In recent decades, ischemic stroke is increasingly prevalent, which has become the second leading cause of death and disability in the world. Insulin resistance and obesity are closely related to the development of ischemic stroke. At present, a number of studies have confirmed that obesity is associated with a variety of metabolic diseases and the role of insulin resistance played in the pathogenesis. But it is still unclear whether TyG, an indicator of insulin resistance, and TyG combined with obesity indicators can be used to predict ischemic stroke.

To assess the influencing factors of TyG, and its combination with different obesity indicators for new-onset ischemic stroke in a cohort of middle-aged and elderly people during a 10-year follow-up .

A prospective cohort design was used. The cohort included 9 406 middle-aged and elderly individuals who attended the 2011 Epidemiological Survey on Cancer Risk in Type 2 Diabetics conducted in six communities in Luzhou (including Qiancao, Xiaoshi, Longmatan, Baolaiqiao, Dashanping and Yutang) . Baseline data were collected, including TyG and its combination with different obesity indicators〔TyG-waist circumference (WC) , TyG-waist-to-height-ratio (WHtR) , TyG-body mass index (BMI) , and TyG-waist-to-hip-ratio (WHR) 〕. A 5-year follow-up initiated since June to November 2016, and a 10-year follow-up initiated since April to June 2021 were conducted, with new-onset ischemic stroke incidence (obtained through Luzhou Health Commission and Luzhou Center for Disease Control & Prevention) as an endpoint. For assessing the predictive value of baseline TyG, TyG-WC, TyG-WHtR, TyG-BMI, and TyG-WHR for new-onset ischemic stroke, patients were divided into quartiles of TyG〔Q1 (n=2 351) , Q2 (n=2 351) , Q3 (n=2 352) , Q4 (n=2 352) 〕, quartiles of TyG-WC〔Q1 (n=2 351) , Q2 (n=2 352) , Q3 (n=2 352) , Q4 (n=2 351) 〕, quartiles of TyG-WHtR〔Q1 (n=2 349) , Q2 (n=2 349) , Q3 (n=2 348) , Q4 (n=2 348) 〕, and quartiles of TyG-BMI〔Q1 (n=2 351) , Q2 (n=2 352) , Q3 (n=2 352) , Q4 (n=2 351) 〕, quartiles of TyG-WHR〔Q1 (n=2 343) , Q2 (n=2 343) , Q3 (n=2 342) , Q4 (n=2 342) 〕, respectively. Multivariate Logistic regression analysis was used to explore the relationship between TyG, TYG-WC, TYG-WTHR, TYG-BMI, TYG-WHR and new ischemic stroke in the elderly.

During the follow-up period, 527 (5.6%) of the 9 406 middle-aged and elderly people had new-onset ischemic stroke. After adjusting for multiple confounding variables, multivariate Logistic regression analysis showed that the risk of new ischemic stroke in the fourth quartile group of TyG was 1.569 times higher than that in the first quartile group of TyG〔OR=1.569, 95%CI (1.007, 2.437) , P=0.046〕. The risk of new ischemic stroke increased by a factor of 1.467, 2.012, and 2.132 in the second, third and fourth quartile groups of TyG-WC〔 OR=1.467, 95%CI (1.010, 2.131) , P=0.044; OR=2.012, 95%CI (1.270, 3.187) , P=0.003; OR=2.132, 95%CI (1.119, 4.063) , P=0.021〕compared with that in the first quartile group of TyG-WC. The risk of new ischemic stroke increased by a factor of 1.481, 1.548, and 1.705 in the second, third and fourth quartile groups of TyG-BMI 〔OR=1.481, 95%CI (1.071, 2.048) , P=0.018; OR=1.548, 95%CI (1.066, 2.247) , P=0.022; OR=1.705, 95%CI (1.054, 2.759) , P=0.030〕compared with that in the first quartile group of TyG-BMI.

The risk of new-onset ischemic stroke in middle-aged and elderly type 2 diabetics in Luzhou increased with the elevation of TyG-WC and TyG-BMI, so TyG-WC and TyG-BMI may be predictors of new-onset ischemic stroke in this population.

Obesity is a risk factor for the development of metabolic syndrome, type 2 diabetes mellitus (T2DM) , atherosclerosis and other diseases, but the correlation between obesity and albuminuria in diabetic patients has been insufficiently explored.

To investigate the correlation between obesity and albuminuria in patients with T2DM.

T2DM inpatients were consecutively recruited from Department of Endocrinology and Metabolism, Shanghai Jiaotong University Affiliated Sixth People's Hospital from January 2007 to June 2009. The general clinical data, physical and laboratory examination results were collected. In accordance with prevalence of obesity (defined as BMI≥25 kg/m²) , the patients were divided into obese group and non-obese group (BMI<25 kg/m²) , then the obese cases were further divided into mild (25 kg/m²≤BMI<30 kg/m²) , moderate (30 kg/m²≤ BMI<35 kg/m²) , and severe obesity subgroups (BMI≥35 kg/m²) . Albuminuria was diagnosed as 24-hour urinary albumin excretion≥30 mg/24 h. The relationship between obesity and albuminuria was analyzed by binary Logistic regression.

In all, 3 023 T2DM cases were enrolled, including 1 609 non-obese cases, and 1 414 obese cases (1 196 cases of mild obesity, 206 cases of moderate obesity and 12 cases of severe obesity) . Compared with non-obese cases, obese cases had higher prevalence of alcohol consumption, hypertension, and history of anti-hypertensive mediation use (P<0.05) . Additionally, obese cases had higher average levels of systolic blood pressure, diastolic blood pressure, waist-to-hip ratio, fasting plasma glucose, 2-h postprandial blood glucose, serum creatinine, fasting C-peptide, 2-hour postprandial C-peptide, triglyceride, total cholesterol, low-density lipoprotein, alanine aminotransferase, and serum uric acid, and lower average levels of glycosylated hemoglobin and high-density lipoprotein (P<0.05) . Obese cases also had higher average level of 24-h urinary albumin excretion 〔13.7 (7.6, 42.6) mg/24 h〕 than did non-obese cases 〔9.7 (6.0, 22.3) mg/24 h〕 (P<0.05) . The prevalence of albuminuria (30.0%, 424/1 414) in obese cases was significantly higher than that of non-obese cases (20.2%, 325/1 609) (P<0.05) . Binary Logistic regression analysis showed that obesity was closely associated with albuminuria in T2DM〔OR=1.266, 95%CI (1.013, 1.582) , P<0.05〕 after adjusting for confounding variables.

Obesity may be an independent risk factor of albuminuria in T2DM. So controlling obesity is very important in decreasing the risk of albuminuria in T2DM patients.

The new electrocardiogram (ECG) criteria have higher accuracy in the diagnosis of left ventricular hypertrophy (LVH) in general population with hypertension than traditional ECG voltage criteria. However, the diagnostic efficacy of new ECG criteria for LVH in overweight and obese patients with hypertension has been rarely reported.

To explore the diagnostic value of new ECG indicators for LVH in overweight and obese patients with hypertension.

A retrospective design was used. A total of 368 overweight and obese patients with hypertension were recruited from the First Affiliated Hospital of Wannan Medical College from December 2017 to December 2020, and divided into LVH (+) group (including males with LVH>115 g/m² and females with LVH >95 g/m²) and LVH (-) group (including males with LVH≤115 g/m² and females with LVH≤95 g/m²) . General data were collected and compared between two groups. Intergroup comparison was also performed in terms of ultrasonic cardiography (UCG) indicators〔diastolic interventricular septal thickness (IVST) , left ventricular posterior wall thickness (LVPWT) , left ventricular mass (LVM) , left ventricular mass index (LVMI) , left ventricular ejection fraction (LVEF) 〕and ECG indicators〔QRS duration (QRSd) , corrected QT interval (QTc) , Sokolow-Lyon voltage criteria, Cornell voltage criteria, Peguero Lo-Presti voltage criteria, Cornell product〕with the accuracy of UCG indicators as the gold standard. Binary Logistic regression model was used to analyze the influencing factors of LVH in hypertension with overweight or obesity. ROC analysis was used to evaluate the diagnostic efficacy of new ECG indicators (Sokolow-Lyon voltage criteria, Cornell voltage criteria, Peguero Lo-Presti voltage criteria, Cornell product) for LVH in hypertension with overweight or obesity.

