Determinants of attrition in a pediatric healthy lifestyle intervention: The CIRCUIT program experience

IntroductionAttrition in pediatric weight management programs is notoriously high. Greater understanding of its determinants is needed to inform retention strategies. We identified determinants of attrition in CIRCUIT, a healthy lifestyle intervention program for youth at risk of cardiovascular disease.MethodsA one-arm intervention study of children aged 4-18 years who initiated the CIRCUIT program in the first five years of its existence (N = 403). We defined attrition as attending the baseline visit but ceasing attendance prior to the 1-year follow-up. Potential determinants of dropout included the child’s age, sex, ethnicity, body mass index (BMI) z-score, family socio-demographic characteristics, and estimated driving time to the program, all measured at baseline. Associations were estimated bivariately, using chi-squared- and t-tests, and simultaneously in a multivariable logistic regression model.ResultsOf the 403 participants who started the program, 198 (49%) dropped out within 12 months of enrollment. Youth who dropped out were older (mean age 12.8y vs. 11.3y; p < 0.01), were less likely to live with both parents (62% vs. 71%; p = 0.05), and to have mothers who had completed high school (79% vs. 88%; p = 0.01). No group differences were observed for sex, ethnicity, baseline BMI z-score, fathers’ education, or driving time to the program. In multivariate models, only older age at initiation of the intervention (OR: 1.2; CI: 1.1,1.3) and lower maternal education (OR: 2.0; CI: 1.0,3.8) were associated with dropout.ConclusionImproved tailoring of interventions to older pediatric participants and to families of lower maternal education may help reduce attrition in CIRCUIT and similar lifestyle intervention programs.     

Association of obesity with illness severity in hospitalized patients with COVID-19: A retrospective cohort study

BackgroundAlthough recent studies have shown an association between obesity and adverse coronavirus disease 2019 (COVID-19) patient outcomes, there is a paucity in large studies focusing on hospitalized patients. We aimed to analyze outcomes associated with obesity in a large cohort of hospitalized COVID-19 patients.MethodsWe performed a retrospective study at a tertiary care health system of adult patients with COVID-19 who were admitted between March 1 and April 30, 2020. Patients were stratified by body mass index (BMI) into obese (BMI ≥ 30 kg/m 2) and non-obese (BMI < 30 kg/m 2) cohorts. Primary outcomes were mortality, intensive care unit (ICU) admission, intubation, and 30-day readmission.ResultsA total of 1983 patients were included of whom 1031 (51.9%) had obesity and 952 (48.9%) did not have obesity. Patients with obesity were younger (P < 0.001), more likely to be female (P < 0.001) and African American (P < 0.001) compared to patients without obesity. Multivariable logistic models adjusting for differences in age, sex, race, medical comorbidities, and treatment modalities revealed no difference in 60-day mortality and 30-day readmission between obese and non-obese groups. In these models, patients with obesity had increased odds of ICU admission (adjusted OR, 1.37; 95% CI, 1.07?1.76; P = 0.012) and intubation (adjusted OR, 1.37; 95% CI, 1.04?1.80; P = 0.026).ConclusionsObesity in patients with COVID-19 is independently associated with increased risk for ICU admission and intubation. Recognizing that obesity impacts morbidity in this manner is crucial for appropriate management of COVID-19 patients.     

Weight change adjusted equations for assessing resting metabolic rate in overweight and obese adults

