1H MRS Assessment of Hepatic Fat Content: Comparison Between Normal- and Excess-weight Children and Adolescents

RATIONALE AND OBJECTIVES

The purpose of the present study was to obtain a cutoff value of liver fat content for the diagnosis of hepatic steatosis by comparing magnetic resonance (MR) spectroscopy results in children and adolescents with normal and excess weight.

MATERIALS AND METHODS

The study included 420 children and adolescents (91 normal-weight, 99 overweight, and 230 obese) 8-18 years of age. Proton magnetic resonance spectroscopy was performed with a 3T MR system using point resolved spectroscopy sequence with series echo times.

RESULTS

The mean absolute mass concentration of liver fat was obtained: 0.5 ± 0.04% in normal-weight boys; 0.5 ± 0.03% in normal-weight girls; 0.9 ± 0.16% in boys with overweight; 1.1 ± 0.24% in girls with overweight; 1.7 ± 0.24% in boys with obesity; and 1.4 ± 0.21% in girls with obesity. The cutoff value of absolute mass concentration of liver fat for hepatic steatosis was found to be 1.5%. Based on this cutoff value, hepatic steatosis was diagnosed in 16% of boys with overweight, 11% of girls with overweight, 32% of boys with obesity, and 27% of girls with obesity.

CONCLUSIONS

Proton magnetic resonance spectroscopy was successfully applied to obtain the cutoff value of absolute mass concentration of liver fat for the diagnosis of hepatic steatosis in children and adolescents. Children and adolescents with obesity have higher risk of hepatic steatosis than their peers with overweight.

[Physical exercise is a help for lean women with polycystic ovary syndrome]

Polycystic ovary syndrome (PCOS) affects 12-21% of women in the childbearing age and is the most common cause of hyperandrogenaemia and anovulatory infertility. There is an increase in insulin resistance in both overweight and lean women with PCOS. Exercise treatment is mandatory among the overweight women due to sufficient evidence that it can improve the signs and symptoms of PCOS. This has not been fully investigated among the lean. However, new randomized controlled trials show that structured physical exercise can also improve insulin sensitivity, hyperandrogenaemia and menstrual frequency in lean women with PCOS.

Trend, projection, and appropriate body mass index cut-off point for diabetes and hypertension in Bangladesh

BACKGROUND

Rapid increasing of high body mass index (BMI) is a global health concern. Population with high BMI predicts an increased risk of diabetes and hypertension. The objective of the present study is to estimate the trend and prediction of diabetes and hypertension in Bangladesh, to examine the association of BMI with risk of diabetes and hypertension, and to ascertain an appropriate BMI cut-off point for screening diabetes.

METHODS

We searched PubMed from inception to August 2016 and identified studies reporting diabetes and hypertension prevalence in Bangladesh. Bangladesh Demographic and Health Survey 2011 data was also included in this study. Bayesian model was used to estimate trend and projection in diabetes and hypertension prevalence by sex and residence. Receiver operating characteristic curves was used to determine the optimal BMI cut-off point for screening diabetes.

FINDINGS

Of 535 articles reviewed, 35 studies reported prevalence of diabetes and hypertension. Prevalence of diabetes (95% credible interval) increased between 1992 and 2015 from 3.2% (2.2-4.3) to 12.1% (9.1-15.4) in men, and from 2.5% (1.8-3.5) to 13.4% (9.7-17.6) in women. Diabetes prevalence in 2030 is expected to reach 23.6% (13.6-36.3) for men and 33.5% (19.9-50.9) for women. Hypertension prevalence increased between 1992 and 2015 from 11.0% (8.6-13.7) to 20.4% (18.4-22.4%) in 2015 in men, and from 14.0% (10.3-19.0) to 21.3% (19.0-23.6) in women. Annual average rate of change for diabetes prevalence was higher among women and in rural areas, while for hypertension prevalence it was higher in men and urban areas. Adults with BMI of 22.5kg/m² or above had a higher risk of diabetes and hypertension in this study. The optimal BMI cut-off point for screening diabetes was 23kg/m² for overall population, 22kg/m² for men, and 23kg/m² for women.

INTERPRETATION

Diabetes is more prevalent among women and rural population groups, while hypertension is more prevalent among men and urban population groups in Bangladesh. A BMI of 22.5kg/m² or more is risk factors for developing diabetes and hypertension. Screening for diabetes may be considered for all Bangladeshi adults with a BMI of ⩾23kg/m².

