This study examines the prevalence and risk factors associated with overweight and obesity among adults aged 18-69 years in the Qatar population as insights from the 2023 Stepwise Survey.

A cross-sectional study using data from a nationally representative population-based 2023 Qatar Stepwise Survey conducted from May to December 2023 in households covering the eight municipalities of Qatar.

A total of 5696 male and female Qatari nationals and non-Qatari long-term residents aged 18-69 years from all municipalities of Qatar. Survey participants with nonresponse or missing data on body mass index (BMI) were excluded from the analysis.

Prevalence of overweight and obesity among adults aged 18-69 years in Qatar, classified according to WHO BMI cut-offs (overweight: 25-29.9 kg/m²; obesity: ≥30 kg/m²). Identification of risk factors associated with BMI categories, including sociodemographics, family history of chronic diseases, lifestyle and habitual factors, diet, physical activity and lipid profile, was analysed using the χ² test, analysis of variance and multinomial logistic regression to investigate the statistical significance of associations between risk factors and BMI categories.

From a total of 5696 eligible participants (52.9% men and 47.1% women, 43% Qatari and 57% non-Qatari), 20.5% had normal weight, 36.4% had overweight and 37.8% had obesity. The prevalence of obesity was significantly higher than the population average among women (38.2%), participants aged ≥45 years (44%), Qataris (40.3%), separated/divorced/widowed people (53.3%), participants with low education (46.8%), government employees (36.6%) or unemployed individuals (38.9%). Overweight was more prevalent among men (41.1%), non-Qatari (40.9%), married people (40%), those with higher education (41.8%) and among self-employed individuals (43.4%). Significant correlates of overweight/obesity were being female (adjusted relative risk ratio, aRRR=1.61; 95% CI 1.04 to 2.50; p=0.031), having a family history of obesity (aRRR=2.17; 95% CI 1.32 to 3.7; p=0.004), higher heart rate (aRRR=1.02; 95% CI 1.0 to 1.04; p=0.008), wider waist circumference (aRRR=1.06; 95% CI 1.05 to 01.07; p<0.001), increased triglyceride levels (aRRR=1.40; 95% CI 1.02 to 1.94; p=0.039) and lower high-density lipoprotein (HDL) cholesterol (aRRR=0.37; 95% CI 0.19 to 0.72; p=0.003).

The combined prevalence of overweight and obesity was high in the Qatar population (74.2%). Family history of obesity and low HDL cholesterol showed the strongest associations with an increased likelihood of obesity among the surveyed individuals. The findings support a primary care-led approach to obesity prevention in Qatar, prioritising middle-aged adults, women and individuals with cardiometabolic conditions, consistent with national NonCommunicable Disease priorities.

African countries face a dual burden of infectious and non-communicable diseases, placing substantial pressure on primary healthcare (PHC) systems. Existing indicator-weighting approaches are limited in addressing redundancy and non-linear relationships. In addition, conventional composite indices often rely on linear aggregation assumptions that may not adequately reflect complex relationships among PHC performance indicators. This study proposes a novel weighting method and composite index to improve facility-level assessment of PHC performance.

We analysed nationally representative healthcare facility data from Service Provision Assessments conducted in eight African countries (Ethiopia, the Democratic Republic of the Congo, Tanzania, Malawi, Kenya, Namibia, Rwanda and Uganda). Based on the Primary Health Care Performance Initiative framework, we constructed an indicator system comprising 34 indicators across five subdomains within the Service Delivery domain. Two composite indices were calculated: the Arithmetic Mean Index (AMI) and the Composite Fuzzy Index (CFI). AMI was derived using a simple arithmetic mean, while CFI employed a distance-based aggregation approach with indicator weights estimated using Multivariate Adaptive Regression Splines. The associations between the composite indices and patient-reported satisfaction were examined, with patient satisfaction calculated as a weighted average across surveyed patients.

A total of 6921 facilities were included. Overall performance across indicators was low, with particularly poor scores observed in community engagement within the population health management subdomain (mean=0.08). AMI ranged from 0.238 to 0.806, and CFI ranged from 0.237 to 0.705. Facility-level CFI scores showed a positive association with patient satisfaction (Spearman's ρ=0.039, p<0.01; Kendall's τ=0.027, p<0.01), whereas AMI showed no significant association.

PHC performance in African countries remains suboptimal across multiple dimensions. The proposed weighting and aggregation approach better captures inter-relationships among indicators and provides a more plausible assessment of PHC performance than traditional composite indices.

