Stable behaviors associated with adults' 10-year change in body mass index and likelihood of gain at the waist

Meat consumption and incident type 2 diabetes: an individual-participant federated meta-analysis of 1·97 million adults with 100 000 incident cases from 31 cohorts in 20 countries

BACKGROUND

Meat consumption could increase the risk of type 2 diabetes. However, evidence is largely based on studies of European and North American populations, with heterogeneous analysis strategies and a greater focus on red meat than on poultry. We aimed to investigate the associations of unprocessed red meat, processed meat, and poultry consumption with type 2 diabetes using data from worldwide cohorts and harmonised analytical approaches.

METHODS

This individual-participant federated meta-analysis involved data from 31 cohorts participating in the InterConnect project. Cohorts were from the region of the Americas (n=12) and the Eastern Mediterranean (n=2), European (n=9), South-East Asia (n=1), and Western Pacific (n=7) regions. Access to individual-participant data was provided by each cohort; participants were eligible for inclusion if they were aged 18 years or older and had available data on dietary consumption and incident type 2 diabetes and were excluded if they had a diagnosis of any type of diabetes at baseline or missing data. Cohort-specific hazard ratios (HRs) and 95% CIs were estimated for each meat type, adjusted for potential confounders (including BMI), and pooled using a random-effects meta-analysis, with meta-regression to investigate potential sources of heterogeneity.

FINDINGS

Among 1 966 444 adults eligible for participation, 107 271 incident cases of type 2 diabetes were identified during a median follow-up of 10 (IQR 7-15) years. Median meat consumption across cohorts was 0-110 g/day for unprocessed red meat, 0-49 g/day for processed meat, and 0-72 g/day for poultry. Greater consumption of each of the three types of meat was associated with increased incidence of type 2 diabetes, with HRs of 1·10 (95% CI 1·06-1·15) per 100 g/day of unprocessed red meat (I2=61%), 1·15 (1·11-1·20) per 50 g/day of processed meat (I2=59%), and 1·08 (1·02-1·14) per 100 g/day of poultry (I2=68%). Positive associations between meat consumption and type 2 diabetes were observed in North America and in the European and Western Pacific regions; the CIs were wide in other regions. We found no evidence that the heterogeneity was explained by age, sex, or BMI. The findings for poultry consumption were weaker under alternative modelling assumptions. Replacing processed meat with unprocessed red meat or poultry was associated with a lower incidence of type 2 diabetes.

INTERPRETATION

The consumption of meat, particularly processed meat and unprocessed red meat, is a risk factor for developing type 2 diabetes across populations. These findings highlight the importance of reducing meat consumption for public health and should inform dietary guidelines.

FUNDING

The EU, the Medical Research Council, and the National Institute of Health Research Cambridge Biomedical Research Centre.

Fruit and vegetable consumption and the risk of hypertension: a systematic review and meta-analysis of prospective studies

PURPOSE

A high fruit and vegetable intake has been associated with reduced risk of hypertension; however, results have been inconsistent and it is unclear whether specific types of fruits and vegetables are particularly beneficial. This systematic review and meta-analysis aimed to summarize the published prospective studies on fruit and vegetable consumption and risk of hypertension.

METHODS

Embase and PubMed databases were searched for relevant prospective studies up to 15th May 2022. Random effects models were used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) for the association between fruit and vegetable intake and risk of hypertension. Strength of evidence was assessed using World Cancer Research Fund (WCRF) criteria.

RESULTS

Eighteen prospective studies (451 291 participants, 145 492 cases) were included. The summary RR (95% CI) of hypertension per 200 g/day was 0.97 (0.95-0.99, I² = 68%, n = 8) for fruits and vegetables, 0.93 (0.89-0.98, I² = 77%, n = 10) for fruits, and 1.00 (0.98-1.02, I² = 38%, n = 10) for vegetables. Reductions in risk were observed up to 800 g/day for fruits and vegetables, and 550 g/day for fruits, and these two associations were considered probably causal using WCRF criteria. Inverse associations were observed for apples or pears, blueberries, raisins or grapes, avocado, broccoli, carrots and lettuce, while positive associations were observed for cantaloupe, Brussels sprouts, cruciferous vegetables, and total and fried potatoes (n = 2-5).

CONCLUSION

A high intake of fruit and vegetables combined, and total fruit was associated with reduced risk of hypertension, while results for fruit and vegetable subtypes were mixed and need further study.

Associations of 5-year changes in alcoholic beverage intake with 5-year changes in waist circumference and BMI in the Coronary Artery Risk Development in Young Adults (CARDIA) study

OBJECTIVE

This study aimed to shed light on contradictory associations of alcohol intake with waist circumference (WC) and body mass index (BMI) by examining 5-yr changes in alcohol intake in relation to 5-yr WC and BMI changes.

METHODS

This prospective study included 4,355 participants (1,974 men and 2,381 women) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study at baseline (1985-1986) and followed over 25 years (2010-2011). Longitudinal random effects linear regression models were used to test whether changes in drinking (defined categorically) as starting to drink, increasing, decreasing, stable drinking or stopping drinking (versus stable non-drinking) over a series of 5-yr periods were associated with corresponding 5-yr WC and BMI changes. Associations with 5-yr changes (defined categorically as starting, stable or stopping) in drinking level (i.e., light/moderate and excessive) and 5-yr changes (defined categorically as increasing, no change, or decreasing) by beverage type (i.e., beer, wine and liquor/mixed drinks) were also examined.

RESULTS

In men, compared to stable non-drinking, decreasing total alcohol intake was associated with lower 5-yr WC (β:-0.62 cm; 95% CI: -1.09, -0.14 cm) and BMI gains (β:-0.20 kg/m2; 95% CI: -0.30, -0.03 kg/m2) and stopping excessive drinking was associated with lower 5-yr WC gains (β:-0.77 cm; 95% CI: -1.51, -0.03 cm). In women, compared to those with stable non-drinking habits, starting light/moderate drinking was associated with lower 5-yr WC (β: -0.78 cm; 95% CI: -1.29, -0.26 cm) and BMI gains (β:-0.42 kg/m2; 95% CI: -0.64, -0.20 kg/m2). Increasing wine intake was associated with a lower 5-yr BMI gain (β:-0.27 kg/m2; 95% CI: -0.51, -0.03 kg/m2). Decreasing liquor/mixed drink (β:-0.33 kg/m2; 95% CI: -0.56, -0.09 kg/m2) intake was associated with lower 5-yr WC (β:-0.88 cm; 95% CI: -1.43, -0.34 cm) and BMI (β:-0.33 kg/m2; 95% CI: -0.56, -0.09 kg/m2) gains.

CONCLUSIONS

Associations of alcohol intake with obesity measures are complex. In women, wine and liquor/mixed drink intakes had contrasting associations with WC and BMI change. In men, decreasing weekly alcoholic beverage intake with an emphasis on stopping excessive consumption may be beneficial in managing WC and BMI gains.

Fruit and Vegetable Intake Among Older African American and Hispanic Adults With Cardiovascular Risk Factors

African Americans and Hispanics are disproportionately burdened by cardiovascular risk factors including hypertension, diabetes mellitus, and obesity. There is evidence that fruits and vegetables have protective benefits for cardiovascular health. Factors associated with fruit and vegetable intake among older minority adults are not well established. A cross-sectional analysis of African American and Hispanic adults >55 years with diagnosis of hypertension and/or diabetes was conducted. Daily intake of fruits and vegetables was analyzed by socio-demographic, health status, health behaviors, and access to fruits and vegetables. 77% of participants did not meet the United States Department of Agriculture ≥5 a day serving guidelines. Fruit and vegetable consumption was not associated with having hypertension or diabetes. Body mass index >25 and regular exercise were significantly associated with more vegetable intake, but not fruit. African Americans consumed significantly less fruits and vegetables than Hispanics. Among those with access to fruits and vegetables, 78% did not meet the guidelines. Many older African American and Hispanic adults with cardiovascular disease risk factors do not meet the fruit and vegetable intake guidelines. Inadequate intake is worse among African Americans, sedentary, and non-overweight/obese adults. Studies are needed to understand the barriers associated with fruit and vegetable intake in this population.

Perceived Produce Availability and Child Fruit and Vegetable Intake: The Healthy Communities Study

Children eat more fruits and vegetables when more are available at home, but less is known about how the neighborhood food environment relates to children's diet and weight outcomes. The goal of this study was to determine whether parental perception of the food environment (neighborhood and home) is associated with children's fruit and vegetable (F&V) intake and weight outcomes, and to assess differences by household food security status and household income. Cross-sectional data from the 2013-2015 U.S. Healthy Communities Study included 5138 children, aged 4 to 15 years old, from 130 U.S. communities. Neighborhood and home food environments were assessed with parent-reported, perceived F&V availability scores. Associations were tested with multi-level linear regression models. Parents' perception of produce availability was associated with household F&V availability ratings (β = 0.09 points, p < 0.001). Household F&V availability was associated with child F&V intake (β = 0.32 cups/day or 25.6 g/day, p < 0.001). A higher child F&V intake was associated with a lower child BMI z-score (β = -0.05, p = 0.002). Weaker relationships were seen for children living in food insecure or low-income households. Optimizing neighborhood and home access to F&V may help children improve diet quality, but may not be as effective for children living in food insecure or low-income households.

