搜索结果：Obesity research & clinical practice

Obesity is closely associated with venous thromboembolism (VTE), yet no studies have thoroughly investigated this specific area or identified potential future research trends. This study aims to address this issue. We searched the Web of Science Core Collection(WoSCC) and Scopus databases for articles on obesity and VTE published between 2000 and 2025. We then used VOSviewer, citeSpace, and the bibliometrix R package to analyze and visualise publication origins, collaboration networks, citations, co-citations, and keywords, research trends. Since 2000, the number of papers and citations in this field has increased yearly. The United States ranks first in academic influence. The most influential institutions are the Mayo Clinic, Harvard Medical School, and Cleveland Clinic. The journals with the greatest impact are "Obesity Surgery," "Surgery for Obesity and Related Diseases," and "Thrombosis and Haemostasis." Keyword analysis emphasises the importance of themes such as "bariatric surgery" and "complications", as well as "risk factors" and "Covid-19". This study systematically summarizes obesity-related VTE research and identifies global hotspots and trends. These findings highlight the collaborative models, research focuses, and emerging research areas commonly found in the existing literature, and can serve as a useful reference to inform future research directions and hypothesis development in this field.

Obesity is a complex, chronic, relapsing disease that affects nearly all physiological functions and homeostatic mechanisms, extending far beyond mere excess adiposity. Traditional clinical practice often relies on uniform interventions that fail to account for diverse patient phenotypes. This review synthesizes current evidence on personalized obesity management, dietary interventions, and advanced pharmacotherapies aligned with the new 2025 Lancet Commission framework. A comprehensive narrative review was conducted across major biomedical databases to evaluate the efficacy, safety, and mechanisms of metabolic interventions, focusing on phenotype-specific dietary matching, bioactive compounds, and modern multi-receptor glucagon-like peptide-1 (GLP-1)-based therapies across preclinical and clinical intervention tiers in adult and pediatric populations. While specific nutraceutical extracts display promising secondary metabolic benefits, their overall weight-loss efficacy remains modest due to variable clinical data and limited sample sizes. Conversely, high-potency anti-obesity medications demonstrate unprecedented weight-reduction efficacy, with semaglutide 2.4 mg and tirzepatide yielding mean body weight losses of ~14.9% and ~20.9%, respectively. Furthermore, landmark outcome data from the SELECT trial confirms that semaglutide 2.4 mg achieves a significant 20% relative risk reduction in major adverse cardiovascular events (MACE), independent of baseline glycemic status or heart failure. However, clinical extension data reveal rapid weight rebound upon drug cessation, highlighting that obesity requires continuous, long-term therapeutic strategies. Effective obesity care demands an operational shift from traditional, one-size-fits-all treatments to personalized, multi-tiered strategies. Combining phenotype-specific lifestyle modifications with potent, long-term multi-hormonal pharmacotherapies or metabolic surgery optimizes long-term therapeutic durability, systemic metabolic health, and sustained cardioprotection.

Inflammation is a key driver of coronary syndromes across the continuum from chronic coronary syndromes to acute coronary syndromes. It contributes to atherogenesis, plaque destabilization, and ischaemic events and influences myocardial injury, repair, and remodelling. Inflammatory activity is further amplified by metabolic and autoimmune comorbidities such as diabetes, obesity, and connective tissue diseases, with obesity representing a major driver of chronic low-grade inflammation through adipose tissue dysfunction and cytokine activation, while psychosocial stress and environmental exposures including air pollution serve as additional triggers. Genetic variations, including human leucocyte antigen genotypes, modulate individual susceptibility to vascular inflammation and myocardial injury. This expert consensus from the European Society of Cardiology's Association for Acute CardioVascular Care summarizes the current understanding of inflammation across the full spectrum of coronary syndromes, including underlying mechanisms, relevant biomarkers, and imaging approaches that characterize vascular inflammation, and integrates insights from experimental and clinical studies. Importantly, this document provides explicit consensus-based guidance on when, how, and in whom inflammation should be assessed and treated in routine clinical practice. While the causal association between inflammation and atherosclerotic cardiovascular disease is well established, pharmacological modification of inflammation has produced conflicting evidence. Some agents, such as low-dose colchicine, have demonstrated modest reductions in cardiovascular events, although results across trials have been inconsistent. Other anti-inflammatory therapies have not shown clinical benefit, whereas selective cytokine inhibition with canakinumab has reduced cardiovascular risk at the cost of increased infection rates. The present manuscript also focuses on the evaluation of inflammatory activity in cardiovascular patients in routine clinical practice. It further discusses criteria for patient selection and clinical decision-making regarding the introduction of anti-inflammatory therapy in individuals with established atherosclerotic cardiovascular disease.

