A Clinical Trial on Weight Loss among Truck Drivers

Background:

The high prevalence of obesity among commercial truck drivers may be related to sedentary nature of the job, lack of healthy eating choices, and lack of exercise. There may be a link between obesity and crash risk, therefore an intervention to reduce obesity in this population is needed.

Objective:

To assess feasibility of a 12-week weight loss intervention for truck drivers with a weight loss goal of 10% of initial body weight.

Methods:

Drivers were selected based on age (≥21 years) and body mass index (≥30 kg/m²). The drivers participated in a before-after clinical trial. The intervention included a 12-week program that provided information on healthy diet and increasing exercise, and telephone-based coaching using SMART goals. Outcomes included change from baseline in reported energy intake, measured weight, waist, hip, and neck circumference, blood pressure, and point of care capillary blood lipids and hemoglobin A1c. Exit interviews were conducted to gain insight into driver opinions on the program features and usefulness. This study was registered with the NIH Clinical Trials Registry, number NCT02348983.

Results:

12 of 13 drivers completed the study. Weight loss was statistically significant (p=0.03). Reported energy (p=0.005), total fat consumption (p=0.04), and saturated fat consumption (p=0.02) intake were also lower after the 12-week intervention. Drivers attributed their weight loss to health coaching and suggested a longer intervention so that they could reach their goal and become accustomed to the changes.

Conclusion:

This weight loss intervention is feasible for this difficult population. Additional research is needed to compare this intervention with a control group.

A prospective cohort of American Indian and Alaska Native people: study design, methods, and implementation

In 2001, the National Cancer Institute funded three centers to test the feasibility of establishing a cohort of American Indian and Alaska Native people. Participating tribal organizations named the study EARTH (Education and Research Towards Health). This paper describes the study methods. A computerized data collection and tracking system was developed using audio computer-assisted survey methodology with touch screens. Data were collected on diet, physical activity, lifestyle and cultural practices, medical and reproductive history, and family history of heart disease, diabetes, and cancer. In addition, a small panel of medical measurements was obtained, including height, weight, waist and hip circumferences, blood pressure, and a lipid panel plus glucose. At the completion of the enrollment visit, data were used to provide immediate health feedback to study participants. During the initial funding period, the authors anticipate enrolling 16,000 American Indian and Alaska Native participants. The age distribution of the study population was similar to that reported in the 2000 US Census for the relevant populations. A component critical to the success of the EARTH Study has been the partnerships with tribal members. The study has focused on involvement of American Indian and Alaska Native communities in development and implementation and on provision of feedback to participants and communities.

Excess gains in weight and waist circumference associated with childbearing: The Coronary Artery Risk Development in Young Adults Study (CARDIA)

OBJECTIVE

To examine the association of childbearing with weight and waist circumference (WC) changes, we compared women with and without pregnancies or births during follow-up.

STUDY DESIGN

A multicenter, longitudinal observational study over 10 years. Comparison groups defined by the number of pregnancies and births during follow-up: P0 (0 pregnancies; nongravid), P1 (1+ miscarriages or abortions; 'short' pregnancies), B1 (1 birth), and B2 (2+ births). Mean changes in weight and WC for P1, B1 and B2 groups vs P0 were examined separately by race (black and white), baseline parity (nulliparous and parous) and baseline weight status (normal weight; BMI <25 kg/m(2) and overweight; BMI >/=25 kg/m(2)).

SUBJECTS

A population-based sample of 2070 women aged 18-30 y at baseline (1053 black subjects and 1017 white subjects) from Birmingham, Alabama, Chicago, Illinois, Minneapolis, Minnesota, and Oakland, California were examined five times between 1985-1986 and 1995-1996.

MEASUREMENTS

Weight and WC measurements were obtained using standardized protocol at baseline and examinations at years 2, 5, 7 and 10. Sociodemographic, reproductive, and behavioral attributes were assessed at baseline and follow-up examinations.

