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Parekh T, Xue H, Al-Kindi S, Nasir K, Cheskin LJ, Cuellar AE. Food Environment Quality and Cardiovascular Disease Mortality in the United States: a County-Level Analysis from 2017 to 2019. J Gen Intern Med 2024; 39:176-185. [PMID: 37507552 PMCID: PMC10853151 DOI: 10.1007/s11606-023-08335-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Upstream socioeconomic circumstances including food insecurity and food desert are important drivers of community-level health disparities in cardiovascular mortality let alone traditional risk factors. The study assessed the association between differences in food environment quality and cardiovascular mortality in US adults. DESIGN Retrospective analysis of the association between cardiovascular mortality among US adults aged 45 and above and food environment quality, measured as the food environment index (FEI), in 2615 US counties. FEI was measured by equal weights of food insecurity (limited access to a reliable food source) and food desert (limited access to healthy food), ranging from 0 (worst) to 10 (best). Age-adjusted cardiovascular mortality rates per 100,000 adults aged 45 and above in the calendar year 2017-2019. County-level association between CVD mortality rate and FEI was modeled using generalized linear regression. Data were weighted using county population. RESULT Median CVD deaths per 100,000 population were 645.4 (IQR 561.5, 747.0) among adults aged 45 years and above across US counties in 2017-2019. About 12.8% (IQR 10.7%, 15.1%) of residents were food insecure and 6.3% (IQR 3.6%, 9.9%) were living in food desert areas. Comparing counties by FEI quartiles, the CVD mortality rate was higher in the least healthy FE counties (704.3 vs 598.6 deaths per 100,000 population) compared to the healthiest FE counties. One unit increase in FEI was associated with - 12.95 CVD deaths/100,000 population. In the subgroup analysis of counties with higher income inequality, the healthiest food environment was associated with 46.4 lower CVD deaths/100,000 population than the least healthy food environment. One unit increase in FEI in counties with higher income inequality was associated with a fivefold decrease in CVD mortality difference in African American counties (- 18.4 deaths/100,000 population) when compared to non-African American counties (- 3.63 deaths/100,000 population). CONCLUSION In this retrospective multi-county study in the USA, a higher food environment index was significantly associated with lower cardiovascular mortality.
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Affiliation(s)
- Tarang Parekh
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA.
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
| | - Hong Xue
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Sadeer Al-Kindi
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Khurram Nasir
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
| | - Alison E Cuellar
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
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Rana ZH, Frankenfeld CL, Kennedy EJ, Bertoldo J, De Jonge L, Cheskin LJ. Why don't college freshmen meet the US dietary guidelines for added sugar, refined grains, sodium, and saturated fat? J Am Coll Health 2024; 72:142-152. [PMID: 35080478 DOI: 10.1080/07448481.2021.2024213] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 12/05/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The objective of the study was to evaluate how well college students meet U.S. dietary guidelines by examining the mean intakes of nutrients to limit (sodium, sugar, refined grains, and saturated fat), and what factors lead to exceeding the dietary recommendations. PARTICIPANTS Participants were first-year undergraduate students (N = 269). METHODS Diet was assessed using a DHQ-III and estimated with food source composition tables. Multivariable logistic regression analysis was used to model variables associated with exceeding the recommendations. One-sample t-tests were performed to compare the cohort with national intakes. RESULTS One-third met added sugar guidelines; only 4% met daily refined grains requirements, Fewer than half met saturated fat guidelines, and slightly over half met recommended sodium guidelines. Level of physical activity, race/ethnicity, and living on campus were the important predictors for exceeding recommended intakes. CONCLUSIONS Most students do not adhere to the U.S. dietary guidelines for nutrients to limit.
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Affiliation(s)
- Ziaul H Rana
- Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA
| | - Cara L Frankenfeld
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Erika J Kennedy
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Jaclyn Bertoldo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lilian De Jonge
- Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA
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Basiri R, Seidu B, Cheskin LJ. Key Nutrients for Optimal Blood Glucose Control and Mental Health in Individuals with Diabetes: A Review of the Evidence. Nutrients 2023; 15:3929. [PMID: 37764713 PMCID: PMC10536295 DOI: 10.3390/nu15183929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Diabetes is associated with an increased risk of mental disorders, including depression, anxiety, and cognitive decline. Mental disorders can also contribute to the development of diabetes through various mechanisms including increased stress, poor self-care behaviors, and adverse effects on glucose metabolism. Consequently, individuals suffering from either of these conditions frequently experience comorbidity with the other. Nutrition plays an important role in both diabetes and mental health disorders including depression and anxiety. Deficiencies in specific nutrients such as omega-3 fatty acids, vitamin D, B vitamins, zinc, chromium, magnesium, and selenium have been implicated in the pathogenesis of both diabetes and mental disorders. While the impact of nutrition on the progression and control of diabetes and mental disorders is broadly acknowledged, there is a notable knowledge gap concerning the implications of distinct nutrients in preventing and mitigating symptoms of both conditions when they coexist. The aim of this study was to examine the role of nutrition in improving glucose homeostasis and promoting mental well-being among individuals with diabetes. Further, we evaluated the preventive or delaying effects of key nutrients on the simultaneous manifestation of these conditions when one of them is present. Our findings indicated that the use of personalized dietary interventions and targeted nutrient supplementation can improve metabolic and mental health outcomes in patients with type 2 diabetes.
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Affiliation(s)
- Raedeh Basiri
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
- Institute for Biohealth Innovation, George Mason University, Fairfax, VA 22030, USA
| | - Blessing Seidu
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
| | - Lawrence J. Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
- Institute for Biohealth Innovation, George Mason University, Fairfax, VA 22030, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Rana ZH, Frankenfeld CL, Kennedy EJ, Leon C, de Jonge L, Jiang L, Davila M, Cheskin LJ. Food sources of energy and nutrients among US college students: The Health Starts Here cohort study. J Am Coll Health 2023:1-10. [PMID: 37290009 DOI: 10.1080/07448481.2023.2220397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 04/10/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
Objective: Identifying the food sources contributing most to total energy percentage, macronutrients, vitamin and mineral consumption among college freshmen, and whether sex played a role. Participants: First-year undergraduate students (N = 269). Methods: Diet was assessed using a DHQ-III and estimated with food source composition tables. Nutrient intakes were expressed as a percentage of total dietary intakes for each food category. Mann-Whitney U tests were used to determine the differences between the two sexes for each food category. Results: A significant proportion of energy and nutrients is contributed by certain food categories, such as grain products, meat, poultry, fish; however, other less desirable sources of energy and nutrient are also identified, including sugary and sports drinks. Among female students, a greater portion of nutritional intakes came from healthier choices. Conclusions: A majority of total energy intake comes from food categories that are energy-dense but also provide essential nutrients.
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Affiliation(s)
- Ziaul H Rana
- Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA
| | - Cara L Frankenfeld
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Erika J Kennedy
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Cibely Leon
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - Lilian de Jonge
- Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA
| | - Li Jiang
- Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA
| | - Marissa Davila
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA
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Nelson JD, Martin LN, Izquierdo A, Kornienko O, Cuellar AE, Cheskin LJ, Fischer S. The role of discrimination and adverse childhood experiences in disordered eating. J Eat Disord 2023; 11:29. [PMID: 36850009 PMCID: PMC9969653 DOI: 10.1186/s40337-023-00753-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND In clinical research, there has been a call to move beyond individual psychosocial factors towards identifying cultural and social factors that inform mental health. Similar calls have been made in the eating disorders (ED) field underscoring the need to understand larger sociocultural influences on EDs. Discrimination is a social stressor that may influence mental health in similar ways to traumatic or adverse childhood experiences (ACEs). Given the high rates of EDs and discrimination among marginalized groups, it is vital to understand the role of discrimination and ACEs as predictors of ED symptoms in these populations. The aim of this study is to examine how perceived discrimination predicts ED pathology when statistically adjusting for gender, race, and ACEs. METHODS The diverse study sample consisted of 331 undergraduate students from a longitudinal cohort study (ages 18-24; 66% female; 35% White/non-Hispanic). Participants completed measures of everyday discrimination, ACEs, and ED pathology. RESULTS Following adjustment for multiple statistical comparisons, the frequency of daily discrimination predicted all ED symptoms above and beyond history of ACEs. In follow-up analyses, number of reasons for discrimination predicted cognitive restraint and purging. Differences in ED symptomatology were found based on the reason for discrimination, gender, and race. Specifically, those who experienced weight discrimination endorsed higher scores on all ED symptoms, and those experiencing gender discrimination endorsed higher body dissatisfaction, cognitive restraint, and restriction. People of color endorsed higher restriction, while female participants endorsed higher scores on all ED symptom with the exception of cognitive restraint. CONCLUSION Discrimination is a salient risk factor for ED symptoms even when accounting for individuals' history of ACEs. Future research should utilize an intersectional approach to examine how perceived discrimination affects ED pathology over time. (Word count: 234).
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Affiliation(s)
- Jillian D Nelson
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Laura N Martin
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Alyssa Izquierdo
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Olga Kornienko
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Alison E Cuellar
- Department of Health Administration and Policy, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Sarah Fischer
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
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6
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Gewa CA, Onyango AC, Opiyo RO, Gittelsohn J, Cheskin LJ. Patterns and predictors of elevated blood pressure and hypertension among primary school children in urban Kenya. J Hypertens 2022; 40:2513-2520. [PMID: 36093874 DOI: 10.1097/hjh.0000000000003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined the prevalence of elevated blood pressure (BP) and hypertension among 390 primary school children of different socioeconomic status (SES) in two urban settings in Kenya and explored the association between children's BP status and their sociodemographic characteristics, dietary behaviours and overweight/obesity status. METHODS Children's BP and anthropometric measurements were taken and parents, with the help of their children, completed questionnaires on the children's dietary behaviours. An average of three BP readings was used to calculate BP percentiles by age, sex and height. BMI-for-age z-scores, waist-circumference-to-height ratio and the sum of skinfold measures were calculated. We utilized prevalence ratio analysis to examine the association between BP and sociodemographic characteristics, dietary behaviours and overweight/obesity. RESULTS About 9% of the school children had elevated BP and 33% had stage 1 hypertension. Among overweight children, the proportion of children with elevated BP was 1.85-fold greater and the proportion of children with hypertension was 1.83-fold greater compared with children with healthy body weight. Similar patterns of significant associations were seen among obese children, children with central obesity and children with high total skinfold values. The proportion of children with hypertension was 1.42-fold greater among children with high frequency of consumption of chips/crisps compared with children with lower frequency of consumption. CONCLUSION These results increase our understanding BP patterns and determinants among school children in Kenya and can help inform noncommunicable disease prevention efforts.
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Affiliation(s)
- Constance A Gewa
- Department of Nutrition & Food Studies, College of Health & Human Services, George Mason University, Fairfax, Virginia, USA
| | | | - Rose O Opiyo
- School of Public Health, University of Nairobi, Nairobi, Kenya
| | - Joel Gittelsohn
- Department of International Health, Bloomberg School of Public Health, John Hopkins University
| | - Lawrence J Cheskin
- Department of Nutrition & Food Studies, College of Health & Human Services, George Mason University, Fairfax, Virginia, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Jiang L, Cheskin LJ, Frankenfeld CL, Rana ZH, de Jonge L. Loneliness is associated with unhealthful dietary behaviors and physical inactivity among US college students. J Am Coll Health 2022:1-6. [PMID: 36395040 DOI: 10.1080/07448481.2022.2141060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 09/26/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Objective: To evaluate dietary and physical activity behavior in relation to loneliness among college students. Participants: Three-hundred forty-six incoming first-year students in Fall 2019 at a large state University in the US. Methods: Students completed online surveys in Fall 2019. Multivariable regression analyses were used to model associations of health behaviors with loneliness, adjusting for gender and body mass index (BMI). Results: Two-hundred sixty-four students were included in this analysis. Students in loneliness score ranges of 4-6 and 7-9 have higher fat diet than students in score range of 10-12 (p = .007). Sedentary (19.2%) and low active (53.8%) behaviors were more frequent in students reporting high loneliness than those reporting low loneliness (13.8%, 36.7%, respectively) (p = .006). Conclusions: In this sample of college students, loneliness was related to altered diet quality and physical inactivity. Interventions to reduce loneliness may have a positive effect on health promotion in this population.
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Affiliation(s)
- Li Jiang
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Cara L Frankenfeld
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Ziaul H Rana
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Lilian de Jonge
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
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Sun X, Yan AF, Shi Z, Zhao B, Yan N, Li K, Gao L, Xue H, Peng W, Cheskin LJ, Wang Y. Health consequences of obesity and projected future obesity health burden in China. Obesity (Silver Spring) 2022; 30:1724-1751. [PMID: 36000246 DOI: 10.1002/oby.23472] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examined the effects of overweight/obesity on mortality and morbidity outcomes and the disparities, time trends, and projected future obesity health burden in China. METHODS Cohort studies that were conducted in China and published in English or Chinese between January 1, 1995, and July 31, 2021, were systematically searched. This study focused on overweight/obesity, type 2 diabetes mellitus (T2DM), hypertension, cardiovascular diseases, metabolic syndrome, cancers, and chronic kidney disease. RESULTS A total of 31 cohorts and 50 cohort studies reporting on mortality (n = 20) and morbidities (n = 30) associated with obesity met study inclusion criteria. Overall, BMI was nonlinearly (U-shaped) associated with all-cause mortality and linearly associated with risks of T2DM, cardiovascular diseases, hypertension, cancer, metabolic syndrome, and chronic kidney disease. In 2018, among adults, the prevalence of overweight/obesity, hypertension, and T2DM was 51.2%, 27.5%, and 12.4%, respectively. Their future projected prevalence would be 70.5%, 35.4%, and 18.5% in 2030, respectively. The projected number of adults having these conditions would be 810.65 million, 416.47 million, and 217.64 million, respectively. The urban-rural disparity in overweight/obesity prevalence was projected to shrink and then reverse over time. CONCLUSIONS The current health burden of obesity in China is high and it will sharply increase in coming years and affect population groups differently. China needs to implement vigorous interventions for obesity prevention and treatment.
