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Katsoulis M, Lai AG, Kipourou DK, Gomes M, Banerjee A, Denaxas S, Lumbers RT, Tsilidis K, Kostara M, Belot A, Dale C, Sofat R, Leyrat C, Hemingway H, Diaz-Ordaz K. On the estimation of the effect of weight change on a health outcome using observational data, by utilising the target trial emulation framework. Int J Obes (Lond) 2023; 47:1309-1317. [PMID: 37884665 PMCID: PMC10663146 DOI: 10.1038/s41366-023-01396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND/OBJECTIVES When studying the effect of weight change between two time points on a health outcome using observational data, two main problems arise initially (i) 'when is time zero?' and (ii) 'which confounders should we account for?' From the baseline date or the 1st follow-up (when the weight change can be measured)? Different methods have been previously used in the literature that carry different sources of bias and hence produce different results. METHODS We utilised the target trial emulation framework and considered weight change as a hypothetical intervention. First, we used a simplified example from a hypothetical randomised trial where no modelling is required. Then we simulated data from an observational study where modelling is needed. We demonstrate the problems of each of these methods and suggest a strategy. INTERVENTIONS weight loss/gain vs maintenance. RESULTS The recommended method defines time-zero at enrolment, but adjustment for confounders (or exclusion of individuals based on levels of confounders) should be performed both at enrolment and the 1st follow-up. CONCLUSIONS The implementation of our suggested method [adjusting for (or excluding based on) confounders measured both at baseline and the 1st follow-up] can help researchers attenuate bias by avoiding some common pitfalls. Other methods that have been widely used in the past to estimate the effect of weight change on a health outcome are more biased. However, two issues remain (i) the exposure is not well-defined as there are different ways of changing weight (however we tried to reduce this problem by excluding individuals who develop a chronic disease); and (ii) immortal time bias, which may be small if the time to first follow up is short.
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Affiliation(s)
- M Katsoulis
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK.
| | - A G Lai
- Institute of Health Informatics, University College London, London, UK
| | - D K Kipourou
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- AstraZeneca, London, UK
| | - M Gomes
- Department of Applied Health Research, University College London, London, UK
| | - A Banerjee
- Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - S Denaxas
- Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
| | - R T Lumbers
- Institute of Health Informatics, University College London, London, UK
| | - K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Maria Kostara
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - A Belot
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - C Dale
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - R Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - C Leyrat
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - H Hemingway
- Institute of Health Informatics, University College London, London, UK
| | - K Diaz-Ordaz
- Dept of Statistical Science, Faculty of Maths & Physical Sciences, University College London, London, UK
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Tian J, Blizzard L, Campbell JA, Gall S, Dwyer T, Venn A. Association of body mass index from childhood to mid-adulthood with health-related quality of life in mid-adulthood. Qual Life Res 2023; 32:3349-3358. [PMID: 37668925 PMCID: PMC10624736 DOI: 10.1007/s11136-023-03497-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Most studies regarding the association of obesity with health-related quality of life (HRQoL) have assessed obesity at only one or two time points. We aimed to examine the associations of life course body mass index (BMI) from childhood with health-related quality of life (HRQoL) in mid-adulthood. METHODS Data were from a cohort study of Australian children (n = 2254, mean baseline age 12.0 (2.0) years in 1985, 46.8% male). Weight and height were measured at baseline and measured or self-reported on average 20, 25, and 30 years later. Age and sex-standardised BMI-z score was calculated at each time point. Physical and mental HRQoL and health state utilities (HSUs) were measured by SF-12 and SF-6D at the last adult follow-up. Linear regression was used to examine the associations adjusting for age, sex, and childhood health status. RESULTS Higher BMI-z score in childhood (βadjusted - 1.39, 95% CI - 1.73 to - 1.05) and increasing BMI-z score from childhood to young adulthood (βadjusted - 1.82, 95% CI - 2.17 to - 1.46) and from young to mid-adulthood (βadjusted - 1.77, 95% CI - 2.28 to - 1.26) were associated with lower physical HRQoL in mid-adulthood. Similar results were found for mid-adulthood HSUs (βadjusted ranged - 0.006 to - 0.014, all P < 0.05). Only increasing BMI-z score from young to mid-adulthood significantly related to poorer mental HRQoL (βadjusted - 0.74, 95% CI - 1.29 to - 0.19) in mid-adulthood. CONCLUSION High BMI from childhood to mid-adulthood had only modest associations with HRQoL and HSUs, with effects on physical HRQoL most apparent.
