Metabolic syndrome (MetS) presents a significant global health challenge, characterized by a cluster of metabolic alterations including obesity, hypertension, insulin resistance/dysglycemia, and atherogenic dyslipidemia. Advances in understanding and pharmacotherapy have added complexity to MetS management, particularly concerning drug interactions and pharmacogenetic variations. Limited literature exists on drug–drug–gene interactions (DDGIs) and drug–drug–transporter gene interactions (DDTGIs), which can significantly impact pharmacokinetics and pharmacodynamics, affecting treatment outcomes. This narrative review aims to address the following three key objectives: firstly, shedding a light on the PK metabolism, transport, and the pharmacogenetics (PGx) of medicines most commonly used in the MetS setting (relevant lipid-lowering drugs, antihypertensives and antihyperglycemics agents); secondly, exemplifying potential clinically relevant pharmacokinetic drug interactions, including drug–drug interactions, DDGIs, and DDTGIs; and, thirdly, describing and discussing their potential roles in clinical practice. This narrative review includes relevant information found with the use of interaction checkers, pharmacogenetic databases, clinical pharmacogenetic practice guidelines, and literature sources, guided by evidence-based medicine principles.

Background: Obesity management in women presents distinct challenges across their lifespan. However, there is limited evidence or recommendations focused solely on women living with obesity. Summary: This European Association for the Study of Obesity (EASO) position statement is based on an expert comprehensive review and summary of the available scientific evidence on women living with obesity. It aims to guide the health and medical assessment of these women during their reproductive life (fertility, preconception, pregnancy, postpartum, and breastfeeding). Key Messages: 1. To better diagnose obesity in women beyond BMI, the use of at least one additional anthropometric measure, like waist-to-height ratio (WHtR), is strongly recommended. When available, the use of bioelectrical impedance vector analysis is encouraged. 2. Women with obesity should be offered obesity management counseling and psychological support. 3. Obesity can negatively impact fertility; weight loss of 5–10% over 6 months improves fertility. 4. In women with Polycystic Ovary Syndrome (PCOS), treatment with metformin and GLP-1 receptor agonists or surgery can be considered. 5. Current recommendations for pregestational obesity suggest a gestational weight gain (GWG) of 5–9 kg. Lower GWG targets should be considered, particularly for class II or III obesity. 6. There is limited clinical data on the safety and efficacy of obesity medication during pregnancy or lactation. 7. All pregnant women with obesity should be offered prenatal screening for fetal anomalies, with discussion of the potential limitations of diagnostic tests and additional growth ultrasounds offered on an individual basis. 8. All pregnant women with a BMI ≥30 kg/m2 should be screened for gestational diabetes in early pregnancy. Measures to prevent preeclampsia should be taken and the need for thromboprophylaxis assessed. 9. Intrapartum fetal surveillance is recommended during active labor. 10. Postpartum weight management is needed to mitigate the risk of adverse outcomes for the mother and for subsequent pregnancies. The assessment of appropriate contraceptive methods during the postpartum and breastfeeding period is crucial.

Background: The worldwide increase in the prevalence of childhood obesity necessitates effective prevention and treatment strategies. Clinical practice guidelines (CPGs) offer guidance, but significant heterogeneity or lack of practical application exists in their recommendations. The purpose of the present study is to provide an expert, comprehensive, and comparative analysis of gaps in current CPGs for the prevention and treatment of obesity in children and adolescents. Results: A total of 14 CPGs were identified, focusing on childhood obesity prevention (n = 11), treatment (n = 9), or both (n = 6). Prevention CPGs generally recommend body mass index (BMI) assessment, but specific measurement frequency is often absent. While some provide age-specific dietary recommendations, graphical tools are lacking. Recommendations for increased physical activity and reduced screen time are common, but age-stratified guidance is deficient. Furthermore, recommendations regarding mental health and sleep are notably absent. Treatment CPGs utilize BMI for obesity diagnosis, but inconsistencies in cut-off points persist. Comorbidity assessment is generally recommended, yet age-specific guidance remains lacking. Dietary recommendations are present in most CPGs, but many lack detailed specifications (e.g., meal frequency, portion sizes, macronutrient distribution, age-appropriate examples). Most CPGs advocate for 60 min of daily physical activity and limit screen time to 2 h per day. Recommendations concerning sleep are consistently absent. While parental involvement is acknowledged, specific guidance for active participation in prevention and treatment is deficient. Pharmacological treatment options are frequently outdated, and surgical intervention is reserved for exceptional cases of severe obesity. Conclusions: Standardizing BMI cut-off points and defining age groups across CPGs would improve consistency and comparability in the diagnosis, prevention, and treatment of childhood obesity. Tailoring recommendations for diet, physical activity, sedentary behavior, and sleep to specific age groups would ensure developmentally appropriate interventions. A stronger emphasis on early prevention strategies is needed to address the root causes of obesity. Clear guidance for parents and families would facilitate their active engagement in prevention and treatment. Up-to-date information regarding pharmacological and surgical treatments is imperative.

