Changes in weight and body composition in a school population post-restart of alternating academic activity after quarantine by COVID-19.

Objective: To determine the change in the anthropometric parameters of the child and adolescent population, which occurred during pandemic period in boys and girls between 8 and 17 years of age, after the resumption of alternating academic activity. Material(s) and Method(s): There were included 130 students from 8 to 17 years of age, through bioimpedatiometry using the InBody 170 scale, taking weight, lean mass, percentage of fat mass and total fat mass, height in cm with an InBody brand ultrasonic stadiometer. Result(s): It was found presence of excess weight in 36.1% of the population with predominance of overweight in females and obesity in males, lean mass 36.15% was below the range for age, being more frequent in the group of men than in women, total fat mass 40.76% was above the range for age and in percentage of total body fat 59.23% above the range for age, men showed greater body fat mass than women. Conclusion(s): Obesity and overweight in the school population in Colombia has grown notably in the pospandemic era, not only because of an increase in body weight that was greater than the ENSIN 2015 and a greater increase compared to that reported between 2010 and 2015 attributed to an abnormal body composition, with a high predominance of fat mass that exposes to an increased cardiometabolic risk related to the presence of lipotoxicity.Copyright © 2022 Sociedad Colombiana de Cardiologia y Cirugia Cardiovascular.

The impact of the COVID-19 pandemic on inequalities in preventive health screenings: Trends and implications for U.S. population health.

The COVID-19 pandemic has profoundly impacted population well-being in the United States, exacerbating existing racial and socioeconomic inequalities in health and mortality. Importantly, as the pandemic disrupted the provision of vital preventive health screenings for cardiometabolic diseases and cancers, more research is needed to understand whether this disruption had an unequal impact across racialized and socioeconomic lines. We draw on the 2019 and 2021 National Health Interview Survey to explore whether the COVID-19 pandemic contributed to racialized and schooling inequalities in the reception of preventive screenings for cardiometabolic diseases and cancers. We find striking evidence that Asian Americans, and to a lesser extent Hispanic and Black Americans, reported decreased reception of many types of cardiometabolic and cancer screenings in 2021 relative to 2019. Moreover, we find that across schooling groups, those with a bachelor's degree or higher experienced the greatest decline in screening reception for most cardiometabolic diseases and cancers, and those with less than a high school degree experienced the greatest decline in screening reception for diabetes. Findings have important implications for health inequalities and U.S. population health in the coming decades. Research and health policy attention should be directed toward ensuring that preventive health care is a key priority for public health, particularly among socially marginalized groups who may be at increased risk of delayed diagnosis for screenable diseases.

The COVID-19 pandemic and temporal change in metabolic risk factors for cardiovascular disease: A natural experiment within the HELIUS study.

The coronavirus disease 2019 (COVID-19) pandemic, including the restrictive measures taken to reduce the spread of the virus, negatively affected people's health behavior. We explored whether the pandemic also had an effect on metabolic risk factors for cardiovascular disease (CVD) in women and men. We conducted a natural experiment, using data from 6962 participants without CVD at baseline (2011-2015) of six ethnic groups of the HELIUS study in Amsterdam, the Netherlands. We studied whether participants whose follow-up measurements were taken within the 11 months before the pandemic (control group) differed from those whose measurements were taken taken within 6 months after the first lockdown (exposed group). Using sex-stratified linear regressions with inverse probability weighting, we compared changes in baseline- and follow-up data between the control and exposed group in six metabolic risk factors: systolic and diastolic blood pressure (SBP, DBP), total cholesterol (TC), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and estimated glomerular filtration rate (eGFR). Next, we explored the mediating effect of changes in body-mass index (BMI), alcohol, smoking, depressive symptoms and negative life events at follow-up. We observed less favorable changes in SBP (+1.12mmHg for women, +1.38mmHg for men), DBP (+0.85mmHg, +0.80mmHg) and FPG (only in women, +0.12 mmol/L) over time in the exposed group relative to the control group. Conversely, changes in HbA1c (-0.65 mmol/mol, -0.84 mmol/mol) and eGFR (+1.06 mL/min, +1.04 mL/min) were more favorable in the exposed compared to the control group, respectively. Changes in SBP, DBP, and FPG were partially mediated by changes in behavioral factors, in particular BMI and alcohol consumption. Concluding, the COVID-19 pandemic, in particular behavioral changes associated with restrictive lockdown measures, may have negatively affected several CVD risk factors, in both women and men.

