) and abnormal (AG) groups based on established cutoff values, and logistic regression analysis was performed to evaluate the odds of MetS in each group. Results: WHtR showed the highest AUC values (0.792 for men and 0.768 for women), indicating superior diagnostic accuracy compared to the other indicators (p < 0.001). Logistic regression analysis indicated that both the unadjusted and adjusted odds ratios (OR) for MetS were significantly higher in the AG than in the NG across all indicators (p < 0.001). Specifically, the adjusted OR (95% confidence interval) for WHtR in the AG was 6.793 (5.929-7.784) for men and 4.665 (4.151-5.423) for women, representing the highest values among all indicators (p < 0.001). Conclusion: Among the various anthropometric indicators, WHtR is the most reliable and practical for predicting MetS in Korean adults. It is useful for early intervention and prevention in both clinical and public health settings.

The current definition of lean is based on body mass index (BMI). However, BMI is an imperfect surrogate for adiposity and provides no information on central obesity (CO). Hence, we explored the differences in clinical profile and liver disease severity in lean patients with nonalcoholic fatty liver disease (NAFLD) with and without CO.

One hundred seventy lean patients with NAFLD (BMI <23 kg/m2) were divided into two groups depending upon the presence or absence of CO (waist circumference ≥80 cm in females and ≥90 cm in males). Noninvasive assessment of steatosis was done by ultrasound and controlled attenuation parameter (CAP), while fibrosis was assessed with FIB-4 and liver stiffness measurement (LSM). FibroScan-AST (FAST) score was used for non-invasive prediction of NASH with significant fibrosis.

Of 170 patients with lean NAFLD, 96 (56.5%) had CO. Female gender (40.6% vs. 17.6%, P = 0.001), hypertriglyceridemia (58.3% vs. 39.2%, P = 0.01) and metabolic syndrome (23.9% vs. 4.1%, P < 0.001) were more common in the CO group. There was a poor correlation between BMI and waist circumference (r = 0.24, 95% CI: 0.09-0.38). Grade 2-3 steatosis on ultrasound was significantly more common in CO patients (30% vs. 12.3%, P = 0.007). CAP [312.5 (289.8-341) dB/m vs. 275 (248-305.1) dB/m, P = 0.002], FAST score [0.42 (0.15-0.66) vs. 0.26 (0.11-0.39), P = 0.04], FIB-4 and LSM were higher in those with CO. Advanced fibrosis was more prevalent among CO patients using FIB-4 (19.8% vs 8.1%, P = 0.03) and LSM (9.5% vs. 0, P = 0.04). CO was independently associated with advanced fibrosis after adjusting for BMI and metabolic risk factors (aOR: 3.11 (1.10-8.96), P = 0.03). Among these 170 patients, 142 fulfilled metabolic dysfunction associated steatotic liver disease (MASLD) criteria. CO was also an independent risk factor for advanced fibrosis in MASLD (3.32 (1.23-8.5), P = 0.02).

Lean patients with NAFLD or MASLD and CO have more severe liver disease compared to those without CO.