RESULTS

Gains in weight and WC associated with pregnancy and childbearing varied by race (P<0.001), baseline parity (P<0.05) and overweight status (P<0.001). Among overweight nulliparas, excess gains in weight (black subjects: 3-5 kg, white subjects: 5-6 kg) and WC (black subjects: 3-4 cm, white subjects: 5-6 cm) were associated with 'short' pregnancies and one or more birth(s) during follow-up compared to no pregnancies (P<0.01 and 0.001). Among normal weight nulliparas, excess gains in weight (about 1 kg) and WC (2-3 cm) were associated with follow-up birth(s) (P<0.05). Among women parous at baseline, no excess weight gains were found, but excess WC gains (2-4 cm) were associated with follow-up births.

CONCLUSION

Substantial excess weight gain is associated with both short pregnancies and a first birth in women overweight prior to initiation of childbearing. Excess weight gain was not associated with higher order births. Increases in waist girth were cumulative with both first and higher order births among overweight as well as normal weight women. Interventions to prevent obesity should be targeted at women who are overweight prior to initiation of childbearing. The impact of excess WC gains associated with childbearing on women's future health risk should be evaluated further.

Contacting controls: are we working harder for similar response rates, and does it make a difference?

Although obtaining high response rates is critical to epidemiologic studies, effort to achieve response rates is undocumented. The authors used three population-based case-control studies conducted in Utah between October 1991 and February 2003 to examine effort required for both initial contact and determination of final status. Differences in lifestyle characteristics between easy- or more-difficult-to-interview female controls were evaluated. Letter, phone, and in-person contacts were recorded to determine contact effort. Regarding effort required to achieve a final outcome, the number of contacts increased from eight to 14 over the 12-year study period. Compared with those in study A (conducted in 1991-1994), controls in studies B and C were twice as likely to require seven or more phone calls and controls in study B were twice as likely to require one or more in-person visit. Hispanic controls in study C were more likely than non-Hispanic White controls to receive an in-person visit and a noncontact letter. Compared with those more difficult to contact, those easy to contact were more likely to be overweight and less likely to have a family history of cancer. The amount of effort required to achieve similar or slightly lower response rates increased over time. This finding may in part depend on demographic characteristics of the population studied.

Self-reported dietary habits, overall dietary quality and symptomatology of breast cancer survivors: a cross-sectional examination

Little information is available about the relationship between quality of life of women who have survived breast cancer (specifically, symptoms including those of menopause and depression) and the quality of their diet. In this cross-sectional study, 117 women with known primary breast cancer completed a self-administered food frequency questionnaire (FFQ) reflecting usual diet during the past year, a Survey of Feelings and Attitudes using the Center for Epidemiologic Studies Depression scale (CES-D) and a survey that includes menopausal symptoms among others common to women with a history of breast cancer. When women's responses to the FFQ were scored using the Healthy Eating Index (HEI), most often diets were evaluated as those that 'need improvement' with a mean total HEI score of 67.2. With regard to the CES-D scores, study women averaged 9.5, with 19 women being classified as clinically depressed. HEI and CES-D scores were inversely related (p = -0.22, p = 0.02). A negative correlation was also observed between energy-adjusted calcium intakes and CES-D scores (p = -0.19, p = 0.04). Clinical depressed women had not only lower HEI scores and calcium intakes, but also lower grain and variety scores. Comparisons to national data for disease-free women and that available for those with breast cancer suggest that our study women consumed diets low in energy and dietary variety. Diet quality may be an important factor influencing the manifestation of depressive symptoms in breast cancer survivors or conversely, poorer diet quality may be an outcome of depression.

