BACKGROUNDObservational studies support an association between a low blood 25-hydroxyvitamin D level and the risk of type 2 diabetes. However, whether vitamin D supplementation lowers the risk of diabetes is unknown. METHODSWe randomly assigned adults who met at least two of three glycemic criteria for prediabetes (fasting plasma glucose level, 100 to 125 mg per deciliter; plasma glucose level 2 hours after a 75-g oral glucose load, 140 to 199 mg per deciliter; and glycated hemoglobin level, 5.7 to 6.4%) and no diagnostic criteria for diabetes to receive 4000 IU per day of vitamin D 3 or placebo, regardless of the baseline serum 25-hydroxyvitamin D level. The primary outcome in this time-to-event analysis was new-onset diabetes, and the trial design was event-driven, with a target number of diabetes events of 508. RESULTSA total of 2423 participants underwent randomization (1211 to the vitamin D group and 1212 to the placebo group). By month 24, the mean serum 25-hydroxyvitamin D level in the vitamin D group was 54.3 ng per milliliter (from 27.7 ng per milliliter at baseline), as compared with 28.8 ng per milliliter in the placebo group (from 28.2 ng per milliliter at baseline). After a median follow-up of 2.5 years, the primary outcome of diabetes occurred in 293 participants in the vitamin D group and 323 in the placebo group (9.39 and 10.66 events per 100 person-years, respectively). The hazard ratio for vitamin D as compared with placebo was 0.88 (95% confidence interval, 0.75 to 1.04; P = 0.12). The incidence of adverse events did not differ significantly between the two groups. CONCLUSIONSAmong persons at high risk for type 2 diabetes not selected for vitamin D insufficiency, vitamin D 3 supplementation at a dose of 4000 IU per day did not result in a significantly lower risk of diabetes than placebo. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; D2d ClinicalTrials.gov number, NCT01942694.)A BS TR AC T

Purpose of review SGLT2 inhibitors are the newest class of oral anti-hyperglycemic agents that have been approved for the treatment of diabetes mellitus. Over the past year there have been significant developments in both the safety and efficacy of this class of medications that are presented in this review. Recent findings Besides data on the glucose lowering effect of SGLT2 inhibitors, other metabolic benefits have been demonstrated for this class of medications. Moreover, there have been 3 FDA Drug Safety Communications issued in 2015 that have led to additional drug labeling. The basic mechanism of action, indications, glucose-lowering benefits, other metabolic benefits, and adverse side effects of SGLT2 inhibitors are presented in this review. Summary SGLT2 inhibitors are medications that have a unique mechanism of action and that lower glucose independent of insulin. Given the recent findings on efficacy and benefits, these agents are rapidly establishing their role in the treatment of diabetes. Especially in patients with type 2 diabetes not willing or not ready to start insulin, SGLT2 inhibitors may be another option in those patients requiring additional glucose lowering and in those with acceptable risk factor profiles. Although there appears to be some positive benefits in cardiovascular endpoints, more research on the long term outcomes in people taking SGLT2 inhibitors is warranted.

Objective: Eating earlier in the daytime to align with circadian rhythms in metabolism enhances weight loss. However, it is unknown whether these benefits are mediated through increased energy expenditure or decreased food intake. Therefore, this study performed the first randomized trial to determine how meal timing affects 24-hour energy metabolism when food intake and meal frequency are matched. Methods: Eleven adults with overweight practiced both early time-restricted feeding (eTRF) (eating from 8 am to 2 pm) and a control schedule (eating from 8 am to 8 pm) for 4 days each. On the fourth day, 24-hour energy expenditure and substrate oxidation were measured by whole-room indirect calorimetry, in conjunction with appetite and metabolic hormones. Results: eTRF did not affect 24-hour energy expenditure (Δ = 10 ± 16 kcal/d; P = 0.55). Despite the longer daily fast (intermittent fasting), eTRF decreased mean ghrelin levels by 32 ± 10 pg/mL (P = 0.006), made hunger more even-keeled (P = 0.006), and tended to increase fullness (P = 0.06-0.10) and decrease the desire to eat (P = 0.08). eTRF also increased metabolic flexibility (P = 0.0006) and decreased the 24-hour nonprotein respiratory quotient (Δ = −0.021 ± 0.010; P = 0.05). Conclusions: Meal-timing interventions facilitate weight loss primarily by decreasing appetite rather than by increasing energy expenditure. eTRF may also increase fat loss by increasing fat oxidation.

Exergaming at home elicited high adherence and improved children's BMI z-score, cardiometabolic health and physical activity levels. Exergaming with social support may be promoted as an exercise option for children.