Status report -- Identifying equity-focussed interventions to promote healthy weights

INTRODUCTION

We developed screening criteria to identify population health interventions with an equity focus for inclusion on the Public Health Agency of Canada's Canadian Best Practices Portal. We applied them to the area of "healthy weights," specifically, obesity prevention.

METHODS

We conducted a review of the literature and obtained input from expert external reviewers on changes to midstream environments. Interventions had to identify outcomes for groups with an underlying social disadvantage. We included papers with a focus on equity and vulnerable populations, intervention and/or evaluation studies, social determinants of health and healthy weights or obesity prevention. We then appraised the shortlisted studies for quality of evidence to determine eligibility for inclusion as promising practices on the Canadian Best Practices Portal.

RESULTS

Few of the references reviewed passed the equity screening criteria (26 out of 2823 published papers reviewed, or 0.9%). Six (of the 26) interventions qualified as promising practices.

CONCLUSION

The ability of the equity screening criteria to distinguish midstream-level interventions for obesity prevention suggests that the criteria have potential to be applied to other public health topics. What is most important about our work is that the Portal, which is no longer being updated but is still accessible, was broadened to include interventions with a focus on equity.

Mediating Effect of Body Image Distortion on Weight Loss Efforts in Normal-Weight and Underweight Korean Adolescent Girls

BACKGROUND

We explored the relationship between body mass index-for-age percentile, body image distortion, and unnecessary weight loss efforts in Korean adolescent girls who are underweight and normal weight and examined the mediating effect of body image distortion on weight loss efforts.

METHODS

This study used data from the 2013 Korea Youth Risk Behavior Web-based Survey conducted by the Korea Centers for Disease Control and Prevention. The study sample comprised 29,633 Korean adolescent girls who are normal weight and underweight. Chi-square tests and correlations were used to assess bivariate relationships between the variables. To assess the mediating effect of body image distortion on the relationship between body mass index-for-age percentile and weight loss efforts, a 3-step regression analysis was used.

RESULTS

There was a significant correlation between body mass index-for-age percentiles and body image distortion, and both significantly correlated with weight loss efforts. In addition, a distorted perception of being overweight or obese was a significant mediating variable.

CONCLUSIONS

School-based health education and intervention programs are needed to promote the formation of a positive body image, not only for obese adolescents, but also for normal-weight and underweight adolescent girls.

Mexican mothers' perceptions of their child's body weight

Currently, Mexico holds one of the top rankings in childhood obesity worldwide. This present qualitative study aims to explore and describe mothers' perceptions concerning the body weight of their children and, based on these findings, be able to arrive at a typology. Research included 91 semi-structured interviews administered to mothers of children who were underweight (UW), normal weight (NW), overweight (OW) or obese (OB). The data were collected between June 2011 and December 2013. The information was analysed with MAXQDA qualitative software. It was found that overestimated perception in UW children is observed in mothers who fear gaining weight. Mothers of NW children tend to gauge the weight of their children close to that which is normal. OW children are appropriately perceived by their mothers; however, these mothers are not concerned by this situation because for them, it is something temporary that will disappear as the child grows. The majority of boys who were OB were underestimated in their weight; those who were appropriately perceived showed class II or III obesity. Mothers typically perceived OW and OB girls with greater precision. The mothers who perceived obesity in their sons or daughters felt responsible, which motivated them to change their children's habits and behaviours. Therefore, health professionals should communicate and help these mothers recognise OW and OB status in their children. Furthermore, the importance of prevention should be stressed when a child is OW, and they should be informed of the high health risks that accompany obesity.

Nutritional value of daily food rations of overweight and normal weight pregnant women

BACKGROUND

Adequate nutrition and nutritional status during pregnancy are essential for mother’s health and foetus development. Due to increased demands, pregnant women are vulnerable to inadequate nutritional status and paradoxically it may also affect overweight women

OBJECTIVE

The aim of the study was to evaluate energy and nutrients intake in the group of pregnant women in relation to nutritional standards and pre-pregnancy BMI

MATERIAL AND METHODS

The study included 90 women, during the third trimester of pregnancy, recruited from Warsaw antenatal classes. The anthropometric data gathered in the research were used to calculate BMI value before pregnancy. Pre-pregnancy BMI was categorised as: normal weight (BMI=18.5-24.9 kg/m2, n=47) and overweight (BMI ≥25.0 kg/m2, n=43). The assessment of women’s nutrition was based on 3-days dietary record. Due to heterogeneous variances, differences between groups were assessed using Mann Whitney U test, p<0.05 was considered as significant