Bitter taste perception and severe vomiting in pregnancy

Hyperemesis gravidarum or severe vomiting during pregnancy is a condition of elusive etiology that can harm both mother and fetus. This study examined the association between increased bitter-taste perception and history of hyperemesis gravidarum. Bitter-taste perception varies genetically and can be altered with conditions that damage taste-related cranial nerves. Sixty women were divided into high- (n = 21) and low-vomit (n = 39) groups based on vomiting exposure across all pregnancies and were screened for genetic variation in taste with bitterness of saturated 6-n-propylthiouracil (PROP) delivered on filter paper. Supertasters perceive PROP as intensely bitter; nontasters, as only weakly. Each reported their history of dysgeusia (persistent taste) and taste-related pathology (otitis media and head trauma). The vomit groups did not differ in the frequency of supertasters, but the high-vomit group had fewest nontasters. The high-vomit group also reported dysgeusia most frequently. A subsample (13 high-vomit and 18 low-vomit women) rated the taste intensity of sodium chloride (1 mol), sucrose (1 mol), citric acid (0.0032 mol), and quinine hydrochloride (0.001 mol) applied to areas innervated by cranial nerves VII and IX. The groups only varied significantly in bitterness of quinine hydrochloride. High-vomit women tasted least bitterness on the anterior tongue (chorda tympani branch of VII) and highest bitterness on the posterior tongue (cranial nerve IX) and palate (superficial petrosal branch of VII). In high-vomit women, elevated bitterness on the posterior tongue and palate does not appear related to hydrochloric acid exposure in vomitus; it may explain the occurrence of dysgeusia. This pattern of spatial taste perception may indicate altered oral sensations that if present during pregnancy, could increase the risk of hyperemesis.

Estimation of individual intakes of folate in women of childbearing age with and without simulation of folic acid fortification

OBJECTIVES

The objectives of this study were to examine variability of folate intake in order to estimate the number of days needed to accurately estimate intakes in women of childbearing age and to simulate the effect of folic acid fortification of cereals and grains on individual folate intake.

DESIGN

Observational study of food intake over a 60-day period.

SAMPLING

A convenience sample of 21 women completed food records on randomly assigned days within a 60-day period.

OUTCOMES MEASURED

Folate intake and variance ratios of folate intake.

STATISTICAL ANALYSIS

Repeated measures analysis of variance.

RESULTS

Six days of food records were needed to describe folate intake of these women of childbearing age (18 to 45 years) with 20% attenuation of a correlation coefficient between dietary folate intake and another biological variable. Seven days of records were needed with simulated folic acid fortification (assuming fortification of 140 micrograms folic acid per 100 g flour) and 5 days were needed with supplements containing 200 to 400 micrograms folic acid in addition to folic acid fortification. Food folate intake was 288 +/- 195 micrograms; only 2 of the participants consumed the recommended 400 micrograms. With fortification, folate intake increased to 550 +/- 279 micrograms without supplements and 609 +/- 327 micrograms with supplements.

APPLICATIONS

Individual intakes of folate should be assessed with at least 7 days of dietary records (20% attenuation). In this sample, when folic acid fortification was added to dietary intake, routine supplementation was not necessary to achieve folate intakes of 400 micrograms in the majority of participants. The practice of routine folic acid supplementation should be considered carefully to ensure that individual intakes of folate do not exceed the upper limits of safety.

Psychological symptoms are greater among weight cycling women with severe binge eating behavior

OBJECTIVE

To identify psychological characteristics and eating behaviors associated with weight cycling and binge eating behaviors in overweight women (body mass index > 27.3).

DESIGN

Questionnaires measuring self-esteem, self-efficacy, coping strategies, psychological symptoms, depression, binge eating, restrained eating, disinhibition, and hunger were administered to female weight cyclers who were overweight. Psychological characteristics were compared between subjects grouped by binge eating disorder classification and by binge eating severity.

SUBJECTS

A convenience sample of 62 female weight cyclers who were overweight was recruited from the Chicago, Ill, area. Questionnaires were administered individually or in small groups in subjects' homes or other private settings.

STATISTICAL ANALYSES

Student's t tests or Mann-Whitney U tests were used to assess differences in psychological characteristics.

RESULTS

Thirty-six weight cyclers (58%) met the criteria for binge eating disorder and 26 (42%) did not. Weight cyclers with binge eating disorder reported greater severity of binge eating (P < .0005) and disinhibition (P < .0005) and poorer eating self-efficacy (P < .0005) than weight cyclers without binge eating disorder. Weight cyclers with severe binge eating behaviors reported greater psychological distress (P < .0005) and depression (P < .005) and lower self-esteem (P = .0001) and used less healthful coping strategies (P = .0027) than weight cyclers with no binge eating to moderate binge eating problems. Weight cyclers with severe binge eating behavior also reported more hunger (P < .0005) and used less cognitive restraint (P = .0024) than those with no binge eating to moderate binge eating problems.

