Journal of Internal Medicine最新文献

{"title":"Dad's legacy: Epigenetic reprogramming and paternal inflammatory memory in offspring health.","authors":"Shamila D Alipoor, Parisa Norouzitallab, Anita Öst, Maria Lerm","doi":"10.1111/joim.20094","DOIUrl":"https://doi.org/10.1111/joim.20094","url":null,"abstract":"<p><p>Over the past decade, numerous reports have highlighted intergenerational and even transgenerational epigenetic effects resulting from parental exposure to diets, toxins, and stress. In many cases, these parentally induced phenotypes do not seem to confer an obvious benefit, making it challenging to understand the evolutionary drivers behind them. In this perspective, we discuss recent observations in humans and rodents indicating that a parental infection or vaccination can enhance the offspring's ability to cope with infections. Such parental priming of their offspring's immune system and cellular defense would provide immediate protection to the newborn, offering a clear evolutionary advantage. Here, focusing mainly on paternal effects, we propose that a parentally induced inflammatory memory in the offspring could be the underlying mechanism for many of the reported inter- and transgenerational effects. Sperm-borne RNA could be a triggering signal to initiate inflammatory pathways in early embryogenesis. This gene-regulatory state would then be maintained via epigenetic mechanisms throughout each mitosis and last for the individual's lifetime. The accumulating understanding that diet, stress, toxins, and infections affect offspring health raises important questions about public health policies. There is an urgent need to understand what consequences different exposures during sensitive time windows have on future generations.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching Gentle Medicine.","authors":"Benjamin Chin-Yee, Ezio Laconi, Jacob Stegenga","doi":"10.1111/joim.20101","DOIUrl":"https://doi.org/10.1111/joim.20101","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors reply: Six-fold increased risk of acute pancreatitis in alcohol-related liver disease compared to matched comparators.","authors":"Ana Dugic, Hannes Hagström","doi":"10.1111/joim.20097","DOIUrl":"https://doi.org/10.1111/joim.20097","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding: Sixfold increased risk of acute pancreatitis in alcohol-related liver disease compared to matched comparators.","authors":"Shih-Wei Lai, Kuan-Fu Liao","doi":"10.1111/joim.20096","DOIUrl":"https://doi.org/10.1111/joim.20096","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing early detection of cognitive impairment in primary care to improve care for older adults.","authors":"Nicole R Fowler, Katherine A Partrick, James Taylor, Michael Hornbecker, Kevin Kelleher, Malaz Boustani, Jeffrey L Cummings, Tim MacLeod, Michelle M Mielke, Jared R Brosch, Janice Lee, Eli Shobin, James E Galvin, Howard Fillit, Chinedu Udeh-Momoh, Deanna R Willis","doi":"10.1111/joim.20098","DOIUrl":"https://doi.org/10.1111/joim.20098","url":null,"abstract":"<p><p>Primary care is the ideal setting for early detection of mild cognitive impairment (MCI) and Alzheimer's disease and related dementias (ADRD), as it serves as the primary point of care for most older adults. With the growing aging population, reliance on specialists for detection and diagnosis is unsustainable, highlighting the need for primary care-led assessment. Recent research findings on successful brain health prevention strategies, AD diagnostic tools, and anti-amyloid treatments empower primary care to play a central role in early detection and intervention. Primary care-focused resources are being developed, including tools for cognitive assessments and materials designed to educate patients about brain health and initiate discussions on lifestyle modifications, thereby making early detection more feasible and efficient. Identifying risk factors early enables providers to implement interventions that can slow cognitive decline and improve outcomes for patients and caregivers. If left undetected and unmanaged, MCI and ADRD can lead to worse outcomes, including increased falls, hospitalizations, financial vulnerability, and caregiver stress. Early detection enables the identification of reversible causes of cognitive impairment, supports the management of comorbidities worsened by cognitive decline, mitigates safety risks, and can preserve quality of life. Importantly, primary care is essential for addressing ADRD-related health disparities that disproportionately affect racial minorities, rural populations, and those of lower socioeconomic status. With a focus on the United States healthcare system, this perspective addresses how implementing early detection practices into primary care can improve outcomes for patients and caregivers, reduce societal burdens, and promote health equity in ADRD care.