RESULTS

The mean intake of energy, protein, fat and carbohydrates in the overweight women were significantly higher than in healthy weight women (p<0.05). Most of the healthy weight women did not reach EAR standard for vitamin D (79.5%), whereas in overweight group it was 41.3%

CONCLUSIONS

Despite the fact that intakes of energy and all nutrients were higher in overweight women than in normal weight ones, we observed that women in both groups had risk of insufficient supply of energy, iodine, potassium and vitamin D. For this reason, accurate nutritional assessment should be an integral part of obstetric care

Associations between adult perception of body weight, diet, preparing meals and dietary patterns

BACKGROUND

The links between dietary patterns, the perception of one’s body weight and diet as well preparing meals are poorly recognised in the literature. In order to develop effective nutritional education and focused interventions, more of such information is thereby required to improve the nation’s health

OBJECTIVE

To identify dietary patterns based on declared food consumption rates and subject responses on whether dieting, perception of body weight and diet and preparing meals are linked to such dietary patterns

MATERIAL AND METHODS

The survey was conducted in 2016 on 344 consumers chosen for age (20-65 years) and their consent for study participation. Rates of eating the foods selected were measured using a 7-point scale. Cluster analysis was used to identify three dietary patterns of behaviour: ‘potentially beneficial to health’, ‘potentially unfavourable for health; deficient’ and ‘potentially unfavourable for health; excessive’. The analysis was performed using IBM SPSS Statistics version 23.0

RESULTS

There were significantly more subjects showing ‘potentially beneficial for health’ behaviour, normal body weight, those dieting (whether now or in the past) and those who evaluated their diet as being very good or good compared to other groups. They were also more involved in preparing their meals at home. Differences were found between the ‘unfavourable for health’ dietary patterns concerning subject’s involvement in meal preparation. The dietary pattern for ‘deficient’ behaviour found lower rates of those preparing their meals at home

CONCLUSIONS

The pattern of potentially beneficial dietary habits was linked to weight control through a slimming diet and greater involvement in the preparation of food for consumption. The results show the need to develop food choice skills rather than just transferring knowledge in the nutrition education process

Longitudinal changes in the dietary inflammatory index: an assessment of the inflammatory potential of diet over time in postmenopausal women

BACKGROUND/OBJECTIVES

The dietary inflammatory index (DII) measured at one time point is associated with risk of several chronic diseases, but disease risk may change with longitudinal changes in DII scores. Data are lacking regarding changes in DII scores over time; therefore, we assessed changes in the DII in the Women's Health Initiative (WHI).

SUBJECTS/METHODS

DII scores were calculated using data from repeated food frequency questionnaires in the WHI Observational Study (OS; n=76 671) at baseline and year 3, and the WHI Dietary Modification trial (DM; n=48482) at three time points. Lower DII scores represent more anti-inflammatory diets. We used generalized estimating equations to compare mean changes in DII over time, adjusting for multiple comparisons, and multivariable-adjusted linear regression analyses to determine predictors of DII change.

RESULTS

In the OS, mean DII decreased modestly from -1.14 at baseline to -1.50 at year 3. In the DM, DII was -1.32 in year 1, -1.60 in year 3 and -1.48 in year 6 in the intervention arm and was -0.65 in year 1, -0.94 in year 3 and -0.96 in year 6 in the control arm. These changes were modified by body mass index, education and race/ethnicity. A prediction model explained 22% of the variance in the change in DII scores in the OS.

CONCLUSIONS

In this prospective investigation of postmenopausal women, reported dietary inflammatory potential decreased modestly over time. Largest reductions were observed in normal-weight, highly educated women. Future research is warranted to examine whether reductions in DII are associated with decreased chronic disease risk.

[All the bodies of anorexia]

Anorexia is an active struggle against hunger. In this fight, the body is a real battlefield where the therapies used aim to re-establish peace. Hence the importance of an integrative 'body to body' approach between patient and caregiver.

Objective and Perceived Weight: Associations with Risky Adolescent Sexual Behavior

CONTEXT

Studies have shown that obesity is associated with increased sexual risk-taking, particularly among adolescent females, but the relationships between obesity, perceived weight and sexual risk behaviors are poorly understood.