Associations between changes in fruit and vegetable consumption and weight change in Japanese adults

BACKGROUND

Fruits and vegetables may induce greater satiety, reduce hunger, decrease energy intake, and modulate energy metabolism, thereby playing a role in weight loss.

OBJECTIVE

To determine the associations between changes in fruit and vegetable consumption and weight change over a 5-year interval in Japanese adults.

METHODS

This cohort study included 54,015 subjects (54.6% female, mean age 56.5 years) of the Japan Public Health Center-based Prospective Cohort Study who had no known history of major chronic diseases at baseline. Data on fruit and vegetable consumption were collected using a validated food frequency questionnaire. Body weight was self-reported. We used multivariable linear mixed-effects regression models to examine the associations between changes in fruit and vegetable consumption and change in body weight.

RESULTS

On average, body weight decreased by 25 g [95% confidence interval (CI), 3, 47] for every 100 g/d increase in total vegetable consumption. Change in fruit consumption was nonlinearly associated with weight change. Fruit consumption was directly associated with weight change among subjects who increased consumption (70 g; 95% CI, 39, 101) but was not associated with weight change among subjects who reduced or did not change fruit consumption. These associations did not vary by sex, age, and body mass index (BMI) at baseline. The association with vegetables was restricted to yellow/red vegetables (- 74 g; 95% CI, - 129, - 18) and allium vegetables (- 129 g; 95% CI, - 231, - 28). Lower-fiber vegetables were inversely associated with weight change, whereas lower-fiber fruits or higher-energy fruits were directly associated with weight change beyond 0 g/d change in consumption.

CONCLUSIONS

Change in vegetable consumption was inversely associated with weight change while fruit consumption was positively associated with weight change among subjects who increased consumption. The influence of fruits and vegetables on weight change may depend on the characteristics of the fruits and vegetables.

Food Groups and Risk of Overweight, Obesity, and Weight Gain: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies

This meta-analysis summarizes the evidence of a prospective association between the intake of foods [whole grains, refined grains, vegetables, fruit, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages (SSBs)] and risk of general overweight/obesity, abdominal obesity, and weight gain. PubMed and Web of Science were searched for prospective observational studies until August 2018. Summary RRs and 95% CIs were estimated from 43 reports for the highest compared with the lowest intake categories, as well as for linear and nonlinear relations focusing on each outcome separately: overweight/obesity, abdominal obesity, and weight gain. The quality of evidence was evaluated with use of the NutriGrade tool. In the dose-response meta-analysis, inverse associations were found for whole-grain (RRoverweight/obesity: 0.93; 95% CI: 0.89, 0.96), fruit (RRoverweight/obesity: 0.93; 95% CI: 0.86, 1.00; RRweight gain: 0.91; 95% CI: 0.86, 0.97), nut (RRabdominal obesity: 0.42; 95% CI: 0.31, 0.57), legume (RRoverweight/obesity: 0.88; 95% CI: 0.84, 0.93), and fish (RRabdominal obesity: 0.83; 95% CI: 0.71, 0.97) consumption and positive associations were found for refined grains (RRoverweight/obesity: 1.05; 95% CI: 1.00, 1.10), red meat (RRabdominal obesity: 1.10; 95% CI: 1.04, 1.16; RRweight gain: 1.14; 95% CI: 1.03, 1.26), and SSBs (RRoverweight/obesity: 1.05; 95% CI: 1.00, 1.11; RRabdominal obesity: 1.12; 95% CI: 1.04, 1.20). The dose-response meta-analytical findings provided very low to low quality of evidence that certain food groups have an impact on different measurements of adiposity risk. To improve the quality of evidence, better-designed observational studies, inclusion of intervention trials, and use of novel statistical methods (e.g., substitution analyses or network meta-analyses) are needed.

Dietary source of saturated fat and percentage body fat of patients with type 2 diabetes mellitus: A cross-sectional study

BACKGROUND

The influence of dietary fat on the body fat of patients with diabetes is not well established. This cross-sectional study aimed to analyze the association between percentage body fat (PBF) and dietary sources of fat from the usual diet of patients with type 2 diabetes.

METHODS

Outpatients were submitted to PBF evaluation estimated by bioelectrical impedance. The patient's usual diet was assessed by a 3-day weighed diet record (WDR), and compliance was analyzed by comparing the protein intake estimated from the WDR and that from 24-hr urinary nitrogen output.

RESULTS

A total of 188 patients with type 2 diabetes (aged 62.5 ± 8.8 years; 57% female, body mass index [BMI] 29.3 ± 3.8 kg/m²) were analyzed and divided into groups with high and low PBF according to mean PBF (men: 26.6 ± 7.1%; women: 39.8 ± 5.9%). Patients with high PBF consumed an increased proportion of red meat (52.0% of total meat), processed meat (5.4%), and saturated fat from red meat (2.1% of energy) compared to low PBF individuals (42.3% [p = 0.036]; 3.0% [p = 0.010]; 1.5% of energy [p = 0.032], respectively). According to Poisson's regression, the consumption of red meat (PR = 1.008 [95% CI = 1.002-1.013]; p = 0.006) and the reuse of frying oil (PR = 1.670 [95% CI = 1.240-2.249]; p = 0.001) were associated with higher PBF. In the adjusted analysis, the upper tertile of processed meat intake was associated with higher PBF (PR = 1.522 [95% CI = 1.226-1.891]; p = 0.001) compared to the lower tertile.

CONCLUSIONS

The present study suggested that a higher ingestion of dietary sources of saturated fat was associated with high PBF in patients with type 2 diabetes.

The Dual Role of Oat Bran Water Extract in Bone Homeostasis Through the Regulation of Osteoclastogenesis and Osteoblast Differentiation

The number of patients with bone metabolic disorders including osteoporosis is increasing worldwide. These disorders often facilitate bone fractures, which seriously impact the patient's quality of life and could lead to further health complications. Bone homeostasis is tightly regulated to balance bone resorption and formation. However, many anti-osteoporotic agents are broadly categorized as either bone forming or anti-resorptive, and their therapeutic use is often limited due to unwanted side effects. Therefore, safe and effective therapeutic agents are needed for osteoporosis. This study aims to clarify the bone protecting effects of oat bran water extract (OBWE) and its mode of action. OBWE inhibited RANKL (receptor activator of nuclear factor-κB ligand)-induced osteoclast differentiation by blocking c-Fos/NFATc1 through the alteration of I-κB. Furthermore, we found that OBWE enhanced BMP-2-stimulated osteoblast differentiation by the induction of Runx2 via Smad signaling molecules. In addition, the anti-osteoporotic activity of OBWE was also evaluated using an in vivo model. OBWE significantly restored ovariectomy-induced bone loss. These in vitro and in vivo results showed that OBWE has the potential to prevent and treat bone metabolic disorders including osteoporosis.

The Relationship between Vegetable Intake and Weight Outcomes: A Systematic Review of Cohort Studies

The relationship between vegetable consumption and measures of adiposity was assessed in cohort studies. Seven databases were searched from inception until February 2018. The quality of individual studies was assessed using the Joanna Briggs Institute Critical Appraisal of Cohort Studies tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to determine the quality of the body of evidence. Ten studies were included. Six measured change in vegetable intake over time. Two showed that increasing vegetable consumption resulted in weight loss of 0.09⁻0.1 kg over four years (p < 0.001). Increased vegetable intake was also associated with a reduced risk of weight gain and overweight or obesity (Odds ratios (ORs) ranged from 0.18 to 0.88) in other studies. Four studies measured vegetable intake at the baseline only. One showed that intakes >4 servings/day reduced the risk of weight gain (OR 0.27 (95% confidence interval (CI) 0.08⁻0.99) and another found an inverse association with waist circumference in women (-0.36 cm per vegetable serving/day). This review provides moderate quality evidence for an inverse association between vegetable intake and weight-related outcomes in adults. When these findings are coupled with no apparent harm from vegetable consumption, the evidence-base can be used with acceptable confidence to guide practice and policy.

Shifting Food Systems: Increasing Well-Being Through Plant-Based Approaches

Growing evidence reveals food production systems and consumption practices contradict goals for environmental well-being and population health. This interdisciplinary paper reviews research for impacts from diets on non-communicable human diseases, climate change, and animal well-being. With increasing pressures to innovate and reduce economic as well as emotional costs associated with ill-health, our recommendations could positively impact policy.

