Increased risk of obesity and high blood sugar in children linked to prenatal cannabis exposure
A newly conducted study suggests that the use of cannabis during pregnancy may heighten the likelihood of children developing obesity or experiencing elevated blood sugar levels by the age of five.
Products containing non-psychoactive cannabidiol (CBD) or the psychoactive compound tetrahydrocannabinol (THC) are often employed by pregnant women to mitigate symptoms such as morning sickness, anxiety, post-traumatic stress disorder (PTSD), insomnia, and pain.
However, the study establishes a correlation between the exposure to such compounds during pregnancy and breastfeeding, and “increased percentages of fat mass and fasting glucose levels” in children upon their entry into school.
Brianna Moore, an assistant professor of epidemiology at the University of Colorado, who focuses her research on how early-life exposure to tobacco and cannabis impacts children’s growth and brain development, is the author of the study. Moore advises women to “avoid all forms of cannabis while pregnant or breastfeeding in order to minimise potential adverse health outcomes in their children.”
The research team analysed urine samples from 103 pregnant women, revealing that 15% of the women had detectable cannabinoid compounds in their bodies.
The findings show that the five-year-old children of these mothers had greater fat mass and fasting glucose levels compared to children whose mothers did not use cannabis during pregnancy.
Cannabis is known to contain over 100 cannabinoids, with CBD and THC being the most widely recognized. According to Dr. Moore, further studies are required to explore the effects of the other compounds on babies exposed to them during gestation and through breastfeeding.
In a separate 2016 study conducted in Colorado, it was discovered that up to 22% of pregnant women exhibited detectable cannabinoid levels in their bodies.
Earlier studies have also indicated that women who use CBD and THC during pregnancy not only increase the risk of their children having low birth weights and behavioural issues but are also doubling the likelihood of premature birth. Additionally, cannabis use during pregnancy has been associated with a higher prevalence of “psychotic-like” behaviours in nine-year-old children, as per other studies conducted in 2019 and 2020.
The research, titled ‘Fetal Exposure to Cannabis and Childhood Metabolic Outcomes: The Healthy Start Study’, is available in the Journal of Clinical Endocrinology and Metabolism published by the Endocrine Society.
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Obesity associated with diminished bone strength, particularly in men
Despite the protective implication often associated with high body weight in terms of fracture risk, recent studies suggest that obesity may in fact raise the risk of fractures, particularly in men with high body fat content.
A comprehensive examination of dual x-ray absorptiometry (DXA) data from a broad spectrum of over 10,000 U.S. individuals revealed an intricate connection between body weight and bone density. Dr. Rajesh Jain and Dr. Tamara Vokes, both from the University of Chicago, discussed these complex findings in the Journal of Clinical Endocrinology & Metabolism.
The duo discovered that each 1 kg/m2 increase in lean mass index correlated with a 0.19 higher T-score in people below 60 years of age. However, every corresponding increase in fat mass index was associated with a 0.10 decline in T-score, with a significant statistical difference (P<0.001).
Their research indicated that while lean mass positively impacted bone mineral density (BMD) equivalently in both genders, the deleterious effect of fat mass was more pronounced in men, leading to a 0.13 lower T-score per additional 1 kg/m2, compared to a 0.08 drop in women (P<0.001 for interaction).
“Our analysis of a large, heterogeneous population presenting a wide range of BMI indicated a clear negative correlation between bone density and fat mass, and a positive correlation with lean mass,” Jain and Vokes stated.
The researchers highlighted that despite lean mass exhibiting a stronger overall impact than fat mass, the detrimental effects of fat on BMD were significantly more evident in men and individuals with excessive fat content.
These insights hold critical clinical implications as they suggest obesity could contribute to declining BMD in patients traditionally not perceived as high fracture risk, and who therefore might not typically undergo DXA screening.
Contrasting previous studies constrained by small sample sizes or referral bias, Jain and Vokes’ findings reflect broader U.S. population data. They emphasise that obesity does not provide immunity against low BMD, advocating for clinicians to assess bone density, especially when other risk factors are present.
To reach their conclusions, the researchers assessed data from the National Health and Nutrition Examination Surveys conducted from 2011 to 2018. This dataset encompassed body composition and DXA measurements for 10,814 individuals aged 20 to 59.