METHODS

Integrative data analysis was performed that combined baseline data from the 1994-1995 National Longitudinal Study of Adolescent Health (from 17,606 respondents in grades 7-12) and the 1997 National Longitudinal Survey of Youth (from 7,752 respondents aged 12-16). Using six sexual behaviors measured in both data sets (age at first intercourse, various measures of contraceptive use and number of partners), cluster analysis was conducted that identified five distinct behavior clusters. Multivariate ordinal logistic regression analysis examined associations between adolescents' weight status (categorized as underweight, normal-weight, overweight or obese) and weight perception and their cluster membership.

RESULTS

Among males, being underweight, rather than normal-weight, was negatively associated with membership in increasingly risky clusters (odds ratio, 0.5), as was the perception of being overweight, as opposed to about the right weight (0.8). However, being overweight was positively associated with males' membership in increasingly risky clusters (1.3). Among females, being obese, rather than normal-weight, was negatively correlated with membership in increasingly risky clusters (0.8), while the perception of being overweight was positively correlated with such membership (1.1).

CONCLUSIONS

Both objective and subjective assessments of weight are associated with the clustering of risky sexual behaviors among adolescents, and these behavioral patterns differ by gender.

Parental response to a letter reporting child overweight measured as part of a routine national programme in England: results from interviews with parents

BACKGROUND

Rising rates of childhood obesity have become a pressing issue in public health, threatening both the mental and physical well-being of children. Attempts to address this problem are multifaceted, and in England include the National Child Measurement Programme (NCMP) which assesses weight status in English primary school children in reception class (aged 4-5) and in year 6 (aged 10-11), with results being sent out to parents. However the effectiveness and impact of this routine parental feedback has yet to be fully understood. This paper reports one component of a mixed methods study undertaken in North East England, examining the impact of the feedback letters on parents' understanding and feelings about their child's weight status and whether or not this seemed likely to lead to behaviour change.

METHODS

One-to-one semi-structured interviews (n = 16) were conducted with a sample of parents/guardians after they had received their child's weight results letter. Eight parents/guardians were sub-sampled from the group whose child had been indicated to be overweight or obese and eight were from the group whose child had been indicated to be of ideal weight status. Interviews were conducted until data saturation was reached for both groups.

RESULTS

The reactions of parents/guardians whose children were identified as being overweight followed a sequence of behaviours ranging from shock, disgust with the programme, through denial and self-blame to acceptance, worry and intention to seek help. On the other hand, the reaction of parents/guardians whose children were identified as being ideal weight ranged from relief, pleasure and happiness through affirmation and self-congratulation to 'othering'.

CONCLUSIONS

Whilst overweight and obesity is often portrayed as a medical condition, parents/guardians see it as deeply rooted in their social lives and not in health terms. Parents believe that the causes of overeating and lack of exercise relate closely to the obesogenic environment, particularly the complex social and cultural milieu and time pressures within which this sample of people live. Associating this problem in feedback letters with dangerous diseases like cancer, and advising parents to visit GPs to resolve child weight issues was perceived as inappropriate by the parents, and caused controversy and anger. Given the likelihood that the NCMP will continue as a monitoring device, it is evident that the management of the process needs to be reviewed, with particular attention being paid to the feedback process. Local health authorities will need to manage parental expectations and ensure linkage with appropriately commissioned remedial weight management interventions.

Pre-pregnancy obesity and non-adherence to multivitamin use: findings from the National Pregnancy Risk Assessment Monitoring System (2009-2011)

BACKGROUND

Although adequate folic acid or multivitamins can prevent up to 70 % of neural tube defects, the majority of U.S. non-pregnant women of childbearing age do not use multivitamins every day. Factors influencing consistent multivitamin use are not fully explored. This study aims to investigate the association between pre-pregnancy body mass index (BMI) and multivitamin use before pregnancy using a large, nationally representative sample of women with recent live births.

METHODS

The national 2009-2011 Pregnancy Risk Assessment Monitoring System data were analyzed. The sample included women with recent singleton live births (N = 104,211). The outcome of interest was multivitamin use which was categorized as no multivitamin use, 1-3 times/week, 4-6 times/week, and daily use. Maternal BMI was examined as underweight (<18.50 kg/m(2)), normal weight (18.50-24.99 kg/m(2)), overweight (25.00-29.99 kg/m(2)), and obese (≥30.00 kg/m(2)). Multinomial logistic regression was conducted, and adjusted odds ratios and 95 % confidence intervals were calculated.