Item response theory-based validation of a short form of the Eating Behavior Scale for Japanese adults

Obesity has become a serious social problem in industrialized countries in recent years. Clinically, although the evaluation of dietary behavior abnormalities is as important as any method of risk assessment for obesity, almost all the existing scales with many items may have numerous practical clinical difficulties. In this study, we aimed to prepare a short questionnaire to assess the dietary behavior abnormalities related to obesity. A total of 1032 individuals aged 20 to 59 years participated in the present study. Using item response theory (IRT), we selected the items for a short version from among 30 items of Sakata Eating Behavior Scale (EBS), which is widely used in Japan. As a result of the IRT-based analysis on the original 30-item version, 7 items were adopted as the short version. The correlation between the total score of the original EBS and the EBS short form was extremely high (r = 0.93, P = .001). In examining the criterion validity, for all participants (n = 1032), male (n = 516), and female (n = 516), the correlation coefficients between the total score of the EBS short form and body mass index (BMI) were r = 0.26, r = 0.28, and r = 0.28, respectively. The results of the receiver operating characteristic analysis was performed with obesity BMI > 25 kg/m as a dependent variable, the value of the area under the curve in the ROC was significantly higher in the 7-item version than in the total score of the original items (P = .0005). In conclusion, the 7-item EBS short form was created. Furthermore, it was found that the EBS short form is a reliable and valid measure that can be used as an indicator of obesity in both clinical and research settings.

Fruit and Vegetable Consumption and Changes in Anthropometric Variables in Adult Populations: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

BACKGROUND

Randomized controlled trials provide conflicting results on the effects of increased fruit and vegetable consumption on changes in body weight. We aimed to perform a systematic review and meta-analysis of prospective cohort studies on fruit and vegetable consumption in relation to changes in anthropometric measures.

METHODS

PubMed and EMBASE were searched up to July 2015 for prospective studies reporting on habitual fruit and/or vegetable consumption in relation to changes in body weight or waist circumference or to risk of weight gain/overweight/obesity in adults. Random-effects meta-analysis was applied to pool results across studies.

FINDINGS

Seventeen cohort studies (from 20 reports) including 563,277 participants met our inclusion criteria. Higher intake of fruits was inversely associated with weight change (decrease) (beta-coefficient per 100-g increment, -13.68 g/year; 95% CI, -22.97 to -4.40). No significant changes could be observed for combined fruit and vegetable consumption or vegetable consumption. Increased intake of fruits was inversely associated with changes (decrease) in waist circumference (beta: -0.04 cm/year; 95% CI, -0.05 to -0.02). Comparing the highest combined fruit & vegetable, fruit, and vegetable intake categories were associated with a 9%, 17%, and 17% reduced risk of adiposity (odds ratio [OR]: 0.91, 95% CI, 0.84 to 0.99), (OR: 0.83, 95% CI, 0.71 to 0.99), and (OR: 0.83, 95% CI, 0.70 to 0.99), respectively.

CONCLUSION

This meta-analysis showed several inverse associations between fruit and vegetable intake and prospective improvements in anthropometric parameters, and risk of adiposity. The present meta-analysis seems to be limited by low study quality. Nevertheless, when combined with evolutionary nutrition and epidemiological modeling studies, these findings have public health relevance and support all initiatives to increase fruit and vegetable intake.

The association between quitting smoking and weight gain: a systematic review and meta-analysis of prospective cohort studies

This systematic review and meta-analysis aimed to quantify weight gain after smoking cessation and the difference in weight gain between quitters and continuing smokers. Five electronic databases were searched before January 2015. Population-based prospective cohort studies were included if they recorded the weight change of adult smokers from baseline (before smoking cessation) to follow-up (at least 3 months after cessation). Thirty-five cohort studies were identified, including 63,403 quitters and 388,432 continuing smokers. The mean weight gain was 4.10 kg (95% confidence interval [CI]: 2.69, 5.51) and body mass index (BMI) gain was 1.14 kg m(-2) (95% CI: 0.50, 1.79) among quitters. Compared with continuing smoking, quitting smoking was significantly associated with absolute weight (adjusted mean difference [MD]: 2.61 kg; 95% CI: 1.61, 3.60) and BMI gain (adjusted MD: 0.63 kg m(-2) ; 95% CI: 0.46, 0.80). Subgroup analyses using geographic region found that the difference in weight gain was considerably greater in studies from North America than from Asia. Follow-up length was identified as a source of heterogeneity, such that studies with longer follow-up showed greater difference in weight gain. Effective strategies are needed to encourage smokers to quit irrespective of potential weight gain and to help quitters avoid excess weight gain.

Demographic, dietary and physical activity predictors of general and abdominal obesity among university students: a cross-sectional study

BACKGROUND

Obesity has become a disease of global public health concern in both developing and developed countries. We investigated the influence of socio-demographic, dietary habits and physical activity levels on general and abdominal obesity among a sample of university students in Ghana.

METHODS

This cross-sectional study was carried out among a sample of 552 students attending the University for Development Studies, School of Medicine and Health Sciences, Tamale, Ghana. Demographic characteristics were assessed using questionnaire. Dietary habits were measured by means of food frequency questionnaires. Anthropometric measurements were done using appropriate methods. Physical activity levels were measured using the World Health Organization (WHO) global physical activity questionnaire. Spearman's nonparametric correlation coefficient and multinomial logistic regression analysis were used to investigate the determinants of general and abdominal obesity.

RESULTS

The prevalence of general overweight/obesity (25.8 % vs. 5.9 %) and abdominal obesity (40.9 % vs. 0.8 %) was higher in female students than in male students. General overweight/obesity was less likely in students who engaged in vigorous physical activity (Adjusted Odds Ratio (AOR) = 0.3, 95 % CI = 0.1 - 0.7, p = 0.004), but more likely in students who consumed fruits and vegetables > 3 days per week (AOR = 2.6, 95 % CI = 1.2 - 5.4, p = 0.015). Abdominal obesity was also less likely in male students (AOR = 0.0, 95 % CI = 0.0 - 0.5, p = 0.017) but more likely in students who consumed roots and tubers > 3 times per week (AOR = 8.0, 95 % CI = 2.2 - 10.1, p = 0.017) and in those who consumed alcoholic and non-alcoholic beverages > 3 times per week (AOR = 8.2, 95 % CI = 2.2 - 31.1, p = 0.002).

CONCLUSION

Demographic factors, dietary habits and physical activity levels were found to be associated to general overweight/obesity and abdominal obesity. General overweight/obesity was associated to the consumption of fruits and vegetables > 3 times a week. The consumption of roots and tubers > 3 times per week and alcoholic and non-alcohol beverages > 3 times a week was associated to abdominal obesity. Engagement in vigorous physical activity and being male were negatively associated to general overweight/obesity and abdominal obesity respectively. Promotion of active lifestyles in young adults should be encouraged.

Higher Intake of Fruit, but Not Vegetables or Fiber, at Baseline Is Associated with Lower Risk of Becoming Overweight or Obese in Middle-Aged and Older Women of Normal BMI at Baseline

BACKGROUND

Fruit, vegetable, and dietary fiber intake have been associated with lower risk of cardiovascular disease (CVD); however, little is known about their role in obesity prevention.

OBJECTIVE

Our goal was to investigate whether intake of fruits, vegetables, and dietary fiber is associated with weight change and the risk of becoming overweight and obese.

METHODS

We studied 18,146 women aged ≥45 y from the Women's Health Study free of CVD and cancer with an initial body mass index (BMI) of 18.5 to <25 kg/m². Fruit, vegetable, and dietary fiber intakes were assessed at baseline through a 131-item food-frequency questionnaire, along with obesity-related risk factors. Women self-reported body weight on annual questionnaires.

RESULTS

During a mean follow-up of 15.9 y, 8125 women became overweight or obese (BMI ≥25 kg/m²). Intakes of total fruits and vegetables, fruits, and dietary fiber were not associated with the longitudinal changes in body weight, whereas higher vegetable intake was associated with greater weight gain (P-trend: 0.02). In multivariable analyses, controlling for total energy intake and physical activity along with other lifestyle, clinical, and dietary factors, women in the highest vs. lowest quintile of fruit intake had an HR of 0.87 (95% CI: 0.80, 0.94; P-trend: 0.01) of becoming overweight or obese. No association was observed for vegetable or dietary fiber intake. The association between fruit intake and risk of becoming overweight or obese was modified by baseline BMI (P-interaction: <0.0001) where the strongest inverse association was observed among women with a BMI <23 kg/m² (HR: 0.82; 95% CI: 0.71, 0.94).

CONCLUSION

Our results suggest that greater baseline intake of fruit, but not vegetables or fiber, by middle-aged and older women with a normal BMI at baseline is associated with lower risk of becoming overweight or obese.

Young woman smokers gain significantly more weight over 2-year follow-up than non-smokers. How Virginia doesn't slim

OBJECTIVE

Although young women often report smoking for weight control purposes, no prospective study has tested whether smokers subsequently gain less weight over time than non-smokers. As this is an important lacuna because smoking results in greater mortality than obesity, the present study addresses this question.

METHOD

Female college students (N = 398; M age = 18.4, SD =0.6; M BMI = 23.7, SD =4.3) recruited for a body acceptance intervention trial provided data on smoking behavior and had their body mass measured at baseline and at 1-mo, 6-mo, 1-yr, and 2-yr follow-ups.

RESULTS

Counter to the belief that smoking is an effective weight control strategy, baseline smokers (n = 29) gained significantly more weight (r = .29) than baseline non-smokers (n = 304), controlling for baseline BMI, parental obesity status, socio-economic status, and intervention condition; over 2-yr follow-up smokers gained 2.9 kg versus 0.9 kg for non-smokers. Descriptive data indicated that weight gain was greater for young women who quit smoking during follow-up (n = 13; M = 4.8 kg) than for persistent smokers (n = 16; M = 1.4 kg), though both groups gained more weight than non-smokers.