The Effect of a Moderately Restricted Carbohydrate Diet on Cardiometabolic Risk Factors in Overweight and Obese Women With Metabolic Syndrome: A Randomized Controlled Trial.

PURPOSE: Metabolic syndrome (MetS) is a major public health concern that increases the risk of cardiovascular disease and mortality. In previous studies of MetS management, low-carbohydrate diets have been strongly emphasized, despite the fact that many apparently healthy individuals have difficulties adhering to these diets on a long-term basis. The purpose of the present study was to elucidate the effects of a moderately restricted carbohydrate diet (MRCD) on cardiometabolic risk factors in women with MetS. METHODS: This parallel 3-month, single-blind randomized controlled trial was conducted in Tehran, Iran, among 70 women with overweight or obesity aged 20 to 50 years with MetS. Patients were randomly allocated to receive either MRCD (42%-45% carbohydrates and 35%-40% fats) (n = 35) or a normal weight loss diet (NWLD) (52%-55% carbohydrates and 25%-30% fats) (n = 35). Both diets contained the same quantity of protein, which accounted for 15% to 17% of total energy. Anthropometric measurements, blood pressure, lipid profile, and glycemic indices were all assessed before and after the intervention. FINDINGS: Compared with the NWLD group, following an MRCD significantly decreased weight (-4.82 vs -2.40 kg; P = 0.01), body mass index (-1.88 vs -0.94 kg/m2; P = 0.01), waist circumference (-5.34 vs -2.75 cm; P = 0.01), hip circumference (-2.58 vs -1.11 cm; P = 0.01), serum triglyceride (-26.8 vs -7.19 mg/dL; P = 0.01), and increased serum HDL-C levels (1.89 vs. 0.24 mg/dL; P = 0.01). There was no significant difference between the 2 diets in waist-to-hip ratio, serum total cholesterol, serum LDL-C, systolic and diastolic blood pressure, fasting blood glucose, insulin levels, or the homeostasis model assessment for insulin resistance. IMPLICATIONS: Moderate carbohydrate replacement with dietary fats significantly improved weight, body mass index, waist circumference, hip circumference, serum triglyceride, and HDL-C levels among women with MetS. Iranian Registry of Clinical Trials identifier: IRCT20210307050621N1.

Impact of COVID-19 Lockdown on cardiometabolic risk scales in Adults: A before and after Pandemic Lockdown Longitudinal Study

Introduction: In December 2019 the first cases of SARS-CoV-2 virus infection were detected, with the months it became pandemic and forced most countries to establish a state of lockdown. The aim of this study is to evaluate the influence of unhealthy lifestyles during lockdown on different cardiometabolic parameters. Methods: A prospective study was performed in 6.236 workers in a Spanish population between March 2019 and March 2021. Different cardiometabolic parameters were determined before and after pandemic lockdown. Results: An increase in all the parameters analyzed in the post-lockdown period compared to the pre-lockdown period was observed. Conclusions. Lockdown has had a negative impact on cardiometabolic parameters in both sexes.