BackgroundAlthough over one hundred equations have been developed to predict the energy expenditure of individuals, none are sensitive to weight change in assessment of resting metabolic rate (RMR) before and after weight loss.ObjectiveTo formulate adjusted equations for overweight and obese individuals and to compare their accuracy with existing prediction RMR equations before and after weight loss.Subjects/materialsThis is historical prospective study. Participants included 39 overweight and obese men and women before and after losing 10–20% from baseline weight on a diet and physical activity regimen for at least three months. Pre and post weight loss measured RMR results were compared to estimated RMR using several existing prediction equations: Harris and Benedict, Ravussin and Bogardus, and Mifflin et al. To improve the accuracy of these prediction equations, we suggest new equations adjusted for weight loss, based on measured RMR and evaluated their accuracy.ResultsPre and post weight loss data indicated: significant fat reduction in both genders; reduction in free-fat mass only in men, and a significant decrease in measured RMR only in women. Our suggested equations were the most accurate and closest to measured RMR in both genders, in comparison to the Harris and Benedict, Ravussin and Bogardus, and Mifflin et al equation results. Estimated RMR using the latter equations was significantly lower than measured RMR in both genders at pre and post weight loss (P < 0.01).ConclusionsThis study highlights the need for adjusting RMR equations before and after weight loss in overweight and obese individuals. Further research is needed to validate our suggested equations.     

Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry

BackgroundObesity has been described as a protective factor in cardiovascular and other diseases being expressed as ‘obesity paradox’. However, the impact of obesity on clinical outcomes including mortality in COVID-19 has been poorly systematically investigated until now. We aimed to compare clinical outcomes among COVID-19 patients divided into three groups according to the body mass index (BMI).MethodsWe retrospectively collected data up to May 31^st, 2020. 3635 patients were divided into three groups of BMI (<25 kg/m²; n = 1110, 25?30 kg/m²; n = 1464, and >30 kg/m²; n = 1061). Demographic, in-hospital complications, and predictors for mortality, respiratory insufficiency, and sepsis were analyzed.ResultsThe rate of respiratory insufficiency was more recorded in BMI 25?30 kg/m² as compared to BMI < 25 kg/m² (22.8% vs. 41.8%; p < 0.001), and in BMI > 30 kg/m² than BMI < 25 kg/m², respectively (22.8% vs. 35.4%; p < 0.001). Sepsis was more observed in BMI 25?30 kg/m² and BMI > 30 kg/m² as compared to BMI < 25 kg/m², respectively (25.1% vs. 42.5%; p = 0.02) and (25.1% vs. 32.5%; p = 0.006). The mortality rate was higher in BMI 25?30 kg/m² and BMI > 30 kg/m² as compared to BMI < 25 kg/m², respectively (27.2% vs. 39.2%; p = 0.31) (27.2% vs. 33.5%; p = 0.004). In the Cox multivariate analysis for mortality, BMI < 25 kg/m² and BMI > 30 kg/m² did not impact the mortality rate (HR 1.15, 95% CI: 0.889?1.508; p = 0.27) (HR 1.15, 95% CI: 0.893?1.479; p = 0.27). In multivariate logistic regression analyses for respiratory insufficiency and sepsis, BMI < 25 kg/m² is determined as an independent predictor for reduction of respiratory insufficiency (OR 0.73, 95% CI: 0.538?1.004; p = 0.05).ConclusionsHOPE COVID-19-Registry revealed no evidence of obesity paradox in patients with COVID-19. However, Obesity was associated with a higher rate of respiratory insufficiency and sepsis but was not determined as an independent predictor for a high mortality.     

The association of general obesity,central obesity and visceral body fat with the risk of gestational diabetes mellitus: Evidence from a systematic review and meta-analysis