CONCLUSIONS

RESULTS challenge the widely held belief that smoking is an effective weight control strategy, ironically suggesting that smokers gain more weight than non-smokers during young adulthood, though non-experimental prospective studies do not establish causal relations and future research with larger representative samples is needed.

Alterations in food group intakes and subsequent weight changes in adults: tehran lipid and glucose study

BACKGROUND

The extent of weight change is varied for specific foods. This highlights the effect of dietary quality and food choices on weight control.

OBJECTIVES

The aim of this study was to examine the association between alterations in food group intake and weight change over a 3 years follow-up period.

MATERIALS AND METHODS

This longitudinal study was conducted on 851 adults in the framework of Tehran Lipid and Glucose Study. Intakes of various foods were measured at baseline and after 3 years using a validated semi-quantitative food frequency questionnaire. Dietary data was grouped into 13 food groups. Alterations in food group intakes were categorized in tertiles; middle tertile of intake changes was considered as the reference category and the first and last tertiles of changes as increased and decreased intakes, respectively. Weight change per year of follow-up was the outcome of interest. Weight gain was defined as ≥ 0.5 kg/y, weight loss as ≤ -0.5 kg/y and stable weight as > -0.5 to < 0.5 kg/y. Multinomial logistic regression was used with stable weight as the reference group.

RESULTS

IN MEN, WEIGHT LOSS WAS SIGNIFICANTLY PREDICTED ONLY BY DECREASED INTAKE OF ADDED SUGARS (OR: 2.21, 95% CI: 1.06-4.63). In women, weight gain was significantly predicted by decreased intake of whole grains (OR: 1.92, 95% CI: 1.11-3.31) and weight loss was predicted by decreased intake of vegetables (OR: 0.44, 95% CI: 0.21-0.91).

CONCLUSIONS

Alterations in consumption of whole grains, vegetables, and added sugars are associated with body weight change, suggesting that it could be helpful in weight control.

Food groups and weight gain in Japanese men

Identifying subjects at high risk of weight gain according to consumption of food groups is important for individualizing nutritional education, but prospective studies of this issue have been few. We determined whether intake of specific food groups could predict future weight gain. We evaluated data from health checkups on 1236 Japanese men aged 28 to 87 years in 2005 and 2006. Dietary intake was assessed by a 24-h dietary recall at baseline. Weight change was measured after 1 year. Weight increased in 44.7% (n = 553) of participants. Multivariate regression analysis involving many food groups showed a significant association between sugar intake and weight gain after adjustment for age, body mass index (BMI), total energy intake, alcohol, smoking and regular physical exercise (β = 0.22, P = 0.04). The effect of intake of 'fats and oils' was significant when adjusted for age and BMI, however, it became insignificant after adjustment for age, BMI and total energy intake. Intake of sugar, which was evaluated as a food group, was predictive of subsequent weight gain among Japanese men, even after adjustment for many confounders. This corroborates the evidence so far concerning the links between sugar intake and weight gain. Further long-term research is required to give robust recommendation to the public.

Predictors of change in weight and waist circumference: 15-year longitudinal study in Australian adults

BACKGROUND/OBJECTIVES

This study examines which socio-demographic and lifestyle characteristics are associated with weight and waist circumference (WC) change in a cohort of Australian adults over a 15-year period (1992-2007). Further, it tests the effect of period of birth (birth cohort) on mean weight and WC at two time points, 15 years apart.

SUBJECTS/METHODS

Up to three repeated measures of weight (n=1437) and WC (n=1317) were used. Self-reported data on socio-demographic and lifestyle characteristics were derived from repeated questionnaires. Multivariable models, stratified by sex, were adjusted for potential confounders.

RESULTS

Participants born more recently were heavier, on average, than those in the same age group 15 years earlier, but there was no such secular trend in WC. Age at baseline was associated with change in weight and WC, but the pattern was different: participants gained weight up to age 55 years, while WC gain continued to 65 years. In women, higher level of recreational physical activity was associated with lower WC gain (P<0.05). Parity was also associated with WC change in women (P<0.05), but there was no linear trend.

CONCLUSIONS

Age was the most important factor associated with change in weight and WC in both sexes, apparently reducing the influence of all potential covariates. Among women, physical activity and parity were also associated with change in weight and WC. This study provides longitudinal evidence to support public health efforts that address the continuous increases in average weight and WC of many populations around the world.

Body mass index gain between ages 20 and 40 years and lifestyle characteristics of men at ages 40-60 years: the Adventist Health Study-2

BACKGROUND

Obesity increases risk of premature disease, and may be associated with unfavorable lifestyle changes that add to risk. This study analyzed the association of midlife BMI change with current lifestyle patterns among multiethnic men.

METHODS

Men aged 40-60 years (n=9864) retrospectively reported body weight between ages 20-40 years and current dietary, TV, physical activity and sleep practices in the Adventist Health Study II, a study of church-goers in the US and Canada. In multivariate logistic regression analysis, odds ratios for BMI gain were calculated for each lifestyle practice controlling for sociodemographic and other lifestyle factors and current BMI.

RESULTS

Men with median or higher BMI gain (2.79 kg/m(2)) between ages 20-40 years were more likely to consume a non-vegetarian diet, and engage in excessive TV watching and little physical activity and had a shorter sleep duration compared to men with BMI gain below the median (all p<0.001). In multivariate logistic analysis current BMI was significantly associated with all lifestyle factors (all p≤0.005). BMI gain was associated with lower odds of vegetarian diet (odds ratio [OR] 0.939; 95% confidence interval [CI] 0.921-0.957) and of physical activity ≥150 min/week (OR 0.979, 95% CI 0.960-0.999).

CONCLUSIONS

These findings imply that diet and less physical activity are associated with both gained and attained BMI, while inactivity (TV watching) and short sleep duration correlated only with attained BMI. Unhealthy lifestyle may add risk to that associated with BMI. Longitudinal and intervention studies are needed to infer causal relationships.

Formative research on HAPA model determinants for fruit and vegetable intake: target beliefs for audiences at different stages of change

Theoretically driven health communications are needed to promote fruit and vegetable intake among people at different stages of change. The Health Action Process Approach, a clearly specified model and good predictor of fruit and vegetable intake, was used as a framework to guide a formative research for the development of health messages targeting individuals at either a non-intentional or intentional stage of change. A mixed-method approach was used, combining eight focus groups (n = 45) and a questionnaire (n = 390). Target beliefs for people at both stages were identified under five theoretical constructs (risk perception, outcome expectancies, action planning, coping planning and self-efficacy). Highlighting health problems due to low fruit and vegetable consumption, health benefits, weight reduction and pleasure and enhancing self-efficacy to increase fruit and vegetable intake are the main guidelines for designing messages to non-intenders. For intenders, messages should reassure them of their ability to maintain adequate fruit and vegetable consumption, outline specific plans for increased consumption, identify barriers such as preparation, forgetting or being tired and unwilling to eat fruits and vegetables and suggest strategies to overcome them, such as presenting some practical examples on how to include fruits and vegetables when eating out.

Long-term student outcomes of the Integrated Nutrition and Physical Activity Program

OBJECTIVE

To examine the long-term effects of the Integrated Nutrition and Physical Activity Program (INPAP), a school-based nutrition education program.

DESIGN

Quasi-experimental design comparing intervention and comparison cohorts at 3-6 years after delivery of the INPAP intervention on nutrition- and physical activity-related outcomes.

SETTING

This study was conducted in 1 school district in a low-income rural county of ∼15,000 residents in south-central Colorado.

PARTICIPANTS

In second grade, intervention and comparison cohorts included 173 (fall 2000) and 190 (fall 1999) students, respectively. Approximately 60% of these students completed assessments in eighth grade.

INTERVENTIONS

INPAP is an experiential school-based nutrition education program, grounded in social cognitive theory and Piaget's cognitive development theory and adapted for use in a rural setting.

OUTCOMES

Nutrition and physical activity knowledge, self-efficacy, attitudes and behaviors, body mass index.

ANALYSIS

Wilcoxon signed rank test, chi-square test for proportions, and t test for means.

RESULTS

Long-term effects were observed in nutrition-related knowledge and attitudes but not self-efficacy or behavior change. The effects that did occur were attenuated over time.

CONCLUSION AND IMPLICATIONS

This study found that INPAP implemented in elementary school had limited lasting effects by the end of middle school, a time when students have increased autonomy to make food choices.