The role of cardiometabolic risk factors and endothelial dysfunction in serum albumin levels and capillary leak syndrome of patients with COVID-19

Background: Growing evidence focuses on the role of hypoalbuminemia in the COVID-19 course and the role of vascular inflammation in the progression to Capillary Leak Syndrome (CLS). CLS may be mediated by a derangement of endothelial barrier following vascular endothelial dysfunction. We investigated the role of cardiometabolic risk factors in the association of hypoalbuminemia with endothelial dysfunction of hospitalized COVID-19 patients. Method(s): In this cross-sectional study, patients hospitalized for COVID- 19 at the medical ward or Intensive Care Unit (ICU) were enrolled. Medical history and laboratory examinations were collected while the endothelial function was assessed by brachial artery flow-mediated dilation (FMD) between the first 24-72 hours of their admission to the hospital. According to the body mass index, history of hypertension, dyslipidemia, and diabetes mellitus, COVID-19 patients were categorized in those with Cardiometabolic Risk Factors (CRFact) or without CRFact (no-CRFact). From the study population, we excluded subjects with established cardiovascular disease. Result(s): Sixty-six patients with COVID-19 (37% admitted in ICU) were recruited. From the study population, 41 were in the group of CRFact and 25 in the no-CRFact. Patients with CFRact were older (65+/-9 years vs. 53+/-14 years, p<0.001), had more impaired FMD (1.16+/-2.13% vs. 2.60+/-2.44%, p=0.01), and lower serum albumin levels (3.10+/-0.68 g/dL vs. 3.52+/-0.26 g/dL, p=0.006) compared to the no-CRFact group. Between CRFact and no-CRFact, there was no difference in CRP and IL-6 levels. Interestingly, serum albumin in patients with CRFact was significantly lower than the lower reference limit (LRL) (=3.5 g/dl) of albumin (p=0.001), while no such finding was noted in subjects with no CRFact (p=0.64). Furthermore, regression analysis revealed that, even after adjustment for age, the presence of CRFact was associated with decreased serum albumin levels by 0.31mg/dl (95% CI 0.08 to 0.63, p=0.04). In the CRFact population, there was a correlation of albumin with FMD (R=0.29, p=0.05) and an inverse correlation with CRP (rho=-0.48, p=0.02) and IL-6 (rho=-0.66, p<0.001), while in the no-CRFact group no such correlation were observed (p=NS for all). Conclusion(s): COVID-19 patients with cardiometabolic risk factors present with low serum albumin levels early at the course of the disease, which may be driven by endothelial dysfunction and vascular inflammation. This data gives insights into the potential association of a dysfunctional endothelial layer and the progression to capillary leak syndrome. (Figure Presented).

Design and Implementation of a Culturally-Tailored Randomized Pilot Trial: Puerto Rican Optimized Mediterranean-Like Diet.

Background: Adhering to a Mediterranean Diet (MedDiet) is associated with a healthier cardiometabolic profile. However, there are limited studies on the MedDiet benefits for non-Mediterranean racial/ethnic minorities, for whom this diet may be unfamiliar and inaccessible and who have a high risk of chronic diseases. Objectives: To describe the study design of a pilot trial testing the efficacy of a MedDiet-like tailored to adults in Puerto Rico (PR). Methods: The Puerto Rican Optimized Mediterranean-like Diet (PROMED) was a single-site 4-mo parallel two-arm randomized pilot trial among a projected 50 free-living adults (25-65 y) living in PR with at least two cardiometabolic risk factors (clinicaltrials.gov registration #NCT03975556). The intervention group received 1 individual nutritional counseling session on a portion-control culturally-tailored MedDiet. Daily text messages reinforced the counseling content for 2 mo, and we supplied legumes and vegetable oils. Participants in the control group received cooking utensils and one standard portion-control nutritional counseling session that was reinforced with daily texts for 2 mo. Text messages for each group were repeated for two more months. Outcome measures were assessed at baseline, 2 and 4 m. The primary outcome was a composite cardiometabolic improvement score; secondary outcomes included individual cardiometabolic factors; dietary intake, behaviors, and satisfaction; psychosocial factors; and the gut microbiome. Results: PROMED was designed to be culturally appropriate, acceptable, accessible, and feasible for adults in PR. Strengths of the study include applying deep-structure cultural components, easing structural barriers, and representing a real-life setting. Limitations include difficulty with blinding and with monitoring adherence, and reduced timing and sample size. The COVID-19 pandemic influenced implementation, warranting replication. Conclusions: If PROMED is proven efficacious in improving cardiometabolic health and diet quality, the findings would strengthen the evidence on the healthfulness of a culturally-appropriate MedDiet and support its wider implementation in clinical and population-wide disease-prevention programs.