Clinical guidelines now recommend administering intrapartum antibiotic prophylaxis (IAP) before skin incision at caesarean section to prevent maternal infection. However, this practice exposes the fetus to antibiotics, raising concerns about potential long-term effects on the infant microbiome and the risk of childhood obesity. To assess whether the timing of IAP at caesarean section-before skin incision versus after umbilical cord clamping-is associated with childhood obesity at age 4-5 years. We conducted a quasi-experimental study of a hospital-wide policy change in clinical practice using data from two birth cohorts (Born in Bradford [BiB] and Born in Bradford's Better Start [BiBBS]). The study included 1985 children of White British or Pakistani heritage born by caesarean section between 2007 and 2019. Children exposed to pre-incision IAP (n = 324) were compared with those unexposed (post-cord clamping IAP; n = 1661). The primary outcome was obesity (BMI z-score > 95th percentile) at age 4-5 years. Adjusted Risk Ratios (aRR) were estimated using multivariable Poisson regression stratified by ethnicity. The prevalence of obesity was 11.9%. Adjusted risk ratios for obesity were 1.25 (95% CI 0.53 to 2.98) for White British children and 1.25 (95% CI 0.64 to 2.43) for Pakistani children. Similarly, estimates for BMI z-score had wide confidence intervals indicating, limited precision. We did not observe a clear difference in childhood obesity at 4-5 years between pre-incision and post-cord clamping prophylactic antibiotics at caesarean section. Confidence intervals were wide, and modest clinically relevant effects cannot be excluded. Findings are compatible with no large adverse effect and may provide reassurance regarding the metabolic safety of current clinical practice.

Pregnancy concurrent with incretin-based medications is contraindicated due to unknown risk of teratogenicity, as is breastfeeding. The aim of this systematic scoping review was to investigate potential risks and benefits of incretin-based medications in relation to preconception, pregnancy, and postnatal health, and to propose expert guidelines for clinical practice. An international expert multidisciplinary group was formed. Research questions relevant to women's reproductive health and incretin-based medications were refined collaboratively, utilizing a lifecourse approach. A systematic search was undertaken on July 23, 2025, across several databases and grey literature sources. Primary data from human studies were prioritized above animal studies. Titles, abstracts, and full text articles were screened independently by two authors. Data were extracted by two people independently using a pre-defined proforma and synthesized narratively. Consensus recommendations were made. Thirty-four articles were included in the evidence synthesis: 11 randomized trials, nine observational studies, two pharmacovigilance reviews, nine case reports/series, two animal studies, and one ex vivo study. No qualitative studies were identified. Evidence was found for 18/32 (56.3%) research questions. Most studies related to preconception or pregnancy usage; two addressed contraception, and one was about lactation. The sample size of exposed pregnancies ranged from 1 to 4267. Three studies reported exposure throughout pregnancy. Three studies investigated postpartum usage. One (animal) study had offspring data beyond birth. No studies reported an increase in congenital anomalies. Clinical practice and research recommendations were made based on current available evidence and evidence gaps, encompassing contraception, preconception, nutritional, pregnancy monitoring, lactation, and longer-term outcomes.

