Predicting weight gain in patients with cystic fibrosis on triple combination modulator

BACKGROUND

Cystic fibrosis (CF) is caused by CF transmembrane conductance regulator (CFTR) gene mutations producing dysfunctional CFTR proteins leading to progressive clinical disease. Elexacaftor-tezacaftor-ivacaftor (ETI) remarkably improves lung disease but is associated with substantial weight gain.

STUDY DESIGN AND METHODS

We performed a single-center longitudinal study predicting 6-month weight gain after ETI initiation. We used linear mixed effects modeling (LME) to determine association of ETI treatment with changing body mass index (BMI). Using linear regression, we examined BMI prediction models with distinct combinations of main effects to identify a model useful for patient counseling. We used up to eight commonly observed clinical characteristics as input variables (age, sex, percent predicted FEV1 [FEV1%], F508del homozygous state, pancreatic sufficiency, HgbA1c, prior modulator use and prior year number of pulmonary exacerbations).

RESULTS

We evaluated 154 patients (19-73 years old, 54% female, FEV1% = 19-121, 0-6 prior year pulmonary exacerbations). LME demonstrated an association between ETI use and weight increases. Exhaustive testing suggested a parsimonious linear regression model well-fitted to data that is potentially useful for counseling. The two variable model shows that on average, BMI decreases by 0.045 (95% Confidence Interval [CI] = -0.069 to -0.021, p < 0.001) for every year of age and increases by 0.322 (CI = 0.142 to 0.502, p = 0.001) for each additional prior year exacerbation at the time of ETI initiation.

INTERPRETATION

Young patients with many prior year pulmonary exacerbations likely have the largest 6 month weight gain after starting ETI.

The impacts of early environmental adversity on cognitive functioning, body mass, and life-history behavioral profiles

Early adverse experiences or exposures have a profound impact on neurophysiological, cognitive, and somatic development. Evidence across disciplines uncovers adversity-induced alternations in cortical structures, cognitive functions, and related behavioral manifestations, as well as an energetic trade-off between the brain and body. Based on the life history (LH) framework, the present research aims to explore the adversity-adapted cognitive-behavioral mechanism and investigate the relation between cognitive functioning and somatic energy reserve (i.e., body mass index; BMI). A structural equation modeling (SEM) analysis was performed with longitudinal self-reported, anthropometric, and task-based data drawn from a cohort of 2,607 8- to 11-year-old youths and their primary caregivers recruited by the Adolescent Brain Cognitive Development (ABCDSM) study. The results showed that early environmental adversity was positively associated with fast LH behavioral profiles and negatively with cognitive functioning. Moreover, cognitive functioning mediated the relationship between adversity and fast LH behavioral profiles. Additionally, we found that early environmental adversity positively predicted BMI, which was inversely correlated with cognitive functioning. These results revealed an adversity-adapted cognitive-behavioral mechanism and energy-allocation pathways, and add to the existing knowledge of LH trade-off and developmental plasticity.

Lifestyle and eating habits changes among adults during COVID-19 era in Egypt: a population-based study

BACKGROUND

The 2019 recent Coronavirus is without a doubt one of the most complicated viruses to ever pose a threat to humanity. Numerous viral containment strategies forced sedentary behaviors and dietary changes that would-otherwise- increase the chances of acquiring non-communicable diseases.

OBJECTIVES

The objectives of the current study are to identify any changes in eating behaviors through the Mediterranean Diet Adherence in a sample of Egyptians throughout the COVID-19 era.

METHODS

A cross-sectional study was done on a sample of 205 Egyptians by an online self-administered questionnaire. The questionnaire included socio-demographic factors, self-reported weights and heights, a validated Arabic form of the well-known International Physical Activity Questionnaire Short Form (IPAQ-SF), a validated Arabic version of 14-items Mediterranean Diet Adherence Screener (MEDAS), in addition to a section assessing dietetic changes. The data was then analyzed using the SPSS version 20 (Statistical Package for Social Sciences).

RESULTS

The majority of the study sample were females (74.6%); had a high level of education (93.2%); and about 75% were married. Most of the participants were non-smokers, with around a 7% increased frequency of smoking after the COVID-19 pandemic. Fast food consumption was also reported by a major percentage of study participants (60%). Low Mediterranean Diet Adherence was found in 52.7%. Moreover, Physical Activity (PA) decreased to 61%. Moreover, there was a statistically significant increase seen in the participants' BMI as well as the number of sleeping hours (p = 0.001 and 0.043 respectively) after the pandemic. Both changed hunger sensation and any changes in physical activity were significantly associated with increased BMI (p < 0.001).

CONCLUSION AND RECOMMENDATIONS

A substantial proportion of the participants showed unhealthy changes in their dietary habits as well as physical activity. Consequently, this calls for urgent public health policies and interventions to guard against the consequences of such unhealthy behaviors.

Weight trends amongst adults with diabetes or hypertension during the COVID-19 pandemic: an observational study using OpenSAFELY

BACKGROUND

COVID-19 pandemic restrictions may have influenced behaviours related to weight.

AIMS

To describe patterns of weight change amongst adults living in England with Type 2 Diabetes (T2D) and/or hypertension during the COVID-19 pandemic. Design and Setting With the approval of NHS England, we conducted an observational cohort study using the routinely collected health data of approximately 40% of adults living in England, accessed through the OpenSAFELY service inside TPP.

METHOD

We investigated clinical and sociodemographic characteristics associated with rapid weight gain (>0·5kg/m2/year) using multivariable logistic regression.

RESULTS

We extracted data on adults with T2D (n=1,231,455, 44% female, 76% white British) or hypertension (n=3,558,405, 50% female, 84% white British). Adults with T2D lost weight overall (median δ = -0.1kg/m2/year [IQR: -0.7, 0.4]), however, rapid weight gain was common (20.7%) and associated with sex (male vs female: aOR 0.78[95%CI 0.77, 0.79]); age, older age reduced odds (e.g. 60-69-year-olds vs 18-29-year-olds: aOR 0.66[0.61, 0.71]); deprivation, (least-deprived-IMD vs most-deprived-IMD: aOR 0.87[0.85, 0.89]); white ethnicity (Black vs White: aOR 0.95[0.92, 0.98]); mental health conditions (e.g. depression: aOR 1.13 [1.12, 1.15]); and diabetes treatment (non-insulin treatment vs no pharmacological treatment: aOR 0.68[0.67, 0.69]). Adults with hypertension maintained stable weight overall (median δ = 0.0kg/m2/year [ -0.6, 0.5]), however, rapid weight gain was common (24.7%) and associated with similar characteristics as in T2D.

CONCLUSION

Amongst adults living in England with T2D and/or hypertension, rapid pandemic weight gain was more common amongst females, younger adults, those living in more deprived areas, and those with mental health condition.

Overnutrition in adolescents and its associated factors in Dale district schools in Ethiopia: a cross-sectional study

Background

Adolescence is the critical stage of an individual's growth and development that determines their nutritional status in the future. Adolescent overnutrition has become an increasing public health concern in developing countries like Ethiopia.

Objective

This study was designed to determine the magnitude and determinants of overnutrition among school-going adolescents in Dale District of Ethiopia.

Methods

An institution-based cross-sectional study was done between November and December 2020. A total of 333 school-going adolescents aged 10-19 years participated in this study. Socio-demographic, lifestyle, physical activity level, dietary energy intake, and height and weight data were collected. Body Mass Index for age Z-score (BAZ) was computed. Binary and multivariable logistic regression models were used to determine the association of outcome variable with explanatory variables, and results were reported using adjusted odds ratio (AOR) with 95% confidence interval.

Results

The magnitude of overnutrition was 7.2% (10.8% in the urban versus. 3.6% of rural schools). Overnutrition was positively associated with lack of sufficient play area within the school (AOR = 2.53, 95% CI [1.02-6.26]), being an urban resident (AOR = 3.05, 95% CI [1.12-8.29]), positive energy balance (AOR = 9.47, 95% CI [1.58-56.80]), consuming fast foods within a month before the survey date (AOR = 2.60, 95% CI [1.93-6.83]), having moderate (AOR = 9.28, 95% CI [6.70-71.63]) or low physical activity (PA) (AOR = 7.95, 95% CI [1.12-56.72]), and consuming snack within last one week before the survey date (AOR = 3.32, 95% CI [1.15-9.58]).

Conclusion

The magnitude of overnutrition among school-going adolescents was suboptimal. Sedentary lifestyles, excess calorie intake, having inadequate play areas within the school, and having snack and fast foods were determinants for overnutrition in the study area.