There were statistically significant differences in sex ratio, mean age, body surface area (BSA) , SBP, DBP, β-blocker utilization rate and blood pressure control between LVH (+) and LVH (-) groups (P<0.05) . The mean values of IVST, LVPWT, LVM, LVMI, QRSd, QTc, Sokolow-Lyon voltage criteria, Cornell voltage criteria, Peguero Lo-Presti voltage criteria and Cornell product in LVH (+) group were higher than those in LVH (-) group (P<0.05) . The mean LVEF value in LVH (+) group was lower than that in LVH (-) group (P<0.05) . Age 〔OR=1.046, 95%CI (1.024, 1.069) 〕 and Sokolow-Lyon voltage criteria〔OR=1.793, 95%CI (1.305, 2.463) 〕 were influential factors for LVH risk in hypertension with overweight or obesity (P<0.05) . The AUC of Sokolow-Lyon voltage criteria, Cornell voltage criteria Peguero Lo-Presti voltage criteria and Cornell product for LVH diagnosis in hypertension with overweight or obesity was 0.674, 0.695, 0.662 and 0.722, respectively. The AUC of the combined diagnostic model with age, BSA, SBP, DBP, time of the duration of hypertension, QRSd, QTc, Sokolow-Lyon voltage criteria, Cornell voltage criteria, Peguero Lo-Presti voltage criteria, and Cornell product incorporated was 0.846.

In overweight and obese people with hypertension, the Sokolow-Lyon voltage criteria was associated with LVH. Moreover, the new ECG indicator Peguero Lo-Presti voltage criteria was less effective than Cornell product and other traditional ECG indicators in diagnosing LVH. The combined diagnostic model has proven to be with better diagnostic performance for LVH, which is recommended to be used and promoted in primary care settings with relatively unsatisfactory examination conditions.

With the growing problem of obesity, the demand for bariatric surgery has increased these years. Patients still need to maintain good living habits after surgery to consolidate the weight loss effects. While the behavioral guidelines are relatively mature, patient's behavioral compliance is not ideal, resulting in a high rate of postoperative weight regain. In that case, we can depend on strategies to promote dietary and physical activity behaviors in patients from the cognitive perspective.

To systematically code and merge the dietary and physical activity behavior promotion strategies after bariatric surgery from the cognitive perspective.

In June 2022, the WHITTEMORE and KNAFL's integrative review methodology was used. Studies written in English related to dietary and physical activity behavior promotion strategies after bariatric surgery were searched in databases of PubMed, Web of Science, the Cochrane Library and CINAHL, and those in Chinese were searched in databases of CNKI and Wanfang Data from January 1994 to June 2022. The 2016 version of the Critical Appraisal Skills Program (CASP) was used to evaluate the quality of the literature. Studies meeting the inclusion criteria were included, and the strategies extracted from which were uniformly coded and merged according to the CALO-RE taxonomy.

A total of 25 studies were included, including 17 randomized controlled trials, 4 observational studies, and 4 reviews. After coding, all strategies were covered by CALO-RE taxonomy, involving 25 kinds, mainly including self-monitoring of behavior, social support, goal setting, identifying barriers/problem resolution, etc. A total of 46 strategies were obtained and used to create a strategy set named "promotion strategies of dietary and physical activity behaviors after bariatric surgery".

Through the application of the integrative review methodology and the guidance of CALO-RE taxonomy, this study systematically coded and merge the dietary and physical activity behavior promotion strategies from the cognitive perspective for applicable to patients after bariatric surgery, providing a reservoir of techniques for postoperative behavioural management. After assessing patients' behavioural levels and cognitive factors, bariatric surgery providers can select appropriate strategies to improve patients' behavioural compliance. This strategy set can be further validated and optimised in future empirical studies.

Microcirculation dysfunction is closely associated with the development of obesity. Exercise intervention could effectively improve the microcirculation in obese people, but the intensity of an exercise intervention schemes often lacks of individualization and precision. FATmax is a precise and individualized exercise intensity determined on the basis of individual fat oxidation rate.

To compare the effects of aerobic exercise and combined aerobic and resistance exercise at FATmax intensity on improving the microcirculation in obese college students, and to explore the mechanism of action by analyzing the changes in nitric oxide (NO) , endogenous NO synthase (eNOS) , endothelin-1 (ET-1) and endothelial growth factor (VEGF) .

In March, 2021, Sixty-six obese college students were recruited from Hubei University for Nationalities, and equally randomized into sex-matched three groups with different 10-week interventions: aerobic exercise group (performing aerobic exercise at the FATmax intensity, 4 times a week, 60 minutes each time) , combined aerobic and resistance exercise group〔performing combined aerobic and resistance exercise at FATmax intensity, 4 times a week, 60 minutes each time (40 minutes for aerobic exercise and 20 minutes for resistance exercise) 〕, and control group (maintaining their normal living habits) . Body weight, body fat percentage, BMI, microvascular reactivity, transcutaneous oxygen pressure (TcPO₂) , muscle oxygen saturation (SmO₂) , NO, eNOS, ET-1, VEGF and HOMA-IR were tested on March 18 and June 2, 2021, respectively.

The intervention modality and duration had significant interactive effects on body weight, BMI and body fat percentage of three groups (P<0.05) . In particular, the average body weight, BMI and body fat percentage decreased significantly in both aerobic exercise group and combined aerobic and resistance exercise group after the intervention (P<0.05) . What's more, the average post-intervention levels of the above-mentioned three indicators in the two groups were significantly lower than those of the control group (P<0.05) . The intervention modality and duration had significant interactive effects on microvascular reactivity, TcPO₂ and SmO₂ of three groups (P<0.05) . In particular, the average microvascular reactivity, TcPO₂ and SmO₂ increased significantly in both aerobic exercise group and combined aerobic and resistance exercise group after the intervention (P<0.05) . In addition, the average post-intervention levels of the average microvascular reactivity and TcPO₂ in the two groups were significantly higher than those of the control group (P<0.05) . The intervention modality and duration produced obvious interactive effects on NO, eNOS, VEGF and HOMA-IR of three groups (P<0.05) . In particular, the average NO, eNOS, and VEGF increased significantly and HOMA-IR decreased significantly in both aerobic exercise group and combined aerobic and resistance exercise group after the intervention (P<0.05) . Moreover, these two groups showed higher average post-intervention levels of NO and lower average post-intervention level of HOMA-IR than the control group (P<0.05) .

Both 10-week aerobic exercise and combined aerobic and resistance exercise at FATmax intensity could reduce body weight, body fat percentage, BMI and HOMA-IR in obese college students, and the latter may be more effective in improving microvascular reactivity and HOMA-IR. These two modalities of exercise improved microcirculation may be by improving the levels of NO, ET-1, VEGF and other factors.

With the rise of overweight/obese people around the world, the prevalence of allogeneic hematopoietic stem cell transplantation (HSCT) for treating hematologic diseases in this population is also increasing. Obesity has been reported to be associated with poor prognosis after transplantation. More research should be conducted to improve the poor outcome in these patients.

To analyze the characteristics of body composition changes in overweight/obese patients with hematologic diseases during allogeneic HSCT, providing evidence and ideas for the delivery of nutritional intervention in the transplantation for these patients.

Two hundred and twelve hematologic disease patients with allogeneic HSCT were selected from the First Affiliated Hospital of Soochow University from November 2018 to March 2021. Baseline data, including personal demographics and clinical information, were collected. SPSS 26.0 software was used to compare the changes in body composition and abnormal glucolipid metabolism parameters between patients with normal BMI (normal group, n=137) and those with overweight/obesity (overweight/obese group, n=75) on the day before and after pretreatment, as well as 14 days after transplantation.

The normal and overweight/obese groups had no significant differences in sex ratio, mean age, diagnosis, preconditioning regimen and HLA typing (P>0.05) . Fourteen days after the allogeneic HSCT, overweight/obese patients had obviously decreased body weight (t=14.271, P<0.001) , fat-free body weight (t=12.344, P<0.001) , skeletal muscle mass (t=14.119, P<0.001) , BMI (t=14.119, P<0.001) and fat-free mass index (FFMI) (t=12.344, P<0.001) , insignificantly changed body fat (P>0.05) , and significantly increased body fat percentage and visceral fat area (t=-3.258, -2.478, P<0.05) . Compared with normal BMI group, overweight/obese group had a more significant decrease in muscle-related indicators such as fat-free body weight, skeletal muscle mass and FFMI (t=3.525, 3.728, 3.545, P<0.05) at 14 days after the allogeneic HSCT. Moreover, the incidence of abnormal fasting glucose and hypercholesterolemia in overweight/obesity group was significantly higher (χ²=7.250, 4.665, P<0.05) .