Using linear regression models with total body BMD as the dependent variable, the researchers scrutinised the impact of lean and fat mass, accounting for age, gender, race/ethnicity, height, and smoking status. Notably, they highlighted the challenge of disentangling the interconnected influences of fat and lean mass on bone density.
Prior studies exploring the impact of fat mass on bone density reported varying results due to differing statistical methods and are somewhat outdated, the researchers pointed out. Moreover, the current study benefited from a densitometer with a higher weight limit, allowing for the examination of more severe obesity cases.
However, the study had limitations, including its focus on adults below 60 years, leaving room for potentially different body composition and bone mass relationships in older individuals. It also didn’t evaluate factors besides sex hormones that might elucidate the observed gender differences in the link between fat mass and bone density.
Despite women generally having a higher proportion of body fat, fat accumulation patterns differ by gender, with women typically storing fat in the hip and thigh areas, and men in the trunk and abdomen. Jain and Vokes acknowledged that differences in fat distribution might influence BMD, although their study could not conclusively prove this.
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Caesarean births linked to higher childhood obesity risk, Japanese study finds
A recent scientific study published in the journal Scientific Reports explores the potential impact of Caesarean section (CS) delivery on the incidence of obesity among three-year-old Japanese children.
Childhood obesity is a growing global health issue, as it can often persist into adulthood and raise the risk of various cardiometabolic disorders. Prior research has suggested that children born via CS may have a higher likelihood of obesity, potentially due to disturbances in their gut microbiomes. These children have been found to exhibit lower adiponectin levels and greater insulin resistance.
While ethnicity and race are also factors in the prevalence of paediatric obesity, with Asian children reportedly at a higher risk than their White and European counterparts, the correlation between CS birth and childhood obesity in the Japanese population remains relatively unexplored.
The objective of this study was to investigate this correlation, which could aid in the early identification of children at risk of adult obesity, thereby enabling early intervention through weight management programs.
For the study, the research team analysed data from 60,769 Japanese mother-child pairs participating in the national Japan Environment and Children’s Study (JECS). The mode of delivery was determined from health records, while anthropometric data was gathered through online questionnaires completed by the participants themselves.
The researchers identified obesity in children using the body mass index (BMI) cut-off values defined by the International Obesity Task Force guidelines, and only included children from singleton births in the analysis. The study excluded any multiple participations, multiple births, stillbirths or miscarriages, or any data with missing information related to height and/or weight, mode of delivery, and other covariates.
The researchers used logistic regression analysis and estimated adjusted risk ratios (aRR), taking into account various maternal and paediatric factors. They also conducted a sensitivity analysis using the obesity thresholds provided by the Japanese Association for Human Auxology guidelines.
The study found that 19% of the children were born via CS, with 8% classified as having obesity. The aRR for obesity in three-year-old Japanese children born through CS was 1.2 compared to those born via vaginal delivery. When the data was stratified by sex, the aRR values were 1.1 for boys and 1.2 for girls.
The sensitivity analysis corroborated these findings, with the risk of childhood obesity remaining statistically significant for Japanese girls. This aligns with previous studies that have reported an increased risk of certain cancers in females born through CS.
The data also revealed that children born via CS had lower birth weights and heights and were more likely to be born before 37 weeks of gestation. Mothers who had a CS were generally older, had higher pre-pregnancy BMIs, were less educated, and had a higher rate of pregnancy-related and obstetric complications. They were also more likely to smoke, suffer from physical illnesses, and use assisted reproductive technology.
In conclusion, the study suggests that CS births slightly heighten the risk of obesity at age three for both boys and girls in the Japanese population. This indicates that the mode of delivery may influence metabolic health, even among ethnic groups that are typically less prone to obesity. Factors such as maternal pre-pregnancy BMI, education level, and the child’s birth weight appeared to confound this relationship.
The study emphasises the need for further research to understand the mechanisms underlying the increased risk of paediatric obesity associated with CS delivery, including the possible association with gut microbiota. Moreover, the long-term cardiometabolic impacts of CS delivery should be further investigated.
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Study finds boys with obesity at higher risk of becoming infertile men
Italian researchers have discovered a potential link between obesity in boys and reduced testicle size, which may increase the risk of infertility in these young men later in life.
The study included boys aged 2 to 18 who were recommended to the Pediatric Endocrinology Unit at the University of Catania in Sicily for weight management. The researchers observed that boys with normal insulin levels displayed up to double the testicular volume in comparison to boys with high insulin levels.