Healthcare professionals' knowledge, attitudes, and beliefs toward adults living with obesity influence clinical engagement, communication, and quality of care. However, existing outcome measurement instruments used to assess these constructs have demonstrated limitations in development quality, contextual relevance, and content validity, particularly within the United Kingdom (UK) healthcare system. To conduct a qualitative concept elicitation study aligned with the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) recommendations to identify key themes shaping UK healthcare professionals' knowledge, attitudes, and beliefs regarding adults living with obesity in order to inform the development of an outcome measurement instrument. Qualitative descriptive study using semi-structured group and individual interviews. 35 UK healthcare professionals from multiple disciplines participated in semi-structured individual and group interviews. Data were analysed using inductive reflexive thematic analysis in accordance with COSMIN recommendations for content validity and item generation. Four interrelated themes were identified: (1) clinical working environment, (2) knowledge of obesity, (3) attitudes to obesity, and (4) beliefs about professional roles. The clinical working environment was identified as a primary contextual determinant influencing how knowledge is constructed, how attitudes are expressed, and how beliefs about professional roles are enacted in practice. Structural constraints, organizational culture, role ambiguity, and service limitations influenced clinicians' confidence, communication, and perceived legitimacy in adult obesity care. Healthcare professionals' knowledge, attitudes, and beliefs regarding adult obesity are not solely individual attributes but are embedded within organizational and service contexts. These findings provide a strong empirical foundation for COSMIN-aligned item development and support the creation of a context-sensitive outcome measurement instrument to inform research, workforce development, and service improvement in UK adult obesity care. Patient and Public Involvement (PPI) contributors reviewed the interview guide to ensure clarity and relevance prior to data collection.

Obesity in India is rising rapidly, with higher body fat at lower BMI and younger age compared to Western populations, leading to earlier onset of type 2 diabetes and cardiovascular disease in a resource-constrained health system. Protocols for obesity care therefore need to address region-specific challenges and ensure culturally acceptable, feasible treatment options. The Obesity and Metabolic Surgery Society of India (OSSI) and the Endocrine Society of India (ESI) jointly developed India-specific obesity management protocols using a modified Delphi consensus. A protocol development team generated 73 statements based on literature review and expert experience. Seventy-eight experts (38 OSSI, 40 ESI) participated; 100% voted in round 1 and 90% attended an in-person round-2 meeting. Statements with more than 80% agreement were considered to have achieved consensus. After revision and deletion of redundant items, 55 statements across eight modules were finalized. Consensus agreement exceeding 80% was achieved for all 55 statements covering obesity recognition, prevention, treatment selection, monitoring and follow-up, lifestyle therapy, obesity management medications, metabolic and bariatric surgery, and palliative care. The panel strongly endorsed recognition of obesity as a chronic non-communicable disease, integration of obesity care into national health programs, equitable access to treatment, and a multimodal, stigma-free approach tailored to Indian BMI and anthropometric thresholds. This first joint OSSI-ESI consensus provides India-specific guidance across the obesity care continuum. By integrating prevention, individualized therapy and multidisciplinary care, the recommendations aim to standardize clinical practice, inform policy and improve outcomes and quality of life for people living with obesity in India.

Natural products derived from plants, animals, and microorganisms have long been used as nutritional supplements and are increasingly recognized for their potential role in preventing and managing human diseases. This narrative review aims to summarize current evidence on the therapeutic relevance of natural products as dietary supplements across major disease categories and to highlight their mechanisms of action, clinical efficacy, and safety considerations. A narrative literature review was conducted using peer-reviewed articles, systematic reviews, and clinical studies focusing on natural products used as nutritional supplements in disease management. Relevant data were analyzed thematically, with emphasis on bioactive compounds, mechanisms of action, and evidence from preclinical and clinical research. Natural products, particularly plant-derived polyphenols, flavonoids, terpenoids, omega-3 fatty acids, and probiotic-derived metabolites, exhibit diverse biological activities, including antioxidant, anti-inflammatory, immunomodulatory, and antimicrobial effects. Evidence suggests potential benefits in cardiovascular diseases, metabolic disorders such as diabetes and obesity, neurodegenerative conditions, certain cancers, gastrointestinal disorders, and infectious diseases. However, clinical efficacy varies depending on compound type, dosage, and formulation. Key limitations include low bioavailability, variability in composition, and insufficient large-scale clinical trials. Safety concerns such as herb-drug interactions and lack of standardization remain significant challenges. Natural products as nutritional supplements represent a promising adjunct strategy in the prevention and management of various human diseases. While preclinical and early clinical evidence is encouraging, stronger clinical validation, improved standardization, and clearer regulatory frameworks are required to fully integrate these agents into evidence-based medical practice.