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher circulating FGF21, lower protein intake, and lower muscle mass: Associations with a higher risk of mortality.","authors":"Adrian Post, Wendy A Dam, Dion Groothof, Casper F M Franssen, Stephan J L Bakker, Robin P F Dullaart","doi":"10.1111/joim.20099","DOIUrl":"https://doi.org/10.1111/joim.20099","url":null,"abstract":"<p><strong>Background and objectives: </strong>This population-based study explores associations of fibroblast growth factor 21 (FGF21), a key modulator of processes linked to protein metabolism, with protein intake and muscle mass, and their relationships with all-cause mortality.</p><p><strong>Methods: </strong>In 6395 participants (mean age 54 years; 50% women), circulating FGF21 (immunoassay), protein intake (Maroni equation using 24-h urinary urea excretion; low intake defined as <0.8 g/kg/day), and muscle mass (24-h creatinine excretion rate indexed to height squared (CERI)) were documented.</p><p><strong>Results: </strong>FGF21 concentration was 896 (540-1384) pg/mL, protein intake was 1.01 (0.85-1.19) g/kg/day, and CERI was 4.1 ± 0.9 mmol/day/m². Higher FGF21 was associated with higher odds of low protein intake (odds ratio per doubling: 1.48; 95% confidence interval [CI]: 1.38-1.58; p < 0.0001) and lower muscle mass (standardized beta: -0.08; 95% CI: -0.10; -0.06; p < 0.001). Over 10.4 years of follow-up, 955 deaths were registered. Higher FGF21 was associated with increased mortality (hazard ratio (HR) per doubling: 1.09; 95% CI: 1.02-1.16; p = 0.009). Conversely, higher protein intake (HR per doubling: 0.67; 95% CI: 0.56-0.81; p < 0.0001) and higher CERI (HR per standard deviation increase: 0.83; 95% CI: 0.76-0.90; p < 0.0001) were associated with a lower risk of mortality, independent of potential confounders. However, the FGF21-mortality association became non-significant after adjusting for protein intake.</p><p><strong>Conclusion: </strong>Higher FGF21 was associated with higher odds of low protein intake. The observed association of higher FGF21 concentrations and risk mortality was predominantly attributable to lower protein intake. In contrast, both higher protein intake and higher muscle mass were independently associated with lower mortality risk, highlighting the potential relevance of protein intake and maintenance of muscle mass in long-term health.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standard and advanced echocardiographic study of patients with Paget's disease of bone: Evidence of a pagetic heart disease?","authors":"Alfonso Giaquinto,&nbsp;Veronica Abate,&nbsp;Anita Vergatti,&nbsp;Riccardo Muscariello,&nbsp;Adelaide Iervolino,&nbsp;Martina Pucci,&nbsp;Guido Cavati,&nbsp;Filippo Pirrotta,&nbsp;Gianpaolo De Filippo,&nbsp;Roberta Esposito,&nbsp;Lanfranco D'Elia,&nbsp;Daniela Merlotti,&nbsp;Luigi Gennari,&nbsp;Domenico Rendina","doi":"10.1111/joim.20069","DOIUrl":"10.1111/joim.20069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Paget's disease of the bone (PDB) is a metabolic bone disorder involving one or more skeletal sites. Cardiovascular diseases (CVDs) have been described in patients with PDB but have not been systematically analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to compare standard and advanced (speckle-tracking) echocardiographic parameters measured in patients with PDB and controls matched for age, weight, height and history of hypertension but without metabolic bone disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicentre case–control study included all patients with PDB referred to the Federico II and Siena Universities, Italy, from March 2019 to October 2022. During the same time, we enrolled at least one control for each patient, matched for age, sex, body mass index (BMI) and history of hypertension.