Large language models (LLMs) are increasingly embedded in conversational agents for cardiometabolic care. These systems could support self-management, but their behavior change content, delivery mechanisms, and implementation transparency are poorly understood. This scoping review mapped behavior change techniques (BCTs) used in LLM-driven conversational agents for cardiometabolic prevention and management, described how these techniques are delivered across static, rule-based, and generative mechanisms, examined LLM design, personalization, and safety reporting, and summarized user experience and behavioral or clinical outcomes. We searched PubMed, Web of Science, Embase, CINAHL, APA PsycInfo, IEEE Xplore, ACM Digital Library, arXiv, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform for records published from January 1, 2020, to November 30, 2025. The final search was run on March 25, 2026, using this publication-date limit. Eligible studies reported a patient-facing text- or voice-based cardiometabolic conversational agent using an LLM or other transformer-based generative model. Two reviewers independently screened records and extracted data. BCTs were coded using the Behavior Change Technique Taxonomy v1; selected self-management BCTs were classified as static, rule-based or templated, or generative or context-aware. Empirical human-participant- or evaluator-based studies were appraised with the Mixed Methods Appraisal Tool, and a study-specific checklist assessed LLM implementation reporting transparency. Thirty-eight studies were included; 19 involved empirical human-participant- or evaluator-based assessments, whereas 19 were technical and system-level evaluations, including framework-development, simulated-output, and proof-of-concept studies. Studies were concentrated in 2024-2025. Instruction on how to perform behavior was identified in 30 of 38 (79%) studies, information about health consequences in 27 of 38 (71%) studies, and feedback and monitoring techniques in 19 of 38 (50%) studies. Most agents were positioned as educators or coaches targeting type 2 diabetes, obesity, or related cardiometabolic risk, and GPT-family models embedded in hybrid architectures with retrieval-augmented generation or rule-based components predominated. Generative outputs were used mainly for tailored explanations, risk information, and socioemotional responses, whereas self-monitoring, reminders, and structured interactions were more often rule-based or mixed-mode. Only 13 of 38 (34%) studies fully reported prompts or system messages, and 16 of 38 (42%) studies fully reported safety or oversight mechanisms. User evaluations reported good usability and perceived helpfulness, but behavioral or physiological outcomes were sparse and usually limited to pilot, short-term, or single-case designs. LLM-driven conversational agents for cardiometabolic care are proliferating but remain early-stage and methodologically heterogeneous. Current systems primarily use LLMs as educational and explanatory layers with "synthetic empathy" over rule-based data capture and safety functions, while behavior change content remains dominated by information provision and simple feedback. More rigorous comparative studies with longer follow-up are needed before firm conclusions can be drawn about sustained behavioral or clinical benefit.
Cardiometabolic conditions-including cardiovascular disease, type 2 diabetes, and obesity-are highly prevalent among individuals with psychotic disorders. These conditions contribute substantially to reduced life expectancy, diminished quality of life, and increased societal and economic burdens. Thus, effective, individualized interventions are urgently needed. Outpatient psychiatric clinics offer an ideal setting for such efforts owing to regular patient contact and access to multidisciplinary care. We have developed a comprehensive, clinically integrated trial aimed at improving cardiometabolic health, promoting healthier lifestyles, and enhancing quality of life for individuals with psychotic disorders receiving care in the Greater Gothenburg region. LAGOM is a multicenter, naturalistic, quasi-experimental case‒control trial conducted across six geographically separate outpatient psychosis clinics within the Department of Psychotic Disorders at Sahlgrenska University Hospital, a multi-site university hospital in the Greater Gothenburg region. A total of 650 adults with psychotic disorders will be recruited from these clinics. Two clinics will implement the LAGOM intervention, whereas four will serve as control sites delivering usual care. The intervention is embedded within routine psychiatric care and grounded in behavioral science. It includes comprehensive cardiometabolic risk assessments, two visual motivational tools (QRISK3 and a body composition analyzer), personalized follow-up plans, risk-oriented referrals to primary care, and structured education for patients, relatives, and staff. The intervention is designed to be scalable, sustainable, and tailored to individual patient needs. If proven superior to usual care, this pragmatic, multicomponent intervention-delivered within routine psychiatric care-could improve cardiometabolic health and quality of life for individuals with psychotic disorders. Embedding the intervention within existing clinical structures enhances its scalability and feasibility and, if effective, could serve as a model for wider implementation. ClinicalTrials.gov (NCT06781801; date registered: 16 January 2025). Recruitment started on 27 February 2025 and will be completed on 31 December 2026. The current clinical investigation plan version is 3.1, dated 21 October 2025.