Shared decision-making (SDM) is recommended in obesity treatment. Yet, little is known about how it occurs in real-world practice, particularly given recent advances in treatment options. This prospective mixed-methods study aimed to understand patient preferences and decision-making processes for obesity treatment. Adults with obesity (N = 103) seeking specialty weight management treatment completed a survey, and a subset (n = 17) participated in qualitative interviews. Both assessed weight loss history, knowledge and expectations of obesity treatment options, decision-making factors, and perceptions of SDM. Participants reported an average of 10.1 (SD = 13.5) prior weight loss attempts and were primarily motivated by physical well-being (86.4%). Key factors influencing decision-making included desired weight loss (84.5%), provider recommendations (76.7%), and cost (62.1%). Anti-obesity medications were viewed most favorably, followed by behavioral and surgical approaches. Qualitative analysis generated four themes: (i) a chronic cycle of weight loss and regain; (ii) guided by stories, not science alone; (iii) navigating trade-offs in choosing weight-loss strategies; and (iv) feeling heard, but still seeking direction. Patients demonstrate strong awareness of obesity treatments and value SDM and personalized recommendations when making decisions. Findings highlight the need for interventions that strengthen SDM and deliver tailored, high-quality health communication. People with obesity are often encouraged to use shared decision-making, a process in which patients work with their healthcare provider to choose the best treatment approach. However, little is known about how this actually works in everyday clinical care, especially as new treatment options become available. In this study, 103 adults seeking specialized weight management care completed surveys and some also participated in interviews to share their experiences with weight loss and shared decision-making. Most participants had tried to lose weight many times before and were mainly motivated by improving their physical health. When deciding on treatment options, people considered how much weight they hoped to lose, what their provider recommended, and how much treatment would cost. Weight loss medications were viewed most positively followed by lifestyle programs and bariatric surgery. Interviews showed participants relied on personal stories as well as medical information and carefully weighed pros and cons of different treatments. Many wanted more guidance even when they felt listened to by providers. Overall, patients valued shared decision-making and personalized recommendations. These findings highlight the need for better tools and communication strategies to support clear, personalized obesity care.

Background/Objectives: Body mass index (BMI) is the most widely used measure for obesity classification, yet it does not directly measure body fat and may substantially underestimate obesity prevalence. Simultaneous evaluation of the diagnostic accuracy of bioelectrical impedance analysis (BIA), BMI, and waist-to-hip ratio (WHR) against dual-energy X-ray absorptiometry (DEXA) for obesity classification is lacking in Saudi Arabia. We aimed to quantify the diagnostic performance of these three surrogate measures against DEXA in Saudi adults. Methods: We conducted a cross-sectional diagnostic accuracy study reported according to the STARD guideline at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. We enrolled a convenience sample of 399 adults aged 18-65 years recruited from primary health care and outpatient clinic waiting areas. Each participant underwent InBody 770 BIA, anthropometric measurements (BMI, WHR), and DEXA (Lunar iDXA, GE) on the same day. We evaluated BIA body fat percentage against DEXA body fat percentage, BMI ≥ 30 kg/m2 against DEXA body fat percentage and fat mass index (FMI)-defined obesity, and WHR against the DEXA android-to-gynoid ratio. We calculated sensitivity, specificity, positive and negative predictive values, likelihood ratios, and area under the receiver operating characteristic curve (AUC), overall and stratified by sex. Results: DEXA classified 86.0% of participants as having obesity, compared with 62.9% by BIA and 24.8% by BMI; against DEXA body fat percentage, BMI ≥ 30 kg/m2 had a sensitivity of 28.9% and specificity of 100%. When FMI replaced body fat percentage as the reference standard, BMI sensitivity increased to 68.5% (specificity 97.3%, AUC 0.95). BIA achieved a sensitivity of 72.3%, specificity of 94.4%, and AUC of 0.86. WHR had the lowest sensitivity for central obesity (54.0%, specificity 94.8%, AUC 0.80). BIA showed the strongest correlation with DEXA body fat percentage (Spearman ρ = 0.82), followed by BMI (ρ = 0.60). Conclusions: BMI alone missed two-thirds of participants with DEXA-defined obesity in this Saudi adult cohort. Although BIA was more sensitive, it still missed 27.7% of individuals with DEXA-defined obesity. These findings support integrating body composition assessment into clinical practice and suggest that national obesity prevalence estimates based on BMI alone substantially underestimate the true burden.