Digital health, cardiometabolic disease and ethnicity: an analysis of United Kingdom government policies from 2010 to 2022.

Recent health policies in the United Kingdom (UK) and internationally have focussed on digitisation of healthcare. We examined UK policies for evidence of government action addressing health inequalities and digital health, using cardiometabolic disease as an exemplar. Using a systematic search methodology, we identified 87 relevant policy documents published between 2010 and 2022. We found increasing emphasis on digital health, including for prevention, diagnosis and management of cardiometabolic disease. Several policies also focused on tackling health inequalities and improving digital access. The COVID-19 pandemic amplified inequalities. No policies addressed ethnic inequalities in digital health for cardiometabolic disease, despite high prevalence in minority ethnic communities. Our findings suggest that creating opportunities for digital inclusion and reduce longer-term health inequalities, will require future policies to focus on: the heterogeneity of ethnic groups; cross-sectoral disadvantages which contribute to disease burden and digital accessibility; and disease-specific interventions which lend themselves to culturally tailored solutions.

The long-term effects of Kerala Diabetes Prevention Program on diabetes incidence and cardiometabolic risk: a study protocol.

INTRODUCTION: India currently has more than 74.2 million people with Type 2 Diabetes Mellitus (T2DM). This is predicted to increase to 124.9 million by 2045. In combination with controlling blood glucose levels among those with T2DM, preventing the onset of diabetes among those at high risk of developing it is essential. Although many diabetes prevention interventions have been implemented in resource-limited settings in recent years, there is limited evidence about their long-term effectiveness, cost-effectiveness, and sustainability. Moreover, evidence on the impact of a diabetes prevention program on cardiovascular risk over time is limited. OBJECTIVES: The overall aim of this study is to evaluate the long-term cardiometabolic effects of the Kerala Diabetes Prevention Program (K-DPP). Specific aims are 1) to measure the long-term effectiveness of K-DPP on diabetes incidence and cardiometabolic risk after nine years from participant recruitment; 2) to assess retinal microvasculature, microalbuminuria, and ECG abnormalities and their association with cardiometabolic risk factors over nine years of the intervention; 3) to evaluate the long-term cost-effectiveness and return on investment of the K-DPP; and 4) to assess the sustainability of community engagement, peer-support, and other related community activities after nine years. METHODS: The nine-year follow-up study aims to reach all 1007 study participants (500 intervention and 507 control) from 60 randomized polling areas recruited to the original trial. Data are being collected in two phases. In phase 1 (Survey), we are admintsering a structured questionnaire, undertake physical measurements, and collect blood and urine samples for biochemical analysis. In phase II, we are inviting participants to undergo retinal imaging, body composition measurements, and ECG. All data collection is being conducted by trained Nurses. The primary outcome is the incidence of T2DM. Secondary outcomes include behavioral, psychosocial, clinical, biochemical, and retinal vasculature measures. Data analysis strategies include a comparison of outcome indicators with baseline, and follow-up measurements conducted at 12 and 24 months. Analysis of the long-term cost-effectiveness of the intervention is planned. DISCUSSION: Findings from this follow-up study will contribute to improved policy and practice regarding the long-term effects of lifestyle interventions for diabetes prevention in India and other resource-limited settings. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry-(updated from the original trial)ACTRN12611000262909; India: CTRI/2021/10/037191.

Increased Cardiovascular Mortality in Ecuador during COVID-19 Pandemic.

