Obesity Care

Cellularsludge in hunger-regulating neurons linked to worsening diabetes and obesity

A recent study published in Nature has identified a mechanism through which inflammation in the hypothalamus promotes fibrotic changes in the perineuronal nets (PNNs), a specialised extracellular matrix (ECM) in the arcuate nucleus (ARC). These changes contribute to metabolic dysfunction, worsening conditions like obesity and diabetes.

Background

When blood glucose levels rise, insulin is released from pancreatic beta cells and signals the ARC to regulate hunger and metabolism. However, loss of insulin sensitivity leads to overeating and fat accumulation, contributing to obesity. The ECM, a network of proteins and sugars surrounding cells, plays a crucial role in this process. In people with obesity, the ECM undergoes fibrotic changes, particularly around Agouti-Related Protein (AgRP)-releasing neurons in the hypothalamus, disrupting insulin signalling and contributing to metabolic diseases.

Study Overview

In the study, researchers fed mice a regular or a high-fat, high-sugar (HFHS) diet to induce diabetes. They investigated whether neuroinflammation contributed to fibrotic buildup in the ECM by performing immunohistochemistry and stereotaxic injections. The team selectively disrupted insulin receptors in AgRP neurons to determine if ECM fibrosis impaired insulin function. They also used insulin tagged with fluorescein isothiocyanate (FITC) to track its signalling in hypothalamic neurons.

To assess the effects of inflammation, the team used adeno-associated viruses (AAVs) expressing receptors for pro-inflammatory TNF-α and anti-inflammatory TGF-β, alongside chondroitinase ABC (chABC), which breaks down fibrotic nets. Patch-clamp electrophysiology tested insulin interaction with PNNs in vitro, and fluorosamine, a drug inhibiting chondroitin sulphate synthesis, was administered to evaluate its therapeutic potential.

Key Findings

The study revealed that obese mice exhibited increased fibrotic PNNs around ARC neurons, disrupting insulin signalling and increasing AgRP neuron firing. Enzymatic breakdown of these PNNs restored insulin sensitivity, improved glucose metabolism, and reduced weight. The fibrosis altered gene expression for insulin receptors, exacerbating insulin resistance. While fibrotic nets impaired insulin activity, they did not affect leptin, the body weight-regulating hormone.

Additionally, obesity heightened levels of the inflammatory marker TNF-α while reducing the anti-inflammatory TGF-β, leading to increased fibrotic buildup. Reducing hypothalamic inflammation improved ECM function, and fluorosamine restored insulin sensitivity and improved metabolic outcomes in obese mice.

Conclusion

This study shows that hypothalamic ECM remodelling plays a significant role in metabolic diseases. Drugs targeting fibrotic PNNs and inflammation in the hypothalamus could improve insulin sensitivity and offer new treatments for obesity and diabetes by enhancing metabolic function.

Ultra-processed foods linked to increasing type 2 diabetes risk

Extensive research has demonstrated that the consumption of ultra-processed foods (UPFs) has a detrimental impact on the development of type 2 diabetes mellitus (T2D). However, the exact influence of other levels of food processing on T2D risk remains uncertain. A recent study published in The Lancet Regional Health sheds new light on this issue, exploring the association between varying degrees of food processing and the risk of developing T2D.

Food Processing and Its Relationship with Type 2 Diabetes

The Nova classification system is widely used to categorise foods based on the extent of their processing. According to this system, foods are divided into four categories: unprocessed or minimally processed foods (MPFs), processed culinary ingredients (PCIs), processed foods (PFs), and ultra-processed foods (UPFs). Research has long associated higher consumption of UPFs with weight gain, obesity, T2D, and cardiovascular diseases. A study conducted as part of the European Prospective Investigation into Cancer and Nutrition (EPIC) initiative revealed that a higher intake of UPFs is also linked to an increased risk of cancer and cardiometabolic multimorbidity.

Despite these findings, the link between T2D and all categories of processed foods, including MPFs, PCIs, and PFs, has yet to be fully elucidated. Further research is necessary to determine whether UPFs or other processed foods are most closely associated with adverse health outcomes. Gaining a deeper understanding of the impact of different types of processed foods may provide researchers with crucial insights into the benefits of replacing UPFs with healthier alternatives, such as MPFs, PCIs, or PFs.

The Study Overview

The recent cohort study used data from the EPIC project to explore the relationship between various food processing categories and T2D risk. Researchers assessed participants’ dietary intake at the start of the study by administering comprehensive dietary questionnaires. Based on this information, food consumption patterns were categorised according to the Nova classification system.

In order to identify cases of T2D, researchers relied on multiple data sources, including participants’ self-reports, primary and secondary care registers, hospital admission records, medication registers, and mortality data. The analysis used Cox regression and statistical substitution models to estimate the associations between T2D risk and the intake of MPFs, PCIs, PFs, and UPFs. Sub-group analyses were also conducted to identify any potential variations in the association between different UPFs and T2D risk.

The average age of the study participants was 52.5 years, and 63.5% of them were female. The average body mass index (BMI) was 25.7 kg/m², indicating that most participants were classified as being slightly overweight. Over the course of a 10.9-year follow-up period, 4.6% of participants were diagnosed with T2D. On average, MPFs and PCIs contributed to 72.1% of participants’ daily dietary intake, while UPFs accounted for 13.0%, and PFs made up 14.9%.

Key Findings of the Study

In examining the relationship between food processing and the development of T2D, the researchers conducted restricted cubic spline analyses to assess the intake of MPFs and PCIs. These analyses revealed a linear relationship between higher consumption of MPFs + PCIs and a lower risk of T2D up until very high intakes. Additionally, the study found that increased consumption of MPFs + PCIs, as well as PFs, was linked to a reduced risk of T2D. In contrast, a higher intake of UPFs was associated with an elevated risk of developing T2D.

To better understand the impact of replacing certain food groups on T2D risk, the researchers performed statistical substitution analyses. These analyses revealed that substituting 10% of UPFs with either MPFs + PCIs or PFs significantly reduced the risk of T2D. Moreover, replacing MPFs + PCIs with PFs also resulted in a reduction in T2D risk. These results held even after accounting for confounding factors such as saturated fat intake, sugar consumption, and adherence to a Mediterranean diet.

When investigating different sub-groups of UPFs, the study uncovered significant heterogeneity in their relationship with T2D. For instance, an increase in the consumption of savoury snacks, ready-to-eat or heat dishes, animal-based products, and artificially or sugar-sweetened beverages (ASBs/SSBs) was associated with a higher risk of T2D. On the other hand, lower T2D risk was linked to the consumption of plant-based alternatives, sweets and desserts, biscuits, breakfast cereals, and breads. Interestingly, no significant association was found between T2D and the consumption of sauces, spreads, condiments, alcoholic beverages, or other miscellaneous UPFs.