Vitamin D Deficiency (VDD) and Benefits of Supplementation in Veterans with IBS-D

Many veterans deployed to Gulf War areas suffer from persistent chronic diarrhea that is disabling and affects their quality of life. The causes for this condition have eluded investigators until recently and recent literature has shed light on the effect of vitamin D on the brain-gut axis. This study focused on determining clinical causes contributing to diarrhea and assessed whether reversing the identified causes, specifically vitamin D deficiency (VDD), could reduce the incidence of diarrhea in Gulf War veterans (GWVs). All patients completed a workup that included serologies (IBD, celiac), routine laboratory tests (CBC, chemistry panels, TSH, T4, CRP), cultures for enteric pathogens (C diff, bacteria, viruses, small intestinal bacterial overgrowth (SIBO)), and upper and lower endoscopies with histology and a trial of cholestyramine to exclude choleretic diarrhea and rifaximin for dysbiosis. A total of 4221 veterans were screened for chronic diarrhea, yielding 105 GWVs, of which 69 GWVs had irritable bowel syndrome with diarrhea (IBS-D). Paired t-tests demonstrated that all GWVs had VDD (t-11.62, df68 and sig(2-tailed) 0.0001) (defined as a vitamin D level less than 30 ng/mL with normal ranges of 30-100 ng/mL) but no positive serologies, inflammatory markers, abnormal endoscopies, cultures, or histology to explain their persistent diarrhea. There was no correlation with age, BMI, or inflammation. Some zip codes had a higher frequency of GWVs with VDD, but the number of deployments had no impact. Treatment with vitamin D supplementation (3000-5000 units), given in the morning, based on weight, reduced the number of bowel movements per day (p < 0.0001) without causing hypercalcemia. We suggest that VDD is important in the etiology of IBS-D in GWVs and that vitamin D supplementation significantly reduces diarrhea.

Hypothalamic volume is associated with body mass index

The hypothalamus is an important neuroendocrine hub for the control of appetite and satiety. In animal studies it has been established that hypothalamic lesioning or stimulation causes alteration to feeding behaviour and consequently body mass, and exposure to high calorie diets induces hypothalamic inflammation. These findings suggest that alterations in hypothalamic structure and function are both a cause and a consequence of changes to food intake. However, there is limited in vivo human data relating the hypothalamus to obesity or eating disorders, in part due to technical problems relating to its small size. Here, we used a novel automated segmentation algorithm to exploratorily investigate the relationship between hypothalamic volume, normalised to intracranial volume, and body mass index (BMI). The analysis was applied across four independent datasets comprising of young adults (total n = 1,351 participants) spanning a range of BMIs (13.3 - 47.8 kg/m2). We compared underweight (including individuals with anorexia nervosa), healthy weight, overweight and obese individuals in a series of complementary analyses. We report that overall hypothalamic volume is significantly larger in overweight and obese groups of young adults. This was also observed for a number of hypothalamic sub-regions. In the largest dataset (the HCP-Young Adult dataset (n = 1111)) there was a significant relationship between hypothalamic volume and BMI. We suggest that our findings of a positive relationship between hypothalamic volume and BMI is potentially consistent with hypothalamic inflammation as seen in animal models in response to high fat diet, although more research is needed to establish a causal relationship. Overall, we present novel, in vivo findings that link elevated BMI to altered hypothalamic structure. This has important implications for study of the neural mechanisms of obesity in humans.

Short-Term Precision and Repeatability of Radiofrequency Echographic Multi Spectrometry (REMS) on Lumbar Spine and Proximal Femur: An In Vivo Study

To determine the short-term intra-operator precision and inter-operator repeatability of radiofrequency echographic multi-spectrometry (REMS) at the lumbar spine (LS) and proximal femur (FEM). All patients underwent an ultrasound scan of the LS and FEM. Both precision and repeatability, expressed as root-mean-square coefficient of variation (RMS-CV) and least significant change (LSC) were obtained using data from two consecutive REMS acquisitions by the same operator or two different operators, respectively. The precision was also assessed in the cohort stratified according to BMI classification. The mean (±SD) age of our subjects was 48.9 ± 6.8 for LS and 48.3 ± 6.1 for FEM. Precision was assessed on 42 subjects at LS and 37 subjects on FEM. Mean (±SD) BMI was 24.71 ± 4.2 for LS and 25.0 ± 4.84 for FEM. Respectively, the intra-operator precision error (RMS-CV) and LSC resulted in 0.47% and 1.29% at the spine and 0.32% and 0.89% at the proximal femur evaluation. The inter-operator variability investigated at the LS yielded an RMS-CV error of 0.55% and LSC of 1.52%, whereas for the FEM, the RMS-CV was 0.51% and the LSC was 1.40%. Similar values were found when subjects were divided into BMI subgroups. REMS technique provides a precise estimation of the US-BMD independent of subjects' BMI differences.

The Overweight Paradox: Impact of Body Mass Index on Patients Undergoing VATS Lobectomy or Segmentectomy

The aim of this study was to assess the impact of BMI on perioperative outcomes in patients undergoing VATS lobectomy or segmentectomy. Data from 5088 patients undergoing VATS lobectomy or segmentectomy, included in the VATS Group Italian Registry, were collected. BMI (kg/m²) was categorized according to the WHO classes: underweight, normal, overweight, obese. The effects of BMI on outcomes (complications, 30-days mortality, DFS and OS) were evaluated with a linear regression model, and with a logistic regression model for binary endpoints. In overweight and obese patients, operative time increased with BMI value. Operating room time increased by 5.54 minutes (S.E. = 1.57) in overweight patients, and 33.12 minutes (S.E. = 10.26) in obese patients (P < 0.001). Compared to the other BMI classes, overweight patients were at the lowest risk of pulmonary, acute cardiac, surgical, major, and overall postoperative complications. In the overweight range, a BMI increase from 25 to 29.9 did not significantly affect the length of stay, nor the risk of any complications, except for renal complications (OR: 1.55; 95% CI: 1.07-2.24; P = 0.03), and it reduced the risk of prolonged air leak (OR: 0.8; 95% CI: 0.71-0.90; P < 0.001). 30-days mortality is higher in the underweight group compared to the others. We did not find any significant difference in DFS and OS. According to our results, obesity increases operating room time for VATS major lung resection. Overweight patients are at the lowest risk of pulmonary, acute cardiac, surgical, major, and overall postoperative complications following VATS resections. The risk of most postoperative complications progressively increases as the BMI deviates from the point at the lowest risk, towards both extremes of BMI values. Thirty days mortality is higher in the underweight group, with no differences in DFS and OS.

Discrepancies in self-reported and measured anthropometric measurements and indices among older Australians: prevalence and correlates

Background

Anthropometric measurements and indices such as weight, height and Body Mass Index (BMI) are often used to assess overall health and nutritional status. Clinicians and epidemiologists often rely on self-reported weight and height to measure BMI. Differences between self-reported and measured weight and height can lead to differences between self-reported and measured BMI, biasing relative risks of diseases associated with differential BMI.

Methods

Applying regression analysis to a large nationally representative survey data with contemporaneous self-reports and measurements on 3412 individuals aged 65 or over, we provided estimates of the difference between self-reports and measurements of weight, height and BMI for older Australians, analysing demographic, socioeconomic and health correlates of estimated differences.

Results

We found both males and females underestimated weight, overestimated height and underestimated BMI and there was some evidence these differences increased with age. There was also evidence that these differences were associated with high levels of education and household composition.

Conclusion

Although average differences were small, for many individuals the differences may be significant, indicating measurements should be taken in clinically focused research and practice. This is important as systematic underestimation of BMI in older adults can have implications for estimating the size of populations at risk of many health conditions, including diabetes, hypertension and functional limitations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14326-y.

Association between Body Weight and Body Mass Index and Patellar Tendinopathy in Elite Basketball and Volleyball Players, a Systematic Review and Meta-Analysis

The features of Patellar-Tendinopathy are (1): pain localised to the inferior pole of the patellar; (2): the presence of load-related pain. Body-Weight and Body-Mass-Index, as two easily-measured variables, could potentially aid the prediction of PT. This review aims to establish relationships between Body-Weight and Body-Mass-Index and Patellar-Tendinopathy via synthesising the evidence from prospective-cohort and cross-sectional studies in elite basketball and volleyball players. Seven databases (PubMed, EMBASE, CINAHL, Google Scholar, Health-Management-Information-Consortium, National-Technical-Information-Service, ClinicalTrial.gov) and citation chasing were used to identify English peer-review articles from 2000 to 2022. An adapted version of the Newcastle-Ottawa scale was used for critical appraisal. Two reviewers were involved in literature searching, data extraction, and quality review. Two prospective cohort and five cross-sectional studies met the inclusion criteria, providing 849 subjects (male:female: 436:413). Five studies found BW is associated with PT. Three studies found a relationship between BMI and PT. Six out of seven studies were classified as very good studies. All studies were level IV evidence. The very low certainty evidence suggests an association between BW and PT. There is moderate certainty evidence that BMI is associated with PT. These preliminary findings should be treated cautiously due to the lack of strong evidence.

Comparison of complications in very obese women undergoing hysterectomy - Abdominal vs laparoscopic approach with short- and long-term follow-up

BACKGROUND

Surgical treatment of obese female patients represents a real challenge. Over the last decade, minimally invasive techniques for hysterectomy have emerged. These approaches reduce the invasiveness of standard surgical procedures while maintaining efficacy and feasibility.

OBJECTIVE

To evaluate the rates of perioperative, early, mid-term and late postoperative complications in very obese [body mass index (BMI) ≥ 35 and < 40 kg/m²] and severely obese (BMI ≥ 40 kg/m²) women who underwent total (non-radical) hysterectomy.

DESIGN

A prospective comparative multi-centre non-randomized study.

METHODS

In total, 328 consecutive total (non-radical) hysterectomies were performed at seven teaching gynaecological centres. Of these, 153 (46.6%) were performed using an open laparotomy (LT) approach and 175 (53.4%) were performed laparoscopically (LS). All data were collected by medical specialists at the pre-operative examination prior to surgery, during surgery and three times postoperatively (during hospital stay, at 6-week follow-up and 6 months following surgery). Another analysis considered a total of 206 women who underwent laparoscopic hysterectomy. The subjects were divided according to BMI into 120 very obese women (BMI ≥ 35 and < 40 kg/m²) and 86 severely obese women (BMI ≥ 40 kg/m²).