Boys who had overweight or obesity and displayed hyperinsulinemia, or insulin resistance, generally had smaller testicles than other boys, according to the researchers. This condition, referred to as “testicular hypotrophy,” is known to elevate the risk of infertility in males.
Dr. Alex Robles, a fertility specialist at the Columbia University Fertility Center in New York, explained to Medical News Today that testicular volume is directly linked to semen profiles and is generally a reliable indicator of hormonal function. He added that infertile men typically have a smaller testicular volume compared to fertile men. This is also seen in men who consume exogenous anabolic steroids, leading to a reduction in the production of endogenous testosterone, testicular size, and sperm production.
Co-author of the study, Rossella Cannarella, a research assistant at the University of Catania in Italy, noted that the impact of obesity and related metabolic disorders on testicular growth is not thoroughly understood, despite the global rise in childhood obesity. The study, published in the European Journal of Endocrinology, found that having overweight or obesity was associated with a decrease in testicular volume during peri-puberty. Additionally, obesity-related conditions like hyperinsulinemia and insulin resistance were found to affect testicular volume both before and after puberty.
Cannarella suggests that more careful management of body weight during childhood could be a preventive strategy for preserving testicular function in adulthood.
Male infertility is believed to contribute to approximately half of all cases of couple infertility, but the causes often remain unknown. Research has shown a decrease in sperm concentration and count over the past four decades, while childhood obesity rates have increased dramatically. It is estimated that by age 35, 60% of children aged 2 to 19 will have obesity.
Dr. Robles also highlighted the significant connection between obesity and fertility issues, particularly in women. Obesity can disrupt the hormonal balance needed for egg growth, development, and ovulation. Similarly, in men, obesity can interfere with the hormones that assist in testosterone production by the testicles. Low testosterone is linked to reduced sperm production and quality.
However, Dr. Jagdish Khubchandani, a professor of public health at New Mexico State University, warned that while the study showed promise in highlighting the connection between obesity, metabolism, and testicular volume, it had limitations. The study was cross-sectional with a small population, so it could not establish a cause-and-effect relationship between testicular size, obesity, and risk of infertility.
Dr. Khubchandani emphasised that although there is a correlation between the global rise in obesity and the decline in sperm count, it doesn’t necessarily mean the two are directly linked. Factors such as diet and environment could independently influence obesity, metabolism, and reproductive health.
Dr. Robles agreed that while the findings of the retrospective review are plausible given the known impacts of obesity on hormonal regulation and testosterone levels, more research is necessary to determine if weight loss is an effective treatment for improving testicular volume. Previous research suggests that weight loss can improve hormonal health in men with obesity by restoring natural testosterone levels, which can subsequently increase testicular volume and sperm production.
Dr. Khubchandani highlighted the importance of early childhood interventions to address many health issues linked to obesity, including those discussed in this study. He added that obesity is a global pandemic and a leading cause of numerous health problems worldwide.
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Bariatric surgery associated with over 50% reduction in cancer risk for individuals with obesity
Bariatric surgery could considerably decrease the risk of cancers related to obesity, such as those of the breast, colon, liver, pancreas, ovaries, and thyroid, in patients with obesity.
“Bariatric surgery, which includes sleeve gastrectomy, gastric bypass, and gastric band procedures, is the principal method for significant weight loss in individuals with obesity,” stated Dr. Vibhu Chittajallu, a gastroenterology fellow at Case Western Reserve University and University Hospitals Cleveland Medical Center, during a Digestive Disease Week media briefing. He highlighted that these procedures offer benefits beyond weight loss, such as enhancements in patients’ mental and physical well-being.
Chittajallu further added, “Emerging evidence suggests that the substantial weight reduction linked with bariatric surgery may also provide a protective shield against the development of cancers associated with obesity. My team and I decided to delve deeper into this trend.”
Chittajallu and his team used TriNetX, a database involving 47 U.S. healthcare institutions and over 107 million patients, to conduct a retrospective study from 2002 to 2022. They singled out adults with a Body Mass Index (BMI) over 35 who underwent bariatric surgery, comparing them with patients with obesity who didn’t have the surgery. The study accounted for risk factors like smoking history, alcohol use, heart disease, hormone therapies, and cancer-screening tests, including 55,789 individuals in each group.