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Affiliation(s)
- Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Terence Dwyer
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
- The George Institute for Global Health, University of Oxford, Wellington Square, Oxford, UK
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
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Breeze P, Gray LA, Thomas C, Bates SE, Brennan A. Estimating the impact of changes in weight and BMI on EQ-5D-3L: a longitudinal analysis of a behavioural group-based weight loss intervention. Qual Life Res 2022; 31:3283-3292. [PMID: 35796997 PMCID: PMC9546944 DOI: 10.1007/s11136-022-03178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE To estimate the association between changes in BMI and changes in Health-Related Quality of Life (EQ-5D-3L). METHODS The WRAP trial was a multicentre, randomised controlled trial with parallel design and recruited 1267 adults (BMI ≥ 28 kg/m2). Participants were allocated to Brief Intervention, a Commercial weight management Programme (WW, formerly Weight Watchers) for 12 weeks, or the same Programme for 52 weeks. Participants were assessed at 0, 3, 12, 24, and 60 months. We analysed the relationship between BMI and EQ-5D-3L, adjusting for age and comorbidities, using a fixed effects model. Test for attrition, model specification and missing data were conducted. Secondary analyses investigated a non-symmetric gradient for weight loss vs. regain. RESULTS A unit increase in BMI was associated with a - 0.011 (95% CI - 0.01546, - 0.00877) change in EQ-5D-3L. A unit change in BMI between periods of observation was associated with - 0.016 017 (95% CI - 0.0077009, - 0.025086) change in EQ-5D-3L. The negative association was reduced during weight loss, as opposed to weight gain, but the difference was not statistically significant. CONCLUSIONS We have identified a strong and statistically significant negative relationship between BMI changes and HRQoL. These estimates could be used in economic evaluations of weight loss interventions to inform policymaking. CLINICAL TRIAL REGISTRATION This trial was registered with Current Controlled Trials, number ISRCTN82857232.
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Affiliation(s)
- Penny Breeze
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Laura A. Gray
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Chloe Thomas
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Sarah E. Bates
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
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Health-related quality of life is substantially worse in individuals with plantar heel pain. Sci Rep 2022; 12:15652. [PMID: 36123358 PMCID: PMC9485111 DOI: 10.1038/s41598-022-19588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 08/31/2022] [Indexed: 12/01/2022] Open
Abstract
This study aimed to compare health-related quality of life (HRQoL) in people with and without plantar heel pain (PHP). This was a cross-sectional observational study that compared 50 adult participants with PHP to 25 participants without PHP who were matched for age, sex and body mass index (BMI). HRQoL measures included a generic measure, the Short Form 36 version 2 (SF-36v2), and foot-specific measures, including 100 mm visual analogue scales (VASs) for pain, the Foot Health Status Questionnaire (FHSQ), and the Foot Function Index-Revised (FFI-R). Comparisons in HRQoL between the two groups were conducted using linear regression, with additional adjustment for the comorbidity, osteoarthritis, which was found to be substantially different between the two groups. For generic HRQoL, participants with PHP scored worse in the SF-36v2 physical component summary score (p < 0.001, large effect size), but there was no difference in the mental component summary score (p = 0.690, very small effect size). Specifically, physical function (p < 0.001, very large effect size), role physical (p < 0.001, large effect size) and bodily pain (p < 0.001, large effect size) in the physical component section were worse in those with PHP. For foot-specific HRQoL, participants with PHP also scored worse in the VASs, the FHSQ and the FFI-R (p ≤ 0.005, huge effect sizes for all domains, except FHSQ footwear, which was large effect size, and FFR-R stiffness, activity limitation, and social issues, which were very large effect sizes). After accounting for age, sex, BMI and osteoarthritis, adults with PHP have poorer generic and foot-specific HRQoL.
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Perceived Difficulties in Physical Tasks and Physical Fitness in Treatment- and Non-Treatment-Seeking Youths with Obesity. CHILDREN 2022; 9:children9091351. [PMID: 36138659 PMCID: PMC9498025 DOI: 10.3390/children9091351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022]
Abstract
Youths with obesity are more likely to experience physical and psychosocial distress which strongly limits physical activity, with consequences on the quality of life. Most evidence of lower physical fitness and physical activity levels has been reported in treatment-seeking samples, while few data are available in community samples. Our aim was to assess whether perceived difficulties in physical tasks and physical fitness performance differed between treatment- and non-treatment-seeking youths with obesity, enrolled from a hospital (H) and a school (S). Three hundred fifty-one youths (269 from H and 82 from S) were enrolled. Sports participation, sedentary habits and perceived difficulties in physical tasks were assessed by interview. Six-minute walk test (SMWD) and long jump (LJ) were performed. BMI Z-score, sedentary time and perceived difficulties were higher in H vs. S. In addition, youths from H scored worse in SMWD and LJ. For the same BMI Z-score, the perceived difficulties and physical fitness were poorer in the H compared to the S group. The setting (H) was the stronger predictor of perceived difficulties and lower performance. Our findings underline that physical aspects imposed by obesity are more evident in treatment-seeking youths. Counseling related to perceived difficulties in physical tasks and performance is useful to treat youth with obesity with appropriate and personalized modalities.