Breast cancer is the most common malignancy among women globally and a leading cause of cancer-related mortality in Ethiopia. Early detection and awareness of risk factors are critical for improving outcomes, yet knowledge gaps and sociocultural barriers persist. The objective of this study was to assess awareness of breast cancer risk factors, symptoms, diagnostic methods, and preventive practices among Ethiopian women. A community-based cross-sectional study was conducted from September 2024 to May 2025 among women employed in governmental, non-governmental, and private organizations in Bahir Dar, Dessie, Debre Berhan, and Gondar. A multistage random sampling technique selected 473 participants. Data were collected using a semi-structured questionnaire covering socio-demographic characteristics, knowledge of breast cancer, attitudes toward screening, and early detection practices. Data were analyzed using SPSS version 20.0 and Epi Info 3.5.1. Binary and multivariable logistic regression analyses were performed to identify factors associated with knowledge, attitude, and practice. Adjusted odds ratios (AORs) with 95% confidence intervals were used to determine the strength of associations, and statistical significance was declared at p&#x2009;<&#x2009;0.05. Participants were predominantly young (&#x2264;&#x2009;30 years) and well-educated (48.0% diploma, 41.2% BSc or higher). Commonly recognized symptoms were breast pain (86.3%), swelling (83.3%), lumps (79.5%), and size changes (78.4%). Self-breast examination was practiced by 68.7%, but knowledge of correct timing and frequency was low. Awareness of Clinical-breast examination (88.6%) and pathological diagnosis (54.1%) was higher. Risk factor knowledge was uneven, with better recognition of smoking, alcohol, and inactivity, but poor understanding of diet, obesity, reproductive factors, hormones, and radiation. Sunlight was commonly misperceived as a risk. Main information sources were mass media, health workers, and teachers. Participants aged 36-40 years had significantly better knowledge (AOR&#x2009;=&#x2009;2.21, 95% CI: 1.51-3.14, p&#x2009;=&#x2009;0.002). Family history of breast cancer was associated with higher odds of good knowledge (AOR&#x2009;=&#x2009;2.13, 95% CI: 1.24-3.61, p&#x2009;=&#x2009;0.004), good attitude (AOR&#x2009;=&#x2009;2.35, 95% CI: 1.26-4.46, p&#x2009;=&#x2009;0.004), and good practices (AOR&#x2009;=&#x2009;1.64, 95% CI: 0.96-2.31, p&#x2009;=&#x2009;0.041). Having a current breast problem was the strongest predictor, associated with better knowledge (AOR&#x2009;=&#x2009;2.24, 95% CI: 1.48-3.84, p&#x2009;=&#x2009;0.004), better attitude (AOR&#x2009;=&#x2009;3.64, 95% CI: 2.62-8.24, p&#x2009;=&#x2009;0.001), and good preventive practices (AOR&#x2009;=&#x2009;3.54, 95% CI: 1.87-6.25, p&#x2009;=&#x2009;0.003). Breast cancer knowledge among Ethiopian women remains poor with notable gaps in understanding risk factors, symptoms, and preventive practices. Sociocultural and structural barriers further impede early detection. Implementing targeted, culturally sensitive health education, integrating breast cancer awareness into routine healthcare, and utilizing mass media and educational institutions are essential strategies to enhance knowledge, promote screening, and improve early detection, ultimately reducing morbidity and mortality.

Obesity and cardiovascular (CV) disease (CVD) are tightly intertwined global epidemics, with excess adiposity now recognized as a major, modifiable driver of atherosclerotic events, heart failure, and mortality. Despite advances in cardiometabolic care, residual CV risk remains high in people with obesity, underscoring the need for therapies that both reduce body weight and directly modify CV risk. Semaglutide, a long-acting glucagon-like peptide-1 receptor agonist (GLP-1RA), has emerged as a pivotal agent across the cardiometabolic spectrum, culminating in the SELECT trial, which demonstrated a reduction in three-point major adverse CV events (3P-MACE) in people with obesity and established CVD but without diabetes. Complementary evidence from heart failure with preserved ejection fraction (HFpEF) trials and real-world studies further supports a broad CV and functional benefit profile. This narrative review synthesizes data from randomized controlled trials (RCTs) and real-world evidence (RWE) on Wegovy&#xae; (semaglutide 2.4 mg, a recombinant DNA-derived GLP-1RA) in obesity with CVD, with a focus on SELECT, mediation analyses suggesting weight-independent CV effects, and outcomes in obesity-related HFpEF. We also discuss guideline positioning, regulatory milestones-including the 2025 Central Drugs Standard Control Organization (CDSCO) approval in India-and the evolving competitive landscape. Overall, semaglutide 2.4 mg represents the first and only anti-obesity medication with proven CV benefit in people with obesity without type 2 diabetes (T2D), with important implications for clinical practice and health policy.