Noncommunicable diseases (NCDs) are currently the leading cause of disability worldwide. In Brazil, NCDs are among the top 10 causes of disability-adjusted life years (DALYs). A better understanding of the profiles of patients who frequently use physical therapy is needed to enhance access.

To estimate the use of physical therapy care and associated factors among individuals with NCDs in the Brazilian population.

This is a subanalysis of the 2019 National Health Survey database among 88,531 Brazilians with NCDs. A multiple logistic regression model was created, and data were reported as odds ratios (ORs) with 95% confidence intervals (95% CIs).

Stroke showed the highest rate of physical therapy utilization (17.0%; 95% CI: 15.4%, 18.7%), and the associated factors were follow-up by a healthcare professional (OR: 5.6; 95% CI: 2.3, 13.7) and use of pharmacotherapy (OR: 2.8; 95% CI: 1.2, 6.7). In chronic back pain, associated factors were follow-up by a healthcare professional (OR: 7.9; 95% CI: 6.8, 9.2), use of pharmacotherapy (OR: 1.9; 95% CI: 1.6, 2.2), age ≥60 years (OR: 1.9; 95% CI: 1.4, 2.5), and severe activity limitation or worse (OR: 1.5; 95% CI: 1.2, 1.8). In chronic respiratory diseases, associated factors were follow-up by a healthcare professional (OR: 5.6; 95% CI: 1.6, 26.3) and Asian/Indigenous race (OR: 23.3; 95% CI: 1.13, 480.8).

Follow-up by a healthcare professional was the only factor common to all three NCDs. Pharmacotherapy was associated with physical therapy use in stroke and chronic back pain, while older age, severe limitation, and race associated with chronic respiratory diseases.

Taurine is a semiessential micronutrient critical to many biological processes. However, the genetic variation and the relationships between circulating taurine and human health are unclear. Here, we conducted the largest genome-wide meta-analysis to date, integrating summary statistics from five publicly available independent genome-wide association studies (GWAS) on circulating taurine levels in 36,490 European individuals. We employed LiftOver to harmonize genomic coordinates across the summary statistics derived from five large European cohorts with plasma taurine measurements, followed by a comprehensive genome-wide meta-analysis of both common and rare genetic variants. We utilized functional mapping and annotation and functional annotation of variants to identify genomic loci and variants and estimated global and local single-nucleotide polymorphism heritability using linkage disequilibrium score regression. In our study, we identified six common and two rare variant loci associated with circulating taurine and prioritized novel taurine-associated genes outside of the taurine transporter (SLC6A13) related to glutathione metabolism and neurotransmitter transport using an integrative pipeline. We used genetic proxies of circulating taurine to assess genetically supported putative causal associations on more than 17,000 clinical phenotypes via a phenome-wide Mendelian randomization analysis and demonstrated that genetically predicted circulating taurine shows evidence consistent with potential causal impacts on cancers, hypertension, neurodevelopment, abundance of Bifidobacterium, and brain phenotypes, among several others. We also identified genetic evidence consistent with modifiable relationships between circulating taurine and exposures, including bone mineral density, serum lactate, glycoproteins and creatinine. Collectively, this study systematically dissects the genetic basis of circulating taurine and highlights high-priority disease phenotypes requiring subsequent experimental validation for taurine-targeted nutritional and pharmacological strategies.

Cardiovascular-kidney-metabolic (CKM) syndrome, as defined by the American Heart Association, encompasses interrelated metabolic, kidney, and cardiovascular disorders that mutually reinforce one another along a shared risk continuum. Its five-stage model, supported by the PREVENT risk equations, guides stage-specific prevention and treatment. Albuminuria, alongside eGFR, plays a central role not only as a marker of kidney damage but as an independent cardiovascular risk factor. Visceral adiposity and insulin resistance promote cardiovascular and kidney injury through interconnected inflammatory, oxidative, hemodynamic, and neurohormonal pathways. The metabolic dysfunction-associated steatotic liver disease (MASLD) as part of the proposed cardiovascular-kidney-liver-metaolic (CKLM) framework further highlights the role of the liver as another key contributor in this multiorgan disease. Effective management requires coordinated interventions, including lifestyle modification, weight management, renin-angiotensin system inhibitors, SGLT2 inhibitors, GLP-1 receptor agonist, non-steroidal mineralocorticoid receptor antagonists (nsMRAs), as consolidated by the AHA/ACC/ADA/ASN and ESC guidelines. However, fragmented care, limited awereness and socioeconomic inequalities - including a persistent risk treatment paradox - continue to limit implementation. Improved preclinical models and more inclusive clinical studies incorporating multiorgan outcomes may facilitate the translation of mechanistic findings, while multimodal imaging and artificial intelligence may improve risk prediction and diagnostic algorithms. Further validation of disease trajectories and broad implementation of interdisciplinary care are needed to improve outcomes across the CKM continuum.

