Assaf Buch

Background: Population ageing is increasing the burden of chronic disease and frailty, raising important questions regarding how health systems define and allocate value. While pharmacological treatments dominate clinical care, lifestyle-based interventions may offer broader benefits for healthy ageing. However, integrated clinical and economic evidence in older populations remains limited. Methods: We conducted a secondary analysis of the CEV-65 randomized controlled trial ( n = 100 older adults aged 65 years and older with type 2 diabetes), comparing a Mediterranean diet (VegMedD), pharmacological treatment (empagliflozin), and exercise (circuit resistance training). Outcomes included changes in glycemic control (HbA1c) and frailty, alongside a composite responder measure. Economic evaluation included trial-based cost-effectiveness analyses (using the composite responder outcome based on improvement in both HbA1c and frailty) and cost–utility analyses using quality-adjusted life years (QALYs) derived from SF-12 data via a validated mapping approach. Adjusted regression models, propensity score weighting, and probabilistic sensitivity analyses were applied. Scenario analyses assessed sensitivity to pharmacological pricing assumptions. Results: All interventions improved glycemic control, with no statistically significant between-group differences. Frailty improvements were modest. Pharmacological treatment achieved the highest responder rate, whereas non-pharmacological interventions were substantially less costly. In cost-effectiveness analysis, lifestyle interventions were associated with lower costs but reduced responder-based effectiveness. In contrast, cost–utility analysis indicated that both dietary and exercise interventions were economically dominant, yielding lower costs and higher QALYs under current pricing conditions. The dietary intervention demonstrated the highest probability of cost-effectiveness across conventional willingness-to-pay thresholds. Scenario analyses showed that responder-based conclusions were sensitive to pharmacological pricing, whereas cost–utility findings remained comparatively robust. Conclusions: Interventions with similar short-term clinical outcomes may differ substantially in their economic and population health value. Within the short-term trial horizon, lifestyle-based strategies were associated with more favorable cost–utility profiles. These findings should be interpreted as exploratory and should not be extrapolated to long-term comparative effectiveness, particularly given the established long-term cardiovascular and renal benefits of SGLT2 inhibitors that could not be captured within the 10-week follow-up period. Clinical trial number: ClinicalTrials.gov (Identifier: NCT03560375; registered on June 5, 2018) https://clinicaltrials.gov/study/NCT03560375?tab=history .

Background: Despite the worldwide increase in life expectancy, individuals aged 75 years and older with an unknown history of cardiovascular disease often receive suboptimal statin treatment for primary prevention, reflecting uncertainties regarding statin efficacy and safety in this aging group. We aimed to assess the impact of statin treatment on all-cause mortality among individuals aged 75 years and older without prior cardiovascular diagnoses. Methods: This retrospective study utilized real-world data from a large cohort of individuals aged 75 years and older who were treated as outpatients in or were admitted to the Tel Aviv Sourasky Medical Center. Extracted variables included demographic details, Charlson Comorbidity Index (CCI), chronic medication regimens, mortality outcomes and blood test results (high-density lipoprotein, low-density lipoprotein and creatinine). Patients with a prior diagnosis of angina, myocardial infarction or stroke were excluded from the study. Results: A total of 98,502 patients were included in the study, of whom 37,171 (mean age 80.67 ± 4.73 years) were treated with statins and 6804 (18.3%) of the latter patients were aged 85 years and above. The majority of the statin-treated patients (72.6%) had received high-intensity statins. The non-statin-treated group comprised 61,331 subjects with a mean age of 82.69 ± 5.77 years, of whom 19,253 (31.39%) were aged 85 years and above. The risk of all-cause mortality was significantly lower in the statin-treated group compared to the non-statin-treated group (adjusted odds ratio [aOR] 0.715, 95% confidence interval [CI] [0.671–0.761], p < 0.001). This trend persisted after stratification for age 85 years and above (aOR 0.7, 95% CI [0.606–0.809], p < 0.001), and for a low CCI (≤4) or a high CCI (>4) score (aOR 0.766, 95% CI [0.708–0.803]; aOR 0.648, 95% CI [0.585–0.717], respectively, p < 0.001). Conclusions: Provision of statin therapy contributes to a reduction in risk of all-cause mortality in individuals aged 75 years and above who have an unknown history of cardiovascular disease, regardless of the type of statin or the patient’s CCI score.

Obesity remains a critical global health issue with profound medical and economic implications. While injectable medications such as semaglutide (Wegovy®) and tirzepatide (Zepbound®) have demonstrated significant efficacy, the development of novel oral anti‐obesity agents presents additional therapeutic potential. This narrative review examines recent advances in oral pharmacotherapy for obesity, focusing on mechanisms of action, clinical effectiveness, anticipated benefits and side effects. A systematic search of PubMed, Cochrane Library, Google Scholar and ClinicalTrials.gov identified relevant studies published between January 2023 and June 2025, including randomized controlled trials and clinical investigations of emerging oral agents. We have selected emerging oral compounds, currently undergoing clinical evaluation but not yet approved by the Food and Drug Administration (FDA). These include oral GLP‐1 RAs, peptides and small molecules, and non‐incretin‐based therapies targeting the melanocortin‐4 receptor and the endocannabinoid system, among others. Several agents have demonstrated promising efficacy, achieving weight loss of ≥10% in clinical trials while also exhibiting favourable safety profiles. Emerging oral therapies could complement or serve as alternatives to approved injectable treatments, particularly for long‐term weight management. They may enhance patient access, adherence and satisfaction, thereby broadening the scope of pharmacological interventions in obesity care. Ongoing research is crucial to confirm the long‐term safety, effectiveness and clinical role of these agents within comprehensive obesity management strategies. By contextualizing these developments, this review underscores the growing promise of oral pharmacotherapy in addressing the global obesity epidemic.

