Alin Albai

Background: Body-composition changes during routine obesity pharmacotherapy require cautious interpretation. Methods: This retrospective observational cohort included 59 adults with paired InBody 770 assessments: 53 receiving tirzepatide and 6 receiving semaglutide. Paired changes and relative device-estimated muscle mass loss were analyzed in all 59; component-share analyses were restricted to the 51 achieving ≥5% weight loss. Analyses used rank-based methods and exploratory robust regression. Results: Recorded treatment duration was a median of 7.0 months, and median observed weight loss was 12.11%. Median fat mass and device-estimated muscle mass losses were 9.9 and 2.3 kg, respectively. Among the 51 participants achieving ≥5% weight loss, median fat, device-estimated muscle, and residual shares were 73.95%, 14.91%, and 10.85%. Each additional five percentage points of weight loss was associated with 2.47 percentage points greater relative device-estimated muscle mass loss (95% CI, 1.89 to 3.05). The corresponding fully adjusted association with muscle share was −0.52 percentage points (95% CI, −1.66 to 0.62); this does not establish stability or equivalence. Final drug-specific dose intensity was not statistically associated with either outcome in the adjusted models. Conclusions: Weight loss observed in this selected, predominantly tirzepatide-treated cohort was mainly accounted for by estimated fat mass reduction. Larger observed weight-loss responses accompanied greater device-estimated muscle mass reductions. Muscle-share estimates were uncertain and model-dependent. The study cannot establish causal medication effects or functional consequences.

Obesity is usually classified or assessed using the body mass index (BMI), mainly because BMI is simple and easy to apply. Its simplicity is also its main weakness. BMI does not measure fat mass, fat-free mass, or fat distribution. This is a relevant limitation, since individuals with the same BMI may have different amounts of visceral adipose tissue and different cardiometabolic risks. Recent recommendations from the Commission on Clinical Obesity also emphasize that BMI should be used mainly as a screening tool, while excess adiposity should be confirmed using additional anthropometric or body composition measures. This narrative review examines clinical methods for obesity assessment beyond BMI and discusses their practical value in routine care. A literature search was performed in PubMed and Google Scholar for articles published up to August 2026. Guidelines, consensus statements, reviews, meta-analyses, and original studies were considered. The review focused on anthropometric indices, body composition techniques, and imaging-based methods used to assess adiposity, fat distribution, and obesity-related risk. The reviewed evidence supports a complementary approach. Anthropometric indices help evaluate abdominal adiposity and cardiometabolic risk. Body composition methods add information on fat mass, fat-free mass, and regional distribution. Imaging techniques offer the most detailed assessment of visceral, subcutaneous, and ectopic fat, although their routine use is limited by cost, availability, technical requirements, or radiation exposure. BMI remains useful for initial screening, but it is not sufficient for a complete obesity assessment. Combining anthropometric, body composition, and imaging-based methods may improve the evaluation of excess adiposity, fat distribution, and clinical risk.

Background and Objectives: Weight gain during winter holidays has been reported in several studies, but most of them focus on short-term changes and rely primarily on body weight or BMI. This study investigates if body composition alterations associated with winter holiday period persist over a one-year follow-up in a Romanian adult population. Materials and Methods: This prospective longitudinal observational study included three assessment points: before the winter holidays (T1), immediately after the holidays (T2), and one year later (T3). Bioelectrical impedance analysis was used to obtain body composition parameters. A total of 120 participants completed all three assessments and were included in the longitudinal analysis. Results: Body weight and visceral fat area increased modestly yet significantly between T1 and T2. At the one-year follow-up, values remained similar to those observed immediately after the holiday period, suggesting persistence at group level (body weight: 68.25 → 69.40 → 69.45 kg and visceral fat area: 98.49 → 100.54 → 101.42 cm²). The net change observed during the holiday period was similar in magnitude to the overall annual difference. Changes in body weight were significantly associated with changes in visceral fat both during the holiday period and across the entire follow-up. Conclusions: Modest increases in body weight and visceral fat observed during the winter holidays were still present at one year. These findings suggest that short seasonal periods may contribute to overall annual changes in body weight and fat distribution.