BackgroundStudies consistently reported that general obesity predicts gestational diabetes mellitus (GDM). However, whether other phenotypes of obesity such as central obesity and visceral adiposity might have differential associations as risk factors of GDM are less known. The objective of this study was to investigate the association of all these obesity phenotypes in developing GDM.MethodsPubMed, CINHAL, Embase, Scopus, Google Scholar and Web of Science were searched. Full-text research articles published in English from 1985 to February 2020 with cohort and cross-sectional studies design and reported an association between obesity and GDM were included. Case-control studies, case reports, conference abstract, women with previous metabolic disorders and articles considered general obesity only were excluded. A bias adjusted-quality effect meta-analysis was conducted to evaluate the association of these obesity phenotypes and GDM risk.ResultsTwenty studies met the inclusion criteria representing data of ∼50 thousand women at the reproductive age with ∼7% prevalence of GDM. Meta-analysis of 14 datasets revealed that the three types of obesity were significantly associated with an increased risk of GDM. In addition, visceral adiposity was a stronger risk factor for GDM than other obesity phenotypes (odd ratio = 3.25, 95% confidence interval = 2.01–5.26) versus (odd ratio = 2.73, 95% confidence interval = 2.20−3.38) for general obesity and (odd ratio = 2.53, 95% confidence interval = 2.04−3.14) for central obesity.ConclusionThe findings of this study suggest that general obesity, central obesity and visceral body fat were associated with an increased risk of GDM. Furthermore, the association with maternal visceral adiposity was more robust compared to general obesity and central obesity.     

Visceral adiposity index is positively associated with blood pressure: A systematic review

PurposeThis systematic review aimed to investigate the association between VAI and blood pressure.MethodsThe study was according to the PRISMA standards and the bibliographic search in the PubMed, EMBASE and Cochrane Library databases.ResultsThis review included 32 articles, with 60,482 individuals – children to elderly people between 7 and 102 years old – of different age groups, most of them female (54.9%; n = 26,478). The year of publication ranged from 2010 to 2020, indicating that it is a recent theme, applied in almost all continents (America, Europe, Africa and Asia). The authors used data as continuous or into quantiles; blood pressure data also varied, with different cutoff points for the classification of arterial hypertension or continuously. The vast majority of studies have shown a positive association between VAI and blood pressure, both the sexes, in different age groups. The evaluation of the quality of the articles used by the Tool of the Joanna Briggs Institute according to their design.ConclusionIndividuals with increased VAI have higher blood pressure levels. Registration (PROSPERO: CRD42020205965).     

Effectiveness to promote weight loss maintenance and healthy lifestyle habits of a group educational intervention program in adults with obesity: IGOBE program

BackgroundTo achieve sustainable weight loss and healthy lifestyle changes is a huge challenge in the fight against obesity. The objective of this study was to evaluate the effectiveness to promote weight loss maintenance and healthy lifestyle habits of a group educational intervention program, Group Intervention in OBEsity (IGOBE), compared with a usual care therapy to lose weight.MethodsPatients with obesity (n = 437; 18.5% men, 18–77 years and 40.4 ± 6.7 kg/m²) were randomised into two groups to follow a prospective interventional real-life study: a control group (CG), treated with usual clinical practice, and an intervention group (IG), in which the patients participate in a group intervention program on healthy lifestyle habits with weekly sessions for six weeks, after which a re-evaluation was made at six months and at 12 months of follow-up. After finishing the study dropout rates were 44.6% in CG and 43.4% in IG. Anthropometric, dietetic habits and body composition data were analysed in both groups at the pre-intervention and post-interventions of the subjects by completer’s analysis.ResultsAt 12 months of following IGOBE program, the IG achieved greater weight loss (–7.1% of the initial weight) than the CG, which exhibited a weight gain (3.0% of the initial weight). The body weight change induced in the IG was accompanied by a reduction in fat mass, particularly visceral fat and waist circumference. Relevantly, the IG adhered to a healthy dietary pattern and changed its eating habits, which correlated with the improvement in body weight.ConclusionsIntensive educational group treatment that induces a change of eating habits and adherence to healthy dietary pattern is more effective in a long-term to counteract obesity traits than a standard treatment performed individually. The IGOBE program could be a cost-effective practice in the clinical management of obesity.     