We found that overweight/obese patients had a more significant decrease in skeletal muscle mass, a tendency of visceral fat accumulation, and a higher risk of abnormal glycolipid metabolism after the allogeneic HSCT. In view of this, more attention should be given to body weight and body composition in the overweight/obese patients, and corresponding nutrition intervention should be provided to them during the peri-transplant period.

The change of food preference after bariatric surgery is an important factor affecting postoperative weight loss. It is particularly important to assess the specific characteristics and predictive factors of food preference changes after the surgery. It is difficult to guide postoperative weight maintenance based on the large variability in results between available studies.

To investigate the characteristics of food preference change and its effect on weight loss outcomes in patients undergoing bariatric surgery, and to analyze the predictive factors of food preference change.

A convenient sampling method was used to select 245 patients undergoing bariatric surgery who were admitted to Outpatient Weight Loss Follow-up Department, the First Affiliated Hospital of Nanjing Medical University from February to August, 2022. The self-developed General Demographic Questionnaire, Weight Loss Outcome Questionnaire and Food Preference Change Features after Bariatric Surgery were used to collect relevant data. Independent samples t-test was used to compare the effects of changes of food preference after bariatric surgery on the weight loss outcome. Univariate analysis and disordered multi-class Logistic regression were performed to analyze the predictive factors of food preference changes after bariatric surgery.

Two hundred and thirty-seven (96.7%) patients who returned responsive questionnaires were finally enrolled, and 97.0% of them had food preference changes after bariatric surgery. Patients with and without changes in food preferences after bariatric surgery had statistically significant differences in postoperative weight, body mass index drop value and total weight loss percentage (P<0.05) . Disordered multi-class Logistic regression analysis showed that postoperative time was the predictor of changes in preferences of patients undergoing bariatric surgery for vegetables and fruits (P<0.05) ; marital status and preoperative comorbidities were predictors of changes in preference of patients undergoing bariatric surgery for high-quality protein foods (P<0.05) ; place of residence (northern or southern China) was the predictor of changes in preference of patients undergoing bariatric surgery for spicy foods (P<0.05) ; gender, place of residence and bariatric surgery methods were predictors of changes in preferences of patients undergoing bariatric surgery for salty snacks (P<0.05) ; gender and bariatric surgery methods were predictors of changes in preferences of patients undergoing bariatric surgery for high-fat meat (P<0.05) ; gender and postoperative time were predictors of changes in preferences of patients undergoing bariatric surgery for sweet food (P<0.05) ; gender and bariatric surgery methods were predictors of changes in preferences of patients undergoing bariatric surgery for sweet drinks (P<0.05) .

The incidence of food preference changes in patients undergoing bariatric surgery is high, showing a decrease in their preference for high calorie foods and an increase in their preference for healthy foods. Gender, marital status, place of residence, preoperative comorbidities, bariatric surgery methods, and postoperative time are predictors of various food preference changes in patients undergoing bariatric surgery. Weight loss professionals should identify the target population at early stage, pay more attention to postoperative dietary education and guidance for patients, in order to improve the postoperative dietary experience and effectively ensure the effect of bariatric surgery.

Hypertriglyceridemia has been increasingly valued as a risk factor for acute pancreatitis (AP) . However, the relationship between obesity and AP has not yet been confirmed, whether baseline triglyceride (TG) affects the risk of AP in non-obese people is still inconclusive.

To explore the association between baseline serum triglyceride (TG) and the risk of AP in a nonobese cohort from Kailuan Group.

A prospective cohort study was performed among in-service and retired workers of Kailuan Group (non-obese, without a history of AP, with complete TG information) who first attended the annual health screening for workers of the group as a benefit conducted between 2006 and 2007 or between 2008-2009. The cumulative incidence of AP across serum TG tertile groups: 〔Q1 group (TG≤0.96 mmol/L) , Q2 group (0.96 mmol/L<TG<1.52 mmol/L) , Q3 group (TG≥1.52 mmol/L) 〕was described using Kaplan-Meier curve, and compared by the Log-rank test. The new AP event, death or the end of follow-up (December 31, 2020) was taken as the end point of follow-up. Cox regression model was used to estimate the association of baseline TG levels and new incidence of AP.

The study included a total of 102 358 subjects. Q1, Q2 and Q3 groups had significant differences in sex ratio, average age, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol (TC) , low-density lipoprotein cholesterol (LDL-C) , and high-density lipoprotein cholesterol (HDL-C) , and prevalence of smoking, drinking, previous hypertension, previous diabetes, previous cholelithiasis, as well as having at least 9 years of education (P<0.05) . Three hundred and sixteen cases developed AP during an average follow-up of (12.8±2.4) years, with an incidence density of AP of 2.41 per 10 000 person-years. The incidence density was 1.82, 2.22, and 3.17 per 10 000 person-years in Q1, Q2, and Q3 groups, respectively. The cumulative incidence of AP was 2.33%, 2.85% and 4.07%, respectively, in Q1, Q2, and Q3 groups, with statistically differences detected by the log-rank test (χ²=17.27, P<0.001) . By the analysis based on COX regression model 3, the HR of developing AP in Q3 group was 1.66〔95%CI (1.25, 2.19) 〕times higher than in Q1 group after adjusting for sex, age, HDL-C, TC, smoking, drinking, education level, history of hypertension, history of diabetes and history of cholelithiasis, and it was 1.68〔95%CI (1.25, 2.24) 〕times higher than in Q1 group after further excluding the cases suffering from AP within 1 year of follow-up.

A baseline serum TG level of ≥ 1.52 mmol/L may increase the risk of AP in nonobese people.

The prevalence of metabolic-associated fatty liver disease (MAFLD) has increased rapidly. And there is no conclusion on body fat composition, characteristics of metabolic indicators, and their predictive values for MAFLD in non-obese populations.

To identify the risk factors for MAFLD by comparing body fat composition and key metabolic indicators (blood lipids, blood sugar, uric acid) between obese and non-obese MAFLD patients, and to assess their associations with MAFLD as well as their predictive values for MAFLD in non-obese patients.

Physical examinees with and without liver B-ultrasound-detected fatty liver were recruited from Health Management Center, Nanjing Drum Tower Hospital from January 2018 to January 2019 after excluding those with non-MAFLD, and divided into obese group (including 129 cases with MAFLD, and 129 without fatty liver) and non-obese group (including 129 without fatty liver cases, and 129 with MAFLD) by BMI. The body fat composition and metabolic indices in non-obese MAFLD cases were compared with those of the other three subgroups. The correlation of each index with MAFLD in non-obese cases was analyzed. The independent risk factors of MAFLD in non-obese cases were identified by using Logistic regression. The predictive value of each index for MAFLD in non-obese was assessed using the receiver operating characteristic (ROC) curve.

