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Bull CJ, Hazelwood E, Legge DN, Corbin LJ, Richardson TG, Lee M, Yarmolinsky J, Smith-Byrne K, Hughes DA, Johansson M, Peters U, Berndt SI, Brenner H, Burnett-Hartman A, Cheng I, Kweon SS, Le Marchand L, Li L, Newcomb PA, Pearlman R, McConnachie A, Welsh P, Taylor R, Lean MEJ, Sattar N, Murphy N, Gunter MJ, Timpson NJ, Vincent EE. Impact of weight loss on cancer-related proteins in serum: results from a cluster randomised controlled trial of individuals with type 2 diabetes. EBioMedicine 2024; 100:104977. [PMID: 38290287 PMCID: PMC10844806 DOI: 10.1016/j.ebiom.2024.104977] [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: 07/19/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Type 2 diabetes is associated with higher risk of several cancer types. However, the biological intermediates driving this relationship are not fully understood. As novel interventions for treating and managing type 2 diabetes become increasingly available, whether they also disrupt the pathways leading to increased cancer risk is currently unknown. We investigated the effect of a type 2 diabetes intervention, in the form of intentional weight loss, on circulating proteins associated with cancer risk to gain insight into potential mechanisms linking type 2 diabetes and adiposity with cancer development. METHODS Fasting serum samples from participants with diabetes enrolled in the Diabetes Remission Clinical Trial (DiRECT) receiving the Counterweight-Plus weight-loss programme (intervention, N = 117, mean weight-loss 10 kg, 46% diabetes remission) or best-practice care by guidelines (control, N = 143, mean weight-loss 1 kg, 4% diabetes remission) were subject to proteomic analysis using the Olink Oncology-II platform (48% of participants were female; 52% male). To identify proteins which may be altered by the weight-loss intervention, the difference in protein levels between groups at baseline and 1 year was examined using linear regression. Mendelian randomization (MR) was performed to extend these results to evaluate cancer risk and elucidate possible biological mechanisms linking type 2 diabetes and cancer development. MR analyses were conducted using independent datasets, including large cancer meta-analyses, UK Biobank, and FinnGen, to estimate potential causal relationships between proteins modified during intentional weight loss and the risk of colorectal, breast, endometrial, gallbladder, liver, and pancreatic cancers. FINDINGS Nine proteins were modified by the intervention: glycoprotein Nmb; furin; Wnt inhibitory factor 1; toll-like receptor 3; pancreatic prohormone; erb-b2 receptor tyrosine kinase 2; hepatocyte growth factor; endothelial cell specific molecule 1 and Ret proto-oncogene (Holm corrected P-value <0.05). Mendelian randomization analyses indicated a causal relationship between predicted circulating furin and glycoprotein Nmb on breast cancer risk (odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.67-0.99, P-value = 0.03; and OR = 0.88, 95% CI = 0.78-0.99, P-value = 0.04 respectively), though these results were not supported in sensitivity analyses examining violations of MR assumptions. INTERPRETATION Intentional weight loss among individuals with recently diagnosed diabetes may modify levels of cancer-related proteins in serum. Further evaluation of the proteins identified in this analysis could reveal molecular pathways that mediate the effect of adiposity and type 2 diabetes on cancer risk. FUNDING The main sources of funding for this work were Diabetes UK, Cancer Research UK, World Cancer Research Fund, and Wellcome.
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Affiliation(s)
- Caroline J Bull
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; School of Translational Health Sciences, Dorothy Hodgkin Building, University of Bristol, Bristol, UK
| | - Emma Hazelwood
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Danny N Legge
- School of Translational Health Sciences, Dorothy Hodgkin Building, University of Bristol, Bristol, UK
| | - Laura J Corbin
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom G Richardson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Lee
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, WHO, Lyon, France
| | - James Yarmolinsky
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Karl Smith-Byrne
- Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, UK
| | - David A Hughes
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mattias Johansson
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, WHO, Lyon, France
| | - Ulrike Peters
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea; Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | | | - Li Li
- Department of Family Medicine, University of Virginia, Charlottesville, VA, USA
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; School of Public Health, University of Washington, Seattle, WA, USA
| | - Rachel Pearlman
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Roy Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mike E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Neil Murphy
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, WHO, Lyon, France
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, WHO, Lyon, France; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma E Vincent
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; School of Translational Health Sciences, Dorothy Hodgkin Building, University of Bristol, Bristol, UK.
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Sattar N, McMurray JJV, McInnes IB, Aroda VR, Lean MEJ. Treating chronic diseases without tackling excess adiposity promotes multimorbidity. Lancet Diabetes Endocrinol 2023; 11:58-62. [PMID: 36460014 DOI: 10.1016/s2213-8587(22)00317-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 09/28/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/03/2022]
Abstract
Few people now reach old age without taking multiple drugs, often attending various clinics, and undergoing secondary or tertiary investigations. Most chronic conditions are, to differing extents, caused or exacerbated by excess adiposity, but weight management is rarely discussed or attempted for patients. Furthermore, progressive symptoms usually attributed to ageing (eg, musculoskeletal pains, fatigue, and breathlessness), and which create considerable health-care demands, can also be attributed to the accumulation of body fat over time. For many symptoms and diseases that are more frequently reported in people with excess adiposity (such as depression), there exist potentially multidirectional, causal relationships that generate a cycle of clinical and social deterioration. There is insufficient research on the effects of effective weight management on these clinically demanding, age and weight-mediated symptoms. Based on current evidence, we suggest that policy makers need to be more proactive in obesity prevention and effective weight management should receive research funding to match the search for novel therapeutics for secondary chronic diseases.
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Affiliation(s)
- Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
| | - John J V McMurray
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Iain B McInnes
- College of Medical, Veterinary & Life Sciences, Wolfson Medical School Building, University of Glasgow, Glasgow, UK
| | - Vanita R Aroda
- Brigham and Women's Hospital, Division of Endocrinology, Diabetes and Hypertension; Harvard Medical School, Boston, MA, USA
| | - Mike E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK
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3
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Thom G, Messow CM, Leslie WS, Barnes AC, Brosnahan N, McCombie L, Al-Mrabeh A, Zhyzhneuskaya S, Welsh P, Sattar N, Taylor R, Lean MEJ. Predictors of type 2 diabetes remission in the Diabetes Remission Clinical Trial (DiRECT). Diabet Med 2021; 38:e14395. [PMID: 32870520 DOI: 10.1111/dme.14395] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 05/28/2020] [Revised: 07/30/2020] [Accepted: 08/25/2020] [Indexed: 01/09/2023]
Abstract
AIM To identify predictors of type 2 diabetes remission in the intervention arm of DiRECT (Diabetes Remission Clinical Trial). METHODS Participants were aged 20-65 years, with type 2 diabetes duration of <6 years and BMI 27-45 kg/m2 , and were not receiving insulin. Weight loss was initiated by total diet replacement (825-853 kcal/day, 3-5 months, shakes/soups), and weight loss maintenance support was provided for 2 years. Remissions (HbA1c <48 mmol/mol [<6.5%], without antidiabetes medications) in the intervention group (n = 149, mean age 53 years, BMI 35 kg/m2 ) were achieved by 68/149 participants (46%) at 12 months and by 53/149 participants (36%) at 24 months. Potential predictors were examined by logistic regression analyses, with adjustments for weight loss and effects independent of weight loss. RESULTS Baseline predictors of remission at 12 and 24 months included being prescribed fewer antidiabetes medications, having lower triglyceride and gamma-glutamyl transferase levels, and reporting better quality of life with less anxiety/depression. Lower baseline HbA1c was a predictor at 12 months, and older age and male sex were predictors at 24 months. Being prescribed antidepressants predicted non-remission. Some, but not all effects were explained by weight loss. Weight loss was the strongest predictor of remission at 12 months (adjusted odds ratio per kg weight loss 1.24, 95% CI 1.14, 1.34; P < 0.0001) and 24 months (adjusted odds ratio 1.23, 95% CI 1.13, 1.35; P <0.0001). Weight loss in kilograms and percentage weight loss were equally good predictors. Early weight loss and higher programme attendance predicted more remissions. Baseline BMI, fasting insulin, fasting C-peptide and diabetes duration did not predict remission. CONCLUSIONS Other than weight loss, most predictors were modest, and not sufficient to identify subgroups for which remission was not a worthwhile target.
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Affiliation(s)
- G Thom
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - C-M Messow
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - W S Leslie
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - A C Barnes
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK
| | - N Brosnahan
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - L McCombie
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - A Al-Mrabeh
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - S Zhyzhneuskaya
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - P Welsh
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - N Sattar
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - R Taylor
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - M E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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Bhopal R, Douglas A, Sheikh A, Wild SH, Gill JMR, Sattar N, Lean MEJ, McKnight J, Tuomilehto J, Wallia S, Cezard G. Diabetes incidence in a high-risk UK population at 7 years: linkage of the Prevention of Diabetes and Obesity in South Asians (PODOSA) trial to the Scottish Diabetes Register. Diabet Med 2021; 38:e14369. [PMID: 32738831 DOI: 10.1111/dme.14369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
- R Bhopal
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - A Douglas
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - A Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - S H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - J M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - N Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - M E J Lean
- School of Medicine, Dentistry and Nursing, University of Glasgow Royal Infirmary, Glasgow, UK
| | - J McKnight
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Metabolic Unit, NHS Lothian, Edinburgh, UK
| | - J Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - S Wallia
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - G Cezard
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Population and Health Research Group, School of Geography and Sustainable Development, University of St Andrews, UK
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Thom G, Lean MEJ, Brosnahan N, Algindan YY, Malkova D, Dombrowski SU. 'I have been all in, I have been all out and I have been everything in-between': A 2-year longitudinal qualitative study of weight loss maintenance. J Hum Nutr Diet 2020; 34:199-214. [PMID: 33089558 DOI: 10.1111/jhn.12826] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/19/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Qualitative studies investigating weight management experiences are usually cross-sectional or of short duration, which limits understanding of the long-term challenges. METHODS Eleven women [mean (SD) age 44.9 (9.8) years; body mass index 40.3 (4.0) kg m-2 ] participated in this longitudinal qualitative study, which included up to 20 weeks of total diet replacement (825-853 kcal day-1 ) and ongoing support for weight loss maintenance (WLM), to 2 years. Semi-structured interviews were conducted at baseline and programme end, as well as at key intervals during the intervention. Questions examined five theoretical themes: motivation, self-regulation, habits, psychological resources and social/environmental influences. Data were coded and analysed in nvivo (https://qsrinternational.com/nvivo) using the framework method. RESULTS In total, 64 interviews were completed (median, n = 6 per participant). Mean (SD) weight loss was 15.7 (9.6) kg (14.6% body weight) at 6 months and 9.6 (9.9) kg (8.8% body weight) at 2 years. The prespecified theoretical model offered a useful framework to capture the variability of experiences. Negative aspects of obesity were strong motivations for weight loss and maintenance. Perceiving new routines as sustainable and developing a 'maintenance mindset' was characteristic of 'Maintainers', whereas meeting emotional needs at the expense of WLM goals during periods of stress and negative mood states was reported more often by 'Regainers'. Optimistic beliefs about maintaining weight losses appeared to interfere with barrier identification and coping planning for most participants. CONCLUSIONS People tended to be very optimistic about WLM without acknowledging barriers and this may undermine longer-term outcomes. The potential for regain remained over time, mainly as a result of emotion-triggered eating to alleviate stress and negative feelings. More active self-regulation during these circumstances may improve WLM, and these situations represent important targets for intervention.