RESULTS

The total number of composite perioperative complications was significantly lower in the LS group (p = 0.006). Composite complications occurred significantly more often in patients in the LT group compared with the LS group in the early (p < 0.001) and mid-term (p < 0.001) postoperative periods. In the late postoperative period, the total number of composite postoperative complications did not differ significantly between the groups (p < 0.396). Among 206 patients who underwent laparoscopic hysterectomy, the number of complications was generally low; the rates of composite perioperative (p = 0.393), early (p = 0.642), mid-term (p = 0.738) and late (p = 1) postoperative complications were generally low; and frequency did not differ significantly with BMI.

CONCLUSION

The LS approach does not increase intra-operative morbidity associated with surgery, and has significantly better outcomes in terms of the postoperative complication rate.

The association between adolescent obesity and later gestational diabetes in military personnel: A retrospective cohort study

BACKGROUND

The association between body mass index (BMI) in adolescence and gestational diabetes mellitus (GDM) has not been completely delineated. The purpose of our study was to determine the extent by which adolescent obesity increases the risk for developing GDM later in life.

METHODS

A retrospective cohort study including all army personnel pregnancies occurring between the years 2009-2019 was conducted. Adolescent BMI of participants was available using pre-recruitment army records. GDM and other pregnancy outcomes were compared between two groups: adolescent BMI below 30 (comparison group) and that of 30 or more (exposed group). Multivariable models were adjusted for sociodemographic factors.

RESULTS

Following exclusion of cases with missing or partial glucose tests, and undocumented BMI, 6877 deliveries were included in the analysis. GDM rates were higher in the exposed group (4.9% vs. 2.9%, p value-0.09). GDM rates were twice as common in the exposed group (4.9% vs. 2.9%, p value-0.09). The multivariable model, adjusted for country of birth, socio-economic class, medical profile score, maternal age, and follow-up time, confirmed an independent association between adolescent obesity and later GDM, with an adjusted odds ratio of 2.22 (CI 1.1-4.5, p value - 0.03).

CONCLUSION

Obesity during the adolescent years is independently associated with gestational diabetes later in life.

Evaluation of Circulating Chitotriosidase Activity in Children with Obesity

Childhood obesity progresses to metabolic disturbances via low-grade inflammation. Identifying novel molecules that reflect the activity of the immune responses is critical in understanding its underlying pathogenesis. Our exploratory study aimed to evaluate the change of chitotriosidase (CHIT1) plasma activity according to Body Mass Index (BMI)-for-age z score in pediatric patients. The study evaluated 68 children consisting of 47.1% girls with a mean age of 12.47 ± 3.71 years and 52.9% boys with a mean age of 11.93 ± 3.18 years. The effect of the most frequent CHIT1 gene variants, the 24 base pair duplication (dup24) and G102S polymorphism, upon the association between circulating CHIT1 activity and the obesity level, was also investigated. A significantly higher logCHIT1 plasma activity was found in children with extreme obesity than in children with overweight (p = 0.048 for the uncorrected CHIT1 and 0.026 for the corrected CHIT1). The BMI-for-age z score significantly (p = 0.031) predicts increased CHIT1 activity in children with overweight, obesity, and extreme obesity after controlling for the two gene variants, age, gender, and time since weight gain. Dup24 and G102S polymorphism were significant independent predictors (p-values < 0.002) for the change of CHIT1 plasma activity. Circulating CHIT1 might be an accurate indicator of inflammation in children with obesity. Its role and the effect of the dup24 and G102S variants on the CHIT1 activity should be validated in a larger cohort.

Prevalence rates of metabolic health and body size phenotypes by different criteria and association with insulin resistance in a Maltese Caucasian population

INTRODUCTION

Hyperinsulinemia and insulin resistance are known to be associated with increased cardiovascular morbidity and mortality. A metabolically unhealthy phenotype is frequently used as a surrogate marker for insulin resistance. The aims of the current study were to compare the prevalence of the body size phenotypes using different definitions of metabolic health and to investigate which one of them is most strongly associated with insulin resistance in men and women.

METHODS

We conducted a cross-sectional study in a middle-aged cohort of Maltese Caucasian non-institutionalized population. Metabolic health was defined using the various currently used definitions.

RESULTS

There were significant differences in the prevalence of body size phenotypes according to the different definitions. We also found significant sex differences in the predictive value of the various definitions of the metabolically unhealthy phenotype to predict insulin resistance. The strongest association was for the definition of having >2 NCEP-ATPIII criteria to characterize the metabolic unhealthy phenotype in women (odds ratio of 19.7). On the other hand, the Aguilar-Salinas et al. definition had the strongest association in men (odds ratio of 18.7).

CONCLUSIONS

We found large differences in the prevalence of the various body size phenotypes when using different definitions, highlighting the need for having standard criteria. Our data also suggest the need for sex-specific definitions of metabolic health.

Sports activity and changes in physical fitness of Polish children and adolescents: OSF study

BACKGROUND

Physical activity promotion programs for children and adolescents should constitute the basis of any national health policy aiming to improve physical fitness, which is a significant health indicator in children, adolescents, adults as well as elderly persons.

METHODS

The study included 1,230 children and adolescents aged 8-16 years (60.1% of girls) from Poland. Five hundred and twenty-seven persons covered by the survey (42.8%) participated in physical activity promotion called "Athletics for All!" (AFA) as an experimental group and 703 peers not participating in any forms of physical extra-curricular activities as a control group. Participants were measured for basic anthropometric parameters and body mass indices were calculated: Body Mass Index (BMI) and Ponderal Index (PI). Evaluation of physical fitness was made using the OSF Test (3 × 10 m shuttle run, standing broad jump, 1 kg medicine ball overhead throw, 4-min run). Comparative analysis between the experimental and control groups was carried out using the T-test for independent samples. Analysis of correlations between quantitative variables was performed with Pearson's r coefficient.

RESULTS

Statistically significant differences in all the tests were noted between the experimental group (AFA) and the control group in favor of the former one. Taking into account reference ranges of BMI created according to the latest Polish norms, statistically significant differences were noted between the subgroups in all physical fitness tests. As far as PI is concerned, in the AFA group significant differences were noted in all physical fitness tests between subgroups created in accordance with the aforementioned norms.

CONCLUSION

The findings of our study show that it is necessary to introduce physical activity promotion programs for children and adolescents. Such programs should constitute the basis of national health policy aiming at improving physical fitness among young people.

The determinants of racial disparities in obesity: baseline evidence from a natural experiment

This paper uses baseline data from an observational study to estimate the determinants of racial and gender disparities in obesity. Samples of low-income workers in Minneapolis and Raleigh reveal that respondents in Minneapolis have lower Body Mass Indices (BMIs) than respondents in Raleigh. There are large, statistically significant race and gender effects in estimates of BMI that explain most of the disparity between the two cities. Accounting for intersectionality - the joint impacts of being Black and a woman - reveals that almost all the BMI gaps between Black women in Minneapolis and Raleigh can be explained by age and education differences.

Intention to lose weight and use of electronic cigarettes among adolescents

Electronic cigarette use among American adolescents is a major public health concern given the negative health consequences of nicotine in youth. Recent literature has shown that weight control may be one motivation for use in this population. This study examined associations between intention to lose weight and e-cigarette use among adolescents having overweight or obesity from an ethnically diverse sample of Texas youth by gender. We performed a cross-sectional analysis of a state representative sample of 9056 eighth and eleventh grade students from the 2015-2016 Texas School Physical Activity and Nutrition (Texas SPAN) study. Validated survey items assessed weight intentions and e-cigarette use. Staff collected anthropometric measures. Logistic regression analysis was conducted to assess the relationship between e-cigarette use and weight intentions with gender interaction, adjusting for grade, race/ethnicity, economic status, weight-behaviors and stratified by BMI class. More than half (50.9%) of the weighted sample were Hispanic and 12.5% were Non-Hispanic Black; 8.5% used e-cigarettes; and 50.0% intended to lose weight. Of the 40.2% of the sample having overweight or obesity, 82.9% intended to lose weight. Among respondents with obesity, use of e-cigarettes was significantly higher among males intending to lose weight than among females intending to lose weight (12% versus 6%, p = 0.007). These findings contrast with previous research suggesting that e-cigarette use in females is more likely to be motivated by an intent to lose weight. The ethnic diversity of the Texas SPAN population may explain this discrepancy.

Maternal diseases and risk of hypertensive disorders of pregnancy across gestational age groups

OBJECTIVES

To estimate the risk of hypertensive disorders of pregnancy in nulliparous women with diabetes, chronic hypertension or obesity in three gestational age groups.

STUDY DESIGN

Population-based observational cohort study of 382 618 nulliparous women (94 280 with known BMI) using Medical Birth Registry of Norway and Statistics Norway. Main exposure variables were diabetes, chronic hypertension, Body Mass Index (BMI). Multiple regression analysis was performed without (model 1) and with (model 2) BMI.

MAIN OUTCOME MEASURES

Preeclampsia stratified by gestational age group at delivery: early (23⁰-33⁶ weeks), intermediate (34⁰-36⁶ weeks) and late (37⁰-43⁶ weeks), and gestational hypertension.