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Affiliation(s)
- Xiaomin Sun
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Alice Fang Yan
- Center for Advancing Population Science, Division of Internal Medicine, Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Bingtong Zhao
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Na Yan
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Ke Li
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Liwang Gao
- Center for Non-communicable Disease Management, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Hong Xue
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Wen Peng
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University and Global Health Institute, Xi'an Jiaotong University, Xi'an, China
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
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Peng W, Li K, Yan AF, Shi Z, Zhang J, Cheskin LJ, Hussain A, Wang Y. Prevalence, Management, and Associated Factors of Obesity, Hypertension, and Diabetes in Tibetan Population Compared with China Overall. IJERPH 2022; 19:ijerph19148787. [PMID: 35886633 PMCID: PMC9316255 DOI: 10.3390/ijerph19148787] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 02/04/2023]
Abstract
Tibetans’ life expectancy lags behind China’s average. Obesity and noncommunicable diseases (NCDs) contribute to health disparity, but NCD patterns among Tibetans are unknown. To examine the prevalence, management, and associated factors for obesity, hypertension, and diabetes among Tibetans, compared with China’s average, we systematically searched PubMed and China National Knowledge Infrastructure databases for studies between January 2010 and April 2021. Thirty-nine studies were included for systematic review, among thirty-seven that qualified for meta-analysis, with 115,403 participants. Pooled prevalence was 47.9% (95% CI 38.0–57.8) for overweight/obesity among adults (BMI ≥ 24 kg/m2) and 15.4% (13.7–17.2) among children using Chinese criteria, which are lower than the national rates of 51.2% and 19.0%, respectively. The estimate for hypertension (31.4% [27.1–35.7]) exceeded China’s average (27.5%), while diabetes (7.5% [5.2–9.8]) was lower than average (11.9%). Men had a higher prevalence of the three conditions than women. Residents in urban areas, rural areas, and Buddhist institutes had monotonically decreased prevalence in hypertension and diabetes. Awareness, treatment, and control rates for hypertension and diabetes were lower than China’s average. Urban residence and high altitude were consistent risk factors for hypertension. Limited studies investigated factors for diabetes, yet none exist for obesity. Tibetans have high burdens of obesity and hypertension. Representative and longitudinal studies are needed for tailored interventions. There are considerable variations in study design, study sample selection, and data-analysis methods, as well as estimates of reviewed studies.
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Affiliation(s)
- Wen Peng
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, Xining 810016, China;
- Global Health Institute, School of Public Health, Xi’an Jiaotong University, Xi’an 710049, China;
| | - Ke Li
- Global Health Institute, School of Public Health, Xi’an Jiaotong University, Xi’an 710049, China;
| | - Alice F. Yan
- Division of Research Patient Care Services, Stanford Health Care, Palo Alto, CA 94305, USA;
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar;
| | - Junyi Zhang
- Department of Clinical Nutrition, The Third People’s Hospital of Chengdu, Chengdu 610014, China;
| | - Lawrence J. Cheskin
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, VA 22030, USA;
- Johns Hopkins School of Medicine, Baltimore, MD 21218, USA
| | - Ahktar Hussain
- International Diabetes Federation (IDF), 1000 Brussels, Belgium;
- Faculty of Health Sciences, Belgian and Nord University, 8001 Bodø, Norway
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi’an Jiaotong University, Xi’an 710049, China;
- Correspondence: ; Tel.: +86-29-8896-7396
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Parekh T, Xue H, Cheskin LJ, Cuellar AE. Food insecurity and housing instability as determinants of cardiovascular health outcomes: A systematic review. Nutr Metab Cardiovasc Dis 2022; 32:1590-1608. [PMID: 35487828 DOI: 10.1016/j.numecd.2022.03.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/26/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022]
Abstract
AIMS The primary objective of this study is to conduct a systematic review of existing literature on the association between food insecurity and housing instability with CVD and its subtypes-related outcomes. Summarizing the comprehensive evidence for independent/interchangeable relationship of food and housing instability with CVD outcomes may inform specific interventions strategies to reduce CVD-risk. DATA SYNTHESIS The search focused on English-language articles in PubMed/Medline, from January 1, 2010, to June 1, 2021, with restriction to the US adult population. We included studies estimating the association between food insecurity or/and housing instability(exposure) and CVD-subtypes-related health outcomes (outcome). The study methodological quality was assessed using the Study Quality Assessment Tools (SQAT). Nineteen studies met eligibility criteria, consisted of 15 cross-sectional and 4 cohort studies. Of total studies, 7 examined housing instability, 11 studies focused on food insecurity, and one examined both. Food insecurity/housing instability was associated with increased overall CVD-mortality rate and greater healthcare cost utilization, while evidence were mixed for hospital readmission rate. By subtype, stroke mortality was greater with food insecurity but not with housing instability. The likelihood of myocardial infarction, coronary heart disease, and congestive heart failure was greater with food insecurity. Although mortality with MI was higher with housing instability, readmission and surgical procedure rates were significantly lower than housing stable adults. CONCLUSION Findings from this review suggest an urgent need to test the impact of screening for food and housing insecurities, referral services, and community engagement for CV health, within clinical and public health settings. PROTOCOL REGISTRATION Prospero CRD4202123352.
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Affiliation(s)
- Tarang Parekh
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Hong Xue
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
| | - Alison E Cuellar
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA.
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11
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Rossheim ME, Khoshhal B, Karon S, Cheskin LJ, Trangenstein PJ, Frankenfeld CL, Ramezani N, Cuellar AE. Substance use and firearm access among college freshmen. J Am Coll Health 2022:1-5. [PMID: 35549821 DOI: 10.1080/07448481.2022.2068959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 03/02/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Examine the proportion of students with rapid firearm access and associations with recent alcohol and marijuana use. PARTICIPANTS Cross-sectional data from college freshmen (n = 183) in 2020 who participated in the Mason: Health Starts Here study. METHODS Using logistic regression, associations were examined between past 30-day substance use and access to firearms within 15-min. RESULTS More than 10% of students could rapidly access a firearm, 53% of whom were current binge drinkers, compared to 13% of those who could not rapidly access firearms. Non-Hispanic White students (AOR = 4.1, 95%CI = 1.3,12.7) and past 30-day binge drinkers (AOR = 6.4, 95%CI = 2.1,19.7) had greater odds of having rapid firearm access. Age, sex, and past 30-day marijuana use were not associated with rapid access. CONCLUSIONS A notable proportion of students had rapid firearm access, which was strongly associated with recent binge drinking. Campus prevention programs should consider how their alcohol and firearm policies could be enhanced to prevent violence/self-harm.
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Affiliation(s)
- Matthew E Rossheim
- School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Bita Khoshhal
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Samantha Karon
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lawrence J Cheskin
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | | | - Cara L Frankenfeld
- Public Health Program, University of Puget Sound, Tacoma, Washington, USA
| | - Niloofar Ramezani
- College of Engineering and Computing, George Mason University, Fairfax, Virginia, USA
| | - Alison E Cuellar
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
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12
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Nelson JD, Cuellar AE, Cheskin LJ, Fischer S. Eating Disorders and Posttraumatic Stress Disorder: A Network Analysis of the Comorbidity. Behav Ther 2022; 53:310-322. [PMID: 35227406 DOI: 10.1016/j.beth.2021.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/10/2021] [Accepted: 09/18/2021] [Indexed: 11/02/2022]
Abstract
Eating disorders (EDs) and posttraumatic stress disorder (PTSD) commonly co-occur, but the mechanisms driving this co-occurrence are not well understood. The current study explored the relationships between symptoms of ED and PTSD in a sample of male and female undergraduate students in order to identify pathways that may maintain the comorbidity. Network analysis was conducted in a sample of 344 first-year undergraduates to visualize partial correlations between each symptom in the comorbidity. Core symptoms, bridge symptoms, and direct pathways between ED and PTSD symptoms were identified. The PTSD symptoms negative emotions (strength = 1.13) and negative beliefs (strength = 1.11) were the strongest symptoms in the network. The strongest bridge nodes were the ED symptoms restriction (bridge strength = 3.32) and binge eating (bridge strength = 2.63). The strongest edges between ED and PTSD nodes were between binge eating and concentration (part r = .16), restriction and sleep (part r = .14), and binge eating and positive emotions (part r = .11). Findings suggest that PTSD symptoms related to negative alterations in cognitions and mood may be highly influential in the ED-PTSD network due to their relatedness to all other symptoms. The pathway between binge eating and inability to experience positive emotions suggest that the comorbidity may be partially maintained through an affect regulation function of binge eating.
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13
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Kharmats AY, Wang C, Fuentes L, Hu L, Kline T, Welding K, Cheskin LJ. Monday-focused tailored rapid interactive mobile messaging for weight management 2 (MTRIMM2): results from a randomized controlled trial. Mhealth 2022; 8:1. [PMID: 35178432 PMCID: PMC8800204 DOI: 10.21037/mhealth-21-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/12/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Text-messaging interventions can reach many individuals across a range of socioeconomic groups, at a low cost. Few randomized controlled trials (RCTs) of text-messaging weight loss interventions have been conducted in United States. METHODS From September of 2016 to September of 2018, we conducted a two-parallel group, superiority, RCT of a 16-week text-messaging, weight loss intervention in Baltimore, Maryland, in overweight and obese adults younger than 71, who were able to receive text-messages. Our objective was to assess the effect of receiving the message content only (in printed documents distributed at baseline and week 8), versus receiving messages via short messaging service (SMS) on weight loss (primary outcome), body mass index, perceived exercise benefits and barriers, self-efficacy, and physical activity (PA). The random allocation sequence was equally balanced intervention groups by gender and age groups. Participants were randomized after the baseline assessment. Then, participants and most study staff were unblinded. Follow-up assessments were conducted at 8-, 16-, and 42-week post randomization. We performed intention-to-treat analysis using mixed linear regression models. RESULTS Of the 155 adults randomized (printed messages =77, SMS =78), 87.1% were women, 53.5% were African Americans, and 93.5% non-Hispanic. Participants who completed at least one follow-up assessment were included in regression analyses (n=145, printed messages =74, SMS =71). Compared to baseline, at the 42-week assessment, the average percent weight loss was 1.23 for the SMS group (P=0.006) and 0.86 for the printed messages group (P=0.047). Both groups experienced small reductions in weight (printed messages: -0.96 kg, P=0.022; SMS: -1.19 kg, P=0.006), BMI (printed messages: -0.32, P=0.035; SMS: -0.52, P=0.002), and percent energy from fat consumption (printed messages: -1.43, P=0.021; SMS: -2.14, P≤0.001). No statistically significant between groups differences were detected for any of the study outcomes. SMS response rates were not statistically significantly associated with study outcomes. No adverse events were reported. CONCLUSIONS A semi-tailored SMS weight loss intervention among overweight and obese adults was not statistically superior in efficacy to paper-based messaging. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04506996.
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Affiliation(s)
- Anna Y. Kharmats
- Bloomberg School of Public Health, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Chan Wang
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Laura Fuentes
- Bloomberg School of Public Health, Department of Health, Behavior & Society, Baltimore, MD, USA
| | - Lu Hu
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Tina Kline
- Bloomberg School of Public Health, Department of Health, Behavior & Society, Baltimore, MD, USA
| | - Kevin Welding
- Bloomberg School of Public Health, Department of Health, Behavior & Society, Baltimore, MD, USA
| | - Lawrence J. Cheskin
- George Mason University, College of Health and Human Services, Department of Nutrition and Food Studies, Fairfax, VA, USA
- Johns Hopkins School of Medicine, Department of Medicine, Baltimore, MD, USA
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14
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Rana ZH, Frankenfeld CL, de Jonge L, Kennedy EJ, Bertoldo J, Short JL, Cheskin LJ. Dietary Intake and Representativeness of a Diverse College-Attending Population Compared with an Age-Matched US Population. Nutrients 2021; 13:3810. [PMID: 34836066 PMCID: PMC8621081 DOI: 10.3390/nu13113810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022] Open
Abstract
Young adults typically gain more dietary autonomy as they start college, though this can also present nutritional challenges; however, research on the generalizability of their dietary intake data is scarce. To address this representativeness concern, we compared food and nutrient intakes reported by college freshmen attending a large, diverse university to an age-matched sample from the National Health and Nutrition Examination Survey (NHANES). We studied 269 students 18-24 years old recruited through the Mason: Health Start Here (HSH) study, a population-based cohort study of college students. Diet was assessed using a diet history questionnaire (DHQ-III) and estimated with food source composition tables. The NHANES sample of 835 adults was the reference dataset. Reported dietary intakes were weighted and compared with national intakes via t-tests. We observed comparable energy, carbohydrate, fat, and protein intakes in both groups; however, the HSH cohort reported a higher density intake of most micronutrients than the NHANES sample. Differences between these samples in intake, mode of dietary assessment administration, and reactivity may help explain the differences detected. These results demonstrate that when appropriately contextualized in terms of methodology and potential sources of bias, single college studies can be useful for understanding nutrition in young adults more broadly.
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Affiliation(s)
- Ziaul H. Rana
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA; (Z.H.R.); (L.d.J.)
| | - Cara L. Frankenfeld
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA; (C.L.F.); (E.J.K.)
| | - Lilian de Jonge
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA; (Z.H.R.); (L.d.J.)
| | - Erika J. Kennedy
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA; (C.L.F.); (E.J.K.)
| | - Jaclyn Bertoldo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Jerome L. Short
- Department of Psychology, George Mason University, Fairfax, VA 22030, USA;
| | - Lawrence J. Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA; (Z.H.R.); (L.d.J.)
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15
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Abstract
Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384:989. 33567185.
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Affiliation(s)
| | - Lawrence J Cheskin
- George Mason University and John Hopkins University, Fairfax, Virginia, and Baltimore, Maryland, USA (L.J.C.)