The Role of Adiposity in the UPF-T2D Relationship

To further understand the mechanisms underlying the association between UPF consumption and T2D, the researchers conducted mediation analyses focused on the waist-height ratio (WHtR), a measure of adiposity. These analyses revealed that WHtR mediated 46.4% of the association between UPF consumption and T2D risk. This suggests that body fat distribution may play a significant role in the relationship between UPF intake and the development of T2D.

Despite the robustness of the findings, some inconsistencies were noted in sensitivity analyses. For example, in France and Italy, the study did not find a statistically significant association between UPF consumption and T2D risk. Additionally, when the intake of MPFs + PCIs was modelled as kcal/day, %kcal/day, or g/day, no significant association with T2D risk was observed.

Conclusions

This study reinforces the growing body of evidence linking higher consumption of ultra-processed foods with an increased risk of type 2 diabetes mellitus. At the same time, it highlights the protective effect of consuming less processed foods, such as minimally processed or processed culinary ingredients, against the development of T2D.

Importantly, the findings point to the significant heterogeneity within the category of UPFs, suggesting that not all UPFs pose the same level of risk. This variability underscores the need for more nuanced public health guidelines, which should focus on reducing the intake of specific harmful UPFs rather than treating UPFs as a single, homogenous group. By encouraging people to make healthier food choices and reduce their consumption of certain types of UPFs, it may be possible to mitigate the rising global incidence of type 2 diabetes.

Childhood obesity associated with elevated risk of schizophrenia in adulthood, study finds

A team of medical researchers and disease management specialists in China has identified a significant link between obesity during childhood and the development of schizophrenia in adulthood. The study, published in the journal Science Advances, involved a comprehensive analysis of health records from two major genetic research projects. The findings underscore the potential long-term mental health consequences of childhood obesity, which was previously linked primarily to physical health issues.

Exploring the Link Between Childhood Obesity and Mental Health

Previous studies have established that obesity in childhood can contribute to various health complications both during childhood and in later life, including conditions like diabetes, cardiovascular disease, and metabolic syndrome. However, the research team sought to explore whether childhood obesity might also increase the risk of developing mental health disorders.

To investigate this, the researchers analysed data from the Psychiatric Genomics Consortium, an extensive project aimed at uncovering the genetic foundations of psychiatric illnesses. Additionally, they examined data from the FinnGen partnership, another major initiative focusing on genetic diseases. By utilising these large-scale genetic databases, the researchers aimed to uncover any associations between childhood obesity and the occurrence of mental health disorders in adulthood.

Examining Mental Health Outcomes in Later Life

The team specifically looked at the health outcomes of individuals who were classified as obese during their childhood and tracked the development of mental health issues as they aged. The mental health conditions they focused on included obsessive-compulsive disorder (OCD), major depression, anxiety disorders, Alzheimer’s disease, and schizophrenia. Interestingly, the researchers found no significant associations between childhood obesity and any of these mental health conditions except for schizophrenia.

The study’s authors describe the evidence linking childhood obesity to an increased risk of schizophrenia in adulthood as “compelling and direct.” Crucially, they found that this link was independent of obesity later in life and other lifestyle factors. This suggests that the risk of developing schizophrenia is specifically associated with excess weight during the childhood years rather than ongoing obesity in adulthood.

The Unexplained Mechanism Behind the Link

Despite establishing a correlation between childhood obesity and schizophrenia, the researchers were unable to determine the exact mechanism behind this relationship. They speculated that the accumulation of excess fat during childhood might influence brain development in ways that predispose individuals to schizophrenia later in life. However, further research is needed to understand how obesity-related changes in the brain during critical developmental periods could lead to this increased risk.

A Surprising Finding: Adult-Onset Obesity and Schizophrenia Risk

In a separate analysis, the team discovered an unexpected outcome: individuals who were not obese as children but became obese during adulthood were actually less likely to develop schizophrenia or OCD. This finding adds complexity to the understanding of how obesity and mental health are connected, suggesting that the timing of obesity onset could play a crucial role in its potential impact on psychiatric health. It also indicates that adult-onset obesity may not carry the same mental health risks as childhood obesity, at least in relation to schizophrenia and OCD.

Implications for Public Health and Policy

The researchers emphasise the importance of childhood obesity prevention as a means of potentially reducing the risk of developing schizophrenia in later life. They argue that these findings highlight the need for health care policies and programmes aimed at preventing children from becoming overweight. Early intervention strategies, education on nutrition, and promoting physical activity in children could be key in addressing this public health issue.

As they conclude, the study presents a strong case for the importance of childhood health and its potential lifelong implications. It suggests that the consequences of obesity are not limited to physical health but may extend to mental health in ways that are only beginning to be understood. Further research into the mechanisms connecting childhood obesity and schizophrenia is required to develop more targeted prevention and treatment strategies.

NHS limiting access to essential obesity services across England, British Medical Journal reveals

The National Health Service (NHS) is restricting access to crucial obesity services across England, leaving individuals in nearly half of the country without the ability to seek appointments with specialist teams for necessary support and treatments, including weight-loss injections. 

This concerning situation was uncovered through an investigation by the British Medical Journal (BMJ), which mirrors the findings of a recent report by the Future Health research agency. The agency’s report highlighted that many of England’s Integrated Care Boards (ICBs) have failed to establish detailed strategies to address obesity and provide treatment, despite the condition costing the United Kingdom an estimated £98 billion annually in healthcare expenses, lost productivity, and other associated costs.

Richard Sloggett, the report’s author and a former special adviser in the Department of Health and Social Care, described these new revelations as evidence of the NHS “rationing” obesity treatment. He emphasised, “These findings back up our Future Health research showing that many ICBs do not currently see obesity as a priority. In certain parts of the country, there is no access to tier 3 and tier 4 services at all. This rationing is leading to a postcode lottery of care. Given the scale of the obesity challenge facing the country and the wider health and economic costs and impacts associated with it, there is an urgent need for the government and the NHS to commit new action. This should start with a clear timeline for reviewing NHS obesity services and ensuring there is a minimum service specification agreed and in place in each ICB.”

A spokesperson for NHS England responded to the BMJ’s investigation by stating that the NHS was “working with the Department of Health to support improvements in the obesity pathway.” However, experts argue that more decisive action is needed.

The BMJ’s investigation also revealed that budget cuts have disproportionately impacted local services focused on obesity care. Individuals living with obesity are often viewed as less deserving of care compared to those with other health conditions, exacerbating the situation. This reality has led to what one expert describes as a “postcode lottery of care,” where access to obesity services varies significantly depending on geographical location.

Data collected through freedom of information requests sent to all 42 of England’s ICBs showed that patients in one in six local healthcare areas were unable to access bariatric surgery, a treatment considered one of the most clinically effective interventions for obesity.

