The levelling off of the obesity epidemic since the year 1999 – a review of evidence and perspectives

The purpose was to investigate a possible levelling off in the obesity epidemic, by systematically reviewing literature and web‐based sources. Eligible studies and data sources were required to have at least two measures of obesity prevalence since 1999. A literature and Internet search resulted in 52 studies from 25 different countries. The findings supported an overall levelling off of the epidemic in children and adolescents from Australia, Europe, Japan and the USA. In adults, stability was found in the USA, while increases were still observed in some European and Asian countries. Some evidence for heterogeneity in the obesity trends across socioeconomic status (SES) groups was found. The levelling off was less evident in the lower‐SES groups. No obvious differences between genders were identified. We discussed potential explanations for a levelling off and the utility of investigating obesity trends to identify the driving forces behind the epidemic. It is important to emphasize that the levelling off is not tantamount to calling off the epidemic. Additionally, it is worthwhile to keep in mind that previous stable phases have been followed by further increases in the prevalence of obesity. Therefore, research into the causes, prevention and treatment of obesity should remain a priority.     

The changing epidemiology of the ageing thalassaemia populations: A position statement of the Thalassaemia International Federation

Therapeutic advances in β-thalassaemia have gradually lead to a significant improvement in prognosis over the past few decades. As a result, patients living in areas where disease-specific programmes offering access to modern therapy are in place experience a new era of prolonged survival that tends to reach that of the normal population. This ageing thalassaemia population, however, faces a new spectrum of comorbidities resulting from increasing age that may jeopardise the advances in prognosis provided by current therapy and thus poses new challenges in diagnosis, monitoring and treatment. In this position paper of the Thalassaemia International Federation, we review the changing epidemiology and clinical spectrum of patients with β-thalassaemia and propose actions to be undertaken in order to address the emerging spectrum of comorbidities resulting from ageing.     

Consensus statement on the role of hepatitis A vaccination in patients with chronic liver disease

Hepatitis A virus (HAV) is a ubiquitous, easily transmitted virus that can cause severe hepatitis, particularly in the adult population. Improvements in sanitation and hygiene in the developing world have led to a decline in immunity against HAV. A growing number of adults are now susceptible to infection, with those who have not been vaccinated against hepatitis B virus (HBV) being at risk of dual infection and potentially more severe illness. The symposium, "The role of hepatitis vaccination in patients with chronic liver disease", provided the opportunity to develop a consensus statement. It was concluded that patients with non-viral chronic liver disease (CLD) and certain groups with HBV infection can develop more severe disease in the event of HAV infection. It was identified that patients with CLD should be targeted for hepatitis A vaccination as soon as CLD is diagnosed.     

Obesity as a risk factor for Alzheimer's disease: weighing the evidence

Alzheimer's disease (AD) is the sixth leading cause of death in the USA today; therefore, it is imperative that public health initiatives and clinical strategies are developed to prevent and effectively treat AD. Despite the enormous impact that AD has on individuals, families, society, and the health care system, there are no biomarkers to clearly identify those at risk for AD, public health prevention strategies in place, or treatments to address the underlying pathology or stop the progression of AD. There is ample scientific as well as empirical evidence that obesity and its metabolic and vascular comorbidities are related to AD and likely in the causative pathway. Obesity prevention and treatment could prove to be an efficacious and safe approach to preventing AD, a serious and daunting epidemic disease. In this review, we present the current pathophysiological and clinical evidence linking obesity and obesity‐related comorbidities (eg, insulin resistance, hyperglycaemia, and type 2 diabetes) with AD. Additionally, we discuss which population to target and when to consider treatment for AD. Finally, we summarize the current evidence regarding the efficacy of anti‐obesity and anti‐diabetic pharmacotherapeutic agents for the treatment of AD.     