Before the COVID-19 pandemic, chronic noncommunicable diseases (NCDs), represented a high burden for low and middle-income countries. Patients with NCDs are at higher risk of COVID-19 and suffer worse clinical outcomes. We present mortality trends for myocardial infarction (AMI), stroke, hypertension (HT), and type-2 diabetes mellitus (T2DM) from 2005 to 2021 in Ecuador. The greatest increase in mortality observed in the pandemic was in AMI, T2DM, and HT. Factors related to COVID-19, health services, and patients with NCDs could contribute to these important increases in mortality.

Status of Antibody against Severe Acute Respiratory Syndrome Coronavirus 2: Preliminary Reports on Seroprevalence of Covid 19 in among Health Care Workers

Introduction: Large number of health care workers (HCW) were infected and died due to COVID-19 infection. It is needed to know the actual seroprevalence of COVID in HCWs to assess the risk and to take protective measures. This study was aimed to measure IgG antibodies against nucleocapsid protein (N) of COVID as a serological marker for detection of viral status in risk prone HCW of Bangladesh and possible association with reno-cardio-metabolic risk factors Methods: This longitudinal study was conducted from May 2021 to January 2022 among physicians and non-physician health care workers (HCW) in three non- COVID designated tertiary hospitals in Bangladesh. Participants' demographic data, medical history and information on past COVID-19 infection and vaccination status were collected. Serial blood samples were collected at 1.5 month in all (n=633) later at 3, 6 and 9 months in vaccinated group. A qualitative measurement of IgG antibody against nucleocapsid protein (N) of SARS-CoV-2 was done by was done by CMIA developed by Abbott (FDA-EUA approved). Result(s): The mean age was 35+/-10years where70% were female. Physician 32%, Nurse 45% and others was 23%. Diabetics were 9.5%, hypertensive 9% and asthma in 5.1%. The two doses of vaccine against COVID-19was completed in 56%. History of past COVID-19 infection was found among 20% participants at recruitment, out of which 13% was diagnosed by rt-PCR. History of past COVID-19 infection was found among 18% participants based on 1gG against N protein. But the subjects in two groups were different. Combination of RTPCR and N protein igG showed 35% seropositive for covid. Comparisons between covid infection positive vs. negative showed only age was different (37+/-11 vs. 34+/-9, years p<0.001) but other risk factors like BMI, SBP, DBP, S Albumin, glucose, hemoglobin were not different (P=NS) between the two groups. Further comparisons for eGFR cut-offs showed higher infection in lower eGFR (infection present vs. absent for >90ml/min group was 17% & 83% and in 60-90 ml/min group 32% &. 68 %). Prevalence of COVID 19 infection based on presence of N antibody (cutoff value >1.5) among vaccinated HCWs at 1.5, 6 and 9 month was 13.6%, 8.8% and 7.7% respectively. The mean titer of IgG (against N protein) >1.5 among vaccinated HCWs at 1.5 month was 3.1+/-1.5 and reduced to 0.87+/-0.96 at month 6 (p<0.001). Conclusion(s): The prevalence of COVID-19 infection in HCWs during the second wave was 35% based on test for RTPR or IgG against N protein positivity. In vaccinated persons, based on antibody against N protein, re-infection rate was around 8% up to 9 months post vaccine. Although no difference was seen for covid infection for cardio-metabolic risk factors, there seems to have some relation of higher infectivity with decreased GFR level. No conflict of interestCopyright © 2023

Maximum Heart Rate- and Lactate Threshold-Based Low-Volume High-Intensity Interval Training Prescriptions Provide Similar Health Benefits in Metabolic Syndrome Patients.