The researchers also used the International Agency for Research on Cancer to identify cancers with “sufficient” evidence of a connection to obesity. This included esophageal adenocarcinoma, multiple myeloma, and cancers of the kidney, colon, rectum, stomach, liver, gallbladder, pancreas, ovary, endometrium, breast, and thyroid.
The results revealed that after ten years, the cumulative occurrence of obesity-related cancer was 4% (n = 2,206) in the bariatric surgery group and 8.9% (n = 4,960) in the nonsurgical control group (HR = 0.482; 95% CI, 0.459-0.507).
Chittajallu pointed out that the bariatric surgery group consistently exhibited lower numbers of new cases for all types of obesity-related cancers, including those of the breast, colon, liver, pancreas, ovaries, and thyroid.
“Although more research is required to fully understand the impact of bariatric surgery on cancer risk,” Chittajallu concluded, “our findings indicate that bariatric surgery is a promising area to investigate.”
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High obesity-related cancer mortality linked to easy access to fast food
Obesity has been a significant contributor to various health issues, including cancer. A recent cross-sectional study published in JAMA Oncology highlights the role of food environments in obesity-related cancer mortality. Communities with easy access to fast food were found to be 77% more likely to have high levels of obesity-related cancer mortality.
Researchers led by Dr. Malcolm Seth Bevel from the Medical College of Georgia analysed food access and cancer mortality data from over 3,000 counties in the United States. The study aimed to understand the association between food deserts (areas with limited access to grocery stores and healthy food options) and food swamps (areas with easy access to convenience stores and fast food) and obesity-related cancer mortality rates.
Using data from the U.S. Department of Agriculture Food Environment Atlas and the Centers for Disease Control and Prevention, the researchers calculated food desert and food swamp scores for each county. A higher score indicated fewer healthy food resources in the area.
The primary outcome of the study was obesity-related cancer mortality, defined as either high or low (71.8 or higher per 100,000 individuals and less than 71.8 per 100,000 individuals, respectively). The results showed that counties with high food swamp scores (easy access to fast food) were 77% more likely to have high rates of obesity-related cancer mortality.
Further analysis revealed a positive dose-response relationship between food desert scores, food swamp scores, and obesity-related cancer mortality rates. Counties with high rates of obesity-related cancer mortality also had a higher percentage of non-Hispanic Black residents, higher percentage of adults older than 65 years, higher rates of adult obesity, and higher rates of adult diabetes.
The study demonstrates the significant impact of food environments on obesity-related cancer mortality rates. Communities with easy access to fast food have a considerably higher risk of obesity-related cancer deaths. The findings emphasise the importance of promoting healthier food environments and improving access to nutritious food options in order to reduce obesity and its associated health risks, including cancer.
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Chronic inflammation may explain why some mothers with obesity struggle with low milk production
A recent study published in The Journal of Nutrition has revealed that inflammation in lactating mothers who have obesity may interfere with the transfer of circulating fatty acids to the mammary gland, resulting in low milk production.
Obesity is associated with chronic inflammation and is a risk factor for insufficient milk production. Inflammation-mediated enzymes have been shown to suppress the uptake of fatty acids from the blood by body tissues, leading to high blood lipid concentrations. Fatty acids are critical for supporting milk production in the mammary gland, and therefore, inflammation could negatively impact milk production through this pathway. To test this hypothesis, a team of researchers led by Rachel Walker, a USDA-funded post-doctoral fellow, analysed blood, milk fatty acid profiles, and inflammatory markers from lactating women. The study included 23 women with very low milk production despite frequent breast emptying, 20 with moderate milk production, and 18 exclusively breastfeeding controls.
The researchers found that mothers with very low milk production had significantly higher obesity and inflammatory biomarkers, lower proportions of long chain fatty acids in milk, and a disrupted association between blood and milk fatty acids, compared to those with moderate milk production and exclusively breastfeeding controls. While milk and blood fatty acids were strongly correlated in controls, this was not the case in the very low or moderate milk production groups. These findings support the hypothesis that inflammation and obesity disrupt the transfer of fatty acids from circulation to the mammary gland, potentially contributing to insufficient milk production in women with obesity.