To assess the implementation of guideline-directed glucose-lowering therapies with proven cardiovascular (CV) benefit in individuals with type 2 diabetes mellitus (T2DM) attending Italian outpatient cardiology clinics.

CardioMET is a multicenter, real-world registry including 2527 consecutive patients with T2DM enrolled between January 2022 and December 2025. Clinical characteristics, CV risk profile, and prescription rates of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) were assessed. Multivariable logistic regression was performed to identify predictors of non-prescription.

Overall, 70.7% of patients had established atherosclerotic CV disease (ASCVD), while 86.1% of those without ASCVD were classified at high or very high CV risk. Heart failure (HF) was present in 48.9% of patients with available data. SGLT2i were prescribed in 42.2% and GLP-1 RA in 27.7% of patients, whereas 14.8% received combination therapy. SGLT2i use was higher in patients with ASCVD than in high/very high CV risk no ASCVD patients (45.0%vs. 34.9%; p < 0.001) and in patients with HF, whereas no differences between groups in prescription rates of GLP-1 RA were observed. Prescription of both drug classes significantly increased after publication of 2023 ESC Guidelines (SGLT2i: 54.7% vs. 35.0%; GLP-1 RA: 48.4% vs. 15.8%; both p < 0.001). Older age, female sex (for SGLT2i), and absence of established ASCVD independently predicted non-prescription.

Implementation of cardioprotective glucose-lowering therapies remains suboptimal in Italian outpatient cardiology practice, underscoring the need for a multidisciplinary approach integrating recommendations from CV, T2DM, and kidney guidelines to optimize implementation of therapy in patients with T2DM.

Resmetirom, a thyroid hormone receptor beta agonist, improves metabolic dysfunction-associated steatohepatitis (MASH) and liver fibrosis in patients with non-cirrhotic MASH. Risk genotypes of PNPLA3, HSD17B13, TM6SF2, MTARC1, MBOAT7, and SERPINA1 have been associated with altered susceptibility to metabolic dysfunction-associated steatotic liver disease (MASLD), MASH, fibrosis, cirrhosis, and/or hepatocellular carcinoma. We evaluated the impact of MASLD risk genotypes on baseline characteristics and the response to resmetirom vs. placebo with respect to MASH, fibrosis, MRI-proton density fat fraction (MRI-PDFF), and other biomarkers.

Testing the effects of MASLD risk genotypes or combinations of high-risk alleles on liver biopsy, MRI-PDFF, and biomarker responses to resmetirom was a pre-specified analysis in 738 patients enrolled in the MAESTRO-NASH phase III trial who consented to DNA collection, were genotyped for all genes, and had liver biopsies at baseline and Week 52.

At baseline, patients with high-risk genotypes of PNPLA3 or HSD17B13 had a lower frequency of metabolic risk factors, including type 2 diabetes mellitus and hypertension, than patients with low-risk genotypes. Interaction analyses and efficacy assessments indicated that resmetirom had similar positive effects on MASH resolution, fibrosis improvement on liver biopsy, MRI-PDFF response, and biomarkers at Week 52 in MAESTRO-NASH patients with high-risk genotypes of PNPLA3, HSD17B13, TM6SF2, MTARC1, and MBOAT7, either individually or as part of a composite genetic risk score. These effects were independent of sex, Hispanic ethnicity, and metabolic risk factors. Due to the limited sample size, the study was not powered to detect small effects of risk genotypes on resmetirom efficacy.

Resmetirom's effects on MASH, liver fibrosis, MRI-PDFF, and MASH biomarkers in the MAESTRO-NASH trial were not significantly impacted by the presence of common MASH risk genotypes, suggesting that resmetirom's mechanism of action may help mitigate the deleterious effects of MASH risk variants.