RESULTS

In model 1, Type 1 diabetes was associated with early (aOR = 5.0, 95%CI 3.8, 6.7), intermediate (aOR = 10.2, 95%CI 8.5, 12.3) and late preeclampsia (aOR = 2.7, 95%CI 2.4, 3.2), compared to no diabetes. Compared to normotensive women, women with chronic hypertension had an increased risk of preeclampsia in all groups: early (aOR = 8.68, 95%CI 6.94, 10.85), intermediate (aOR = 5.59, 95%CI 4.46, 7.02), late (aOR = 3.45, 95%CI 3.00, 3.96). The same trends persisted after adjusting for BMI (model 2). Obesity remained an independent risk factor for hypertensive disorders of pregnancy.

CONCLUSIONS

Maternal diabetes, chronic hypertension and obesity were associated with an increased risk of hypertensive disorders of pregnancy across all gestational age groups in nulliparous women. Adjusting for BMI did not further modify the risk in these women, although 75% of the women in the study lacked BMI data.

Distribution and Characteristics of Pancreatic Volume Using Computed Tomography Volumetry

OBJECTIVES

Changes in the pancreatic volume (PV) are useful as potential clinical markers for some pancreatic-related diseases. The objective of this study was to measure the volume of the pancreas using computed tomography (CT) volumetry and to evaluate the relationships between sex, age, body mass index (BMI), and sarcopenia.

METHODS

We retrospectively analyzed the abdominal CT scans of 1,003 subjects whose ages ranged between 10 and 90 years. The pancreas was segmented manually to define the region of interest (ROI) based on CT images, and then the PVs were measured by counting the voxels in all ROIs within the pancreas boundary. Sarcopenia was identified by examination of CT images that determined the crosssectional area of the skeletal muscle around the third lumbar vertebra.

RESULTS

The mean volume of the pancreas was 62.648 ± 19.094 cm3. The results indicated a negative correlation between the PV and age. There was a positive correlation between the PV and BMI for both sexes, females, and males (r = 0.343, p < 0.001; r = 0.461, p < 0.001; and r = 0.244, p < 0.001, respectively). Additionally, there was a positive correlation between the PV and sarcopenia for females (r = 0.253, p < 0.001) and males (r = 0.200, p < 0.001).

CONCLUSIONS

CT pancreas volumetry results may help physicians follow up or predict conditions of the pancreas after interventions for pancreatic-related disease in the future.

An exploratory Interpretative Phenomenological Analysis (IPA) of childbearing women's perceptions of risk associated with having a high Body Mass Index (BMI)

BACKGROUND

In 2016, the World Health Organization (WHO) labelled 13% of the world's adult population as obese. This increase in obesity is accompanied by mortality and morbidity problems, with maternal obesity and its accompanying risk for mother and infant requiring to be carefully managed.

AIM

To explore childbearing women with a high BMI (>35 kg/m²) perceptions of risk and its potential impacts upon pregnancy and outcome.

METHOD

Qualitative Interpretative Phenomenological Analysis (IPA) was used to gain deeper understanding of the lived experiences of childbearing women with a BMI>35 kg/m² and perceptions of their risk and potential pregnancy outcome.

FINDINGS

One of the superordinate themes that emerged was (1) Risk or no risk, and its associated three subthemes of (1a) Emotional consequences of her risky position, (1b) Recognition of high-risk complicationsfinally sinking in, and (1c) Accepting the risk body.

RECOMMENDATIONS FOR PRACTICE

In general, health care professionals are uncomfortable about discussing obesity-associated risks with pregnant women. The participants in this study did not classify themselves as obese, with this absence of acknowledgement and 'risky talk' leaving participants' unaware of their obesity-associated risk. This downplaying of obesity related talk requires to be corrected, simply because women in denial will perceive no need to engage with health promotion messages. In response, directives are required to be embedded into policy and practice.

CONCLUSION

Specific training is required to teach maternity care professionals how to have difficult, sensitive conversations about obesity related risks with childbearing women with high BMI's. In addition, this risk information needs to be accompanied by relevant advice and support.

Long-Term Changes in Sleep Disordered Breathing in Renal Transplant Patients: Relevance of the BMI

Sleep disordered breathing (SDB), as defined by the Apnea Hypopnea Index (AHI), is a highly prevalent disturbance in end stage kidney disease. SDB improves early on after renal transplantation but long-term changes in AHI in these patients have not been studied. We studied the long-term changes in AHI in a series of 221 renal transplant patients (mean age: 47 ± 12 years; 70% males) over a median follow up of 35 months. Data analysis was made by the generalized estimating equations method (GEE). On longitudinal observation, the median AHI rose from 1.8 (Interquartile range: 0.6-5.0) to 2.9 (IQR: 1.0-6.6) and to 3.6 (IQR: 1.7-10.4) at the second and third visit, respectively (p = 0.009 by the GEE model and the proportion of patients with moderate to severe SDB rose from 8% to 20%. Longitudinal changes in minimum oxygen saturation (minSaO2) mirrored those in the AHI. In adjusted analyses, repeated measurements of BMI (p < 0.009) emerged as the strongest independent longitudinal correlate of AHI and MinSaO2. The AHI worsens over time in renal transplant patients and longitudinal changes of this biomarker are directly related to simultaneous changes in BMI. Overweight/obesity, a potentially modifiable risk factor, is an important factor underlying the risk of SDB in this population.

Analysis of Faecal Zonulin and Calprotectin Concentrations in Healthy Children During the First Two Years of Life. An Observational Prospective Cohort Study

Factors affecting the intestinal-barrier permeability of newborns, such as body mass index (BMI), nutrition and antibiotics, are assumed to affect intestinal-barrier permeability in the first two years of life. This study assessed 100 healthy, full-term newborns to 24 months old. Faecal zonulin/calprotectin concentrations were measured at 1, 6, 12, 24 months as gut-permeability markers. Zonulin concentrations increased between 1 and 12 months (medians: 114.41, 223.7 ng/mL; respectively), whereas calprotectin concentrations decreased between one and six months (medians: 149. 29, 109.28 µg/mL); both then stabilized (24 months: 256.9 ng/mL zonulin; 59.5 µg/mL calprotectin). In individual children, high levels at one month gave high levels at older ages (correlations: calprotectin: between 1 and 6 or 12 months: correlation coefficient (R) = 0.33, statistical significance (p) = 0.0095; R = 0.28, p = 0.032; zonulin: between 1 and 24 months: R = 0.32; p = 0.022, respectively). Parameters which gave marker increases: antibiotics during pregnancy (calprotectin; six months: by 80%, p = 0.038; 12 months: by 48%, p = 0.028); vaginal birth (calprotectin: 6 months: by 140%, p = 0.005); and > 5.7 pregnancy-BMI increase (zonulin: 12 months: by 74%, p = 0.049). Conclusions: “Closure of the intestines” is spread over time and begins between the sixth and twelfth month of life. Antibiotic therapy, BMI increase > 5.7 during pregnancy and vaginal birth are associated with increased intestinal permeability during the first two years of life. Stool zonulin and calprotectin concentrations were much higher compared with previous measurements at older ages; clinical interpretation and validation are needed (no health associations found).

Risk and protective factors associated with depressive symptoms in young adults with overweight and obesity

Objective: Approximately one-third of college students are categorized as overweight/obese and elevated weight has been associated with increased risk of depressive symptoms. Less is known about protective factors in this context. This study examined associations between depressive symptoms and health behaviors, as well as body image variables among college students with overweight/obesity, while accounting for contributions of BMI and demographics. Participants: College students (N = 175; M_age = 19.87, SD = 1.93; 70% female; 58% Non-Hispanic Black) with overweight/obesity completed in-person surveys. Methods: Depressive symptoms, exercise and diet engagement, body positivity, and body dissatisfaction were assessed. Data were examined using a hierarchical linear regression. Results: Greater exercise engagement and greater body positivity were significantly associated with lower levels of depressive symptoms. Conclusions: Established links between elevated weight and depression are complex but imperative to understand, as mutable factors that contribute to this relationship may provide novel avenues for intervening.

Increased Insulin Concentrations During Growth Hormone Treatment in Girls With Turner Syndrome Are Ameliorated by Hormone Replacement Therapy

OBJECTIVE

Turner syndrome (TS) is characterized by complete or partial loss of one sex chromosome and is commonly associated with short stature, metabolic changes (such as central obesity, abnormal glucose tolerance and high triglycerides) and premature ovarian insufficiency (POI). Primary management of TS during childhood and adolescence comprises treatment with human growth hormone (hGH) and, in cases with early loss of ovarian function, hormone replacement therapy (HRT). Given that metabolic parameters are altered when HRT is applied during menopause, we analyzed whether metabolic changes might be positively or negatively affected within 10 years after HRT and/or hGH in girls with TS.

DESIGN

Observational study.

METHODS

Data were collected from the medical records of 31 girls with TS attending two endocrinologic centers in Germany between 2000 and 2020. Descriptive statistics are reported as the mean ± SEM or percentages.