Multiple long-term conditions (MLTC or multimorbidity) are increasing in global prevalence and represent a growing burden for individuals and health-care systems. Grouping cardiometabolic MLTC can be justified because aetiological antecedents and risk factors are often shared, and similar therapeutic approaches can have positive effects on the prevention, treatment, and delayed progression of many of the constituent conditions. In this Series paper, we focus on interventions for the prevention and management of cardiometabolic MLTC, under the broad headings of population-level, individual-level, and system-level interventions. Population-level public health measures such as educational, fiscal, regulatory, and environmental policies, and population-level screening and early detection can result in improved risk factor identification and control, although evidence that they reduce incidence and progression of cardiometabolic MLTC is more scarce. At an individual level, lifestyle interventions and pharmacotherapeutics can reduce the incidence and progression of cardiometabolic MLTC and provide effective treatment. Together with pharmacotherapeutic strategies, approaches to improve medicines management could help to optimise clinical outcomes in those living with cardiometabolic MLTC. System-level solutions, including integrated models of care and care continuity, provide opportunities to better address the holistic needs of people living with cardiometabolic MLTC. Together, combinations of multilevel approaches are required.
BACKGROUND: Intragastric balloon (IGB) therapy is a minimally invasive endoscopic intervention for weight reduction in patients with Class I-II obesity and in lower BMI patients with obesity-related comorbidities such as diabetes mellitus. Diabetes mellitus is associated with vascular complications, increased susceptibility to infection and delayed gastric emptying, underscoring the need to evaluate procedural safety and device tolerance in this population. However, evidence regarding short-term safety in this higher-risk population remains limited. This study aims to compare 30-day safety outcomes after IGB placement in patients with and without diabetes mellitus. METHODS: This was a retrospective cohort study of 4,555 patients undergoing primary IGB placement using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from 2015 to 2023. Propensity score-matching was performed in R version 4.5.0 to balance baseline characteristics in two matched analyses: (1) patients with diabetes mellitus matched to patients without diabetes mellitus, and (2) non-insulin dependent diabetes mellitus (NIDDM) versus insulin-dependent diabetes mellitus (IDDM). Outcomes included 30-day rates of outpatient intravenous (IV) treatments, emergency department (ED) visits, hospital readmissions, reoperations, procedural interventions, and serious adverse events (SAEs). RESULTS: Patients with diabetes, particularly those with insulin dependence, were older, more frequently male, and had a higher burden of cardiometabolic-associated medical problems compared to patients without diabetes. Among 424 propensity-matched patients with and without diabetes, rates of 30-day healthcare utilization including outpatient IV treatment, ED visit, hospital readmission, reoperation, and procedural intervention were comparable. Postoperative SAEs were rare, with no observed significant differences in rates of organ space infection, pneumonia, unplanned intubation, pulmonary embolism, deep vein thrombosis, prolonged mechanical ventilation, urinary tract infection, renal insufficiency, acute renal failure, cerebrovascular accident, cardiac arrest, myocardial infarction, sepsis, septic shock, unplanned intensive care unit admission and mortality. In a sub-analysis of 106 matched patients with NIDDM and IDDM, 30-day healthcare utilization and all postoperative SAEs were likewise similar, with no observed statistically significant differences between cohorts. CONCLUSION: Patients with diabetes exhibited a greater burden of associated medical problems but demonstrated comparable rates of short-term healthcare utilization, safety outcomes and tolerability to those without diabetes after adjustment for baseline differences. These findings support the safety of IGB placement in patients with diabetes and suggest it may be considered both as a safe option for primary weight loss intervention or as a bridge therapy to Metabolic and Bariatric Surgery (MBS) in this population.
Obesity treatment improves long-term health and quality of life outcomes. Weight reduction and its maintenance play an important role in achieving these goals. We evaluated the efficacy and safety of continuing tirzepatide at the maximum tolerated dose (MTD) or lowering the dose to 5 mg compared with switching to placebo on the maintenance of bodyweight reduction obtained with tirzepatide MTD in adults with obesity. This phase 3b, placebo-controlled, 112-week trial, including a 60-week open-label weight-loss period and a 52-week, double-blind weight maintenance period, was conducted across 20 sites in the USA. After completing the initial weight-loss period with once weekly subcutaneous tirzepatide at the MTD (10 mg or 15 mg), adults (aged ≥18 years) with a BMI of 30 kg/m2 and above or 27 kg/m2 and above with one or more weight-related comorbidity, and a history of at least one self-reported unsuccessful dietary effort to lose bodyweight were randomly assigned in a 3:3:2 ratio to continue tirzepatide