Dr Nicola Heslehurst, a professor of maternal and child nutrition at Newcastle University and chair of the UK Association for the Study of Obesity, voiced her concerns about the current state of weight management services. She told the BMJ, “Current weight management services do not in any way meet the need,” and warned that “radical” action was necessary to combat the rising prevalence of obesity, the associated care costs, and health inequalities. She also stressed the impact on future generations, cautioning that without intervention, children may be “set up for a life course of poor health.”

Obesity imposes a significant financial burden on the NHS in England, costing an estimated £6.5 billion each year. It is also recognised as the second leading cause of cancer after smoking, highlighting the urgency for a comprehensive and effective response.

ICBs receive funding from NHS England to deliver healthcare services for their local communities. However, recent budget cuts have placed immense financial pressure on these boards. In many cases, when resources are limited, services perceived as lower priority are denied funding, with obesity care frequently being the first to face budget reductions.

The BMJ’s investigation found that just over half (24) of England’s 42 ICBs commissioned the full spectrum of adult weight loss services and were open to new referrals. These services range from localised diet and lifestyle classes to more advanced interventions, such as semaglutide weight-loss injections (marketed as Wegovy) and gastric bypass surgery.

However, over a third of ICBs reported imposing restrictions on tier three obesity services, which involve multidisciplinary teams capable of prescribing weight-loss medications. Among these ICBs, six had closed their services to new patients, seven provided services only to certain parts of their catchment area, and four lacked any tier three services altogether.

Tier four services, which include more intensive weight-management interventions like gastric bypass surgery, are also severely restricted. The investigation found that seven ICBs do not offer any bariatric surgery, further highlighting the disparities in access to care across different regions of England.

John Wilding, a professor of medicine at the University of Liverpool, criticised the lack of prioritisation for obesity services, stating, “Obesity services are not deemed a priority.” He also pointed out a prevailing bias within the healthcare system, noting, “I think there is an unconscious bias which says: ‘This is mostly their fault, so they should just get on with it, go on a diet and lose weight.’ But we know from genetics and other factors that it’s much more complicated than that.”

These findings underscore an urgent need for a comprehensive review of NHS obesity services and the establishment of a uniform standard of care across all ICBs. The current restrictions on access to essential obesity treatment services not only create health inequalities but also contribute to escalating healthcare costs and long-term negative health outcomes. Without significant changes in policy and practice, the NHS faces an ongoing struggle to address the obesity crisis effectively.

Night owls at increased risk for higher BMI, larger waistlines, and type 2 diabetes

Individuals who stay up late and wake up later, often referred to as “night owls,” are more likely to have higher body mass index (BMI), larger waist circumferences, and more hidden body fat. Furthermore, they face an almost 50% greater likelihood of developing type 2 diabetes (T2D) compared to those who follow earlier sleep schedules. These findings are part of new research set to be presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Madrid, Spain (9–13 September, 2024).

Lead researcher Dr Jeroen van der Velde, from Leiden University Medical Centre in the Netherlands, explained: “Previous studies have shown that a late chronotype – a preference for going to bed late and waking up late – is linked to an unhealthy lifestyle. Night owls are more prone to smoking or maintaining unhealthy diets, which has been suggested as a possible reason for their higher risk of obesity and metabolic conditions, such as type 2 diabetes.”

Dr van der Velde continued, “However, we believe that lifestyle factors alone cannot fully account for the relationship between being a late chronotype and the development of metabolic disorders. While it is well-documented that late chronotypes tend to have higher BMI, it remains unclear how exactly sleep timing affects the distribution of body fat.”

To investigate this further, Dr van der Velde and his team explored the associations between sleep timing, type 2 diabetes, and body fat distribution in more than 5,000 individuals as part of the Netherlands Epidemiology of Obesity study, an ongoing research project focused on the impact of body fat on health outcomes.

The analysis involved participants with an average age of 56 years, 54% of whom were women, and a mean BMI of 30 kg/m², placing many in the category of obesity. Participants completed a questionnaire about their typical bedtimes and wake-up times, from which researchers calculated their midpoint of sleep (MPS).

The participants were categorised into three groups:

• Early chronotype (the 20% with the earliest MPS),
• Late chronotype (the 20% with the latest MPS),
• Intermediate chronotype (the remaining 60% of participants).

Researchers measured BMI and waist circumference in all participants. Additionally, visceral fat and liver fat content were evaluated in 1,526 individuals using advanced imaging techniques such as MRI scans and MR spectroscopy.

Over a follow-up period of 6.6 years, 225 participants were diagnosed with type 2 diabetes. The data were adjusted for multiple factors, including age, sex, education, total body fat, and various lifestyle habits, such as physical activity levels, diet quality, alcohol consumption, smoking status, and sleep quality and duration. The findings revealed that those identified as late chronotypes had a 46% higher risk of developing type 2 diabetes compared to individuals with an intermediate chronotype.

This significant increase in risk suggests that lifestyle factors alone cannot explain the heightened risk of type 2 diabetes in late chronotypes.

“We believe that other mechanisms are contributing to this increased risk,” said Dr van der Velde. “A likely explanation is that late chronotypes experience misalignment between their natural circadian rhythms and the work and social schedules imposed by society. This misalignment can disrupt their circadian system, which is known to result in metabolic disturbances, potentially leading to type 2 diabetes.”

The researchers also investigated whether early chronotypes – those who prefer to go to bed and wake up earlier – were at a lower risk of developing type 2 diabetes. “From the literature, we expected early chronotypes to exhibit a risk level similar to those with intermediate chronotypes,” Dr van der Velde said. “Our results did show a slightly increased risk for early chronotypes, but this finding was not statistically significant.”

Beyond the risk of diabetes, the results also highlighted key differences in body composition. Late chronotypes, on average, had a BMI that was 0.7 kg/m² higher than those with an intermediate chronotype. They also had a 1.9 cm larger waist circumference, 7 cm² more visceral fat, and 14% greater liver fat content.

Dr van der Velde concluded, “Individuals with a late chronotype seem to be at greater risk for type 2 diabetes compared to those with an intermediate chronotype. This elevated risk might be due to higher levels of body fat, including visceral fat and liver fat.”

Looking ahead, Dr van der Velde emphasised that the next steps in research will involve studying whether individuals with late chronotypes can improve their metabolic health by adjusting the timing of their lifestyle behaviours. He mentioned that they are currently involved in the TIMED consortium, which investigates how the timing of sleep, eating, and physical activity can influence type 2 diabetes outcomes.

“We’ve already demonstrated that the timing of physical activity plays an important role in reducing insulin resistance,” he noted.

Another promising area of research is exploring the impact of meal timing. “It’s likely that people with late chronotypes are more inclined to eat later into the evening,” explained Dr van der Velde. “While we didn’t examine this in our study, there is growing evidence that time-restricted eating – such as not consuming food after a certain hour, like 6pm – could lead to metabolic benefits.”