RESULTS

The mean age at first presentation was 99.06 ± 8.07 months, the mean height was 115.8 ± 3.94 cm, and the mean BMI 19.0 ± 0.99 was kg/m². Treatment with hGH was given to 96.8% of the girls, starting at an average age of 99.06 ± 8.70 months, and was continued for 67.53 ± 6.28 months. HRT was administered to 80.6% of all patients and was started at a mean age of 164.4 ± 4.54 months. During the follow-up, we did not observe any significant absolute changes in lipid parameters, but we detected beneficial effects of childhood hGH: significantly lower cholesterol (-0.206/month; p = 0.006), lower low density lipoprotein cholesterol (-0.216/month; p = 0.004), and higher high density lipoprotein cholesterol (+0.095/month; p = 0.048). Insulin concentrations, showed a significant increase attributable to hGH treatment (+0.206/month; p = 0.003), which was ameliorated by concomitant or subsequent HRT (-0.143/month; p = 0.039).

CONCLUSION

Treatment with hGH and HRT is provided to most girls with TS. Metabolic effects are associated with both modalities. Monitoring of metabolic changes appears to be important to detect unfavorable effects, and could guide treatment adjustment and duration.

Body Mass Index and Associated Clinical Variables in Patients with Non-Celiac Wheat Sensitivity

Background: Non-Celiac Wheat Sensitivity (NCWS) is still a largely undefined condition, due to the lack of a diagnostic marker. Few data are available about the nutritional characteristics of NCWS patients at diagnosis. Aims: To evaluate the proportion of NCWS patients who were underweight, normal weight, overweight, or obese at diagnosis, and to search for possible correlations between their Body Mass Index (BMI) and other NCWS-related disease characteristics. Patients and Methods: The clinical charts of 145 NCWS patients (125 F, 20 M, mean age 37.1 ± 11.4 years), diagnosed between January 2012 and March 2018, were reviewed. As a comparison, 84 celiac disease (CD) patients (73 F, 11 M, mean age 39.8 ± 13.9 years) were evaluated. All NCWS diagnoses were based on a double-blind placebo-controlled wheat challenge (DBPCWC) method. Results: BMI distribution was similar in the NCWS (6.2% underweight and 15.2% obese subjects) and CD patients (6% underweight and 7.1% obese subjects). Underweight NCWS subjects were significantly younger and had a shorter clinical history than the overweight or obese ones. Unlike the other NCWS patients, none of them had a DQ2 and/or DQ8 haplotype. Overweight and obese NCWS patients were more frequently suffering from associated autoimmune diseases than the other BMI categories (P = 0.05). Compared to the CD controls, NCWS patients showed a higher frequency of Irritable Bowel Syndrome (IBS)-like (P = 0.01) and extraintestinal symptoms (P = 0.03) and a longer clinical history (P = 0.04), whereas weight loss was more frequent in CD (P = 0.02). Conclusions: NCWS patients showed a BMI distribution similar to CD patients. However, NCWS was found to be a heterogenous condition that regards BMI, and clinical characteristics differed between the underweight and overweight/obese patients.

The Influence of Maternal-Foetal Parameters on Concentrations of Zonulin and Calprotectin in the Blood and Stool of Healthy Newborns during the First Seven Days of Life. An Observational Prospective Cohort Study

Background: It can be hypothetically assumed that maternal and perinatal factors influence the intestinal barrier. Methods: The study was conducted with 100 healthy, full-term newborns breastfed in the first week of life, with similar analyses for their mothers. Zonulin and calprotectin levels were used as intestinal permeability markers. Results: The median (range) zonulin concentrations (ng/mL) were in mothers: serum, 21.39 (6.39–57.54); stool, 82.23 (42.52–225.74); and newborns: serum cord blood, 11.14 (5.82–52.34); meconium, 54.15 (1.36–700.65); and stool at age seven days, 114.41 (29.38–593.72). Calprotectin median (range) concentrations (µg/mL) in mothers were: stool, 74.79 (3.89–211.77); and newborns: meconium, 154.76 (6.93–8884.11); and stool at age seven days 139.12 (11.89–627.35). The use of antibiotics during pregnancy resulted in higher zonulin concentrations in umbilical-cord serum and calprotectin concentrations in newborn stool at seven days, while antibiotic therapy during labour resulted in higher zonulin concentrations in the stool of newborns at seven days. Zonulin concentrations in the stool of newborns (at seven days) who were born via caesarean section were higher compared to with vaginal birth. With further analyses, caesarean section was found to have a greater effect on zonulin concentrations than prophylactic administration of antibiotics in the perinatal period. Pregnancy mass gain >18 kg was associated with higher calprotectin concentrations in maternal stool. Body Mass Index (BMI) increase >5.7 during pregnancy was associated with decreased zonulin concentrations in maternal stool and increased calprotectin concentrations in stool of mothers and newborns at seven days. There was also a negative correlation between higher BMI increase in pregnancy and maternal zonulin stool concentrations and a positive correlation between BMI increase in pregnancy and maternal calprotectin stool concentrations. Conclusion: Maternal-foetal factors such as caesarean section, antibiotic therapy during pregnancy, as well as change in mother’s BMI during pregnancy may increase intestinal permeability in newborns. Changes in body mass during pregnancy can also affect intestinal permeability in mothers. However, health consequences associated with increased intestinal permeability during the first days of life are unknown. Additionally, before the zonulin and calprotectin tests can be adopted as universal diagnostic applications to assess increased intestinal permeability, validation of these tests is necessary.

Sociodemographic and behavioural factors associated with body mass index among men and women in Nairobi slums: AWI-Gen Project

Background: Body mass index (BMI) is rising globally with a faster increase in urban areas in low- and middle-income countries. It is critical to identify modifiable risk factors for BMI to prevent the occurrence of associated health consequences.

Objective: To investigate socio-demographic, behavioural and biological factors associated with BMI in Nairobi slums.

Methods: In 2014-2015, a cross sectional study of men and women aged 40–60 years in Nairobi slums (Korogocho and Viwandani) was conducted. Data were collected on socio-demographic, behavioural and biological characteristics. Mean BMI, overweight and obesity were computed. Hierarchical multiple linear regression analysis was conducted separately for men and women to explore factors associated with BMI.

Results: In total, 1942 study participants (54.4%, women) with a mean age (SD) of 48.3 (5.3) years and 48.8(5.6) years for women and men respectively were recruited. Mean BMI was higher among women than men (27.6 versus 22.8; p < 0.001). More women were overweight (30.9% versus 19.6%; p < 0.001) and obese (32.1% versus 5.1%; p < 0.001) than men. Among men, BMI was independently associated with wealth index, bread consumption and self-reported diabetes and was negatively associated with current tobacco smoking, HIV and TB infections. Among women, BMI was independently associated with wealth, current non-problematic drinking, and sedentary time, but was lower among other ethnicities compared to Kikuyu, among current smokers, women with longer sleep, and those with HIV infection and tuberculosis. Wealth index contributed the most variance in BMI among women and men (10.4%, 7.5%, respectively), but behavioural factors (7.4%) among men and biological factors (6.5%) among women accounted for most of the additional BMI variance.

Conclusions: Adults aged 40–60 years in the urban slums of Nairobi have a high BMI associated with wealth. Bread consumption by men and sedentary life among women are the main risky behaviours that need urgent targeted interventions.

Obesity and increased susceptibility to arsenic-related type 2 diabetes in Northern Chile

BACKGROUND

The prevalence of type 2 diabetes (T2D) has nearly doubled since 1980. Elevated body mass index (BMI) is the leading risk factor for T2D, mediated by inflammation and oxidative stress. Arsenic shares similar pathogenic processes, and may contribute to hyperglycemia and β-cell dysfunction.

OBJECTIVES

We assessed a unique situation of individuals living in Northern Chile with data on lifetime arsenic exposure to evaluate the relationship between arsenic and T2D, and investigate possible interactions with BMI.

METHODS

We analyzed data collected from October 2007-December 2010 from an arsenic-cancer case-control study. Information on self-reported weight, height, smoking, diet, and other factors were obtained. Diabetes was defined by self-reported physician-diagnoses or use of hypoglycemic medication. A total of 1053 individuals, 234 diabetics and 819 without known diabetes were included.

RESULTS

The T2D odds ratio (OR) for cumulative arsenic exposures of 610-5279 and ≥ 5280 μg/L-years occurring 40 years or more before interview were 0.97 (95% CI: 0.66-1.43) and 1.53 (95% CI: 1.05-2.23), respectively. Arsenic-associated T2D ORs were greater in subjects with increased BMIs. For example, the ORs for past cumulative exposures ≥ 5280 μg/L-years was 1.45 (95% CI: 0.74-2.84) in participants with BMIs < 25 kg/m² but 2.64 (95% CI: 1.14-6.11) in those with BMIs ≥ 30 kg/m² (synergy index = 2.49, 95% CI: 0.87-7.09). Results were similar when people with cancer were excluded.

CONCLUSIONS

These findings identify increased odds of T2D with arsenic exposure, which are significantly increased in individuals with excess BMI.

Impact of competitive foods in public schools on child nutrition: effects on adolescent obesity in the United States an integrative systematic literature review

Background: The United States (US) is currently facing a public health crisis due to the percentage of obesity in adolescents. The Center for Disease Control (CDC) stated the risks for children due to obesity are many. Adolescents obtain a large portion of their daily caloric intake at school; therefore, what foods/drinks they are consuming is so serious.

Objective: To identify and analyze literature on the effects of competitive foods in public schools on adolescent weight, or Body Mass Index (BMI), and possible impacts they may have on adolescent obesity in the United States.