(1) Comparison of body fat composition and metabolic indicators: compared with non-obese without fatty liver cases, non-obese cases with MAFLD had greater average BMI, body fat (BF), body fat ratio (BFR), visceral fat area (VFA), waist circumference (WC), waist-hip-ratio (WHR), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), uric acid (UA), alanine transaminase (ALT) and gamma-glutamyl transpeptidase (GGT), and lower high-density lipoprotein cholesterol (HDL-C) (P<0.05). In comparison with obese cases with MAFLD, non-obese cases with MAFLD had lower average BMI, BF, VFA, WC, WHR, fasting plasma glucose (FPG), and glycosylated hemoglobin (HbA_1c) (P<0.05). Non-obese cases with MAFLD had lower average BMI, BF and WC, and higher average TG, UA, ALT and GGT than obese cases without fatty liver (P<0.05). Non-obese female cases with MAFLD had greater average age, BF, BFR and VFA and lower WC, VA, GGT than non-obese male cases with MAFLD (P<0.05). (2) Kendall's rank correlation analysis showed that the risk of MAFLD in non-obese cases increased with the growth of BFR, VFA, WHR, TC, TG, LDL-C, UA, ALT, and GGT (r=0.099, 0.092, 0.136, 0.095, 0.176, 0.092, 0.114, 0.125, 0.142, P<0.05), but decreased with the growth of HDL-C (r=-0.112, P<0.05). (3) Multivariate Logistic regression analysis showed that TG, ALT, UA, BFR and VFA were risk factors of MAFLD in non-obese cases. (4) The results of ROC analysis of the performance of five indicators predicting MAFLD in non-obese cases were as follows: BFR had an AUC of 0.853〔95%CI (0.807, 0.898) 〕, with 0.789 sensitivity, 0.770 specificity when 22.30% was chosen as the optimal cut-off value; VFA had an AUC of 0.938〔95%CI (0.906, 0.970) 〕, with 0.852 sensitivity, 0.904 specificity when 61.45 cm² was chosen as the optimal cut-off value; TG had an AUC of 0.807〔95%CI (0.754, 0.860) 〕, with 0.822 sensitivity, 0.713 specificity when 1.02 mmol/L was chosen as the optimal cut-off value; UA had an AUC of 0.665〔95%CI (0.599, 0.731) 〕, with 0.605 sensitivity, 0.682 specificity when 356.00 μmol/L was chosen as the optimal cut-off value; ALT had an AUC of 0.752〔95%CI (0.692, 0.812) 〕, with 0.814 sensitivity, 0.770 specificity when 18.35 U/L was chosen as the optimal cut-off value.

Compared with non-obese people without fatty liver, non-obese people with MAFLD had increased BF and visceral fat, abnormal lipid metabolism, elevated levels of UA and transaminase. The risk of MAFLD in non-obese people increased with the increase in TG, ALT, UA, BFR and VFA, but decreased with the increase in HDL-C. BFR, VFA, TG, UA and ALT could partially predict and diagnose MAFLD in non-obese people, providing evidence for the delivery of interventions as soon as possible.

Bariatric surgery is the effective treatment for obesity, however, the effect of surgery on patients' psychological status is still unclear.

To investigate the treatment effects of bariatric surgery on patients' psychological status one year after the surgery.

This is a retrospective cross-sectional study. This study selected 172 patients who underwent bariatric surgery in the department of general surgery, First Affiliated Hospital of Nanjing Medical University during June 2019 to June 2020, and collected their clinical data. The indicators of the treatment effects of bariatric surgery include body composition indicators〔Weight, Body mass index (BMI) , Percentage of excess weight loss (EWL%) , Body muscle mass (BM) , Body fat mass (BF) , Visceral fat (VSF) , metabolism-related biochemical indexes〔Alanine aminotransferase (ALT) , Aspartate aminotransferase (AST) , Total protein (TP) , Albumin (ALB) 〕, preoperative comorbidities, relief of comorbidities after surgery, postoperative complications, postoperative complaints, surgery methods; Indicators of the postoperative psychological status include quality of life, perceived stress, general well-being and satisfaction degree of surgery. This study used the12-item Short Form Survey (SF-12) , Chinese version of the Perceived Stress Scale (CPSS) , General Well-being Schedule (GWS) , Questionnaire of Bariatric Surgery Patient' Satisfaction Survey to investigate the psychological status. This study used the Pearson correlation analysis and Spearman rank correlation analysis to explore the correlation between body composition indicators and metabolic-related biochemical indexes and postoperative psychological status, used the multivariate linear regression analysis to explore the factors that affect postoperative psychological status.

One year after surgery, EWL% was (82.7±31.7) %, and BMI decreased by (10.3±4.3) kg/m². 96 patients (55.8%) had metabolic-related comorbidities such as type 2 diabetes mellitus, hypertension, fatty liver before surgery, 48 patients (27.9%) achieved complete remission, 30 patients (17.4%) achieved partial remission, and 18 patients (10.5%) had no remission after surgery. Patients'weight, BMI, BM, BF, VSF, ALT, AST were lower than those before surgery, the TP and ALB were higher than those before surgery (P<0.05) .The correlation analysis showed that patients' MCS scores were negatively correlated with ΔALT (r_s=-0.160, P=0.036) ; the CPSS scores were negatively correlated with EWL% (r=-0.181, P=0.017) and ΔBM% (r_s=-0.174, P=0.022) but positively correlated with ΔALT (r_s=-0.236, P=0.002) ; the GWS scores were negatively correlated with ΔALT (r_s=-0.228, P=0.003) and ΔAST (r_s=-0.216, P=0.004) ; the satisfaction of surgery were negatively correlated with ΔBMI (r=-0.171, P=0.025) , ΔBF% (r=-0.174, P=0.022) and ΔVSF (r=-0.154, P=0.043) but positively correlated with EWL% (r=0.284, P<0.001) . The multivariate linear regression analysis showed that postoperative stomachache (β=-0.239, P=0.002) and postoperative fatigue (β=-0.169, P=0.025) were factors that affect PCS scores; ΔALT (β=-0.181, P=0.017) and postoperative fatigue (β=0.171, P=0.024) were factors that affect MCS scores; EWL% (β=-0.188, P=0.010) , ΔBM% (β=-0.146, P=0.047) , ΔALT (β=0.219, P=0.003) and postoperative fatigue (β=0.169, P=0.022) were factors that affect CPSS scores; ΔALT (β=-0.254, P=0.001) and acid reflux (β=-0.251, P=0.001) were factors that affect GWS scores; ΔBMI (β=-0.245, P=0.010) , EWL% (β=0.247, P=0.003) and ΔBF% (β=-0.366, P<0.001) were factors that affect satisfaction of surgery. Among the 96 patients with preoperative comorbidities, multiple linear regression analysis showed that postoperative relief of comorbidities (β=0.411, P<0.001) and stomachache (β=-0.192, P=0.040) were factors that affect PCS scores; ΔALT (β=-0.273, P=0.006) and acid reflux (β=-0.263, P=0.008) were factors that affect MCS scores; postoperative relief of comorbidities (β=-0.220, P=0.024) , ΔALT (β=0.301, P=0.002) , stomachache (β=0.214, P=0.023) and ΔVSF (β=0.212, P=0.031) were factors that affect CPSS scores; postoperative relief of comorbidities (β=0.290, P=0.002) , ΔALT (β=-0.310, P=0.001) and stomachache (β=-0.271, P=0.004) were factors that affect GWS scores; postoperative relief of comorbidities (β=0.402, P<0.001) , ΔBF% (β=-0.452, P<0.001) and ΔBMI (β=-0.364, P<0.001) were factors that affect satisfaction of surgery.

Patients' BMI decreased significantly one year after bariatric surgery. The postoperative acid reflux, stomachache, fatigue and the increase of ΔBF% and ΔALT negatively affect patients'psychological status; the increase of EWL% and ΔBM% positively affect patients'psychological status. For patients with comorbidities, the higher the degree of postoperative comorbidity remission, the greater the positive impact on the patient's psychological status.

Maladaptive eating behavior after bariatric surgery is an im-portant cause of postoperative weight regain. However, the depth and reliability of its related research has been greatly hindered partially by non-unification of its concept and inappro-priate words used to explain the concept.

To clarify the concept of maladaptive eating behavior after bariatric surgery.

In May 2022, database of CNKI, WanFang Data, SinoMed, PubMed, Web of Science and CINAHL were systematically searched for studies in Chinese or English mainly about maladaptive eating behavior after bariatric surgery from inception to May 10, 2022, involving related concepts, definition attributes, antecedents and consequences. The contents of included literature were analyzed using the Rodgers' process of concept analysis, involving the evolution, attributes, antecedents, consequences, related concepts, typical case, assumptions and enlightenment for further development.

Altogether, 36 studies were included, 33 of which in English, and the other three were in Chinese. The conceptual attributes of maladaptive eating behavior after bariatric surgery were composed of six aspects: uncontrolled eating, grazing, emotional eating, food craving, food addiction and compensatory behaviors. The antecedents include subjective factors (containing self-efficacy, dietary attitude, psychological status, work pressure and so on) , and objective factors (containing age, gender, education level, obesity history and others) . Eating disorders, mental illness, weight-loss outcome, nutritional status and quality of life compose the consequences.

The concept of maladaptive eating behavior after bariatric surgery is still non-unified. Its meanings in China should be discussed according to the national condition, and in-depth research on relevant theories, assessment tools, influencing factors and intervention should be conducted on this foundation, so as to maintain the effect of bariatric surgery and improve the quality of life in these patients.

