Search Results (110)

Type 2 diabetes (T2D) constitutes a major health problem, reaching alarming rates over the last decades, especially due to contemporary lifestyle and associated obesogenic environments, as well as the aging population. Diabetes not only causes social consequences but also leads to increasing healthcare costs, posing a significant challenge for the health system. This paper applies a five-step approach for estimating T2D-related costs in Greece. The approach initially estimates the T2D-related ICD10 prevalence and the target population. Next it applies the appropriate therapeutic protocols to identify the most appropriate treatments. Subsequently, it calculates the total cost of medical treatments for each target population, based on the distribution of patients between the different treatments and treatment lines. Finally, based on the diagnostic and treatment protocols, it calculates the annual direct costs associated with the cost categories. Using the estimated future population of the country, the proposed methodology can also project the budget required, under certain conditions, to deal with T2D. The analysis estimated that T2D-related costs in 2021 under rational use of resources were EUR 1,397,871,172.55 billion and EUR 1,512,934,947.63 billion projected in the year 2030 considering the aging effect, per cost category, and in total, presenting an increase of approximately 115 million euros in 2030 compared to 2021. The term “rational use of resources” in this study refers to the use of internationally recognized, evidence-based diagnostic and therapeutic protocols, as adopted by the Greek Ministry of Health. This scenario represents an idealized standard of care rather than actual real-world adherence and is used to estimate the potential resource needs under optimal medical practice conditions. An inflation rate of 4.2% was applied to costs between 2021 and 2030. The analysis showed that the highest percentage (39%) of the total T2D-related healthcare expenditures is associated with complications that occur in T2D patients. Despite a comparatively modest prevalence of T2D in Greece relative to other European and Mediterranean countries, the economic burden associated with its management remains high. The aging of the population will lead to an increase in the total cost of T2D. The applied methodology of estimating budgets by aggregating categories of expenses under a specific disease (ICD10), instead of dividing budgets into categories of expenses, can successfully lead to the optimization and rationalization of expenses according to actual needs. The findings underline the significant economic burden of T2D in Greece, particularly due to complications and population aging. These results emphasize the urgent need for health policy strategies focusing on prevention, early intervention, and the efficient allocation of healthcare resources. The methodology applied can serve as a decision-making tool for forecasting healthcare budgets and optimizing expenditures under different population and treatment scenarios. Full article

Background/Objectives: Policy implementers play a crucial role in the effective delivery of policies aiming at promoting a healthy lifestyle in the most vulnerable populations. This study aimed to explore (a) policy implementers’ knowledge and perceptions of the policy framework promoting physical activity and healthy nutrition among children in need in Greece, and (b) self-perceived barriers and facilitators of the framework implementation. The term children in need refers to children who are at risk of poverty and/or social exclusion. Methods: A qualitative study design was employed consisting of semi-structured interviews with 25 policy implementers, who represented four delivery systems (health, social protection, food, and education sectors) from three geographical regions in Greece. Interviews were completed between November and December 2023. Thematic analysis was conducted using inductive and deductive approaches to identify key themes, following data management in the N-VIVO 14 software. Results: Commonly mentioned policies that study participants were involved in included school- and/or community-level-based behavioral interventions. Participants perceived policy implementation efforts that often relied on individual initiatives as inconsistent. Most participants argued that existing policies were not tailored to the needs of children in need. Major self-perceived barriers included limited personnel training, limited facilities and infrastructure, and lack of incentives or opportunities to encourage active participation. Major self-perceived facilitators included personnel motivation, integration of nutrition and physical education into school curricula, and provision of free school meals, which was associated with regular school attendance of children from the Roma communities. Conclusions: Individual, sociocultural, and structural issues are shown to persist across different delivery systems indicating the complexity of tackling obesogenic environments, especially among children in need. This is the first study in Greece to provide evidence on self-perceived barriers and facilitators and could inform ongoing national and European efforts to address obesogenic environments in children in need. Full article