Pathophysiology of hypertension in obese children: a systematic review

Hypertension is increasingly common in overweight and obese children. The mechanisms behind the development of hypertension in obesity are complex, and evidence is limited. In order to effectively treat obese children for hypertension, it is important to have a deeper understanding of the pathophysiology of hypertension in obese children. The present review summarizes the main factors associated with hypertension in obese children and discusses their potential role in its pathophysiology. Systematic searches were conducted in PubMed and EMBASE for articles published up to October 2014. In total, 60 relevant studies were included. The methodological quality of the included studies ranged from weak to strong. Several factors important in the development of hypertension in obese children have been suggested, including endocrine determinants, such as corticosteroids and adipokines, sympathetic nervous system activity, disturbed sodium homeostasis, as well as oxidative stress, inflammation and endothelial dysfunction. Understanding the pathophysiology of hypertension in overweight and obese children is important and could have implications for its screening and treatment. Based on solely cross‐sectional observational studies, it is impossible to infer causality. Longitudinal studies of high methodological quality are needed to gain more insight into the complex mechanisms behind the development of hypertension in obese children.     

Clinical evaluation of the overweight patient

Evaluation of an overweight patient is the first step in any therapeutic program. The syndromes of obesity can be classified in several ways. The first is an anatomic classification based on the size, number, and distribution of fat cells and fat tissue. The second is an etiologic classification based on identification of specific diseases and settings that produce obesity. Hypothalamic injury and endocrine disease such as Cushing's disease and the polycystic ovary syndrome are three identifiable causes of obesity. In this medicated society drugs are always candidates to produce weight gain. The most common causes, however, are stopping smoking, overconsumption of high-fat foods, a decrease in the level of activity, and aging. The natural history of obesity provides a useful framework in which to view both preventive and therapeutic strategies. Some individuals will never become overweight, but of those who do, about one-third will do so during the first two decades, and the remaining two-thirds will become overweight after age 20. A number of epidemiological and metabolic factors can serve as a guide to those individuals who are at high risk. Having overweight parents tops the list, but multiple births, cessation of smoking, and a sedentary lifestyle are additional factors. Therapeutic decisions should be based on risk-benefit decisions. The risk can be assessed from the body mass index, the distribution of fat in upper or lower body obesity, the rate of weight gain, and the degree of physical inactivity. After assessing risk, the therapeutic choices can be selected from the age category of the patient. With any therapeutic activity, involvement of the patient in a realistic approach to the treatment process is essential.     

Consumption of pure oats by individuals with celiac disease: a position statement by the Canadian Celiac Association.

The treatment of celiac disease is a strict adherence to a gluten-free diet for life. In the past, oats were considered to be toxic to individuals with celiac disease and were not allowed in a gluten-free diet. However, recent evidence suggests that oats that are pure and uncontaminated with other gluten-containing grains, if taken in limited quantities, are safe for most individuals with celiac disease. For adults, up to 70 g (1/2 to 3/4 cup) of oats per day and for children, up to 25 g (1/4 cup) per day are safe to consume. These oats and oat products must fulfill the standards for a gluten-free diet set by the Canadian Food Inspection Agency and Health Canada. The Canadian Celiac Association, in consultation with Health Canada, Agriculture & Agri-Food Canada and the Canadian Food Inspection Agency, has established requirements for growing, processing, and purity testing and labelling of pure oats. These strategies have led to the production of pure, uncontaminated oats for the first time in Canada. Oats and oat products that are safe for consumption by individuals with celiac disease and dermatitis herpetiformis are now commercially available in Canada.     

Obesity: the science behind the management

The prevalence of obesity is increasing in Western and Westernizing countries. The changing environment plays a major role in this increase, particularly the reduction in physical activity. There is also a strong genetic contribution to the development of obesity, although single-gene defect obesity is rare. Neither the environment nor genes is simple to modify. Obesity is an energy-balance disorder, and the human body has evolved to resist any loss of body fat. This biological drive to maintain weight is coordinated through central pathways, with the involvement of many neuropeptides. Thus, dietary restriction will induce changes designed to counter weight loss, including a fall in resting metabolic rate. The management of obesity demands reasonable goals, which focus on metabolic, rather than cosmetic, improvement. As obesity is a complex condition, multiple therapeutic strategies are required. Dietary modification, an increase in physical activity, a reduction in sedentary activity and behaviour modification all form the basis of obesity therapy. Drug therapy options at present are limited and may have a stronger role in weight maintenance. Currently, surgical management of obesity has the best long-term outcomes. Long-term maintenance of weight loss is achieved by few individuals. Those individuals who are successful are able to maintain long-term restrictive eating habits and high levels of physical activity.     