MTD, reduce to tirzepatide 5 mg, or switch to placebo for an additional 52 weeks. Starting at week 84 (24 weeks after random allocation), participants could receive rescue tirzepatide if their weight regain exceeded 50%. The primary endpoint was the percentage change in bodyweight from baseline to week 112. The primary estimand was the modified treatment-regimen estimand, which assumed that participants who initiated rescue tirzepatide would not have gained further benefit from their assigned study treatment and included all randomly allocated participants, regardless of treatment discontinuation or initiation of prohibited medications. The efficacy estimand was supportive. Safety was assessed in all participants who received at least one dose of study drug. This completed trial was registered at ClinicalTrials.gov (NCT06047548). From Sept 20, 2023, to Jan 20, 2026, 441 patients were enrolled in and took at least one dose of study treatment during the weight-loss period, with 378 participants randomly allocated at week 60 (140 to tirzepatide MTD; 144 to dose-reduction to 5 mg tirzepatide; and 94 to placebo). 372 received at least one dose of study drug during the weight maintenance period (139 for tirzepatide MTD; 142 for 5 mg tirzepatide; and 91 for placebo). 345 (91%) of 378 participants completed the study. The majority of participants were White (67%); 288 (65%) participants were female and 153 (35%) were male; and the mean age was 46·6 years (SD 13·0). At baseline, participants had a mean bodyweight of 113·8 kg (SD 27·0), a BMI of 40·1 kg/m2 (SD 8·1), and HbA1c 5·64% (SD 0·4; 38·2 mmol/mol [SD 4·0]). The model-based estimate percent change in bodyweight from baseline to week 112 was -21·9% (95% CI -23·5 to -20·3) with MTD (estimated treatment difference [ETD] -12·0% [95% CI -13s·8 to -10·1]), -16·6% (95% CI -18·0 to -15·1) with 5 mg tirzepatide (ETD -6·6 [95% CI -8·3 to -5·0]), versus -9·9% (95% CI -11·1 to -8·8) with placebo (p<0·0001 for all comparisons). Among participants who regained at least 50% of lost bodyweight, observed means were 11 (8%) of 138, 35 (25%) of 142, and 60 (67%) of 90 participants received rescue therapy in the tirzepatide MTD, 5 mg tirzepatide, and placebo, respectively. The most common adverse events with tirzepatide were gastrointestinal events, which were mostly mild to moderate in severity and mostly occurred during dose escalation. In adults with obesity, long-term treatment is often necessary to maintain bodyweight reduction and its associated cardiometabolic benefits. In the SURMOUNT-MAINTAIN trial, continuing tirzepatide at MTD maintained bodyweight reduction and health-related benefits. Reducing to 5 mg tirzepatide might provide a valuable alternative to discontinuation, although individuals' treatment response might vary. Together, these findings support the importance of ongoing therapy for long-term obesity management and provide evidence to inform individualised, patient-centred obesity care. Eli Lilly.
Hypertension is common among patients with type 2 diabetes mellitus (T2DM) and represents a major contributor to cardiovascular and renal morbidity. Real-world data from primary care are essential to characterise associated clinical profiles and cardiometabolic multimorbidity patterns in routine clinical practice. To assess the prevalence of hypertension among patients with T2DM managed in primary care, to characterise associated clinical profiles, and to explore sex-related differences using real-world data. A cross-sectional study was conducted including 680 adults with T2DM receiving routine care in primary care settings. Clinical, sociodemographic and laboratory data were obtained from electronic health records, direct clinical assessment, and structured patient interviews. Hypertension was defined as a previously recorded clinical diagnosis, current antihypertensive treatment, or blood pressure ≥ 140/90 mmHg. Comparisons were performed according to sex. Factors independently associated with hypertension were analysed using bivariate analyses and multivariable logistic regression models adjusted for age, sex, duration of T2DM, pharmacologically treated dyslipidaemia, and established cardiovascular disease. The mean age of participants was 69.8 ± 13.3 years and the mean duration of diabetes was 9.9 ± 4.6 years; 52.1% were men. Overall hypertension prevalence was 84.3%, with no significant difference between men (85.9%) and women (82.5%). Hypertension prevalence increased with age in both sexes. Women had lower educational and socioeconomic levels, higher abdominal obesity, and higher lipid concentrations, whereas men showed higher fasting glucose, serum creatinine, and markers of renal damage. In multivariable analysis, hypertension was independently associated with older age (OR 1.04 per year; 95% CI 1.02-1.06), pharmacologically treated dyslipidaemia (OR 1.83; 95% CI 1.17-2.86), established cardiovascular disease (OR 2.03; 95% CI 1.16-3.55), and longer duration of T2DM (OR 1.06 per year; 95% CI 1.00-1.12). Sex was not independently associated with hypertension after adjustment. Hypertension was common among patients with T2DM in primary care and was associated with older age, longer diabetes duration, and established cardiovascular disease. Sex-related differences in clinical profiles were observed but should be interpreted as descriptive. This cross-sectional secondary analysis has limitations, including the lack of blood pressure control data and the potential for residual confounding.