Preoperative management of obese patients undergoing bariatric surgery: Role of endoscopy and Helicobacter eradication

BackgroundObesity is a pandemic disease associated to severe health problems. Management is usually multimodal, but many patients eventually need surgery to reduce weight. Many guidelines recommend endoscopy prior to surgery. This study reviews a series of patients undergoing sleeve gastrectomy to see whether endoscopy performance and histopathological findings influence surgery outcome.Material and methodsRetrospective series of patients undergoing sleeve gastrectomy as bariatric procedure at a single institution. We have reviewed the demographic data, the associated pathologies, endoscopic findings prior to surgery, histopathological findings in the surgical resection specimen and postoperative complication rate.Results259 patients fulfilled criteria for the study. Over 70% were women and the mean age was 46.9 (SD 9.8). Preoperative endoscopy was performed in 28.9% of the patients and biopsy only in 19.3%. Helicobacter pylori was detected in 28% of the patients undergoing endoscopy (either in the biopsy or the urease test) and eradicated before surgery in all the patients. Helicobacter pylori was present in 9.7% of the surgical resection specimens and its presence was significantly associated with the development of postoperative complications, mostly staple line leaks (p = 0.01).ConclusionOur study confirms that Helicobacter infection is significantly associated with postoperative complications after sleeve gastrectomy. It is therefore important to detect its presence and eradicate it before surgery.     

Effects of a single bout of short-duration high-intensity and long-duration low-intensity exercise on insulin resistance and adiponectin/leptin ratio

ObjectivesModerate-intensity exercise improves insulin sensitivity, which may depend on the intensity, duration, and frequency of exercise. We examined the effects of a single bout of short-duration high-intensity exercise (HIE) and long-duration lowintensity exercise (LIE) on insulin sensitivity and the adiponectin/leptin ratio in individuals with different body mass indices (BMIs) who do not exercise regularly.MethodsWe enrolled 42 healthy volunteers aged 20–64 years and divided them into two groups based on BMI: BMI <24 kg/m² and BMI ≥27 kg/m². They were randomly assigned to either the short-duration (20 min) HIE (70%–80% heart rate reserve, HRR) or long-duration (60 min) LIE training groups (30%–40% HRR). Glucose, insulin, adiponectin, and leptin levels were assessed before training and at 0, 30, 60, and 120 min after training.ResultsWe finally analyzed 27 normal weight and 9 obese individuals. No significant differences were observed in the baseline information of both BMI groups. Homeostatic model assessment for insulin resistance significantly improved for both exercise patterns in the normal weight group and for the HIE pattern in the obese group (P < 0.01), whereas the adiponectin/leptin ratio increased significantly only among normal weight participants with the LIE intervention.ConclusionBoth exercise patterns in BMI <24 kg/m² and BMI ≥27 kg/m² benefit on insulin resistance. Therefore, people can choose the way they can fit to improve insulin resistance both short-duration high-intensity exercise and long-duration low-intensity exercise.     

Untangling the relationship between early adversity,placement breakdowns,and obesity in a secure adolescent developmental disorder service: A cross-sectional study

BackgroundObesity is a growing global health concern, and those with a developmental disorder are at particular risk. Elevated levels of childhood trauma, placement breakdowns and obesity have been documented in the developmental disorder population, yet their relative associations remain unclear.ObjectiveA previous study (Morris et al., 2020) highlighted a high prevalence of adverse childhood experiences (ACEs) and obesity in adolescents with developmental disorders residing in a secure inpatient setting. The current cross-sectional study sought to further explore the prevalence of placement breakdowns and its relationship with Body Mass Index (BMI) in this sample.MethodsSecondary analysis was conducted on existing data for 34 adolescents, aged 10–17 years at admission, held in a secure mental health hospital developmental disorder service in the United Kingdom (UK) under the Mental Health Act.ResultsAlmost half of participants had experienced a placement breakdown (47.1%), the majority of whom typically experienced multiple breakdowns (M = 3.94, SD = 2.14). Placement breakdowns significantly predicted BMI and had a predictive effect that was independent to and above that of ACEs.ConclusionsPlacement breakdowns significantly contribute to risk for obesity, above that explained by early adversity. Those who have experienced placement breakdowns have a greater risk for obesity, irrespective of their level of exposure to ACEs. A history of previous placement breakdowns may act as a red flag for obesity.