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16
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Benusic M, Cheskin LJ. Obesity prevalence in large US cities: association with socioeconomic indicators, race/ethnicity and physical activity. J Public Health (Oxf) 2021; 43:148-154. [PMID: 31294802 DOI: 10.1093/pubmed/fdz077] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 06/16/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obesity has a complex association with socioeconomic factors. Further clarification of this association could guide population interventions. METHODS To determine the relationship between obesity prevalence, socioeconomic indicators, race/ethnicity, and physical activity, we performed a cross-sectional, multivariable linear regression, with data from large US cities participating in the Big Cities Health Inventory. RESULTS Increased household income was significantly associated with decreased obesity prevalence, for White (-1.97% per 10 000USD), and Black (-3.02% per 10 000USD) populations, but not Hispanic. These associations remained significant when controlling for the proportion of the population meeting physical activity guidelines. Educational attainment had a co-linear relationship with income, and only a bachelor's degree or higher was associated with a lower prevalence of obesity in White (-0.30% per percentage) and Black (-0.69% per percentage) populations. No association was found between obesity prevalence and the proportion of the population meeting physical activity guidelines for any race/ethnicity grouping. CONCLUSION At the population level of large US cities, obesity prevalence is inversely associated with median household income in White and Black populations. Strategies to increase socioeconomic status may also decrease obesity. Targeting attainment of physical activity guidelines as an obesity intervention needs further appraisal.
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Affiliation(s)
- Michael Benusic
- Public Health & Preventive Medicine, University of Toronto. Dalla Lana School of Public Health, 155 College St, Toronto, ON Canada
| | - Lawrence J Cheskin
- Nutrition and Food Studies, Interim Chair, Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
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17
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Cuellar AE, Adams LM, de Jonge L, Espina V, Espinoza L, Fischer SF, Frankenfeld CL, Hines DA, Kornienko O, Lawrence HY, Rana ZH, Ramezani N, Rossheim ME, Short JL, Waithaka EN, Wilson AN, Cheskin LJ. Protocol for the Mason: Health Starts Here prospective cohort study of young adult college students. BMC Public Health 2021; 21:897. [PMID: 33980206 PMCID: PMC8114021 DOI: 10.1186/s12889-021-10969-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/04/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Young adulthood is a period of increasing independence for the 40% of young adults enrolled in U.S. colleges. Previous research indicates differences in how students' health behaviors develop and vary by gender, race, ethnicity, and socioeconomic status. George Mason University is a state institution that enrolls a highly diverse student population, making it an ideal setting to launch a longitudinal cohort study using multiple research methods to evaluate the effects of health behaviors on physical and psychological functioning, especially during the COVID-19 pandemic. RESULTS Mason: Health Starts Here was developed as a longitudinal cohort study of successive waves of first year students that aims to improve understanding of the natural history and determinants of young adults' physical health, mental health, and their role in college completion. The study recruits first year students who are 18 to 24 years old and able to read and understand English. All incoming first year students are recruited through various methods to participate in a longitudinal cohort for 4 years. Data collection occurs in fall and spring semesters, with online surveys conducted in both semesters and in-person clinic visits conducted in the fall. Students receive physical examinations during clinic visits and provide biospecimens (blood and saliva). CONCLUSIONS The study will produce new knowledge to help understand the development of health-related behaviors during young adulthood. A long-term goal of the cohort study is to support the design of effective, low-cost interventions to encourage young adults' consistent performance of healthful behaviors, improve their mental health, and improve academic performance.
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Affiliation(s)
- Alison E Cuellar
- Department of Health Administration and Policy, George Mason University, Fairfax, USA
| | - Leah M Adams
- Departments of Psychology, and of Women & Gender Studies, George Mason University, Fairfax, USA
| | - Lilian de Jonge
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Peterson Hall 4113, Fairfax, USA
| | - Virginia Espina
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Fairfax, USA
| | - Laurette Espinoza
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Peterson Hall 4113, Fairfax, USA
| | - Sarah F Fischer
- Department of Psychology, George Mason University, Fairfax, USA
| | - Cara L Frankenfeld
- Department of Global and Community Health, George Mason University, Fairfax, USA
| | - Denise A Hines
- Department of Social Work, George Mason University, Fairfax, USA
| | - Olga Kornienko
- Department of Psychology, George Mason University, Fairfax, USA
| | | | - Ziaul H Rana
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Peterson Hall 4113, Fairfax, USA
| | | | - Matthew E Rossheim
- Department of Global and Community Health, George Mason University, Fairfax, USA
| | - Jerome L Short
- Department of Psychology, George Mason University, Fairfax, USA
| | - Eric N Waithaka
- Department of Social Work, George Mason University, Fairfax, USA
| | - Alyssa N Wilson
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Peterson Hall 4113, Fairfax, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Peterson Hall 4113, Fairfax, USA.
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18
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Shi Z, Yan A, Zimmet P, Sun X, Cristina do Vale Moreira N, Cheskin LJ, Wang L, Qu W, Yan H, Hussain A, Wang Y. COVID-19, Diabetes, and Associated Health Outcomes in China: Results from a Nationwide Survey of 10 545 Adults. Horm Metab Res 2021; 53:301-310. [PMID: 33962477 DOI: 10.1055/a-1468-4535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study examined the associations between diabetes and self-reported/familial COVID-19 infection and investigated health-related outcomes among those with diabetes during China's nationwide quarantine. The 2020 China COVID-19 Survey was administered anonymously via social media (WeChat). It was completed by 10 545 adults in all of mainland China's 31 provinces. The survey consisted of 74 items covering sociodemographic characteristics, preventive measures for COVID-19, lifestyle behaviors, and health-related outcomes during the period of quarantine. Regression models examined associations among study variables. Diabetes was associated with a six-fold increased risk of reporting COVID-19 infection among respondents or their family members. Among people with diabetes, individuals who rarely wore masks had double the risk of suspected COVID-19 infection compared with those who always wore masks, with an inverse J-shaped relationship between face mask wearing and suspected COVID-19 infection. People with diabetes tended to have both poor knowledge of COVID-19 and poor compliance with preventive measures, despite perceiving a high risk of personal infection (40.0% among respondents reporting diabetes and 8.0% without diabetes). Only 54-55% of these respondents claimed to consistently practice preventive measures, including wearing face masks. Almost 60% of those with diabetes experienced food or medication shortages during the quarantine period, which was much higher than those without diabetes. Importantly, respondents who experienced medication shortages reported a 63% higher COVID-19 infection rate. Diabetes was associated with an increased risk of self-reported personal and family member COVID-19 infection, which is mitigated by consistent use of face masks.
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Affiliation(s)
- Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Alice Yan
- Center for Advancing Population Science, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - Xiaoming Sun
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | | | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
| | - Liming Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weidong Qu
- Centers for Water and Health, Key Laboratory of the Public Health Safety, Ministry of Education, Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Hong Yan
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Akhtar Hussain
- Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Brazil
- Faculty of Health Sciences, Nord University, Bodø, Norway
- International Diabetes Federation, Brussels, Belgium
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
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19
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Cheng X, Lin SY, Wang K, Hong YA, Zhao X, Gress D, Wojtusiak J, Cheskin LJ, Xue H. Healthfulness Assessment of Recipes Shared on Pinterest: Natural Language Processing and Content Analysis. J Med Internet Res 2021; 23:e25757. [PMID: 33877052 PMCID: PMC8097524 DOI: 10.2196/25757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 01/03/2023] Open
Abstract
Background Although Pinterest has become a popular platform for distributing influential information that shapes users’ behaviors, the role of recipes pinned on Pinterest in these behaviors is not well understood. Objective This study aims to explore the patterns of food ingredients and the nutritional content of recipes posted on Pinterest and to examine the factors associated with recipes that engage more users. Methods Data were collected from Pinterest between June 28 and July 12, 2020 (207 recipes and 2818 comments). All samples were collected via 2 new user accounts with no search history. A codebook was developed with a raw agreement rate of 0.97 across all variables. Content analysis and natural language processing sentiment analysis techniques were employed. Results Recipes using seafood or vegetables as the main ingredient had, on average, fewer calories and less sodium, sugar, and cholesterol than meat- or poultry-based recipes. For recipes using meat as the main ingredient, more than half of the energy was obtained from fat (277/490, 56.6%). Although the most followed pinners tended to post recipes containing more poultry or seafood and less meat, recipes with higher fat content or providing more calories per serving were more popular, having more shared photos or videos and comments. The natural language processing–based sentiment analysis suggested that Pinterest users weighted taste more heavily than complexity (225/2818, 8.0%) and health (84/2828, 2.9%). Conclusions Although popular pinners tended to post recipes with more seafood or poultry or vegetables and less meat, recipes with higher fat and sugar content were more user-engaging, with more photo or video shares and comments. Data on Pinterest behaviors can inform the development and implementation of nutrition health interventions to promote healthy recipe sharing on social media platforms.
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Affiliation(s)
- Xiaolu Cheng
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Shuo-Yu Lin
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Kevin Wang
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Y Alicia Hong
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Xiaoquan Zhao
- Department of Communication, College of Humanities and Social Sciences, George Mason University, Fairfax, VA, United States
| | - Dustin Gress
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Janusz Wojtusiak
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Hong Xue
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States
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20
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Wang Y, Beydoun MA, Min J, Xue H, Kaminsky LA, Cheskin LJ. Has the prevalence of overweight, obesity and central obesity levelled off in the United States? Trends, patterns, disparities, and future projections for the obesity epidemic. Int J Epidemiol 2021; 49:810-823. [PMID: 32016289 DOI: 10.1093/ije/dyz273] [Citation(s) in RCA: 256] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/27/2019] [Accepted: 12/30/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Obesity (OB) is a serious epidemic in the United States. METHODS We examined OB patterns and time trends across socio-economic and geographic parameters and projected the future situation. Large national databases were used. Overweight (OW), OB and severe obesity (SOB) were defined using body mass index cut-points/percentiles; central obesity (CO), waist circumference cut-point in adults and waist:height ratio cutoff in youth. Various meta-regression analysis models were fit for projection analyses. RESULTS OB prevalence had consistently risen since 1999 and considerable differences existed across groups and regions. Among adults, men's OB (33.7%) and OW (71.6%) levelled off in 2009-2012, resuming the increase to 38.0 and 74.7% in 2015-2016, respectively. Women showed an uninterrupted increase in OB/OW prevalence since 1999, reaching 41.5% (OB) and 68.9% (OW) in 2015-2016. SOB levelled off in 2013-2016 (men: 5.5-5.6%; women: 9.7-9.5%), after annual increases of 0.2% between 1999 and 2012. Non-Hispanic Blacks had the highest prevalence in women's OB/SOB and men's SOB. OB prevalence in boys rose continuously to 20.6% and SOB to 7.5% in 2015-2016, but not in girls. By 2030, most Americans will be OB/OW and nearly 50% of adults OB, whereas ∼33% of children aged 6-11 and ∼50% of adolescents aged 12-19 will be OB/OW. Since 1999, CO has risen steadily, and by 2030 is projected to reach 55.6% in men, 80.0% in women, 47.6% among girls and 38.9% among boys. Regional differences exist in adult OB prevalence (2011-2016) and across ethnicities; South (32.0%) and Midwest (31.4%) had the highest rates. CONCLUSIONS US obesity prevalence has been rising, despite a temporary pause in 2009-2012. Wide disparities across groups and geographical regions persist. Effective, sustainable, culturally-tailored interventions are needed.
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Affiliation(s)
- Youfa Wang
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, USA.,Department of Nutrition and Health Sciences, College of Health, Ball State University, Muncie, IN, USA
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Jungwon Min
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, USA.,Healthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hong Xue
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, USA
| | - Lawrence J Cheskin
- Johns Hopkins Weight Management Center, Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, USA.,Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
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21
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Abstract
Obesity affects 2 of 5 Americans, and nearly 1 of 10 is considered severely obese, with the greatest risk of morbidity and mortality. A reduction in body weight of 2% to 5% can lead to improvements in cardiovascular health, with weight loss maintenance associated with the best health outcomes. Lifestyle interventions that focus on changes in diet and physical activity behaviors are best to maintain weight loss. This article provides a review of the treatment of adult obesity with a focus on dietary interventions.
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Affiliation(s)
- Sina Gallo
- Foods and Nutrition, University of Georgia, Dawson Hall room 209, 305 Sanford Drive, Athens, GA 30602, USA.
| | - Lawrence J Cheskin
- Nutrition and Food Studies, George Mason University, Johns Hopkins School of Medicine, Peterson Hall, 4114, 1F7, 4400 University Drive, Fairfax, VA 22030, USA
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22
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Beavis AL, Najjar O, Cheskin LJ, Mangal R, Rositch AF, Langham G, Fader AN. Prevalence of endometrial cancer symptoms among overweight and obese women presenting to a multidisciplinary weight management center. Gynecol Oncol Rep 2020; 34:100643. [PMID: 32995455 PMCID: PMC7502818 DOI: 10.1016/j.gore.2020.100643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/22/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022] Open
Abstract
44% of overweight or obese women reported abnormal bleeding symptoms associated with endometrial cancer (EC). Many obese women have not talked to their providers about these symptoms. Gynecologists should collaborate with providers of obese women to facilitate prevention and early detection of EC.