Triglyceride-glucose (TyG) index is an index to evaluate insulin resistance (IR) and obesity-related metabolic diseases, which is closely related to the high risk of cardiovascular disease (CVD). However, TyG index may be different from the high risk of CVD in middle-aged obese people of different genders.

To investigate the relationship between TyG index and the high risk of CVD in middle-aged obese people of different genders, and to evaluate its role in the prevention and treatment of CVD.

A total of 30 425 middle-aged obese residents were selected from 10 early screening and comprehensive intervention projects of high-risk CVD population in Anhui Province and investigated by investigators who were trained and qualified, using the preliminary screening questionnaire and basic information registration form designed by the National Cardiovascular Center. The main survey contents included gender, age, hypertension, dyslipidemia, diabetes, smoking and alcohol consumption, etc, and perform a CVD high-risk assessment. The included residents were divided into the male group (n=11 566) and female group (n=18 859). The male group was divided into T₁ (7.417-8.870) (n=2 892), T₂ (8.871-9.204) (n=2 891), T₃ (9.205-9.578) (n=2 892) and T₄ (9.579-11.435) (n=2 891) subgroups, the female group was divided into F₁ (7.579-8.876) (n=4 715), F₂ (8.877-9.183) (n=4 720), F₃ (9.184-9.526) (n=4 710) and F₄ (9.527-11.647) (n=4 714) subgroups according to the quartiles of TyG index. Binary Logistic regression analysis was used to explore the relationship between TyG index and the high risk of CVD, and Z-test was used to compare the differences in effect values among subgroups.

The high risk rate of CVD was 28.4% (3 280/11 566) in the male group and 26.0% (4 909/18 859) in the female group. Binary Logistic regression analysis showed that TyG index T₂ (F₂), T₃ (F₃), T₄ (F₄) in male group (female group) were correlated with the high risk of CVD (P<0.05), and the correlation with the high risk of CVD increased with the gradual increase of TyG index. In the male group, the risk of developing high risk of CVD in the T₄ subgroup compared to T₁ was OR (95%CI) =1.827 (1.622, 2.058) ; In the female group, the risk of developing high risk of CVD in the F₄ subgroup compared to F₁ was OR (95%CI) =1.552 (1.410, 1.708). There were significant differences in the TyG index and risk of developing high risk of CVD between the T₄ and F₄ subgroups in both male and female groups (P<0.05). After further adjustment for total cholesterol and other indicators (model 2), the correlation between T₂ (F₂), T₃ (F₃), T₄ (F₄) and the risk of developing high risk of CVD was attenuated. However, in both male and female groups, T₂ (F₂), T₃ (F₃) and T₄ (F₄) were all correlated with the high risk of CVD (P<0.05), and the correlation increased with the gradual increase of TyG index level. In the male group, the risk of developing high risk of CVD in the T₄ subgroup compared to T₁ subgroup was OR (95%CI) =1.804 (1.584, 2.055), in the female group, the risk of developing high risk of CVD in the F₄ subgroup compared to F₁ subgroup was OR (95%CI) =1.496 (1.345, 1.665) ; There were significant differences in the risk of developing high risk of CVD between the T₄ and F₄ subgroup in both male and female groups (P<0.05) .

Middle-aged obese men with high TyG index are more prone to develop high risk for CVD, and more attention should be paid to the TyG index level of the population.

Obesity is an increasingly prevalent and costly public health problem. Many people regard exercise as an effective weight loss strategy, even superior to dieting. However, the effectiveness and safety of exercise for weight loss in obese individuals need to be carefully weighed. This paper briefly discusses the view that "Exercise is not the foundation of weight loss" in the combination of evidence-based medicine, from the aspects of mild effect of exercise on weight loss, poor adherence to long-term high-intensity exercise, safety of high-intensity exercise in obese individuals, and the mechanism of poor weight loss effect of exercise.

Female railway workers are a high-risk group for obesity. Information technology is increasingly used in interventions for weight loss in overweight and obese populations. Daily self-weighing is a cognitive-behavioral strategy for self-monitoring of weight, but its effect on weight loss remains still controversial.

To investigate the effect of daily self-weighing plus online group interaction on weight loss and development of healthy lifestyle in overweight and obese female workers in Beijing Railway Bureau.

A prospective randomized controlled study was conducted. Participants were 72 overweight or obese female workers of Beijing Railway Bureau voluntarily recruited from June 1 to September1, 2019. They were equally randomized into an experimental group and a control group, receiving different weight loss interventions for 3 months (intervention scheme for the experimental group: individualized diet and exercise recommendations, daily self-weighing plus online group-based cognitive-behavioral therapy for weight loss, and that for the control group: individualized diet and exercise recommendations, and self-measurement of body weight with weight management counseling during the telephone or hospital follow-up once a month). Baseline and post-intervention data of both groups were collected, including composition indices (body weight, BMI, body fat percentage, fat content, waist circumference, hip circumference, waist-to-hip ratio), blood lipid indices〔total cholesterol (TC), triacylglyceride (TG), high-density liptein cholesterol (HDL-C), low-density liptein cholesterol (LDL-C) 〕and total score and dimension scores of the Health Promoting Lifestyle Profile-Ⅱ (HPLP-Ⅱ). Univariate and multivariate Logistic regression was used to explore factors associated with a 5% or more weight loss from baseline.

Seventy-one participants (35 cases and 36 controls) who completed the study were finally included for analysis. The each body composition index, each blood lipid index, and total score and dimension scores of the HPLP-Ⅱ were similar in both groups at baseline (P>0.05). After the intervention, the experimental group showed a significant decrease in the body composition indices (except the waist-to-hip ratio), blood lipid indices (except the HDL-C), and a significant increase in the total score and dimension scores of the HPLP-Ⅱ (P<0.05). However, no significant differences were found in each observation index in the control group before and after the intervention (P>0.05). Compared with the control group, the experimental group showed lower post-intervention body composition indices (except the waist-to-hip ratio) and blood lipid indices (except the HDL-C), and higher post-intervention total score and dimension scores of the HPLP-Ⅱ (P<0.05). A total of 22 participants (31.0%) had a weight loss of ≥5% from the baseline, including 16 cases (72.7%), and 6 controls (27.3%). Both univariate and multivariate Logistic regression analyses showed that intervention scheme and baseline nutrition status were the influencing factors of a 5% or more weight loss from baseline.

Daily self-weighing and online group-based cognitive-behavioral interventions contributed to weight loss, formation of a healthy lifestyle, and improvement in quality of life in overweight and obese female workers in Beijing Railway Bureau.

The prevalence of overweight and obesity has been increasing yearly and become a global public health problem with a range of consequences causing widespread concern. Weight loss can reduce the incidence of type 2 diabetes, cardiovascular risk, and all-cause mortality. The most common approaches of weight loss are drug therapy, surgery and lifestyle interventions including diet and exercise, however, exercise intervention remains the healthiest and most fundamental approach of weight loss. Exercise can reduce cellulite, increase muscle mass and improve metabolism. The combination of exercise and other weight loss approaches can reduce adverse reactions and produce better results. Continuing exercise after weight loss can also effectively prevent rebound and maintain weight loss effects. This paper reviews the definition, mechanism, effect, and management of "exercise is the foundation of weight loss", and provide a reference for weight loss through exercise in the context of the experience of Zhongda Hospital.

In the context of rising obesity rates, metabolically healthy obesity (MHO) can achieve favorable outcomes through early intervention. However, grazing behavior in this population poses a significant barrier to weight management. Understanding the factors influencing grazing behavior is essential to improve dietary compliance in obesity management. Currently, there is a lack of qualitative research on this topic.

To explore the influencing factors of grazing behavior in metabolically healthy obese individuals.

Based on the capacity opportunity motivation-behavior (COM-B) model and the theoretical domains framework (TDF), the interview guide was developed. 17 cases of metabolically healthy obese were selected from the Department of Endocrinology, Northern Jiangsu People's Hospital for semi-structured interviews via purpose sampling method. The interview data were coded using the COM-B and TDF frameworks and analyzed through both inductive thematic analysis and deductive framework methods.

Six core themes were identified, including lack of dietary management knowledge, insufficient cognitive resources, perceptual and practical influences, maladaptive coping strategies, absence of reflection/self-motivation, environmental and social influences.