Cardiovascular-kidney-metabolic (CKM) syndrome is a condition reflecting the interactions among metabolic dysfunction, chronic kidney disease (CKD), and cardiovascular disease. It is driven by excess adipose tissue, insulin resistance, inflammation, and vascular and kidney dysfunction, which accelerates the development of hypertension, dyslipidemia, type 2 diabetes, and CKD. Early identification and intervention are critical to prevent progression to advanced cardiovascular and kidney disease; however, optimal interdisciplinary approaches to CKM management are not well established. This narrative review summarizes pharmacotherapeutic strategies to prevent CKM progression for individuals with CKM stages 1 and 2 and the expanding role of pharmacists. Obesity is a primary driver of CKM syndrome, and early assessment with weight-loss interventions is critical to reduce progression of CKM stages. Management emphasizes lifestyle modification, with pharmacotherapy increasingly used as an adjunct. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide/GLP-1 RAs promote substantial weight loss and provide cardiovascular benefits. Hypertension is an important modifiable risk factor as it contributes to kidney damage and adverse cardiovascular events. Management includes lifestyle modification and antihypertensive therapy with angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), calcium channel blockers, or thiazide diuretics. In patients with albuminuria and CKD, ACEis or ARBs should be prioritized due to their kidney-protective effects. Dyslipidemia contributes to endothelial dysfunction, atherosclerosis, and cardiovascular risk. Statins are first-line therapy, with ezetimibe or PCSK9 inhibitors considered when low-density lipoprotein cholesterol remains above goal despite maximally tolerated statin therapy. Type 2 diabetes and CKD substantially increase the risk of progression to advanced CKM stages. Sodium-glucose cotransporter 2 inhibitors and GLP-1 RAs provide additional cardiovascular and kidney-protective benefits, while ACEis or ARBs remain foundational therapy for slowing CKD progression and reducing CKM risk. Pharmacists play a critical role in early CKM management through medication optimization, patient education, access facilitation, and longitudinal follow-up. Pharmacist-led interventions have been shown to improve blood pressure, lipid levels, glycemic control, weight outcomes, and kidney parameters, supporting prevention of progression to advanced disease stages. Pharmacotherapy optimization for cardiometabolic and kidney risk factors during CKM stages 1 and 2 is essential to prevent progression to late stage CKM. Although pharmacists are well positioned to participate in comprehensive CKM management, most previous interventions have focused on isolated disease states. Future research should assess the impact of pharmacist-led care on CKM syndrome as an integrated condition to inform patient-centered, multidisciplinary prevention strategies.
Individuals with Down syndrome (DS) are at an increased risk of obesity and, subsequently, its cardiometabolic and cognitive impacts. Caregivers play a critical role in managing health, yet their perceptions and behaviors have been poorly characterized. We performed a cross-sectional online survey of caregivers (n = 764) taking care of 48% females and 52% males with DS, conducted across European populations, predominantly in Spain and France. We assessed perceived obesity, perceived harmfulness of current weight, professional consultation, and confidence in promoting healthy behaviors. Associations were examined using chi-square tests, correlation analysis, and ordinal and logistic regression models. Around one-third (32%) of caregivers perceived their family member with DS with obesity. Perceived obesity changed with age and was more frequently reported in female family members with DS. Awareness of general metabolic risk factors was high among caregivers, but half of respondents were unaware that abdominal fat affects brain health. Consultation with healthcare professionals was uncommon (57% "Never/Rarely/Sometimes") even among those perceived with obesity. Caregivers demonstrate good general awareness about high energy food risks but limited knowledge of the link between obesity and brain health. Enhancing caregiver education and supporting behavioral change could promote healthier lifestyles in families with individuals with DS.
Maternal nutritional status and dietary patterns represent key determinants of pregnancy outcomes and long-term health of the offspring, through metabolic, epigenetic, and developmental programming mechanisms. Mediterranean Diet (MD) has been widely acknowledged as a model of healthy eating, with anti-inflammatory and cardiometabolic benefits, and evidence on the impact of MD during pregnancy on maternal/infant outcomes is growing. The present systematic review and meta-analysis evaluates the association between adherence to MD during pregnancy and maternal and neonatal health outcomes. This review was conducted in accordance with PRISMA 2020 and MOOSE guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, and Cochrane Library was performed up to February 28, 2024. Study quality was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was evaluated with the NUTRIGRADE approach. Pooled effect sizes were computed using a random-effects model and expressed as risk ratios (RR), hazard ratios (HR), or odds ratios (OR), as appropriate. Thirty-three studies (19 RCTs and 14 observational; >180 000 pregnant women) were included. Higher MD adherence was associated with lower risk of gestational diabetes mellitus (cohorts: OR 0.93, 95% CI 0.91-0.96; RCTs: RR 0.74, 95% CI 0.63-0.88), preterm delivery (cohorts: OR 0.96, 95% CI 0.92-0.99; RCTs: RR 0.45, 95% CI 0.05-0.84), low neonatal weight (cohorts: OR 0.96, 95% CI 0.91-1.00; RCTs: RR 0.61, 95% CI 0.42-0.88) and fetal growth alterations (RR 0.93, 95% CI 0.87-0.995). Evidence for pre-eclampsia was inconsistent, with significant associations in cohorts but not in RCTs. No significant effects were found for caesarean section, fetal death, neonatal asthma, or childhood obesity. NUTRIGRADE indicated moderate-to-high certainty for gestational diabetes, preterm delivery and low neonatal weight, and low certainty for other outcomes. Adherence to MD during pregnancy is associated with reduced risk of gestational diabetes, preterm birth and abnormal fetal growth. Given its safety and broader cardiometabolic benefits, the MD represents a suitable dietary pattern in pregnancy, although further high-quality trials with diverse populations and standardized MD metrics are warranted.