Endometrial cancer rates are rising in parallel with the obesity epidemic. We aimed to determine the prevalence of endometrial hyperplasia or cancer (EH/EC) bleeding symptoms among at-risk women. We conducted a retrospective cohort study of overweight and obese women at a multidisciplinary weight management center who had completed a gynecologic/menstrual history questionnaire from May 2018 to October 2019. The primary outcome of any EH/EC symptom was defined as follows: in premenopausal women, any recent abnormal uterine bleeding (AUB); in postmenopausal women: any bleeding/discharge. The prevalence of EH/EC symptoms was compared by menopausal status using Fisher’s exact tests, and multivariable regression identified independent factors associated with having EH/EC symptoms. A total of 103 women were included, and 4 (4%) had a history of EH/EC. Of the 84 (n = 82%) of women with no prior hysterectomy, 57% (n = 33/58) of premenopausal women reported any EH/EC symptom compared to 15% (n = 15/26) of postmenopausal women (p < 0.001). Two-thirds of symptomatic premenopausal women had two or more symptoms, most commonly heavy menses (49% (n = 25/51)) and irregular periods (39% (n = 17/44)). Sixty percent (n = 20/33) had discussed these with a gynecologist, and one third had undergone an endometrial biopsy. A history of polycystic ovarian syndrome (RR:1.72, 95% CI 1.24–2.38) was associated with EH/EC symptoms, while being postmenopausal was not (RR:0.32, 95%CI: 0.12–0.87). We demonstrate that EH/EC bleeding symptoms are prevalent in this at-risk population, but frequently are not discussed with gynecologists. Providers who care for obese women should ask about EH/EC symptoms, and provide prompt referrals to facilitate prevention and early detection of this cancer.
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Affiliation(s)
- Anna L. Beavis
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Corresponding author at: 600 North Wolfe St, Phipps 281, Baltimore, MD 21287, USA.
| | - Omar Najjar
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lawrence J. Cheskin
- Department of Nutrition and Food Services, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | | | - Anne F. Rositch
- Department Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Geri Langham
- Meharry Medical College School of Medicine, Nashville, TN, USA
| | - Amanda N. Fader
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Johnson KA, Jones-Smith J, Curriero FC, Cheskin LJ, Benjamin-Neelon SE, Perin J, Caicedo MR, Thornton RLJ. Low-Income Black and Hispanic Children's Neighborhood Food Environments and Weight Trajectories in Early Childhood. Acad Pediatr 2020; 20:784-792. [PMID: 31783182 PMCID: PMC7324231 DOI: 10.1016/j.acap.2019.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND High obesity rates among young black and Hispanic children place them at a higher risk for adult obesity and its comorbidities. Neighborhoods with predominately racial and ethnic minority residents have fewer healthful food options, which may contribute to obesity disparities. Few studies have assessed the relationship between neighborhood food environments and obesity in this population. METHODS Electronic health records from 2 pediatric primary care clinics serving predominately low-income, black, and Hispanic children were used to create a cohort of 3724 2- to 5-year olds, encompassing 7256 visits from 2007 to 2012 (mean 1.9 visits per patient, range: 1-5 visits per child). Longitudinal regression was used to model the association of mean body mass index z-score (BMI-z) over time and 3 measures of the neighborhood food environment: healthful food availability, availability of stores accepting the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) benefits, and fast food availability. RESULTS Compared to peers in neighborhoods with no or few stores accepting WIC, children in neighborhoods with many WIC stores had higher BMI-z at age 2 years (average difference of 0.272; 95% confidence interval: 0.041-0.503; P = .021). No relationship was found for healthful food or fast food availability. Although children in neighborhoods with low fast food availability did not have statistically significantly different BMI-z at age 2 as compared to children in areas with high fast food availability, they did have a statistically significantly higher change in average BMI-z over time (0.006 per month, 0.000-0.012, P = .024). CONCLUSIONS Access to WIC stores was associated with lower obesity rates and more healthful average BMI-z over time and represents a potentially important neighborhood food environment characteristic influencing racial/ethnic disparities in childhood obesity among young black and Hispanic children. More studies are needed to assess what aspects of WIC stores may underlie the observed association.
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Affiliation(s)
- Katherine Abowd Johnson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health (KA Johnson, SE Benjamin-Neelon, and RLJ Thornton), Baltimore, Md
| | - Jessica Jones-Smith
- University of Washington School of Public Health (J Jones-Smith), Seattle, Wash
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (FC Curriero), Baltimore, Md
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, College of Health & Human Services (LJ Cheskin), Fairfax, Va
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health (KA Johnson, SE Benjamin-Neelon, and RLJ Thornton), Baltimore, Md
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health (J Perin), Baltimore, Md
| | - Mariana Rincon Caicedo
- Department of Pediatrics, Johns Hopkins School of Medicine (MR Caicedo and RLJ Thornton), Baltimore, Md
| | - Rachel L J Thornton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health (KA Johnson, SE Benjamin-Neelon, and RLJ Thornton), Baltimore, Md; Department of Pediatrics, Johns Hopkins School of Medicine (MR Caicedo and RLJ Thornton), Baltimore, Md.
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Slavin M, Li HA, Frankenfeld C, Cheskin LJ. What is Needed for Evidence-Based Dietary Recommendations for Migraine: A Call to Action for Nutrition and Microbiome Research. Headache 2020; 59:1566-1581. [PMID: 31603554 DOI: 10.1111/head.13658] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The gastrointestinal symptoms of migraine attacks have invited numerous dietary hypotheses for migraine etiology through the centuries. Substantial efforts have been dedicated to identifying dietary interventions for migraine attack prevention, with limited success. Meanwhile, mounting evidence suggests that the reverse relationship may also exist - that the biological mechanisms of migraine may influence dietary intake. More likely, the truth involves some combination of both, where the disease influences food intake, and the foods eaten impact the manifestations of the disease. In addition, the gut's microbiota is increasingly suspected to influence the migraine brain via the gut-brain axis, though these hypotheses remain largely unsubstantiated. OBJECTIVE This paper presents an overview of the strength of existing evidence for food-based dietary interventions for migraine, noting that there is frequently evidence to suggest that a dietary risk factor for migraine exists but no evidence for how to best intervene; in fact, our intuitive assumptions on interventions are being challenged with new evidence. We then look to the future for promising avenues of research, notably the gut microbiome. CONCLUSION The evidence supports a call to action for high-quality dietary and microbiome research in migraine, both to substantiate hypothesized relationships and build the evidence base regarding nutrition's potential impact on migraine attack prevention and treatment.
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Affiliation(s)
- Margaret Slavin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
| | - Huilun Amber Li
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
| | - Cara Frankenfeld
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
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25
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Hedjoudje A, Abu Dayyeh BK, Cheskin LJ, Adam A, Neto MG, Badurdeen D, Morales JG, Sartoretto A, Nava GL, Vargas E, Sui Z, Fayad L, Farha J, Khashab MA, Kalloo AN, Alqahtani AR, Thompson CC, Kumbhari V. Efficacy and Safety of Endoscopic Sleeve Gastroplasty: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2020; 18:1043-1053.e4. [PMID: 31442601 DOI: 10.1016/j.cgh.2019.08.022] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/18/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Bariatric surgery is the most successful treatment for obesity. However, many patients avoid surgery due to its perceived invasive nature and fear of complications. Endoscopic sleeve gastroplasty (ESG) is a seemingly less invasive option for patients with obesity. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of ESG in adults. METHODS We searched MEDLINE, Embase, Web of Science, and Cochrane Library through July 2019. Investigated outcomes included the percent total body weight loss (TBWL), body mass index reduction, percent excess weight loss (EWL), and adverse events. RESULTS We extracted data from 8 original studies, published from 2016 through 2019, which included a total of 1772 patients. At 6 months, mean TBWL was 15.1% (95% CI, 14.3-16.0), mean decrease in body mass index was 5.65 kg/m2 (95% CI, 5.07-6.22), and mean excess weight loss was 57.7% (95% CI, 52.0-63.4). Weight loss was sustained at 12 months and 18-24 months with a TBWL of 16.5% (95% CI, 15.2-17.8) and 17.2% (95% CI, 14.6-19.7), respectively. The pooled post-ESG rate of severe adverse events was 2.2% (95% CI, 1.6%-3.1%), including pain or nausea requiring hospitalization (n = 18, 1.08%), upper gastrointestinal bleeding (n=9, 0.56%), and peri-gastric leak or fluid collection (n = 8, 0.48%). CONCLUSIONS In a systematic review and meta-analysis, we found ESG to produce clinically significant weight loss that was reproducible among independent centers and to have a low rate of severe adverse events. ESG appears to be an effective intervention for patients with obesity, although comparative studies and randomized controlled trials are necessary. PROSPERO Identifier: CRD42019121921.
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Affiliation(s)
- Abdellah Hedjoudje
- Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland
| | | | - Lawrence J Cheskin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Atif Adam
- Johns Hopkins Weight Management Center, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Manoel Galvão Neto
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Endovitta Institute, São Paulo, Brazil
| | - Dilhana Badurdeen
- Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland
| | | | | | - Gontrand Lopez Nava
- Bariatric Endoscopy Unit, Madrid Sanchinarro University Hospital, Madrid, Spain
| | - Eric Vargas
- Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Zhixian Sui
- BMI Clinic, Double Bay, Australia; School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia
| | - Lea Fayad
- Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Jad Farha
- Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Anthony N Kalloo
- Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Aayed R Alqahtani
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; New You Medical Center, Riyadh, Saudi Arabia
| | | | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland.
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26
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Wang Y, Min J, Khuri J, Xue H, Xie B, A Kaminsky L, J Cheskin L. Effectiveness of Mobile Health Interventions on Diabetes and Obesity Treatment and Management: Systematic Review of Systematic Reviews. JMIR Mhealth Uhealth 2020; 8:e15400. [PMID: 32343253 PMCID: PMC7218595 DOI: 10.2196/15400] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/04/2019] [Accepted: 01/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diabetes and obesity have become epidemics and costly chronic diseases. The impact of mobile health (mHealth) interventions on diabetes and obesity management is promising; however, studies showed varied results in the efficacy of mHealth interventions. OBJECTIVE This review aimed to evaluate the effectiveness of mHealth interventions for diabetes and obesity treatment and management on the basis of evidence reported in reviews and meta-analyses and to provide recommendations for future interventions and research. METHODS We systematically searched the PubMed, IEEE Xplore Digital Library, and Cochrane databases for systematic reviews published between January 1, 2005, and October 1, 2019. We analyzed 17 reviews, which assessed 55,604 original intervention studies, that met the inclusion criteria. Of those, 6 reviews were included in our meta-analysis. RESULTS The reviews primarily focused on the use of mobile apps and text messaging and the self-monitoring and management function of mHealth programs in patients with diabetes and obesity. All reviews examined changes in biomarkers, and some reviews assessed treatment adherence (n=7) and health behaviors (n=9). Although the effectiveness of mHealth interventions varied widely by study, all reviews concluded that mHealth was a feasible option and had the potential for improving patient health when compared with standard care, especially for glycemic control (-0.3% to -0.5% greater reduction in hemoglobin A1c) and weight reduction (-1.0 kg to -2.4 kg body weight). Overall, the existing 6 meta-analysis studies showed pooled favorable effects of these mHealth interventions (-0.79, 95% CI -1.17 to -0.42; I2=90.5). CONCLUSIONS mHealth interventions are promising, but there is limited evidence about their effectiveness in glycemic control and weight reduction. Future research to develop evidence-based mHealth strategies should use valid measures and rigorous study designs. To enhance the effectiveness of mHealth interventions, future studies are warranted for the optimal formats and the frequency of contacting patients, better tailoring of messages, and enhancing usability, which places a greater emphasis on maintaining effectiveness over time.
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Affiliation(s)
- Youfa Wang
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, United States
- Department of Nutrition and Health Sciences, College of Health, Ball State University, Muncie, IN, United States
| | - Jungwon Min
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, United States
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jacob Khuri
- School of Public Health, Imperial College London, London, United Kingdom
| | - Hong Xue
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States
| | - Bo Xie
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
- School of Information, The University of Texas at Austin, Austin, TX, United States
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, United States
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, United States
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, United States
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Kumbhari V, Cheskin LJ. In reflux-related heartburn unresponsive to PPIs, surgery increased treatment success vs active medical treatment. Ann Intern Med 2020; 172:JC32. [PMID: 32176898 DOI: 10.7326/acpj202003170-032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Vivek Kumbhari
- Johns Hopkins Medical InstitutionsBaltimore, Maryland, USA
| | - Lawrence J. Cheskin
- George Mason University, College of Health and Human ServicesFairfax, Virginia, USADisclosures: The commentators have disclosed no conflicts of interest. The forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3040
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28
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Garcia-Alvarez A, Cunningham CA, Mui B, Penn L, Spaulding EM, Oakes JM, Divers J, Dickinson SL, Xu X, Cheskin LJ. A randomized, placebo-controlled crossover trial of a decaffeinated energy drink shows no significant acute effect on mental energy. Am J Clin Nutr 2020; 111:719-727. [PMID: 31990972 PMCID: PMC7049526 DOI: 10.1093/ajcn/nqz343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/23/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND "Energy drinks" are heavily marketed to the general public, across the age spectrum. The efficacy of decaffeinated energy drinks in enhancing subjective feelings of energy (s-energy) is controversial. OBJECTIVE The authors sought to test the efficacy of the caffeine-free version of a popular energy drink compared with a placebo drink. METHODS This study was a randomized, double-blind, placebo-controlled, crossover trial in 223 healthy men and women aged 18-70 y with intention-to-treat and completers analysis. Participants were randomly assigned to consumption of either the decaffeinated energy drink or a placebo drink on testing day 1, and the other drink a week later. A battery of computer-based mood and cognitive tests to assess s-energy was conducted at baseline and at 0.5, 2.5, and 5 h post-ingestion. The main outcome measures were 1) mood, which was assessed by using a General Status Check Scale and the Profile of Mood States 2nd edition brief form, and 2) cognitive measures, including the N-back task (reaction time and accuracy), Reaction Time test, Flanker task (distraction avoidance), and Rapid Visual Information Processing test. RESULTS No statistically significant or meaningful benefits were observed for any outcome measure, including mood and cognitive measures. Analyses of mean differences, slopes, and median differences were consistent. CONCLUSIONS No differences were detected across a range of mood/cognitive/behavioral/s-energy-level tests after consumption of the energy drink compared with a placebo drink in this diverse sample of adults. Thus, we found strong evidence that the energy drink is not efficacious in enhancing s-energy levels, nor any related cognitive or behavioral variables measured. In light of federal regulations, these findings suggest that labeling and marketing of some products which claim to provide these benefits may be unsubstantiated. This trial was registered at www.clinicaltrials.gov as NCT02727920.