RESULTS

Compared to women with normal weight, overweight and obese women had significantly increased odds of not taking multivitamins after adjusting for confounding factors. Further, the lack of multivitamin use increased in magnitude with the level of BMI (ORoverweight = 1.2, 95 % CI = 1.1-1.3; ORobese = 1.4, 95 % CI = 1.2-1.5).

CONCLUSIONS

Obese and overweight women were less likely to follow the recommendation for preconception multivitamin use compared to normal weight women. All health care professionals must enhance preconception care with particular attention to overweight and obese women. Preconception counseling may be an opportunity to discuss healthy eating and benefits of daily multivitamin intake before pregnancy.

Increasing compliance with low tidal volume ventilation in the ICU with two nudge-based interventions: evaluation through intervention time-series analyses

OBJECTIVES

Low tidal volume (TVe) ventilation improves outcomes for ventilated patients, and the majority of clinicians state they implement it. Unfortunately, most patients never receive low TVes. 'Nudges' influence decision-making with subtle cognitive mechanisms and are effective in many contexts. There have been few studies examining their impact on clinical decision-making. We investigated the impact of 2 interventions designed using principles from behavioural science on the deployment of low TVe ventilation in the intensive care unit (ICU).

SETTING

University Hospitals Bristol, a tertiary, mixed medical and surgical ICU with 20 beds, admitting over 1300 patients per year.

PARTICIPANTS

Data were collected from 2144 consecutive patients receiving controlled mechanical ventilation for more than 1 hour between October 2010 and September 2014. Patients on controlled mechanical ventilation for more than 20 hours were included in the final analysis.

INTERVENTIONS

(1) Default ventilator settings were adjusted to comply with low TVe targets from the initiation of ventilation unless actively changed by a clinician. (2) A large dashboard was deployed displaying TVes in the format mL/kg ideal body weight (IBW) with alerts when TVes were excessive.

PRIMARY OUTCOME MEASURE

TVe in mL/kg IBW.

FINDINGS

TVe was significantly lower in the defaults group. In the dashboard intervention, TVe fell more quickly and by a greater amount after a TVe of 8 mL/kg IBW was breached when compared with controls. This effect improved in each subsequent year for 3 years.

CONCLUSIONS

This study has demonstrated that adjustment of default ventilator settings and a dashboard with alerts for excessive TVe can significantly influence clinical decision-making. This offers a promising strategy to improve compliance with low TVe ventilation, and suggests that using insights from behavioural science has potential to improve the translation of evidence into practice.

Roux-en-Y gastric bypass 10-year follow-up: the found population

BACKGROUND

The long-term durability of Roux-en-Y gastric bypass (RYGB) remains ill-defined in the American population secondary to poor follow-up after bariatric surgery.

OBJECTIVES

This study evaluated the population lost to follow-up to better define the long-term durability of RYGB for weight loss and co-morbidity amelioration.

METHODS

All patients (n = 1087) undergoing RYGB at a single institution between 1985 and 2004 were evaluated. Univariate differences in preoperative co-morbidities, postoperative complications, annual weight loss, and 10-year co-morbidities were analyzed to compare outcomes between patients with routine follow-up and those without. Using electronic medical record review for all encounters at our academic medical center and telephone survey, we obtained data for patients lost to follow-up.

RESULTS

Among 1087 RYGB patients, 151 (14%) had consistent 10-year follow-up in our prospectively collected database, with yearly clinic visits beyond 2 years postoperatively. Electronic medical record review and telephone survey data were collected on an additional 500 (46%) patients, resulting in 60% of patients having 10-year follow-up after RYGB. There was no statistical difference in any preoperative or postoperative variables between the 2 groups. We found no difference in co-morbidity prevalence preoperatively or at 10 years between groups. Examination of percent excess body mass index lost at yearly intervals revealed no difference between the groups at each interval up to 10 years (P = .36).

CONCLUSION

We found no difference in 10-year outcomes, including weight loss and co-morbidity reduction, between patients with routine clinic visits and those lost to follow-up. These 10-year data address the gap in knowledge resulting from poor long-term follow-up after bariatric surgery.

The fat-but-fit paradigm and all-cause mortality among coronary artery disease patients

BACKGROUND

Limited research has examined the fat-but-fit paradigm among coronary artery disease patients.

OBJECTIVES

The objective of this study was to evaluate the fat-but-fit paradigm as it relates to mortality risk among patients with coronary artery disease.