Exercise is an integral part of metabolic syndrome (MetS) treatment. Recently, low-volume high-intensity interval training (LOW-HIIT) has emerged as a time-efficient approach to improving cardiometabolic health. Intensity prescriptions for LOW-HIIT are typically based on maximum heart rate (HRmax) percentages. However, HRmax determination requires maximal effort during exercise testing, which may not always be feasible/safe for MetS patients. This trial compared the effects of a 12-week LOW-HIIT program based on: (a) HRmax (HIIT-HR), or (b) submaximal lactate threshold (HIIT-LT), on cardiometabolic health and quality of life (QoL) in MetS patients. Seventy-five patients were randomized to HIIT-HR (5 × 1 min at 80-95% HRmax), HIIT-LT (5 × 1 min at 95-105% LT) groups, both performed twice weekly on cycle ergometers, or a control group (CON). All patients received nutritional weight loss consultation. All groups reduced their body weight (HIIT-HR: -3.9 kg, p < 0.001; HTT-LT: -5.6 kg, p < 0.001; CON: -2.6 kg, p = 0.003). The HIIT-HR and HIIT-LT groups similarly, improved their maximal oxygen uptake (+3.6 and +3.7 mL/kg/min, p < 0.001), glycohemoglobin (-0.2%, p = 0.005, and -0.3%, p < 0.001), homeostasis model assessment index (-1.3 units, p = 0.005, and -1.0 units, p = 0.014), MetS z-score (-1.9 and -2.5 units, p < 0.001) and QoL (+10 points, p = 0.029, and +11 points, p = 0.002), while the CON did not experience changes in these variables. We conclude that HIIT-LT is a viable alternative to HIIT-HR for patients who are not able/willing to undergo maximal exercise testing.

The Negative Impact of Routine, Dietary Pattern, and Physical Activity on Obesity and Dysglycemia During the COVID-19 Pandemic.

The global coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, has disrupted routines in education, work, exercise, and dining habits. To prevent viral spread, communal spaces including offices, schools, restaurants, and gyms have closed or drastically limited their capacity. Additionally, government-mandated lockdown orders have forced people to spend more time at home. Studies have shown that these COVID-19 restrictions have led to unhealthier eating patterns, increased sedentary behaviors, and decreased physical activity, leading to weight gain, dysglycemia, and increased metabolic risk. While strict social distancing measures have been necessary to curb the spread of the SARS-CoV-2 virus, people have been forced to adapt by altering their daily routines. Based on existing literature, a model is proposed for intentionally creating daily routines to ensure healthy habits, minimize weight gain, and prevent worsening dysglycemia.

Association Between CKD, Obesity, Cardiometabolic Risk Factors, and Severe COVID-19 Outcomes.

Introduction: Chronic kidney disease (CKD) is a risk factor for acquiring severe COVID-19, but underlying mechanisms are unknown. We aimed to study the risk associated with CKD for severe COVID-19 outcomes in relation to body mass index (BMI) and diabetes because they are common risk factors for both CKD and severe COVID-19. Methods: This nationwide case-control study with data from mandatory national registries included 4684 patients (cases) admitted to the intensive care units (ICUs) requiring mechanical ventilation and 46,840 population-based controls matched by age, sex, and district of residency. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for associations between severe COVID-19 and exposures with adjustment for confounders, in subgroups by BMI, and matched by type 2 diabetes. Results: The median age was 64 years, and 27.7% were female. CKD was observed in 5.4% of the cases and 1.5% of the controls, whereas 1.9% and 0.3% had end-stage CKD, respectively. CKD was associated with severe COVID-19 (OR, 2.20 [95% CI, 1.85-2.62]), continuous renal replacement therapy (CRRT) in ICU (OR, 7.36 [95% CI, 5.39-10.05]), and death any time after ICU admission (OR, 2.51 [95% CI, 1.96-3.22]). The risk associated with CKD for severe COVID-19 did not differ significantly by weight but was higher in those without diabetes (OR, 2.76 [95% CI, 2.15-3.55]) than in those with diabetes (OR, 1.88 [95% CI, 1.37-2.59]). Conclusion: CKD, especially end-stage CKD, is an important risk factor for severe COVID-19 and death after ICU admission also in patients with normal BMI and without type 2 diabetes.

Metabolic Profile of Patients with Long COVID: A Cross-Sectional Study.