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Affiliation(s)
- Alicia Garcia-Alvarez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Corbin A Cunningham
- Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Byron Mui
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lia Penn
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Erin M Spaulding
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - J Michael Oakes
- Division of Epidemiology, University of Minnesota, Minneapolis, MN, USA
| | - Jasmin Divers
- Department of Biostatistics and Data Science, Division of Public Health, Wake Forest School of Medicine, Bowman Gray Center, Winston-Salem, NC, USA
| | - Stephanie L Dickinson
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University School of Public Health, Bloomington, IN, USA
| | - Xiao Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University School of Public Health, Bloomington, IN, USA
| | - Lawrence J Cheskin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
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29
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Cheskin LJ, Hill C, Adam A, Fayad L, Dunlap M, Badurdeen D, Koller K, Bunyard L, Frutchey R, Al-Grain H, Kahan S, Hedjoudje A, Khashab MA, Kalloo AN, Kumbhari V. Endoscopic sleeve gastroplasty versus high-intensity diet and lifestyle therapy: a case-matched study. Gastrointest Endosc 2020; 91:342-349.e1. [PMID: 31568769 DOI: 10.1016/j.gie.2019.09.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Endoscopic sleeve gastroplasty (ESG) is a safe and effective minimally invasive bariatric procedure. This study compared weight loss in patients undergoing ESG with that of matched patients undergoing high-intensity diet and lifestyle therapy (HIDLT). METHODS In this case-matched study, patients were matched 2/3:1 (HIDLT/ESG) by age, sex, and body mass index (BMI). One hundred five patients (30 men) who underwent ESG + low-intensity diet and lifestyle therapy (LIDLT) between 2016 and 2018 were compared with 281 patients (92 men) who underwent HIDLT at the Johns Hopkins Medical Institutions from 2013 to 2014. Weight was evaluated 1, 3, 6, and 12 months after beginning HIDLT or post-ESG to determine the mean percent total body weight loss (%TBWL). RESULTS Mean age across both cohorts was 48.0 ± 12.1, and baseline BMI was 40.0 ± 7.7 kg/m2. In multivariable analysis controlling for age, sex, and baseline BMI, the mean %TBWL at 1, 3, 6, and 12 months was significantly higher in patients undergoing ESG than matched patients undergoing HIDLT. Specifically, at 3 months, the mean %TBWL in the ESG cohort was 14.0% compared with 11.3% in the HIDLT cohort (P <.011), and at 12 months the mean %TBWL in the ESG cohort was 20.6% versus 14.3% in the HIDLT cohort (P < .001). ESG patients with baseline BMI ≤40 kg/m2 continued to show significantly greater %TBWL than those of the same BMI group in the HIDLT group at 1, 3, 6, and 12 months after intervention (3 months, coefficient = 3.43 [P < .001]; 12 months, coefficient = 8.14 [P < .001]). CONCLUSIONS Through 12 months of follow-up, patients who underwent ESG achieved significantly greater weight loss than patients enrolled in HIDLT. ESG appears to be a valuable alternative for patients who experience difficulty complying with HIDLT.
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Affiliation(s)
- Lawrence J Cheskin
- Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Christine Hill
- Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Atif Adam
- U.S. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lea Fayad
- U.S. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Margo Dunlap
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Kristen Koller
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Linda Bunyard
- Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robin Frutchey
- Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Haitham Al-Grain
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Scott Kahan
- National Center for Weight and Wellness, Washington, DC, USA
| | | | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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30
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Vaughan EM, Johnston CA, Moreno JP, Cheskin LJ, Dutton GR, Gee M, Gaussoin SA, Knowler WC, Rejeski WJ, Wadden TA, Yanovski SZ, Foreyt JP. Symptom prevalence differences of depression as measured by BDI and PHQ scales in the Look AHEAD study. Obes Sci Pract 2020; 6:28-38. [PMID: 32128240 PMCID: PMC7042097 DOI: 10.1002/osp4.378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To compare depressive symptomatology as assessed by two frequently used measures, the Beck Depression Inventory (BDI-1A) and Patient Health Questionnaire (PHQ-9). METHODS Investigators conducted a cross-sectional secondary analysis of data collected as part of the follow-up observational phase of the Look AHEAD study. Rates of agreement between the BDI-1A and PHQ-9 were calculated, and multivariable logistic regression was used to examine the relationship between differing depression category classifications and demographic factors (ie, age, sex, race/ethnicity) or comorbidities (ie, diabetes control, cardiovascular disease). RESULTS A high level of agreement (κ = 0.47, 95% CI (0.43 to 0.50)) was found in the level of depressive symptomatology between the BDI-1A and PHQ-9. Differing classifications (minimal, mild, moderate, and severe) occurred in 16.8% of the sample. Higher scores on the somatic subscale of the BDI-1A were significantly associated with disagreement as were having a history of cardiovascular disease, lower health-related quality of life, and minority racial/ethnic classification. CONCLUSIONS Either the BDI-1A or PHQ-9 can be used to assess depressive symptomatology in adults with overweight/obesity and type 2 diabetes. However, further assessment should be considered in those with related somatic symptoms, decreased quality of life, and in racial/ethnic minority populations.
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Affiliation(s)
| | - Craig A. Johnston
- Department of Health and Human PerformanceUniversity of HoustonHoustonTexas
| | - Jennette P. Moreno
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics‐NutritionBaylor College of MedicineHoustonTexas
| | - Lawrence J. Cheskin
- Department of Nutrition and Food Studies, College of Health and Human ServicesGeorge Mason UniversityFairfaxVirginia
- Department of Health, Behavior & SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Gareth R. Dutton
- Division of Preventive MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Molly Gee
- Department of MedicineBaylor College of MedicineHoustonTexas
| | - Sarah A. Gaussoin
- Department of Biostatistical Sciences and Data Science, Division of Public Health ServicesWake Forest School of MedicineWinston‐SalemNorth Carolina
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research SectionNational Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of HealthPhoenixArizona
| | - W. Jack Rejeski
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNorth Carolina
| | - Thomas A. Wadden
- Department of PsychiatryPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvania
| | - Susan Z. Yanovski
- Division of Digestive Diseases and NutritionNational Institute of Diabetes and Digestive and Kidney DiseasesBethesdaMaryland
| | - John P. Foreyt
- Department of MedicineBaylor College of MedicineHoustonTexas
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31
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Lewis CE, Bantle JP, Bertoni AG, Blackburn G, Brancati FL, Bray GA, Cheskin LJ, Curtis JM, Egan C, Evans M, Foreyt JP, Ghazarian S, Gibbs BB, Glasser S, Gregg EW, Hazuda HP, Hesson L, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Kitabchi AE, Kitzman D, Knowler WC, Lipkin E, Michaels S, Montez MG, Nathan DM, Nyenwe E, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Ryan DH, Wadden TA, Wagenknecht LE, Wyatt H, Wing RR, Yanovski SZ. History of Cardiovascular Disease, Intensive Lifestyle Intervention, and Cardiovascular Outcomes in the Look AHEAD Trial. Obesity (Silver Spring) 2020; 28:247-258. [PMID: 31898874 PMCID: PMC6980987 DOI: 10.1002/oby.22676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/11/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the effects of an intensive lifestyle intervention (ILI) on cardiovascular disease (CVD), the Action for Health in Diabetes (Look AHEAD) trial randomized 5,145 participants with type 2 diabetes and overweight/obesity to a ILI or diabetes support and education. Although the primary outcome did not differ between the groups, there was suggestive evidence of heterogeneity for prespecified baseline CVD history subgroups (interaction P = 0.063). Event rates were higher in the ILI group among those with a CVD history (hazard ratio 1.13 [95% CI: 0.90-1.41]) and lower among those without CVD (hazard ratio 0.86 [95% CI: 0.72-1.02]). METHODS This study conducted post hoc analyses of the rates of the primary composite outcome and components, adjudicated cardiovascular death, nonfatal myocardial infarction (MI), stroke, and hospitalization for angina, as well as three secondary composite cardiovascular outcomes. RESULTS Interaction P values for the primary and two secondary composites were similar (0.060-0.064). Of components, the interaction was significant for nonfatal MI (P = 0.035). This interaction was not due to confounding by baseline variables, different intervention responses for weight loss and physical fitness, or hypoglycemic events. In those with a CVD history, statin use was high and similar by group. In those without a CVD history, low-density lipoprotein cholesterol levels were higher (P = 0.003) and statin use was lower (P ≤ 0.001) in the ILI group. CONCLUSIONS Intervention response heterogeneity was significant for nonfatal MI. Response heterogeneity may need consideration in a CVD-outcome trial design.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jeffrey M. Curtis
- Southwestern American Indian Center, Phoenix, AZ; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ; St. Joseph’s Hospital and Medical Center, Phoenix
| | - Caitlin Egan
- The Miriam Hospital, Brown Medical School; Providence, RI
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
| | | | | | | | | | | | - Helen P. Hazuda
- University of Texas Health Science Center at San Antonio; San Antonio, TX
| | | | - James O. Hill
- University of Colorado Anschutz Medical Campus; Aurora, CO
| | | | - Van S. Hubbard
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
| | | | | | | | - Steven E. Kahn
- VA Puget Sound Health Care System, University of Washington; Seattle, WA
| | | | | | - William C. Knowler
- Southwestern American Indian Center, Phoenix; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Edward Lipkin
- VA Puget Sound Health Care System, University of Washington; Seattle, WA
| | | | - Maria G. Montez
- University of Texas Health Science Center at San Antonio; San Antonio, TX
| | | | | | - Jennifer Patricio
- St. Luke’s Roosevelt Hospital Center, Columbia University; New York, NY
| | - Anne Peters
- University of Southern California; Los Angeles, CA
| | - Xavier Pi-Sunyer
- St. Luke’s Roosevelt Hospital Center, Columbia University; New York, NY
| | | | | | - Donna H. Ryan
- Pennington Biomedical Research Center; Baton Rouge, LA
| | | | | | - Holly Wyatt
- University of Colorado Anschutz Medical Campus; Aurora, CO
| | - Rena R. Wing
- The Miriam Hospital, Brown Medical School; Providence, RI
| | - Susan Z. Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
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Jakicic JM, Horton ES, Curtis JM, Killean TM, Bray GA, Cheskin LJ, Johnson KC, Middelbeek RJW, Pi-Sunyer FX, Regensteiner JG, Ribisl PM, Wagenknecht L, Espeland MA. Abnormal Exercise Test or CVD History on Weight Loss or Fitness: the Look AHEAD Trial. Transl J Am Coll Sports Med 2020; 5:e000134. [PMID: 34017914 PMCID: PMC8130141 DOI: 10.1249/tjx.0000000000000134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Obesity and type 2 diabetes are associated with an increased risk of cardiovascular disease (CVD) and the combination of weight loss and increased physical exercise are commonly recommended to reduce CVD. This study examined whether people with obesity and type 2 diabetes with an abnormal graded exercise tolerance test (GXT) or a history of CVD would have less success in achieving weight loss and improved fitness, compared to adults without these conditions. METHODS The Look AHEAD Study examined whether an intensive lifestyle intervention (ILI) compared with diabetes support and education (DSE) reduced cardiovascular events in adults with overweight/obesity and type 2 diabetes. Participants underwent a baseline maximal GXT and provided medical history data. Weight loss and fitness change were examined in 5011 participants over four years in those with or without an abnormal baseline GXT and/or history of CVD. RESULTS After four years, weight loss in both ILI and DSE were significantly greater in those without a prior history of CVD than in those with a CVD history (6.69% vs 5.98%, p=0.02, in ILI and 0.73 vs -.07% (weight gain), p=0.01, in DSE). Likewise, those without a prior history of CVD experienced greater improvements in fitness in both ILI and DSE relative to those with a history of CVD. Having an abnormal GXT at baseline did not affect weight loss or fitness. CONCLUSIONS A history of CVD at baseline modestly lessened weight loss and fitness changes at 4 years, whereas having any abnormality on the baseline GXT did not affect these outcomes. Thus, weight loss and improved fitness are achievable in adults with a history of CVD or ECG abnormalities.
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Affiliation(s)
| | | | - Jeffrey M. Curtis
- NIDDK, Phoenix, AZ
- St. Joseph’s Hospital and Medical Center, Phoenix, AZ
| | - Tina M. Killean
- NIDDK, Phoenix, AZ
- Northern Navajo Medical Center, Shiprock, NM
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Knapp EA, Bennett WL, Wilson RF, Zhang A, Tseng E, Cheskin LJ, Bass EB, Kharrazi H, Stuart EA. Methods and Risks of Bias in Natural Experiments in Obesity: Opportunities for the Future Informed by a Systematic Review. Obesity (Silver Spring) 2019; 27:1950-1957. [PMID: 31693802 DOI: 10.1002/oby.22645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/19/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This paper promotes rigorous methods and designs currently underutilized in obesity research, informed by a recent systematic review of the methods and risks of bias in studies of policies, programs, and built environment changes for obesity prevention and control. METHODS To determine the current state of the field, relevant databases from 2000 to 2017 were searched to identify studies that fit the inclusion criteria. Study design, analytic approach, and other details of study methods were abstracted. These findings inform recommendations for obesity researchers and the field as a whole. RESULTS Previously identified were 156 natural experiment studies. Most were cross-sectional (35%), pre-post single group comparison (31%), or difference-in-differences designs (29%). Few used rigorous causal designs such as interrupted time series with more than two time points, propensity score methods, or instrumental variables. The potential relevance for obesity research is discussed, and recommendations for obesity researchers are provided. CONCLUSIONS To strengthen natural experiment study designs and enhance the validity of results, researchers should carefully consider and control for confounding and selection of comparison groups and consider study designs that address these biases.
