A High Intake of Saturated Fatty Acids Strengthens the Association between the Fat Mass and Obesity-Associated Gene and BMI123

Evidence that physical activity (PA) modulates the association between the fat mass and obesity-associated gene (FTO) and BMI is emerging; however, information about dietary factors modulating this association is scarce. We investigated whether fat and carbohydrate intake modified the association of FTO gene variation with BMI in two populations, including participants in the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) study (n = 1069) and in the Boston Puerto Rican Health (BPRHS) study (n = 1094). We assessed energy, nutrient intake, and PA using validated questionnaires. Genetic variability at the FTO locus was characterized by polymorphisms rs9939609 (in the GOLDN) and rs1121980 (in the GOLDN and BPRHS). We found significant interactions between PA and FTO on BMI in the GOLDN but not in the BPRHS. We found a significant interaction between SFA intake and FTO on BMI, which was stronger than that of total fat and was present in both populations (P-interaction = 0.007 in the GOLDN and P-interaction = 0.014 in BPRHS for categorical; and P-interaction = 0.028 in the GOLDN and P-interaction = 0.041 in BPRHS for continuous SFA). Thus, homozygous participants for the FTO-risk allele had a higher mean BMI than the other genotypes only when they had a high-SFA intake (above the population mean: 29.7 ± 0.7 vs. 28.1 ± 0.5 kg/m2; P = 0.037 in the GOLDN and 33.6. ± 0.8 vs. 31.2 ± 0.4 kg/m2; P = 0.006 in BPRHS). No associations with BMI were found at lower SFA intakes. We found no significant interactions with carbohydrate intake. In conclusion, SFA intake modulates the association between FTO and BMI in American populations

Disparities in healthy food zoning, farmers’ market availability, and fruit and vegetable consumption among North Carolina residents

Background Context and purpose of the study. To examine (1) associations between county-level zoning to support farmers’ market placement and county-level farmers’ market availability, rural/urban designation, percent African American residents, and percent of residents living below poverty and (2) individual-level associations between zoning to support farmers’ markets; fruit and vegetable consumption and body mass index (BMI) among a random sample of residents of six North Carolina (NC) counties. Methods Zoning ordinances were scored to indicate supportiveness for healthy food outlets. Number of farmers’ markets (per capita) was obtained from the NC-Community Transformation Grant Project Fruit and Vegetable Outlet Inventory (2013). County-level census data on rural/urban status, percent African American, and percent poverty were obtained. For data on farmers’ market shopping, fruit and vegetable consumption, and BMI, trained interviewers conducted a random digit dial telephone survey of residents of six NC counties (3 urban and 3 rural). Pearson correlation coefficients and multilevel linear regression models were used to examine county-level and individual-level associations between zoning supportiveness, farmers’ market availability, and fruit and vegetable consumption and BMI. Results At the county-level, healthier food zoning was greater in more urban areas and areas with less poverty. At the individual-level, self-reported fruit and vegetable consumption was associated with healthier food zoning. Conclusions Disparities in zoning to promote healthy eating should be further examined, and future studies should assess whether amending zoning ordinances will lead to greater availability of healthy foods and changes in dietary behavior and health outcomes.ECU Open Access Publishing Support Fun

Socioeconomic inequalities in patients undergoing abdominal wall reconstruction in the North-West of England, UK: a three-centre retrospective cohort study

Purpose: Patients from deprived areas are more likely to experience longer waiting times for elective surgery, be multimorbid, and have inferior outcomes from elective and emergency surgery. This study aims to investigate how surgical outcomes vary by deprivation for patients undergoing elective abdominal wall reconstruction. Methods: A three-centre retrospective cohort study was conducted across three hospitals in North-West England, including patients with complex ventral hernias undergoing abdominal wall reconstruction between 2013 and 2021. Demographic data, comorbidities, and index of multiple deprivation quintiles were recorded. Results: 234 patients (49.6% female), age 57 (SD 13) years, underwent elective abdominal wall reconstruction. Significantly higher unemployment rates were found in the most deprived quintiles (Q1 and Q2). There were more smokers in Q1 and Q2, but no significant deprivation related differences in BMI, diabetes, chronic kidney disease or ischaemic heart disease. There were also higher rates of Clavien-Dindo 1–2 complications in Q1 and Q5, but no difference in the Clavien-Dindo 3–4 outcomes. Patients in Q1 and Q5 had a significantly greater hospital length of stay. Conclusion: The association between deprivation and greater unemployment and smoking rates highlights the potential need for equitable support in patient optimisation. The lack of differences in patient co-morbidities and hernia characteristics could represent the application of standardised operative criteria and thresholds. Further research is needed to better understand the relationship between socioeconomic status, complications, and prolonged hospital length of stay