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Halloun R, Weiss R. Bariatric Surgery in Adolescents with Obesity: Long-Term Perspectives and Potential Alternatives. Horm Res Paediatr 2022; 95:193-203. [PMID: 34758466 DOI: 10.1159/000520810] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Severe obesity among adolescent shows a worrisome trend in regard to its increasing prevalence and poses a great challenge for treatment. Conservative measures have modest effects on weight loss, usually fail in achieving a sustainable weight loss and resolution of comorbidities. This has led to greater utilization of bariatric surgery (BS) that offers a fast reduction in body mass index with little perioperative complications. Despite the increasing utilization of BS, data are still insufficient, regarding their long-term outcome in adolescents. We review short- and long-term effects of BS and their implications on bone health and nutritional deficiencies in adolescents. In addition, we discuss possible pharmaceutical alternatives. SUMMARY BS results in a substantial weight loss of roughly 37% in the first-year post-operation and is superior to conservative measures in resolution of metabolic comorbidities. BS significantly improves health-related quality of life. Longer follow-up (F/U) shows weight regain in 50% of patients. Furthermore, reduced bone mass and nutritional deficiencies were reported in up to 90% of patients. Most recently, alternative to BS became more relevant with approval of GLP-1 analogues use in adolescents. GLP-1 analogues are potent enough to induce moderate clinically meaningful weight loss and improvement of metabolic component. KEY MESSAGES We conclude that obese adolescents without major obesity-related complications may benefit from pharmacological interventions with lifestyle modification. We advise considering BS as treatment approach in adolescents with severe obesity and major obesity-related complications with proper preoperative preparation and postoperative F/U in excellence centers.
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Affiliation(s)
- Rana Halloun
- Department of Pediatrics, Ruth Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Ram Weiss
- Department of Pediatrics, Ruth Children's Hospital, Rambam Medical Center, Haifa, Israel.,Bruce Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel
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Beckmann S, Künzler-Heule P, Kabut K, Mauthner O. The Main Thing is to be Alive-Exploring Patients' Experiences With Weight Gain After Liver Transplantation: A Qualitative Study. Transpl Int 2022; 35:10256. [PMID: 35497890 PMCID: PMC9046544 DOI: 10.3389/ti.2022.10256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/08/2022] [Indexed: 01/11/2023]
Abstract
Weight gain after liver transplantation (LTx) contributes to new-onset obesity. We explored patients’ experiences with gaining weight after LTx. Individual interviews were guided by open-ended questions. We analyzed transcripts with the reflexive thematic analysis approach by Braun and Clarke. The 12 participants gained 11.5 kg weight (median) over a median of 23 months after LTx. The constitutive theme “The main thing is to be alive” was a recurrent insight, captured in three facets: “The arduous path back to living” was the emotional expression of the ups and downs during a life-threatening illness to finally being grateful for the new life. “A pleasurable new phase of life” was the legitimation, reflecting the appreciation of gaining weight and returning to a healthy appearance. “I am allowed to look like this now” was the consoling facet after a time of burden due to the increased weight and frustration of being unsuccessful in losing weight. Finally, the awareness of being a LTx survivor outplayed the burden of the excess weight. Early interventions are crucial because the comforting insight “I am allowed to look like this now” may hinder further engagement in weight loss activities. Our recommendations on education and self-management support may guide clinical practice.
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Affiliation(s)
- Sonja Beckmann
- Nursing Science, University of Basel, Basel, Switzerland.,Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Patrizia Künzler-Heule
- Nursing Science, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Nursing, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Kajetan Kabut
- Zentrum für NeuroRehabilitation, Beatmungs- und Intensivmedizin, BDH-Klinik Elzach, Elzach, Germany
| | - Oliver Mauthner
- Nursing Science, University of Basel, Basel, Switzerland.,University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
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Onyimadu O, Violato M, Astbury NM, Jebb SA, Petrou S. Health Economic Aspects of Childhood Excess Weight: A Structured Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:461. [PMID: 35455505 PMCID: PMC9028108 DOI: 10.3390/children9040461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
An economic perspective is crucial to understand the broad consequences of childhood excess weight (CEW). These can manifest in the form of elevated health care and societal costs, impaired health status, or inefficiencies in the allocation of resources targeted at its prevention, management, or treatment. Although existing systematic reviews provide summaries of distinct economic research strands covering CEW, they have a restricted focus that overlooks relevant evidence. The overarching aim of this structured review was to update and enhance recent key reviews of four strands of economic evidence in this area, namely, (1) economic costs associated with CEW, (2) health utilities associated with CEW, (3) economic evaluations of interventions targeting CEW, and (4) economic determinants and broader consequences of CEW. Our de novo searches identified six additional studies for the first research strand, five studies for the second, thirty-one for the third, and two for the fourth. Most studies were conducted in a small number of high-income countries. Our review highlights knowledge gaps across all the research strands. Evidence from this structured review can act as data input into future economic evaluations in this area and highlights areas where future economic research should be targeted.