Despite recent advances in prevention and treatment, cardiovascular disease (CVD) remains a leading cause of premature death and disability globally, with a rising burden in many low- and middle-income countries. Several modifiable determinants of CVD are well-established (eg, smoking, hypertension, obesity, dyslipidaemia), but they do not fully explain temporal trends and large variations in disease rates between different populations. Moreover, the causal relevance of certain CVD risk factors and/or their associated biological mechanisms is still incompletely understood. High-throughput affinity-based proteomic assays now enable quantification of several thousand protein markers in the blood, and their application in large epidemiological and clinical studies will facilitate the development of precision cardiovascular medicine. This review describes recent findings from large population-based studies to illustrate the value of proteomics in cardiology for improved risk prediction, diagnosis and patient stratification; better understanding of disease aetiology and pathophysiology; and identification of repurposing and novel therapeutic targets. To overcome the current limitations, future studies should aim to further increase the sample size, number of proteins measured reliably (eg, via multiple assay platforms) and longitudinally, and ancestry population diversity, to expedite clinical translation of key research findings that will help to transform development of precision medicine in cardiology globally.

To assess the real-world associations of five glucagon-like peptide-1 receptor agonists (GLP-1RAs) with weight loss in a diverse US population of adults with obesity, with and without type 2 diabetes, and whether the relative ordering of weight loss observed in trials is mirrored in routine practice. We conducted a retrospective, new-user, active-comparator cohort study using the National Institutes of Health All of Us Research Program. We included 14,046 adults with obesity (body mass index [BMI] &#x2265;30 kg/m2) initiating exenatide, liraglutide, dulaglutide, semaglutide, or tirzepatide. Groups were compared after multivariable adjustment for baseline confounders. Participants were followed from the index date until the outcome, death, or loss to follow-up; percent weight and BMI change was assessed at 12 months (&#xb1;45 days). Cox proportional hazards models estimated the relative likelihood over time of achieving weight-loss thresholds (&#x2265;5%, &#x2265;10%, &#x2265;15%) and &#x2265;1 BMI-category reduction; linear regression assessed the magnitude of weight change, with liraglutide as reference. Tirzepatide showed the highest likelihood of &#x2265;15% weight loss (adjusted hazard ratio [aHR] 5.57; 95% CI, 3.66-8.49) and the greatest mean weight loss at 12 months (-13.0%), followed by semaglutide (aHR 1.77; 95% CI, 1.56-2.01; -5.9%); both were significantly greater than the older agents in adjusted analyses. Exenatide, dulaglutide, and liraglutide showed comparable, modest weight loss (approximately -4.0%). This ordering was consistent regardless of type 2 diabetes status, although weight loss was greater without diabetes for semaglutide but similar for tirzepatide. In this large, diverse real-world cohort, tirzepatide and semaglutide were associated with significantly greater weight loss than older agents. These findings are consistent with the relative ordering reported in trials, though the observational design cannot confirm it. Residual confounding cannot be excluded, and the small tirzepatide sample (n=386) and limited follow-up warrant cautious interpretation. Obesity is a long-term condition, and many people need more than lifestyle changes to manage it. Newer medicines called GLP-1 receptor agonists can reduce appetite and have worked well in clinical trials. But trials enroll selected volunteers who may differ from people in everyday care. We compared how five of these medicines work for weight loss in a large, diverse, real-world group. We studied health records from 14,046 adults with obesity in the National Institutes of Health&#xa0;All of Us&#xa0;Research Program. We compared how much weight patients lost in one year after starting exenatide, liraglutide, dulaglutide, semaglutide, or tirzepatide. On average, tirzepatide users lost about 13.0% and semaglutide users about 5.9%, while patients taking the three older medicines lost around 4%. Tirzepatide users were also the most likely to achieve large weight loss of 15% or more. These findings suggest the two newest medicines, tirzepatide and semaglutide, are linked to greater weight loss than older options, even in everyday care. Greater weight loss is generally linked to better health, so these differences could matter for patients, though our study cannot prove the drugs caused them. Because we used everyday medical records rather than a clinical trial, the results show links rather than proof of cause and effect. Tirzepatide is new, so few patients had taken it; larger studies are needed to confirm these early findings.