Background and Objectives: Obesity is linked to liver cancer through metabolic mechanisms and can promote tumor growth through metabolic impairment, decreased lipid metabolism, and interference of the energy balance in the liver. NAMPT is an enzyme expressed in the liver and is involved in the progression of tumors in obesogenic environments, while iNAMPT is known to be the rate-limiting enzyme in the synthesis of NAD, an essential coenzyme involved in ATP synthesis which promotes a pro-growth environment in the context of obesity. Because iNAMPT and cellular energetics, a hallmark of cancer, play an important role in liver cancer progression, it has become a target for cancer therapies focused on inhibiting its functions. The objective of this study was to determine the contribution of NAD biosynthesis in obesity-associated liver cancer progression. Methods: Cell culture studies were conducted with serum from male mice randomized to diet-induced obesity (OB) or control (CR) ± FK866 (iNAMPT inhibitor) in SNU, HepG2 human liver cancer cells, and Hepa 1-6 liver murine cells. Protein analysis of pAkt and pErk was performed via immunoblot. Cytotoxicity, reactive oxygen species (ROS), cell viability, and invasion were also measured in the cells. For the mouse model, the C57BL/6J male mice were randomized to the DIO or CR group. At 21 weeks of age, the mice were injected subcutaneously with Hepa 1-6 liver cancer cells. At 23 weeks, the mice received an I.P. injection of FK866 (30 mg/kg) for 2 weeks. The tumor and mouse weights were measured. Results: The cells exposed to OB sera showed increased proliferation, lactate dehydrogenase (LDH) secretion, ROS, and invasion. FK866 decreased proliferation, LDH secretion, ROS, and invasion for all liver cancer cells. The cells exposed to CR sera and OB + FK866 resulted in more LDH, suggesting increased apoptosis compared with OB sera. The OB sera increased phosphorylation of Akt, which was suppressed by FK866 compared with the OB group. In liver cancer cells, physiological and cellular signaling is affected differently when inhibiting NAD biosynthesis in an in vitro model of obesity and liver cancer. In vivo, the diet-induced obese (DIO) mice weighed significantly more than the mice fed a control diet. In addition, 70% of the DIO mice developed tumors, compared with 20% of the CR mice, and had tumors with greater volumes and weights. NAD inhibition blocked obesity-induced tumor growth. Conclusions: In this study, we demonstrate that inhibition of iNAMPT resulted in suppression of tumor growth in the context of obesity. Identifying pre-clinical strategies to reverse the impact of obesity on liver cancer progression is important due to the strong increased risk of liver cancer and its poor prognosis. Future translational research studies can be built from this pre-clinical foundational research. Full article

The pathogenesis of obesity is complex and incompletely understood, with an underlying interplay between our genetic architecture and obesogenic environment. The public understanding of the development of obesity is shrouded in myths with widespread societal misconceptions. Body Mass Index (BMI) is a highly heritable trait. However, despite reports from recent genome-wide association studies, only a small proportion of the overall heritability of BMI is known to be lurking within the human genome. Other non-genetic heritable traits may contribute to BMI. The gut microbiome is an excellent candidate, implicating complex interlinks with hypothalamic control of appetite and metabolism via entero-endocrine, autonomic, and neuro-humeral pathways. The neonatal gut microbiome derived from the mother via transgenerational transmission (vaginal delivery and breastfeeding) tends to have a permanence within the gut. Conversely, non-maternally derived gut microbiota manifest mutability that responds to changes in lifestyle and diet. We should all strive to optimize our lifestyles and ensure a diet that is replete with varied and unprocessed plant-based foods to establish and nurture a healthy gut microbiome. Women of reproductive age should optimize their gut microbiome, particularly pre-conception, ante- and postnatally to enable the establishment of a healthy neonatal gut microbiome in their offspring. Finally, we should redouble our efforts to educate the populace on the pathogenesis of obesity, and the role of heritable (but modifiable) factors such as the gut microbiome. Such renewed understanding and insights would help to promote the widespread adoption of healthy lifestyles and diets, and facilitate a transition from our current dispassionate and stigmatized societal approach towards people living with obesity towards one that is epitomized by understanding, support, and compassion. Full article

Introduction: The food environment is an important determinant of children’s eating behavior. Improving the environment to encourage healthier choices is crucial to prevent obesity, especially in restaurants where the majority of kids’ menus are unhealthy. This study explored the perceptions, attitudes, motivations, influencing factors, and opportunities of restaurant owners, managers, and chefs for implementing healthier kids’ menus in Dutch restaurants. Method: We used a mixed methods design in two consecutive study parts. Part I consisted of an online unstandardized questionnaire that was completed by 44 restaurant owners, 26 chefs, 18 managers, and 6 other restaurant employees (n = 94). This was followed by semi-structured interviews with 3 restaurant owners, 2 chefs, and 1 manager, to gather exploratory information in Part II (n = 6). The quantitative data were categorized into three groups: restaurants without kids’ menus (n = 18), restaurants with unhealthy kids’ menus (n = 24), and restaurants with (partially) healthy kids’ menus (n = 52). Group differences were assessed using the Kruskal–Wallis test. We used thematic analysis for the interviews. Results: Parts I and II showed that the restaurant sector is aware of the need, and willing and motivated to offer healthier kids’ menus. Nevertheless, the concerns about food waste, the unhealthy demand from children and parents, and seeing eating out as a free pass to consume unhealthy meals by children and parents were important factors limiting the implementation of healthier kids’ menus. Discussion: We discussed potential solutions to enhance demand and acceptance of healthier kids’ menus, such as attractive names, storytelling, offering children’s portions based on adult menus, and using participatory approaches in which parents, children, and chefs co-create meal composition. Full article