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Affiliation(s)
- Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK;
| | - Nerys M. Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
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Randhawa S, Randhawa N, Hassanin E, Yi‐Frazier JP, Briggs Early K. Pilot evaluation of obesity-specific health-related quality of life following a 12-week non-randomized lifestyle intervention in youth. Obes Sci Pract 2021; 7:803-807. [PMID: 34877016 PMCID: PMC8633934 DOI: 10.1002/osp4.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQOL), a multifaceted construct for understanding health and healthcare outcomes, is comprised of eight domains of well-being and functioning over time and has become an essential factor in assessing outcomes for youth with obesity. AIMS To evaluate the effect of a community based, lifestyle intervention, on obesity-specific HRQOL using the Sizing Me Up (SMU) in this group of Latino and White youth. MATERIALS AND METHODS For this 12-week family and community-based intervention (ACT; Actively Changing Together), HRQOL was measured before and after the intervention concluded using the obesity-specific HRQOL tool, SMU. This study enrolled 68 youth (10.9 ± 2 years; 54% male; 50% non-Hispanic white). Paired t-tests were used to examine the Sizing Me Up sub-scales: Emotion, Physical, Social Avoidance, Positive Attributes, Teasing, and the total score. A greater change score indicated a larger increase in quality of life sub-scale. RESULTS Significant improvements from baseline to follow-up were found in the total SMU (mean change = 5.27, SD 10.76, p = 0.00) and for the sub-scores of: emotion (mean change = 8.06, SD 16.85, p ≤ 0.00), teasing (mean change = 5.65, SD 16.79, p = 0.01), and social avoidance (mean change = 3.92, SD 11.21, p = 0.01). CONCLUSIONS Sizing Me Up provided a clinically meaningful tool for this research study to evaluate obesity-specific HRQOL among Hispanic and non-Hispanic White youth with obesity.
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Affiliation(s)
| | - Navkiran Randhawa
- Franciscan Health Internal Medicine Residency Olympia FieldsOlympia FieldsIllinoisUSA
| | - Es‐Haq Hassanin
- Department of Internal MedicineThe University of Texas Health Science Center at TylerTylerTexasUSA
| | - Joyce P. Yi‐Frazier
- Center for Clinical and Translational ResearchSeattle Children's Research Institute SeattleSeattleWashingtonUSA
| | - Kathaleen Briggs Early
- Department of Biomedical SciencesCollege of Osteopathic MedicinePacific Northwest UniversityYakimaWashingtonUSA
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Differences in Dietary Habits, Physical Exercise, and Quality of Life between Male and Female Patients with Overweight. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111255. [PMID: 34769772 PMCID: PMC8582794 DOI: 10.3390/ijerph182111255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 12/02/2022]
Abstract
Overweight can be an additional problem in patients admitted to hospital. Objective: To analyze gender differences in pre-admission dietary habits and physical exercise and in HRQoL at hospital discharge among hospitalized adults with overweight. Methods: Cross-sectional study in non-diabetic patients enrolled in a clinical trial with body mass index (BMI) ≥ 25 Kg/m2 at admission. Bivariate analyses used Pearson’s chi-square test and Fisher’s exact test for qualitative variables and the Mann–Whitney test for numerical variables. Results: The study included 148 males and 127 females. At admission, women had higher BMI (p = 0.016) than men and a larger percentage consumed drugs for depression (p = 0.030) and anxiety (p = 0.049), and followed a religion-based diet (p = 0.022). Pre-admission, women had healthier habits related to dietary caloric intake (p = 0.009) and greater adherence to recommendations for a healthy diet (p = 0.001). At discharge, women described worse self-perceived health (p = 0.044) and greater pain/discomfort (p = 0.004) in comparison to men. Conclusions: Pre-admission, women had better habits related to a healthy diet and did not differ from men in habits related to physical exercise but had a higher BMI. At discharge, women reported worse self-perceived health and greater pain/discomfort. These differences should be considered for the adequate clinical management of patients with overweight.
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Herrera-Espiñeira C, de Pascual y Medina AM, López-Morales M, Díaz Jiménez P, Rodríguez Ruiz A, Expósito-Ruiz M. Differences in Dietary Habits, Physical Exercise, and Quality of Life between Patients with Obesity and Overweight. Healthcare (Basel) 2021; 9:healthcare9070916. [PMID: 34356294 PMCID: PMC8305240 DOI: 10.3390/healthcare9070916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Overweight and obesity differ in their repercussions on the health and health-related quality of life (HRQoL) of patients. The objective of this study was to compare physical activity levels and dietary habits before admission and HRQoL at discharge between patients with obesity and overweight. METHODS A cross-sectional study was undertaken among participants in a clinical trial on education for healthy eating and physical activity, enrolling non-diabetic patients admitted to Internal Medicine Departments. These were classified by body mass index (BMI) as having overweight (25-29.9 Kg/m2) or obesity (≥30 kg/m2). Data were gathered on sociodemographic characteristics, clinical variables (medication for anxiety/depression, Charlson Comorbidity Index, length of hospital stay), physical exercise and diet (International Physical Activity and Pardo Questionnaires), and HRQoL (EQ-5D-5L). The study included 98 patients with overweight (58.2% males) and 177 with obesity (52% males). RESULTS In comparison to patients with obesity, those with overweight obtained better results for regular physical exercise (p = 0.007), healthy diet (p = 0.004), and "emotional eating" (p = 0.017). No between-group difference was found in HqoL scores. CONCLUSION Patients with overweight and obesity differ in healthy dietary and physical exercise behaviors. Greater efforts are warranted to prevent an increase in the BMI of patients, paying special attention to their state of mind.