Number: NCT03900429 IMPACT AND IMPLICATIONS: Resmetirom has recently been approved for the treatment of metabolic dysfunction-associated steatohepatitis (MASH). It leads to MASH resolution and improvement of fibrosis in patients with non-cirrhotic MASH. Patients with MASH have higher prevalence of certain genetic variants which can be associated with more severe disease. In this study we evaluated the relationship between the presence of select MASH risk genotypes (e.g. PNPLA3, TM6SF2, or HSD17B13) or the combined total of MASH genetic risk alleles on the response to resmetirom and placebo in 738 patients with non-cirrhotic MASH with serial liver biopsies at baseline and week 52. Within the limitation of study sample size, resmetirom's benefits on MASH resolution, fibrosis improvement and hepatic steatosis were independent of the presence of MASH genetic risk genotypes either alone or in combination.

Although biologic therapies are essential for managing severe asthma, injection-related pain may be a frequently overlooked barrier to treatment persistence.

To quantify biologic injection-related pain in asthma cases, identify clinical factors associated with such pain and treatment aversion, and explore practical pain-relief approaches.

This multicenter observational study enrolled patients with asthma receiving biologics between May 2025 and March 2026. Insertion pain, injection pain, and treatment aversion attributable to injection-related pain were assessed using 0 to 10 visual analog scales. Associations between clinical factors, pain scores, and treatment aversion scores and the effects of local pressure and cooling at the injection site were evaluated. Patients with diabetes mellitus receiving tirzepatide served as a reference group.

In total, 122 biologic-treated and 27 tirzepatide-treated patient responses were analyzed. Mean insertion and injection pain scores for biologics were 3.00 ± 2.60 and 3.28 ± 2.91, respectively. Adjusted pain scores did not differ significantly across biologics and tirzepatide. Insertion pain was associated with anxiety and arm injection, whereas injection pain was associated with younger age and female sex. Both insertion and injection pain showed independent associations with log-transformed treatment aversion score (unstandardized regression coefficient [B] = 0.08, 95% CI, 0.03-0.12, and B = 0.07, 95% CI, 0.03-0.11, respectively). Injection-site cooling significantly reduced both pain types.

Among patients receiving biologics for asthma, injection-related pain is common and independently associated with treatment aversion. Local cooling may offer a simple approach to reducing injection-related pain and addressing treatment aversion.

Chronic hyperglycemia accelerates the accumulation of advanced glycation end-products and collagen cross-linking, which may impair collagen remodeling, alter tissue morphology, and increase muscle-tendon stiffness. These changes may restrict ankle mobility and elevate forefoot plantar loading, increasing susceptibility to skin breakdown and ulcers in individuals with diabetes. Because many muscle-tendon impairments in those with diabetes are attributed to neuropathy, whether these changes are present before clinically detectable neuropathy remains unclear. This study investigated biomechanical alterations of the ankle joint, Achilles tendon, and plantar flexor muscles in individuals with diabetes without neuropathy.

Morphological and mechanical properties of the Achilles tendon, soleus, medial gastrocnemius, and lateral gastrocnemius muscles were evaluated using ultrasound across preset ankle and knee positions. Participants included individuals with diabetes without neuropathy (n = 11, age 53 ± 12 years, 3 males, 8 females, 87 ± 16 kg, HbA1c 7.37 ± 1.80, duration of disease 75 ± 79 months) and non-diabetic controls (n = 12, age 45 ± 16 years, 5 males, 7 females, 75 ± 14 kg). A custom ankle-foot device was used to measure passive ankle joint torque.

Compared to controls, individuals with diabetes demonstrated reduced Achilles tendon cross-section area (p = 0.018). They also demonstrated increased Achilles tendon and lateral gastrocnemius stiffness (p = 0.024, p = 0.035), after adjusting for Achilles tendon/fascicle length.

Significant reductions in Achilles tendon cross-sectional area, and increased Achilles tendon and lateral gastrocnemius stiffness were observed in individuals with diabetes without neuropathy. These findings are consistent with changes in tissue properties that may occur before overt neuropathy and warrant further investigation into their functional and clinical significance.

Unlike most other chronic diseases and cancers in Australia, outcomes for cirrhosis and hepatocellular cancer are not improving. Public hospitals are overwhelmed by decompensated cirrhosis and struggling to provide best practice care for the large population of patients with less severe (compensated) cirrhosis. Adding to this dysfunction is a lack of education and support for the primary care workforce. To improve the current care for patients with cirrhosis, we must recognise the current poor outcomes and develop appropriate policy responses, including increasing workforce capacity via training of the primary care workforce and establishment of shared care models.