Methods: An integrative systematic review of literature was conducted. The literature was collected in CINAHL, MEDLINE and EMBASE databases. Refined keyword search is further detailed in the report. Year restrictions were 2006–2017 from peer-reviewed journals and published in English, including adolescents 13–18 years old in the US. Criteria for inclusion targeted at least one of (1) sugar-sweetened beverages (SSB), (2) competitive foods, (3) commercial foods, (4) vending machines, (5) al a carte venues, and (6) school stores, examining their associations with weight measurements, using either weight or BMI, or caloric intake analysis.

Results: A total of 164 articles were detected and assessed, for a final analysis of 34 full text articles. Twenty-six articles met the inclusion criteria. Common aspects of interest involved BMI/Obesity/Weight (73%), (58%) examined Calorie density or consumption, (77%) discussed the Availability of competitive foods in schools, (54%) included Analysis of competitive food, beverage and nutrition policies, and (69%) addressed Other effects.

Conclusion: This review discovered substantial evidence that competitive foods are highly available in schools, however, lacking in robust evidence proving causality in increasing BMI or weight. There is strong corroboration in the research revealing that Other effects are factors worthy of studying further. Additional longitudinal and higher-quality research needs to be performed.

Independent Relationship between Serum Osteocalcin and Uric Acid in a Cohort of Apparently Healthy Obese Subjects

BACKGROUND

It is generally accepted that serum osteocalcin (OC) is a reliable marker of bone formation, while the role of serum uric acid (UA) in bone metabolism is still debated. However, recent studies have shown that endogenous UA within the normal range may exert a positive effect in bone formation by means of its antioxidant role in both sexes. To date, no studies have been carried out in obese subjects aiming to study the relationship between serum OC and UA, given that obesity is considered as a risk factor for osteoporosis and fracture and, at the same time, for cardiovascular events.

OBJECTIVES

Our search purpose was to verify the relationship between endogenous levels of OC and serum UA in a cohort of obese subjects without any metabolic or chronic diseases (i.e. hypertension, renal failure, diabetes mellitus, etc.).

MATERIALS AND METHODS

One hundred and twenty one obese subjects (93 women and 28 men) were enrolled for this study. Serum OC and UA were assessed and compared with demographic characteristics, clinical and biochemical parameters (age, body mass index (BMI), blood pressure, waist circumference, serum lipids and glycaemia).

RESULTS

Serum OC was directly and independently correlated with circulating UA in our population of obese subjects, while neither BMI, age, serum lipids, fasting glycaemia nor gender showed a statistically significant correlation with endogenous plasma levels of OC.

CONCLUSION

The positive effect determined by serum OC in bone metabolism of our obese subjects might be partly due to the antioxidant properties that normal plasma UA levels exert at bone tissue level.

Biopsychological and pathophysiological features of Cold-Heat subgroup of Sasang typology with Sasang Digestive Function Inventory, Sasang Personality Questionnaire and Body Mass Index

Background

The Sasang typology is a traditional Korean personalized medicine and its Cold-Heat subgroup identification is essential for effective use of medical herbs and acupuncture. The purpose of this study was to discover differences between Cold-Heat subgroups with objective clinical measures and to examine its clinical usefulness.

Methods

The pathophysiological symptoms of the digestive system, temperament and body shape of 241 patients were measured using the Sasang Digestive Function Inventory (SDFI), Sasang Personality Questionnaire (SPQ) and Body Mass Index (BMI). The differences between Cold and Heat subgroups of each Sasang types were tested by Analysis of Covariance considering age and sex, while the associations of SDFI, SPQ and BMI with Cold-Heat subgroup were examined by logistic regression analysis.

Results

There were significant differences between Cold and Heat subgroups in SDFI, SPQ and BMI for the So-Yang, SDFI and BMI for the Tae-Eum type and SDFI-Digestion subscale for the So-Eum type. Moreover, the SDFI-Digestion was a substantial predictor for Cold-Heat subgroup identification in three Sasang types. The logistic regression model with SDFI, SPQ and BMI correctly predicted 81.9%, 77% and 75.5% of the Cold-Heat subgroups in So-Yang, Tae-Eum and So-Eum types, respectively.

Conclusion

The results of the present study showed that the objective and validated clinical measures of SDFI, SPQ and BMI would be useful for differentiating Cold-Heat subgroups of Sasang typology. Further clinical studies on pathophysiological mechanisms in Cold-Heat subgroup are required to generalize these results.

Changing Trends in Nutritional Behavior among University Students in Greece, between 2006 and 2016

The objective of the present survey was to study the dietary behavior of university students residing away from the family home. In this context, we (a) compared their dietary habits in two time periods, namely 2006 and 2016; and (b) explored the possible impact of gender on the behavioral changes in nutritional choices. A total of four hundred and five university students (2006, n = 242; 2016, n = 163) participated in the study. Dietary assessment was carried out using a qualitative Food Frequency Questionnaire, while data about demographic and lifestyle factors were also collected. Students' dietary habits have been modified in a generally desirable direction, as reflected, e.g., in the elevated consumption of several plant-based foods. Gender was also significantly associated with Body Mass Index (BMI) and changes in dietary attitudes. Possible reasons for the transition towards healthier and more balanced dietary habits could involve the budgetary constraints facing Greece in the last decade, as well as increasing nutritional awareness and other socio-cultural factors characterizing this target group. A deeper understanding of these relations would be crucial to foster nutritional education and further enhance the effectiveness of health promotion campaigns.

The Association between Types of Soda Consumption and Overall Diet Quality: Evidence from National Health and Nutrition Examination Survey (NHANES)

BACKGROUND AND PURPOSE

Daily soda consumption may lead to high energy intake and poor diet quality. Although diet sodas contain no calories, they lack healthful nutrients. The study examined different types of soda consumption [regular (sugar-sweetened) sodas, diet sodas, and non-sodas] associated with overall diet quality.

METHODS

Cross sectional, 24-hour dietary recall data from the National Health and Nutrition Examination Survey (NHANES) from 2005-2012 were utilized for the study. Majority of the participants (n = 4,427) were female (57%), adults aged 19-55 years (51%), and non-Hispanic whites (67%). Nutritional Quality Index (NQI) was calculated as an indicator of diet quality. Multiple linear regression models were used to estimate the significant association between types of soda consumption and NQI stratified by body mass index.

RESULTS

Regular soda drinkers had lower NQI than diet soda drinkers, but only for overweight (β =-9.72; p=0.031) and obese (β =-7.06; p<0.002) individuals. Non-soda drinkers had higher NQI compared to diet soda drinkers in normal weight (β =12.38; p=0.006) and obese (β =6.19; p<0.000) individuals.

CONCLUSION

Nutrition intervention programs, therefore, should target overweight and obese soda drinkers, emphasizing reduction in soda consumption, which may improve nutrient density in their diets and subsequently impact long-term health outcomes.

The Relationship between Body Mass Index (BMI) and Depression According to the rs16139NPY Gene

Objective: Obesity and depression are likely to interact mutually, which makes it unclear whether obesity causes depression or depression leads to obesity, and how the genotypes have a role in obesity and depression. Method: This cross- sectional study was conducted on a sample of 400 individuals from the participants in the third phase of the comprehensive Iranian Multicenter Osteoporosis Study (IMOS). Anthropometric measurements and depression were assessed. PCR-RFLP was used to investigate the NPY polymorphism. Binary logistic regression model was employed to determine depression as the dependent factor and gene polymorphism. Results: The frequency of NPY rs16139 was 6%. No significant association was found between NPY genotypes and depression (p >0.05). Furthermore, the results suggest that those with central obesity had an increased chance of developing depression (P = 0.02). Conclusion: The frequency of NPY polymorphism was 6%. Our study could not find a correlation between rs16139 and depression.

Comparison Of Dietary Practices And Body Mass Index Among Educated Housewives And Working Women In Karachi

BACKGROUND

Body Mass Index (BMI) is considered as a major determinant of health. The objective of study was to find out differences between dietary practices, as well as BMI in educated housewives and working woman. It is supposed that both study groups may have difference in work pressures with resultant diverse preferences for food. This can affect health status particularly in relation to obesity in women. Furthermore, we selected participants with 14 years' education expecting basic awareness of healthful diet.

METHODS

This cross-sectional study had a convenient sampling method and sample size of 600 with 300 house wives and 300 working women, aged 35-45 years. Dietary habits were recorded by interview. Body Mass Index was calculated by standard formula, and results obtained by Chi-Square using SPSS-17.

RESULTS

Working women had healthier dietary practices. Number of meals, fruits, fish/ poultry and water consumption was better in working mothers with significant p-value <0.00.1. Intake of vegetables and fast food was found similar. BMI comparison showed that majority of housewives were noted as overweight whereas working women showed normal weight (p-value <0.001). Most housewives responded that they have a sedentary life style as opposed to working women p-value <0.001. Self- assessment of diet quality was comparable as it was mentioned moderate by most of the participants, however more working females accepted that they need to improve their diet and would need expert advice.

CONCLUSIONS

Healthier BMI, active life style and better dietary habits were witnessed in working women as compared to housewives.

Beyond Body Mass Index. Is the Body Cell Mass Index (BCMI) a useful prognostic factor to describe nutritional, inflammation and muscle mass status in hospitalized elderly?: Body Cell Mass Index links in elderly

BACKGROUND & AIM

The aim of this study was to establish the effectiveness of Body Cell Mass Index (BCMI) as a prognostic index of (mal)nutrition, inflammation and muscle mass status in the elderly.