PURPOSE: The use of glucagon-like peptide-1 (GLP-1) receptor agonists (RA) and the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RA tirzepatide has increased rapidly for the management of type 2 diabetes mellitus and obesity. This study aimed to describe real-world prescribing patterns, patient characteristics, and observational short-term changes in weight and blood pressure among adults receiving GLP-1 RA and dual GIP/GLP-1 RA in a tertiary academic healthcare setting in the United Arab Emirates. METHODS: This retrospective observational study included adult patients prescribed GLP-1 RA or tirzepatide (dual GIP/GLP-1 RA) between January 2022 and December 2024. Electronic health records and pharmacy dispensing databases were reviewed. Prescription trends were standardized using monthly treatment units. Baseline demographic and clinical characteristics were described, and short-term changes in body weight and blood pressure were assessed where follow-up data were available. The mean treatment duration among patients with follow-up data was 6.99 months. An exploratory multivariable logistic regression adjusted for age group, sex, BMI category, treatment group, and HbA1c category was performed to evaluate factors associated with achieving clinically meaningful weight loss (≥ 5%). RESULTS: A total of 238 patient records and 1,744 dispensing records were analyzed. Utilization of GLP-1–based therapies increased by 371.7% over the study period, with a marked shift toward tirzepatide as the predominant agent. Most patients had obesity (83.6%), type 2 diabetes mellitus (89.0%), and multiple cardiometabolic comorbidities. Among patients with paired follow-up data, the mean percentage weight reduction was 3.91% (SD 7.32; 95% CI 2.70 to 5.12), and the mean treatment duration was 6.99 months (SD 3.69). Weight responses were heterogeneous, reflecting substantial interindividual variability in patient weight outcomes, with 35.6% achieving ≥ 5% weight loss and 25.1% experiencing weight gain. After adjustment for age group, sex, BMI category, treatment group, and HbA1c category, no independent association was observed between treatment group and achieving ≥ 5% weight loss. CONCLUSION: In this tertiary care setting, prescribing of GLP-1–based therapies expanded rapidly, accompanied by heterogeneous short-term changes in weight and blood pressure observed in routine clinical practice. These findings highlight the need for longer-term, multicentre studies to evaluate the real-world effectiveness, safety, and population-level impact of GLP-1 RA and dual GIP/GLP-1 RA. CLINICAL TRIAL NUMBER: Not applicable.
Metabolic dysfunction-associated steatotic liver disease (MASLD) poses a significant health burden and impacts quality of life (QoL). This study evaluates the effects of essential phospholipids (EPL) on liver steatosis, QoL, and other liver and metabolic parameters in patients with MASLD and associated comorbidities. In this multicenter, double-blind, randomised, placebo-controlled phase 4 clinical trial, patients with MASLD and type 2 diabetes, hyperlipidemia, or obesity received either EPL or placebo, alongside standard of care. change in hepatic steatosis from baseline to 6 months (measured by Controlled Attenuation Parameter [CAP] score); secondary endpoints: changes in QoL (measured by the Chronic Liver Disease Questionnaire [CLDQ-MASLD]), symptom changes; other endpoints: other liver, metabolic, and lipid parameters, and safety. Of 193 randomised patients, 165 constituted the modified intention-to-treat population (median age: 56.5 years [EPL arm], 55.0 years [placebo arm]). More than ¾ of patients were obese and had CAP score ≥ 280 dB/m. At 6 months, EPL treatment significantly reduced CAP (p = 0.0269) versus placebo. This effect was evident at 3 months (p = 0.0049) and sustained until 3 months post treatment (p = 0.0234). QoL total score showed numerical improvement, with statistically significant improvement in fatigue subscore (p = 0.0229) with EPL versus placebo at 6 months. EPL significantly improved HbA1c levels (p = 0.0069) over 6 months. No safety concerns arose. The beneficial effects of EPL on hepatic steatosis, QoL and glycemic control, and its favourable safety profile make it a promising candidate for managing steatosis and enhancing overall liver health in MASLD patients with cardiometabolic risk. The trial was registered in the EudraCT (2021-006069-39). Essential phospholipids (EPLs) can be used along with standard treatments to reduce liver fat in patients with fatty liver disease linked to metabolic health issues. However, strong evidence from well‐controlled studies is limited. The present phase 4 clinical study (EXCEL) found that EPLs, when added to standard care, significantly reduced liver fat, tiredness and blood sugar levels within 6 months in such patients. These results suggest that EPLs could be a safe and effective option to improve liver health in patients with fatty liver disease with conditions like diabetes, high cholesterol, or obesity.