Grazing behavior in individuals with MHO are shaped by a multifaceted interplay of personal, healthcare-related and societal factors. Appropriate intervention measures should be taken according to the multidimensional needs of patients and help them establish healthy eating habits and behaviors.

Obesity may cause insulin resistance (IR), then leads to type 2 diabetes mellitus (T2DM), seriously affecting human health. Irisin is a newly discovered myokine produced by adipose and skeletal muscle tissues, which plays an important role in metabolic regulation. It is worth investigating what changes will occur in serum irisin levels in T2DM patients with overweight or obesity.

To examine the abnormality in serum irisin levels in overweight or obese patients with T2DM, and to explore the influencing factors.

A total of 119 patients with T2DM who were hospitalized in Department of Endocrinology, the First Affiliated Hospital of Anhui Medical University from December 2019 to June 2021 were selected, including 78 with overweight or obesity and 41 with normal weight assessed by body mass index (BMI). They were compared to 52 healthy people with normal body weight in terms of general demographics, laboratory test indices and serum irisin level. Spearman rank correlation analysis was used to explore the correlation of serum irisin level with demographic and laboratory test indices. Multiple linear regression analysis was used to explore factors associated with the abnormality in serum irisin in overweight or obese T2DM patients.

Normal-weight diabetics, overweight or obese diabetics and healthy controls had significant differences in levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), BMI, triacylglycerol (TG), high-density lipoprotein cholesterol (HDL-C), glycosylated hemoglobin (HbA_1c), fasting blood glucose (FBG), fasting insulin (FINS) and homeostasis model assessment of insulin resistance (HOMA-IR) (P<0.05). The serum irisin level in normal-weight diabetics was lower than that in healthy controls (P<0.05). Overweight or obese diabetics had lower serum irisin level than healthy controls or normal-weight diabetics (P<0.05). Spearman rank correlation analysis showed that serum irisin level was positively correlated with HDL-C (r_s=0.304, P<0.05), and negatively correlated with SBP, DBP, BMI, TG, HbA_1c, FBG, FINS, and HOMA-IR (r_s=-0.271, -0.420, -0.372, -0.164, -0.418, -0.348, -0.293, -0.348, P<0.05). Multiple linear regression analysis showed that DBP 〔b=-0.049, P=0.011〕, HbA_1c〔b=-0.156, P=0.009〕, and FINS〔b=-0.21, P=0.038〕 were associated with the abnormality in serum irisin in overweight or obese T2DM patients.

T2DM patients, especially those who were overweight or obese, were found with lower serum irisin level, which was associated with BMI, blood pressure, blood lipids, blood glucose and IR.

Research has linked the physical constitution of overweight/obese individuals to obesity, with a potential bidirectional association. Although FATmax exercise can boost their fitness, the exact magnitude of this benefit needs further study.

Systematic evaluation is needed to assess the impact of FATmax exercise on physical fitness indicators among overweight or obese populations.

Retrieve RCTs from PubMed, Web of Science, EBSCO, CNKI, VIP, Wanfang Data (January 2001 to January 2024) on FATmax exercise effects on body composition, cardiovascular endurance, lipid metabolism in overweight/obese patients. Evaluate quality with Cochrane tool, Meta-analysis with RevMan 5.4.

A total of 16 randomized controlled trials were included, including 568 overweight or obese patients. The Meta-analysis results showed that compared with the control group, the FATmax exercise intervention group significantly improved body composition (BMI: WMD=-1.82, P<0.01; BFR: WMD=-2.86, P<0.01; WHR: WMD=-0.04, P<0.01), cardiovascular endurance (VO_2max: WMD=3.34, P<0.01), and lipid metabolism except for TC (TG: WMD=-0.24, P<0.01; HDL-C: WMD=0.14, P<0.01; LDL-C: WMD=-0.27, P<0.01). Optimal results vary: ≥12 weeks, 3-5 times/week, 60-minute running for body composition; ≥12 weeks, 5 times/week, <60 minutes combined for VO_2max; ≥12 weeks, 3 times/week, 60-minute running for TG; <12 weeks, 4 times/week, 60-minute combined for HDL-C; <12 weeks, 4 times/week, >60-minute combined for LDL-C.

FATmax exercise benefits body composition, cardiovascular endurance, and lipid metabolism (except TC) in overweight/obese patients.

People with normal weight obesity (NWO) are prone to cardiovascular diseases in their middle and old age. High-intensity interval training (HIIT) has been demonstrated to effectively improve cardiovascular health. However, whether HIIT can decrease the risk of cardiovascular diseases in NWO population is not clear.

To explore the effects of HIIT on the advanced glycation end-products (AGEs) and the risk of cardiovascular disease in NWO female university students.

From November to December 2020, 137 female college students were recruited in Shanghai University of Medicine & Health Sciences, among whom 40 NWO cases were screened out as subjects by the Asian female NWO standard. They were equally and randomly divided into a control group (n=20) and a HIIT intervention group (n=20) to receive no interventions or weekly five-day interventions, for consecutive four weeks after one-week adaptive training. Body weight, body mass index (BMI) , body fat percentage (BF%) , visceral fat level (VFL) , visceral fat area (VFA) , waist circumference, levels of four blood lipids 〔high-density lipoprotein (HDL) , low-density lipoprotein (LDL) , triglyceride (TG) , and total cholesterol (TC) 〕, cardiovascular disease risk (assessed by the China-PAR model) , AGEs, and fasting blood glucose of two groups were observed before and after intervention. The correlation between AGEs and cardiovascular disease risk was analyzed.

Except for 10 dropouts, the remaining 30 cases (13 in the control group and 17 in the HIIT intervention group) were finally included for analysis. After intervention, the average BMI, BF%, VFA, VFL, waist circumference, TC/HDL ratio, LDL/HDL ratio, TG/HDL ratio, AGEs and fasting blood glucose in HIIT intervention group were lower than those in control group (P<0.05) . Nine subjects in the HIIT intervention group were evaluated for the risk of cardiovascular and cerebrovascular diseases as the China-PAR model was applicable to subjects aged 20 years or older. The risk of cardiovascular disease was (11.82±0.47) % and (9.79±0.57) % in control group and HIIT intervention group, respectively, before intervention, and (14.13±0.97) % and (6.93±1.17) % in the two groups, respectively, after intervention. The post-intervention risk of cardiovascular disease in HIIT intervention group was lower than that in control group (P<0.05) . Spearman rank correlation analysis showed that AGEs were not correlated with cardiovascular disease risk (r_s=-0.006, P=0.979) .

The four-week HIIT can effectively reduce the body fat, the levels of AGEs and fasting blood glucose as well as the risk of cardiovascular disease in NWO female university students.

Earlier studies have investigated the association between overweight/obesity and an elevated risk of breast cancer in women. However, some studies have found that it may not be scientifically accurate to solely analyze the association between overweight/obesity and breast cancer in women for overweight/obesity can be classified into different metabolic phenotypes. The current findings on the association of different metabolic phenotypes with breast cancer remain inconsistent.

To prospectively analyze the associations of different metabolic obesity phenotypes with the risk of breast cancer in women.

In this prospective cohort study, female employees (n=23 406) of Kailuan Group who participated in physical examinations for the first time in Kailuan General Hospital and its 11 affiliated hospitals from 2006 to 2008 were selected as the study subjects and received questionnaire investigation, physical examination and laboratory tests. The study subjects were divided into the four groups based on the types of metabolic syndrome and BMI, including metabolically healthy normal weight (MHNW) group (n=12 739), metabolically unhealthy normal weight (MUNW) group (n=1 060), metabolically healthy overweight/obese (MHO) group (n=6 394), and metabolically unhealthy overweight/obese (MUO) group (n=3 213). The subjects were followed up, with the first physical examination attended as the starting point, and new onset breast cancer, death, or the end of follow-up time (2020-12-31) as the endpoints. Multivariate Cox proportional hazard regression model was used to estimate the association of the four groups with the risk of breast cancer.