METHODS

A cross-sectional observational study has been conducted on 114 elderly patients (80 women and 34 men), with mean age equal to 81.07 ± 6.18 years. We performed a multivariate regression model by Structural Equation Modelling (SEM) framework. We detected the effects over a Mini Nutritional Assessment (MNA) stratification, by performing a multi-group multivariate regression model (via SEM) in two MNA nutritional strata, less and bigger (or equal) than 17.

RESULTS

BCMI had a significant effect on albumin (β = +0.062, P = 0.001), adjusting for the other predictors of the model as Body Mass Index (BMI), age, sex, fat mass and cognitive condition. An analogous result is maintained in MNA<17 stratum. BMI has confirmed to be a solid prognostic factor for both free fat mass (FFM) (β = +0.480, P < 0.001) and Skeletal Muscle Index (SMI) (β = +0.265, P < 0.001), assessed by DXA. BCMI also returned suggestive evidences (0.05 < P < 0.10) for both the effect on FFM and on SMI in overall sample.

CONCLUSIONS

The main result of this study is that the BCMI, compared to BMI, proved to be significantly related to an important marker as albumin in geriatric population. Then, assessing the BCMI could be a valuable, inexpensive, easy to perform tool to investigate the inflammation status of elderly patients.

Association between Obesity and Serum 25(OH)D Concentrations in Older Mexican Adults

Background: Vitamin D is essential for maintaining bone mineralization and calcium homeostasis, and prevents falls and fractures in older adults. Mexico is undergoing an epidemiologic and demographic transition with increasing obesity rates. The study’s aim was to determine the association of obesity with serum 25-hydroxyvitamin D [25(OH)D] concentrations in older Mexican adults. Methods: Data from 1772 Mexicans, aged ≥50 years, enrolled in a sub-sample of the 3rd wave of the Mexican Health and Aging Study, were included. Serum 25(OH)D concentrations were used to define vitamin D status, and were categorized into tertiles. Body mass index measures were used to categorize older adults into under/normal weight, overweight, and obese groups. Multinomial logistic regression models were used to assess the relationship, adjusting for potential confounders. Results: Approximately 40% and 37% of older Mexican adults were either overweight or obese, respectively. Compared to under/normal weight older Mexicans, obese adults were 1.78 times (95% Confidence Interval (CI) 1.27–2.48) and 1.94 times (95% CI 1.40–2.68) more associated with the first and second tertile concentrations of serum 25(OH)D, respectively. Overweight adults were 1.52 times (95% CI 1.12–2.06) more associated with the second tertile of serum 25(OH)D concentration than under/normal weight adults. Conclusion: Overweight/Obesity was found to be significantly associated with low concentrations of serum 25(OH) in older Mexican adults.

Obesity in Nursery School Children in Corum, Turkey

BACKGROUND

Regular body mass index (BMI) screenings in schools is important to ensure that 3- to 6-year-old children are not negatively affected by obesity in terms of their current and future health.

OBJECTIVES

The aim of this study was to determine the overweight and obesity results of 3- to 6-year-old children and to guide children and their family in making healthier dietary choices by informing them.

METHODS

This analytical-descriptive study was conducted in Corum, Turkey, in the year 2011. The study's sample consisted of all available 3- to 6-year-old children entering nursery school (specifically, the Buharaevler, Karsıyaka, Nasrettin Hoca, Ulukavak, Mimar Sinan, and Sevgi nursery schools). Findings from the study were statistically analyzed using the SPSS 15.0 program. The Chi-square test and analysis of variance (ANOVA) program were used in the comparison of study data. A p-value of less than 0.05 was considered significant.

RESULTS

It was determined that 9.5% of the participating female children and 5.2% of the male children were underweight and that the boys were more obese than the girls in general. The correlation between the child's gender and their BMI was not found to be statistically significant (P-value > 0.05). The overweight frequency of the children was 12.1%, and the obesity frequency was 14.3%. Furthermore, it was determined that the obesity rates of the children increased with their age. Accordingly, the correlation between the child's age and BMI was found to be statistically significant (P-value < 0.05).

CONCLUSIONS

An approach to preventing obesity must not be enacted only in health centers. Schools should also offer information and resources for families in order to prevent obesity in children.

Relationship of anthropometric measures with Knee Osteoarthritis in diabetes mellitus

OBJECTIVE

To determine the frequency of knee osteoarthritis in adult patients with Diabetes mellitus and its association with body mass index (BMI) in kg/m² and waist circumference (WC).

METHODS

This is a cross-sectional comparative study at a tertiary hospital based in an industrial area of Karachi. Patient population comprised of all adult diabetic subjects. Clinical and demographic data was obtained with detailed musculoskeletal examination on all patients. BMI and WC were measured as kg/m² and cm respectively. Data was analyzed on SPSS version 15.

RESULTS

A total of 413 subjects were recruited. Among them diabetic and non-diabetic subjects were 210 and 203 respectively. Mean age of diabetics was 50.7+-10.2 years as compared to non-diabetic subjects i.e. 49.5+-10.5 years. Proportion of male subjects was 72(34.3%) and 71(35.0) respectively in both groups. Mean duration of diabetes was 6.2 years. Frequency of knee osteoarthritis (OA) was found to be 52(24.8%) and 54(26.6%) in diabetic and non-diabetic respectively. Among the diabetic group 6 (18%) subjects with OA had normal BMI (18.5-22.9) whereas 4 (16%) were overweight (BMI 23-24.9) and 41(27.5%) were obese(BMI ≥25). Near 98% (n=51) of the diabetic patients with OA had high waist circumference. Females (n= 42, 31.1%) were more frequent than males (n=9, 16%) in the diabetic subjects with OA and a higher WC.

CONCLUSION

Both diabetic and non diabetic group did not show any difference in the frequency of knee OA. However, frequency of knee OA showed a significant difference between overweight and obese category of BMI.WC appears as a strong predictor of knee osteoarthritis.

A Multicomponent Intervention Helped Reduce Sugar-Sweetened Beverage Intake in Economically Disadvantaged Hispanic Children

PURPOSE

This study aimed to examine the effect of a multicomponent intervention program on consumption of sugar-sweetened beverages (SSBs), and lifestyle factors associated with SSB intake, in Hispanic children from low-income families.

DESIGN

A five-wave longitudinal study using a quasi-experimental design was conducted.

SETTING

Five elementary schools in West Texas served as the setting.

SUBJECTS

Participants included 555 predominantly Hispanic children (ages 5-9 years) from low-income families and their parents (n = 525).

INTERVENTION

A multicomponent intervention program was implemented.

MEASURES

Children's anthropometric measures were obtained. Their weight status was determined based on body mass index for age and gender. Parents responded to a demographic questionnaire, a shelf inventory, an acculturation scale, and a family survey.

ANALYSIS

Growth curve analyses were used to test differences between intervention and comparison participants' SSB intake and to examine potential covariates.

RESULTS

Comparison group children's daily SSB intake significantly increased over time (B = 1.06 ± .40 ounces per month, p < .01), but this linear increase of SSB was slowed down by the intervention (B = -.29 ± .12, p < .05). More daily TV time, more fast food intake, and more types of SSBs available at home were associated with higher SSB intake.

CONCLUSION

Risk factors of childhood obesity were associated with each other. The intervention program produced a modest reduction in SSB consumed by economically disadvantaged and predominantly Hispanic children.

Intraclass correlation and design effect in BMI, physical activity and diet: a cross-sectional study of 56 countries

OBJECTIVES

Measuring the intraclass correlation coefficient (ICC) and design effect (DE) may help to modify the public health interventions for body mass index (BMI), physical activity and diet according to geographic targeting of interventions in different countries. The purpose of this study was to quantify the level of clustering and DE in BMI, physical activity and diet in 56 low-income, middle-income and high-income countries.

DESIGN

Cross-sectional study design.

SETTING

Multicountry national survey data.

METHODS

The World Health Survey (WHS), 2003, data were used to examine clustering in BMI, physical activity in metabolic equivalent of task (MET) and diet in fruits and vegetables intake (FVI) from low-income, middle-income and high-income countries. Multistage sampling in the WHS used geographical clusters as primary sampling units (PSU). These PSUs were used as a clustering or grouping variable in this analysis. Multilevel intercept only regression models were used to calculate the ICC and DE for each country.

RESULTS

The median ICC (0.039) and median DE (1.82) for BMI were low; however, FVI had a higher median ICC (0.189) and median DE (4.16). For MET, the median ICC was 0.141 and median DE was 4.59. In some countries, however, the ICC and DE for BMI were large. For instance, South Africa had the highest ICC (0.39) and DE (11.9) for BMI, whereas Uruguay had the highest ICC (0.434) for MET and Ethiopia had the highest ICC (0.471) for FVI.

CONCLUSIONS

This study shows that across a wide range of countries, there was low area level clustering for BMI, whereas MET and FVI showed high area level clustering. These results suggested that the country level clustering effect should be considered in developing preventive approaches for BMI, as well as improving physical activity and healthy diets for each country.

A Study on the Level of Oxidative Stress and Inflammatory Markers in Type 2 Diabetes Mellitus Patients with Different Treatment Modalities

INTRODUCTION

The prevalence of type 2 diabetes mellitus is increasing worldwide in all the age group. UKPDS study had shown that good glycaemic control is maintained by the administration of insulin in addition to hypoglycaemic drugs. But, hyperinsulinemia might cause vascular complications in T2DM. Oxidative stress and inflammation are common in diabetes and plays an important role in vascular complications.