Digital health technologies are transforming healthcare. There is limited research describing how these technologies have been applied by nutrition and dietetic professionals across the nutrition care process. A summary of the literature is needed to guide future research. To examine how digital health technologies have been applied in acute care nutrition and dietetics practice, identify strengths and gaps in the literature, and offer recommendations for future research. A scoping review was conducted according to JBI guidance and was reported against the PRISMA-ScR checklist. Six databases (MEDLINE, Embase, Web of Science, Scopus, PsycInfo, IEEE Xplore) were systematically searched from January 1, 2014 to 16 April, 2025. Articles that described the use of any digital health technology by nutrition and dietetic professionals to deliver, monitor, or evaluate practice across the nutrition care process in acute hospital settings were eligible. Data were extracted, narratively synthesized, and mapped to the nutrition care process, National Institute of Health & Care Classification of Digital Health Technologies, and Quadruple Aim of Healthcare. A total of 101 articles across 24 countries (85% high-income) were included, representing 333,517 patients, 2,846 nutrition professionals, 21 diseases, and 78 primary outcomes. Telehealth was the most common technology applied in practice (31%), followed by electronic medical records and mHealth (19% each), clinical decision support (15%), machine learning and computerized provider order entry (5% each), data visualizations (3%), and digital food service systems (2%). Malnutrition was the primary therapeutic target (39%). Most study designs were observational (67%) compared to interventional (33%). Process outcomes (quality, efficiency, or safety) were more common than health, cost, or experience outcomes. Patterns of reported findings may suggest mostly favorable or mixed primary outcomes where technologies were the main exposure. Technologies were mostly applied at the intervention (n=55) or assessment (n=35) stages of the nutrition care process. Nutrition and dietetic professionals had diverse digital roles, such as interpreting risk scores in assessment, delivering telehealth care as interventions, and navigating and extracting electronic medical record data in monitoring and evaluation. In 24 countries, a range of digital health technologies were applied across the entire nutrition care process in acute care nutrition and dietetics practice. Telehealth, electronic medical records, mHealth, and clinical decision support were most frequently used by nutrition and dietetic professionals to deliver nutrition interventions and undertake nutrition assessment.

To provide a clinically oriented overview of ultrasound elastography in chronic liver disease, focusing on currently available techniques, their clinical applications, quality assurance, technical pitfalls, and emerging developments that may shape future liver imaging practice. A narrative review of the current literature was conducted using international guidelines, systematic reviews, and original studies retrieved from major scientific databases. Particular emphasis was placed on the clinical applications of ultrasound elastography, quality assurance procedures, interpretation of liver stiffness measurements, and future technological developments. Vibration-controlled transient elastography (VCTE) and shear wave elastography (SWE) have become established non-invasive techniques for liver fibrosis assessment, demonstrating excellent diagnostic performance, particularly for advanced fibrosis and cirrhosis. Beyond fibrosis staging, ultrasound elastography contributes to prognostic stratification, treatment planning, and longitudinal disease monitoring across a broad spectrum of chronic liver diseases. However, liver stiffness measurements may be influenced by technical and biological confounding factors, including inflammation, cholestasis, hepatic congestion, obesity, and postprandial status, highlighting the importance of standardised acquisition protocols and careful clinical interpretation. Emerging developments, including spleen stiffness assessment, multiparametric ultrasound, and artificial intelligence-assisted image analysis, are expected to further improve diagnostic accuracy and support precision hepatology. Ultrasound elastography has become an essential component of the non-invasive evaluation of chronic liver disease, substantially reducing the need for liver biopsy while improving fibrosis staging, prognostic stratification, and longitudinal patient monitoring. Its optimal clinical implementation requires appropriate patient selection, adherence to quality assurance procedures, and careful interpretation within the broader clinical context. Future advances in multiparametric ultrasound, artificial intelligence, and international standardisation are expected to further strengthen the role of ultrasound elastography within precision hepatology and personalised liver disease management. Ultrasound elastography should be integrated into routine liver imaging as part of a multimodal diagnostic approach. Standardised acquisition protocols, continuous quality assurance, and appropriate operator training are essential to ensure reliable and reproducible liver stiffness measurements. Radiographers play a key role in examination quality, protocol adherence, and multidisciplinary patient care, contributing to accurate diagnosis and improved clinical decision-making.