Exploring the association between socioeconomic status and cardiopulmonary exercise testing measures: a cohort study based on routinely collected data

Background: Cardiopulmonary exercise testing (CPET) provides objective measures of cardiorespiratory fitness and can support surgical risk stratification. As socioeconomic status is a factor known to influence patient health and outcomes, we analysed how CPET-derived measures vary across levels of socioeconomic status in patients being considered for elective surgery. Methods: A database of patients who underwent CPET between 2011 and 2024 was analysed. Measures including oxygen consumption (V̇O₂) at gas exchange threshold (GET), peak V̇O₂, and ventilatory equivalent for carbon dioxide (VE/V̇CO₂) were compared across socioeconomic deprivation quintiles. Multivariable linear and logistic regression models assessed the effects of age, sex, body mass index (BMI), Revised Cardiac Risk Index (RCRI), and deprivation quintiles on CPET measures. Hierarchical regression models incorporating the Indices of Deprivation (IoD) domains and Access to Healthy Assets and Hazards (AHAH) scores determined whether wider social determinants of health explained the variance in CPET measures. Results: A total of 3344 patients (2476 male) were included, referred prior to procedures in vascular (2006), colorectal (650), upper GI (267), urology (205), and other (216) surgical specialties. Lower socioeconomic status was associated with younger age (p<0.001), higher BMI (p=0.022), higher smoking prevalence (p<0.001), and RCRI ≥3 (p=0.013). CPET measures were lower in the most deprived quintile (Q1) compared to the least (Q5): mean GET was 11.0 vs. 11.5 ml·kg-1·min-1 and peak V̇O2 was 14.8 vs. 16.3 ml·kg-1·min-1 (p<0.05). Deprivation remained an independent predictor of lower GET and peak V̇O2, even after adjustment. Several IoD and AHAH domains explained small but significant variance in CPET measures. Conclusion: Patients from more deprived areas exhibit risk factors for poor health and lower cardiorespiratory fitness as measured by CPET. These findings add to our understanding of socioeconomic disparities in physiological reserve among surgical patients and may support the need for more holistic approaches to peri-operative care

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

A Common CNR1 (Cannabinoid Receptor 1) Haplotype Attenuates the Decrease in HDL Cholesterol That Typically Accompanies Weight Gain

We have previously shown that genetic variability in CNR1 is associated with low HDL dyslipidemia in a multigenerational obesity study cohort of Northern European descent (209 families, median  = 10 individuals per pedigree). In order to assess the impact of CNR1 variability on the development of dyslipidemia in the community, we genotyped this locus in all subjects with class III obesity (body mass index >40 kg/m2) participating in a population-based biobank of similar ancestry. Twenty-two haplotype tagging SNPs, capturing the entire CNR1 gene locus plus 15 kb upstream and 5 kb downstream, were genotyped and tested for association with clinical lipid data. This biobank contains data from 645 morbidly obese study subjects. In these subjects, a common CNR1 haplotype (H3, frequency 21.1%) is associated with fasting TG and HDL cholesterol levels (p = 0.031 for logTG; p = 0.038 for HDL-C; p = 0.00376 for log[TG/HDL-C]). The strength of this relationship increases when the data are adjusted for age, gender, body mass index, diet and physical activity. Mean TG levels were 160±70, 155±70, and 120±60 mg/dL for subjects with 0, 1, and 2 copies of the H3 haplotype. Mean HDL-C levels were 45±10, 47±10, and 48±9 mg/dL, respectively. The H3 CNR1 haplotype appears to exert a protective effect against development of obesity-related dyslipidemia

What laparoscopic skills are necessary for Certificate of Completion of Training? A prospective nationwide cross-sectional survey of Obstetrics & Gynaecology and General Surgery trainees and consultants in the UK

