Aims: Trials of the Glucagon‐like Peptide‐1 Receptor Agonists (GLP1RAs) found mean weight losses of 15%–21%, yet realworld dose titration and persistence remain suboptimal, limiting effectiveness. This study aims to determine real‐world titration, persistence and effectiveness of GLP1RAs in patients managed within a multidisciplinary obesity clinic. Materials and Methods: This is a singlecentre, retrospective cohort study of patients seen in a multidisciplinary obesity clinic at an academic medical centre from January 2022 to December 2024. Consecutive patients aged 18–75 years enrolled in a ‘no cost to patient’ Medical Weight Loss Bundle program who received ≥1 prescription fill of semaglutide or tirzepatide. Of 2855 enrollees, 2306 (81%) received at least one GLP1RA prescription. The primary outcome was persistence with GLP1RA therapy (continuous prescription fills without a gap ≥84 days). Secondary measures included titration adherence and percentage change in body weight. Results: Among 2306 patients (median age 46.0 years, Interquartile Ratio [IQR] 38.0–55.0; 85% female; 68% White, 28% Black, 4% Hispanic), with median persistence 10.7 months (IQR 5.4–16.3). Semaglutide was used by 1614 (70%), tirzepatide by 117 (5%), and both agents by 575 (25%). Of semaglutide users, 81% escalated to ≥1 mg and 23% to 2.4 mg; of tirzepatide users, 75% received ≥10 mg and 28% received 15 mg. Among patients persistent for ≥6 months, median weight loss was 9.4% (IQR 6.0%–13.4%); for those persistent for ≥12 months, median weight loss was 14.4% (IQR 9.5%–20.5%). Conclusions: GLP1RA persistence and dosetitration adherence were moderate but weight loss approximated that seen in clinical trials, supporting real‐world effectiveness.

INTRODUCTION: This is the first randomized controlled diet intervention trial to investigate both the amount and type of carbohydrate on symptomatic gastroesophageal reflux disease (GERD). METHODS: Ninety-eight veterans with symptomatic GERD were randomly assigned to high total/high simple, high total/low simple, low total/high simple, or low total/low simple carbohydrate diet for 9 weeks. The primary outcomes were esophageal acid exposure time (AET) and total number of reflux episodes derived from 24-hour ambulatory pH monitoring. Secondary outcomes were esophageal reflux symptoms rated using the Gastroesophageal Reflux Disease Questionnaire (GERDQ) and GERD Symptom Assessment Scale (GSAS). RESULTS: Half of the subjects were White and half African American (mean age, 60.0 ± 12.5 years; mean body mass index, 32.7 ± 5.4 kg/m²). There was a significant main effect of diet treatment on AET (P = 0.001) and on the total number of reflux episodes (P = 0.003). The change in AET in the high total/low simple group (−4.3% ± 3.8%) differed significantly from the high total/high simple control group (+3.1% ± 3.7%), (P = 0.04). The reduction in simple sugar intake averaged 62 g less per day. Subjects' ratings of symptoms improved in all carbohydrate modification groups, including significant reductions in heartburn frequency, heartburn severity, acid taste in the mouth, lump/pain in the throat or chest, and sleep disturbance. DISCUSSION: A modification of dietary carbohydrate intake that targeted a substantial reduction in the intakes of simple sugars improved pH monitoring outcomes and symptoms of GERD that profoundly affect daily life. These findings provide a feasible and clinically applicable contribution to the limited objective data existing for efficacious dietary recommendations in the routine treatment and management of GERD.

Background: Calorie-dense diet is a main driver of the global epidemics of obesity and type 2 diabetes (T2DM). While various dietary strategies and patterns are efficacious in reducing risk and improving glycemic control, dietary intake and diet quality have been inadequately studied among individuals who remain living in their native environments. There is also little published on dietary patterns of diverse ethnic, cultural, or regional populations. Objective: To explore dietary intakes, patterns and overall diet quality in adults with obesity and T2DM from diverse countries. We hypothesized that individuals sharing a common clinical phenotype (age, BMI, years since T2DM diagnosis and inadequate glycemic control) would demonstrate comparable high calorie “western” dietary patterns and low diet quality despite differences in geographic regions and cultures. Design: Diet data were acquired from 611 adults in Argentina, Germany, Poland, Serbia, Slovakia, Slovenia, Spain, Turkey and the USA via three 24-h diet recalls. Contribution of 168 foods to 14 primary food groups was confirmed by Spearman’s rank-order correlations and Principle Component Factor Analysis identified dietary patterns. Diet quality was assessed using the Healthy Eating Index 2015. Results: Eleven dietary patterns were extracted; the most common were a “Mediterranean-like” pattern shared by six countries and a “Calorie Dense” pattern shared by five countries. Also common were “Lacto-Vegetarian, “Pesco-Vegetarian,” and “Vegan” patterns. Only 2.1% of subjects had good diet quality (HEI-2015 score >80). Conclusions: The diet pattern data suggest that influences of more traditional region-specific diets remain. However, overall diet quality was poor and may contribute to inadequate glycemic control, possibly due to excess intake of high calorie/nutrient poor foods, which may be associated with global transitions occurring in the available food supply.

Sarcopenia has significant burden in cirrhosis and has been shown to worsen short-term post-liver transplantation (LT). This study aims to evaluate the long-term change in sarcopenia post-LT along with its associations and predictors. A retrospective study of adult patients who underwent LT at a tertiary centre between 1/1/2009 and 12/31/2018. Relevant demographic and clinical data were collected. Skeletal muscle index (SMI) was calculated using standard of care computerised tomography (CT) scans pre- and post-LT. Sarcopenia was defined using previously established cut-points. The primary outcome was SMI change post-LT and secondary outcome was post-LT mortality. Out of 1165 patients, 401 met inclusion criteria (1,205 CT scans reviewed). The average age at transplant was 57 years; 63% were male. The average BMI was 28 kg/m². Thirteen percent of females and 32% of males had sarcopenia pre-LT. Post-LT SMI declined by 4.7 cm²/m² in the first year then by 0.39 cm²/m² per year thereafter. Females had greater rate of decline in SMI after the first year compared with males (0.87 cm²/m² per year vs. 0.17 cm²/m² per year, respectively, p = 0.02). Post-LT physical rehabilitation, infection, and readmissions were not associated with SMI trajectory. At 3 years post-LT, 31% of females and 48% of males had sarcopenia. Baseline sarcopenia was the only predictor of long-term post-LT sarcopenia on multivariable analysis, but it was not associated with mortality. Sarcopenia does not appear to resolve post-LT and likely worsens leading to nearly doubling its prevalence in those with long-term follow-up. Immediate post-LT physical rehabilitation was not associated with SMI trajectory in our cohort. The prevalence of sarcopenia is high among patients with cirrhosis; however, data are mixed on the impact of sarcopenia on post-liver transplant (LT) course and there have been no studies evaluating the long-term evolution of sarcopenia post-LT beyond 1 year. In this study, we analysed changes in muscle mass up to 3 years after transplant in 401 patients and found that sarcopenia did not resolve in most liver transplant recipients and skeletal muscle mass tended to worsen after transplant with the greatest decline in muscle mass in the first year post-LT. Interestingly, sarcopenia did not influence post-transplant outcomes. Future prospective studies are needed to further understand the natural course of sarcopenia post-LT to guide interventions aiming at reversing post-LT sarcopenia.