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Affiliation(s)
- Emily A Knapp
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wendy L Bennett
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Renee F Wilson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allen Zhang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eva Tseng
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lawrence J Cheskin
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Eric B Bass
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hadi Kharrazi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth A Stuart
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Cheskin LJ, Slavin M. Review: No high-certainty evidence exists that nutritional supplements or diets affect cardiovascular outcomes. Ann Intern Med 2019; 171:JC50. [PMID: 31739333 DOI: 10.7326/acpj201911190-050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Margaret Slavin
- George Mason UniversityDepartment of Nutrition and Food StudiesFairfax, Virginia, USA
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Sartoretto A, Sui Z, Hill C, Dunlap M, Rivera AR, Khashab MA, Kalloo AN, Fayad L, Cheskin LJ, Marinos G, Wilson E, Kumbhari V. Endoscopic Sleeve Gastroplasty (ESG) Is a Reproducible and Effective Endoscopic Bariatric Therapy Suitable for Widespread Clinical Adoption: a Large, International Multicenter Study. Obes Surg 2019; 28:1812-1821. [PMID: 29450845 DOI: 10.1007/s11695-018-3135-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Endoscopic sleeve gastroplasty (ESG), an incisionless endoscopic bariatric procedure, has shown impressive results in case series. This study examines the reproducibility, efficacy, and safety in three centers across two countries, and identifies key determinants for procedural success. DESIGN Patients who underwent ESG between February 2016 and May 2017 at one of three centers (Australia and USA) were retrospectively analyzed. All procedures were performed on an outpatient basis using the Apollo OverStitch device (Apollo Endosurgery, Austin, TX). Primary outcomes included absolute weight loss (ΔWeight, kg), change in body mass index (∆BMI, in kg/m2), total body weight loss (TBWL, %), excess weight loss (EWL, in %), and immediate and delayed adverse events. RESULTS In total, 112 consecutive patients (male 31%, age 45.1 ± 11.7 years, baseline BMI 37.9 ± 6.7 kg/m2) underwent ESG. At 1, 3, and 6 months, Δweight was 9.0 ± 4.6 kg (TBWL 8.4 ± 4.1%), 12.9 ± 6.4 kg (TBWL 11.9 ± 4.5%), and 16.4 ± 10.7 kg (TBWL 14.9 ± 6.1%), respectively. The proportion of patients who attained greater than 10% TBWL and 25% EWL was 62.2 and 78.0% at 3 months post-ESG and 81.0 and 86.5% at 6 months post-ESG. Weight loss was similar between the three centers. Multivariable analysis showed that male sex, greater baseline body weight, and lack of prior endoscopic bariatric therapy were predictors of greater Δweight at 6 months. Three (2.7%) severe adverse events were observed. CONCLUSIONS ESG is an effective, reproducible, and safe weight loss therapy that is suitable for widespread clinical adoption.
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Affiliation(s)
| | - Zhixian Sui
- Bariatric and Metabolic Institute, Double Bay, NSW, Australia
| | - Christine Hill
- Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Margo Dunlap
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - Angielyn R Rivera
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - Lawrence J Cheskin
- Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - George Marinos
- Bariatric and Metabolic Institute, Double Bay, NSW, Australia
| | - Erik Wilson
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA.
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Fahey JW, Wade KL, Stephenson KK, Panjwani AA, Liu H, Cornblatt G, Cornblatt BS, Ownby SL, Fuchs E, Holtzclaw WD, Cheskin LJ. Bioavailability of Sulforaphane Following Ingestion of Glucoraphanin-Rich Broccoli Sprout and Seed Extracts with Active Myrosinase: A Pilot Study of the Effects of Proton Pump Inhibitor Administration. Nutrients 2019; 11:nu11071489. [PMID: 31261930 PMCID: PMC6682992 DOI: 10.3390/nu11071489] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022] Open
Abstract
We examined whether gastric acidity would affect the activity of myrosinase, co-delivered with glucoraphanin (GR), to convert GR to sulforaphane (SF). A broccoli seed and sprout extract (BSE) rich in GR and active myrosinase was delivered before and after participants began taking the anti-acid omeprazole, a potent proton pump inhibitor. Gastric acidity appears to attenuate GR bioavailability, as evidenced by more SF and its metabolites being excreted after participants started taking omeprazole. Enteric coating enhanced conversion of GR to SF, perhaps by sparing myrosinase from the acidity of the stomach. There were negligible effects of age, sex, ethnicity, BMI, vegetable consumption, and bowel movement frequency and quality. Greater body mass correlated with reduced conversion efficiency. Changes in the expression of 20 genes in peripheral blood mononuclear cells were evaluated as possible pharmacodynamic indicators. When grouped by their primary functions based on a priori knowledge, expression of genes associated with inflammation decreased non-significantly, and those genes associated with cytoprotection, detoxification and antioxidant functions increased significantly with bioavailability. Using principal components analysis, component loadings of the changes in gene expression confirmed these groupings in a sensitivity analysis.
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Affiliation(s)
- Jed W Fahey
- Cullman Chemoprotection Center, Johns Hopkins University, Baltimore, MD 21205, USA.
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
- Center for Human Nutrition, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Kristina L Wade
- Cullman Chemoprotection Center, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Katherine K Stephenson
- Cullman Chemoprotection Center, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Anita A Panjwani
- Cullman Chemoprotection Center, Johns Hopkins University, Baltimore, MD 21205, USA
- Center for Human Nutrition, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Hua Liu
- Cullman Chemoprotection Center, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Grace Cornblatt
- Nutramax Laboratories Consumer Care, Inc., Edgewood, MD 21040, USA
| | | | - Stacy L Ownby
- Nutramax Laboratories Consumer Care, Inc., Edgewood, MD 21040, USA
| | - Edward Fuchs
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Walter David Holtzclaw
- Cullman Chemoprotection Center, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Lawrence J Cheskin
- Department of Health Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA
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Fayad L, Cheskin LJ, Adam A, Badurdeen DS, Hill C, Agnihotri A, Dunlap M, Simsek C, Khashab MA, Kalloo AN, Kumbhari V. Endoscopic sleeve gastroplasty versus intragastric balloon insertion: efficacy, durability, and safety. Endoscopy 2019; 51:532-539. [PMID: 30841009 DOI: 10.1055/a-0852-3441] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Intragastric balloon (IGB) placement and endoscopic sleeve gastroplasty (ESG) are reported to be safe and effective endoscopic bariatric therapies. This study aimed to compare the patient demographics and therapeutic outcomes between the IGB and ESG procedures. METHODS This was a retrospective review of prospectively collected data from consecutive patients between December 2015 and October 2017 who underwent IGB or ESG at a single academic center. Fluid-filled IGBs implanted for a 6-month duration were used. IGB and ESG patients were subjected to identical post-procedure dietary instructions and follow-up protocols. Body weight was recorded at 1, 3, 6, and 12 months post-procedure. RESULTS A total of 47 patients underwent IGB insertion and 58 underwent ESG. The IGB cohort had a lower baseline body mass index (BMI) than the ESG (34.5 vs. 41.5 kg/m2; P < 0.001) and a significantly lower proportion of men (2.1 % vs. 41.4 %; P < 0.001). IGB patients showed a mean (standard deviation [SD]) percentage total body weight loss (%TBWL) that was significantly lower than ESG patients at 1 month (6.6 % [2.6 %] vs. 9.9 % [2.4 %]; P < 0.001), 3 months (11.1 % [4.4 %] vs. 14.3 % [4.6 %]; P = 0.004), 6 months (15.0 % [7.6 %] vs. 19.5 % [5.7 %]; P = 0.01), and 12 months (13.9 % [9.0 %] vs. 21.3 % [6.6 %]; P = 0.005). The IGB cohort also experienced significantly more adverse events compared with the ESG (17 % vs. 5.2 %; P = 0.048). CONCLUSIONS IGB placement and ESG result in clinically meaningful weight loss. However, ESG appears to provide clinically superior and more enduring weight loss with fewer adverse events compared with an IGB.
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Affiliation(s)
- Lea Fayad
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lawrence J Cheskin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Atif Adam
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Christine Hill
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Margo Dunlap
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cem Simsek
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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38
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Weiss CR, Abiola GO, Fischman AM, Cheskin LJ, Vairavamurthy J, Holly BP, Akinwande O, Nwoke F, Paudel K, Belmustakov S, Hong K, Patel RS, Shin EJ, Steele KE, Moran TH, Thompson RE, Dunklin T, Ziessman H, Kraitchman DL, Arepally A. Bariatric Embolization of Arteries for the Treatment of Obesity (BEAT Obesity) Trial: Results at 1 Year. Radiology 2019; 291:792-800. [PMID: 30938624 DOI: 10.1148/radiol.2019182354] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Bariatric embolization is a new endovascular procedure to treat patients with obesity. However, the safety and efficacy of bariatric embolization are unknown. Purpose To evaluate the safety and efficacy of bariatric embolization in severely obese adults at up to 12 months after the procedure. Materials and Methods For this prospective study (NCT0216512 on ClinicalTrials.gov ), 20 participants (16 women) aged 27-68 years (mean ± standard deviation, 44 years ± 11) with mean body mass index of 45 ± 4.1 were enrolled at two institutions from June 2014 to February 2018. Transarterial embolization of the gastric fundus was performed using 300- to 500-µm embolic microspheres. Primary end points were 30-day adverse events and weight loss at up to 12 months. Secondary end points at up to 12 months included technical feasibility, health-related quality of life (Short Form-36 Health Survey ([SF-36]), impact of weight on quality of life (IWQOL-Lite), and hunger or appetite using a visual assessment scale. Analysis of outcomes was performed by using one-sample t tests and other exploratory statistics. Results Bariatric embolization was performed successfully for all participants with no major adverse events. Eight participants had a total of 11 minor adverse events. Mean excess weight loss was 8.2% (95% confidence interval [CI]: 6.3%, 10%; P < .001) at 1 month, 11.5% (95% CI: 8.7%, 14%; P < .001) at 3 months, 12.8% (95% CI: 8.3%, 17%; P < .001) at 6 months, and 11.5% (95% CI: 6.8%, 16%; P < .001) at 12 months. From baseline to 12 months, mean SF-36 scores increased (mental component summary, from 46 ± 11 to 50 ± 10, P = .44; physical component summary, from 46 ± 8.0 to 50 ± 9.3, P = .15) and mean IWQOL-Lite scores increased from 57 ± 18 to 77 ± 18 (P < .001). Hunger or appetite decreased for 4 weeks after embolization and increased thereafter, without reaching pre-embolization levels. Conclusion Bariatric embolization is well tolerated in severely obese adults, inducing appetite suppression and weight loss for up to 12 months. Published under a CC BY-NC-ND 4.0 license. Online supplemental material is available for this article.
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Affiliation(s)
- Clifford R Weiss
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Godwin O Abiola
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Aaron M Fischman
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Lawrence J Cheskin
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Jay Vairavamurthy
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Brian P Holly
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Olaguoke Akinwande
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Franklin Nwoke
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Kalyan Paudel
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Stephen Belmustakov
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Kelvin Hong
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Rahul S Patel
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Eun J Shin
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Kimberley E Steele
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Timothy H Moran
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Richard E Thompson
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Taylor Dunklin
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Harvey Ziessman
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Dara L Kraitchman
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Aravind Arepally
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
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Fayad L, Adam A, Schweitzer M, Cheskin LJ, Ajayi T, Dunlap M, Badurdeen DS, Hill C, Paranji N, Lalezari S, Kalloo AN, Khashab MA, Kumbhari V. Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study. Gastrointest Endosc 2019; 89:782-788. [PMID: 30148991 DOI: 10.1016/j.gie.2018.08.030] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/12/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endoscopic sleeve gastroplasty (ESG) reduces the gastric lumen to a size comparable with that of laparoscopic sleeve gastrectomy (LSG). However, there is a paucity of research comparing outcomes between the 2 procedures. Our study compared the 6-month weight loss outcomes and adverse events of ESG with LSG in a case-matched cohort. METHODS We retrospectively reviewed prospectively collected data for patients undergoing ESG or LSG at a single academic center. Weight was recorded at 1 and 6 months postprocedure, and percent total body weight loss (%TBWL) was calculated. Adverse events and new-onset Gastroesophageal Reflux Disease (GERD) were also recorded. RESULTS A total of 54 ESG patients were matched with 83 LSG patients by age, sex, and body mass index. The proportion of patients with GERD at baseline was similar in the 2 groups (16.7% in ESG group vs 25.3% in LSG group, P = .27). At the 6-month follow-up, %TBWL (compared with baseline) was significantly lower in the ESG group compared with the LSG group (17.1% ± 6.5% vs 23.6% ± 7.6%, P < .01). ESG patients had significantly lower rates of adverse events compared with LSG patients (5.2% vs 16.9%, P < .05). New-onset GERD was also significantly lower in the ESG group compared with the LSG group (1.9% vs 14.5%, P < .05). CONCLUSIONS ESG, a minimally invasive same-day procedure, achieved less weight loss at 6 months than LSG, with the caveat that LSG caused more adverse events and new-onset GERD than ESG.
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Affiliation(s)
- Lea Fayad
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Atif Adam
- Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael Schweitzer
- Division of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Lawrence J Cheskin
- Johns Hopkins Weight Management Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tokunbo Ajayi
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Margo Dunlap
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Dilhana S Badurdeen
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Christine Hill
- Johns Hopkins Weight Management Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neethi Paranji
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Sepehr Lalezari
- Division of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Johnson KA, Showell NN, Flessa S, Janssen M, Reid N, Cheskin LJ, Thornton RL. Do Neighborhoods Matter? A Systematic Review of Modifiable Risk Factors for Obesity among Low Socio-Economic Status Black and Hispanic Children. Child Obes 2019; 15:71-86. [PMID: 30565954 PMCID: PMC6386088 DOI: 10.1089/chi.2018.0044] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Childhood obesity increases the risk of obesity and harmful comorbidities later in life. It is influenced by characteristics of a child's neighborhood, particularly among underserved groups. Our objective was to systematically review the evidence relating neighborhood environment and obesity risk among urban, low socioeconomic status (SES) Black and Hispanic children. METHODS We included studies published from 1993 through early 2017 from PubMed, SCOPUS, Web of Science, and Sociological Abstracts databases investigating relationships between empirically measured neighborhood characteristics and obesity risk factors in the populations of interest. Databases were last searched on May 8, 2018. Initial analysis took place during 2014 and was completed during 2017. We extracted data on study population, design, and associations between neighborhood characteristics and obesity risk factors. RESULTS We identified 2011 unique studies; 24 were included. Few studies demonstrated consistent patterns of association. Most neighborhood characteristics were not examined across multiple studies. BMI may be related to living in a lower-income neighborhood or convenience store access. CONCLUSIONS This review found that the body of evidence relating neighborhood exposures and obesity risk factors among urban, low SES Black (also commonly referred to in the literature as "non-Hispanic Black" or African American) and Hispanic children is limited. Given the high risk of obesity and cardiovascular disease among these populations throughout the life course, research on neighborhood determinants of obesity should specifically include these populations, ensuring adequate power and methodological rigor to detect differences.