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Affiliation(s)
- G Thom
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - M E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - N Brosnahan
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Y Y Algindan
- Department of Clinical Nutrition, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - D Malkova
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - S U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
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Tsofliou F, Pitsiladis YP, Lara J, Hadjicharalambous M, Macdonald IA, Wallace MA, Lean MEJ. The effects of moderate alterations in adrenergic activity on acute appetite regulation in obese women: A randomised crossover trial. Nutr Health 2020; 26:311-322. [PMID: 32729763 PMCID: PMC7534026 DOI: 10.1177/0260106020942117] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Previous evidence has demonstrated that serum leptin is correlated with appetite in combination with, but not without, modest exercise. Aim: The present experiments investigated the effects of exogenous adrenaline and α/β adrenoceptor blockade in combination with moderate exercise on serum leptin concentrations, appetite/satiety sensations and subsequent food intake in obese women. Methods: A total of 10 obese women ((mean ± SEM), age: 50 (1.9) years, body mass index 36 (4.1) kg/m2, waist 104.8 (4.1) cm) participated in two separate, double-blind randomised experimental trials. Experiment 1: moderate exercise after α/β adrenergic blocker (labetalol, 100 mg orally) versus moderate exercise plus placebo; experiment 2: adrenaline infusion for 20 minutes versus saline infusion. Appetite/satiety and biochemistry were measured at baseline, pre- and immediately post-intervention, then 1 hour post-intervention (i.e., before dinner). Food intake was assessed via ad libitum buffet-style dinner. Results: No differences were found in appetite/satiety, subsequent food intake or serum leptin in any of the studies (experiment 1 or experiment 2). In experiment 1, blood glucose was higher (p < 0.01) and plasma free fatty acids lower (p = 0.04) versus placebo. In experiment 2, plasma free fatty acids (p < 0.05) increased after adrenaline versus saline infusion. Conclusions: Neither inhibition of exercise-induced adrenergic activity by combined α/β adrenergic blockade nor moderate increases in adrenergic activity induced by intravenous adrenaline infusion affected acute appetite regulation.
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Affiliation(s)
- Fotini Tsofliou
- Human Nutrition, School of Medicine, 3526University of Glasgow, United Kingdom.,Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, 375756Bournemouth University, United Kingdom
| | - Yannis P Pitsiladis
- College of Medical Veterinary and Life Science, Institute of Cardiovascular & Medical Sciences, 3526University of Glasgow, United Kingdom.,Centre for Sport and Exercise Science and Medicine, University of Brighton, United Kingdom
| | - Jose Lara
- Department of Applied Sciences, Faculty of Health and Life Sciences, 5995Northumbria University, United Kingdom
| | - Marios Hadjicharalambous
- College of Medical Veterinary and Life Science, Institute of Cardiovascular & Medical Sciences, 3526University of Glasgow, United Kingdom.,Human Performance Laboratory, Department of Life & Health Sciences, School of Sciences and Engineering, 121343University of Nicosia, Cyprus
| | - Ian A Macdonald
- School of Life Sciences, 6123University of Nottingham Medical School, Queen's Medical Centre, United Kingdom
| | - Mike A Wallace
- University Department of Pathological Biochemistry, Glasgow Royal Infirmary, United Kingdom
| | - Mike E J Lean
- Human Nutrition, School of Medicine, 3526University of Glasgow, United Kingdom
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Affiliation(s)
- M D Hopkins
- Diabetes UK, Wells Lawrence House, London, UK
| | - R Taylor
- Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - M E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Han TS, Al-Gindan YY, Govan L, Hankey CR, Lean MEJ. Associations of BMI, waist circumference, body fat, and skeletal muscle with type 2 diabetes in adults. Acta Diabetol 2019; 56:947-954. [PMID: 30927105 PMCID: PMC6597601 DOI: 10.1007/s00592-019-01328-3] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/19/2019] [Indexed: 02/06/2023]
Abstract
AIMS Type 2 diabetes (T2D) is known to be associated with high BMI and waist circumference (WC). These measures do not discriminate well between skeletal muscle (SM) and body fat (BF), which may have opposite influences. METHODS We conducted a secondary analysis of population-based data from 58,128 aged 18-85 yrs from Scottish Health Surveys (2003, 2008-2011) and Health Surveys for England (2003-2006, 2008-2013), excluding pregnant women and insulin-treated diabetes. Logistic regression was used to assess associations of known T2D, and of screened HbA1c > 48 mmol/mol (> 6.5%), with sex-specific quintiles of BMI, WC, and BF% and SM% estimated by validated anthropometric equations, adjusted for age, sex, smoking, ethnicity, country, and survey year. RESULTS As expected, ORs for having known T2D rose with quintiles of BMI (1, 1.5, 2.3, 3.1, and 6.5) and WC (1, 1.8, 2.5, 3.5, and 8.7). Compared to the lowest BF% quintile, OR for having T2D in highest BF% quintile was 11.1 (95% CI = 8.4-14.6). Compared to the highest SM% quintile, OR for having T2D in lowest SM% quintile was 2.0 (1.7-2.4). Of 72 adults with T2D/HbA1c > 6.5% in the lowest quintile of BF%, 27 (37.5%) were in quintile 1 of SM%. Similar patterns of OR were observed for having HbA1c > 6.5% in those without known T2D. CONCLUSIONS Estimated BF% associates strongly with T2D. Low SM% also has a significant association, suggesting a neglected aspect of aetiology within T2D. These two simple measures with biological relevance, available from data collected in most health surveys, may be more useful than the purely statistical terms BMI.
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Affiliation(s)
- T S Han
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK.
- Department of Diabetes and Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK.
| | - Y Y Al-Gindan
- Department of Nutrition, School of Medicine, University of Glasgow, Glasgow, UK
- Department of Clinical Nutrition, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - L Govan
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C R Hankey
- Department of Nutrition, School of Medicine, University of Glasgow, Glasgow, UK
| | - M E J Lean
- Department of Nutrition, School of Medicine, University of Glasgow, Glasgow, UK.
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9
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Xin Y, Davies A, McCombie L, Briggs A, Messow CM, Grieve E, Leslie WS, Taylor R, Lean MEJ. Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight-Plus weight management programme within a primary care randomized controlled trial. Diabet Med 2019; 36:1003-1012. [PMID: 31026353 DOI: 10.1111/dme.13981] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Accepted: 04/24/2019] [Indexed: 12/21/2022]
Abstract
AIM The Counterweight-Plus weight management programme achieved 46% remission of Type 2 diabetes at 1 year in the DiRECT trial. We estimated the implementation costs of the Counterweight-Plus programme and its 1-year cost-effectiveness in terms of diabetes remission, compared with usual care, from the UK National Health Service (NHS) perspective. METHODS Within-trial total costs included programme set-up and running costs (practitioner appointment visits, low-energy formula diet sachets and training), oral anti-diabetes and anti-hypertensive medications, and healthcare contacts. Total costs were calculated for aggregated resource use for each participant and 95% confidence intervals (CI) were based on 1000 non-parametric bootstrap iterations. RESULTS One-year programme costs under trial conditions were estimated at £1137 per participant (95% CI £1071, £1205). The intervention led to a significant cost-saving of £120 (95% CI £78, £163) for the oral anti-diabetes drugs and £14 (95% CI £7.9, £22) for anti-hypertensive medications compared with the control. Deducting the cost-savings of all healthcare contacts from the intervention cost resulted an incremental cost of £982 (95% CI £732, £1258). Cost per 1 year of diabetes remission was £2359 (95% CI £1668, £3250). CONCLUSIONS Remission of Type 2 diabetes within 1-year can be achieved at a cost below the annual cost of diabetes (including complications). Providing a reasonable proportion of remissions can be maintained over time, with multiple medical gains expected, as well as immediate social benefits, there is a case for shifting resources within diabetes care budgets to offer support for people with Type 2 diabetes to attempt remission. (Clinical Trial Registry No.: ISRCTN03267836).
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Affiliation(s)
- Y Xin
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - A Davies
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L McCombie
- Human Nutrition, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - A Briggs
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C-M Messow
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - E Grieve
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - W S Leslie
- Human Nutrition, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - R Taylor
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - M E J Lean
- Human Nutrition, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
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10
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Affiliation(s)
- Louise McCombie
- Human Nutrition Section, School of Medicine, University of Glasgow, Glasgow, G31 2ER, UK
| | - Wilma Leslie
- Human Nutrition Section, School of Medicine, University of Glasgow, Glasgow, G31 2ER, UK
| | - Roy Taylor
- Magnetic Resonance Centre, Campus for Ageing and Vitality, University of Newcastle, Newcastle Upon Tyne, UK
| | - Brian Kennon
- Diabetes Centre, Queen Elizabeth University Hospital, Glasgow
| | - Naveed Sattar
- University of Glasgow Biomedical Research Centre, Glasgow
| | - Mike E J Lean
- Human Nutrition Section, School of Medicine, University of Glasgow, Glasgow, G31 2ER, UK
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Abstract
BACKGROUND Type 4 renal tubular acidosis causes hyperkalaemia, for which diabetes and medications commonly used in this patient group are aetiological factors. Here we describe the novel use of fludrocortisone in this difficult condition. CASE REPORT A 55-year-old woman with complex co-morbidities, including Type 2 diabetes (HbA1c 37 mmol/mol 5.5%), was admitted with renal failure. Bloods on admission: eGFR 25 ml/min, creatinine 184 ?mol/L, urea 35.9 mmol/L, sodium 128 mmol/L, potassium 5.6 mmol/L, bicarbonate 15 mmol/L, and albumin 30 g/L. Her admission was prolonged, complicated by hospital-acquired sepsis (lower respiratory tract, urinary tract, and infected leg ulcers), poor venous access and severe depression. She had recurrent hyperkalaemia and deteriorating renal function, from presumed Type 4 renal tubular acidosis and excessive fluid losses from leg ulcers. Her renal function recurrently deteriorated, despite conventional treatment methods. After 69 days, she was commenced on fludrocortisone 50 mcg/day. Her renal function and serum potassium stabilized and she was discharged with potassium 4.3 mmol/L, eGFR 42 ml/min, and bicarbonate 23 mmol/L. She has remained stable on this treatment, without requiring further hospital admission for over 6 months, with eGFR 40 ml/min, and potassium 5.5 mmol/L, and albumin 26 g/L. CONCLUSION This woman was presumed to have Type 4 renal tubular acidosis and recurrent hyperkalaemia due to renal insufficiency, in the context of underlying diabetes and chronic kidney disease, which was poorly responsive to conventional management. There is limited evidence for using fludrocortisone in this setting. Our case suggests that fludrocortisone might offer a novel therapeutic strategy when conventional management is not working.