Facial affective reactions to bitter-tasting foods and body mass index in adults

Differences in food consumption among body-weight statuses (e.g., higher fruit intake linked with lower body mass index (BMI) and energy-dense products with higher BMI) has raised the question of why people who are overweight or are at risk of becoming overweight eat differently from thinner people. One explanation, in terms of sensitivity to affective properties of food, suggests that palatability-driven consumption is likely to be an important contributor to food intake, and therefore body weight. Extending this approach to unpalatable tastes, we examined the relationship between aversive reactions to foods and BMI. We hypothesized that people who have a high BMI will show more negative affective reactions to bitter-tasting stimuli, even after controlling for sensory perception differences. Given that hedonic reactions may influence consumption even without conscious feelings of pleasure/displeasure, the facial expressions were included in order to provide more direct access to affective systems than subjective reports. Forty adults (28 females, 12 males) participated voluntarily. Their ages ranged from 18 to 46 years (M=24.2, SD=5.8). On the basis of BMI, participants were classified as low BMI (BMI<20; n=20) and high BMI (BMI>23; n=20). The mean BMI was 19.1 for low BMI (SD=0.7) and 25.2 for high BMI participants (SD=1.8). Each subject tasted 5 mL of a grapefruit juice drink and a bitter chocolate drink. Subjects rated the drinks' hedonic and incentive value, familiarity and bitter intensity immediately after each stimulus presentation. The results indicated that high BMI participants reacted to bitter stimuli showing more profound changes from baseline in neutral and disgust facial expressions compared with low BMI. No differences between groups were detected for the subjective pleasantness and familiarity. The research here is the first to examine how affective facial reactions to bitter food, apart from taste responsiveness, can predict differences in BMI.

Associação entre consumo de alimentos embutidos e obesidade em um estudo de base populacional de nipo-brasileiros

OBJETIVO: Investigar a associação entre consumo de alimentos embutidos e obesidade generalizada, abdominal e generalizada com abdominal em nipo-brasileiros de Bauru, SP. SUJEITOS E MÉTODOS: Quatrocentos e quarenta e três mulheres e 329 homens nipo-brasileiros não miscigenados (≥ 30 anos) foram avaliados em estudo transversal de base populacional. Para o diagnóstico de obesidade, foram empregados os critérios da Organização Mundial da Saúde para asiáticos. A ingestão de alimentos foi avaliada por meio de questionário de frequência alimentar validado. A ingestão foi estratificada em terços para análise. RESULTADOS: Nos homens, a ingestão de colesterol e alimentos embutidos mostrou-se positivamente associada à obesidade generalizada com abdominal quando o primeiro terço de ingestão foi comparado ao último, após ajustes (OR 2,97; IC95% 1,13-7,78). Em mulheres, somente o grupo das carnes vermelhas associou-se à obesidade geral com abdominal após ajustes (OR 0,47; IC95% 0,23-0,96). CONCLUSÃO: Ingestão elevada de alimentos embutidos associou-se à obesidade generalizada com adiposidade abdominal em homens nipo-brasileiros, mas não em mulheres.

Fruit and vegetable exposure in children is linked to the selection of a wider variety of healthy foods at school

Schools often offer healthy fruits and vegetables (FV) and healthy entrées. However, children may resist these efforts due to a lack of familiarity with the offerings. While numerous exposures with a food increase its liking, it may be that an exposure to a variety of FV at home leads to greater willingness to select other foods - even those that are unrelated to those eaten at home. As an initial test of this possibility, this study was designed to examine how self-reports of exposure and consumption of various FV were associated with the selection of FV and lunch entrées at school. Participants (n = 59) were a convenience sample of elementary children. A median split was used to place students into high- and low-exposure groups for self-reports of both exposure and consumption at home. The primary dependent variables were self-reports of selecting FV at school; the children's absolute and relative ratings of eight 'healthier' lunch entrées; and self-reports of selecting these entrées. These entrées were recently added to the school menu and, therefore, tended to be less familiar to children. Food ratings were collected through taste exposures conducted at school. Results indicate that children who reported more frequent exposure to FV at home consumed a wider variety of FV at school and were more likely to report selecting 'healthier' entrées at school lunch. These data suggest that exposure to, and the consumption of, a variety of FV may make children more willing to select a wider range of FV and other healthy entrées.

The impact of state-level nutrition-education program funding on BMI: evidence from the behavioral risk factor surveillance system

Currently, there is insufficient evidence regarding which policies will improve nutrition, reduce BMI levels and the prevalence of obesity and overweight nationwide. This preliminary study investigates the impact of a nutrition-education policy relative to price policy as a means to reduce BMI in the United States (US). Model estimations use pooled cross-sectional data at the individual-level from the Centers for Disease Control's (CDC), Behavioral Risk Factor Surveillance System (BRFSS), state-level food prices from the American Chamber of Commerce Research Association (ACCRA) and funding for state-specific nutrition-education programs from the United States Department of Agriculture (USDA) from 1992 to 2006. The total number of observations for the study is 2,249,713 over 15 years. During this period, federal funding for state-specific nutrition-education programs rose from approximately $660 thousand for seven states to nearly $248 million for all fifty-two states. In 2011, federal funding for nutrition-education programs reached $375 million. After controlling for state-fixed effects, year effects and state specific linear and quadratic time trends, we find that nutrition education spending has the intended effect on BMI, obese and overweight in aggregate. However, we find heterogeneity as individuals from certain, but not all, income and education levels respond to nutrition-education funding. The results regarding nutrition-education programs suggest that large scale funding of nutrition-education programs may improve BMI levels and reduce obesity and overweight. However, more study is required to determine if these funds are able make the requisite dietary improvements that may ultimately improve BMI for individuals from low income and education-levels.

Diet quality, measured by fruit and vegetable intake, predicts weight change in young women

This study investigates the relationship between diet quality and weight gain in young women. Young women (n = 4,287, with 1,356 women identified as plausible subsample aged 27.6 ± 1.5 years at baseline) sampled from the Australian Longitudinal Study on Women's Health study completed food frequency questionnaires in 2003, which were used to evaluate diet quality using three indices: Australian Recommended Food Score (ARFS), Australian Diet Quality Index (Aus-DQI), and Fruit and Vegetable Index (FAVI). Weight was self-reported in 2003 and 2009. Multivariate linear regression was used to examine the association between tertiles of each diet quality index and weight change from 2003 to 2009. The ARFS and FAVI were significant predictors of 6-year weight change in this group of young women, while Aus-DQI did not predict weight change (P > 0.05). In the fully adjusted model, those who were in the top tertile of the ARFS significantly gained lower weight gain compared with the lower tertile for the plausible TEI sub-sample (β = -1.6 kg (95% CI: -2.67 to -0.56), P = 0.003). In the fully adjustment model, young women were classified in the highest FAVI tertile and gained significantly less weight than those in the lowest tertile for the plausible TEI (β = -1.6 kg (95% CI: -2.4 to -0.3) P = 0.01). In conclusion, overall diet quality measured by the ARFS and the frequency and variety of fruit and vegetable consumption may predict long-term weight gain in young women. Therefore, health promotion programs encouraging frequent consumption of a wide variety of fruits and vegetables are warranted.

Is beer consumption related to measures of abdominal and general obesity? A systematic review and meta-analysis

A systematic review was conducted to assess the evidence linking beer consumption to abdominal and general obesity. Following a systematic search strategy, 35 eligible observational studies and 12 experimental studies were identified. Regarding abdominal obesity, most observational data pointed towards a positive association or no association between beer intake and waist circumference or waist-to-hip ratio in men, whereas results for women were inconsistent. Data from a subset of studies indicated that beer intake > 500 mL/day may be positively associated with abdominal obesity. Regarding general obesity, most observational studies pointed towards an inverse association or no association between beer intake and body weight in women and a positive association or no association in men. Data from six experimental studies in men, in which alcoholic beer was compared with low-alcoholic beer, suggested that consumption of alcoholic beer (for 21-126 days) results in weight gain (0.73 kg; P < 0.0001), but data from four studies comparing intake of alcoholic beer with intake of no alcohol did not support this finding. Generally, experimental studies had low-quality data. In conclusion, the available data provide inadequate scientific evidence to assess whether beer intake at moderate levels (<500 mL/day) is associated with general or abdominal obesity. Higher intake, however, may be positively associated with abdominal obesity.

Combined impact of lifestyle factors on prospective change in body weight and waist circumference in participants of the EPIC-PANACEA study

Background

The evidence that individual dietary and lifestyle factors influence a person’s weight and waist circumference is well established; however their combined impact is less well documented. Therefore, we investigated the combined effect of physical activity, nutrition and smoking status on prospective gain in body weight and waist circumference.

Methods

We used data of the prospective EPIC-PANACEA study. Between 1992 and 2000, 325,537 participants (94,445 men and 231,092 women, aged between 25–70) were recruited from nine European countries. Participants were categorised into two groups (positive or negative health behaviours) for each of the following being physically active, adherent to a healthy (Mediterranean not including alcohol) diet, and never-smoking for a total score ranging from zero to three. Anthropometric measures were taken at baseline and were mainly self-reported after a medium follow-up time of 5 years.

Results

Mixed-effects linear regression models adjusted for age, educational level, alcohol consumption, baseline body mass index and follow-up time showed that men and women who reported to be physically active, never-smoking and adherent to the Mediterranean diet gained over a 5-year period 537 (95% CI −706, −368) and 200 (−478, −87) gram less weight and 0.95 (−1.27, −0.639) and 0.99 (−1.29, −0.69) cm less waist circumference, respectively, compared to participants with zero healthy behaviours.

Conclusion

The combination of positive health behaviours was associated with significantly lower weight and waist circumference gain.