There is growing evidence that public hospitals in high-income countries—in particular, Anglo-Saxon neoliberal countries (USA, UK, Canada, New Zealand, and Australia)—have been engaging with food retailers to attract private capital and maximise their incomes in a drive to reduce costs. Added to which, public hospital food can have a substantial influence on the health of children and young people. However, there is still relatively little research on food for young people in healthcare settings. This is concerning, as an appropriate food intake is vital not only for the prevention of and recovery from diseases, but also for the physical growth and psychological development of young people. This critical narrative review examined the available evidence on hospital food provision, practices, and environments, as well as children’s experiences of hospitalization in high-income countries, drawing on both peer-reviewed articles and the grey literature. Our analytical lens for this review was the Commercial Determinants of Health (CDOH), a framework that necessitates a critical examination of commercial influences on individual, institutional, and policy practices relevant to health. Our findings illustrate the mechanisms through which the CDOH act as a barrier to healthy food and eating for children in hospitals in high-income countries. Firstly, hospital food environments can be characterised as obesogenic. Secondly, there is a lack of culturally inclusive and appropriate foods on offer in healthcare settings and an abundance of processed and convenience foods. Lastly, individualised eating is fostered in healthcare settings at the expense of commensal eating behaviours that tend to be associated with healthier eating. Public hospitals are increasingly facing commercial pressures. It is extremely important to resist these pressures and to protect patients, especially children and adolescents, from the marketing and selling of foods that have been proven to be addictive and harmful. Full article

In an obesogenic environment, such as the one we have been experiencing in recent decades, epigenetics provides answers to the relationship between hereditary and environmentally acquired patterns that have significantly contributed to the global rise in obesity prevalence. MicroRNA (miRNA) constitutes a diminutive non-coding small RNA molecule, 20 to 24 nucleotides in length, that functions as a regulator of gene regulation at the post-translational level. Circulating miRNAs (c-miRNAs) have been detected in multiple body fluids, including blood, plasma, serum, saliva, milk from breastfeeding mothers, and urine. These molecules hold significant therapeutic value and serve as extracellular biomarkers in metabolic diseases. They aid in the diagnosis and tracking of therapy responses, as well as dietary and physical habit modifications. Researchers have studied c-miRNAs as potential biomarkers for diagnosing and characterizing systemic diseases in people of all ages and backgrounds since then. These conditions encompass dyslipidemia, type 2 diabetes mellitus (T2DM), cardiovascular risk, metabolic syndrome, cardiovascular diseases, and obesity. This review therefore analyzes the usefulness of c-miRNAs as therapeutic markers over the past decades. It also provides an update on c-miRNAs associated with general obesity and overweight, as well as with the most prevalent pathologies in the adult population. It also examines the effect of different nutritional approaches and physical activity regarding the activity of miRNAs in circulation in adults with overweight or general obesity. All of this is done with the aim of evaluating their potential use as biomarkers in various research contexts related to overweight and obesity in adults. Full article

Background/Objectives: The consumption of diets with high fat, salt, and sugar content has been associated with increasing the risk of developing a range of pathologies, including cardiovascular disease, obesity, and diabetes. Furthermore, there is growing evidence to suggest a relationship between variation in the nutritional environment and pancreatic dysregulation, which may be a consequence of oxidative stress. This study aimed to examine the effects of a high-fat, high-carbohydrate (obesogenic) maternal diet during pregnancy and lactation on the metabolic health and pancreatic structure of rat offspring. Methods: Pregnant rats were divided into two groups: one fed a standard diet and the other an obesogenic diet. After weaning, male pups from both groups were fed the same diet until they were 30 days old, which is when they were euthanized. Results: Metabolic and murinometric changes: Increased body weight and pancreas size, elevated blood glucose and cholesterol levels, and reduced glucose tolerance (which is indicative of the beginning of insulin resistance). Oxidative stress: Higher levels of oxidative damage markers and decreased antioxidants in the pancreas, suggesting a state of oxidative stress in this organ. Changes in pancreatic structure: Increased size and number of pancreatic islets and decreased size and number of pancreatic acini. Conclusions: A maternal obesogenic diet induces metabolic alterations, increases oxidative stress, and causes changes in the structure of the pancreas in rat offspring, suggesting a higher risk of developing metabolic diseases such as type 2 diabetes in adulthood. Full article