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Affiliation(s)
- Carmen Herrera-Espiñeira
- National Network of Research in Health Departments and Chronic Diseases (REDISSEC), 18012 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Faculty of Health Sciences, University of Granada, 18012 Granada, Spain
- Correspondence:
| | - Ana María de Pascual y Medina
- GREISSEC Spanish Research Group on Care in Chronic Diseases Health Services (INVESTEN), 38109 Las Palmas de Gran Canaria, Spain;
- Evaluation and Planning Service of the Canary Health Service (SESCS), 38109 Las Palmas de Gran Canaria, Spain
| | - Manuel López-Morales
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Faculty of Health Sciences, University of Granada, 18012 Granada, Spain
- Granada-Metropolitan Health District, 18012 Granada, Spain
| | - Paloma Díaz Jiménez
- Foundation for Biohealth Research of Eastern Andalusia (FIBAO), 18012 Granada, Spain; (P.D.J.); (M.E.-R.)
| | | | - Manuela Expósito-Ruiz
- Foundation for Biohealth Research of Eastern Andalusia (FIBAO), 18012 Granada, Spain; (P.D.J.); (M.E.-R.)
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Pulfer S, Ziehfreund S, Gebhard J, Hindelang B, Biedermann T, Brockow K, Zink A. Health-Related Quality of Life and Influencing Factors in Adults with Nonadvanced Mastocytosis-A Cross-Sectional Study and Qualitative Approach. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3166-3175.e2. [PMID: 33965596 DOI: 10.1016/j.jaip.2021.04.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/14/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mastocytosis comprises a heterogeneous group of disorders characterized by an accumulation of mast cells in 1 or more organs. Symptoms range from mild complaints to severe and life-threatening events. Impact on quality of life seems to vary widely, but influencing factors are poorly understood so far. OBJECTIVE To examine impairments, psychological burden, health-related quality of life (HRQOL), and possible influencing factors in patients with mastocytosis. METHODS In semistructured telephone interviews, patients provided information on impairments in everyday life and psychological burden caused by mastocytosis. HRQOL was measured using the Mastocytosis Quality of Life (MC-QoL) questionnaire. Clinical data were collected from patient files. RESULTS A total of 101 adult patients with mastocytosis (74.3% women; mean age, 47.7 ± 13.5 years) were included. Half of the interviewed patients (50.6%) reported disease-related impairments in everyday life, and 42.4% stated a psychological burden. MC-QoL questionnaire scores showed a broad distribution, with a mean total score at a "mild" impairment level (mean total score, 34.7 ± 22.5). One-third of patients felt moderately (22.8%) or severely (13.9%) impaired, whereas one-third reported no impairment at all (30.7%). Symptoms of mast cell activation and perceived food intolerance had the highest impact on HRQOL. Higher age, higher body mass index, higher tryptase level, and longer duration of symptoms, as well as current drug therapy and pathological bone density, were each associated with reduced HRQOL. CONCLUSIONS A high level of suffering and strong associations between impairments and symptom-related factors indicate the importance of addressing patients' concerns and adequate symptom management in mastocytosis.
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Affiliation(s)
- Stephanie Pulfer
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Stefanie Ziehfreund
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Julia Gebhard
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Benedikt Hindelang
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Knut Brockow
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany.
| | - Alexander Zink
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
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Crose A, Alvear A, Singroy S, Wang Q, Manoogian E, Panda S, Mashek DG, Chow LS. Time-Restricted Eating Improves Quality of Life Measures in Overweight Humans. Nutrients 2021; 13:nu13051430. [PMID: 33922683 PMCID: PMC8146708 DOI: 10.3390/nu13051430] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022] Open
Abstract
Time-restricted eating (TRE) reduces weight in humans, but its effects on quality of life have not been well characterized. By performing a secondary analysis of a randomized clinical trial, we examined the effects of TRE (12-week intervention, 8 h eating window) vs. non-TRE (unrestricted eating) on quality of life (QoL) measures. Twenty subjects with overweight and prolonged eating window (mean (SD): 15.4 h (0.9)) were randomized to either 12 weeks of TRE (8 h eating window: (n = 11)) or non-TRE (n = 9). QoL data were collected with the 36-item Short Form Survey (SF-36) pre- and post-intervention. Given a two-way ANOVA model and post-hoc t-test analysis, the TRE group improved limitations due to emotional health post-intervention: +97.0 (10.0)) vs. baseline: +66.7 (42.2) (p = 0.02) and perceived change in health over the last year end intervention: +68.2 (16.2) vs. baseline: +52.3 (23.6) (p = 0.001) relative to baseline. The TRE group improved limitations due to emotional health TRE: +97.0 (10.0) vs. non-TRE: +55.6 (44.1) (p = 0.05) and perceived change in health (TRE: +68.2 (16.2) vs. non-TRE: +44.4 (31.6) (p = 0.04) relative to the non-TRE group at post-intervention (p < 0.025). In conclusion, 12 weeks of TRE does not adversely affect QoL and may be associated with modest improvements in QoL relative to baseline and unrestricted eating; these findings support future studies examining TRE compliance and durability.