Non-communicable diseases, particularly cardiovascular diseases (CVD) and metabolic syndrome (MS), remain a major challenge for primary health care (PHC). This study aimed to assess cardiometabolic risk and health behaviours in adult PHC patients using routine preventive screening. This prospective observational study included 506 adults attending routine consultations in an urban PHC centre in Poland. Preventive assessment included anthropometric measurements (body weight, height, BMI, and waist circumference), blood pressure, lipid profile, and fasting glucose levels. Health behaviours were recorded using the standardised NFZ CHUK questionnaire. The 10-year CVD risk was estimated using the SCORE2 algorithm. Multivariable logistic regression was used to identify independent factors associated with high cardiovascular risk (SCORE2 ≥ 5%) and of a composite endpoint defined as the presence of any non-optimal biochemical parameter. Nearly half of the participants had excess body weight (overweight or obesity), and more than half met criteria for central obesity. Borderline or elevated total cholesterol was found in 47% of patients, abnormal LDL in 27%, low HDL-C (<40 mg/dL) in 80% (84% when applying sex-specific cut-offs), and impaired fasting glucose or diabetes in about 12%. High SCORE2 risk (≥5%) was observed in approximately 9% of the cohort. In multivariable models, SCORE2 components (age, sex, and smoking) were, as expected, associated with high SCORE2 risk, and obesity (BMI ≥ 30 kg/m2)-a factor not included in SCORE2-was additionally associated with higher risk. Additionally, age, male sex, and obesity also predicted the presence of at least one non-optimal biochemical marker. The prevalence of high SCORE2 risk increased from 1.2% in patients with 0-1 modifiable risk factor to 25.7% in those with 4-5 factors. Lower educational attainment was associated with a higher proportion of high-risk individuals in univariate analysis. Routine preventive activities in PHC enable the identification of important lipid and glucose abnormalities and the clustering of modifiable risk factors, even in a relatively young, highly educated population. Systematic cardiovascular screening and a focus on patients with accumulated risk factors should remain a priority in PHC to enable early identification of high-risk patients and timely implementation of lifestyle and therapeutic interventions.
To evaluate whether an endocrinology-integrated transplant clinic and differing healthcare delivery models are associated with metabolic outcomes during the first year after kidney transplantation in recipients with pre-existing diabetes. We conducted a retrospective longitudinal cohort study of adult kidney transplant recipients with diabetes at a US and a European academic centre. Participants were classified by post-transplant diabetes care model: Cohort 1, endocrinology-led Endocrine Transplant Clinic (ETC; n = 99); Cohort 2, historical standard transplant care at the same US centre (n = 81); and Cohort 3, standard endocrinology care at a Spanish academic centre (n = 40). Pre-specified outcomes included HbA1c, body mass index (BMI), blood pressure, and lipid levels measured at baseline and 3, 6, and 12 months. Linear mixed-effects models adjusted for demographic and clinical covariates were applied. Missing longitudinal data were addressed using multiple imputation with complete-case sensitivity analyses. Among 220 recipients, adjusted metabolic trajectories were broadly similar across cohorts. HbA1c was unchanged at 3 and 6 months but higher at 12 months; >50% had HbA1c >7% at 1 year. BMI remained stable, with ≥30% meeting obesity criteria throughout follow-up. Blood pressure did not improve, and systolic hypertension (>130 mmHg) remained common (49%-77%). At 12 months, LDL-C ≥70 mg/dL was present in 20.8%, 63.3%, and 42.3% of Cohorts 1-3. Findings were consistent in sensitivity analyses. Metabolic control in the first post-transplant year showed stabilisation rather than improvement, with many recipients above cardiometabolic targets. Prospective studies should test whether earlier, protocolised multidisciplinary management improves cardiovascular and graft outcomes.
Spermidine administration ameliorates hepatic steatosis and cardiometabolic dysfunction in animal models. However, evidence in humans remains limited. We aimed to explore the 1-year longitudinal associations between changes in dietary spermidine intake and changes in hepatic function indexes and cardiometabolic traits in overweight and obese older adults with metabolic syndrome. We used baseline and 1-year follow-up data from 2664 participants from the PREDIMED-Plus trial. Dietary spermidine intake was estimated using a semi-quantitative food frequency questionnaire. Time series clustering identified temporal patterns of 1-year change in spermidine intake. Linear mixed-effects models assessed the associations between spermidine intake clusters and changes in hepatic and cardiometabolic markers. Three distinct spermidine intake patterns were identified across baseline, six months and 1 year follow-up. Cluster 3, characterized by the highest baseline and increased 1-year spermidine intake, was associated with mean reductions in fatty liver index (- 8.97 [- 9.96 to - 7.97], p-int < 0.001), hepatic steatosis index (- 1.88 [- 2.13 to - 1.63], p-int < 0.001), alanine aminotransferase (- 2.93 [- 3.83 to - 2.02] U/L, p-int < 0.05), aspartate aminotransferase (- 1.11 [- 1.76 to - 0.45] U/L, p-int < 0.05) and glycated hemoglobin levels (- 0.14 [- 0.18 to - 0.10]%, p-int < 0.01). Cluster 3 also showed, mean decreases in body mass index (- 1.26 [- 1.37 to - 1.15]), waist (- 3.72 [- 4.11 to - 3.32] cm) and hip circumference (- 2.33 [- 2.67 to - 1.99] cm) (all p-int < 0.001). A 1-year increase in dietary spermidine intake was associated with improvements in hepatic function indexes and cardiometabolic traits in overweight and obese older adults with metabolic syndrome.