During an average follow-up of (13.26±1.85) years, with 353 new cases of breast cancer and an incidence density of 11.38 cases per 10 000 person-years in the total population. The incidence cases in the MHNW, MUNW, MHO, and MUO groups were 154, 21, 113, and 65, respectively, with the incidence density of 9.08, 15.37, 13.27, and 15.49 per 10 000 person-years, and the cumulative incidence of 1.22%, 2.01%, 1.67%, and 1.93%, respectively. Multivariate Cox proportional hazard regression model analysis, after adjusting for confounders, showed that compared with the MHNW group, the risk of breast cancer was increased by 42% (HR=1.42, 95%CI=1.11-1.82) and 59% (HR=1.59, 95%CI=1.17-2.17) in the MHO group and MUO group, respectively. Stratified analysis by menopausal status showed that compared to the MHNW group, the MUO group was associated with a 69% increase in risk of premenopausal breast cancer (HR=1.69, 95%CI=1.01-2.83). The risk of postmenopausal breast cancer was increased by 85% (HR=1.85, 95%CI=1.09-3.14), 50% (HR=1.50, 95%CI=1.06-2.13), and 55% (HR=1.55, 95%CI=1.05-2.28) for the MUNW, MHO, and MUO groups, respectively, compared to the MHNW group.

Overweight/obesity is a risk factor for female breast cancer, and overweight/obesity with metabolic abnormalities further increases the risk of breast cancer. Additionally, normal weight postmenopausal women who are metabolically unhealthy may be at an increased risk of postmenopausal breast cancer.

Currently, the number of obese adolescents in China is increasing dramatically, and adolescent obesity is not only closely related to metabolic diseases, but also a risk factor for coronary heart disease mortality in adulthood. Lipid metabolic flexibility is regarded as an important indicator of the metabolic health of an organism. Studies confirm that cardiorespiratory fitness is associated with lipid metabolic flexibility, but are lacking in obese adolescents with different metabolic phenotypes.

To investigate the association of cardiorespiratory fitness with lipid metabolic flexibility in metabolically unhealthy obesity (MUO) adolescents and metabolically healthy obesity (MHO) adolescents.

Ninety-one obese adolescents were selected to participate in the Shenzhen Weight Loss Camp (2022-2023), and were divided into 35 in the MUO group and 56 in the MHO group in accordance with the "Expert Consensus on the Definition and Screening of Metabolically Healthy Obesity in Chinese Children". The gas metabolism data from the resting metabolic test, incremental load treadmill test and heart rate data were collected using a gas metabolism analyzer and a heart rate meter; the maximum oxygen uptake (VO_2max) was estimated based on the heart rate-oxygen uptake relationship; and the third-order polynomial fitting curve was used to obtain the maximal fat oxidation rate (MFO) or the corresponding maximal fat oxidation intensity (FAT_max) to reflect the flexibility of lipid metabolism. The linear regression analysis was used to explore the correlation between VO_2max and MFO and FAT_max.

The overall MFO and FAT_max of the two groups were (5.54±1.37) mg·min^-1·kg^-1 and (4.19±0.87) MET. The BMI, systolic blood pressure, diastolic blood pressure, and triacylglycerol levels in the MUO group were higher than those in the MHO group, and the level of high-density lipoprotein cholesterol was lower than that in the MHO group (P<0.05). Before adjustment, the MFO in the MUO group was lower than that in the MHO group (P<0.05) ; after adjustment for VO_2max, the difference in MFO between the two groups of obese adolescents was not statistically significant (P>0.05) ; before adjustment and after adjusting VO_2max, there was no statistically significant difference between the two groups of obese adolescents when comparing FAT_max (P>0.05). VO_2max was positively correlated with MFO in obese adolescents in the overall (B=0.077, 95%CI=0.011-0.144, P=0.023) and MHO groups (B=0.105, 95%CI=0.027-0.182, P=0.009) ; VO_2max was positively correlated with FAT_max in obese adolescents in the MHO group (B=0.057, 95%CI=0.003-0.111, P=0.041) ; VO_2max was not linearly related to MFO and FAT_max in obese adolescents in the MUO group (P>0.05) .

MUO adolescents have lower MFO than MHO adolescents; during running exercise, obese adolescents with different metabolic phenotypes could reach MFO at (4.19±0.87) MET intensity. Cardiorespiratory fitness is a key factor influencing lipid metabolic flexibility in MHO adolescents, and MUO adolescents may need to be transformed into MHO adolescents to promote lipid metabolic flexibility.

Osteosarcopenic obesity syndrome (OSO) is a disease that seriously endangers the health of older people. The rational classification of the disease can guide the clinical diagnosis and treatment. Therefore, classifying OSO based on inter-correlations of its diagnostic variables and exploring its structural properties may offer insights into clinical prevention and treatment of OSO.

To explore the structural properties of OSO, providing a theoretical basis for individualized diagnosis and treatment of the disease.

A cross-sectional study was conducted with a random sample of OSO patients (≥60 years old) who underwent physical examination in Physical Examination Center, the 2nd Affiliated Hospital of Harbin Medical University from January 2018 to December 2020. The data collected include 9 diagnostic variables for OSO〔skeletal muscle index, grip strength, body fat percentage, BMD of the lumbar spine (L1-L4), hip and femoral neck, BMI, waist circumference, walking pace〕, sociodemographic characteristics, lifestyle and prevalence of common chronic diseases. KMO test and Bartlett's test of sphericity were used to evaluate the suitability of diagnostic variables for factor analysis. The components with an eigenvalue equal to or greater than 1.000 were extracted by principal component analysis, and the varimax orthogonal rotation matrix was obtained by the varimax orthogonal rotation method. The common factors were named according to the orthogonal rotation matrix of factors. On the basis of factor analysis, thesum of squares and systematic cluster analysis were used to develop a dendrogram for classifying patients. The structural properties of OSO were analyzed by comparing the values of diagnostic variables and clinical features among patients of different categories.

A total of 107 cases were included. The KMO value (0.688) and the result of Bartlett's test of sphericity (χ²=492.374, P<0.001) indicated that the data of diagnostic variables were suitable for factor analysis. Three common factors (osteoporosis factor, muscle + body fat factor and obesity factor) with an eigenvalue greater than 1.000 were extracted, explaining 81.408% variance of the total. The load value of each diagnostic variable on its common factor ranged from 0.770 to 0.918. The patients were divided into 3 categoriesby cluster analysis using the common factors. The skeletal muscle index, grip strength, body fat percentage, BMD of L1-L4, hip and femoral neck, BMI and waist circumference varied significantly across patients of different categories (P<0.05). The values of BMD of L1-L4, hip and femoral neck of OSO patients in the first category were significantly lower than those of the other two categories (P<0.05). The BMI and waist circumference values of OSO patients in the second category were lower than those of the other two categories (P<0.05). OSO patients in the third category had higher values of skeletal muscle index, grip strength and BMD of L1-L4, hip and femoral neck, but lower body fat percentage than those of the other two categories (P<0.05). There were statistically significant differences in sex ratio, distribution of education level and total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), uric acidand creatinine in the serum among different categories of patients (P<0.05). OSO patients in the first category had higher prevalence of below the undergraduate education level than those in the third category (P<0.017). OSO patients in the second category had higher level of TC than those in the third category (P<0.05). In comparison with those in other two categories, OSO patients in the third category had higher personal monthly income equal to or greater than 5 000 yuan, and lower female ratio (P<0.017). Moreover, OSO patients in the third category also demonstrated higher levels of uric acid and creatinine in the serum (P<0.05) .

OSO diagnostic variables can be generalized and interpreted in terms of osteoporosis, muscle and body fat, and obesity. And OSO patients have different structural properties. The application of multivariate statistical methods to study the structural properties of OSO patients will contribute to the individualized management of such patients.

The grazing behavior after bariatric surgery is significantly related to postoperative weight regain, and its incidence will increase with the extension of time after surgery. So it is particularly important to early detect and accurately evaluate the grazing behavior of patients undergoing bariatric surgery. At present, the assessment tools for grazing behavior in these patients in China are still lacking.

To translate the Repetitive Eating Questionnaire〔Rep (eat) -Q) 〕into Chinese and evaluate its reliability and validity among patients undergoing bariatric surgery.

The Brislin's model of translation was adopted for translation. We developed the Chinese version of Rep (eat) -Q following the process of translation of the English version of the Rep (eat) -Q, back translation, expert review and a pilot study. On 2022-08-31, patients undergoing bariatric surgery admitted to the bariatric follow-up clinic of the First Affiliated Hospital with Nanjing Medical University from March to August 2022 were selected for the study using convenience sampling. Then we used the general information questionnaire, Chinese version of Rep (eat) -Q and the 21-item Three-Factor Eating Questionnaire (TFEQ-R21) to conduct a survey among 294 patients undergoing bariatric surgery to test the reliability and validity of the Chinese version of Rep (eat) -Q.