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Affiliation(s)
- S J H Dobbin
- Department of Diabetes and Endocrinology, Glasgow Royal Infirmary, Glasgow, UK
| | - J R Petrie
- Department of Diabetes and Endocrinology, Glasgow Royal Infirmary, Glasgow, UK
| | - M E J Lean
- Department of Diabetes and Endocrinology, Glasgow Royal Infirmary, Glasgow, UK
| | - G A McKay
- Department of Diabetes and Endocrinology, Glasgow Royal Infirmary, Glasgow, UK
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Leslie WS, Taylor R, Harris L, Lean MEJ. Weight losses with low-energy formula diets in obese patients with and without type 2 diabetes: systematic review and meta-analysis. Int J Obes (Lond) 2017; 41:997. [PMID: 28290463 PMCID: PMC5467239 DOI: 10.1038/ijo.2017.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Leslie WS, Taylor R, Harris L, Lean MEJ. Weight losses with low-energy formula diets in obese patients with and without type 2 diabetes: systematic review and meta-analysis. Int J Obes (Lond) 2017; 41:96-101. [PMID: 27698345 PMCID: PMC5368342 DOI: 10.1038/ijo.2016.175] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/16/2022]
Abstract
AIM To provide a systematic review, of published data, to compare weight losses following very low calorie (<800 kcal per day VLCD) or low-energy liquid-formula (>800 kcal per day LELD) diets, in people with and without type 2 diabetes mellitus (T2DM). METHODS Systematic electronic searches of Medline (1946-2015) and Embase (1947-2015) to identify published studies using formula total diet replacement diets (VLCD/LELD). Random effects meta-analysis using weighted mean difference (WMD) in body weight between groups (with and without diabetes) as the summary estimate. RESULTS Final weight loss, in the five included studies, weighted for study sizes, (n=569, mean BMI=35.5-42.6 kg/m2), was not significantly different between participants with and without T2DM: -1.2 kg; 95% CI: -4.1 to 1.6 kg). Rates of weight loss were also similar in the two groups -0.6 kg per week (T2DM) and 0.5 kg per week (no diabetes), and for VLCD (<800 kcal per day) and LELD (>800 kcal per day). CONCLUSIONS Weight losses with liquid-formula diets are very similar for VLCD and LELD and for obese subjects with or without T2DM. They can potentially achieve new weight loss/ maintenance targets of >15-20% for people with severe and medically complicated obesity.
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Affiliation(s)
- W S Leslie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - R Taylor
- Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - L Harris
- Institute of Mental Health & Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - M E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
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14
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Laurent MR, Cook MJ, Gielen E, Ward KA, Antonio L, Adams JE, Decallonne B, Bartfai G, Casanueva FF, Forti G, Giwercman A, Huhtaniemi IT, Kula K, Lean MEJ, Lee DM, Pendleton N, Punab M, Claessens F, Wu FCW, Vanderschueren D, Pye SR, O'Neill TW. Lower bone turnover and relative bone deficits in men with metabolic syndrome: a matter of insulin sensitivity? The European Male Ageing Study. Osteoporos Int 2016; 27:3227-3237. [PMID: 27273111 DOI: 10.1007/s00198-016-3656-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/26/2016] [Indexed: 01/26/2023]
Abstract
UNLABELLED We examined cross-sectional associations of metabolic syndrome and its components with male bone turnover, density and structure. Greater bone mass in men with metabolic syndrome was related to their greater body mass, whereas hyperglycaemia, hypertriglyceridaemia or impaired insulin sensitivity were associated with lower bone turnover and relative bone mass deficits. INTRODUCTION Metabolic syndrome (MetS) has been associated with lower bone turnover and relative bone mass or strength deficits (i.e. not proportionate to body mass index, BMI), but the relative contributions of MetS components related to insulin sensitivity or obesity to male bone health remain unclear. METHODS We determined cross-sectional associations of MetS, its components and insulin sensitivity (by homeostatic model assessment-insulin sensitivity (HOMA-S)) using linear regression models adjusted for age, centre, smoking, alcohol, and BMI. Bone turnover markers and heel broadband ultrasound attenuation (BUA) were measured in 3129 men aged 40-79. Two centres measured total hip, femoral neck, and lumbar spine areal bone mineral density (aBMD, n = 527) and performed radius peripheral quantitative computed tomography (pQCT, n = 595). RESULTS MetS was present in 975 men (31.2 %). Men with MetS had lower β C-terminal cross-linked telopeptide (β-CTX), N-terminal propeptide of type I procollagen (PINP) and osteocalcin (P < 0.0001) and higher total hip, femoral neck, and lumbar spine aBMD (P ≤ 0.03). Among MetS components, only hypertriglyceridaemia and hyperglycaemia were independently associated with PINP and β-CTX. Hyperglycaemia was negatively associated with BUA, hypertriglyceridaemia with hip aBMD and radius cross-sectional area (CSA) and stress-strain index. HOMA-S was similarly associated with PINP and β-CTX, BUA, and radius CSA in BMI-adjusted models. CONCLUSIONS Men with MetS have higher aBMD in association with their greater body mass, while their lower bone turnover and relative deficits in heel BUA and radius CSA are mainly related to correlates of insulin sensitivity. Our findings support the hypothesis that underlying metabolic complications may be involved in the bone's failure to adapt to increasing bodily loads in men with MetS.
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Affiliation(s)
- M R Laurent
- Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, PO box 7003, 3000, Leuven, Belgium.
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, PO box 901, 3000, Leuven, Belgium.
- Center for Metabolic Bone Diseases, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - M J Cook
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - E Gielen
- Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, PO box 7003, 3000, Leuven, Belgium
- Center for Metabolic Bone Diseases, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - K A Ward
- Elsie Widdowson Laboratory, Medical Research Council Human Nutrition Research, 120 Fulbourn Road, Cambridge, CB1 9NL, UK
| | - L Antonio
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, PO box 901, 3000, Leuven, Belgium
- Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, PO box 902, 3000, Leuven, Belgium
| | - J E Adams
- Radiology Department, and Manchester Academic Health Science Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK
| | - B Decallonne
- Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, PO box 902, 3000, Leuven, Belgium
| | - G Bartfai
- Department of Obstetrics, Gynecology and Andrology, Albert Szent-György Medical University, Semmelweis u. 1, 6725, Szeged, Hungary
| | - F F Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, CIBER de Fisiopatología Obesidad y Nutricion, Instituto Salud Carlos III, Travesía de Choupana s/n, 15706, Santiago de Compostela, Spain
| | - G Forti
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - A Giwercman
- Department of Urology, Scanian Andrology Centre, Malmö University Hospital, University of Lund, Jan Waldenströms gata 35, 20502, Malmö, Sweden
| | - I T Huhtaniemi
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, W12 0HS, UK
| | - K Kula
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Pomorska 45/47, Śródmieście, 90-406, Łódź, Poland
| | - M E J Lean
- Department of Human Nutrition, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, Scotland, UK
| | - D M Lee
- Cathie Marsh Institute for Social Research, School of Social Sciences, University of Manchester, Humanities Bridgeford Street-G17, Manchester, M13 9PL, UK
| | - N Pendleton
- School of Community Based Medicine, University of Manchester, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - M Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, L. Puusepa 1a, Tartu, Estonia
| | - F Claessens
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, PO box 901, 3000, Leuven, Belgium
| | - F C W Wu
- Developmental and Regenerative Biomedicine Research Group, Andrology Research Unit, Manchester Academic Health Science Centre, Manchester Royal Infirmary, University of Manchester, Grafton Street, Manchester, M13 9WL, UK
| | - D Vanderschueren
- Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, PO box 902, 3000, Leuven, Belgium
| | - S R Pye
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - T W O'Neill
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, 29 Grafton Street, Manchester, M13 9WU, UK
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15
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Little P, Stuart B, Hobbs FR, Kelly J, Smith ER, Bradbury KJ, Hughes S, Smith PWF, Moore MV, Lean MEJ, Margetts BM, Byrne CD, Griffin S, Davoudianfar M, Hooper J, Yao G, Zhu S, Raftery J, Yardley L. An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR+): a pragmatic, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol 2016; 4:821-8. [PMID: 27474214 DOI: 10.1016/s2213-8587(16)30099-7] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [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: 04/05/2016] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The obesity epidemic has major public health consequences. Expert dietetic and behavioural counselling with intensive follow-up is effective, but resource requirements severely restrict widespread implementation in primary care, where most patients are managed. We aimed to estimate the effectiveness and cost-effectiveness of an internet-based behavioural intervention (POWeR+) combined with brief practice nurse support in primary care. METHODS We did this pragmatic, parallel-group, randomised controlled trial at 56 primary care practices in central and south England. Eligible adults aged 18 years or older with a BMI of 30 kg/m(2) or more (or ≥28 kg/m(2) with hypertension, hypercholesterolaemia, or diabetes) registered online with POWeR+-a 24 session, web-based, weight management intervention lasting 6 months. After registration, the website automatically randomly assigned patients (1:1:1), via computer-generated random numbers, to receive evidence-based dietetic advice to swap foods for similar, but healthier, choices and increase fruit and vegetable intake, in addition to 6 monthly nurse follow-up (control group); web-based intervention and face-to-face nurse support (POWeR+Face-to-face [POWeR+F]; up to seven nurse contacts over 6 months); or web-based intervention and remote nurse support (POWeR+Remote [POWeR+R]; up to five emails or brief phone calls over 6 months). Participants and investigators were masked to group allocation at the point of randomisation; masking of participants was not possible after randomisation. The primary outcome was weight loss averaged over 12 months. We did a secondary analysis of weight to measure maintenance of 5% weight loss at months 6 and 12. We modelled the cost-effectiveness of each intervention. We did analysis by intention to treat, with multiple imputation for missing data. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN21244703. FINDINGS Between Jan 30, 2013, and March 20, 2014, 818 participants were randomly assigned to the control group (n=279), the POWeR+F group (n=269), or the POWeR+R group (n=270). Weight loss averaged over 12 months was recorded in 666 (81%) participants. The control group lost almost 3 kg over 12 months (crude mean weight: baseline 104·38 kg [SD 21·11; n=279], 6 months 101·91 kg [19·35; n=136], 12 months 101·74 kg [19·57; n=227]). The primary imputed analysis showed that compared with the control group, patients in the POWeR+F group achieved an additional weight reduction of 1·5 kg (95% CI 0·6-2·4; p=0·001) averaged over 12 months, and patients in the POWeR+R group achieved an additional 1·3 kg (0·34-2·2; p=0·007). 21% of patients in the control group had maintained a clinically important 5% weight reduction at month 12, compared with 29% of patients in the POWeR+F group (risk ratio 1·56, 0·96-2·51; p=0·070) and 32% of patients in the POWeR+R group (1·82, 1·31-2·74; p=0·004). The incremental overall cost to the health service per kg weight lost with the POWeR+ interventions versus the control strategy was £18 (95% CI -129 to 195) for POWeR+F and -£25 (-268 to 157) for POWeR+R; the probability of being cost-effective at a threshold of £100 per kg lost was 88% and 98%, respectively. No adverse events were reported. INTERPRETATION Weight loss can be maintained in some individuals by use of novel written material with occasional brief nurse follow-up. However, more people can maintain clinically important weight reductions with a web-based behavioural program and brief remote follow-up, with no increase in health service costs. Future research should assess the extent to which clinically important weight loss can be maintained beyond 1 year. FUNDING Health Technology Assessment Programme of the National Institute for Health Research.