Atrial fibrillation and congestive heart failure: specific considerations at the intersection of two common and important cardiac disease sets

Atrial fibrillation (AF) and congestive heart failure (CHF) are two increasingly common cardiac disorders with a growing prevalence in the overall population. Improved treatment of acute medical conditions has increased the incidence of these cardiac disorders. AF and CHF have similar epidemiologic characteristics and adversely affect quality of life and life expectancy of affected patients. CHF predisposes to AF, and AF may worsen the prognosis of CHF. The relevant literature was intensively reviewed with emphasis on aspects at the intersection of both disease sets. Recent advances in basic research have provided a more in-depth view of changes promoting the occurrence of AF in CHF. Data from clinical trials have provided means to improve medical treatment of AF. Precautions must be taken for specific CHF-related side effects, such as torsades de pointes tachycardia, when treating AF. The specific electrophysiologic basis of AF associated with CHF may provide targets for improved treatment modalities. New treatment approaches, both pharmacologic and nonpharmacologic, as well as the results of ongoing controlled clinical studies are likely to greatly alter AF therapy over the next 5 to 10 years in patients with CHF.     

Obesity is the only independent factor associated with ultrasound-diagnosed non-alcoholic fatty liver disease: A cross-sectional case-control study

Objective. There is increasing interest in ultrasound-diagnosed non-alcoholic fatty liver disease (NAFLD) in the ambulatory care setting. The aim of this study was to determine the clinical and metabolic features of ultrasound-diagnosed NAFLD. Material and methods. Fifty ultrasound-diagnosed NAFLD patients who had not consumed alcohol for at least the previous 3 months were matched with 100 controls by age and gender distribution. Clinical, biochemical, and nutritional variables were compared between the ultrasound-diagnosed NAFLD patients and the controls. Conditional logistic regression analyses were used to identify independent factors associated with ultrasound-diagnosed NAFLD. Results. The ultrasound-diagnosed NAFLD patients had higher values on the anthropometric measurements than those of the controls. Aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), uric acid, and γ-glutamyl transpeptidase levels were higher in the ultrasound-diagnosed NAFLD patients than those in the controls (p<0.001). The ASAT/ALAT ratio of the ultrasound-diagnosed NAFLD patients was lower than that of the controls (p<0.001). Total cholesterol, triglycerides, high-density lipoprotein (HDL)-cholesterol, non-HDL-cholesterol, atherogenic index, fasting glucose, systolic blood pressure (BP), diastolic BP, and pulse pressure were higher in the ultrasound-diagnosed NAFLD patients than in the control subjects, while lipoprotein(a) was lower. There were no significant differences in low-density lipoprotein (LDL)-cholesterol levels or nutritional intake between patients and controls. Abnormal ASAT or ALAT, hypertriglyceridemia, lower HDL-cholesterol levels, silent myocardial ischemic pattern on electrocardiogram (ECG), impaired fasting glucose, and obesity were common among the ultrasound-diagnosed NAFLD patients. The only independent factor associated with ultrasound-diagnosed NAFLD was obesity (p<0.001). Conclusions. Our data suggest that NAFLD diagnosed by ultrasound is associated with hypertriglyceridemia, impaired fasting glucose, silent myocardial ischemic pattern of ECG, obesity, and abnormal liver tests in adults. Among these factors, obesity was the only independent factor associated with ultrasound-diagnosed NAFLD.     