For individuals who identify as night owls and are concerned about their increased risk for type 2 diabetes, Dr van der Velde suggested that they may want to experiment with adjusting meal times or avoiding late-night eating. “The evidence isn’t definitive yet, but over time, we aim to provide more specific advice on how changes in lifestyle habits can reduce the risk of metabolic diseases.”

Scientists identify key enzyme connecting obesity and atrial fibrillation offering new hope for treatment

Scientists from the University of Illinois Chicago (UIC) have uncovered a cellular mechanism that links obesity to atrial fibrillation (AF), a condition affecting over 33 million people worldwide. This breakthrough not only enhances our understanding of the relationship between excess body fat and AF but also presents a promising new target for the development of therapeutic treatments.

Atrial fibrillation is a common yet serious heart disorder characterised by an irregular heartbeat, which can lead to complications such as heart failure and stroke. Obesity is widely recognised as a significant contributor to this condition. However, the precise cellular mechanisms by which excess body fat triggers atrial fibrillation have remained elusive.

In a newly published study in The Journal of Clinical Investigation, researchers at UIC have identified a crucial cellular pathway that plays an essential role in the onset of obesity-related atrial fibrillation. The study reveals that inhibiting a specific enzyme known as NOX2 can prevent and potentially reverse the adverse changes in the heart caused by obesity.

According to Dr Dawood Darbar, senior author of the study, chief of cardiology, and professor of medicine and pharmacology at UIC, this discovery paves the way for developing new treatments aimed at both preventing and managing AF in people with obesity.

“A drug that blocks this enzyme may have two uses,” explained Dr Darbar. “We could use this drug to prevent the development of atrial fibrillation in individuals who have obesity but who haven’t yet developed atrial fibrillation. For those who already have obesity and atrial fibrillation, we can use it to treat them and prevent the progression of the disease.”

Investigating the Role of Oxidative Stress

The research team, led by UIC postdoctoral scholar Arvind Sridhar, focused on oxidative stress, a cellular process that has long been suspected of connecting obesity and atrial fibrillation. Oxidative stress occurs when harmful molecules called reactive oxygen species (ROS) accumulate in cells, causing damage. This can result from various conditions, including obesity and diabetes.

Antioxidants, such as vitamins and minerals found in fruits and vegetables, are known to neutralise ROS and protect against oxidative stress. However, antioxidant therapies for treating atrial fibrillation have so far produced inconsistent results. Some clinical studies have shown positive effects, while others have been inconclusive or ineffective.

“Some of these studies were positive, some were negative, some were neutral, and we didn’t understand why,” said Dr Darbar. “Now it seems the reason why antioxidants didn’t work in atrial fibrillation is because they didn’t target the specific pathway that caused the oxidative stress.”

Through their investigation, the UIC team uncovered this specific pathway by analysing heart tissue samples obtained from individuals during surgery. They discovered that the enzyme NOX2, which is responsible for generating reactive oxygen species, was significantly more active in patients with higher body mass indexes (BMIs) compared to those with lower BMIs.

“As the BMI of the individual increased, we saw an increased severity of atrial fibrillation,” explained Sridhar. “We also saw a similar increase in the expression of NOX2 as the BMI increased, which tells us that the two are intrinsically related.”

Experimental Evidence in Mice and Human Cells

Building on this insight, the researchers conducted a series of experiments using mice and cells derived from people with atrial fibrillation. In one set of experiments, they studied mice that had been genetically engineered to lack the NOX2 gene. While normal mice fed a high-fat diet developed atrial fibrillation, the mice without the NOX2 gene did not.

Additionally, the researchers found that administering a drug to normal mice to block NOX2 activity prevented the development of atrial fibrillation, even when the mice were fed a high-fat diet.

In another key experiment, the team used heart stem cells taken from individuals with atrial fibrillation. This innovative technique, developed by Dr Darbar in collaboration with Salman Khetani from UIC’s College of Engineering, enabled the researchers to mimic the cellular environment of people with atrial fibrillation. When these cells were treated with a NOX2 inhibitor, the levels of reactive oxygen species dropped, and the abnormal electrical activity that characterises atrial fibrillation was eliminated.

Moving Towards New Therapeutic Approaches

Although the drug used in the laboratory experiments has not yet received approval from the U.S. Food and Drug Administration (FDA), the researchers are optimistic about the potential to identify and test other compounds that inhibit NOX2. These alternative compounds could eventually lead to clinical trials and the development of new therapies for atrial fibrillation in individuals with obesity.

“Because obesity is becoming so common, I think this finding will have a tremendous impact,” stated Dr Darbar. “If we can find a way to safely and effectively block NOX2 in humans, we could not only prevent atrial fibrillation from developing in people with obesity, but also stop it from getting worse in those who already have the condition.”

The study’s implications extend beyond obesity and atrial fibrillation, as oxidative stress plays a role in many other diseases as well. Identifying NOX2 as a key player in this process could therefore open the door to a range of new therapeutic strategies for various conditions linked to oxidative stress.

A Collaborative Effort

This significant discovery was the result of collaborative work among various experts at UIC. In addition to Dr Darbar and Arvind Sridhar, other co-authors of the paper include Jaime DeSantiago, Hanna Chen, Mahmud Arif Pavel, Olivia Ly, Asia Owais, Miles Barney, Jordan Jousma, Sarath Babu Nukala, Dr Khaled Abdelhady, Dr Malek Massad, Lona Ernst Rizkallah, Sang Ging Ong, and Dr Jalees Rehman.

The researchers are hopeful that their findings will accelerate the development of new, targeted treatments that can significantly improve the lives of individuals living with both obesity and atrial fibrillation.

Increased protein and fibre intake linked to effective long-term weight loss, study reveals

A recent study has revealed that participants in a one-year dietary education programme who experienced the most significant weight loss consumed notably higher amounts of protein and fibre. Among this group, 41% of all 22 participants successfully lost an average of 12.9% of their body weight, while those who were less successful saw a reduction of only slightly over 2%.

The research highlights the critical importance of personalised, adaptable weight loss programmes, which enable individuals to adhere to their diet plans more effectively. According to the researchers, these flexible programmes empower participants to tailor their approaches, maximising long-term success.

The study’s participants were involved in the Individualised Diet Improvement Programme (iDip), a highly customised dietary intervention that equips individuals with the knowledge and tools to develop effective weight loss strategies. The iDip programme incorporates visualisation tools and intensive dietary education to help participants better understand key nutrients, allowing them to create safe, tailored, and sustainable weight loss plans.

“Flexibility and personalisation are key in creating programmes that optimise dieters’ success at losing weight and maintaining that loss,” explained Professor Manabu T. Nakamura, a professor of nutrition at the University of Illinois Urbana-Champaign in the United States and leader of the research.