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Affiliation(s)
- Ainslee Crose
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN 55455, USA; (A.C.); (A.A.); (S.S.); (D.G.M.)
| | - Alison Alvear
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN 55455, USA; (A.C.); (A.A.); (S.S.); (D.G.M.)
| | - Stephanie Singroy
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN 55455, USA; (A.C.); (A.A.); (S.S.); (D.G.M.)
| | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Emily Manoogian
- Salk Institute for Biological Studies, La Jolla, San Diego, CA 92037, USA; (E.M.); (S.P.)
| | - Satchidananda Panda
- Salk Institute for Biological Studies, La Jolla, San Diego, CA 92037, USA; (E.M.); (S.P.)
| | - Douglas G. Mashek
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN 55455, USA; (A.C.); (A.A.); (S.S.); (D.G.M.)
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Lisa S. Chow
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN 55455, USA; (A.C.); (A.A.); (S.S.); (D.G.M.)
- Correspondence:
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14
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Tsiros MD, Tian EJ, Shultz SP, Olds T, Hills AP, Duff J, Kumar S. Obesity, the new childhood disability? An umbrella review on the association between adiposity and physical function. Obes Rev 2020; 21:e13121. [PMID: 32779327 DOI: 10.1111/obr.13121] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/30/2020] [Accepted: 07/22/2020] [Indexed: 12/29/2022]
Abstract
The adverse physical impacts of childhood obesity are increasingly being recognized. The objective of this study is to examine relationships between physical function and adiposity in youth. An umbrella review searched seven databases from inception to May 2019 for systematic reviews examining associations between adiposity and physical function in 0-20-year-olds. Findings were synthesized using the International Classification of Functioning, Disability and Health Framework and NHMRC FORM. Seventeen of 21 systematic reviews reported impairments to body function, including cardiorespiratory fitness (CRF), muscle function, balance/coordination, gait biomechanics, pain and injury. Six reviews reported activity restrictions in motor skills, running speed/agility and functional mobility, and two found inverse associations between adiposity and physical health-related quality of life (p-HRQOL). Some causal relationships indicated that adiposity inversely predicted p-HRQOL/CRF and CRF/muscle function inversely predicted adiposity. Assessments of physical function were heterogeneous and impacts on participation in life situations meaningful to the individual were largely unknown. Substantial evidence associates childhood overweight/obesity with reduced physical function. Associations were mainly cross-sectional, with causative evidence for some outcomes. Comprehensive physical function assessments by qualified health professionals are needed, along with targeted interventions to address deficits. Research should further examine causality of relationships, underlying mechanisms and participation challenges in real-life contexts.
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Affiliation(s)
- Margarita D Tsiros
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Esther J Tian
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Sarah P Shultz
- Kinesiology Department, Seattle University, Seattle, Washington, USA
| | - Timothy Olds
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Andrew P Hills
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Jed Duff
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Saravana Kumar
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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15
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Improvement in patient-reported outcomes in Chinese adults after bariatric surgery: 1-year follow-up of a prospective cohort. Surg Obes Relat Dis 2020; 16:1563-1572. [DOI: 10.1016/j.soard.2020.04.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 11/24/2022]
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16
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Hwang AC, Lee WJ, Peng LN, Liu LK, Lin MH, Loh CH, Chen LK. Unfavorable body composition and quality of life among community-dwelling middle-aged and older adults: What really matters? Maturitas 2020; 140:34-40. [DOI: 10.1016/j.maturitas.2020.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/19/2020] [Accepted: 05/29/2020] [Indexed: 12/25/2022]
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17
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Health-related quality of life of Portuguese children and adolescents according to diet quality and food intake. Qual Life Res 2020; 29:2197-2207. [PMID: 32219706 DOI: 10.1007/s11136-020-02475-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The implication of adolescence diet quality and of certain specific foods' intake on HRQoL remain underexplored, and little importance has been given to biological changes (e.g. growth, maturation, dimorphism, body composition), that remarkably increase the variability of diet and physical activity behaviours. The aim of this study was to analyse the relationship between diet quality and food intake with HRQoL in adolescents, considering maturity, body composition, and physical activity level. METHODS In total 669 Portuguese adolescents aged 10-17 years, attending three secondary schools, were enrolled in this cross-sectional study. Diet quality was assessed by Diet Quality International-Index (DQI-I), physical activity level was self-reported, and the HRQoL was assessed by the KIDSCREEN-52 questionnaire. The KIDSCREEN-52 includes ten dimensions (physical well-being, psychological well-being, moods and emotions, self-perception, autonomy, parent relations and home life, social support and peers, school environment, social acceptance and bullying and financial resources) and it allowed to compute a general index of the HRQoL (KIDSCREEN-10 index) through a selection of 10 items out of the KIDSCREEN-52 list. Fat mass was obtained by skinfold thickness. Maturity was objectively measured. The level of significance was set at α = 0.05. RESULTS Boys scored higher in HRQoL and in physical well-being, self-perception, autonomy, parent relations and home life than girls. Intakes of unhealthy foods were negatively correlated with physical well-being, self-perception, and social acceptance and bullying, while healthy foods were positively correlated with psychological well-being, moods and emotions, self-perception, and school environment. The DQI-I showed to be positively correlated with physical well-being. Participants who reported to have a higher DQI-I (≥ 60) perceived better their school environment and social acceptance and bullying. However, those results were not determined by diet quality but rather by bone age and physical activity level. CONCLUSION Our results showed that boys reported higher HRQoL and higher scores in the majority of HRQoL dimensions, compared to girls. The intake of unhealthy foods was negatively correlated with some HRQoL dimensions, whilst healthy foods showed positive correlations with some HRQoL dimensions. Biological maturity and physical activity level revealed to be important confounders in the study of diet quality and perception of school environment and social acceptance and bullying in adolescents.