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Affiliation(s)
- Paul Little
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Beth Stuart
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jo Kelly
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Emily R Smith
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Katherine J Bradbury
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Stephanie Hughes
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Peter W F Smith
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Michael V Moore
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mike E J Lean
- Human Nutrition, School of Medicine, University of Glasgow, Glasgow, UK
| | - Barrie M Margetts
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Chris D Byrne
- Southampton National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton, UK
| | - Simon Griffin
- Cambridge Medical Research Council Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Mina Davoudianfar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Hooper
- Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Guiqing Yao
- Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Shihua Zhu
- Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - James Raftery
- Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
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16
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Tanamas SK, Lean MEJ, Combet E, Vlassopoulos A, Zimmet PZ, Peeters A. Changing guards: time to move beyond body mass index for population monitoring of excess adiposity. QJM 2016; 109:443-446. [PMID: 26527773 DOI: 10.1093/qjmed/hcv201] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 06/04/2015] [Indexed: 11/14/2022] Open
Abstract
With the obesity epidemic, and the effects of aging populations, human phenotypes have changed over two generations, possibly more dramatically than in other species previously. As obesity is an important and growing hazard for population health, we recommend a systematic evaluation of the optimal measure(s) for population-level excess body fat. Ideal measure(s) for monitoring body composition and obesity should be simple, as accurate and sensitive as possible, and provide good categorization of related health risks. Combinations of anthropometric markers or predictive equations may facilitate better use of anthropometric data than single measures to estimate body composition for populations. Here, we provide new evidence that increasing proportions of aging populations are at high health-risk according to waist circumference, but not body mass index (BMI), so continued use of BMI as the principal population-level measure substantially underestimates the health-burden from excess adiposity.
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Affiliation(s)
- S K Tanamas
- From the 1Baker IDI Heart and Diabetes Institute, the Alfred Centre, Level 4, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - M E J Lean
- Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Royal Infirmary Campus, Alexandra Parade, Glasgow G31 2ER, UK
| | - E Combet
- Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Royal Infirmary Campus, Alexandra Parade, Glasgow G31 2ER, UK
| | - A Vlassopoulos
- Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Royal Infirmary Campus, Alexandra Parade, Glasgow G31 2ER, UK
| | - P Z Zimmet
- From the 1Baker IDI Heart and Diabetes Institute, the Alfred Centre, Level 4, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - A Peeters
- From the 1Baker IDI Heart and Diabetes Institute, the Alfred Centre, Level 4, 99 Commercial Road, Melbourne, Victoria 3004, Australia
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O'Connell MDL, Tajar A, O'Neill TW, Roberts SA, Lee DM, Pye SR, Silman AJ, Finn JD, Bartfai G, Boonen S, Casanueva FF, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean MEJ, Pendleton N, Punab M, Vanderschueren D, Wu FCW. Frailty Is Associated with Impaired Quality of Life and Falls in Middle-Aged and Older European Men. J Frailty Aging 2016; 2:77-83. [PMID: 27070662 DOI: 10.14283/jfa.2013.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Adapt a measure of frailty for use in a cohort study of European men and explore relationships with age, health related quality of life and falls. DESIGN Longitudinal cohort study. SETTING 8 European centers. PARTICIPANTS 3047 men aged 40-79 participating in the European Male Ageing Study (EMAS). MEASUREMENTS Frailty was assessed using an adaptation of the Cardiovascular Health Study criteria. Health related quality of life was evaluated using the Rand Short Form-36 (SF-36) questionnaire which comprises both mental and physical component scores. Self reported falls in the preceding 12 months were recorded at 2-year follow-up. RESULTS 78 men (2.6%) were classified as frail (≥3 criteria) and 821 (26.9%) as prefrail (1-2 criteria). The prevalence of frailty increased from 0.1% in men aged 40-49 up to 6.8% in men aged 70-79. Compared to robust men, both prefrail and frail men had lower health related quality of life. Frailty was more strongly associated with the physical than mental subscales of the SF-36. Frailty was associated with higher risk of falls OR (95% CI) 2.92 (1.52, 5.59). CONCLUSIONS Frailty, assessed by the EMAS criteria, increased in prevalence with age and was related to poorer health related quality of life and higher risk of falls in middle-aged and older European men. These criteria may help to identify a vulnerable subset of older men.
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Affiliation(s)
- M D L O'Connell
- Prof. Frederick C.W. Wu, Email address: , Phone: +44 161 2766330. Fax: +44 161 2766363
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18
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Leslie WS, Ford I, Sattar N, Hollingsworth KG, Adamson A, Sniehotta FF, McCombie L, Brosnahan N, Ross H, Mathers JC, Peters C, Thom G, Barnes A, Kean S, McIlvenna Y, Rodrigues A, Rehackova L, Zhyzhneuskaya S, Taylor R, Lean MEJ. The Diabetes Remission Clinical Trial (DiRECT): protocol for a cluster randomised trial. BMC Fam Pract 2016; 17:20. [PMID: 26879684 PMCID: PMC4754868 DOI: 10.1186/s12875-016-0406-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 01/21/2016] [Indexed: 12/14/2022]
Abstract
Background Despite improving evidence-based practice following clinical guidelines to optimise drug therapy, Type 2 diabetes (T2DM) still exerts a devastating toll from vascular complications and premature death. Biochemical remission of T2DM has been demonstrated with weight loss around 15kg following bariatric surgery and in several small studies of non-surgical energy-restriction treatments. The non-surgical Counterweight-Plus programme, running in Primary Care where obesity and T2DM are routinely managed, produces >15 kg weight loss in 33 % of all enrolled patients. The Diabetes UK-funded Counterpoint study suggested that this should be sufficient to reverse T2DM by removing ectopic fat in liver and pancreas, restoring first-phase insulin secretion. The Diabetes Remission Clinical Trial (DiRECT) was designed to determine whether a structured, intensive, weight management programme, delivered in a routine Primary Care setting, is a viable treatment for achieving durable normoglycaemia. Other aims are to understand the mechanistic basis of remission and to identify psychological predictors of response. Methods/Design Cluster-randomised design with GP practice as the unit of randomisation: 280 participants from around 30 practices in Scotland and England will be allocated either to continue usual guideline-based care or to add the Counterweight-Plus weight management programme, which includes primary care nurse or dietitian delivery of 12-20weeks low calorie diet replacement, food reintroduction, and long-term weight loss maintenance. Main inclusion criteria: men and women aged 20-65years, all ethnicities, T2DM 0-6years duration, BMI 27-45 kg/m2. Tyneside participants will undergo Magnetic Resonance (MR) studies of pancreatic and hepatic fat, and metabolic studies to determine mechanisms underlying T2DM remission. Co-primary endpoints: weight reduction ≥ 15 kg and HbA1c <48 mmol/mol at one year. Further follow-up at 2 years. Discussion This study will establish whether a structured weight management programme, delivered in Primary Care by practice nurses or dietitians, is a viable treatment to achieve T2DM remission. Results, available from 2018 onwards, will inform future service strategy. Trial registration Current Controlled Trials ISRCTN03267836. Date of Registration 20/12/2013 Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0406-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wilma S Leslie
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | - Ian Ford
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | - Naveed Sattar
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | | | - Ashley Adamson
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - Falko F Sniehotta
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | | | - Naomi Brosnahan
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | | | - John C Mathers
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - Carl Peters
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - George Thom
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | - Alison Barnes
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - Sharon Kean
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | | | - Angela Rodrigues
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - Lucia Rehackova
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | | | - Roy Taylor
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - Mike E J Lean
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
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19
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Han TS, Hart CL, Haig C, Logue J, Upton MN, Watt GCM, Lean MEJ. Contributions of maternal and paternal adiposity and smoking to adult offspring adiposity and cardiovascular risk: the Midspan Family Study. BMJ Open 2015; 5:e007682. [PMID: 26525718 PMCID: PMC4636631 DOI: 10.1136/bmjopen-2015-007682] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Obesity has some genetic basis but requires interaction with environmental factors for phenotypic expression. We examined contributions of gender-specific parental adiposity and smoking to adiposity and related cardiovascular risk in adult offspring. DESIGN Cross-sectional general population survey. SETTING Scotland. PARTICIPANTS 1456 of the 1477 first generation families in the Midspan Family Study: 2912 parents (aged 45-64 years surveyed between 1972 and 1976) who had 1025 sons and 1283 daughters, aged 30-59 years surveyed in 1996. MAIN MEASURES Offspring body mass index (BMI), waist circumference (WC), cardiometabolic risk (lipids, blood pressure and glucose) and cardiovascular disease as outcome measures, and parental BMI and smoking as determinants. All analyses adjusted for age, socioeconomic status and family clustering and offspring birth weight. RESULTS Regression coefficients for BMI associations between father-son (0.30) and mother-daughter (0.33) were greater than father-daughter (0.23) or mother-son (0.22). Regression coefficient for the non-genetic, shared-environment or assortative-mating relationship between BMIs of fathers and mothers was 0.19. Heritability estimates for BMI were greatest among women with mothers who had BMI either <25 or ≥30 kg/m(2). Compared with offspring without obese parents, offspring with two obese parents had adjusted OR of 10.25 (95% CI 6.56 to 13.93) for having WC ≥102 cm for men, ≥88 cm women, 2.46 (95% CI 1.33 to 4.57) for metabolic syndrome and 3.03 (95% CI 1.55 to 5.91) for angina and/or myocardial infarct (p<0.001). Neither parental adiposity nor smoking history determined adjusted offspring individual cardiometabolic risk factors, diabetes or stroke. Maternal, but not paternal, smoking had significant effects on WC in sons (OR=1.50; 95% CI 1.13 to 2.01) and daughters (OR=1.42; 95% CI 1.10 to 1.84) and metabolic syndrome OR=1.68; 95% CI 1.17 to 2.40) in sons. CONCLUSIONS There are modest genetic/epigenetic influences on the environmental factors behind adverse adiposity. Maternal smoking appears a specific hazard on obesity and metabolic syndrome. A possible epigenetic mechanism linking maternal smoking to obesity and metabolic syndrome in offspring is proposed. Individuals with family histories of obesity should be targeted from an early age to prevent obesity and complications.
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Affiliation(s)
- T S Han
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey, UK
| | - C L Hart
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C Haig
- Robertson Centre for Biostatics, University of Glasgow, Glasgow, UK
| | - J Logue
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - M N Upton
- Woodlands Family Medical Centre, Stockton-on-Tees, UK
| | - G C M Watt
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - M E J Lean
- School of Medicine, Royal Infirmary, University of Glasgow, Glasgow, UK
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Han TS, Lee DM, Lean MEJ, Finn JD, O'Neill TW, Bartfai G, Forti G, Giwercman A, Kula K, Pendleton N, Punab M, Rutter MK, Vanderschueren D, Huhtaniemi IT, Wu FCW, Casanueva FF. Associations of obesity with socioeconomic and lifestyle factors in middle-aged and elderly men: European Male Aging Study (EMAS). Eur J Endocrinol 2015; 172:59-67. [PMID: 25326134 DOI: 10.1530/eje-14-0739] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 11/08/2022]
Abstract
BACKGROUND Social and lifestyle influences on age-related changes in body morphology are complex because lifestyle and physiological response to social stress can affect body fat differently. OBJECTIVE In this study, we examined the associations of socioeconomic status (SES) and lifestyle factors with BMI and waist circumference (WC) in middle-aged and elderly European men. DESIGN AND SETTING A cross-sectional study of 3319 men aged 40-79 years recruited from eight European centres. OUTCOMES We estimated relative risk ratios (RRRs) of overweight/obesity associated with unfavourable SES and lifestyles. RESULTS The prevalence of BMI ≥ 30 kg/m(2) or WC ≥ 102 cm rose linearly with age, except in the eighth decade when high BMI, but not high WC, declined. Among men aged 40-59 years, compared with non-smokers or most active men, centre and BMI-adjusted RRRs for having a WC between 94 and 101.9 cm increased by 1.6-fold in current smokers, 2.7-fold in least active men and maximal at 2.8-fold in least active men who smoked. Similar patterns but greater RRRs were observed for men with WC ≥ 102 cm, notably 8.4-fold greater in least active men who smoked. Compared with men in employment, those who were not in employment had increased risk of having a high WC by 1.4-fold in the 40-65 years group and by 1.3-fold in the 40-75 years group. These relationships were weaker among elderly men. CONCLUSION Unfavourable SES and lifestyles associate with increased risk of obesity, especially in middle-aged men. The combination of inactivity and smoking was the strongest predictor of high WC, providing a focus for health promotion and prevention at an early age.