The Association between Anthropometric Indices of Obesity and Chronic Kidney Disease in Middle-aged Japanese Men and Women: A Cohort Study

Objective This study investigated associations between three indices of obesity-the body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR)-and the incidence of chronic kidney disease (CKD). Methods The employees of a company in Japan (1,725 men, 1,186 women; aged 35-55 years) had BMI, WC, and WHtR measured in health examinations. The incidence of CKD was determined at annual medical examinations over a six-year period. The hazard ratios for CKD were calculated using proportional hazard models, and the χ² statistic was used to compare the strengths of the associations. Results The mean BMI (kg/m²), WC (cm), and WHtR were 23.6, 84.3, and 0.49 for men and 22.3, 79.7, and 0.50 for women, respectively. The incidence of CKD (/1,000 person-years) was 18.1 for men and 8.4 for women. In men, positive linear associations were observed between the BMI, WC, and WHtR and the risk of CKD, even after adjusting for the presence of metabolic abnormalities (p for trend <0.001, 0.012, and 0.023, respectively). In women, a linear association was observed only between the WHtR and CKD, not the BMI or WC (p for trend =0.042, 0.057, and 0.186). The χ² statistics were the highest for the BMI in both men and women. Conclusion The BMI, WC, and WHtR were linearly associated with the risk of CKD independently of metabolic abnormalities in men, while the associations were weaker or not significant in women. The BMI was the most strongly associated with the incidence of CKD in both men and women.     

The metabolic syndrome in an Arab population: a first look at the new International Diabetes Federation criteria.

AIMS: To report the prevalence of the metabolic syndrome in Arab men and women using the new International Diabetes Federation (IDF) criteria, and to compare this with the prevalence using the 1999 World Health Organization (WHO) and 2001 National Cholesterol Education Program Adult Treatment Panel III (NECP ATPIII) definitions. METHODS: The study involved 863 subjects (343 men and 520 women) aged > or = 40 years living in Tunis, Tunisia, taken from an initially randomized, population sample. RESULTS: The prevalence of the metabolic syndrome using the IDF criteria was found to be 45.5%; 55.8% in women and 30.0% in men (P < 0.001), higher than the rates of 28.7% (WHO) and 24.3% (NECP ATPIII) using the previous definitions. Using all the definitions, the prevalence was higher in women than in men predominantly because of significant differences in central obesity and high-density lipoprotein (HDL) cholesterol and, to a lesser extent, hypertension. CONCLUSION: The increased prevalence using the IDF criteria compared with the 1999 WHO criteria and the 2001 NCEP ATPIII definitions is striking and has huge implications for public health worldwide. The major reason for the higher rate using the new definition seems to be the predominant focus placed on central obesity. Using tighter criteria for fasting glycaemia has also played a factor. The question remains as yet unanswered as to whether the new IDF criteria are better at predicting hard outcomes such as diabetes mellitus and cardiovascular diseases.     

Veno-active drugs in the management of chronic venous disease. An international consensus statement: current medical position, prospective views and final resolution

BACKGROUND: Veno-active drugs (VAD) have effects on edema and symptoms related to chronic venous disease (CVD), especially so-called venous pain. VAD's effectiveness, although well established, is regularly debated. OBJECTIVE: Our purpose was to select all randomized controlled trials (RCTs) and meta-analyses devoted to VAD and symptoms in CVD, to submit them to a group of international experts in CVD and to vote with secrete ballot to determine the level of efficacy of each drug, according to EBM (Evidence-Based Medicine) rules and critical analysis. METHODS: Publications in any language devoted to VAD and venous symptoms were searched for in different databanks and submitted to the experts prior to the meeting. RESULTS: 83 papers were analyzed, including 72 RCTs or meta-analyses. Experts determined the level of EBM of each drug, according to the literature and personal experience, using 3 levels of recommendation, A, B and C (from large RCTs to non-randomized trials). CONCLUSIONS: VAD are effective and may be applied in CVD when symptomatic, from C0s to C6s. However, etiological treatment of venous reflux and venous hypertension has always priority. In some cases VAD may replace compression and/or complement its effects. If respecting these prerequisites, VAD are safe and effective.