According to the score of the Chinese version of Rep (eat) -Q, these patients were divided into high-score group (n=79) and low-score group (n=78) by the critical ratio. High-score group scored higher in each item of the Chinese version of Rep (eat) -Q compared with the low-score group (P<0.05) . The score of each item in the Chinese version of Rep (eat) -Q was linear positively correlated with the total score (r=0.368-0.782, P<0.05) . The value of Cronbach's α for the scale, repetitive eating subscale and compulsive grazing subscale was 0.943, 0.928 and 0.898, respectively. The value of split-half reliability for the scale, repetitive eating subscale and compulsive grazing subscale was 0.835, 0.938 and 0.891, respectively. And the value of test-retest reliability of the scale, repetitive eating subscale and compulsive grazing subscale was 0.867, 0.800, and 0.836, respectively. The item-level content validity index (CVI) ranged from 0.80 to 1.00. The scale-level CVI /universal agreement and S-CVI/average were 0.92 and 0.98, respectively. Two common factors were obtained after varimax orthogonal rotation by principal component analysis, whose eigenvalues were 7.086, and 1.596, respectively, explaining 72.35% of the total variance. The factor loading values of all items ranged 0.637 to 0.878. The confirmatory factor analysis indicated that the values ofχ²/df, GFI, AGFI, NFI, IFI, CFI and RMSEA were 2.211, 0.905, 0.860, 0.920, 0.955, 0.954, and 0.080, respectively. 294 patients' total score of the Chinese version of Rep (eat) -Q showed a significant correlation with three dimensions of the TFEQ-R21 (P<0.05) .

The Chinese version of Rep (eat) -Q has good reliability and validity, and is simple and easy-to-operate, which can be used to assess the grazing behavior among Chinese patients undergoing bariatric surgery.

As the number of obese and elderly population increases worldwide, sarcopenic obesity is becoming associated with a higher risk of adverse events and outcomes in multiple clinical situations, including cancer. However, there is a lack of unified definition and diagnostic criteria for sarcopenic obesity, and the interaction between sarcopenic obesity and cancer needs to be further clarified. This paper systematically and comprehensively summarizes the relevant definitions and diagnostic methods of sarcopenic obesity, discusses its clinical impact on cancer patients in detail, including the impact on patients undergoing surgery and chemotherapy, and briefly describes the main prevention and treatment strategies. This paper reviews literature and concludes that the incidence of sarcopenic obesity is high in cancer patients, but its definition and diagnostic criteria are still controversial. Sarcopenic obesity is an independent predictor of cancer prognosis with important clinical application value.

Previous studies have shown that the risk of acute pancreatitis (AP) is increased in obesity population, while obese patients are often combined with abnormal fasting plasma glucose (FPG). It still remians controversial whether FPG independently increases the risk of AP and the relationship between FPG and the risk of AP in non-obese patients has been rarely reported in China and abroad.

To explore the association between baseline FPG level and the risk of AP in non-obese population.

Using a prospective cohort study method, a total of 102 512 non-obese cases from the Kailuan study cohort who completed physical examination for the first time in KaiLuan General Hospital and its 10 affiliated hospitals from 2006 to 2009 were enrolled as study subjects. Epidemiological data, anthropometric data, laboratory test indicators and other information of the subjects were collected. The study subjects were divided into 4 groups according to the FPG quartile: the first quartile group (group Q1, FPG≤4.66 mmol/L, n=25 929) ; the second quartile group (group Q2, 4.66 mmol/L≤FPG<5.10 mmol/L, n=25 797) ; the third quartile group (group Q3, 5.10 mmol/L≤FPG<5.67 mmol/L, n=25 162) ; the fourth quartile group (group Q4, FPG≥5.67 mmol/L, n=25 624). The Kaplan-Meier method was used to plot the survival curves of new-onset AP in non-obese population. The cumulative incidence of AP in non-obese population in different FPG level groups were calculated and Log-rank method was used for inter-group test. The Cox proportional hazard regression model was used to analyze the influencing factors for the new-onset AP in non-obese population and the correlation between different FPG level groupings and new-onset AP in non-obese population.

The median follow-up time in this study was (12.8±2.4) years with the cumulative incidence of 320 cases and incidence density of 2.44 cases per 10 000 person-years in AP. There were statistically significant differences in the cumulative incidence of AP among the 4 FPG level groups (χ²=13.96, P<0.001). The results of Cox proportional hazard regression analysis showed that advanced age〔HR=1.02, 95%CI (1.01, 1.03), P=0.001〕, high triacylglycerol (TG) level〔HR=1.22, 95%CI (1.13, 1.30), P<0.001〕, history of cholithiasis〔HR=2.79, 95%CI (1.88, 4.13), P<0.001〕were risk factors for new-onset AP in non-obese population. Years of education ≥9 years〔HR=0.65, 95%CI (0.47, 0.90), P<0.001〕was the protective factor for new-onset AP in non-obese population. The HR for new-onset AP in group Q4 was 1.40 〔95%CI (1.02, 1.92), P=0.038〕. After excluding the population applying hypoglycemic drugs, the conclusions were unchanged, the HR for new-onset AP in group Q4 was 1.40 〔95%CI (1.02, 1.92), P=0.036〕.

Advanced age, high TG levels, and history of cholithiasis are risk factors for new-onset AP, years of education ≥9 years is the protective factor for new-onset AP. And the risk of AP increases when FPG ≥5.67 mmol/L in non-obose population.

Dietary inflammatory index (DII), as a new index for quantitative evaluation of dietary inflammatory potential, has been widely used in various chronic disease studies, but the correlation between DII and different types of obesity has not been uniformly established.

To systematically evaluate the correlation of DII with overweight, obesity and abdominal obesity to provide reference for the prevention of different types of obesity.

CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, Cochrane Library and Web of Science were searched by computer for cross-sectional studies of the association of DII with overweight, obesity and abdominal obesity from inception to January 10, 2023. Risk of Bias Rating Scale of AHRQ was used to evaluate the included studies. Meta-analysis was performed using RevMan 5.4.1 to calculate OR and 95%CI of the pooled data to assess the association of DII with overweight, obesity and abdominal obesity. Subgroup analyses were performed based on differences in gender, study geography, survey method, number of DII components, whether the sample population was healthy, diagnostic criteria, and type of DII grouping.

A total of 20 studies from 9 countries with 214 808 subjects were included. Meta-analysis results showed that high levels of DII may be a possible risk factor for overweight 〔OR=1.12, 95%CI (1.03, 1.22), P=0.005〕, obesity 〔OR=1.56, 95%CI (1.34, 1.82), P<0.000 01〕, abdominal obesity 〔OR=1.42, 95%CI (1.14, 1.78), P=0.002〕. Subgroup analysis for differences in gender, study geography, survey method, number of DII components, whether the sample population was healthy, diagnostic criteria, and type of DII grouping in the original studies showed no significant between-group heterogeneity within each subgroup for the correlation between DII and overweight (P>0.05). Among the subgroups for the correlation between DII and obesity, the male population〔OR=1.79, 95%CI (1.13, 2.85) 〕 had a higher proportion of obesity than the other gender groups, the North American population 〔OR=1.57, 95%CI (1.27, 1.83) 〕 had a higher proportion of obesity compared to populations from other geographic regions, and the results of the 24-h recall 〔OR=1.83, 95%CI (1.39, 2.42) 〕 had a higher proportion of obesity compared to studies with other survey methods. Among the subgroups for the correlation between DII and abdominal obesity, the North American population 〔OR=1.87, 95%CI (1.44, 2.44) 〕 had a higher proportion of abdominal obesity compared to populations from other geographic regions, and no significant heterogeneity was found among other groups. The funnel plot distribution in this study had good symmetry, suggesting no significant publication bias.

DII diets may be a risk factor for overweight, obesity and abdominal obesity, and the association is more obvious in North American populations. The association between a high DII diet and obesity was more significant in men. Increasing the intake of anti-inflammatory dietary components is important for the prevention and treatment of overweight, obesity and abdominal obesity.