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18
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Gramaglia C, Gattoni E, Vecchi C, Di Tullio E, Biroli G, D'Andrea F, Riso S, Gualano MR, Marchetti M, Sarchiapone M, Siliquini R, Zeppegno P. No correlation among expressed emotion, anxiety, stress and weight loss in patients with overweight and obesity. Food Nutr Res 2019; 63:3522. [PMID: 31645850 PMCID: PMC6787637 DOI: 10.29219/fnr.v63.3522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/19/2019] [Accepted: 09/10/2019] [Indexed: 11/20/2022] Open
Abstract
Background The onset of some types of obesity may correlate with specific familial relational patterns, and expressed emotion (EE), the family life's 'emotional temperature', may play a role in obesity treatment compliance and outcome. Objective The aim of this study is to address the current gap in the literature about EE and obesity, assessing EE in a sample of patients with overweight or obesity and their relatives. A further objective is to assess patients' weight loss, patients' and relatives' anxiety, perceived stress and their possible correlation with EE and diet compliance. Design A total of 220 patients with overweight or obesity and 126 relatives were recruited; their socio-demographic and clinical features were collected; and Level of Expressed Emotion Scale (LEE), State-Trait Anxiety Inventory 1 and 2 (STAI-Y1 and STAI-Y2) and Paykel Scale of Stressful Life Events were administered. Results Patients' baseline body mass index (BMI) was negatively correlated with educational level, but we failed to find any correlation between BMI and the other variables assessed. We found a positive correlation between EE median and stressful life events, as well as between median EE and state and trait anxiety. Conclusions Our results seem to suggest that other factors than the psychological ones we investigated may play a role in treatment adherence and outcome in patients with overweight and obesity.
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Affiliation(s)
- Carla Gramaglia
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gattoni
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Camilla Vecchi
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Elisa Di Tullio
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Giampaolo Biroli
- S.C. Dietetica e Nutrizione, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Federico D'Andrea
- S.C. Dietetica e Nutrizione, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Sergio Riso
- S.C. Dietetica e Nutrizione, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | | | - Marco Marchetti
- Department of Bioscience and Territory, University of Molise, Campobasso, Italy
| | - Marco Sarchiapone
- Department of Medical and Health Sciences, University of Molise, Campobasso, Italy
| | | | - Patrizia Zeppegno
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
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19
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Santos-Antonio G, Bravo-Rebatta F, Velarde-Delgado P, Aramburu A. [Effects of front-of-package nutritional labeling of food and beverages: synopsis of systematic reviewsEfeitos da rotulagem nutricional frontal de alimentos e bebidas: sumário de estudos de revisão sistemática]. Rev Panam Salud Publica 2019; 43:e62. [PMID: 31456819 PMCID: PMC6692502 DOI: 10.26633/rpsp.2019.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/15/2019] [Indexed: 12/16/2022] Open
Abstract
Objetivos. Sintetizar la información disponible sobre el efecto del etiquetado nutricional frontal en la elección, compra y consumo de alimentos y bebidas, y el estado nutricional de los consumidores, e identificar los factores que influyen en su efectividad. Métodos. Se realizó una sinopsis de revisiones sistemáticas (RS) conforme a las recomendaciones PRISMA. La búsqueda bibliográfica se realizó en Medline (Pubmed), The Cochrane Library, LILACS, EBSCOhost y Scopus, limitada a estudios publicados en español o inglés sin restricción por fecha de publicación. La calidad metodológica se evaluó utilizando la herramienta AMSTAR 2. Resultados. Se incluyeron siete RS. El etiquetado frontal facilitó la elección de alimentos saludables y tuvo un efecto variable sobre las dimensiones de consumo y compra. Ninguna RS evaluó el efecto sobre el estado nutricional. El costo y sabor, los hábitos alimentarios, el nivel educativo y los sistemas dominantes de procesamiento de información en el consumidor influyeron en su efectividad. La mayoría de RS mostraron limitaciones metodológicas y un nivel de confianza críticamente bajo. Conclusiones. El etiquetado frontal tuvo efecto positivo en la elección de alimentos saludables, con resultados variables en las dimensiones de compra y consumo. Se necesitan estudios locales con una adecuada calidad metodológica para identificar el formato de etiquetado más efectivo en cada país. Su implementación como política de salud pública debe acompañarse de estrategias para mejorar el acceso a alimentos saludables, promover la actividad física y brindar educación nutricional a los consumidores.