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Affiliation(s)
- Katherine Abowd Johnson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nakiya N. Showell
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sarah Flessa
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Natalie Reid
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lawrence J. Cheskin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Global Obesity Prevention Center at Johns Hopkins, Baltimore, MD
| | - Rachel L.J. Thornton
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.,Address correspondence to: Rachel L.J. Thornton, MD, PhD, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Suite 4200, Baltimore, MD 21224
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Loh IH, Schwendler T, Trude ACB, Anderson Steeves ET, Cheskin LJ, Lange S, Gittelsohn J. Implementation of Text-Messaging and Social Media Strategies in a Multilevel Childhood Obesity Prevention Intervention: Process Evaluation Results. Inquiry 2018; 55:46958018779189. [PMID: 29865969 PMCID: PMC6022210 DOI: 10.1177/0046958018779189] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Social media and text messaging show promise as public health interventions, but little evaluation of implementation exists. The B’more Healthy Communities for Kids (BHCK) was a multilevel, multicomponent (wholesalers, food stores, recreation centers) childhood obesity prevention trial that included social media and text-messaging components. The BHCK was implemented in 28 low-income areas of Baltimore City, Maryland, in 2 waves. The texting intervention targeted 241 low-income African American caregivers (of 283), who received 3 texts/week reinforcing key messages, providing nutrition information, and weekly goals. Regular posting on social media platforms (Facebook, Instagram, Twitter) targeted community members and local stakeholders. High implementation standards were set a priori (57 for social media, 11 for texting), with low implementation defined as <50%, medium as 50% to 99%, high as ≥100% of the high standard for each measure. Reach, dose delivered, and fidelity were assessed via web-based analytic tools. Between waves, social media implementation improved from low-moderate to high reach, dose delivered, and fidelity. Text messaging increased from moderate to high in reach and dose delivered, fidelity decreased from high to moderate. Data were used to monitor and revise the BHCK intervention throughout implementation. Our model for evaluating text messaging–based and social media–based interventions may be applicable to other settings.
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Affiliation(s)
- Ivory H Loh
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Angela C B Trude
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Sarah Lange
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joel Gittelsohn
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Tseng E, Zhang A, Shogbesan O, Gudzune KA, Wilson RF, Kharrazi H, Cheskin LJ, Bass EB, Bennett WL. Effectiveness of Policies and Programs to Combat Adult Obesity: a Systematic Review. J Gen Intern Med 2018; 33:1990-2001. [PMID: 30206789 PMCID: PMC6206360 DOI: 10.1007/s11606-018-4619-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/30/2018] [Accepted: 07/31/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND This systematic review identifies programs, policies, and built-environment changes targeting prevention and control of adult obesity and evaluates their effectiveness. METHODS We searched PubMed, CINAHL, PsycINFO, and EconLit from January 2000 to March 2018. We included natural experiment studies evaluating a program, policy, or built-environment change targeting adult obesity and reporting weight/body mass index (BMI). Studies were categorized by primary intervention target: physical activity/built environment, food/beverage, messaging, or multiple. Two reviewers independently assessed the risk of bias for each study using the Effective Public Health Practice Project tool. RESULTS Of 158 natural experiments targeting obesity, 17 reported adult weight/BMI outcomes. Four of 9 studies reporting on physical activity/built environment demonstrated reduced weight/BMI, although effect sizes were small with low strength of evidence and high risk of bias. None of the 5 studies targeting the food/beverage environment decreased weight/BMI; strength of evidence was low, and 2 studies were rated high risk of bias. DISCUSSION We identified few natural experiments reporting on the effectiveness of programs, policies, and built-environment changes on adult obesity. Overall, we found no evidence that policies intending to promote physical activity and healthy eating had beneficial effects on weight/BMI and most studies had a high risk of bias. Limitations include few studies met our inclusion criteria; excluded studies in children and those not reporting on weight/BMI outcomes; weight/BMI reporting was very heterogeneous. More high-quality research, including natural experiments studies, is critical for informing the population-level effectiveness of obesity prevention and control initiatives in adults.
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Affiliation(s)
- Eva Tseng
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA.
| | - Allen Zhang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | | | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - Renee F Wilson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - Hadi Kharrazi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence J Cheskin
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - Wendy L Bennett
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
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Trude ACB, Surkan PJ, Cheskin LJ, Gittelsohn J. A multilevel, multicomponent childhood obesity prevention group-randomized controlled trial improves healthier food purchasing and reduces sweet-snack consumption among low-income African-American youth. Nutr J 2018; 17:96. [PMID: 30373597 PMCID: PMC6206663 DOI: 10.1186/s12937-018-0406-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 10/17/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Consumption of foods and beverages rich in sugar remains high across all races and ages in the United States. Interventions to address childhood obesity and decrease sugar intake are needed, particularly in low-income settings. METHODS B'more Healthy Communities for Kids (BHCK) was a group-randomized, controlled trial implemented among 9-15-year olds in 30 low-income areas of Baltimore. We increased access to low-sugar foods and beverages at wholesalers and small food stores. Concurrently, we encouraged their purchase and consumption by children through youth-led nutrition education in recreation centers, in-store promotions, text messaging and a social media program directed at caregivers. Sugar consumption (sugar sweetened beverage (SSB), sweets) in youth was assessed pre- (n = 534) and post-intervention (n = 401) using the Block Kids Food Frequency Questionnaire. Purchasing of 38 healthier and 28 less healthier food/beverage varieties in the previous 7 days was assessed via self-report. Multilevel models at the community and individual levels were used. Analyses were stratified by age (younger: 9-12-year olds (n = 339) vs older: 13-15 (n = 170)). Models were controlled for child's sex, race, total daily caloric intake, and caregiver's age and sex. RESULTS Overall baseline mean healthier food purchasing was 2.5 (+ 3.6; min. 0, max. 34 items per week), and unhealthier food purchasing 4.6 (+ 3.7; 0-19 items per week). Mean intake at baseline for kcal from SSB was 176 (+ 189.1) and 153 (+ 142.5), and % of calories from sweets (i.e. cookies, cakes, pies, donuts, candy, ice cream, sweetened cereals, and chocolate beverages) was 15.9 (+ 9.7) and 15.9 (+ 7.7) in comparison and intervention youth, respectively. Intervention youth increased healthier foods and beverages purchases by 1.4 more items per week than comparison youth (β = 1.4; 95% CI: 0.1; 2.8). After the intervention, there was a 3.5% decrease in kcal from sweets for older intervention youth, compared to the control group (β = - 3.5; 95% CI: -7.76; - 0.05). No impact was seen on SSB consumption. CONCLUSION BHCK successfully increased healthier food purchasing variety in youth, and decreased % calories from sweet snacks in older youth. Multilevel, multicomponent environmental childhood obesity programs are a promising strategy to improve eating behaviors among low-income urban youth. TRIAL REGISTRATION NCT02181010 (July 2, 2014, retrospectively registered).
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Affiliation(s)
- Angela C. B. Trude
- Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Pamela J. Surkan
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Lawrence J. Cheskin
- Department of Health Behavior and Society, and the Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, 550 N. Broadway, Baltimore, MD 21205 USA
| | - Joel Gittelsohn
- Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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Mazidi M, Kengne AP, Cheskin LJ, Banach M. Serum lipophilic antioxidants levels are associated with leucocyte telomere length among US adults. Lipids Health Dis 2018; 17:164. [PMID: 30029639 PMCID: PMC6054751 DOI: 10.1186/s12944-018-0781-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/15/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To examine the association between serum concentrations of antioxidant and telomere length (TL) in U.S adults. METHODS Participants of the National Health and Nutrition Examination Survey (NHANES) with data available on TL measures from 2001 to 2002 were included. Serum lipophilic antioxidants level was measured using high performance liquid chromatography with photodiode array detection. We used analysis of co-variance and multivariable-adjusted linear regression models, accounting for the survey design and sample weights. RESULTS Of the 5992 eligible participants, 47.5% (n = 2844) were men. The mean age was 46.9 years overall, 47.2 years in men and 46.6 in women (p = 0.071). In age, sex, race, education, marital status, adiposity, smoking, C-reactive protein adjusted linear regressions, antioxidant, serum α-carotene, trans-β-carotene, cis- β-carotene, β-cryptoxanthin and combined Lutein/zeaxanthin were positively and significantly associated with TL (all p < 0.001). CONCLUSIONS Our findings support a possible positive association between serum concentrations of lipophylic antioxidant and TL. The implications of this association deserve further investigation.
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Affiliation(s)
- Mohsen Mazidi
- Department of Biology and Biological Engineering, Food and Nutrition Science, Chalmers University of Technology, SE-412 96, Gothenburg, Sweden.
| | - Andre Pascal Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council and University of Cape Town, Cape Town, South Africa
| | - L J Cheskin
- Department of Health, Johns Hopkins Weight Management Center Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Global Obesity Prevention Center at Johns Hopkins University, International Health/Human Nutrition, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Cardiovascular Research Center, University of Zielona-Gora, Zielona Gora, Poland
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Vargas EJ, Pesta CM, Bali A, Ibegbu E, Bazerbachi F, Moore RL, Kumbhari V, Sharaiha RZ, Curry TW, DosSantos G, Schmitz R, Agnihotri A, Novikov AA, Pitt T, Dunlap MK, Herr A, Aronne L, Ledonne E, Kadouh HC, Cheskin LJ, Mundi MS, Acosta A, Gostout CJ, Abu Dayyeh BK. Single Fluid-Filled Intragastric Balloon Safe and Effective for Inducing Weight Loss in a Real-World Population. Clin Gastroenterol Hepatol 2018; 16:1073-1080.e1. [PMID: 29425781 PMCID: PMC6008169 DOI: 10.1016/j.cgh.2018.01.046] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/16/2018] [Accepted: 01/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The Orbera intragastric balloon (OIB) is a single fluid-filled intragastric balloon approved for the induction of weight loss and treatment of obesity. However, little is known about the effectiveness and safety of the OIB outside clinical trials, and since approval, the Food and Drug Administration has issued warnings to health care providers about risk of balloon hyperinflation requiring early removal, pancreatitis, and death. We analyzed data on patients who have received the OIB since its approval to determine its safety, effectiveness, and tolerance in real-world clinical settings. METHODS We performed a postregulatory approval study of the safety and efficacy of the OIB, and factors associated with intolerance and response. We collected data from the Mayo Clinic's database of patient demographics, outcomes of OIB placement (weight loss, weight-related comorbidities), technical aspects of insertion and removal, and adverse events associated with the device and/or procedure, from 8 centers (3 academic, 5 private, 4 surgeons, and 4 gastroenterologists). Our final analysis comprised 321 patients (mean age, 48.1 ± 11.9 y; 80% female; baseline body mass index, 37.6 ± 6.9). Exploratory multivariable linear and logistic regression analyses were performed to identify predictors of success and early balloon removal. Primary effectiveness outcomes were percentage of total body weight lost at 3, 6, and 9 months. Primary and secondary safety outcomes were rates of early balloon removal, periprocedural complications, dehydration episodes requiring intravenous infusion, balloon migration, balloon deflation or hyperinflation, pancreatitis, or other complications. RESULTS Four patients had contraindications for placement at the time of endoscopy. The balloon was safely removed in all instances with an early removal rate (before 6 months) in 16.7% of patients, at a median of 8 weeks after placement (range, 1-6 mo). Use of selective serotonin or serotonin-norepinephrine re-uptake inhibitors at the time of balloon placement was associated with increased odds of removal before 6 months (odds ratio, 3.92; 95% CI, 1.24-12.41). Total body weight lost at 3 months was 8.5% ± 4.9% (n = 204), at 6 months was 11.8% ± 7.5% (n = 199), and at 9 months was 13.3% ± 10% (n = 47). At 6 months, total body weight losses of 5%, 10%, and 15% were achieved by 88%, 62%, and 31% of patients, respectively. Number of follow-up visits and weight loss at 3 months were associated with increased weight loss at 6 months (β = 0.5 and 1.2, respectively) (P < .05). Mean levels of cholesterol, triglycerides, low-density lipoprotein, and hemoglobin A1c, as well as systolic and diastolic blood pressure, were significantly improved at 6 months after OIB placement (P < .05). CONCLUSIONS In an analysis of a database of patients who received endoscopic placement of the OIB, we found it to be safe, effective at inducing weight loss, and to reduce obesity-related comorbidities in a real-world clinical population. Rates of early removal (before 8 weeks) did not differ significantly between clinical trials and the real-world population, but were affected by use of medications.