Objective: Comparing two dietary cost measurements at the individual level: ‘Food Frequency Questionnaire (FFQ) and supermarkets prices’ with ‘cash-register-receipts-items’. Design: Method comparison study. Reference method: participants collected receipts of food purchases for 28 days; conventional method: participants completed a diet-specific online FFQ. Setting: A Vegan Israeli Study substudy. Participants: 30 participants were recruited using advertisements on social media. Main outcome measure: Average diet cost, energy and nutrients consumption, generated by: (1) items on receipts; (2) online FFQ with supermarkets prices. Analysis: Examining correlations between methods and generating Bland-Altman graphs. Results: Agreement between measurement tools increased when ‘eating-away-from-home’ dietary costs were omitted from the analysis, from differences of 1453 New Israeli Shekel (NIS)/28 days (414 US$/28 days) higher to 1010 NIS/28-days (288 US$/28days) lower compared with differences of 756 NIS/28 days (215 US$/28 days) higher to 1159 NIS/28 days (330 US$/28 days) lower. Moreover, the Pearson correlation between methods, which was r=0.29 (p=0.13), increased to r=0.52 (p<0.0042). Finally, Pearson correlations between questionnaire-based and receipt-based nutrients were: energy=0.58 (p=0.001); protein=0.46 (p=0.012); fat=0.50 (p=0.005); carbohydrates=0.76 (p<0.001); calcium=0.46 (p=0.012); and iron=0.37 (p=0.049). Conclusions and implications: The dietary cost of the ‘FFQ-and-supermarket-prices’ method is more strongly correlated and agreeable with the ‘cash-register-receipts-items’ method when ‘eating-away-from-home’ items are omitted, indicating that ‘eating-away-from-home’ costs are poorly estimated when using the standard ‘FFQ-and-supermarket-prices’ method. Finally, estimating energy, carbohydrates, protein, fat, calcium and iron using ‘cash-register-receipts-items’ is feasible.

Purpose of Review: Protein intake is recognized as a key nutritional factor crucial for optimizing Metabolic Bariatric Surgery (MBS) outcomes by preventing protein malnutrition, preserving fat-free mass, and inducing satiety. This paper discusses the current evidence regarding protein intake and its impact on clinical outcomes following MBS. Recent Findings: There are considerable gaps in the understanding of protein requirements following MBS, as existing guidelines are based on limited and inconsistent reports. This highlights the urgent need for updated clinical practice recommendations grounded in high-quality evidence. Summary: Further investigation using robust methodologies is essential to address existing research gaps related to the individualization of protein requirements following MBS. Future research should consider factors such as the time elapsed since surgery, the form and quantity of protein consumed, and necessary adjustments for physical activity. Ultimately, in alignment with recent literature, a more specific and personalized dietary protein approach should be examined.

Background/Objectives: Type 2 diabetes mellitus (DM2) and hypothyroidism are two of the most common endocrine disorders in clinical practice. Hospital length of stay (LOS) is a quality metric of the health systems. We evaluated the association between elevated thyroid-stimulating hormone (TSH) levels and prolonged LOS among all adult patients (age ≥ 18 years) with DM admitted to our Internal Medicine departments between 2014 and 2022. Methods: Data on patient characteristics, LOS, and in-hospital mortality were collected. A TSH level > 4.7 μIU/mL was considered as being elevated. A LOS > 75th percentile and in-hospital mortality were defined as being prolonged. Univariate and multivariable analyses were applied, and propensity score matching controlled for differences between patients with normal and those with elevated TSH levels. Results: Of the 19,066 study participants (median age 75.6 years, IQR 75.9–83.3), 1524 (7.9%) had elevated TSH levels, and prolonged LOS was significantly more common among them (before matching: 38.6% vs. 29.1%, p < 0.001; after matching: 38.7% vs. 32.6%, p = 0.001). After adjustment for potential confounders, elevated TSH levels were also associated with prolonged LOS (OR = 1.22, 95% CI 1.07–1.39, p = 0.002). Conclusions: Elevated TSH levels in diabetic patients hospitalized in Internal Medicine departments are associated with prolonged LOS, emphasizing the importance of identifying hypothyroidism among them.

Purpose of Review This review explores characterizing candidates for obesity treatments including pharmacotherapy, endoscopic bariatric therapies, and metabolic bariatric surgery (MBS), focusing on established clinical parameters for diagnosing obesity beyond body mass index alone. Recent Findings Existing literature primarily provides rates for fat mass percentage (i.e., a marker for adiposity quantity), waist circumference (i.e., a marker for adiposity distribution), and C-reactive protein levels (i.e., a marker for adiposity functionality) among obesity treatment candidates. Limited data on abnormal values and sex-based differentiation exist. The literature indicates high central-tendency measures for fat mass percentage and waist circumference, while C-reactive protein levels vary. Data on the Edmonton Obesity Staging System (i.e., a marker for adiposity-related disease severity) is predominantly available for MBS candidates. Summary Future studies in obesity interventions should improve screening and diagnosis of obesity by incorporating sex-specific considerations and providing abnormal value rates for measurements to enhance understanding of patients' characteristics.