Critical review: vegetables and fruit in the prevention of chronic diseases

BACKGROUND

Vegetables and fruit provide a significant part of human nutrition, as they are important sources of nutrients, dietary fibre, and phytochemicals. However, it is uncertain whether the risk of certain chronic diseases can be reduced by increased consumption of vegetables or fruit by the general public, and what strength of evidence has to be allocated to such an association.

METHODS

Therefore, a comprehensive analysis of the studies available in the literature and the respective study results has been performed and evaluated regarding obesity, type 2 diabetes mellitus, hypertension, coronary heart disease (CHD), stroke, cancer, chronic inflammatory bowel disease (IBD), rheumatoid arthritis (RA), chronic obstructive pulmonary disease (COPD), asthma, osteoporosis, eye diseases, and dementia. For judgement, the strength of evidence for a risk association, the level of evidence, and the number of studies were considered, the quality of the studies and their estimated relevance based on study design and size.

RESULTS

For hypertension, CHD, and stroke, there is convincing evidence that increasing the consumption of vegetables and fruit reduces the risk of disease. There is probable evidence that the risk of cancer in general is inversely associated with the consumption of vegetables and fruit. In addition, there is possible evidence that an increased consumption of vegetables and fruit may prevent body weight gain. As overweight is the most important risk factor for type 2 diabetes mellitus, an increased consumption of vegetables and fruit therefore might indirectly reduces the incidence of type 2 diabetes mellitus. Independent of overweight, there is probable evidence that there is no influence of increased consumption on the risk of type 2 diabetes mellitus. There is possible evidence that increasing the consumption of vegetables and fruit lowers the risk of certain eye diseases, dementia and the risk of osteoporosis. Likewise, current data on asthma, COPD, and RA indicate that an increase in vegetable and fruit consumption may contribute to the prevention of these diseases. For IBD, glaucoma, and diabetic retinopathy, there was insufficient evidence regarding an association with the consumption of vegetables and fruit.

CONCLUSIONS

This critical review on the associations between the intake of vegetables and fruit and the risk of several chronic diseases shows that a high daily intake of these foods promotes health. Therefore, from a scientific point of view, national campaigns to increase vegetable and fruit consumption are justified. The promotion of vegetable and fruit consumption by nutrition and health policies is a preferable strategy to decrease the burden of several chronic diseases in Western societies.

Walking attenuates the relationships of high-meat, low-fruit dietary intake to total and regional adiposity in men and women

Vigorous physical activity (running) has been shown to attenuate the association between diet and body weight. Walking is the most popular physical activity, but is a moderate-intensity physical activity because it requires less than sixfold the energy expenditure of sitting at rest. We therefore examined whether reported distance walked per week affected the relationship of diet to BMI and circumferences of the waist, hip, and chest in 30,014 female and 7,133 male participants of the National Walkers' Health Study. Reported meat and fruit intakes served as indicators of high-risk diets for weight gain. The analyses showed that higher meat and lower fruit intake were significantly and consistently associated with greater BMI and waist circumference at all activity levels. Longer usual walking distance significantly attenuated the concordant relationships of diet with women's BMIs (P < 10(-8)), men's BMIs (P = 0.04), and women's waist (P < 10(-6)), hip (P = 0.0001), and chest circumferences (P < 10(-5)). Compared to walkers who averaged <1.5 km/day, the association of diet with adiposity in subjects who walked ≥1.5 km/day was reduced 21% in women and 31% in men for BMI; 20% in women and 27% in men for waist circumference; 19% for women's hip circumference; and 26% for women's chest circumference. Thus we conclude that diets characterized by high-meat/low-fruit intake were significantly associated with greater BMI, and this association was attenuated by moderate physical activity. The weaker results in men than women probably related to the smaller sample size, and reduced statistical power of the men.

The role of high-protein diets in body weight management and health

Studies examining the health benefits of high-protein diets typical of most affluent and many developing countries are not consistent. Prospective epidemiological studies relating dietary protein to clinical and metabolic endpoints suggest increased weight gain and increased risk of diabetes amongst those with a high protein intake and an increased risk of cancer with high intakes of red meat, but lower blood pressure and possibly a reduced risk of heart disease with higher protein intakes. The potential for high-protein diets to confer greater benefit than other diets has been examined using ad libitum and energy restricted diets. Of greatest interest have been the comparisons between high-protein and high-carbohydrate diets. Many trials have reported greater weight loss especially in the context of ad libitum diets over the short-to medium-term, sparing of lean body mass, lowering of triglyceride levels, improved HDL: total cholesterol ratio and improved glycaemic control. Limited data regarding insulin sensitivity are less consistent. A major difficulty in interpreting the results of these studies is that carbohydrate quality has not been taken into account. Furthermore, longer term comparisons of weight reducing diets differing in macronutrient composition have reported similar outcomes, suggesting that compliance is a more important consideration. Nevertheless dietary patterns with high-protein intakes are appropriate for weight reduction and weight maintenance and may be useful for those who have high triglyceride levels and other features of the metabolic syndrome.

Physical activity and the risk of becoming overweight or obese in middle-aged and older women

Although public health campaigns stress leisure time physical activity (LTPA) as essential for obesity prevention, few epidemiological studies have focused on the association of specific types and intensities of LTPA and the clinical endpoints of overweight and obesity. Therefore, we prospectively assessed whether moderate- and vigorous-intensity as well as total LTPA were associated with the risk of becoming either overweight or obese using a prospective cohort design of 19,003 women enrolled in the Women's Health Study (WHS). Women reported their participation in walking and LTPA at baseline. During a median follow-up of 11.6 years, 7,865 women became overweight or obese. In multivariable-adjusted models that included demographic, lifestyle, and dietary factors, both vigorous-intensity and total LTPA showed a modest inverse relationship with the development of overweight/obesity. The hazard ratios (HR) and 95% confidence interval (CI) for the highest categories of vigorous-intensity LTPA (>2,000 kcal/week) and total LTPA (>3,000 kcal/week) compared with no LTPA were 0.79 (0.71-0.89) and 0.87 (0.78-0.96), respectively. In addition, a greater percentage of total LTPA spent performing vigorous intensity activities was associated with a lower risk of overweight/obesity (multivariable HR 0.93, 95% CI 0.87-0.98 for performing >50% compared with <50% of activity as vigorous). In conclusion, higher amounts of total LTPA should be encouraged to prevent obesity. Among those willing to participate in vigorous LTPA, and for whom such activities are not contraindicated, vigorous LPTA should be encouraged.

Physical activity, walking and leanness: an analysis of the Northern Ireland Sport and Physical Activity Survey (SAPAS)

OBJECTIVE

To report on the contribution walking makes to total weekly physical activity and the relationship between the volume and intensity of walking and leanness in a representative sample of the Northern Ireland population.

METHOD

4563 adults participated in this cross-sectional survey of physical activity behaviour. Self-reported height and weight was used to determine inverse body mass index (iBMI) as a measure of leanness. Data across all domains of physical activity including self-reported volume and intensity of walking (in bouts of 10 min or more) were analysed to determine their contribution to leanness using ANCOVA, having controlled for age, gender, socio-economic and smoking status.

RESULTS

Over 68% of the participants reported walking >10 minutes during the previous week but only 24% report walking at a brisk or fast pace. Time walking at a brisk or fast pace for personal transport was identified as having the strongest positive association with being lean (F(1,4256)=10.45, β=0.051 cm(2) kg(-1) min(-1) (SE=0.016),P=0.001).

CONCLUSIONS

In addition to increasing the amount of walking and the percentage of people walking regularly, public health messages encouraging an increase in walking pace may be valuable to increase the proportion of the population meeting physical activity guidelines and gaining associated health benefits.

Longitudinal changes in BMI in older adults are associated with meat consumption differentially, by type of meat consumed

Hypotheses regarding the role of meat consumption in body weight modulation are contradictory. Prospective studies on an association between meat consumption and BMI change are limited. We assessed the association between meat consumption and change in BMI over time in 3902 men and women aged 55-69 y from the Netherlands Cohort Study. Dietary intake was estimated at baseline using a FFQ. BMI was ascertained through baseline self-reported height (1986) and weight (1986, 1992, and 2000). Analyses were based on sex-specific categories of daily total fresh meat, red meat, beef, pork, minced meat, chicken, processed meat, and fish consumption at baseline. Linear mixed effect modeling adjusted for confounders was used to assess longitudinal associations. Significant cross-sectional differences in BMI between quintiles of total meat intake were observed (P-trend < 0.01; both sexes). No association between total fresh meat consumption and prospective BMI change was observed in men (BMI change highest vs. lowest quintile after 14 y: -0.06 kg/m²; P = 0.75) and women (BMI change: 0.26 kg/m²; P = 0.20). Men with the highest intake of beef experienced a significantly lower increase in BMI after 6 and 14 y than those with the lowest intake (BMI change after 14 y 0.60 kg/m²). After 14 y, a significantly higher increase in BMI was associated with higher intakes of pork in women (BMI change highest vs. lowest quintile: 0.47 kg/m²) and chicken in both sexes (BMI change highest vs. lowest category in both men and women: 0.36 kg/m²). The results remained similar when stratifying on median baseline BMI, and age-stratified analyses yielded mixed results. Differential BMI change effects were observed for several subtypes of meat. However, total meat consumption, or factors directly related to total meat intake, was not strongly associated with weight change during the 14-y prospective follow-up in this elderly population.