The study suggests the need for further investigation into the transfer of fatty acids to milk and its relationship with milk volume. The findings are of significant importance as it has been known for decades that mothers with obesity are at an increased risk of shortened breastfeeding duration. This study provides important new evidence that physiological differences, such as chronic inflammation, may contribute to some mothers’ struggles with milk production.
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Men and women have different obesity drivers, pointing to the need for tailored interventions
A recent study conducted by researchers from UCLA has found sex-specific brain signals that may indicate why men and women develop obesity differently. Published in the journal Brain Communications, the study combined data from multiple modes of MRI imaging with clinical features and personal histories of patients to identify sex-specific mechanisms in the brain associated with obesity. The study aims to help tailor obesity interventions based on an individual’s sex.
The researchers analysed data from 183 participants aged between 18 and 55, which included 42 males with a non-obese BMI, 23 males with a high BMI, 63 females with a non-obese BMI, and 55 females with a high BMI. All participants completed a battery of self-report questionnaires that assessed various factors, including childhood trauma, anxiety and depression, visceral sensitivity, food addiction, bowel symptoms, and personality traits.
The researchers conducted three different brain MRIs to assess the structure, function, and connectivity of each participant’s brain. They then analysed the data sets from the three scans, along with clinical information, using an analytical tool to identify a limited number of variables from multiple data sets to predict an outcome.
The results of the study showed that specific network connectivity changes were associated with high BMI, regardless of sex. The researchers also found that in females, brain regions and networks had alterations associated with early life trauma, consistent with previous studies that showed that females with obesity may have greater anxiety, lower resilience, and difficulty integrating emotions with action-directed goal planning. The study also revealed that females may be more susceptible to the sight, smell, and taste of highly processed foods.
According to the researchers, the study’s results suggest that tailoring treatment plans for females with a high BMI should focus on emotional regulation techniques and vulnerability factors. However, they note that the study identified associations, not cause and effect. Future studies are needed to determine whether changes in the brain are a factor in the development of obesity or a result of the condition. The study builds on previous research that examined sex-related differences in the prominence and signalling of brain regions in obesity, which showed that women’s obesity was associated with emotion-related and compulsive eating, while men’s eating behaviour tended to be affected by a greater awareness of gut sensations and visceral responses.
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Mediterranean diet linked to fewer signs of Alzheimer’s disease
According to a recent study, following a diet rich in leafy green vegetables, whole grains, nuts, and fish could result in fewer signs of Alzheimer’s disease. The study found that older adults who followed the MIND and Mediterranean diets had fewer amyloid plaques and tau tangles in their brains. While researchers are yet to establish a cause-and-effect relationship, the study showed that consuming specific foods can enhance brain health.
Individuals following the Mediterranean diet had levels of plaque and tangles in their brains similar to that of people 18 years younger than those who consumed the least brain-healthy foods. For those following the MIND diet, the figure was 12 years younger.
The Mediterranean diet contains food items from countries bordering the Mediterranean Sea, such as Italy, Greece, Cyprus, and Spain, including olive oil, dairy products, poultry, fish, fruits, vegetables, whole grains, legumes, nuts, and seeds.
The MIND diet, on the other hand, combines the DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets. It promotes eating leafy green vegetables, berries, nuts, and whole grains. It is also recommended to consume at least one serving of fish per week.
The study involved 581 older adults who agreed to donate their brains for research after death. Before dying, 39% were diagnosed with dementia, and after death, 66% met the criteria for Alzheimer’s disease. Participants completed yearly questionnaires about their eating habits, which were analysed and scored based on the type and quality of the food they consumed.
One of the most noteworthy findings of the study was that consuming green leafy vegetables corresponded to a lower amount of plaque in the brain, almost 19 years younger than those who ate less. However, researchers could not establish a direct relationship between a healthy diet and fewer brain deposits of amyloid plaques, known as an indicator of Alzheimer’s disease.
Dr. Puja Agarwal, a study author, said that improvement in people’s diets in one area, such as eating green leafy vegetables or not consuming fried foods, was associated with fewer amyloid plaques in the brain, similar to being around four years younger. The study provides evidence for a real food approach to eating, which focuses on natural, unprocessed or minimally processed foods while reducing processed or ultra-processed foods.