Background: Patients with type 2 diabetes (T2D) have high morbidity and mortality rates, mainly due to cardiovascular diseases (CVDs). Given the heterogeneity of this population, in whom atherosclerotic CVD may coexist with varying degrees of microvascular and renal involvement, preventive and therapeutic needs differ among these patients. Multifactorial CV risk factor control has proven beneficial in T2D; however, it remains suboptimal, particularly for lipid and weight targets. Aims: The aims were to evaluate, in a real-world cohort of patients with T2D, whether different cardio-reno-microvascular phenotypes are associated with differences in multifactorial cardiometabolic control and to assess individual target attainment along with the use of cardioprotective therapies across phenotypes. Methods: In a single-center, cross-sectional study, 174 patients with T2D were enrolled and clustered into four phenotypes based on the presence of atherosclerotic CVD (ASCVD), chronic kidney disease, retinopathy and neuropathy. Achievement of individual and multifactorial cardiometabolic risk factor control was examined across phenotypes. Results: More than three quarters of the cohort had ASCVD, microvascular/renal disease, or both. While approximately half of the patients had optimal glycemic control, achievement of LDLC and normal BMI was modest. Target attainment did not differ significantly across phenotypes, with most patients achieving one or two targets and less than one third achieving three or more. Statin use was significantly higher in phenotypes with ASCVD, whereas use of other lipid-lowering therapies remained low. Use of SGLT2is and GLP-1 RAs was also limited. Higher BMI was independently associated with lower odds of multifactorial control. Conclusions: In this real-world cohort of patients with T2D, individual and multifactorial cardiometabolic risk factor control was suboptimal, particularly for LDLC and body weight. A phenotype-based approach may help clinicians identify vulnerable subgroups requiring more intensive, risk-based preventive strategies.

Background/Objectives: The winter holiday period is often associated with lifestyle changes that can affect body composition. This study aimed to evaluate short-term changes in body composition and anthropometric indices over the winter holidays. Methods: A total of 168 adults (126 women and 42 men) were assessed before (December) and after (January) the holidays using bioelectrical impedance analysis (InBody 770) and standard anthropometric measurements. Participants also completed a Healthy Eating Assessment questionnaire to evaluate their dietary habits during this period. Results: After the holiday, statistically significant increases were observed in weight (68.55 → 69.70 kg), body fat mass (20.60 → 21.15 kg), visceral fat area (95.40 → 97.60 cm²), and waist circumference (84.30 → 85.08 cm). Men showed greater gains in weight and fat-related parameters compared to women. Participants who reported healthier dietary behaviors had smaller increases in fat mass and anthropometric measures. Conclusions: These findings suggest that even brief holiday periods can lead to measurable gains in weight and body fat and, if repeated over time, may contribute to the development of obesity.

Background and Objectives: Telemedicine solutions have proven their value and efficacy in augmenting diabetes care. In addition to the availability of tools needed to implement telemedicine solutions for patients with diabetes, the patients’ desirability, acceptance, and adherence represent major burdens in implementing them. The main aim of this research is to evaluate which factors are influencing the desirability, acceptance, and adherence of patients with diabetes to telemedicine interventions in diabetes care. Materials and Methods: QTelemeDiab, a previously validated instrument for assessing patients’ desirability, acceptance, and adherence to telemedicine in diabetes care, was used on 114 enrolled patients with diabetes mellitus, in parallel with demographic, socio-economic, disease history, and psychometric data from all patients. Results: Left-skewed score distributions were observed for the QTelemeDiab total score (median = 166; skewness = −1.738), as well as all its components, thus denoting a high desirability, acceptance, and adherence towards telemedicine use. The presence of severe depression was associated with significant decreases in the QTelemeDiab score (148 vs. 167; p < 0.001), as well as on the desirability sub-score (101 vs. 115; p < 0.001) and adherence sub-score (30 vs. 35; p < 0.001). The presence of severe anxiety was associated with significant decreases in QTelemeDiab score (150 vs. 166), as well as the desirability sub-score (104 vs. 114; p = 0.008) and adherence sub-score (30 vs. 34; p = 0.012). Conclusions: There is a high desirability, acceptance, and adherence to the use of telemedicine interventions in patients with diabetes, both in special and in normal epidemiological settings. The presence of severe anxiety decreases the patient’s desirability, acceptance, and adherence, while the presence of severe depression decreases the patient’s desirability and adherence to the use of telemedicine interventions in diabetes care.

Background and Objectives: The prevalence of cachexia has increased across all of the cancer types and accounts for up to 20% of cancer-related deaths. This paper is a systematic review of nutritional interventions aiming to improve cachexia outcomes in cancer, focusing on weight gain. Materials and Methods: A search in Medline and Elsevier databases for articles up until the 23 January 2022, was conducted. Results: Out of 5732 screened records, 26 publications were included in the final analysis. Four randomized clinical trials showed a significant body weight (BW) increase in patients treated with eicosapentaenoic acid (EPA), β-hydroxy-beta-methyl butyrate (β-HMB), arginine, and glutamine or marine phospholipids (MPL). An upward BW trend was observed in patients treated with L-carnitine, an Ethanwell/Ethanzyme (EE) regimen enriched with ω-3 fatty acids, micronutrients, probiotics, fish oil, a leucine-rich supplement, or total parental nutrition (TPN) with a high dose of a branched-chain amino acid (BCAA). Conclusions: Although clinical trials relating to large numbers of nutritional supplements present promising data, many trials provided negative results. Further studies investigating the underlying mechanisms of action of these nutritional supplements in cancer cachexia are needed. Early screening for cancer cachexia risk and nutritional intervention in cancer patients before aggravating weight loss may stabilize their weight, preventing cachexia syndrome. According to the GRADE methodology, no positive recommendation for these nutritional supplements may be expressed.