The aim of the present study is to identify obesogenic environment profiles to find the obesogenic environment pattern for Belo Horizonte City. The current research followed the ecological approach and was substantiated by data from food shops, public sports venues, crime rates (homicides and robberies) and the rate of accidents with pedestrians. Descriptive analyses and principal component analysis (PCA) were conducted in Stata software, version 14.0. Georeferencing and map plotting were carried out in Qgis software, version 2.10. All neighborhoods in Belo Horizonte City (n = 486) were included in the study. The obesogenic pattern comprised the highest mean number of shops selling ultra-processed food, crime rates, and accidents with pedestrians. The generated latent variable was divided into tertiles, and the second and third tertiles represented the most obesogenic environments. Neighborhoods accounting for the highest obesogenic profile also recorded the largest number of shops selling all food types. Furthermore, neighborhoods in the third tertile recorded the highest mean income (BRL 2352.00) (p = 0.001) and the lowest Health Vulnerability Index (HVI = 54.2; p = 0.001). These findings point towards the need for developing actions, policies and programs to improve these environments, such as tax incentives to open healthy food retailers and public sports venues to promote healthier lifestyles and to prevent diseases in the middle and long term. Full article

The pervasive presence of per- and polyfluoroalkyl substances (PFAS) in the environment and their persistent nature raise significant concerns regarding their impact on human health. This review delves into the obesogenic potential of PFAS, shedding light on their mechanisms of action, epidemiological correlations with obesity and metabolic disorders, and the challenges faced in regulatory frameworks. PFAS, characterized by their carbon-fluorine chains, are ubiquitous in various consumer products, leading to widespread exposure through ingestion of contaminated food and water. Emerging evidence suggests that PFAS may act as endocrine-disrupting chemicals, interfering with lipid metabolism and hormone functions related to obesity. We examine in vitro, in vivo, human, and in silico studies that explore the interaction of PFAS with PPARs and other molecular targets, influencing adipogenesis and lipid homeostasis. Furthermore, the review highlights epidemiological studies investigating the association between maternal PFAS exposure and the risk of obesity in offspring, presenting mixed and inconclusive findings that underscore the complexity of PFAS effects on human health. Presently, there are major challenges in studying PFAS toxicity, including their chemical diversity and the limitations of current regulatory guidelines, potential remediation, and detoxification. This review emphasizes the need for a multidisciplinary approach, combining advanced analytical methods, in silico models, and comprehensive epidemiological studies, to unravel the obesogenic effects of PFAS and inform effective public health strategies. Full article

Background/Objectives: One of the main culprits of the obesity epidemic is the obesogenic food environment, which promotes the consumption of ultra-processed foods (UPFs) that are highly palatable, have low nutritional quality and a high caloric impact and are economical and ready to use. This monocentric retrospective study explored the association between UPFs, obesity and adiposity measurements among adults living with obesity in Southern Italy. Methods: According to their Body Mass Index (BMI) values, 175 participants (63M) were recruited and stratified into three groups. To evaluate their usual eating habits, PREDIMED and the Nova Food Frequency Questionnaire (NFFQ) were administered to investigate Mediterranean diet (MD) adherence and UPF consumption. Anthropometric and biochemical measurements, body composition, as well as visceral obesity indices were collected. Results: The data showed an increase in UPF consumption as the BMI increased, with a concomitant decrease in MD adherence. Soft drinks were the most representative UPF in all groups, and we observed a significant increase in such consumption as the BMI increased. In addition, in the highest tertile of UPF consumption, there was an increase in adiposity indices. Conclusions: Our data suggest that high UPF consumption correlates with an increased BMI and visceral adiposity, and it is a predictive risk factor for the occurrence of non-communicable diseases. Full article

This narrative review explores the pathophysiology of obesity, cellular senescence, and exosome release. When exposed to excessive nutrients, adipocytes develop mitochondrial dysfunction and generate reactive oxygen species with DNA damage. This triggers adipocyte hypertrophy and hypoxia, inhibition of adiponectin secretion and adipogenesis, increased endoplasmic reticulum stress and maladaptive unfolded protein response, metaflammation, and polarization of macrophages. Such feed-forward cycles are not resolved by antioxidant systems, heat shock response pathways, or DNA repair mechanisms, resulting in transmissible cellular senescence via autocrine, paracrine, and endocrine signaling. Senescence can thus affect preadipocytes, mature adipocytes, tissue macrophages and lymphocytes, hepatocytes, vascular endothelium, pancreatic β cells, myocytes, hypothalamic nuclei, and renal podocytes. The senescence-associated secretory phenotype is closely related to visceral adipose tissue expansion and metaflammation; inhibition of SIRT-1, adiponectin, and autophagy; and increased release of exosomes, exosomal micro-RNAs, pro-inflammatory adipokines, and saturated free fatty acids. The resulting hypernefemia, insulin resistance, and diminished fatty acid β-oxidation lead to lipotoxicity and progressive obesity, metabolic syndrome, and physical and cognitive functional decline. Weight cycling is related to continuing immunosenescence and exposure to palmitate. Cellular senescence, exosome release, and the transmissible senescence-associated secretory phenotype contribute to obesity and metabolic syndrome. Targeted therapies have interrelated and synergistic effects on cellular senescence, obesity, and premature aging. Full article