The Mediterranean diet (MD) is widely recognized for its potential health benefits, yet the extent and certainty of its association with metabolic outcomes remains incompletely understood. The aim of this systematic review and meta-analysis was to evaluate the relationship between adherence to the MD and the risk or prevalence of cardiometabolic disorders in the general population, with a focus on its role in primordial and primary prevention. This review followed PRISMA 2020 and MOOSE guidelines. A systematic search of PubMed/MEDLINE, Scopus, Embase, and the Cochrane Library was conducted through February 28, 2024. Eligible studies examined adherence to the MD in relation to the risk or prevalence of metabolic disorders. Study quality was assessed using the Newcastle-Ottawa Scale, and evidence certainty was rated with the NUTRI-GRADE framework. Pooled effect estimates were calculated using a random-effects model and reported as risk ratios (RR), hazard ratios (HR), or odds ratios (OR), as appropriate. Sixty studies comprising over 1.1 million participants were included. Higher MD adherence was consistently associated with a reduced risk of T2DM (RR: 0.96; 95% CI: 0.95-0.97), supported by moderate to high certainty of evidence. Similar inverse associations were observed for overweight (OR: 0.94; 95% CI: 0.91-0.97) and adult obesity (OR: 0.95; 95% CI: 0.93-0.97). The PREDIMED randomized trial further demonstrated a 20% reduction in diabetes incidence with MD intervention. Evidence for metabolic syndrome (RR: 0.98; 95% CI: 0.98-0.99) and hyperuricemia (OR: 0.43; 95% CI: 0.25-0.75) was suggestive of protective effects, though with lower certainty. Associations with hypercholesterolemia and hypertriglyceridemia were inconsistent and inconclusive. Adherence to the Mediterranean diet is associated with a lower risk of several metabolic disorders, particularly T2DM and obesity in adults. These findings support the inclusion of the MD in public health strategies for metabolic disease prevention. Further high-quality longitudinal and interventional studies are warranted to clarify its effects on other metabolic outcomes.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have significantly influenced contemporary obesity pharmacotherapy, emerging as a major development in obesity care. Rising visibility in public discourse, healthcare practice, and commercial markets highlights the need to understand how these medications are accessed and experienced outside controlled experimental studies. Despite widespread use, real-world patterns of engagement, motivations, and concerns remain poorly understood amid high discontinuation rates, substantial and accelerated weight regain following cessation compared to traditional weight management intervention, and the potential for reduced effectiveness outside of the controlled setting of clinical trials. This study is the first to explore public perceptions, attitudes, and lived experiences of GLP-1RA use among UK adults, with attention to age, sex, BMI and use duration-specific responses. A cross-sectional design was employed using a self-administered online survey (n = 684), including 544 current or former GLP-1RA users. The survey captured demographic characteristics, health status, medication use, satisfaction, side effects, and body image. Findings showed high satisfaction with GLP-1RA use, however effects on perceived energy, dietary habits, and concerns about a reduction in muscle mass were reported, with age and BMI influencing these experiences. Most users sourced medication from online pharmacies, reporting inconsistent pre-assessment rigour. Social media was the dominant information source, while healthcare professionals were less frequently consulted. A minority of users reported behaviours suggestive of misuse, including exceeding recommended doses, often driven by perceived inefficacy. Non-users expressed conditional willingness to adopt GLP-1RAs, influenced by clinical recommendation and stronger evidence, though concerns about side effects and long-term safety were prevalent. This study suggests potential implications for regulatory strategy and highlights a need for targeted education and integrated behavioural support, particularly in light of reported rapid weight regain and reversal of beneficial effects on cardiometabolic markers following medication cessation. These results also provide important insights into demographic-specific experiences and provide important considerations to aid development of holistic, evidence-informed strategies to ensure safe and effective GLP-1RA use.