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Affiliation(s)
- T S Han
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - D M Lee
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - M E J Lean
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - J D Finn
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - T W O'Neill
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - G Bartfai
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - G Forti
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - A Giwercman
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - K Kula
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - N Pendleton
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - M Punab
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - M K Rutter
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The Un
| | - D Vanderschueren
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - I T Huhtaniemi
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - F C W Wu
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - F F Casanueva
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The Un
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Nikolau CK, Hankey C, Lean MEJ. A randomised controlled trial for weight gain prevention in young adults. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku163.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nikolaou CK, Hankey CR, Lean MEJ. Calorie-labelling: does it impact on calorie purchase in catering outlets and the views of young adults? Int J Obes (Lond) 2014; 39:542-5. [PMID: 25174452 DOI: 10.1038/ijo.2014.162] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 04/24/2014] [Revised: 07/04/2014] [Accepted: 07/27/2014] [Indexed: 11/09/2022]
Abstract
Calorie-labelling of meals has been suggested as an antiobesity measure, but evidence for impact is scarce. It might have a particular value for young adults, when weight gain is most rapid. A systematic literature review and a meta-analysis was performed to assess the effect of calorie-labelling on calories purchased. Seven studies met the inclusion and quality criteria of which six provided data allowing a meta-analysis. Three reported significant changes, all reductions in calories purchased (-38.1 to -12.4 kcal). Meta-analysis showed no overall effect, -5.8 kcal (95% confidence interval (CI)=-19.4 to 7.8 kcal) but a reduction of -124.5 kcal (95% CI=-150.7 to 113.8 kcal) among those who noticed the calorie-labelling (30-60% of customers). A questionnaire, to gauge views on calorie-labelling, was devised and sent to young adults in higher education: 1440 young adults (mean age 20.3 (s.d.=2.9) years) completed the survey. Nearly half (46%) said they would welcome calorie information in catering settings and on alcoholic drinks. Females opposing to calorie-labelling were heavier to those who did not (64.3 kg vs. 61.9 kg, P=0.03; BMI=22.4 kg m(-2) vs. 21.7 kg m(-2), P=0.02). In conclusion, the limited evidence supports a valuable effect from clearly visible calorie-labelling for obesity prevention, and it appears an attractive strategy to many young adults.
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Affiliation(s)
- C K Nikolaou
- Department of Human Nutrition, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - C R Hankey
- Department of Human Nutrition, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - M E J Lean
- Department of Human Nutrition, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Vlassopoulos A, Lean MEJ, Combet E. Protein-phenolic interactions and inhibition of glycation - combining a systematic review and experimental models for enhanced physiological relevance. Food Funct 2014; 5:2646-55. [PMID: 25170687 DOI: 10.1039/c4fo00568f] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND while antiglycative capacity has been attributed to (poly)phenols, the exact mechanism of action remains unclear. Studies so far are often relying on supra-physiological concentrations and use of non-bioavailable compounds. METHODS to inform the design of a physiologically relevant in vitro study, we carried out a systematic literature review of dietary interventions reporting plasma concentrations of polyphenol metabolites. Bovine Serum Albumin (BSA) was pre-treated prior to in vitro glycation: either no treatment (native), pre-oxidised (incubated with 10 nM H2O2, for 8 hours) or incubated with a mixture of phenolic acids at physiologically relevant concentrations, for 8 hours). In vitro glycation was carried out in the presence of (i) glucose only (0, 5 or 10 mM), (ii) glucose (0, 5 or 10 mM) plus H2O2 (10 nM), or (iii) glucose (0, 5 or 10 mM) plus phenolic acids (10-160 nM). Fructosamine was measured using the nitro blue tetrazolium method. RESULTS following (high) dietary polyphenol intake, 3-hydroxyphenylacetic acid is the most abundant phenolic acid in peripheral blood (up to 338 μM) with concentrations of other phenolic acids ranging from 13 nM to 200 μM. The presence of six phenolic acids with BSA during in vitro glycation did not lower fructosamine formation. However, when BSA was pre-incubated with phenolic acids, significantly lower concentration of fructosamine was detected under glycoxidative conditions (glucose 5 or 10 mM plus H2O2 10 nM) (p < 0.001 vs. native BSA). CONCLUSION protein pre-treatment, either with oxidants or phenolic acids, is an important regulator of subsequent glycation in a physiologically relevant system. High quality in vitro studies under conditions closer to physiology are feasible and should be employed more frequently.
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Affiliation(s)
- A Vlassopoulos
- Human Nutrition, School of Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G3 8SJ, UK.
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Yardley L, Ware LJ, Smith ER, Williams S, Bradbury KJ, Arden-Close EJ, Mullee MA, Moore MV, Peacock JL, Lean MEJ, Margetts BM, Byrne CD, Hobbs RFD, Little P. Randomised controlled feasibility trial of a web-based weight management intervention with nurse support for obese patients in primary care. Int J Behav Nutr Phys Act 2014; 11:67. [PMID: 24886516 PMCID: PMC4045942 DOI: 10.1186/1479-5868-11-67] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [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: 01/30/2014] [Accepted: 05/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a need for cost-effective weight management interventions that primary care can deliver to reduce the morbidity caused by obesity. Automated web-based interventions might provide a solution, but evidence suggests that they may be ineffective without additional human support. The main aim of this study was to carry out a feasibility trial of a web-based weight management intervention in primary care, comparing different levels of nurse support, to determine the optimal combination of web-based and personal support to be tested in a full trial. METHODS This was an individually randomised four arm parallel non-blinded trial, recruiting obese patients in primary care. Following online registration, patients were randomly allocated by the automated intervention to either usual care, the web-based intervention only, or the web-based intervention with either basic nurse support (3 sessions in 3 months) or regular nurse support (7 sessions in 6 months). The main outcome measure (intended as the primary outcome for the main trial) was weight loss in kg at 12 months. As this was a feasibility trial no statistical analyses were carried out, but we present means, confidence intervals and effect sizes for weight loss in each group, uptake and retention, and completion of intervention components and outcome measures. RESULTS All randomised patients were included in the weight loss analyses (using Last Observation Carried Forward). At 12 months mean weight loss was: usual care group (n = 43) 2.44 kg; web-based only group (n = 45) 2.30 kg; basic nurse support group (n = 44) 4.31 kg; regular nurse support group (n = 47) 2.50 kg. Intervention effect sizes compared with usual care were: d = 0.01 web-based; d = 0.34 basic nurse support; d = 0.02 regular nurse support. Two practices deviated from protocol by providing considerable weight management support to their usual care patients. CONCLUSIONS This study demonstrated the feasibility of delivering a web-based weight management intervention supported by practice nurses in primary care, and suggests that the combination of the web-based intervention with basic nurse support could provide an effective solution to weight management support in a primary care context. TRIAL REGISTRATION Current Controlled Trials ISRCTN31685626.
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Affiliation(s)
- Lucy Yardley
- Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK.
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Abstract
BACKGROUND Widespread subclinical iodine insufficiency has recently been reported in Europe, based on urinary iodine using World Health Organization/Food and Agriculture Organization criteria, in particular among young women. Although urinary iodine concentration (UIC) is a useful measurement of the iodine status in a population, it does not provide an insight into the habitual iodine intake of this population. This is compounded by the fact that very few iodine-specific food frequency questionnaires (FFQ) have been validated so far. The present study aimed to develop and validate a new, simple, rapid survey tool to assess dietary iodine exposure in females of childbearing age. METHODS Iodine was measured in a duplicate 24-h urine collection. Iodine intake was measured with duplicate 4-day semi-quantitative food diaries and the FFQ. Correlation, cross-classification and Bland-Altman analyses were used to estimate agreement, bias and the reliability of the method. The triangular (triad) method was used to calculate validity coefficients. RESULTS Forty-three women, aged 19-49 years, took part in the validation of the 17-items FFQ. Median (interquartile range) UIC was 74 (47-92) μg L(-1) , which is indicative of mild iodine insufficiency. The FFQ showed good agreement with food diaries with respect to classifying iodine intake (82% of subjects were classified in the same or adjacent quartile). The FFQ was moderately correlated with the food diaries (rs = 0.45, P = 0.002) and urinary excretion in μg L(-1) (rs = 0.34, P = 0.025) but not in μg day(-1) (P = 0.316). The validity coefficients were 0.69, 0.66 and 0.52 for the food diaries, FFQ and urinary iodine excretion, respectively. CONCLUSIONS The FFQ provides a rapid and reliable estimate of dietary iodine exposure to identify those population subgroups at risk of iodine deficiency.
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Affiliation(s)
- E Combet
- Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
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26
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Nikolaou CK, Lean MEJ, Hankey CR. Sleep duration and BMI in young adults. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt123.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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27
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Lean MEJ, Carraro R, Finer N, Hartvig H, Lindegaard ML, Rössner S, Van Gaal L, Astrup A. Tolerability of nausea and vomiting and associations with weight loss in a randomized trial of liraglutide in obese, non-diabetic adults. Int J Obes (Lond) 2013; 38:689-97. [PMID: 23942319 PMCID: PMC4010971 DOI: 10.1038/ijo.2013.149] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 06/23/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Liraglutide 3.0 mg, with diet and exercise, produced substantial weight loss over 1 year that was sustained over 2 years in obese non-diabetic adults. Nausea was the most frequent side effect. OBJECTIVE To evaluate routinely collected data on nausea and vomiting among individuals on liraglutide and their influence on tolerability and body weight. DESIGN A randomized, placebo-controlled, double-blind 20-week study with an 84-week extension (sponsor unblinded at 20 weeks, open-label after 1 year) in eight European countries (Clinicaltrials.gov: NCT00422058). SUBJECTS After commencing a 500-kcal/day deficit diet plus exercise, 564 participants (18-65 years, body mass index (BMI) 30-40 kg m(-2)) were randomly assigned (after a 2-week run-in period) to once-daily subcutaneous liraglutide (1.2, 1.8, 2.4 or 3.0 mg), placebo or open-label orlistat (120 mg × 3 per day). After 1 year, participants on liraglutide/placebo switched to liraglutide 2.4 mg, and subsequently, to liraglutide 3.0 mg (based on 20-week and 1-year results, respectively). RESULTS The intention-to-treat population comprised 561 participants (n=90-98 per arm, age 45.9±10.3 years, BMI 34.8±2.7 kg m(-2) (mean±s.d.)). In year 1, more participants reported ⩾1 episode of nausea/vomiting on treatment with liraglutide 1.2-3.0 mg (17-38%) than with placebo or orlistat (both 4%, P⩽0.001). Most episodes occurred during dose escalation (weeks 1-6), with 'mild' or 'moderate' symptoms. Among participants on liraglutide 3.0 mg, 48% reported some nausea and 13% some vomiting, with considerable variation between countries, but only 4 out of 93 (4%) reported withdrawals. The mean 1-year weight loss on treatment with liraglutide 3.0 mg from randomization was 9.2 kg for participants reporting nausea/vomiting episodes, versus 6.3 kg for those with none (a treatment difference of 2.9 kg (95% confidence interval 0.5-5.3); P=0.02). Both weight losses were significantly greater than the respective weight losses for participants on placebo (P<0.001) or orlistat (P<0.05). Quality-of-life scores at 20 weeks improved similarly with or without nausea/vomiting on treatment with liraglutide 3.0 mg. CONCLUSION Transient nausea and vomiting on treatment with liraglutide 3.0 mg was associated with greater weight loss, although symptoms appeared tolerable and did not attenuate quality-of-life improvements. Improved data collection methods on nausea are warranted.