He continued, “Sustainable dietary change, which varies from person to person, must be achieved to maintain a healthy weight. The iDip approach allows participants to experiment with various dietary iterations, and the knowledge and skills they develop while losing weight serve as the foundation for sustainable maintenance.”

The programme focuses on increasing the intake of protein and fibre, all while keeping daily caloric consumption within the limit of 1,500 calories.

Protein and Fibre: Key Nutrients for Success

For all 22 study participants, the iDip research team developed an innovative, two-dimensional quantitative data visualisation tool. This tool plots the density of protein and fibre in foods per calorie, and it provides a target range for each meal. Participants attended 19 dietary education sessions during the year-long programme, with additional prescribed homework to reinforce their learning and commitment.

Participants were encouraged to create personalised plans based on their usual dietary preferences, with a specific focus on boosting their intake of protein and fibre. The study’s goal was for participants to consume approximately 80 grams of protein and 20 grams of fibre daily.

Throughout the programme, researchers monitored participants’ eating habits and tracked their weight via Wi-Fi-enabled scales. They discovered strong inverse correlations between protein and fibre intake and weight loss at both the three-month and twelve-month marks.

“The strong correlation suggests that participants who were able to develop sustainable dietary changes within the first three months continued to lose weight in the subsequent months. In contrast, those who struggled to implement lasting dietary changes early on rarely succeeded in making significant progress later,” noted Professor Nakamura.

The study’s findings align with broader industry recognition of the role protein plays in effective weight loss. Major nutrition companies, such as Nestlé, have introduced high-protein, portion-controlled foods that can complement individuals’ diets, particularly for those using weight-loss medications.

Weight Loss Results: A Closer Look

Published in Obesity Science & Practice, the study examined the experiences of nine men and thirteen women, aged between 30 and 64. All participants reported having made at least two previous attempts to lose weight before enrolling in the programme.

The study population also presented with various health conditions: 54.6% had high cholesterol, 50% experienced skeletal issues, 36.4% had hypertension, 36.4% had sleep apnoea, and 31.8% had a history of depression. Additionally, some participants were diagnosed with diabetes, non-alcoholic fatty liver disease, and cancer.

On average, participants lost 6.49% of their body weight over the 12-month period. Of the nine individuals who achieved a reduction of more than 5% of their initial body weight, two participants reached a body mass index (BMI) of 25 kg/m², which is within the normal weight range. For these successful participants, researchers found that 78% of their weight loss was attributable to fat reduction.

The study revealed a notable difference in weight loss outcomes for participants with depression. Individuals living with depression experienced a significantly lower weight reduction, averaging a 2.4% decrease in body weight, compared to 8.39% for those without depression. However, there were no significant differences in weight loss outcomes based on other health conditions, age, or gender.

Preservation of Lean Body Mass

One of the key findings of the study was the participants’ ability to reduce fat mass without sacrificing lean body mass. On average, participants’ fat mass decreased from 42.6 kg at the start of the programme to 35.7 kg by the end of the 12-month period. Notably, both successful and unsuccessful participants were able to preserve their lean body mass, a critical factor in maintaining metabolic health during weight loss.

Nakamura emphasised the importance of preserving lean body mass during weight loss, particularly for individuals who are using weight-loss medications.

“Recently, the popularity of injectable weight loss medications has been increasing,” he remarked. “However, using these medications when food intake is minimal will cause serious side effects, including muscle and bone loss, unless protein intake is increased during weight loss.”

The researchers underscored the importance of maintaining a high-quality diet, particularly for individuals taking anti-obesity medications. Earlier in the year, medical experts developed a set of evidence-based nutritional guidelines to assist healthcare professionals in supporting patients who are using such medications.

Conclusion

The study demonstrates that higher intakes of protein and fibre are strongly linked to more successful weight loss outcomes in individuals following a personalised dietary programme. The findings highlight the importance of flexible, tailored approaches to weight loss that prioritise nutrient-rich foods while maintaining adequate caloric intake. For individuals using weight-loss medications, attention to dietary quality, especially protein intake, is essential to preserving muscle mass and preventing adverse health effects.

Addressing sleep issues is critical for the health of adults with overweight and obesity

Recent research conducted by Oregon Health & Science University (OHSU) has highlighted the adverse health implications for individuals who are overweight and disregard their body’s natural cues to sleep at night. The study, which reveals important gender-specific differences, underscores the critical role that good sleep practices play in maintaining overall health, particularly for those who have overweight or obesity.

Study Overview

The findings of this research were published in the latest issue of The Journal of Clinical Endocrinology & Metabolism. According to Brooke Shafer, Ph.D., the study’s lead author and a postdoctoral researcher in the Sleep, Chronobiology, and Health Laboratory at the OHSU School of Nursing, the results strongly advocate for the adoption of healthy sleep habits. “This study builds support for the importance of good sleep habits,” Shafer noted. “Sleep practices, like going to bed when you’re tired or setting aside your screen at night, can help to promote good overall health.”

The research involved 30 participants, with an equal distribution of men and women, all of whom had a body mass index (BMI) exceeding 25, placing them in the categories of people with overweight or obesity. The study’s purpose was to explore the connection between sleep patterns and potential health risks, with a specific focus on the differences between men and women.

Health Implications of Disrupted Sleep Patterns

“Obesity and cardiometabolic disease are growing public health concerns,” Shafer explained. “Our research shows that disruptions in the body’s internal biological clock could contribute to negative health consequences for people who may already be vulnerable due to weight.”

The participants, who were generally healthy despite their elevated BMI, were asked to provide saliva samples every 30 minutes late into the night at a sleep laboratory located on OHSU’s Marquam Hill campus. This procedure was aimed at determining the precise moment their bodies naturally began producing melatonin, the hormone responsible for initiating the sleep process. The onset of melatonin production varies from person to person, depending on their internal biological clock.

Following their time in the sleep lab, participants returned home and kept a detailed log of their sleep habits for the subsequent seven days. The researchers then analysed the time difference between the onset of melatonin and the average sleep timing for each participant. This data allowed them to categorise the participants into two distinct groups: those with a narrow window, where there was a short duration between melatonin onset and sleep, and those with a wide window, characterised by a longer duration between melatonin onset and sleep.

A narrow window, which indicates that an individual is staying awake too late relative to their internal body clock, is generally associated with poorer health outcomes. This new study confirmed a range of potentially harmful health measures in the group that went to sleep closer to the onset of melatonin.

Gender-Specific Findings

The study also revealed significant differences between men and women. Men who fell into the group with a narrow window exhibited higher levels of abdominal fat, elevated levels of fatty triglycerides in the blood, and increased overall metabolic syndrome risk scores compared to men who slept more in line with their biological clocks. On the other hand, women in the same group showed a higher overall body fat percentage, elevated glucose levels, and increased resting heart rates.