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Obesity in childhood and puberty linked to higher risk of blood clots in later life
According to a new study by the University of Gothenburg, being overweight during childhood and early adulthood increases the risk of developing blood clots in later years. The study analysed the health data of 37,000 men and their early body mass index (BMI) and any blood clots that developed as they got older. The researchers found that both overweight in childhood and overweight in young adulthood increased the risk of venous blood clots later in life, with overweight in young adulthood proving to be a more influential factor than childhood overweight. While most blood clots occur in the legs and are not dangerous, they can become life-threatening if they travel to the lungs and cause a pulmonary embolism.
The link between obesity and blood clots is already well known, but the impact of a higher BMI in childhood on the risk was unclear. The researchers examined the data of a large group of men in Sweden who were born between 1945 and 1961, looking at school records at age 8 and Armed Forces medical examinations at age 20 to establish BMI data. They then looked at blood clot data on the men up to an average age of 62.
The study found that BMI at both age 8 and age 20 can be linked to blood clots independently of each other. As adults, the researchers found that two groups were more at risk – those who had been overweight both as a child and in early adulthood, and those with a normal weight in childhood but who became overweight in early adulthood. In addition, the study found that carrying excess weight in both childhood and early adulthood increased a person’s risk of arterial thrombi, which are clots that result from constricted blood vessels with fatty deposits. However, the researchers noted that more research is needed in this area as they only found a small number of cases.
The study’s senior authors emphasised that obesity and overweight during puberty seem to have a marked impact on a person’s future risks of venous thrombi. The study has been published in the Journal of Internal Medicine.
Common painkillers linked with heart failure in people with type 2 diabetes
A recent study published in the Journal of the American College of Cardiology suggests that the use of common pain medications such as Advil or Motrin (ibuprofen) may increase the risk of heart failure in people with type 2 diabetes. The study found that NSAIDs (nonsteroidal anti-inflammatory drugs) may lead to first-time hospitalisation for heart failure in patients with type 2 diabetes. This is noteworthy, as these individuals are already known to face an elevated risk of heart failure.
The Danish study included more than 330,000 individuals with type 2 diabetes, of whom 1 in 6 filled at least one NSAID prescription within a year. During a follow-up of almost six years, more than 23,000 subjects were hospitalised with heart failure for the first time, and NSAID use was associated with a 40 percent higher relative risk of first-time heart failure hospitalisation. Ibuprofen and diclofenac were found to increase the risk of heart failure hospitalisation, but not celecoxib and naproxen. There was no association of NSAID use and increased risk in people with well-controlled diabetes. Strong associations were found in people aged 65 and older, while no association was found in those younger than 65. The strongest association was found in very infrequent or new users of NSAIDs. The study highlights the need for education in patients with cardiac risk factors, such as diabetes, on the dangers of over-the-counter medications.
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Obesity can lead to frailty in old age, study finds
A new study has found that adults with obesity are at greater risk of experiencing frailty in later life than adults with an average body mass index (BMI).
Researchers conducted a long-term study on adult men and women in Norway and discovered that obesity puts individuals at risk of becoming frail as they age. Frailty is characterised by physical deterioration and increased vulnerability, and while it has been associated with underweight older adults, the study reveals a positive association between obesity and the risk of frailty among older adults.
The study, published in the BMJ Open journal, analysed the body mass index and waist circumference of 2,340 women and 2,169 men over the age of 45 between 1994 and 1995. The participants were followed up for a period of 21 years to determine their risk of frailty. The researchers defined physical frailty as having three or more symptoms including poor grip strength, slow walking speed, exhaustion, unintentional weight loss, and low physical activity.
The findings show that participants with “baseline obesity” were more likely to be frail or pre-frail compared to those with an average BMI. Additionally, those with high waist circumference throughout follow-up were also more likely to be pre-frail or frail compared to participants with a stable normal waist circumference trajectory. Excess weight exacerbating the decline in muscle strength and physical capacity that occurs with age, along with metabolic disorders, inflammaging, and oxidative stress associated with obesity, could contribute to the risk of frailty.
The study’s lead author, Dr. Anju Jain, emphasised the importance of early intervention to prevent and treat obesity. She noted that while weight loss can be challenging, it is possible and can have significant health benefits. She also called for more public health efforts to promote healthy eating and physical activity throughout life.
The researchers caution against viewing frailty as solely a wasting disorder and highlight the importance of routinely assessing and maintaining optimal BMI and waist circumference throughout adulthood to reduce the risk of frailty in later life.
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