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-nine patients with PDB and 115 healthy controls were enrolled in this study. All patients with PDB were treated with zoledronic acid at the time of diagnosis. Compared with controls, on standard echocardiography, patients with PDB showed a high prevalence of aortic and mitral valve calcifications and/or sclerosis, reduced left ventricular (LV) ejection fraction, stroke volume, cardiac output, increased interventricular septum thickness, posterior wall thickness, LV mass index, relative wall thickness, relative diastolic wall thickness, <i>E</i>/<i>e</i>′ ratio and systemic vascular resistance. Using speckle-tracking echocardiography, patients with PDB showed a lower global longitudinal strain and global myocardial work efficiency than controls. There was no relationship between the PDB activity and extent and severity of cardiac abnormalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Overall, the myocardial function and structure were impaired in patients with PDB. Additionally, PDB was associated with early subclinical myocardial damage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 6","pages":"630-641"},"PeriodicalIF":9.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The yin–yang between clonal hematopoiesis of indeterminate potential and autoimmune diseases","authors":"Zachary Brady,&nbsp;Valeria Visconte","doi":"10.1111/joim.20091","DOIUrl":"10.1111/joim.20091","url":null,"abstract":"&lt;p&gt;The article by Wu et al. [&lt;span&gt;1&lt;/span&gt;] in the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt; investigates the relation between clonal hematopoiesis of indeterminate potential (CHIP) and autoimmune diseases. The reason behind such relation might be attributed to changes in the immune system occurring with advanced age.&lt;/p&gt;&lt;p&gt;Indeed, CHIP is common in the elderly and asymptomatic. Individuals with CHIP have an increased risk of hematologic malignancies and chronic inflammatory diseases, such as cardiovascular disease [&lt;span&gt;2, 3&lt;/span&gt;]. The latter has been associated to enhanced production of proinflammatory cytokines and accelerated atherosclerosis. More recently, studies have found associations between CHIP and multiple autoimmune diseases; specifically, large CHIP clones (&gt;10% or &gt;15%) were associated with an increased risk of seropositive rheumatoid arthritis (RA) and, to a lesser extent, RA [&lt;span&gt;4&lt;/span&gt;]. Of note is that 60% of patients with the notable hemato-immunoinflammatory VEXAS syndrome have CHIP [&lt;span&gt;5&lt;/span&gt;]. Observations from studies of Behçet's disease, a chronic inflammatory immune-mediated disorder, indicate that some extent of inflammation is associated with CHIP emergence [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Wu et al. [&lt;span&gt;1&lt;/span&gt;] set out to address the interplay between CHIP and autoimmune diseases. To do so, the authors analyzed data collected from whole blood-derived exome sequencing (WES) of 456,692 UK Biobank participants after exclusion of (a) individuals with hematologic malignancies, (b) individuals with more than 10 third-degree relatives, (c) heterozygous outliers, and (d) participants with a baseline autoimmune disease. Overall, 19 immune-mediated inflammatory diseases were selected (Addison's disease, ankylosing spondylitis, coeliac disease, type 1 diabetes, Graves’ disease, Crohn's disease, ulcerative colitis, multiple sclerosis, myasthenia gravis, pernicious anemia, polymyalgia rheumatica, primary biliary cholangitis, psoriasis, RA, Sjögren's syndrome, systemic lupus erythematosus, systemic sclerosis, vasculitis, and vitiligo). Association between CHIP (with a variant allele frequency [VAF] more than (a) 2%, (b) 10%, and (c) specific CHIP mutation) was analyzed. In total, 58 CHIP genes were included.&lt;/p&gt;&lt;p&gt;Overall, 17,433 (3.82%) individuals had any CHIP (&lt;i&gt;DNMT3A&lt;/i&gt; [2.40%] with p.R882H being the most common mutation, &lt;i&gt;TET2&lt;/i&gt; [0.47%], &lt;i&gt;ASXL1&lt;/i&gt; variants [0.25%], spliceosomal genes [0.11%], and &lt;i&gt;PPM1D&lt;/i&gt; [0.11%] variants). More than one CHIP mutation was detected in 6.10% of individuals. Specific CHIP mutations were associated with different autoimmune diseases. A large part of the study focuses on making inflammation the central node between CHIP and autoimmune disorders. However, as per today, this connection is still very vague and rather inconclusive due to the high number of inflammatory markers possibly involved in the process and the inability to assess all of them.&lt;/p&gt;&lt;p&gt;A point of discussion rem","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 6","pages":"558-559"},"PeriodicalIF":9.