“It was really somewhat surprising to see these differences present themselves in a sex-dependent manner,” remarked Andrew McHill, Ph.D., the study’s senior author and an assistant professor at the OHSU School of Nursing, the School of Medicine, and the Oregon Institute of Occupational Health Sciences at OHSU. “It’s not one size fits all, as we sometimes think in academic medicine.”

Future Research and Implications

The researchers are now planning to explore sex-specific differences in groups that experience more extreme changes in sleep patterns, such as those who work overnight shifts. This next phase of research aims to develop targeted interventions that can help maintain the health of this essential segment of the workforce.

“We want to figure out possible interventions that keep this vital core group of the workforce healthy,” Shafer stated, highlighting the importance of addressing the unique challenges faced by individuals whose work schedules disrupt their natural sleep patterns.

Conclusion

The study from OHSU serves as a stark reminder of the crucial role that sleep plays in our overall health, particularly for those who are already at risk due to having overweight or obesity. The gender-specific findings add a new layer of complexity to our understanding of sleep and health, suggesting that tailored approaches may be necessary to address the unique needs of men and women. As the research continues, it is hoped that new interventions will be developed to support healthy sleep habits across all populations, especially those most vulnerable to the effects of disrupted sleep.

Rising BMI and fat mass linked to ultra-processed food consumption in young Chilean children

A recent study published in BMC Medicine has illuminated the significant relationship between the consumption of ultra-processed foods (UPFs), rising obesity rates, and certain metabolic indicators among preschool-aged children in Chile. The findings underscore the potential long-term health risks associated with diets high in UPFs, particularly in young children, a demographic increasingly vulnerable to the adverse effects of poor nutrition.

Study Overview

The study was conducted as part of the Food and Environment Chilean Cohort (FECHIC) study, a prospective cohort investigation designed to explore the impact of dietary habits on health outcomes in Chilean children. The researchers focused on the influence of UPF consumption on obesity and metabolic outcomes over a two-year period, with initial data collection beginning in 2016.

Participant Selection and Data Collection

The study analysed dietary data from 962 children, all of whom were around four years old at the start of the research. Dietary intake information was collected using the United States Department of Agriculture’s (USDA) multiple-pass technique, a method known for its accuracy in capturing 24-hour dietary recalls. Mothers served as the primary respondents, providing detailed accounts of their children’s food intake during structured in-person interviews. Where necessary, the children themselves contributed additional details about their eating habits, especially for meals consumed outside the home, such as during school hours.

In order to maintain the integrity of the study, records indicating extreme levels of UPF consumption were excluded. The researchers utilised the NOVA classification system to categorise all foods consumed by the participants. This system divides foods into four categories: natural and minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods. To estimate the children’s UPF consumption both in terms of grams and calories, the Multiple Source Method (MSM) was employed.

Assessment of Adiposity and Metabolic Indicators

Two years after the initial data collection, when the children had reached the age of six, the research team measured various indicators of adiposity and metabolism. Adiposity indicators included waist circumference, body fat mass (both as a percentage and in kilograms), and body mass index (BMI) z-scores. The metabolic indicators assessed were fasting blood glucose levels, insulin levels, the homeostatic model assessment for insulin resistance (HOMA-IR), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglycerides, and total cholesterol.

To evaluate the children’s energy requirements, the Dietary Reference Intake (DRI) equation was applied. The relationship between UPF intake and the various health outcomes was analysed using linear regression models, which were adjusted for covariates such as age, sex, baseline BMI z-scores, screen time, and maternal factors including BMI, age, education, employment status, and socioeconomic status.

Results and Analysis

At the beginning of the FECHIC study, the average age of the children was five years, with a slight female majority (52%). The average BMI z-score was recorded at 1.0, indicating a tendency towards overweight. The mothers were, on average, 31 years old, with 55% having attained a medium level of education.

By the end of the two-year study period, the average fat mass of the children had risen to 24%, and the average fasting glucose level was measured at 82 mg/dL. Notably, UPFs accounted for 48% of the children’s total caloric intake at four years of age, and 39% of their total food intake by weight. Despite UPFs contributing the majority of calories, minimally processed foods still constituted the largest portion by weight (57%).

The adjusted regression models revealed significant positive associations between UPF consumption and several key indicators of obesity, including BMI, waist circumference, fat mass in kilograms, and percentage fat mass. However, the study did not find a direct relationship between UPF intake and the metabolic markers assessed.

Sensitivity analyses, which included models without the use of stabilised inverse probability of censoring weights and considered UPF intake in quartiles, produced consistent results, further reinforcing the study’s findings.

Discussion

The study’s results suggest that the proportional contribution of UPFs to the diet is more impactful than the total quantity consumed. This observation aligns with broader research indicating that health improvements often follow a shift away from diets dominated by ultra-processed foods.

UPFs are typically characterised by a poor nutritional profile, with high levels of added sugars and saturated fats, and low concentrations of essential vitamins and minerals. The production processes involved in creating UPFs often use refined ingredients that not only reduce satiety but also increase glycaemic response, leading to a higher propensity for overeating. Additionally, UPFs are energy-dense but low in water content, allowing for rapid consumption of both volume and calories, which further promotes excessive intake. The low protein density in these foods may also contribute to an overconsumption of other, potentially unhealthy, foods.

There is also concern that the widespread consumption of UPFs increases exposure to rare or unnatural food additives, which could pose additional, as yet unquantified, health risks.

Conclusion and Recommendations

The findings from this study indicate a clear link between UPF consumption and rising obesity rates among Chilean preschoolers, though no significant connection to metabolic consequences was observed within the two-year period. Longer follow-up studies are necessary to fully understand the long-term risks associated with UPF consumption in young children.

In light of these findings, health authorities and policymakers are urged to strengthen global initiatives aimed at creating environments that encourage diets rich in minimally processed foods. There is a pressing need to restrict children’s access to UPFs, which are increasingly prevalent in modern diets, to curb the growing trend of childhood obesity and its associated health risks.

Obesity potentially linked to 18 additional cancers, expands understanding of risks

In a groundbreaking study recently published in The Lancet Regional Health – Europe, researchers have further explored the complex associations between body mass index (BMI) and the risk of developing obesity-related cancers. The study builds on previous findings and uncovers 18 additional cancers that may be linked to obesity, broadening the scope of understanding in the field of cancer research.

The rising prevalence of obesity and overweight worldwide underscores the urgency of understanding their impact on morbidity. Increasing evidence suggests that obesity is not just a health risk but may also serve as a preventable cause of various cancers. The 2016 report by the International Agency for Research on Cancer (IARC) had already established a connection between BMI and 13 specific cancers, laying the groundwork for further exploration.

Building on these earlier findings, an umbrella review later confirmed that most of these cancers were indeed linked to obesity. However, much of the existing research has focused on overall cancer risk without delving deeply into the associations between BMI and specific morphological cancer subtypes.