METHODS

A total of 766 coronary artery disease patients (Mage = 65.4 years) were evaluated. Physical activity was assessed via self-report, with weight status determined from measured body mass index. Six mutually exclusive groups were evaluated, including (i) Normal Weight and Inactive (referent), (ii) Overweight and Inactive, (iii) Obese and Inactive, (iv) Normal Weight and Active, (v) Overweight and Active and (vi) Obese and Active.

RESULTS

A total of 301 died over the follow-up period, with the duration of the unweighted median follow-up period being 86 months (IQR: 62-113). The Cox proportional hazard results, after adjusting for age, gender, and race-ethnicity, were as follows: Group 2: HRadjusted = 0.95, 95% CI: 0.57-1.60, p = 0.87; Group 3: HRadjusted = 0.91, 95% CI: 0.57-1.44, p = 0.68; Group 4: HRadjusted = 0.35, 95% CI: 0.14-0.86, p = 0.02; Group 5: HRadjusted = 0.51, 95% CI: 0.28-0.93, p = 0.02; Group 6: HRadjusted = 0.43, 95% CI: 0.21-0.85, p = 0.01.

CONCLUSION

These findings provide support for the fat-but-fit paradigm applied to CAD patients. Ultimately, these findings underscore the importance of promoting physical activity to all weight groups of CAD patients.

Universal equation for estimating ideal body weight and body weight at any BMI

BACKGROUND

Ideal body weight (IBW) equations and body mass index (BMI) ranges have both been used to delineate healthy or normal weight ranges, although these 2 different approaches are at odds with each other. In particular, past IBW equations are misaligned with BMI values, and unlike BMI, the equations have failed to recognize that there is a range of ideal or target body weights.

OBJECTIVE

For the first time, to our knowledge, we merged the concepts of a linear IBW equation and of defining target body weights in terms of BMI.

DESIGN

With the use of calculus and approximations, we derived an easy-to-use linear equation that clinicians can use to calculate both IBW and body weight at any target BMI value. We measured the empirical accuracy of the equation with the use of NHANES data and performed a comparative analysis with past IBW equations.

RESULTS

Our linear equation allowed us to calculate body weights for any BMI and height with a mean empirical accuracy of 0.5-0.7% on the basis of NHANES data. Moreover, we showed that our body weight equation directly aligns with BMI values for both men and women, which avoids the overestimation and underestimation problems at the upper and lower ends of the height spectrum that have plagued past IBW equations.

CONCLUSIONS

Our linear equation increases the sophistication of IBW equations by replacing them with a single universal equation that calculates both IBW and body weight at any target BMI and height. Therefore, our equation is compatible with BMI and can be applied with the use of mental math or a calculator without the need for an app, which makes it a useful tool for both health practitioners and the general public.

Objectively measured physical activity levels and sedentary time in 7-9-year-old Estonian schoolchildren: independent associations with body composition parameters

BACKGROUND

Sufficient daily physical activity (PA) is necessary for physical, social and mental health benefits during growth. Most of the available data on children is based on subjective reports, while only limited data on objective PA and sedentary levels is available for primary school children. Increased PA is also an important health indicator of body composition parameters, especially body adiposity indices. The aim of the present study was to determine objectively the amount of daily PA levels at different intensities and sedentary time in normal-weight (NW) and overweight (OW) 7-9-year-old boys and girls, and to find associations between objectively measured PA levels and sedentary time with different body composition values.

METHODS

Two hundred and seventy eight (142 boys and 136 girls) primary school children aged 7.9 ± 0.7 years participated in this study. Objective PA intensity and sedentary levels were measured over 7 days by accelerometry. Indices of total fat mass (body fat %, sum of skinfolds), fat distribution (waist-to-height ratio) and muscular component (fat free mass [FFM]) were calculated from measured anthropometric parameters.

RESULTS

There were no differences (p > 0.05) in PA intensity levels and sedentary time between boys and girls as well as between NW and OW children. About 11 % of children met the current guidelines of at least 60 min per day of moderate-to-vigorous PA (MVPA). Sedentary time was positively and negatively associated (p < 0.05) with all body fat and FFM values, respectively. Moderate and vigorous PA along with MVPA were negatively and positively associated (p < 0.05) with all body fat and FFM indices, respectively.