A significant proportion of patients experience a wide range of symptoms following acute coronavirus disease 2019 (COVID-19). Laboratory analyses of long COVID have demonstrated imbalances in metabolic parameters, suggesting that it is one of the many outcomes induced by long COVID. Therefore, this study aimed to illustrate the clinical and laboratory markers related to the course of the disease in patients with long COVID. Participants were selected using a clinical care programme for long COVID in the Amazon region. Clinical and sociodemographic data and glycaemic, lipid, and inflammatory screening markers were collected, and cross-sectionally analysed between the long COVID-19 outcome groups. Of the 215 participants, most were female and not elderly, and 78 were hospitalised during the acute COVID-19 phase. The main long COVID symptoms reported were fatigue, dyspnoea, and muscle weakness. Our main findings show that abnormal metabolic profiles (such as high body mass index measurement and high triglyceride, glycated haemoglobin A1c, and ferritin levels) are more prevalent in worse long COVID presentations (such as previous hospitalisation and more long-term symptoms). This prevalence may suggest a propensity for patients with long COVID to present abnormalities in the markers involved in cardiometabolic health.

The syndromic triad of COVID-19, type 2 diabetes, and malnutrition.

The coronavirus disease 2019 (COVID-19) pandemic challenges our collective understanding of transmission, prevention, complications, and clinical management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Risk factors for severe infection, morbidity, and mortality are associated with age, environment, socioeconomic status, comorbidities, and interventional timing. Clinical investigations report an intriguing association of COVID-19 with diabetes mellitus and malnutrition but incompletely describe the triphasic relationship, its mechanistic pathways, and potential therapeutic approaches to address each malady and their underlying metabolic disorders. This narrative review highlights common chronic disease states that interact epidemiologically and mechanistically with the COVID-19 to create a syndromic phenotype-the COVID-Related Cardiometabolic Syndrome-linking cardiometabolic-based chronic disease drivers with pre-, acute, and chronic/post-COVID-19 disease stages. Since the association of nutritional disorders with COVID-19 and cardiometabolic risk factors is well established, a syndromic triad of COVID-19, type 2 diabetes, and malnutrition is hypothesized that can direct, inform, and optimize care. In this review, each of the three edges of this network is uniquely summarized, nutritional therapies discussed, and a structure for early preventive care proposed. Concerted efforts to identify malnutrition in patients with COVID-19 and elevated metabolic risks are needed and can be followed by improved dietary management while simultaneously addressing dysglycemia-based chronic disease and malnutrition-based chronic disease.

Online Food Security Discussion Before and During the COVID-19 Pandemic in Native Hawaiian and Pacific Islander Community Groups and Organizations: Content Analysis of Facebook Posts.

Background: The Native Hawaiian and Pacific Islander (NHPI) population experiences disproportionately higher rates of food insecurity, which is a risk factor for cardiometabolic diseases such as cardiovascular disease, type 2 diabetes, obesity, and hypertension, when compared to white individuals. Novel and effective approaches that address food insecurity are needed for the NHPI population, particularly in areas of the continental United States, which is a popular migration area for many NHPI families. Social media may serve as an opportune setting to reduce food insecurity and thus the risk factors for cardiometabolic diseases among NHPI people; however, it is unclear if and how food insecurity is discussed in online communities targeting NHPI individuals. Objective: The objective of this study was to characterize the quantity, nature, and audience engagement of messages related to food insecurity posted online in community groups and organizations that target NHPI audiences. Methods: Publicly accessible Facebook pages and groups focused on serving NHPI community members living in the states of Washington or Oregon served as the data source. Facebook posts between March and June 2019 (before the COVID-19 pandemic) and from March to June 2020 (during the COVID-19 pandemic) that were related to food security were identified using a set of 36 related keywords. Data on the post and any user engagement (ie, comments, shares, or digital reactions) were extracted for all relevant posts. A content analytical approach was used to identify and quantify the nature of the identified posts and any related comments. The codes resulting from the content analysis were described and compared by year, page type, and engagement. Results: Of the 1314 nonduplicated posts in the 7 relevant Facebook groups and pages, 88 were related to food security (8 in 2019 and 80 in 2020). The nature of posts was broadly classified into literature-based codes, food assistance (the most common), perspectives of food insecurity, community gratitude and support, and macrolevel contexts. Among the 88 posts, 74% (n=65) had some form of engagement, and posts reflecting community gratitude and support or culture had more engagement than others (mean 19.9, 95% CI 11.2-28.5 vs mean 6.1, 95% CI 1.7-10.4; and mean 26.8, 95% CI 12.7-40.9 vs mean 5.3, 95% CI 3.0-7.7, respectively). Conclusions: Food security-related posts in publicly accessible Facebook groups targeting NHPI individuals living in Washington and Oregon largely focused on food assistance, although cultural values of gratitude, maintaining NHPI culture, and supporting children were also reflected. Future work should capitalize on social media as a potential avenue to reach a unique cultural group in the United States experiencing inequitably high rates of food insecurity and risk of cardiometabolic diseases.