The present study seeks to bridge this gap by investigating potential obesity-related cancers, including their subtypes, and by quantifying the strength of these associations. The researchers utilised data from the Obesity and Disease Development Sweden (ODDS) study, drawing from an extensive database that spans several decades.

Cancer diagnoses recorded between 1963 and 2019 were meticulously identified through the Swedish Cancer Register, which classified cancers using standardised codes. The 13 cancers previously recognised by the IARC as obesity-related served as a foundation for this study, but the researchers also applied an explorative decision algorithm to identify additional cancers potentially linked to obesity. These were defined as cancers showing a positive association with increased obesity risk, either compared to normal weight or per a 5 kg/m² increase in BMI.

To determine the strength of the association between BMI and cancer risk, BMI was evaluated in categorical terms (such as underweight, overweight, etc.) or per a 5 kg/m² increment, provided there were sufficient cases—250 for categorical evaluations and 100 for incremental evaluations.

The analysis employed Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). These models were stratified by birth year and sex, and adjustments were made for several variables, including baseline age, mode of height and weight assessment, education level, country of birth, and marital status. Additionally, for cancers known to be related to smoking, the models were repeated in individuals with available smoking data to adjust for this significant confounder. The Wald test was then utilised to examine potential interactions based on sex.

The study’s scope was vast, including 4.14 million individuals—2.01 million females and 2.12 million males—with an average baseline age of 31.3 years for females and 23.1 years for males. The average BMI recorded was 22.5 kg/m² for males and 24 kg/m² for females, with obesity prevalence noted at 9% in females and 3% in males. Over a median follow-up period of 24.2 years, 332,501 cancer cases were identified—139,685 in females and 192,816 in males. The median age at cancer diagnosis was 55.7 years for females and 63.1 years for males.

The findings revealed that obesity was associated with an elevated risk of 18 cancers (16 in females and 15 in males) relative to normal weight or per a 5 kg/m² increase in BMI. Importantly, these cancers had not previously been established as obesity-related and accounted for 15% of all cancer cases identified in the study.

For females, these potential obesity-related cancers included those of the cervix, vulva, head and neck (specifically squamous cell carcinoma), and nodular melanoma. For males, the study identified cancers of the penis, head and neck (particularly adenocarcinoma), and malignant melanoma. Moreover, both sexes exhibited increased risks for cancers of the small intestine, stomach, oral cavity, paranasal and nasal sinuses, biliary tract, adrenal glands, pituitary gland, pancreatic islets, connective tissue, parathyroid gland, and both myeloid and lymphoid neoplasms.

Interestingly, there were notable sex-based interactions in the risk of certain cancers, including malignant melanoma, lymphoid neoplasms, and cancers of the lip, head and neck, tongue, and connective tissue. Additionally, specific subtypes of some potential obesity-related cancers demonstrated a stronger association with BMI than others. When smoking was considered, the association between BMI and some cancers persisted, while it weakened for others.

Beyond these newly identified cancers, obesity was also linked to an increased risk of all established obesity-related cancers, which constituted a quarter of all cases. The hazard ratios for these established and potential obesity-related cancers were 1.17 and 1.24 in males and 1.13 and 1.12 in females, respectively.

The absolute risk of developing a potential obesity-related cancer by the age of 80 was 5.7% for males with obesity and 5.5% for those with normal weight. In females, the corresponding risks were 4.2% for those with obesity and 3.5% for those with normal weight. When considering both established and potential obesity-related cancers, the combined risk by age 80 was 14.2% for males with obesity compared to 12% for those with normal weight, and 18.7% for females with obesity compared to 16.3% for those with normal weight.

In summary, this study has significantly expanded the list of cancers potentially linked to obesity, identifying 18 new cancers across various organ systems, including the gastrointestinal tract, endocrine organs, head and neck, genitals, and haematological malignancies. While the association between BMI and these newly identified cancers was somewhat weaker in males compared to the established obesity-related cancers, it was comparable in females. The findings underscore the need for further studies that account for cancer-specific confounders to validate these associations and deepen our understanding of the complex relationship between obesity and cancer.

The impact of high-protein diets on weight, energy, and blood sugar regulation

Over the past two decades, there has been a marked increase in interest surrounding the role of dietary protein in enhancing health outcomes. This heightened attention is largely driven by growing evidence that links protein intake with a variety of metabolic benefits. A recent comprehensive review published in Frontiers in Endocrinology delves into the effects of dietary protein on energy intake, appetite regulation, and postprandial blood sugar levels, offering valuable insights into both the short-term and long-term impacts of protein consumption.

Immediate Effects of Protein Consumption

Current research suggests that high-protein diets play a significant role in promoting weight loss, reducing weight gain, and improving glycaemic control. One of the key benefits of protein intake is its ability to lower postprandial (after eating) blood sugar levels and suppress energy intake. These effects are thought to be linked to protein’s capacity to stimulate gastrointestinal (GI) hormones and other post-absorptive mechanisms. Additionally, protein consumption has been shown to reduce hunger and increase feelings of fullness, with these effects being dose-dependent in both healthy and obese individuals.

A notable meta-analysis has highlighted the ability of protein-rich diets to reduce hunger, lower food intake, and diminish the desire to eat, while simultaneously increasing feelings of fullness. This reduction in postprandial blood sugar levels is one of the mechanisms through which protein aids in appetite control. However, it is important to note that the benefits of increased protein consumption may only last for a period of six to twelve months.

Comparative studies on various protein sources have produced interesting findings. For example, preloads containing milk proteins such as casein or whey, as well as proteins from turkey, egg, tuna, or soy, have been evaluated for their effects on satiety and blood sugar regulation. Among these, whey protein has been found to have the most profound impact on reducing blood sugar levels, although some studies suggest that it might be less satiating than other proteins. Nevertheless, milk proteins have consistently demonstrated a stronger ability to lower blood glucose compared to proteins derived from peas, eggs, or fish.

The digestion of proteins and their by-products stimulates the release of GI hormones such as incretins, cholecystokinin (CCK), glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and peptide tyrosine-tyrosine. These hormones are crucial in the regulation of postprandial blood sugar levels as they are transported to peripheral organs where they increase pyloric pressure and insulin secretion. This, in turn, helps to reduce blood sugar levels after meals.

The effects of different proteins on GI functions also vary, with whey protein generally showing greater efficacy than other sources. For instance, a study involving intraduodenal (directly into the duodenum) infusion of whey protein revealed a dose-dependent stimulation of plasma CCK, GLP-1, and pyloric pressures in both lean and obese participants. The high content of branched-chain amino acids, particularly isoleucine and leucine, in whey protein is thought to contribute significantly to its ability to reduce glycaemia and energy intake.