CONCLUSIONS

The results of present study showed that about 11 % of primary school children were engaged in PA of at least 60 min of MVPA daily. While MVPA is negatively associated with fat mass indices and positively associated with FFM regardless of different confounders, sedentary time is negatively related to FFM and positively with fat mass values after adjusting for several confounders. These results suggest that higher MVPA level and lower sedentary time level are important in maintaining and developing healthy body composition in primary school children during growth.

Ideals versus reality: Are weight ideals associated with weight change in the population?

OBJECTIVE

To quantify weight ideals of young adults and to examine whether the discrepancy between actual and ideal weight is associated with 10-year body mass index (BMI) change in the population.

METHODS

This study comprised 4,964 adults from the prospective population-based FinnTwin16 study. They reported their actual and ideal body weight at age 24 (range 22-27) and 10 years later (attrition 24.6%). The correlates of discrepancy between actual and ideal body weight and the impact on subsequent BMI change were examined.

RESULTS

The discrepancy between actual and ideal weight at 24 years was on average 3.9 kg (1.4 kg/m(2) ) among women and 1.2 kg (0.4 kg/m(2) ) among men. On average, participants gained weight during follow-up irrespective of baseline ideal weight: women ¯x = +4.8 kg (1.7 kg/m(2) , 95% CI 1.6-1.9 kg/m(2) ), men ¯x = +6.3 kg (2.0 kg/m(2) , 95% CI 1.8-2.1 kg/m(2) ). Weight ideals at 24 years were not correlated with 10-year weight change. At 34 years, just 13.2% of women and 18.9% of men were at or below the weight they had specified as their ideal weight at 24 years. Women and men adjusted their ideal weight upward over time.

CONCLUSIONS

Irrespective of ideal weight at baseline, weight gain was nearly universal. Weight ideals were shifted upward over time.

Harris-Benedict Equation and Resting Energy Expenditure Estimates in Critically Ill Ventilator Patients

BACKGROUND

In routine practice, assessment of the nutritional status of critically ill patients still relies on traditional methods such as anthropometric measurements, biochemical markers, and predictive equations.

OBJECTIVE

To compare resting energy expenditure measured by indirect calorimetry (REEIC) with REE calculated by using the Harris-Benedict equation with 3 different sources of body weight (from bed scale, REEHB1; ideal body weight, REEHB2; and predicted body weight, REEHB3).

METHODS

This study included 205 critically ill patients (115 men, 90 women) evaluated within the first 48 hours of admission and undergoing mechanical ventilation. REE was measured by indirect calorimetry for 30 minutes and calculated by using the Harris-Benedict equation with the 3 sources of body weight. Data were compared by the Bland-Altman method.

RESULTS

The values based on ideal and predicted body weight (REEHB2 and REEHB3) did not agree with REEIC. Bland-Altman analysis showed that the limits of agreement varied from +796.1 kcal/d to -559.6 kcal/d for REEHB2 and from +809.2 kcal/d to -564.7 kcal/d for REEHB3. REEIC and REEHB1 (body weight determined by bed scale) agreed the best; the bias was -18.8 kcal/d. However, REEHB1 still overestimated REEIC by +555.3 kcal/d and underestimated it by -593.0 kcal/d.

CONCLUSION

For measuring REE in critically ill patients undergoing mechanical ventilation, calculation via the Harris-Benedict equation, regardless of the source of body weight, cannot be substituted for indirect calorimetry.

Body Dissatisfaction in Individuals with Obesity Compared to Normal-Weight Individuals: A Systematic Review and Meta-Analysis

BACKGROUND

Body dissatisfaction has been identified as a psychological correlate of obesity that is related to disordered eating, poor self-esteem, and depression. However, not all individuals with obesity are equally vulnerable to these correlates, and 'normative discontent' is present in individuals with normal weight, too. In this light, the complex relationship of body image and individual weight status seems like a worthwhile direction of research inquiry. As such, this review aims to systematically explore the degree of body dissatisfaction in individuals with obesity compared to normal-weight individuals.

METHODS

A systematic literature search was conducted. All quantitative studies of adult samples reporting results regarding differences in body dissatisfaction between individuals with normal weight and obesity were included.

RESULTS

17 articles were found. Across studies, individuals with obesity reported higher body dissatisfaction than normal-weight individuals (questionnaires: d = 0.89, 95% CI = 0.63-1.16, p < 0.001; silhouette scales: d = 1.41, 95% CI = 0.57-2.25, p < 0.001). Meta-regression revealed a significant association of female gender and higher body dissatisfaction (b = 0.60, p = 0.007).