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Affiliation(s)
- M E J Lean
- Life-Course Nutrition and Health, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - R Carraro
- Department of Endocrinology, University Hospital La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - N Finer
- National Centre for Cardiovascular Prevention and Outcomes, UCL Institute of Cardiovascular Science, London, UK
| | | | | | - S Rössner
- Obesity Unit, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - L Van Gaal
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Antwerp, Belgium
| | - A Astrup
- Department of Nutrition, Exercise and Sports, Faculty of Sciences, University of Copenhagen, Frederiksberg, Denmark
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Abstract
The rising rate of overweight/obesity among the ever-growing ageing population is imposing massive and rapidly changing burdens of ill health. The observation that the BMI value associated with the lowest relative mortality is slightly higher in older than in younger adults, mainly through its reduced impact on coronary heart disease, has often been misinterpreted that obesity is not as harmful in the elderly, who suffer a large range of disabling consequences of obesity. All medical consequences of obesity are multi-factorial and most alleviated by modest, achievable weight loss (5-10 kg) with an evidence-based maintenance strategy. But severe obesity, e.g. BMI >40 may demand greater weight loss e.g. >15 kg to reverse type 2 diabetes. Since relatively reduced physical activity and reduced muscle mass (sarcopenic obesity) are common in the elderly, combining exercise and modest calorie restriction optimally reduces fat mass and preserves muscle mass - age presents no obstacle and reducing polypharmacy is a valuable outcome. The currently licensed drug orlistat has no age-related hazards and is effective in a low fat diet, but the risks from bariatric surgery begin to outweigh benefits above age 60. For the growing numbers of obese elderly with diabetes, the glucagon-like peptide-1 (GLP-1) receptor analogue liraglutide appears a safe way to promote and maintain substantial weight loss. Obesity and sarcopenia should be prevented from younger age and during life-transitions including retiral to improve future health outcomes and quality of life, with a focus on those in "obese families".
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Affiliation(s)
- T S Han
- Department of Diabetes & Endocrinology, St Peter's NHS Foundation Trust, Chertsey, Surrey KT16 0PZ, United Kingdom
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29
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Vlassopoulos A, Lean MEJ, Combet E. Role of oxidative stress in physiological albumin glycation: a neglected interaction. Free Radic Biol Med 2013; 60:318-24. [PMID: 23517782 DOI: 10.1016/j.freeradbiomed.2013.03.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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: 12/18/2012] [Revised: 02/20/2013] [Accepted: 03/08/2013] [Indexed: 12/26/2022]
Abstract
Protein glycation is a key mechanism involved in chronic disease development in both diabetic and nondiabetic individuals. About 12-18% of circulating proteins are glycated in vivo in normoglycemic blood, but in vitro studies have hitherto failed to demonstrate glucose-driven glycation below a concentration of 30mM. Bovine serum albumin (BSA), reduced BSA (mercaptalbumin) (both 40g/L), and human plasma were incubated with glucose concentrations of 0-30mM for 4 weeks at 37°C. All were tested preoxidized for 8h before glycation with 10nM H2O2 or continuously exposed to 10nM H2O2 throughout the incubation period. Fructosamine was measured (nitroblue tetrazolium method) at 2 and 4 weeks. Oxidized BSA (both preoxidized and continuously exposed to H2O2) was more readily glycated than native BSA at all glucose concentrations (p = 0.03). Moreover, only oxidized BSA was glycated at physiological glucose concentration (5mM) compared to glucose-free control (glycation increased by 35% compared to native albumin, p < 0.05). Both 5 and 10mM glucose led to higher glycation when mercaptalbumin was oxidized than when unoxidized (p < 0.05). Fructosamine concentration in human plasma was also significantly higher when oxidized and exposed to 5mM glucose, compared to unoxidized plasma (p = 0.03). The interaction between glucose concentration and oxidation was significant in all protein models (p < 0.05). This study has for the first time demonstrated albumin glycation in vitro, using physiological concentrations of albumin, glucose, and hydrogen peroxide, identifying low-grade oxidative stress as a key element early in the glycation process.
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Affiliation(s)
- A Vlassopoulos
- Human Nutrition, School of Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G3 8SJ, UK
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30
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Rutter MK, Sattar N, Tajar A, O'Neill TW, Lee DM, Bartfai G, Boonen S, Casanueva FF, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean MEJ, Pendleton N, Punab M, Silman AJ, Vanderschueren D, Lowe G, O'Rahilly S, Morris RW, Wu FC, Wannamethee SG. Epidemiological evidence against a role for C-reactive protein causing leptin resistance. Eur J Endocrinol 2013; 168:101-6. [PMID: 23047304 DOI: 10.1530/eje-12-0348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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] [Indexed: 01/02/2023]
Abstract
OBJECTIVE It has been suggested that elevated levels of C-reactive protein (CRP) might interfere with leptin signalling and contribute to leptin resistance. Our aim was to assess whether plasma levels of CRP influence leptin resistance in humans, and our hypothesis was that CRP levels would modify the cross-sectional relationships between leptin and measures of adiposity. DESIGN AND METHODS W assessed four measures of adiposity: BMI, waist circumference, fat mass and body fat (%) in 2113 British Regional Heart Study (BRHS) men (mean (s.d.) age 69 (5) years), with replication in 760 (age 69 (6) years) European Male Ageing Study (EMAS) subjects. RESULTS IN BRHS subjects, leptin correlated with CRP (SPEARMAN'S R=0.22, P0.0001). Leptin and crp correlated with all four measures of adiposity (R VALUE RANGE: 0.22-0.57, all P<0.0001). Age-adjusted mean levels for adiposity measures increased in relation to leptin levels, but CRP level did not consistently influence the β-coefficients of the regression lines in a CRP-stratified analysis. In BRHS subjects, the BMI vs leptin relationship demonstrated a weak statistical interaction with CRP (P=0.04). We observed no similar interaction in EMAS subjects and no significant interactions with other measures of adiposity in BRHS or EMAS cohorts. CONCLUSION We have shown that plasma CRP has little influence on the relationship between measures of adiposity and serum leptin levels in these middle-aged and elderly male European cohorts. This study provides epidemiological evidence against CRP having a significant role in causing leptin resistance.
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Affiliation(s)
- M K Rutter
- University of Manchester, Manchester, UK.
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Corona G, Wu FCW, Forti G, Lee DM, O'Connor DB, O'Neill TW, Pendleton N, Bartfai G, Boonen S, Casanueva FF, Finn JD, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean MEJ, Punab M, Vanderschueren D, Jannini EA, Mannucci E, Maggi M. Thyroid hormones and male sexual function. ACTA ACUST UNITED AC 2012; 35:668-79. [PMID: 22834774 DOI: 10.1111/j.1365-2605.2012.01266.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The role of thyroid hormones in the control of erectile functioning has been only superficially investigated. The aim of the present study was to investigate the association between thyroid and erectile function in two different cohorts of subjects. The first one derives from the European Male Ageing Study (EMAS study), a multicentre survey performed on a sample of 3369 community-dwelling men aged 40-79 years (mean 60 ± 11 years). The second cohort is a consecutive series of 3203 heterosexual male patients (mean age 51.8 ± 13.0 years) attending our Andrology and Sexual Medicine Outpatient Clinic for sexual dysfunction at the University of Florence (UNIFI study). In the EMAS study all subjects were tested for thyroid-stimulating hormone (TSH) and free thyroxine (FT4). Similarly, TSH levels were checked in all patients in the UNIFI study, while FT4 only when TSH resulted outside the reference range. Overt primary hyperthyroidism (reduced TSH and elevated FT4, according to the reference range) was found in 0.3 and 0.2% of EMAS and UNIFI study respectively. In both study cohorts, suppressed TSH levels were associated with erectile dysfunction (ED). Overt hyperthyroidism was associated with an increased risk of severe erectile dysfunction (ED, hazard ratio = 14 and 16 in the EMAS and UNIFI study, respectively; both p < 0.05), after adjusting for confounding factors. These associations were confirmed in nested case-control analyses, comparing subjects with overt hyperthyroidism to age, BMI, smoking status and testosterone-matched controls. Conversely, no association between primary hypothyroidism and ED was observed. In conclusion, erectile function should be evaluated in all individuals with hyperthyroidism. Conversely, assessment of thyroid function cannot be recommended as routine practice in all ED patients.
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Affiliation(s)
- G Corona
- Department of Clinical Physiopathology, Sexual Medicine and Andrology Unit, University of Florence, Florence, Italy
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Abstract
A number of evidence-based weight management interventions are now available with different models and serving different patient/client groups. While positive outcomes are a key to the decision-making process, so too is the information around how these outcomes were achieved, in what population, how transferable the outcomes would be to the population a service would be aiming to cover and at what cost to the service provider and or the individual. This paper examines all the UK interventions with recent peer-reviewed evidence of their effectiveness in 'realistic' settings and cost-effectiveness, in the context of National Institute of Health and Clinical Excellence (NICE) and Scottish Intercollegiate Guideline Network (SIGN) guidelines. It concludes that the evidence-based approaches allow intervention at different stages in the disease process of obesity, which are effective in different settings. Self-referral to commercial agencies, by individuals with relatively low body mass index (BMI) and few medical complications, is a reasonable first step. For more severely obese individuals (e.g. BMI > 35 kg m(-2) ) requiring more medically complicated care, evidence is largely lacking for these services, but the community-based Counterweight Programme is effective and cost-effective in maintaining weight loss >5 kg up to 2 years for 30-40% of attenders. For more complicated and resistant obesity, referral to a secondary care-based service can generate short-term weight loss, but 12-month data are unavailable.