Medium- and Long-Term Effects

The impact of high-protein diets on weight loss has been extensively studied, particularly through ad libitum (eating at one’s own discretion) and energy-restricted dietary interventions. Regardless of the method employed, diets rich in protein have consistently led to greater weight loss compared to standard diets, especially in interventions lasting up to six months. Interestingly, ad libitum high-protein diets appear to be particularly effective.

A meta-analysis of 24 clinical trials observed a modest but significantly greater reduction in body weight and fat mass with an isocaloric energy-restricted high-protein diet compared to a standard diet over an average period of 12 weeks. Another meta-analysis, encompassing 74 trials, reported reductions in body weight, waist circumference, and body mass index (BMI) following six months on a high-protein diet.

However, the long-term effects of high-protein diets remain less clear, as studies extending beyond one year are limited. For instance, a meta-analysis of 15 clinical trials with interventions lasting at least 12 months found no clear benefits or detriments associated with high-protein intake concerning sustained weight loss. One 12-month study did observe modest improvements in weight maintenance with a high-protein diet compared to diets high in fat or carbohydrates, but the overall evidence remains inconclusive.

Plant Versus Animal Protein

The source of dietary protein—whether plant-based or animal-based—also plays a crucial role in determining health outcomes. Numerous studies have indicated that consuming large amounts of animal protein may increase the risk of developing diabetes, while plant proteins tend to offer protective effects.

Epidemiological studies consistently show a correlation between high animal protein intake, weight gain, and an elevated risk of obesity. For example, one study found that higher daily consumption of total and animal protein, predominantly sourced from chicken and red meat, was associated with significant weight gain over a period of 6.5 years.

In contrast, plant protein consumption has not been linked to either protective or adverse outcomes. In a study investigating the relationship between different protein sources and long-term weight gain across three cohorts, animal proteins were independently associated with weight gain over four years, whereas plant proteins were linked to weight loss.

Moreover, long-term consumption of animal proteins has been frequently associated with an increased risk of diabetes, while plant proteins appear to have neutral or even protective effects. The mechanisms underlying these differences are not entirely understood, but they may involve factors such as the glycaemic load, amino acid composition, and the insulinotropic (insulin-stimulating) effects of animal proteins, which could contribute to the beneficial effects observed with plant protein consumption.

Conclusion

There is substantial evidence supporting the role of increased protein intake in improving glycaemic control and promoting weight loss, particularly in the context of high-protein diets. However, the long-term health benefits of such diets are not yet fully understood, and more comprehensive, longitudinal studies involving diverse populations are needed to draw definitive conclusions. As research continues to evolve, it is clear that both the quantity and source of dietary protein are critical factors in determining the overall impact on health.

Children with obesity more likely to develop immune-related skin conditions

New research highlights the significant link between childhood obesity and the increased likelihood of developing immune-mediated skin diseases (IMSDs), including conditions such as alopecia areata, atopic dermatitis, and psoriasis. The study underscores the importance of maintaining a healthy weight in childhood as a potential preventative measure against these skin conditions.

The findings, published in the Journal of Investigative Dermatology, are based on an extensive analysis of 2,161,900 Korean children tracked from 2009 to 2020. The study aimed to explore the relationship between obesity, dynamic changes in body weight, and the development of IMSDs over time.

IMSDs can have profound impacts on the quality of life, affecting children’s emotional, physical, social, and functional well-being, as well as that of their families. Although some biologics have shown promise in treating conditions like atopic dermatitis and psoriasis in children, there remains a dearth of effective treatment options. Furthermore, the lack of clinical trials for systemic therapies continues to pose significant challenges in managing IMSDs in paediatric populations.

In recent years, childhood obesity rates have risen sharply, exacerbating what has now become a pressing public health issue. The COVID-19 pandemic and associated lockdowns have further compounded this crisis. Despite the clear association between obesity and chronic inflammatory skin diseases, such as psoriasis and atopic dermatitis, the exact mechanisms through which obesity contributes to these conditions remain unclear.

Dr Seong Rae Kim, MD, Co-lead investigator of the study from the Department of Dermatology at Seoul National University College of Medicine, Seoul, Republic of Korea, explained, “Previously, many studies have looked at the link between childhood obesity and IMSDs. However, most of these studies only looked at data from one point in time or compared groups with and without the condition (i.e., obesity or overweight), and they had small sample sizes. Very few studies have followed children over a long period to see how their body weight affects the development of these skin conditions. This means we still don’t know for sure whether having obesity or overweight causes atopic dermatitis and psoriasis or if the opposite is true. Also, no studies have yet looked at the effect of body weight on alopecia areata or how dynamic changes in a child’s weight affect development of common IMSDs.”

The study stands out due to its scale and comprehensive approach, following children longitudinally to assess how fluctuations in body weight influence the risk of developing IMSDs. This extensive dataset, drawn from a national database covering nearly all infants and children in Korea, provided researchers with a unique opportunity to gain insights into the complex relationship between weight and skin health.

Dr Hyunsun Park, MD, Ph.D., another co-lead investigator from the same institution and a member of the Laboratory of Intestinal Mucosa and Skin Immunology, elaborated on the team’s broader research interests, stating, “Our research team is very interested in the skin-gut axis. We think that various factors, including diet, obesity, or other lifestyles can affect the gut environment and contribute to the development of IMSDs. We are trying to find the puzzle pieces to demonstrate how they are connected, and our current research is a step towards that understanding. We conducted a large study using data from a national database in Korea, which includes information on almost all infants and children across the country. Our goal was to see how a child’s weight and changes in their weight are related to the development of alopecia areata, atopic dermatitis, and psoriasis.”

The study’s results were telling. It was found that children with obesity had a higher likelihood of developing IMSDs compared to their peers of normal weight. Atopic dermatitis, in particular, showed the most significant association with changes in body weight. Children who transitioned from a normal weight to being overweight were at an elevated risk of developing atopic dermatitis. Conversely, those who managed to reduce their weight from overweight to normal had a reduced risk of developing the condition compared to children who remained overweight.

Dr Seong-Joon Koh, MD, Ph.D., another co-lead investigator from the Department of Internal Medicine and Liver Research Institute at Seoul National University College of Medicine, as well as the Laboratory of Intestinal Mucosa and Skin Immunology, concluded, “Our findings support the importance of promoting weight maintenance among children who are already within the normal weight range because it may help reduce the risk of developing atopic dermatitis. In addition, prevention of excessive weight gain and purposeful weight loss, including adopting healthy diet strategies in children with obesity to prevent atopic dermatitis, particularly before school age, should be promoted. Implementing purposeful interventions, including nutritional strategies, to decrease body weight may aid in reducing the risk of developing IMSDs in children.”

This study offers crucial insights that could influence public health strategies and clinical practices, advocating for early interventions in managing childhood obesity as a means to reduce the burden of IMSDs. The research underscores the need for continued exploration into the connections between body weight, lifestyle factors, and immune-mediated skin diseases to better understand how to prevent and treat these conditions effectively.