AIM

The study has been designed to estimate and compare the level of oxidative stress and inflammation in type 2 diabetic patients under different treatment modalities.

MATERIALS AND METHODS

Sixty Type 2 diabetic subjects undergoing treatment were selected from Government Hospital and VMKV Medical College & Hospital at Salem. The subjects were divided into two groups based on treatment modalities, hypoglycaemic drugs subjects as Group-I (30) and hypoglycaemic drugs & Insulin subjects in Group-II (30). BMI was calculated by standard formula and Fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated haemoglobin (HbA1c), Lipid profile, oxidative stress (MDA) and inflammatory markers were measured by well established methods. SPSS 16.0 version was used for statistical analysis.

RESULT

In our study we have found significantly high levels of BMI, MDA and hsCRP (25.5±2.79, 2.73±1.65, 1.98±0.85) in Group II subjects when compared to Group I subjects (23.4±3.09, 2.23±1.76, 1.168±1.124).

CONCLUSION

Since risk factors like BMI, MDA and hsCRP were high in Diabetes mellitus patients on both oral hypoglycaemic drugs and insulin, they are more susceptible to cardiovascular diseases. Evaluation of these markers at regular interval can reduce the incidence of vascular complications in Type 2 DM patients.

Waist-to-hip ratio versus body mass index as predictors of fitness in women

The claim that men prefer women with low waist-to-hip ratios (WHR) has been vigorously disputed. We examine self-report data from 359 primiparous Polish women (with normal singleton births and healthy infants) and show that WHR correlates with at least one component of a woman's biological fitness (her first child's birth weight, a variable that significantly affects infant survival rates). However, a woman's Body Mass Index (BMI) is a better predictor of her child's neonatal weight in small-bodied women (<54 kg). The failure to find a preference for low WHR in some traditional populations may thus be a consequence of the fact that, even in western populations, body mass is a better predictor of fitness in those cases characterized by low maternal body weight.

Regional lymph node radiotherapy in breast cancer: single anterior supraclavicular field vs. two anterior and posterior opposed supraclavicular fields

Background:

The treatment of lymph nodes engaged in breast cancer with radiotherapy leads to improved locoregional control and enhanced survival rates in patients after surgery. The aim of this study was to compare two treatment techniques, namely single anterior posterior (AP) supraclavicular field with plan depth and two anterior and posterior opposed (AP/PA) supraclavicular fields. In the study, we also examined the relationships between the depth of supraclavicular lymph nodes (SCLNs) and the diameter of the wall of the chest and body mass index (BMI).

Methods:

Forty patients with breast cancer were analyzed using computed tomography (CT) scans. In planning target volume (PTV), the SCLNs and axillary lymph nodes (AXLNs) were contoured, and, with the attention to PTV, supraclavicular (SC) depth was measured. The dosage that reached the aforementioned lymph nodes and the level of hot spots were investigated using two treatment methods, i.e., 1) AP/PA and 2) AP with three-dimensional (3D) planning. Each of these methods was analyzed using the program Isogray for the 6 MV compact accelerator, and the diameter of the wall of the chest was measured using the CT scan at the center of the SC field.

Results:

Placing the plan such that 95% of the target volume with 95% or greater of the prescribed dose of 50 Gy (V95) had ≥95% concordance in both treatment techniques. According to the PTV, the depth of SCLNs and the diameter of the wall of the chest were 3–7 and 12–21cm, respectively. Regression analysis showed that the mean SC depth (the mean Plan depth) and the mean diameter of the wall of the chest were related directly to BMI (p<0.0001, adjusted R²=0.67) and (p<0.0001, adjusted R²=0.71), respectively.

Conclusion:

The AP/PA treatment technique was a more suitable choice of treatment than the AP field, especially for overweight and obese breast cancer patients. However, in the AP/PA technique, the use of a single-photon, low energy (6 MV) caused more hot spots than usual.

Elevated Serum Leptin Level Is Associated with Body Mass Index But Not with Serum C-reactive Protein and Erythrocyte Sedimentation Rate Values in Hemodialysis Patients

Objectives:

Aim of the present study was to investigate serum concentration of leptin and its association with values of body mass index (BMI), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in hemodialysis (HD) patients.

Methods:

This cross-sectional study included 60 HD patients (34 male, 26 female) and 30 age- and sex-matched (4 males, 26 females) apparently healthy subjects. Serum leptin concentration was determined by an enzyme-linked immunosorbent assay (ELISA). Serum CRP concentration was measured by means of particle-enhanced immunonephelometry. ESR value was determined by Western Green method. BMI was calculated as weight (kg) divided by height squared (m²).

Results:

Results have shown that median serum leptin concentration (30.65 ng/mL; 12.48-86.40 ng/mL) was statistically significantly higher in HD patients compared to median serum leptin concentration (15.75 ng/mL; 9.15-30.65 ng/mL) in the control group of healthy subjects (p<0.05). Likewise, median serum CRP concentration (5.5 mg/L; 1.93-8.9 mg/L) and median ESR value (57.5 mm/h; 40.5-77.0 mm/h) were significantly higher in HD patients compared to median serum CRP concentration (0.8 mg/L; 0.38-1.43 mg/L) (p<0.001) and median ESR value (10.0 mm/h; 6.5-14.0 mm/h) (p<0.001) determined in the control group. Statistically significant positive correlation was found between BMI values and serum leptin concentration in HD patients (rho=0.434; p<0.001). Positive, although not significant, correlation was observed between serum CRP and leptin levels in HD patients (rho=0.171; p>0.05). Negative correlation between ESR values and serum leptin concentrations in HD patients was determined but it was not statistically significant (rho= -0.029; p>0.05).

Conclusions:

Increased serum concentration of leptin as pro-inflammatory cytokine as well as elevated serum values of CRP and ESR indicate presence of systemic micro inflammation in HD patients. Results of the present study point to possible use of serum leptin concentration as an indicator of nutritional status in HD patients based on observed significant positive correlation between serum leptin concentrations and BMI values. However, absence of significant association between serum leptin and CRP levels as well as between serum leptin concentrations and ESR values in HD patients requires further investigation and clarification.

Psychosocial risk factors for excessive gestational weight gain: A systematic review

BACKGROUND

Excessive weight gain during pregnancy can have adverse health outcomes for mother and infant throughout pregnancy. However, few studies have identified the psychosocial factors that contribute to women gaining excessive weight during pregnancy.

AIM

To review the existing literature that explores the impact of psychosocial risk factors (psychological distress, body image dissatisfaction, social support, self-efficacy and self-esteem) on excessive gestational weight gain.

METHODS

A systematic review of peer-reviewed English articles using Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, MEDLINE Complete, PsycINFO, Informit, Web of Science, and Scopus was conducted. Quantitative studies that investigated psychosocial factors of excessive GWG, published between 2000 and 2014 were included. Studies investigating mothers with a low risk of mental health issues and normally-developing foetuses were eligible for inclusion. From the total of 474 articles located, 12 articles were identified as relevant and were subsequently reviewed in full.

FINDINGS

Significant associations were found between depression, body image dissatisfaction, and social support with excessive gestational weight gain. No significant relationships were reported between anxiety, stress, self-efficacy, or self-esteem and excessive gestational weight gain.

CONCLUSION

The relationship between psychosocial factors and weight gain in pregnancy is complex; however depression, body dissatisfaction and social support appear to have a direct relationship with excessive gestational weight gain. Further research is needed to identify how screening for, and responding to, psychosocial risk factors for excessive gestational weight gain can be successfully incorporated into current antenatal care.

Relationships among factors related to body mass index, healthy lifestyle beliefs and behaviors, and mental health indicators for youth in a title 1 school

INTRODUCTION

The effect of being overweight in childhood has both physical and psychological implications. The purpose of this study was to determine the relationships among body mass index (BMI), healthy lifestyle beliefs and behaviors, and mental health indicators for 5th- and 6th-grade children in a Title I school.

METHODS

This is a cross-sectional, descriptive correlational design on a convenience sample of youth in an urban school. BMI was calculated. Participants completed surveys that assessed healthy beliefs and behaviors, activity and nutrition knowledge, and mental health indicators.

RESULTS

Children with higher BMIs reported difficulty in living a healthy lifestyle. This perceived difficulty affected their ability to make healthy choices. Belief in the ability to live a healthy lifestyle resulted in reported healthier behaviors. Anxiety and depression symptomatology were not significantly related to healthy lifestyle indicators.

DISCUSSION

The results demonstrate that the proposed thinking, feeling, behavior triangle model was supported in this population.

A study on the correlation between patients' physical characteristics and effective dose of liver computed tomography

This suggests indicators to be considered in the protocol for setting up equipment and minimizing patient doses by identifying the effective dose and correlations of each equipment company according to a patient's body characteristics in liver CT. The study was conducted with 445 patients who went to the hospital and received liver CT at the diagnostic radiology department of S medical center from 2010 January to June. As the statistical methods, t-test, one-way ANOVA, and Pearson's correlation analysis were used. The study results show that as height, weight, and BMI increased, the effective dose increased with all equipment vendors. Correlations between a patient's body characteristics and the effective dose were shown to be positive with all equipment vendors in regard to weight, BMI, and height, in order.