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Affiliation(s)
- Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Ahmad Bali
- Bali Surgical Practice, South Charleston, West Virginia
| | - Eric Ibegbu
- Atlantic Medical Group, Kinston, North Carolina
| | - Fateh Bazerbachi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Vivek Kumbhari
- Division of Gastroenterology, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Reem Z Sharaiha
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | | | | | | | - Abhishek Agnihotri
- Division of Gastroenterology, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Aleksey A Novikov
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | - Tracy Pitt
- Journey Lite Surgery Center, Cincinnati, Ohio
| | - Margo K Dunlap
- Division of Gastroenterology, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrea Herr
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | - Louis Aronne
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | | | - Hoda C Kadouh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Lawrence J Cheskin
- Division of Gastroenterology, John Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Manpreet S Mundi
- Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Andres Acosta
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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Agnihotri A, Xie A, Bartalos C, Kushnir V, Sullivan S, Islam S, Islam E, Lamet M, Lamet A, Farboudmanesch R, Overholt BF, Altawil J, Early DS, Bennett M, Lowe A, Mullady DK, Adeyeri CS, El Zein M, Mishra P, Fayad L, Dunlap M, Oberbach A, Cheskin LJ, Kalloo AN, Khashab MA, Kumbhari V. Real-World Safety and Efficacy of Fluid-Filled Dual Intragastric Balloon for Weight Loss. Clin Gastroenterol Hepatol 2018; 16:1081-1088.e1. [PMID: 29481969 DOI: 10.1016/j.cgh.2018.02.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/23/2018] [Accepted: 02/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Reshape Duo is a saline-filled dual, integrated intragastric balloon (IGB) approved by the Food and Drug Administration for weight loss in patients with obesity. In a prospective, randomized trial, obese patients who received the balloon had significantly greater percent excess weight loss (%EWL) compared with patients treated with diet and exercise alone. However, there are limited data on the real-world efficacy of the Reshape balloon. METHODS We performed a retrospective study of data collected from 2 academic centers and 5 private practices in which all patients paid for the IGB and follow-up visits out of pocket. The IGB was removed after 6 months. We collected data (demographic, medical, and laboratory) from 202 adults (mean age 47.8 ± 10.8 years; 83% female) with a baseline mean body mass index of 36.8 + 8.4 kg/m2 who had IGB insertion for weight loss therapy, along with counselling on lifestyle modifications focused on diet and exercise. Primary outcomes were percent total body weight loss (%TBWL) and %EWL at 1, 3, 6, 9, and 12 months after the procedure. RESULTS Mean %TBWL at 1, 3, 6, 9 and 12 months was 4.8 ± 2.4%, 8.8 ± 4.3%, 11.4 ± 6.7%, 13.3 ± 7.8%, and 14.7 ± 11.8%, respectively. Data were available from 101 patients at 6 months and 12 patients at 12 months; 60.4% of patients achieved more than 10% TBWL and 55.4% had more than 25% EWL. Seventeen patients (8.4%) had esophageal tears during balloon insertion, with no intervention required. Thirteen patients (6.4%) had their IGB removed before the end of the 6-month treatment period. Nausea, vomiting, and abdominal pain were the most common adverse effects, occurring in 149 (73.8%), 99 (49%), and 51 (25.2%) patients. In one patient, the IGB migrated distally leading to small intestinal obstruction requiring surgical removal. CONCLUSION In a retrospective analysis of real-world patients who received the Reshape Duo IGB, we found it to be a safe and efficacious endoscopic method for producing weight loss, with most patients achieving greater than 10% TBWL at 6 months.
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Affiliation(s)
- Abhishek Agnihotri
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy Xie
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Vladimir Kushnir
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | | | | | - Ebtesam Islam
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Mark Lamet
- Center for Gastrointestinal Disorders, Hollywood, Florida
| | - Ari Lamet
- Center for Gastrointestinal Disorders, Hollywood, Florida
| | - Ramin Farboudmanesch
- Advanced Gastroenterology and Hepatology of Greater Washington, Vienna, Virginia
| | | | | | - Dayna S Early
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Michael Bennett
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Abigail Lowe
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Daniel K Mullady
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | | | - Mohamad El Zein
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Priya Mishra
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lea Fayad
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Margo Dunlap
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andreas Oberbach
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lawrence J Cheskin
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anthony N Kalloo
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mouen A Khashab
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vivek Kumbhari
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Bennett WL, Wilson RF, Zhang A, Tseng E, Knapp EA, Kharrazi H, Stuart EA, Shogbesan O, Bass EB, Cheskin LJ. Methods for Evaluating Natural Experiments in Obesity: A Systematic Review. Ann Intern Med 2018; 168:791-800. [PMID: 29710087 DOI: 10.7326/m18-0309] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Given the obesity pandemic, rigorous methodological approaches, including natural experiments, are needed. PURPOSE To identify studies that report effects of programs, policies, or built environment changes on obesity prevention and control and to describe their methods. DATA SOURCES PubMed, CINAHL, PsycINFO, and EconLit (January 2000 to August 2017). STUDY SELECTION Natural experiments and experimental studies evaluating a program, policy, or built environment change in U.S. or non-U.S. populations by using measures of obesity or obesity-related health behaviors. DATA EXTRACTION 2 reviewers serially extracted data on study design, population characteristics, data sources and linkages, measures, and analytic methods and independently evaluated risk of bias. DATA SYNTHESIS 294 studies (188 U.S., 106 non-U.S.) were identified, including 156 natural experiments (53%), 118 experimental studies (40%), and 20 (7%) with unclear study design. Studies used 106 (71 U.S., 35 non-U.S.) data systems; 37% of the U.S. data systems were linked to another data source. For outcomes, 112 studies reported childhood weight and 32 adult weight; 152 had physical activity and 148 had dietary measures. For analysis, natural experiments most commonly used cross-sectional comparisons of exposed and unexposed groups (n = 55 [35%]). Most natural experiments had a high risk of bias, and 63% had weak handling of withdrawals and dropouts. LIMITATION Outcomes restricted to obesity measures and health behaviors; inconsistent or unclear descriptions of natural experiment designs; and imperfect methods for assessing risk of bias in natural experiments. CONCLUSION Many methodologically diverse natural experiments and experimental studies were identified that reported effects of U.S. and non-U.S. programs, policies, or built environment changes on obesity prevention and control. The findings reinforce the need for methodological and analytic advances that would strengthen evaluations of obesity prevention and control initiatives. PRIMARY FUNDING SOURCE National Institutes of Health, Office of Disease Prevention, and Agency for Healthcare Research and Quality. (PROSPERO: CRD42017055750).
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Affiliation(s)
- Wendy L Bennett
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Renee F Wilson
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Allen Zhang
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Eva Tseng
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Emily A Knapp
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Hadi Kharrazi
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Elizabeth A Stuart
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Oluwaseun Shogbesan
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Eric B Bass
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
| | - Lawrence J Cheskin
- Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (W.L.B., R.F.W., A.Z., E.T., E.A.K., H.K., E.A.S., O.S., E.B.B., L.J.C.)
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Yang HY, Chen HJ, Hsu YJ, Cheskin LJ, Wang Y. Impact of weight-related advice from healthcare professionals on body mass index of patients in the USA. Public Health 2018; 159:50-57. [PMID: 29729491 DOI: 10.1016/j.puhe.2018.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/28/2017] [Accepted: 02/28/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Healthcare professionals (HCPs) can help promote healthy eating and active living in patients. This study assessed the effects of weight-related advice from HCPs on change in body mass index (BMI) of patients in the USA. STUDY DESIGN A 1-year follow-up study of 20,002 adults who participated in a nationally representative survey between 2004 and 2008. METHODS Using the 2004-2008 Medical Expenditure Panel Survey data, 1-year BMI and weight status changes were compared between patients who did and did not report receiving advice on exercise or on restricted intake of fat and cholesterol from their HCPs. RESULTS Patients who received weight-related advice had a greater increase in BMI compared with those who did not receive weight-related advice. Stratified by the baseline weight status of patients (i.e. normal weight, overweight or obese), adverse direction of BMI change was only significantly associated with advice on exercise. Patients who received advice to exercise more were more likely to move to a higher weight status than remaining at the same weight status, compared with patients who did not receive advice to exercise more. CONCLUSION This study did not find that weight-related advice from HCPs had a positive impact on BMI loss in patients. On the contrary, patients who reported receiving weight-related advice from HCPs had worse weight outcomes 1 year later than patients who did not report receiving weight-related advice. Further research is warranted to elucidate the role of weight-related advice from HCPs on lifestyle change and obesity prevention and control.
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Affiliation(s)
- H-Y Yang
- Department of Nursing, Mackay Medical College, Taipei, Taiwan; Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - H-J Chen
- Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Institute of Public Health and Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Y-J Hsu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - L J Cheskin
- Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Y Wang
- Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN, USA.
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Lee BY, Adam A, Zenkov E, Hertenstein D, Ferguson MC, Wang PI, Wong MS, Wedlock P, Nyathi S, Gittelsohn J, Falah-Fini S, Bartsch SM, Cheskin LJ, Brown ST. Modeling The Economic And Health Impact Of Increasing Children's Physical Activity In The United States. Health Aff (Millwood) 2018; 36:902-908. [PMID: 28461358 DOI: 10.1377/hlthaff.2016.1315] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Increasing physical activity among children is a potentially important public health intervention. Quantifying the economic and health effects of the intervention would help decision makers understand its impact and priority. Using a computational simulation model that we developed to represent all US children ages 8-11 years, we estimated that maintaining the current physical activity levels (only 31.9 percent of children get twenty-five minutes of high-calorie-burning physical activity three times a week) would result each year in a net present value of $1.1 trillion in direct medical costs and $1.7 trillion in lost productivity over the course of their lifetimes. If 50 percent of children would exercise, the number of obese and overweight youth would decrease by 4.18 percent, averting $8.1 billion in direct medical costs and $13.8 billion in lost productivity. Increasing the proportion of children who exercised to 75 percent would avert $16.6 billion and $23.6 billion, respectively.
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Affiliation(s)
- Bruce Y Lee
- Bruce Y. Lee is executive director of the Global Obesity Prevention Center and an associate professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Atif Adam
- Atif Adam is a senior analyst at the Global Obesity Prevention Center
| | - Eli Zenkov
- Eli Zenkov is a programmer analyst at the Global Obesity Prevention Center and a public health applications developer at the Pittsburgh Supercomputing Center at Carnegie Mellon University, in Pittsburgh, Pennsylvania
| | - Daniel Hertenstein
- Daniel Hertenstein is a senior programmer analyst at the Global Obesity Prevention Center
| | - Marie C Ferguson
- Marie C. Ferguson is a senior analyst at the Global Obesity Prevention Center and a research associate in the Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Peggy I Wang
- Peggy I. Wang is a senior research program coordinator at the Global Obesity Prevention Center
| | - Michelle S Wong
- Michelle S. Wong is a senior analyst at the Global Obesity Prevention Center
| | - Patrick Wedlock
- Patrick Wedlock is a systems modeler at the Global Obesity Prevention Center
| | - Sindiso Nyathi
- Sindiso Nyathi is a systems modeler at the Global Obesity Prevention Center
| | - Joel Gittelsohn
- Joel Gittelsohn is director of community interventions at the Global Obesity Prevention Center and a professor in the Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Saeideh Falah-Fini
- Saeideh Falah-Fini is an assistant professor in the Department of Industrial and Manufacturing Engineering at the California State Polytechnic University, in Pomona, and a collaborator at the Global Obesity Prevention Center
| | - Sarah M Bartsch
- Sarah M. Bartsch is a senior analyst at the Global Obesity Prevention Center and a research associate in the Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Lawrence J Cheskin
- Lawrence J. Cheskin is director of clinical research at the Global Obesity Prevention Center and associate professor in the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health
| | - Shawn T Brown
- Shawn T. Brown is director of computational research at the Global Obesity Prevention Center and director of public health applications at the Pittsburgh Supercomputing Center at Carnegie Mellon
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50
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Hill C, Weir BW, Fuentes LW, Garcia-Alvarez A, Anouti DP, Cheskin LJ. Relationship Between Weekly Patterns of Caloric Intake and Reported Weight Loss Outcomes: Retrospective Cohort Study. JMIR Mhealth Uhealth 2018; 6:e83. [PMID: 29661750 PMCID: PMC5928328 DOI: 10.2196/mhealth.8320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/15/2018] [Accepted: 01/31/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although millions of overweight and obese adults use mobile phone apps for weight loss, little is known about the predictors of success. OBJECTIVE The objective of this study was to understand the relationship between weight loss outcomes and weekly patterns of caloric intake among overweight and obese adults using a mobile phone app for weight loss. METHODS We examined the relationship between weekly patterns of caloric intake and weight loss outcomes among adults who began using a weight loss app in January 2016 and continued consistent use for at least 5 months (N=7007). Unadjusted and adjusted linear regression analyses were used to evaluate the predictors of percentage of bodyweight lost for women and men separately, including age, body mass index category, weight loss plan, and difference in daily calories consumed on weekend days (Saturday and Sunday) versus Monday. RESULTS In adjusted linear regression, percentage of bodyweight lost was significantly associated with age (for women), body mass index (for men), weight loss plan, and differences in daily caloric intake on Mondays versus weekend days. Compared with women consuming at least 500 calories more on weekend days than on Mondays, those who consumed 50 to 250 calories more on weekend days or those with balanced consumption (±50 calories) lost 1.64% more and 1.82% more bodyweight, respectively. Women consuming 250 to 500 calories or more than 500 calories more on Mondays than on weekend days lost 1.35% more and 3.58% more bodyweight, respectively. Compared with men consuming at least 500 calories more on weekend days than on Mondays, those consuming 250 to 500 calories or more than 500 calories more on Mondays than on weekend days lost 2.27% and 3.42% less bodyweight, respectively. CONCLUSIONS Consistent caloric intake on weekend days and Mondays or consuming slightly fewer calories per day on Mondays versus weekend days was associated with more successful weight loss. TRIAL REGISTRATION ClinicalTrials.gov NCT03136692; https://clinicaltrials.gov/ct2/show/NCT03136692 (Archived by WebCite at http://www.webcitation.org/6y9JvHya4).
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Affiliation(s)
- Christine Hill
- Johns Hopkins Weight Management Center, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Brian W Weir
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Laura W Fuentes
- Lerner Center for Public Health Promotion, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Alicia Garcia-Alvarez
- Johns Hopkins Weight Management Center, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Danya P Anouti
- Johns Hopkins Weight Management Center, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Lawrence J Cheskin
- Johns Hopkins Weight Management Center, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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