Primary care physicians (PCPs) are on the front lines of health promotion and disease prevention, yet evidence supports a longstanding gap in physicians' capacity to counsel about diet, a key factor in patient health and chronic disease risk. Momentum to address the nutrition training needs of physicians is growing; however, challenges PCPs experience due to inadequate training are further complicated by clinical practice barriers. This study seeks to better understand the complex problem PCPs face addressing nutrition with patients to inform potential solutions. This qualitative study takes a design thinking approach to understanding the problem by learning from PCPs about their experience, challenges, and priorities addressing nutrition with patients. Findings from semi-structured interviews with 32 PCPs revealed that while they value nutrition and believe they have an important role in addressing diet with patients, their role as a generalist in addressing nutrition lacks clarity. PCPs describe learning their current approach to nutrition primarily outside of formal medical training, resulting in variability and inconsistency in approaches and recommendations and general frustrations about their ability to give actionable guidance. While registered dietitians (RDs) are often viewed as valuable support for patients, PCPs describe multiple challenges to RD utilization and subsequently at times may be the only ones with the opportunity to address diet with patients. Additional system- and societal-level barriers, such as time limitations and the food environment, further complicate PCPs' experiences advising patients about nutrition. Main limitations of this study are limited generalizability from recruiting graduates of a single medical school and PCPs with greater interest in nutrition or more frustration with their current approach to nutrition may have been more likely to participate. Our results support the need to clearly define a realistic role for PCPs as generalists addressing nutrition. Clarified expectations in turn can inform nutrition training of physicians and guiding frameworks and strategies for giving practical, evidence-based nutrition guidance. PCPs also need increased support through access to resources, strategies to improve RD collaboration, and attention to system- and societal-level challenges influencing dietary interventions in primary care.

Obesity stands as a formidable 21st-century public health crisis, with its capacity to aggravate depressive symptoms gaining increasing clinical attention. Traditional treatment models often treat these two conditions separately. However, recent research evidence suggests a complex network linking obesity and depressive symptoms across metabolism, behavior, and mental health, with dietary patterns proposed as a key upstream modulator of both metabolic and psychological pathways. The specific mechanisms by which diet influences obesity and depressive symptoms remain unclear. Therefore, this narrative review focuses on analyzing molecular connections between diet, obesity, and depressive symptoms, including adipose tissue inflammation, the gut-brain axis, the hypothalamus-pituitary-adrenal axis, insulin and brain-derived neurotrophic factor levels, and neuroplasticity. We discuss the possible pathways and effects of different diet therapies in regulating metabolism and simultaneously impacting mental health, including calorie restriction diet, intermittent fasting, ketogenic diet, low glycemic index diet, plant-based diet, Mediterranean diet, Dietary Approaches to Stop Hypertension, among others. This review aims to provide a scientific basis for precision nutrition and personalized, sustainable diet therapies in clinical practice, promoting awareness and improving treatment strategies for depressive symptoms in obese patients.

Internal medicine (IM) programs often inadequately prepare trainees to manage obesity. To develop a novel obesity medicine (OM) pathway for IM trainees. Clinic-based weight management program at an urban Federally Qualified Health Center. PGY2 and PGY3 categorical residents within a large urban IM residency training program. This 1-2-year longitudinal OM pathway includes (1) foundational knowledge: developed through asynchronous on-line modules and in-person journal clubs; (2) experiential training: direct, longitudinal care of a patient panel at a weight management clinic; and (3) professional development: completion of the professional requirements for the OM board certification. Eighteen residents participated in the pathway and completed pre- and post-pathway surveys. The pathway resulted in an increase in self-reported confidence and practice patterns in OM management. One hundred percent ranked their confidence as high/moderate for the clinical skills of counseling on diet and nutrition and prescribing anti-obesity medications. Eighty-three percent of the residents felt they would likely/very likely sit for the OM board exam. This novel comprehensive OM pathway showed increased self-reported physician confidence and obesity management behaviors among IM residents. Additionally, the professional development component will be a promising avenue to prepare residents to become obesity board certified.