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Affiliation(s)
- L McCombie
- Counterweight Ltd, c/o Windywhins, Gollanfield, Inverness, UK
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34
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Ward KA, Pye SR, Adams JE, Boonen S, Vanderschueren D, Borghs H, Gaytant J, Gielen E, Bartfai G, Casanueva FF, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Labrie F, Lean MEJ, Pendleton N, Punab M, Silman AJ, Wu FCW, O'Neill TW. Influence of age and sex steroids on bone density and geometry in middle-aged and elderly European men. Osteoporos Int 2011; 22:1513-23. [PMID: 21052641 PMCID: PMC3073040 DOI: 10.1007/s00198-010-1437-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 07/27/2010] [Indexed: 11/23/2022]
Abstract
SUMMARY The influence of age and sex steroids on bone density and geometry of the radius was examined in two European Caucasian populations. Age-related change in bone density and geometry was observed. In older men, bioavailable oestradiol may play a role in the maintenance of cortical and trabecular bone mineral density (BMD). INTRODUCTION To examine the effect of age and sex steroids on bone density and geometry of the radius in two European Caucasian populations. METHODS European Caucasian men aged 40-79 years were recruited from population registers in two centres: Manchester (UK) and Leuven (Belgium), for participation in the European Male Ageing Study. Total testosterone (T) and oestradiol (E(2)) were measured by mass spectrometry and the free and bioavailable fractions calculated. Peripheral quantitative computed tomography was used to scan the radius at distal (4%) and midshaft (50%) sites. RESULTS Three hundred thirty-nine men from Manchester and 389 from Leuven, mean ages 60.2 and 60.0 years, respectively, participated. At the 50% radius site, there was a significant decrease with age in cortical BMD, bone mineral content (BMC), cortical thickness, and muscle area, whilst medullary area increased. At the 4% radius site, trabecular and total volumetric BMD declined with age. Increasing bioavailable E(2) (bioE(2)) was associated with increased cortical BMD (50% radius site) and trabecular BMD (4% radius site) in Leuven, but not Manchester, men. This effect was predominantly in those aged 60 years and over. In older Leuven men, bioavailable testosterone (Bio T) was linked with increased cortical BMC, muscle area and SSI (50% radius site) and total area (4% radius site). CONCLUSIONS There is age-related change in bone density and geometry at the midshaft radius in middle-aged and elderly European men. In older men bioE(2) may maintain cortical and trabecular BMD. BioT may influence bone health through associations with muscle mass and bone area.
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Affiliation(s)
- K A Ward
- Nutrition and Bone Health, MRC Human Nutrition Research, Fulbourn Road, Cambridge CB1 9NL, UK.
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35
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Abstract
Our population is ageing, and obesity is increasing in the elderly bringing massive and rapidly changing burdens of ill health related to increased body weights and fat as well as the main drivers of poor diet and inactivity. Overweight and obesity, and a static body mass index (BMI) commonly conceal sarcopenia (gain in body fat but loss of muscle mass and functional capacity) in older people, aggravated by inactivity. A systematic computerized literature search using an iterative manipulation process of the keywords: obesity, elderly, weight loss. The following databases were accessed on 20 October 2010: Medline, Cochrane Collaboration, Ovid and Scholar Google. A large number of clinical consequences of overweight and obesity are particularly problematic for elderly individuals, including type 2 diabetes mellitus, arthritis, urinary incontinence and depression. The observation that the BMI value associated with the lowest relative mortality is slightly higher in older than in younger adults has often been misinterpreted that obesity is not as harmful in the elderly. BMI may be a less appropriate index in the elderly. All the medical consequences of obesity are multi-factorial but all are alleviated by modest, achievable weight loss (5-10 kg) with an evidence-based maintenance strategy. Since sarcopenic obesity is common in the elderly, a combination of exercise and modest calorie restriction appears to be the optimal method of reducing fat mass and preserving muscle mass. Reduction in polypharmacy is a valuable target for weight management. Age is not an obstacle to weight management interventions using moderate calorie restriction and exercise, and the currently licensed drug orlistat appears to have no age-related hazards. Overall balance of clinical outcomes has not been evaluated. In older people the risks from bariatric surgery outweigh benefits. Obesity, and specifically sarcopenic obesity, should also be prevented not only from younger age, but also during major life transitions including retirement, to improve better health outcomes and quality of life in later years, with a focus on those in 'obese families', where the main increases in obesity are located. Randomized controlled trials to determine health benefits and risks from long-term weight management in obese elderly are necessary.
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Affiliation(s)
- T S Han
- Department of Diabetes and Endocrinology, Ashford and St Peter’s NHS Trust, Chertsey, Surrey, UK
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Vanderschueren D, Pye SR, Venken K, Borghs H, Gaytant J, Huhtaniemi IT, Adams JE, Ward KA, Bartfai G, Casanueva FF, Finn JD, Forti G, Giwercman A, Han TS, Kula K, Labrie F, Lean MEJ, Pendleton N, Punab M, Silman AJ, Wu FCW, O'Neill TW, Boonen S. Gonadal sex steroid status and bone health in middle-aged and elderly European men. Osteoporos Int 2010; 21:1331-9. [PMID: 20012940 DOI: 10.1007/s00198-009-1144-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [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: 03/20/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
Abstract
SUMMARY The influence of sex steroids on calcaneal quantitative ultrasound (QUS) parameters was assessed in a population sample of middle-aged and elderly European men. Higher free and total E(2) though not testosterone, were independently associated with higher QUS parameters. INTRODUCTION The aim of this study was to investigate the association between QUS parameters and sex steroids in middle-aged and elderly European men. METHODS Three thousand one hundred forty-one men aged between 40 and 79 years were recruited from eight European centres for participation in a study of male ageing: the European Male Ageing Study. Subjects were invited by letter to attend for an interviewer-administered questionnaire, blood sample and QUS of the calcaneus (Hologic-SAHARA). Blood was assessed for sex steroids including oestradiol (E(2)), testosterone (T), free and bio-available E(2) and T and sex hormone binding globulin (SHBG). RESULTS Serum total T was not associated with any of the QUS parameters. Free T and both free and total E(2) were positively related to all QUS readings, while SHBG concentrations were negatively associated. These relationships were observed in both older and younger (<60 years) men. In a multivariate model, after adjustment for age, centre, height, weight, physical activity levels and smoking, free E(2) and SHBG, though not free T, remained independently associated with the QUS parameters. After further adjustment for IGF-1, however, the association with SHBG became non-significant. CONCLUSION Higher free and total E(2) are associated with bone health not only among the elderly but also middle-aged European men.
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Affiliation(s)
- D Vanderschueren
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium.
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Lean MEJ, Reckless JPD, Finer N, McCombie L. Counterweight - counter-cost, counter-loss. Int J Clin Pract 2010; 64:828-9. [PMID: 20518958 DOI: 10.1111/j.1742-1241.2010.02400.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Trueman P, Haynes SM, Felicity Lyons G, Louise McCombie E, McQuigg MSA, Mongia S, Noble PA, Quinn MF, Ross HM, Thompson F, Broom JI, Laws RA, Reckless JPD, Kumar S, Lean MEJ, Frost GS, Finer N, Haslam DW, Morrison D, Sloan B. Long-term cost-effectiveness of weight management in primary care. Int J Clin Pract 2010; 64:775-83. [PMID: 20353431 DOI: 10.1111/j.1742-1241.2010.02349.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [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: 11/29/2022] Open
Abstract
BACKGROUND As obesity prevalence and health-care costs increase, Health Care providers must prevent and manage obesity cost-effectively. METHODS Using the 2006 NICE obesity health economic model, a primary care weight management programme (Counterweight) was analysed, evaluating costs and outcomes associated with weight gain for three obesity-related conditions (type 2 diabetes, coronary heart disease, colon cancer). Sensitivity analyses examined different scenarios of weight loss and background (untreated) weight gain. RESULTS Mean weight changes in Counterweight attenders was -3 kg and -2.3 kg at 12 and 24 months, both 4 kg below the expected 1 kg/year background weight gain. Counterweight delivery cost was pound59.83 per patient entered. Even assuming drop-outs/non-attenders at 12 months (55%) lost no weight and gained at the background rate, Counterweight was 'dominant' (cost-saving) under 'base-case scenario', where 12-month achieved weight loss was entirely regained over the next 2 years, returning to the expected background weight gain of 1 kg/year. Quality-adjusted Life-Year cost was pound2017 where background weight gain was limited to 0.5 kg/year, and pound2651 at 0.3 kg/year. Under a 'best-case scenario', where weights of 12-month-attenders were assumed thereafter to rise at the background rate, 4 kg below non-intervention trajectory (very close to the observed weight change), Counterweight remained 'dominant' with background weight gains 1 kg, 0.5 kg or 0.3 kg/year. CONCLUSION Weight management for obesity in primary care is highly cost-effective even considering only three clinical consequences. Reduced healthcare resources use could offset the total cost of providing the Counterweight Programme, as well as bringing multiple health and Quality of Life benefits.
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Affiliation(s)
- P Trueman
- York Health Economics Consortium Ltd., University of York, UK
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Del Rio D, Costa LG, Lean MEJ, Crozier A. Polyphenols and health: what compounds are involved? Nutr Metab Cardiovasc Dis 2010; 20:1-6. [PMID: 19713090 DOI: 10.1016/j.numecd.2009.05.015] [Citation(s) in RCA: 207] [Impact Index Per Article: 14.8] [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: 03/18/2009] [Revised: 05/14/2009] [Accepted: 05/25/2009] [Indexed: 11/30/2022]
Abstract
On the basis of prospective, cross-sectional and intervention studies linking polyphenols to human health, several experimental papers in the literature have tried to evaluate the molecular mechanisms involved in their bioactivity. Polyphenols are reported to in vitro inhibit cancer cell proliferation, reduce vascularisation, protect neurons, stimulate vasodilation and improve insulin secretion, but are often studied as aglycones or as sugar conjugates and at non-physiological concentration. However, it is now well established that polyphenols undergo substantial metabolism after being ingested by humans in dietary relevant amount and that concentrations of plasma metabolites after a normal dietary intake rarely exceed nmol/L. This viewpoint intends to highlight that uncritical judgements made on the basis of the published literature, particularly about toxicity and bioactivity, may sometimes have been misled and misleading and to conclude that i) bioavailability values reported in the literature for phenolic compounds should be strongly reconsidered in the light of the large number of newly identified circulating and excreted metabolites, with particular attention to colonic ring-fission products which are obviously contributing much more than expected to the percentage of their absorption; ii) it is phenolic metabolites, formed in the small intestine and hepatic cells, and low molecular weight catabolic products of the colonic microflora to travel around the human body in the circulatory system or reach body tissues to elicit bioactive effects. Understanding these compounds certainly carries interest for drug-discovery but also for dietary prevention of disease.
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Affiliation(s)
- D Del Rio
- Human Nutrition Unit, Department of Public Health, University of Parma, Via Volturno 39, 43100 Parma, Italy.
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McQuigg M, Brown JE, Broom JI, Laws RA, Reckless JPD, Noble PA, Kumar S, McCombie EL, Lean MEJ, Lyons GF, Mongia S, Frost GS, Quinn MF, Barth JH, Haynes SM, Finer N, Haslam DW, Ross HM, Hole DJ, Radziwonik S. Engaging patients, clinicians and health funders in weight management: the Counterweight Programme. Fam Pract 2008; 25 Suppl 1:i79-86. [PMID: 19042914 DOI: 10.1093/fampra/cmn081] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Counterweight Programme provides an evidence based and effective approach for weight management in routine primary care. Uptake of the programme has been variable for practices and patients. Aim. To explore key barriers and facilitators of practice and patient engagement in the Counterweight Programme and to describe key strategies used to address barriers in the wider implementation of this weight management programme in UK primary care. METHODS All seven weight management advisers participated in a focus group. In-depth interviews were conducted with purposeful samples of GPs (n = 7) and practice nurses (n = 15) from 11 practices out of the 65 participating in the programme. A total of 37 patients participated through a mixture of in-depth interviews (n = 18) and three focus groups. Interviews and focus groups were analysed for key themes that emerged. RESULTS Engagement of practice staff was influenced by clinicians' beliefs and attitudes, factors relating to the way the programme was initiated and implemented, the programme content and organizational/contextual factors. Patient engagement was influenced by practice endorsement of the programme, clear understanding of programme goals, structured proactive follow-up and perception of positive outcomes. CONCLUSIONS Having a clear understanding of programme goals and expectations, enhancing self-efficacy in weight management and providing proactive follow-up is important for engaging both practices and patients. The widespread integration of weight management programmes into routine primary care is likely to require supportive public policy.