Quantifying impact of obesity on cardiometabolic comorbidities and public health implications: Insights from South Africa.

INTRODUCTION: South Africa has the highest obesity and hypertension rates in the African region. In this cross-sectional study, we aimed to quantify the correlates and burden of obesity and their impacts on cardiometabolic conditions. METHODS: The study population was 80,270 men(41 %) and women(59 %) who participated in South African national surveys (2008-to-2017). Weighted-logistic regression models and the population attributable risk (PAR %) were used after accounting for the correlation structure of the risk factors in a multifactorial setting. RESULTS: Overall, 63 % of the women and 28 % of the men were either overweight or obese. Parity was identified as the most influential factor and exclusively associated with 62 % of the obesity in women; being married/cohabiting had the highest impact on obesity in men and associated with 37 % of the obesity. Overall, 69 % of them had comorbidities including hypertension, diabetes and heart disease. More than 40 % of the comorbidities were attributed to overweight/obesity. CONCLUSION: Developing culturally appropriate prevention programs are urgently needed to raise awareness of obesity, hypertension and their impacts on severe cardiometabolic diseases. This approach would also significantly reduce COVID-19 related poor health outcomes and premature deaths.

Dietary Intervention on Overweight and Obesity after Confinement by COVID-19.

BACKGROUND: Obesity has become a public health problem in our society and is associated with many diseases, including type 2 diabetes mellitus, cardiovascular diseases, dyslipidemia, respiratory diseases, and cancer. Several studies relate weight loss in obese patients to improved anthropometric measurements and cardiometabolic risk. The objective of our study was to evaluate anthropometric changes, analytical parameters, insulin resistance, fatty liver, and metabolic scales, after a personalized weight loss program, through dietary advice to increase adherence to the Mediterranean diet and a motivational booster via mobile SMS messaging. METHODS: Intervention study on a sample of 1964 workers, in which different anthropometric parameters were evaluated before and after dietary intervention: the metabolic score of insulin resistance; non-alcoholic fatty liver disease using different scales; metabolic syndrome; atherogenic dyslipidemia; and the cardiometabolic index. A descriptive analysis of the categorical variables was performed, by calculating the frequency and distribution of the responses for each one. For quantitative variables, the mean and standard deviation were calculated, since they followed a normal distribution. Bivariate association analysis was performed by applying the chi-squared test (corrected by Fisher's exact statistic when conditions required it) and Student's t-test for independent samples (for comparison of means). RESULTS: The population subjected to the Mediterranean diet improved in all the variables evaluated at 12 months of follow-up and compliance with the diet. CONCLUSIONS: Dietary advice on a Mediterranean diet and its reinforcement with reminder messages through the use of mobile phones may be useful to improve the parameters evaluated in this study and reduce the cardiometabolic risk of patients.