Background: The worldwide increase in the prevalence of childhood obesity necessitates effective prevention and treatment strategies. Clinical practice guidelines (CPGs) offer guidance, but significant heterogeneity or Lack of practical application exists in their recommendations. The purpose of the present to provide an expert, comprehensive and comparative analysis of gaps in current CPGs for the prevention and treatment of obesity in children and adolescents.Results: A total of 13 CPGs were identified, focusing on childhood obesity prevention (n=10), treatment (n=9), or both (n=6). Prevention CPGs recommend incorporating BMI assessment however, specific frequency of measurement is often lacking. Some offer specific dietary recommendations by age, but graphical tools are absent. Increasing physical activity and minimizing screen time is recommended in most CPGs, but age-specific guidance is lacking. Also, recommendations on mental health or sleep are absent. Treatment CPGs recommend BMI for childhood obesity diagnosis but there are inconsistencies in cut-off points among CPGs. Assessment for comorbidities is generally recommended, but age-specific guidance is lacking. Dietary recommendations are present in most CPGs, but some lack details (number of meals per day, portion size, macronutrient percentages, examples according to age). Most CPGs recommended 60 minutes of physical activity/day and limit screen time to 2 hours/day. Recommendations on sleep are absent. Most CPGs acknowledge parental importance but lack specific guidance for their active involvement in childhood obesity prevention and treatment. Pharmacological treatment options are outdated and surgical treatment is recommended in exceptional cases of severe obesity (BMI ≥ 40 kg/m2 or ≥ 35 kg/m2 with severe comorbid disease). Conclusions: Standardizing BMI cut-off points and defining age groups across CPGs would improve consistency and comparability in the diagnosis, prevention and treatment of childhood obesity. Tailoring recommendations for diet, physical activity, sedentary behavior and sleep to specific age groups would ensure that interventions are developmentally appropriate. A stronger emphasis on early prevention strategies is needed to address the root causes of obesity, while providing clear guidance to parents and families would facilitate their active involvement in both prevention and treatment. Up-to-date information regarding pharmacological and surgical treatments is needed.

Background: The COVID-19 pandemic led to an increase in research activity worldwide. The Vall d’Hebron University Hospital Research Ethics Committee (VH-REC) adapted its procedures to give out the opinion rapidly. We aimed to describe the characteristics of the VH-REC activity and studies evaluated during the first outbreak. Methods: Clinical trials (CT), post-authorization studies (PAS) and research projects (RP) on COVID-19 were included and followed up. Variables were described through usual descriptive methods. Results: 157 studies were evaluated: 10 CT, 16 PAS and 131 RP, in 25 bi-weekly online meetings. Non-commercial, unicentric and national studies predominated (95%, 54% and 88%, respectively). The main objective of CT and PAS studies was to test efficacy and safety, and for RP to describe patients’ outcomes. Some studies focused on specific interest groups, such as healthcare professionals or immunosuppressed patients (10% both). The median time of protocols’ evaluation was 3 days. 58.6% (92) required further clarifications, mainly due to aspects of data protection, informed consent, and biological samples. The final opinion was favourable in 93% (146). Regarding follow-up, 123 studies had been initiated and 64 also finalized. Results have been published in 59% (51) of studies. Conclusions and implications: COVID-19 pandemic has led to greater academic and local research, especially through research projects. Electronic sources were implemented for evaluation shortening and ease follow-up. These measures should remain to streamline VH-REC processes, and trends to publish results favoured. This study could allow comparisons with other activity periods (e.g. pre or post-pandemic), or with other REC’