Objectives: To explore the views of Obstetrics & Gynaecology (O&G) and General Surgery (GS) trainees and consultants on the laparoscopic skills considered necessary to achieve the Certificate of Completion of Training (CCT) and identify any mismatch between consultants and trainees in their expectations of these skills. Design: A prospective nationwide cross-sectional study in the UK. Setting: A national survey distributed through Health Education, England and national training bodies such as the Royal College of Obstetricians & Gynaecologist (RCOG), British society for gynaecological endoscopy (BSGE) and the Association of Surgeons of Great Britain and Ireland (ASGBI). Participants: O&G and GS consultants and specialty trainees in O&G and GS. Specialty trainees below ST3 level and consultants performing open surgery or minor laparoscopic surgery only were excluded. Interventions: Trainees completed a 27-item questionnaire on their training characteristics, rated their confidence and perceived importance of 10 laparoscopic skills required for CCT using a 5-point Likert scale. Consultants answered a 36-item questionnaire on their demographic details, their views on the importance of the same 10 laparoscopic skills, their confidence and the standard of laparoscopic skills they observed amongst trainees approaching CCT. Results: 345 participants responded to the questionnaire: 117 O&G trainees, 95 O&G consultants, 57 GS trainees & 76 GS consultants. O&G trainees and consultants expected similar laparoscopic skills required for CCT for all ten skills (P> 0.050), whilst GS consultants had higher expectations of GS trainees for suturing (P=0.003), use of endovascular devices (P=0.020) and staplers (P=0.020). Consultants in both specialties observed that trainees were performing significantly below the expected standards; P< 0.010 (O&G) and P<0.001 (GS) for all 10 listed skills. O&G trainees reported lower confidence than GS trainees for all 10 laparoscopic skills (P<0.001). Conclusions: This nationwide study showed that UK O&G trainees and consultants both agree on the skills required for CCT, but GS consultants had higher expectations than their trainees. Trainees in GS were more confident in their surgical skills than those in O&G. However, consultants in both specialities believed that trainees were not achieving the requisite laparoscopic skills required for CCT

A prospective observational study comparing proficiency of obstetrics & gynaecology trainees with general surgical trainees using simulated laparoscopic tasks in Health Education England, North-West

BACKGROUND: Training programmes for obstetrics and gynaecology (O&G) and general surgery (GS) vary significantly, but both require proficiency in laparoscopic skills. We sought to determine performance in each specialty. DESIGN: Prospective, Observational study. SETTING: Health Education England North-West, UK. PARTICIPANTS: 47 surgical trainees (24 O&G and 23 GS) were sub-divided into four groups: 11 junior O&G, 13 senior O&G, 11 junior GS, and 12 senior GS trainees. OBJECTIVES: Trainees were tested on four simulated laparoscopic tasks; laparoscopic camera navigation (LCN), hand eye co-ordination (HEC), bimanual co-ordination (BMC) and suturing with intracorporeal knot tying (suturing). RESULTS: O&G trainees completed LCN (P <0.001), HEC (P <0.001) and BMC (P <0.001) significantly slower than GS trainees. Furthermore, O&G found fewer number of targets in LCN (P =0.001) and dropped a greater number of pins than the GS trainees in BMC (P =0.04). In all three tasks, there were significant differences between O&G and GS trainees but no difference between the juniors and senior groups within each specialty. Performance in suturing also varied by specialty; senior O&G trainees scored significantly lower than senior GS trainees; O&G 11.4 ± 4.4 vs GS 16.8 ± 2.1, P = 0.03. Whilst suturing scores improved with seniority among O&G trainees, there was no difference between the junior and senior GS trainees; senior O&G 11.4 ± 4.4 vs junior O&G 3.6 ± 2.1, P = 0.004. DISCUSSION: GS trainees performed better than O&G trainees in core laparoscopic skills and the structure of obstetrics and gynaecology training may require modification

Genome-Wide Meta-Analysis Identifies Regions on 7p21 (AHR) and 15q24 (CYP1A2) As Determinants of Habitual Caffeine Consumption

We report the first genome-wide association study of habitual caffeine intake. We included 47,341 individuals of European descent based on five population-based studies within the United States. In a meta-analysis adjusted for age, sex, smoking, and eigenvectors of population variation, two loci achieved genome-wide significance: 7p21 (P = 2.4×10−19), near AHR, and 15q24 (P = 5.2×10−14), between CYP1A1 and CYP1A2. Both the AHR and CYP1A2 genes are biologically plausible candidates as CYP1A2 metabolizes caffeine and AHR regulates CYP1A2

Alcohol and head and neck cancer risk in a prospective study

We investigated the relation between head and neck cancer risk and alcohol consumption in the NIH-AARP Diet and Health Study. During 2 203 500 person-years of follow-up, 611 men and 183 women developed head and neck cancer. With moderate drinking (up to one alcoholic drink per day) as the referent group, non-drinkers showed an increased risk of head and neck cancer (men: hazard ratio (HR) 1.68, 95% confidence interval (95% CI) 1.37–2.06; women: 1.46, 1.02–2.08). Among male and female alcohol drinkers, we observed a significant dose–response relationship between alcohol consumption and risk. The HR for consuming >3 drinks per day was significantly higher in women (2.52, 1.46–4.35) than in men (1.48, 1.15–1.90; P for interaction=0.0036). The incidence rates per 100 000 person-years for those who consumed >3 drinks per day were similar in men (77.6) and women (75.3). The higher HRs observed in women resulted from lower incidence rates in the referent group: women (14.7), men (34.4). In summary, drinking >3 alcoholic beverages per day was associated with increased risk in men and women, but consumption of up to one drink per day may be associated with reduced risk relative to non-drinking