Summary Background Structured exergaming with prescribed moderate intensity physical activity has reduced adiposity among adolescents. The extent to which adolescents reduce adiposity when allowed to self-select intensity level is not known. Objective The objective of the study was to examine the influence of exergaming on adolescent girls’ body composition and cardiovascular risk factors. Methods This randomized controlled trial assigned 41 overweight and obese girls aged 14 to 18 years to group-based dance exergaming (36 h over 3 months) or to a self-directed care control condition. Body size and composition were measured by anthropometry, dual-energy X-ray absorptiometry [%fat and bone mineral density {BMD}] and magnetic resonance imaging. Cardiovascular risk factors included blood pressure, cholesterol, triglycerides, glucose and insulin. Results Attrition was 5%. Using analysis of covariance controlling for baseline value, age and race, there were no significant condition differences. Per protocol (attended >75%), the intervention group significantly decreased abdominal subcutaneous adiposity and increased trunk and spine BMD (ps < 0.05). Per protocol (>2600 steps/session), the intervention group significantly decreased leg %fat and decreased abdominal subcutaneous and total adiposity (ps < 0.05). Conclusion Exergaming reduced body fat and increased BMD among those adolescent girls who adhered. Further research is required before exergaming is recommended in clinical settings.

ImportanceSARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.ObjectiveTo develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.Design, Setting, and ParticipantsProspective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling.ExposureSARS-CoV-2 infection.Main Outcomes and MeasuresPASC and 44 participant-reported symptoms (with severity thresholds).ResultsA total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.Conclusions and RelevanceA definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.

Background Exercise is recommended for weight management, yet exercise produces less weight loss than expected, which is called weight compensation. The mechanisms for weight compensation are unclear. Objective The aim of this study was to identify the mechanisms responsible for compensation. Methods In a randomized controlled trial conducted at an academic research center, adults (n = 198) with overweight or obesity were randomized for 24 wk to a no-exercise control group or 1 of 2 supervised exercise groups: 8 kcal/kg of body weight/wk (KKW) or 20 KKW. Outcome assessment occurred at weeks 0 and 24. Energy intake, activity, and resting metabolic rate (RMR) were measured with doubly labeled water (DLW; with and without adjustments for change in RMR), armband accelerometers, and indirect calorimetry, respectively. Appetite and compensatory health beliefs were measured by self-report. Results A per-protocol analysis included 171 participants (72.5% women; mean ± SD baseline body mass index: 31.5 ± 4.7 kg/m2). Significant (P < 0.01) compensation occurred in the 8 KKW (mean: 1.5 kg; 95% CI: 0.9, 2.2 kg) and 20 KKW (mean: 2.7 kg; 95% CI: 2.0, 3.5 kg) groups, and compensation differed significantly between the exercise groups (P = 0.01). Energy intake by adjusted DLW increased significantly (P < 0.05) in the 8 KKW (mean: 90.7 kcal/d; 95% CI: 35.1, 146.4 kcal/d) and 20 KKW (mean: 123.6 kcal/d; 95% CI: 64.5, 182.7 kcal/d) groups compared with control (mean: −2.3 kcal/d; 95% CI: −58.0, 53.5 kcal/d). Results were similar without DLW adjustment. RMR and physical activity (excluding structured exercise) did not differentially change among the 3 groups. Participants with higher compared with lower compensation reported increased appetite ratings and beliefs that healthy behaviors can compensate for unhealthy behaviors. Furthermore, they increased craving for sweet foods, increased sleep disturbance, and had worsening bodily pain. Conclusions Compensation resulted from increased energy intake and concomitant increases in appetite, which can be treated with dietary or pharmacological interventions. Compensation was not due to activity or metabolic changes. This trial was registered at clinicaltrials.gov as NCT01264406.

Background Given the low levels of physical activity (PA) among adolescent girls in the US, there is a need to identify tools to motivate increased PA. Although there is limited evidence that adolescents transfer PA from one context to another context, exergames (i.e., video games that require gross motor activity) may act as a gateway to promote overall PA outside of game play. The purpose of this study was to examine potential transfer effects (i.e., influences on external behaviors and psychological constructs) of a 12-week exergaming intervention on adolescent girls’ PA, screen-time, and self-efficacy towards PA, as well as the intrinsic motivation of exergaming. Methods Participants were 37 girls aged 14–18 years (65% African American, 35% White) who were overweight or obese (body mass index ≥ 85th percentile) and were recruited from the community via school, physicians, news media, and social media sites. Adolescents were randomly assigned to a 12-week group exergaming intervention (thirty-six 60 min sessions of group-based dance exergaming in a research laboratory using Kinect for Xbox 360) or to a no-treatment control group. Outcome variables included objectively measured PA (total) and self-reported leisure-time PA (discretionary time only) 1-week before vs. 1-week after the intervention; selected type and intensity of PA when placed in a gym setting for 30 min (“cardio free choice”); screen-time; self-efficacy towards PA; and intrinsic motivation towards exergaming. Results Attendance to the exergaming sessions was high (80%). Compared to the control group, the intervention group self-reported an increase in PA (p = 0.035) and fewer hours watching TV/videos (p = 0.01) after the intervention, but there were no significant differences in sedentary, light, moderate, or vigorous PA measured by accelerometry. The intervention group significantly improved self-efficacy towards PA (p = 0.028). The intervention group highly rated intrinsic motivation towards exergaming. Conclusion Twelve weeks of exergaming was associated with positive impacts on adolescent girls’ self-reported PA, television viewing, self-efficacy, and intrinsic motivation. Future research is warranted to leverage exergames as an enjoyable, motivating, and effective PA tool.