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-related cardiovascular disease in Down syndrome: A population-based matched cohort study","authors":"Annie Pedersen,&nbsp;Anna Skarin Nordenvall,&nbsp;Giorgio Tettamanti,&nbsp;Ann Nordgren","doi":"10.1111/joim.20093","DOIUrl":"10.1111/joim.20093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Life expectancy for individuals with Down syndrome (DS) has increased dramatically. To improve detection and prevention, the risk of age-related cardiovascular disease in this population needs to be better defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a population-based matched cohort study. Through the National Patient Register (NPR) and/or the Medical Birth Register, we identified all individuals born in Sweden between 1946 and 2000 with a diagnosis of DS. Each individual with DS was matched to 50 comparators by sex, birth year, and county of birth. Data on ischemic and hemorrhagic stroke, acute myocardial infarction (AMI), and covariates indicating cardiovascular risk were retrieved from the NPR. Associations between DS and cardiovascular outcomes were estimated using Cox proportional hazards models. We also assessed the influence of cardiovascular risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 5155 individuals with DS, of which 55% were male. The median age at the end of follow-up was 35 in the DS population and 42 among the comparisons. DS was associated with increased risk of ischemic stroke (hazard ratios [HR] 4.41, 95% confidence intervals [CI] 3.53–5.52) and hemorrhagic stroke (HR 5.14, 95% CI 3.84–6.89). The overall risk of AMI was similar in DS and comparators but increased in young individuals with DS. The risk of ischemic stroke was elevated in individuals with DS with selected atherosclerotic (HR 12.67, 95% CI 7.04–22.78) as well as embolic (HR 10.35, 95% CI 6.69–16.01) risk factors, as compared to comparators without risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Individuals with DS were at increased risk of cardiovascular outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 6","pages":"683-692"},"PeriodicalIF":9.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse effects of obesity on overall health, quality of life, and related physical health metrics: A cross-sectional and longitudinal study from the All of Us Research Program","authors":"Zhiqi Yao,&nbsp;Beverly G. Tchang,&nbsp;Kacey Chae,&nbsp;Michael Albert,&nbsp;Jeanne M. Clark,&nbsp;Michael J. Blaha","doi":"10.1111/joim.20083","DOIUrl":"10.1111/joim.20083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Population-level adverse effects of obesity beyond commonly considered chronic conditions need to be characterized to understand its overall burden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the cross-sectional associations between obesity and self-reported status of overall health, quality of life, pain, fatigue, ability of physical activity, and the risks of developing chronic pain syndrome, chronic fatigue syndrome, fibromyalgia, and insomnia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from the All of Us Research Program (the United States), we included participants with a body mass index (BMI) ≥18.5 kg/m² and available Overall Health Survey or electronic health records. Cross-sectional analyses of self-reported variables were conducted using multivariable logistic and linear regression models. Cox proportional-hazard models were used to assess risks for incident outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 323,640 participants (60.3% were female, mean age: 51.3 years), 20.7%, 11.0%, and 9.5% were with Classes I, II, and III obesity, respectively. Higher BMI categories were correlated with worse health metrics, with Class III obesity exhibiting the greatest disparities. Among those with Class III obesity, 9.6% (vs. 3.2% for normal weight) reported poor overall health, 28.3% (vs. 13.2%) reported severe pain, and 11.8% (vs. 8.4%) had prevalent insomnia. Graded associations were observed across high BMI categories, with Class III obesity showing the strongest effects. Compared with normal weight, in Class III obesity, the odds ratio (95% CI) was 3.82 (3.69–3.96) for fair/poor overall health, 3.93 (3.71–4.17) for severe pain, and 3.13 (2.98–3.29) for severely limited physical activity; the hazard ratio (95% CI) was 2.83 (2.36–3.40) for fibromyalgia and 1.53 (1.41–1.65) for insomnia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Obesity imposes a substantial burden on broad aspects of well-being in the US population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 6","pages":"657-671"},"PeriodicalIF":9.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}