Metabolic syndrome (MetS) is a major risk factor for type 2 diabetes and cardiovascular disease. In recent years, telemedicine and digital health interventions have emerged as promising strategies to support lifestyle modification and the long-term management of cardiometabolic conditions. However, their clinical effectiveness in MetS remains heterogeneously reported. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and Web of Science were searched for studies published between 2019 and 2024. Eligible studies included adults with MetS or its components and evaluated telemedicine or technology-enabled interventions, including mobile health (mhealth) applications, remote monitoring, wearable devices, or telecommunication-based care. Outcomes of interest included waist circumference (WC), glycemic parameters, blood pressure, and lipid profile. Twenty seven studies met inclusion criteria. Most interventions incorporated telemedicine components such as remote coaching, digital feedback, and continuous monitoring, frequently delivered through mobile platforms and wearable technologies. These interventions consistently resulted in reductions in WC, while modest but recurrent improvements were observed in glycemic control and blood pressure. Effects on lipid parameters were more variable, with more frequent improvements in high-density lipoprotein cholesterol than in low-density lipoprotein cholesterol. Higher intervention intensity and user engagement were associated with greater clinical benefits. Telemedicine and digital health interventions represent effective adjuncts to conventional lifestyle management of MetS, particularly for central obesity and glycemic outcomes. Their ability to deliver scalable, personalized, and remotely supported care highlights their potential role in cardiometabolic prevention and management. Further research is needed to standardize intervention components and optimize long-term effectiveness.
There are a number of guidelines on how to manage obesity, but inconsistencies in healthcare access, varying infrastructure, resource constraints, and diverse local practices restrict their global applicability. This underscores the need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our Global Guidelines emphasize the incorporation of novel therapies while integrating standards of care with the most up-to-date evidence to enable clinicians to optimize obesity management. Context-specific recommendations tailored to individual patient needs are highlighted, providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These Global Guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged, and-most importantly-also provide recommendations on several issues where resource limitations may put constraints on the care provided to patients living with obesity. Such "economic adjustment" recommendations aim to guide situations when "Resources are somewhat limited" or when "Resources are severely limited." Hence, this document presents a comprehensive update to obesity management guidelines, thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, and invasive management of this significant global health challenge that is applicable to the needs of healthcare around the globe.
To quantify real-world diagnosis and treatment of obesity in Sweden, describe cardiometabolic comorbidity burden across obesity classes, and compare long-term cardiovascular outcomes with the general population. This population-based cohort study used the AROS (Analysis of Real-world data of patients with Obesity in Sweden) database to identify adults with a recorded BMI ≥ 30 kg/m2 between January 2013 and June 2023. Individuals were stratified by obesity class. Baseline demographics, comorbidities, medications and laboratory values were described. Outcomes included recorded obesity prevalence, obesity diagnosis (ICD-10: E66), healthcare setting at first BMI ≥ 30 kg/m2, cardiometabolic comorbidity profiles, treatment patterns and long-term cardiovascular outcomes. Cardiovascular outcomes were compared with a matched general population. In 2022, recorded obesity prevalence was 13.6%. Amongst 328 094 individuals with obesity (mean age 53.5 years; 55.0% women), 67.6% had at least one cardiometabolic comorbidity. At the first observed BMI ≥ 30 kg/m2 (index), 28.8% had a recorded obesity diagnosis, increasing to 48.0% 5 years later. Index BMI was most often recorded in primary care (39.7%). Within 5 years after index, 7.8% had received obesity-management medication and 4.2% had undergone bariatric surgery. Compared with matched population representatives, the obesity cohort had higher cumulative incidence across all cardiovascular outcomes, with the largest relative difference for heart failure hospitalisation (HR 2.34, 95% CI 2.29-2.40). Obesity remains underdiagnosed and undertreated in Swedish healthcare, despite a high burden of cardiometabolic comorbidities and substantially higher long-term cardiovascular risk compared with the general population.
To estimate the prevalence of self-reported physician-diagnosed obesity and identify its risk factors among adults attending primary healthcare centers in Riyadh, Saudi Arabia. A cross-sectional survey was conducted from March to July 2023. Participants aged 18 years or older attending 48 randomly selected primary healthcare centers were recruited using a multistage sampling approach, involving random selection of primary healthcare centers followed by systematic random sampling of attendees. Obesity status was defined based on self-reported prior physician diagnosis of obesity, collected using a validated questionnaire. Multivariable logistic regression was used to identify factors independently associated with obesity. A total of 14,239 adults participated in the study. The prevalence of self-reported physician-diagnosed obesity was 5.2% (95% CI: 4.9-5.6). Males were 30% less likely to be obese than females (AOR: 0.72; 95% CI: 0.60-0.86), while smokers were more than twice as likely to be obese compared to non-smokers (AOR: 2.37; 95% CI: 1.94-2.89). Fast food consumers higher odds of obesity (AOR: 1.61; 95% CI: 1.24-2.09). Obesity was also positively associated with diabetes (AOR: 1.48; 95% CI: 1.15-1.89), hypertension (AOR: 1.60; 95% CI: 1.23-2.09), hypercholesterolemia (AOR: 4.36; 95% CI: 3.43-5.55), and heart disease (AOR: 4.46; 95% CI: 3.47-5.74). Self-reported physician-diagnosed obesity was significantly associated with behavioral and cardiometabolic risk factors among adults attending primary healthcare centers. These findings highlight the importance of early identification and integrated management of obesity-related comorbidities in primary care settings.