Breastfeeding education, across all disciplines, is often inconsistent and lacking in expertise and confidence. However, recommendations from health professionals, the sociocultural environment, and previous knowledge and experiences significantly influence women’s decision to breastfeed. This study aimed to identify factors that promote the assignment of greater importance to breastfeeding and associated practical benefits. This retrospective cross-sectional study included 276 participants who completed a self-administered questionnaire. Descriptive and bivariate analyses were performed, and multivariate linear models were applied to identify factors influencing the importance assigned to breastfeeding. Most participants were married or in a relationship, were native Spaniards, had secondary or higher education, and had an average age of 32.6 years. Seventy percent met the physical activity recommendations, and 91% felt comfortable with their body image during pregnancy. The importance assigned to breastfeeding was high across various aspects, except for postpartum weight loss and body image. Group prenatal care was only significantly associated with the importance assigned to the breastfeeding technique (how to breastfeed). The obesogenic environment and the importance assigned to nutritional aspects and physical activity also turned out to be predictors, although not for all models. In our region, the educational strategy of antenatal care groups could contain gaps regarding the mother’s health, which should be addressed in the future to improve results regarding the initiation and continuation of breastfeeding. Full article

The prevalence of obesity and morbid obesity in Taiwan has risen sharply in recent decades, as in other parts of the world, necessitating urgent action to prevent and curb its detrimental effects. Asian populations are susceptible to the repercussions of obesity at a lower body weight. A higher BMI is associated with more frequent outpatient visits, in-hospital admissions, higher medical costs, and a lower quality of life. However, effective weight management approaches are unlikely to be maintained in the long term without assimilation into daily lifestyle practices. This qualitative study, based on semi-structured interviews with 14 doctors, dieticians, and nurses who work to control the weight of people with obesity, explored and identified multilevel barriers in the context of daily life to improve the efficacy and execution of weight management strategies. They considered diets, physical activity, and sleep as key weight management activities. The cultural and psychosocial aspects of daily life were observed to have an impact upon weight management, particularly family conflicts due to cultural dynamics and socially and culturally reinforced food practices. To improve population weight, less-recognised aspects need to be addressed alongside the inclusion of mental health specialists in weight management protocols and policy interventions to minimise obesogenic practices and create environments conducive to weight management. Full article

Supply chain disruptions, a pandemic, and war in Ukraine have exposed faultlines in a globalised food system that depends on a few staple crops grown in a few exporting regions and transported to consumers around the world. In the UK, just three crops, (wheat, barley, and oilseed rape), account for 75 per cent of the UK’s 4.5 million hectares of arable land whilst the country imports around half its food—nearly 40 per cent—from just four EU countries (The Netherlands, Ireland, Germany, and France). Poor diets contribute to one in seven deaths in the UK, 63 per cent of the population is overweight or obese and health inequality is increasing between the poorest and most affluent regions. The food security and health of the UK population is therefore dependent on a small number of locally grown crops, vulnerable supply chains, and an unhealthy, obesogenic diet. The UK food system must diversify if it is to become food and nutritionally secure, meet its climate and biodiversity goals and have a healthy and active population. Climate-resilient and nutritious underutilised crops can help diversify the UK agrifood system, but research and investment in them is sporadic, piecemeal, and unfocused. In this paper, we compare two approaches to identifying potentially suitable underutilised crops for the UK. The first, based on UK Department for Environment, Food and Rural Affairs (Defra) Project CH0224, was delivered through literature and database searches and the expertise of growers, advisers, breeders, seed suppliers, processors, traders, and researchers. The second used the CropBASE digital knowledge base for underutilised crops. The two approaches produced no single crop that was common to both shortlists. We propose that the analytical and predictive tools derived from CropBASE could be combined with local knowledge and expertise from the Defra project to provide a common framework for the identification of underutilised crops that are best suited to local UK circumstances now and in climates of the future. Full article