CONCLUSION

The findings underline the severity of body dissatisfaction among individuals with obesity and especially among women. Future research recommendations are discussed.

Risk of diabetes in combined metabolic abnormalities and body mass index categories

AIM

The present study was designed to estimate the progression rates from combination of normal weight, overweight, obesity, and number of metabolic abnormalities (MA) to type 2 diabetes (T2D) in a non-diabetic high risk population in Isfahan, Iran.

METHODS

A total of 1869 non-diabetic first-degree relatives (FDR) of patients with T2D 30-70 years old were examined and followed for a mean (SD) of 7.3 (2.2) years for T2D incidence. At baseline and through follow-up, participants underwent a standard 75-g 2-h oral glucose tolerance test.

RESULTS

The metabolically healthy overweight and obese at baseline were associated with incidence of T2D, independently of age and gender. Any one MA increased the risk of developing T2D among normal weight, overweight and obese individuals. Those with normal weight and ≥3 MA were over 20 times (odds ratios (OR) 20.21; 95% confidence intervals (CI) 2.4, 170.4) and those with overweight and ≥3 MA 22.5 times (OR 22.5; 95% CI 3.0, 167.0) and obese with ≥3 MA were 25.4 times (OR 25.4; 95% CI 3.4, 187) more likely to develop T2D than those with normal weight and without MA. Compared with participants without MA, obese individuals with concomitant MA were not significantly more likely to progress to T2D.

CONCLUSION

Our data provide further evidence that normal weight, overweight and obese individuals with MA had a higher risk of incident T2D than normal weight individuals without MA.

Association of circulating adipokines with metabolic dyslipidemia in obese versus non-obese individuals

AIM

Previous studies have shown that circulating adipokines may play an important role in the pathogenesis of some obesity related chronic disease such as dyslipidemia and type2 diabetes mellitus. The aim of the present study was to investigate the association between vaspin, omentin-1 and retinol binding protein-4 levels with metabolic dyslipidemia (MD) criteria in obese and non-obese individuals.

METHOD

The study was conducted on 170 obese and 81 non-obese individuals. After collecting the blood samples, serum levels metabolic parameters as well as three circulating adipokines and body composition were measured.

RESULTS

No significant difference was noted regarding the mean serum levels of omentin-1 and vaspin between the obese and non-obese groups, while, serum level of RBP4 was significantly higher in the non-obese group. We found the 0.22 increased risk of MD in obese individuals with higher RBP4 concentration. After the adjustment for confounding factors, this association was still significant. No significant association was noted between MD and its components relative risks with omentin-1 and vaspin levels.

CONCLUSION

Our study demonstrated that circulating RBP4 was significantly higher in the obese individuals which may increase the risk of MD in them. Further researches are needed to address this association.

Upper-normal waist circumference is a risk marker for metabolic syndrome in normal-weight subjects

BACKGROUND AND AIMS

To elucidate implication of upper-normal waist circumference (WC), we examined whether the normal range of WC still represents a risk of metabolic syndrome (MetS) or non-adipose MetS components among normal-weight subjects.

METHODS AND RESULTS

A total of 173,510 persons (100,386 men and 73,124 women) with normal WC (<90/80 cm in men/women) and body mass index (BMI) of 18.5-24.9 were included. Subjects were categorized as having low, moderate, and upper-normal WC for those with WC < 80, 80-84, and 85-89 cm in men and <70, 70-74, and 75-79 cm in women, respectively. The prevalence of all the non-adipose MetS components (e.g. prediabetes and borderline dyslipidemia) was significantly higher in subjects with upper-normal WC on comparison with those with low WC. Overall, the prevalence of MetS (having three or more of four non-adipose MetS components) gradually increased with increasing WC (12%, 21%, and 27% in men and 11%, 14%, and 19% in women for low, moderate, and upper-normal WC, respectively). Moreover, the risk of having a greater number of MetS components increased in subjects with upper-normal WC compared with those with low WC (odds ratios for the number of one, two, three, and four MetS components: 1.29, 1.81, 2.53, and 2.47 in men and 1.16, 1.55, 1.49, and 2.20 in women, respectively).

CONCLUSION

Upper-normal WC represents a risk for acquiring a greater number of MetS components and the early stage of MetS components (prediabetes and borderline dyslipidemia), after adjusting for BMI, in a large general population with normal WC and BMI.