Fruit and vegetable consumption and prospective weight change in participants of the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home, and Obesity study

BACKGROUND

Fruit and vegetable consumption might prevent weight gain through their low energy density and high dietary fiber content.

OBJECTIVE

We assessed the association between the baseline consumption of fruit and vegetables and weight change in participants from 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition study.

DESIGN

Diet was assessed at baseline in 373,803 participants by using country-specific validated questionnaires. Weight was measured at baseline and self-reported at follow-up in most centers. Associations between baseline fruit and vegetable intakes (per 100 g/d) and weight change (g/y) after a mean follow-up of 5 y were assessed by using linear mixed-models, with age, sex, total energy intake, and other potential confounders controlled for.

RESULTS

After exclusion of subjects with chronic diseases at baseline and subjects who were likely to misreport energy intakes, baseline fruit and vegetable intakes were not associated with weight change overall. However, baseline fruit and vegetable intakes were inversely associated with weight change in men and women who quit smoking during follow-up. We observed weak positive associations between vegetable intake and weight change in women who were overweight, were former smokers, or had high prudent dietary pattern scores and weak inverse associations between fruit intake and weight change in women who were >50 y of age, were of normal weight, were never smokers, or had low prudent dietary pattern scores.

CONCLUSIONS

In this large study, higher baseline fruit and vegetable intakes, while maintaining total energy intakes constant, did not substantially influence midterm weight change overall but could help to reduce risk of weight gain in persons who stop smoking. The interactions observed in women deserve additional attention.

Exercise attenuates the association of body weight with diet in 106,737 runners

PURPOSE

The high prevalence of obesity in Western societies has been attributed in part to high-fat low-CHO food consumption. However, people have also become less active, and inactivity may have increased the risk for weight gain from poor dietary choices. Analyses were performed to test whether diet-weight relationships were attenuated by vigorous exercise.

METHODS

Age- and education-adjusted cross-sectional regression analyses of 62,042 men and 44,695 women recruited for the National Runners' Health Study were conducted. Reported meat and fruit intakes were analyzed separately and as indicators of high-risk diets.

RESULTS

The runners were generally lean (mean ± SD: males = 24.15 ± 2.81 kg·m(-2), females = 21.63 ± 2.70 kg·m(-2)) as measured by body mass index (BMI), educated (males = 16.42 ± 2.47 yr, females = 16.04 ± 2.32 yr), and middle-aged (males = 44.40 ± 10.83 yr, females = 38.21 ± 10.08 yr), who ran 5.30 ± 3.23 km·d(-1) if male and 4.79 ± 3.00 km·d(-1) if female. Running significantly attenuated BMI's relationship to reported meat and fruit intakes in men (P < 10(-8) and P < 10(-12), respectively) and women (P < 10(-15) and P < 10(-6), respectively). Specifically, compared with running <2 km·d(-1), running >8 km·d(-1) reduced the apparent BMI increase per serving of meat by 43% in men (slope ± SE = from 0.74 ± 0.10 to 0.42 ± 0.06) and 55% in women (from 1.26 ± 0.13 to 0.57 ± 0.09) and reduced the apparent BMI reduction per serving of fruit by 75% in men (from -0.28 ± 0.04 to -0.07 ± 0.02) and 94% in women (from -0.16 ± 0.05 to -0.01 ± 0.02). Running also significantly attenuated the concordant relationship between reported meat intake and waist and chest circumferences in men (P < 10(-9) and P = 0.0002, respectively) and women (P = 0.0004 and P < 10(-5), respectively) and the concordant relationship between meat intake and hip circumference in women (P < 10(-6)).

CONCLUSIONS

Vigorous exercise may mitigate diet-induced weight gain, albeit not guaranteeing protection from poor dietary choices.

Cross-sectional association of nut intake with adiposity in a Mediterranean population

BACKGROUND AND AIMS

Nut intake has been inversely related to body mass index (BMI) in prospective studies. We examined dietary determinants of adiposity in an elderly Mediterranean population with customarily high nut consumption.

METHODS AND RESULTS

A cross-sectional study was conducted in 847 subjects (56% women, mean age 67 years, BMI 29.7kg/m(2)) at high cardiovascular risk recruited into the PREDIMED study. Food consumption was evaluated by a validated semi-quantitative questionnaire, energy expenditure in physical activity by the Minnesota Leisure Time Activity questionnaire, and anthropometric variables by standard measurements. Nut intake decreased across quintiles of both BMI and waist circumference (P-trend <0.005; both). Alcohol ingestion was inversely related to BMI (P-trend=0.020) and directly to waist (P-trend=0.011), while meat intake was directly associated with waist circumference (P-trend=0.018). In fully adjusted multivariable models, independent dietary associations of BMI were the intake of nuts inversely (P=0.002) and that of meat and meat products directly (P=0.042). For waist circumference, independent dietary associations were intake of nuts (P=0.002) and vegetables (P=0.040), both inversely, and intake of meat and meat products directly (P=0.009). From the regression coefficients, it was predicted that BMI and waist circumference decreased by 0.78kg/m(2) and 2.1cm, respectively, for each serving of 30g of nuts. Results were similar in men and women.

CONCLUSION

Nut consumption was inversely associated with adiposity independently of other lifestyle variables. It remains to be explored whether residual confounding related to a healthier lifestyle of nut eaters might in part explain these results.

Relationship of fruit and vegetable intake with adiposity: a systematic review

Fruit and vegetable (FV) intake has been proposed to protect against obesity. The purpose of this paper was to assess the FV consumption to adiposity relationship. Twenty-three publications were included.

INCLUSION CRITERIA

longitudinal or experimental designs; FV intake tested in relation to adiposity; child, adolescent or adult participants; published in English-language peer-reviewed journals.

EXCLUSION CRITERIA

dietary pattern and cross-sectional designs; participants with health concerns. Experimental studies found increased FV consumption (in conjunction with other behaviours) contributed to reduced adiposity among overweight or obese adults, but no association was shown among children. Longitudinal studies among overweight adults found greater F and/or V consumption was associated with slower weight gain, but only half of child longitudinal studies found a significant inverse association. Limitations in methods prevented a thorough examination of the role of increased FV intake alone or mechanisms of effect. An inverse relationship between FV intake and adiposity among overweight adults appears weak; this relationship among children is unclear. Research needs to clarify the nature of, and mechanisms for, the effects of FV consumption on adiposity. Whether increases in FV intake in isolation from lower caloric intake or increased physical activity will result in declines or slower growth in adiposity remains unclear.

A brief assessment of eating habits and weight gain in a Mediterranean cohort

Assessment of eating habits (EH) through closed questions could be an alternative tool to assess diet as a predictor of weight change in epidemiological studies. The aim was to assess the association between baseline EH and the risk of weight gain or becoming overweight/obese in a Spanish dynamic prospective cohort (the Seguimiento Universidad de Navarra Project) of 10 509 participants. The baseline questionnaire included ten short questions with two possible answers: yes or no. We calculated a baseline EH score, categorised in quartiles, positively weighting answers on more fruit, vegetables, fish and fibre and less meat, sweets and pastries, fat, butter, fatty meats and added sugar in drinks. Reducing the consumption of meat or fat and removing fat from meat were significantly associated with lower weight gain. The partial correlation coefficient between EH score and weight change was - 0·033 (P = 0·001). We observed 1063 cases of incident overweight/obesity among 7217 participants without overweight/obesity at baseline. Trying to eat more fruit, fish or fibre and less meat was inversely significantly associated with incident overweight/obesity. Those participants in the upper quartile of the score were at a 38 % (adjusted OR 0·62; 95 % CI 0·48, 0·81) lower risk of developing overweight/obesity during the follow-up compared with those in the lower quartile. However, the receiver-operating characteristic curves for the model with and without the EH score were materially identical. Despite the apparent significant inverse association, this score had a low predictive value for future weight gain and for incident overweight/obesity in a Mediterranean population, although some EH were independently and positively associated with weight gain.

Potential health impact of switching from car to public transportation when commuting to work

We assessed humidity-corrected particulate matter (PM(2.5)) exposure and physical activity (using global positioning system monitors and diaries) among 18 people who commuted by car to Queens College, New York, New York, for 5 days, and then switched to commuting for the next 5 days via public transportation. The PM(2.5) differed little between car and public transportation commutes (1.41 μg/M(3)·min; P = .226). Commuting by public transportation rather than by car increased energy expenditure (+124 kcal/day; P < .001) equivalent to the loss of 1 pound of body fat per 6 weeks.

Meat consumption and prospective weight change in participants of the EPIC-PANACEA study

BACKGROUND

Meat intake may be related to weight gain because of its high energy and fat content. Some observational studies have shown that meat consumption is positively associated with weight gain, but intervention studies have shown mixed results.

OBJECTIVE

Our objective was to assess the association between consumption of total meat, red meat, poultry, and processed meat and weight gain after 5 y of follow-up, on average, in the large European population who participated in the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home and Obesity (EPIC-PANACEA) project.