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Affiliation(s)
- S W Mercer
- General Practice and Primary Care, Division of Community-based Sciences, Faculty of Medicine, University of Glasgow, Glasgow G12 9LX.
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Macfarlane GJ, Pye SR, Finn JD, Wu FCW, Silman AJ, Bartfai G, Boonen S, Casanueva F, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean MEJ, O'Neill TW, Pendleton N, Punab M, Vanderschueren D. Investigating the determinants of international differences in the prevalence of chronic widespread pain: evidence from the European Male Ageing Study. Ann Rheum Dis 2008; 68:690-5. [PMID: 18653627 DOI: 10.1136/ard.2008.089417] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether among middle-aged and elderly men there is evidence of international differences in the prevalence of chronic widespread pain (CWP) and whether any such differences could be explained by psychological, psychosocial factors or differences in physical health status. METHODS The European Male Ageing Study (EMAS) sampled from population registers in cities (centres) of eight European countries. Each centre recruited an age-stratified sample of men aged 40-79 years. Information on pain was collected by questionnaire and subjects were classified according to whether they satisfied the American College of Rheumatology definition of CWP. Information was collected on social status, mental health, recent life events and co-morbidities. RESULTS Across all centres 3963 subjects completed a study questionnaire, with participation rates ranging from 24% in Hungary to 72% in Estonia. There were significant differences in prevalence: between 5% and 7% in centres in Italy, England, Belgium and Sweden, 9-15% in centres in Spain, Poland and Hungary and 15% in Estonia. There were strong relationships between poor mental health, adverse recent life events, co-morbidities and CWP. Adjustment for these factors explained between half and all of the excess risk in the eastern European centres: the excess risk in Poland was explained (odds ratio (OR) 1.1, 95% CI 0.9 to 1.2) but there remained excess risk in Hungary (OR 1.6, 95% CI 1.4 to 1.8) and Estonia (OR 2.6, 95% CI 2.2 to 2.9). CONCLUSIONS This study is the first directly to compare the occurrence of CWP internationally. There is an excess prevalence in countries of eastern Europe and this excess is associated with adverse psychosocial factors as well as poorer psychological and physical health.
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Affiliation(s)
- G J Macfarlane
- Department of Public Health, University of Aberdeen, School of Medicine, Polwarth Building, Foresterhill, Aberdeen , UK.
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Abstract
OBJECTIVE To document patterns of measured weight and waist circumference (WC) change and the increase in overweight and obesity over a 9-year period. SUBJECTS/METHODS A total of 1044 subjects from two age-defined cohorts aged 39 and 59 in 1991. Height, weight and WC were measured in 1991, 1995 and 2000 and body mass index (BMI) was calculated. Pattern of weight and WC change was studied over approximately 9 years. RESULTS The prevalence of overweight and obesity increased markedly and the younger cohort showed greater increases in weight and WC than the older cohort. There was no significant difference in mean BMI and/or mean 9-year weight change between men and women in either age cohort, and mean weight gain was similar for all occupational groups. Only 20% of subjects maintained a stable weight (+/-2 kg), while 42.2 and 17.6% gained greater than 5 and 10 kg over the 9-year period, respectively. The rate of weight gain appeared to be relatively steady over the 9 years among younger subjects but declined in the older subjects in the second half of the observation period. CONCLUSIONS Health promotion strategies to prevent weight gain need to be population-based, targeting all social and age groups, but particularly those in their early middle-age.
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Affiliation(s)
- M Ebrahimi-Mameghani
- Department of Nutrition, Faculty of Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
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Abstract
Several drugs, or categories of drugs, listed by the WHO and other writers and used in the treatment of chronic disease, are consistently associated with weight gain as a side effect and considered 'obesogenic'. The extent to which they may contribute to the multifactorial process behind obesity is not well documented. We systematically reviewed papers from Medline 1966-2004, Embase 1980-2004, PsycINFO 1967-2004, and Cochrane Register of Controlled Trials, to determine the effect on body weight of some drugs that are believed to favour weight gain. We included randomized controlled studies of adult participants (>18 years) prescribed a drug considered obesogenic, that compared the 'obesogenic' drug with placebo, an alternative drug or other treatment, and that had a duration of at least 3 months: 43 studies totalling 25,663 subjects met these criteria. The main objective of the majority of studies was to compare the efficacy and safety of drug therapy, with weight change recorded under safety outcomes; weight change was a primary outcome measure in only six studies. There was evidence of weight gain for all drugs included, up to 10 kg at 52 weeks. Differences in dosage, patient population, duration of treatment and dietary advice make generalization of the results difficult. Data on body weight are often not recorded in published clinical trials or is reported in insufficient detail. This side-effect has potentially serious consequences, and should be mentioned to patients. Weight management measures should be routinely considered when prescribing drugs known to promote weight gain. Future clinical trials should always document weight changes.
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Affiliation(s)
- W S Leslie
- Human Nutrition, Division of Developmental Medicine, University of Glasgow, Queen Elizabeth Building, Glasgow Royal Infirmary, Glasgow, UK.
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Akbartabartoori M, Lean MEJ, Hankey CR. The associations between current recommendation for physical activity and cardiovascular risks associated with obesity. Eur J Clin Nutr 2007; 62:1-9. [PMID: 17342166 DOI: 10.1038/sj.ejcn.1602693] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [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: 11/09/2022]
Abstract
OBJECTIVE To examine associations between current recommended physical activity levels and body mass index (BMI) with some cardiovascular disease (CVD) risk factors (total cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-cholesterol (non-HDL-C), C-reactive protein (CRP), fibrinogen, and blood pressure), general health score (GHQ12) and predicted coronary heart disease (CHD) risk. DESIGN Further analysis of the cross-sectional Scottish Health Survey 1998 data. SUBJECTS Five thousand four hundred and sixty adults 16-74 years of age. RESULTS After controlling for some confounding factors, obesity was significantly associated with higher odds ratio (OR) for elevated cholesterol, CRP, systolic blood pressure, non-HDL-C and lower HDL-C (P<0.001), and with greater predicted CHD risk compared to BMI <25 kg/m(2). Regular self-reported physical activity was associated with smaller OR of lower HDL-C and higher CRP, and average predicted 10-year CHD risk in obese subjects, but did not eliminate the higher risk of the measured CVD risk factors in this group. The OR of these two risk factors were still high 4.39 and 2.67, respectively, when compared with those who were inactive with BMI <25 kg/m(2) (P<0.001). Those who reported being physically active had better GHQ scores in all BMI categories (P<0.001). CONCLUSION Reporting achievement of recommended physical activity levels may reduce some CVD risk factors, predicted CHD risk and improve psychosocial health, but may not eliminate the extra risk imposed by overweight/obesity. Therefore, increasing physical activity and reducing body weight should be considered to tackle CVD risk factors.
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Affiliation(s)
- M Akbartabartoori
- 1Nutrition and Biochemistry Department, School of Public Health, Yasuj University of Medical Sciences, Yasuj, Iran
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Leslie WS, Lean MEJ, Woodward M, Wallace FA, Hankey CR. Unidentified under-nutrition: dietary intake and anthropometric indices in a residential care home population. J Hum Nutr Diet 2007; 19:343-7. [PMID: 16961680 DOI: 10.1111/j.1365-277x.2006.00719.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [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: 11/27/2022]
Abstract
BACKGROUND Research investigating the nutritional status of older people in residential care homes is scant. OBJECTIVE To determine the anthropometric measures and dietary intakes of older people in this setting as a basis for future intervention studies. METHODS Dietary intake was assessed using 3-day-weighed food records, nutritional status was evaluated using anthropometric measurements (knee height to predict standing height, and body weight). Catering provision was assessed using a computer-based menu assessment tool (CORA). RESULTS Mean body mass index (BMI) for the 34 participants was 22.2 kg m(2) (range 14.5-34.4). Six participants (17.6%) had a BMI < or =18.5 kg m(2) with a further seven identified as having a BMI >18.5 but <20 kg m(2). Only two subjects with BMI <18.5 kg m(2) were prescribed oral supplements. In both men and women, recorded mean energy intakes were below current estimated average requirements by 24% and 22% respectively. CONCLUSION Despite adequate food provision, under-nutrition was prevalent and, in the majority of cases, unidentified and untreated. A larger study is warranted to investigate whether improved nutritional intake is achievable through dietary modification. These data indicate that a sample size of around 60, with 90% power and at the 5% significance level, is required to detect a difference of 1674 kJ between groups of residents in an intervention study following a cluster randomized design.
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Affiliation(s)
- W S Leslie
- Human Nutrition, Division of Developmental Medicine, University of Glasgow, Glasgow, UK
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Hankey CR, Eley S, Leslie WS, Hunter CM, Lean MEJ. Eating habits, beliefs, attitudes and knowledge among health professionals regarding the links between obesity, nutrition and health. Public Health Nutr 2007; 7:337-43. [PMID: 15003142 DOI: 10.1079/phn2003526] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [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: 11/11/2022]
Abstract
AbstractObjective:To document knowledge, attitudes, beliefs and eating habits of health professionals with respect to obesity, nutrition and weight management.Design:A self-complete questionnaire postal survey.Setting:Primary care and dietetic practice in Scotland.Subjects:A systematic stratified sample of 2290 subjects incorporated general practitioners (n = 1400), practice nurses (n = 613) and all practising dietitians (n = 360) who were members of the British Dietetic Association.Results:The overall response rate was 65%. All professionals showed a clear understanding of nutrition and health. Understanding of obesity as a disease and of the effectiveness of weight management using low-energy diets was limited. Below 10% had carried out audit to determine the incidence of obesity and overweight, and most were uncertain about their own effectiveness in delivering weight management advice.Conclusion:This study confirms that health professionals have some knowledge of nutrition and weight management but are unclear how to deliver effective weight management advice. Further training is justified to ensure the effective provision of nutritional advice to patients.
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Affiliation(s)
- C R Hankey
- University of Glasgow Department of Human Nutrition, Queen Elizabeth Building, Royal Infirmary, Glasgow G31 2ER, UK.
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Abstract
BACKGROUND It is currently unclear how physical activity and diet interact within the ranges of activity seen in the general population. This study aimed to establish whether a small, acute, increase in physical activity would lead to compensatory change in energy intake and nutrient balance, and to provide power analysis data for future research in this field. METHOD Twelve participants were studied over 7 days of habitual activity and 2 weeks after instruction to increase physical activity by 2000 steps per day. Physical activity was assessed using a diary, the 'activPAL' activity monitor and a pedometer. Dietary analyses from prospective food diaries were compared between the first and third weeks. RESULTS Participants increased step-counts (+2600 steps per day, P = 0.008) and estimated energy expenditure (+300-1000 kJ day(-1), P = 0.002) but did not significantly change their energy intake, dietary composition or number of meals per day. From reverse power analysis 38 participants would be needed to exclude a change in energy intake of 400 kJ day(-1) with 90% power at P < 0.05; 400 kJ day(-1) would compensate for a 2000 steps per day increase in physical activity. CONCLUSION These results did not demonstrate any compensatory increase in food consumption when physical activity was increased by walking an average of 2600 additional steps per day. Power analysis indicates that a larger study (n = 38) will be necessary to exclude such an effect with confidence.
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Affiliation(s)
- A-A Koulouri
- Department of Human Nutrition, Division of Developmental Medicine, University of Glasgow, Glasgow, UK
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