Background and Objectives: Dapagliflozin treatment proved to reduce the epicardial fat volume (EFV) in patients with type 2 diabetes (T2D). Despite the reduction in EFV being associated with improved diastolic function in patients with T2D, EVF is not routinely evaluated in T2D because it is costly and involves radiation exposure. This study aims to identify biomarkers that predict EFV reduction after dapagliflozin treatment in patients with T2D. Materials and Methods: In a prospective, observational, consecutive-case enrollment scenario, 52 patients with T2D were initiated on dapagliflozin 10 mg q.d. as part of the standard of care. At enrollment and after six months of dapagliflozin treatment, patients were evaluated using cardiac ultrasonography, native computer tomography, transient liver elastography, and metabolic lab tests. In addition, the atherogenic index of plasma (AIP), atherogenic coefficient (AC), triglyceride glucose index (TyG), cardiac risk ratio (CRR), and visceral abdominal index (VAI) were calculated. Results: Higher AIP (r = 0.28; p = 0.04), CRR (r = 0.28; p = 0.04), and TyG (r = 0.32; p = 0.01) are associated with more important reductions in the EFV. A lower conicity index (β = −0.29; p = 0.03), visceral fat volume at the 4^th vertebrae (L4VFV) (β = −0.32; p = 0.02), left atrium volume (β = −3.08; p = 0.003), and right ventricle diameter (β = −2.13; p = 0.04) are associated with higher reductions in the EFV after six months of dapagliflozin treatment. A valid performance for predicting clinically relevant decreases in EFV after dapagliflozin treatment was observed for AIP (AUROC = 0.903; Youden = 0.732; p < 0.001), CRR (AUROC = 0.772; Youden = 0.595; p = 0.004), TyG (AUROC = 0.957; Youden = 0.904; p < 0.001), and VAI (AUROC = 0.898; Youden = 0.712; p < 0.001). Conclusion: Higher initial EFV values are associated with more important reductions in EFV in patients with T2D treated for six months with dapagliflozin. TyG values have the best prediction performances for EFV reduction, having the highest sum of sensitivity and specificity at the 0.904 threshold level. AIP, CRR, VAI, conicity index, L4VF, left atrium volume, and right ventricle volume are valid biomarkers for a decrease in EFV after dapagliflozin treatment in diabetes patients.

Purpose: To develop, test, and validate an instrument for assessing patients’ desirability, acceptability, and adherence to telemedicine in diabetes. Patients and Methods: A group of six experts defined the components that needed to be assessed when developing telemedicine platforms aimed at improving the care of patients with diabetes. The resulting instrument was tested for reliability and construct validity of 114 patients with diabetes and re-tested for reproducibility and consistency on a sub-group of 34 patients. Based on the analysis, the questionnaire’s syntax, phrasing, and flow were improved to obtain optimal assessment results. Results: The resulting questionnaire has three major sections: one for the main evaluated component (acceptability, desirability, and adherence to telemedicine in diabetes), one for collecting socio-economic and demographical information, and one for diabetes history-related data, respectively. The corresponding data for these sections are collected using 29 questions. The developed instrument has a good reliability (Cronbach’s alpha = 0.890), reproducibility (Total score 164 vs 166 points at re-test vs test; Mann–Whitney U p-value = 0.394) and external validity (Spearman’s rho = − 0.580; p < 0.001 for correlation with Patient’s Health Questionnaire − 9; and Spearman’s rho = − 0.516; p < 0.001 for correlation with Generalized Anxiety Disorder – 7). Conclusion: The developed questionnaire is a valid and reliable instrument in assessing the patients’ acceptability, desirability, and adherence to telemedicine use in diabetes care. In addition, the use of this instrument in the development of telemedicine platforms may improve and optimize their usage by providing valuable information regarding patients’ preferences and specific needs.

At the beginning of the last century, the association between diabetes mellitus and pregnancy was credited with a high risk of complications and mortality. However, nowadays, such issue no longer bears such a pessimistic approach. Planning the pregnancy during a period of optimal metabolic control and careful monitoring of the pregnant woman significantly reduces maternal and fetal mortality. The most important aspects of fetal pathology are: intrauterine fetal death, congenital malformations, growing disorders (macrosomia or delays in growing), neonatal hypoglycemia, respiratory distress syndrome, hypertrophic cardiomyopathy etc. The fetus’s viability is significantly impacted if a quality maternal glycemic control is not obtained at least 3 months prior to birth, as well as throughout the entire pregnancy term (particularly during the first 10 weeks, term during which organogenesis is completed). This systematic review of scientific literature aims to summarize the pathogenic ways in which hyperglycemia may influence the fetus of women with Diabetes Mellitus.