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Affiliation(s)
- Gabriela Santos-Antonio
- Centro Nacional de Alimentación y Nutrición Centro Nacional de Alimentación y Nutrición Instituto Nacional de Salud Lima Perú Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud, Lima, Perú
| | - Fernando Bravo-Rebatta
- Centro Nacional de Alimentación y Nutrición Centro Nacional de Alimentación y Nutrición Instituto Nacional de Salud Lima Perú Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud, Lima, Perú
| | - Patricia Velarde-Delgado
- Centro Nacional de Alimentación y Nutrición Centro Nacional de Alimentación y Nutrición Instituto Nacional de Salud Lima Perú Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud, Lima, Perú
| | - Adolfo Aramburu
- Centro Nacional de Alimentación y Nutrición Centro Nacional de Alimentación y Nutrición Instituto Nacional de Salud Lima Perú Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud, Lima, Perú
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20
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Hagberg L, Winkvist A, Brekke HK, Bertz F, Hellebö Johansson E, Huseinovic E. Cost-effectiveness and quality of life of a diet intervention postpartum: 2-year results from a randomized controlled trial. BMC Public Health 2019; 19:38. [PMID: 30621673 PMCID: PMC6325882 DOI: 10.1186/s12889-018-6356-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 12/21/2018] [Indexed: 12/23/2022] Open
Abstract
Background Pregnancy has been identified as a contributor to obesity. We have shown that a diet intervention postpartum produced a 2-y weight loss of 8%. Here, we present the impact of the diet intervention on cost-effectiveness and explore changes in quality of life (QOL). Methods A total of 110 postpartum women with overweight/obesity were randomly assigned to diet (D-group) or control (C-group). D-group received a 12-wk diet intervention within primary health care followed by monthly emails up to the 1-y follow-up. C-group received a brochure. Changes in QOL were measured using the 36-item Short Form Health Survey and EQ-5D. The analysis of cost-effectiveness was a cost-utility analysis with a health care perspective and included costs of intervention for stakeholder, quality-adjusted life-years (QALYs) gained and savings in health care. The likelihood of cost-effectiveness was examined using the net monetary benefit method. Results The D-group increased their QOL more than the C-group at 12 wk. and 1 y, with pronounced differences for the dimensions general health and mental health, and the mental component summary score (all p < 0.05). Cost per gained QALY was 1704–7889 USD. The likelihood for cost-effectiveness, based on a willingness to pay 50,000 USD per QALY, was 0.77–1.00. Conclusions A diet intervention that produced clinically relevant postpartum weight loss also resulted in increased QOL and was cost-effective. Trial registration Clinical trials, NCT01949558, 2013-09-24
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Affiliation(s)
- Lars Hagberg
- Centre for Health Care Science, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Box 459, SE-405 30, Gothenburg, Sweden
| | - Hilde K Brekke
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Box 459, SE-405 30, Gothenburg, Sweden.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Fredrik Bertz
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Box 459, SE-405 30, Gothenburg, Sweden
| | - Else Hellebö Johansson
- Närhälsan, Research and Development Primary Health Care, Region Västra Götaland, Borås, Sweden
| | - Ena Huseinovic
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Box 459, SE-405 30, Gothenburg, Sweden.
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21
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Lee CT, Lin CY, Strong C, Lin YF, Chou YY, Tsai MC. Metabolic correlates of health-related quality of life among overweight and obese adolescents. BMC Pediatr 2018; 18:25. [PMID: 29397047 PMCID: PMC5797659 DOI: 10.1186/s12887-018-1044-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 01/31/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Little is known about the metabolic factors associated with the health-related quality of life (HRQOL) among obese youths. The aim of this study is to assess metabolic correlates of HRQOL in a clinical sample of Taiwanese overweight and obese (OW/OB) adolescents. METHODS OW/OB adolescents (age 11-19 years) were recruited and compared to their normal-weight counterparts in a tertiary hospital. HRQOL was assessed by the Pediatric Quality of Life Inventory (PedsQL). Student t tests and Cohen's d were used to compare the differences in the PedsQL scores between normal-weight and OW/OB participants who were stratified by their cumulative number of cardiometabolic risk factors (CRF). Pearson's correlation and multivariate linear regression analyses were applied to identify predictors of PedsQL. RESULTS OW/OB adolescents (n = 60) reported lower PedsQL scores than those of normal-weight peers. The negative effects were even larger in OW/OB participants with more than one CRF. Body mass index z-scores and serum alanine aminotransferase (ALT) levels were negatively correlated with overall and subscales of PedsQL (r = - 0.283 to - 0.431). Multivariate linear models showed ALT to be the most salient factor associated with poor obesity-related HRQOL. CONCLUSION Taiwanese OW/OB adolescents, particularly those having additional CRF, reported worse HRQOL. Impaired liver functions may predispose OW/OB subjects to even worse HRQOL.
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Affiliation(s)
- Chih-Ting Lee
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Physical Education, Health and Leisure Studies, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Carol Strong
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Fang Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 70101, Taiwan
| | - Yen-Yin Chou
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 70101, Taiwan
| | - Meng-Che Tsai
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 70101, Taiwan.
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