DESIGN

A total of 103,455 men and 270,348 women aged 25-70 y were recruited between 1992 and 2000 in 10 European countries. Diet was assessed at baseline with the use of country-specific validated questionnaires. A dietary calibration study was conducted in a representative subsample of the cohort. Weight and height were measured at baseline and self-reported at follow-up in most centers. Associations between energy from meat (kcal/d) and annual weight change (g/y) were assessed with the use of linear mixed models, controlled for age, sex, total energy intake, physical activity, dietary patterns, and other potential confounders.

RESULTS

Total meat consumption was positively associated with weight gain in men and women, in normal-weight and overweight subjects, and in smokers and nonsmokers. With adjustment for estimated energy intake, an increase in meat intake of 250 g/d (eg, one steak at approximately 450 kcal) would lead to a 2-kg higher weight gain after 5 y (95% CI: 1.5, 2.7 kg). Positive associations were observed for red meat, poultry, and processed meat.

CONCLUSION

Our results suggest that a decrease in meat consumption may improve weight management.

Dietary determinants of changes in waist circumference adjusted for body mass index - a proxy measure of visceral adiposity

Background

Given the recognized health effects of visceral fat, the understanding of how diet can modulate changes in the phenotype “waist circumference for a given body mass index (WC_BMI)”, a proxy measure of visceral adiposity, is deemed necessary. Hence, the objective of the present study was to assess the association between dietary factors and prospective changes in visceral adiposity as measured by changes in the phenotype WC_BMI.

Methods and Findings

We analyzed data from 48,631 men and women from 5 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Anthropometric measurements were obtained at baseline and after a median follow-up time of 5.5 years. WC_BMI was defined as the residuals of waist circumference regressed on body mass index, and annual change in WC_BMI (ΔWC_BMI, cm/y) was defined as the difference between residuals at follow-up and baseline, divided by follow-up time. The association between energy, energy density (ED), macronutrients, alcohol, glycemic index (GI), glycemic load (GL), fibre and ΔWC_BMI was modelled using centre-specific adjusted linear regression, and random-effects meta-analyses to obtain pooled estimates. Men and women with higher ED and GI diets showed significant increases in their WC_BMI, compared to those with lower ED and GI [1 kcal/g greater ED predicted a ΔWC_BMI of 0.09 cm (95% CI 0.05 to 0.13) in men and 0.15 cm (95% CI 0.09 to 0.21) in women; 10 units greater GI predicted a ΔWC_BMI of 0.07 cm (95% CI 0.03 to 0.12) in men and 0.06 cm (95% CI 0.03 to 0.10) in women]. Among women, lower fibre intake, higher GL, and higher alcohol consumption also predicted a higher ΔWC_BMI.

Conclusions

Results of this study suggest that a diet with low GI and ED may prevent visceral adiposity, defined as the prospective changes in WC_BMI. Additional effects may be obtained among women of low alcohol, low GL, and high fibre intake.

Diet quality, physical activity, smoking status, and weight fluctuation are associated with weight change in women and men

The effect of diet quality on weight change, relative to other body weight determinants, is insufficiently understood. Furthermore, research on long-term weight change in U.S. adults is limited. We evaluated prospectively patterns and predictors of weight change in Framingham Offspring/Spouse (FOS) women and men (n = 1515) aged > or =30 y with BMI > or = 18.5 kg/m2 and without cardiovascular disease, diabetes, and cancer at baseline over a 16-y period. Diet quality was assessed using the validated Framingham Nutritional Risk Score. In women, older age (P < 0.0001) and physical activity (P < 0.05) were associated with lower weight gain. Diet quality interacted with former smoking status (P-interaction = 0.02); former smokers with lower diet quality gained an additional 5.2 kg compared with those with higher diet quality (multivariable-adjusted P-trend = 0.06). Among men, older age (P < 0.0001) and current smoking (P < 0.01) were associated with lower weight gain, and weight fluctuation (P < 0.01) and former smoking status (P < 0.0001) were associated with greater weight gain. Age was the strongest predictor of weight change in both women (partial R(2) = 11%) and men (partial R(2) = 8.6%). Normal- and overweight women gained more than obese women (P < 0.05) and younger adults gained more weight than older adults (P < 0.0001). Patterns and predictors of weight change differ by sex. Age in both sexes and physical activity among women as well as weight fluctuation and smoking status in men were stronger predictors of weight change than diet quality among FOS adults. Women who stopped smoking over follow-up and had poor diet quality gained the most weight. Preventive interventions need to be sex-specific and consider lifestyle factors.

Trajectories of cigarette smoking from adolescence to young adulthood as predictors of obesity in the mid-30s

INTRODUCTION

The purpose of this longitudinal study was to examine the relationship between two major health problems, smoking and obesity, and to determine to what extent trajectories of cigarette smoking from early adolescence to young adulthood are related to obesity in the mid-30s.

METHODS

Participants (N = 806) were interviewed using a structured questionnaire at 6 points in time over a period of 23 years. Semiparametric group-based modeling and logistic regression analyses were used to analyze the data. The main outcome measure was obesity, assessed by body mass index in the mid-30s.

RESULTS

Five distinct trajectories of tobacco use were identified (N = 806): heavy/continuous smokers, late starters, quitters/decreasers, occasional smokers, and nonsmokers. Compared with nonsmokers, heavy/continuous smokers or late starters had a significantly lower likelihood of obesity. Also, compared with nonsmokers or occasional smokers, heavy/continuous smokers or late starters had a significantly lower likelihood of being overweight or obese.

DISCUSSION

Smoking cessation programs should focus on weight control methods, such as physical exercise and learning healthy habits. In addition, weight control programs should incorporate smoking cessation efforts as integral components.

Psychosocial determinants of fruit and vegetable intake in adult population: a systematic review

BACKGROUND

Accumulating evidence suggests that fruit and vegetable intake (FVI) plays a protective role against major diseases. Despite this protective role and the obesity pandemic context, populations in Western countries usually eat far less than five servings of fruits and vegetables per day. In order to increase the efficiency of interventions, they should be tailored to the most important determinants or mediators of FVI. The objective was to systematically review social cognitive theory-based studies of FVI and to identify its main psychosocial determinants.

METHODS

Published papers were systematically sought using Current Contents (2007-2009) and Medline, Embase, PsycINFO, Proquest and Thesis, as well as Cinhal (1980-2009). Additional studies were identified by a manual search in the bibliographies. Search terms included fruit, vegetable, behaviour, intention, as well as names of specific theories. Only studies predicting FVI or intention to eat fruits and vegetables in the general population and using a social cognitive theory were included. Independent extraction of information was carried out by two persons using predefined data fields, including study quality criteria.

RESULTS

A total of 23 studies were identified and included, 15 studying only the determinants of FVI, seven studying the determinants of FVI and intention and one studying only the determinants of intention. All pooled analyses were based on random-effects models. The random-effect R2 observed for the prediction of FVI was 0.23 and it was 0.34 for the prediction of intention. Multicomponent theoretical frameworks and the theory of planned behaviour (TPB) were most often used. A number of methodological moderators influenced the efficacy of prediction of FVI. The most consistent variables predicting behaviour were habit, motivation and goals, beliefs about capabilities, knowledge and taste; those explaining intention were beliefs about capabilities, beliefs about consequences and perceived social influences.

CONCLUSIONS

Our results suggest that the TPB and social cognitive theory (SCT) are the preferable social cognitive theories to predict behaviour and TPB to explain intention. Efficacy of prediction was nonetheless negatively affected by methodological factors such as the study design and the quality of psychosocial and behavioural measures.

Food group intake and central obesity among children and adolescents in the Third National Health and Nutrition Examination Survey (NHANES III)

OBJECTIVE

To explore mean food group intakes associated with central obesity anthropometry among children and adolescents enrolled in the Third National Health and Nutrition Examination Survey (NHANES III).

DESIGN

Cross-sectional study.

SETTING

Representative sampling of the US population (1998-2002).

SUBJECTS

Subjects were 3761 children (5-11 years) and 1803 adolescents (12-16 years) with single 24 h dietary recalls and anthropometric measures of central body fat (waist circumference and sum of subscapular and suprailiac skinfold thicknesses).

RESULTS

Results were controlled for confounding by age, height, race/ethnicity, Tanner stage, television viewing and parental education. In younger children, there was no relationship between central adiposity and mean intakes of dairy, fruit, vegetables or grains, while a positive association with meat intake was found among boys. In adolescent boys and girls, central body fat measures were inversely associated with mean dairy and grain intakes. Adolescent boys in the highest quartile of central adiposity consumed less fruit and fewer vegetables; those in the lowest central adiposity quartile consumed less meat. Finally, adolescents who met the criteria for central obesity (waist circumference >or=85th percentile for age and sex) reported consuming significantly less total dairy (as well as milk and cheese separately), total grains (whole and refined) and total fruit and vegetables. There was no association with meat consumption. To test the stability of these findings, the final analysis was replicated in 2541 same-aged adolescents from NHANES 1999-2002; the results were very similar.

CONCLUSIONS

These cross-sectional analyses suggest that intakes of dairy, grains and total fruits and vegetables are inversely associated with central obesity among adolescents.