APPLICATIONS

Operational definitions of weight cycling and binge eating are needed to facilitate research on effective weight-loss treatments. Persons seeking to lose weight (especially weight cyclers) should be assessed for binge eating severity, problematic eating behaviors, and psychological symptoms.

Energy intake and glycemia in lactating women with type 1 diabetes

OBJECTIVE

To describe glycemia and insulin administration in lactating women with type 1 diabetes and compare their energy intake, lactation onset, and postpartum weight to lactating women without diabetes.

DESIGN

A prospective observational study conducted at 2, 3, 6, 14, 42, and 84 days postpartum. Insulin dosage and glucose levels after fasting and at 80 and 110 minutes after eating (by measuring capillary blood glucose concentrations and glycated hemoglobin [HbA1c] values) are described for women with type 1 diabetes. Dietary intake, weight, and lactation onset for women with type 1 diabetes are compared with those without the disease.

SUBJECTS/SETTING

Fourteen lactating women with type 1 diabetes and 25 women without diabetes (control subjects) were recruited from private obstetrician offices and high-risk prenatal clinics at 3 major medical centers.

STATISTICAL ANALYSES

A repeated-measures 2-factor analysis of variance was used to determine group, time, and interaction effects between women with type 1 diabetes and the control group at 2, 3, 7, 14, 42, and 84 days postpartum.

RESULTS

Seven women with type 1 diabetes breast-fed through 84 days postpartum, although they perceived later onset of milk and had fasting and postprandial hyperglycemia. Their HbA1c levels increased by 20%, confirming relative hyperglycemia. After adjustment for prepregnancy weight, women with type 1 diabetes consumed 7 kcal fewer per kilogram per day than control subjects. Average insulin dose was returned to prepregnancy levels of 45.3 +/- 3.6 U/d (least square means +/- standard error of the mean) by 1 week.

APPLICATION

Achieving desired metabolic control during the establishment of lactation is difficult. A better understanding of energy and insulin needs and their relationship to lactation in women with type 1 diabetes is needed.

Plasma vitamins E and C concentrations of adult patients during cardiopulmonary bypass

OBJECTIVE

This study was designed with two aims: 1) to determine if the coronary artery bypass graft (CABG) procedure alters plasma vitamin E and C concentrations of adult patients through repeated determinations of vitamin levels at time points before, during and following CABG, and 2) to assess whether plasma vitamin E concentrations reflect myocardial tissue content.

METHODS

A consecutive sample of 38 patients undergoing CABG surgery at a Midwest tertiary care hospital was enrolled. Patients receiving blood transfusions before or during surgery were excluded.

RESULTS

Plasma vitamin E/total lipid ratios rose with reperfusion, remained elevated immediately following bypass, and fell to preoperative concentrations by 24 hours. Plasma vitamin E/total cholesterol levels varied little throughout this time course. Both plasma uric acid and ascorbate concentrations (corrected for hemodilution) also rose by the preischemic interval, and remained elevated until a return to preoperative levels by 24 hours. Corrected malondialdehyde (MDA) concentrations rose by pre-ischemia but returned more quickly to preoperative levels. Atrial appendage tissue vitamin E concentrations bore a significant relationship to those of plasma prior to surgery (r=+0.49, p=0.004). Reported supplement use, plasma concentrations and body mass index contributed to the variability in atrial tissue concentrations of vitamin E.

CONCLUSIONS

In short, when not confounded by transfusions or hemodilution, several peripheral indices of antioxidants increase with the reperfusion segment of CABG procedure and return to baseline levels within 24 hours of surgery. Parallel changes in MDA were observed. The observed changes are consistent with the hypothesis that oxidative stress accompanies the ischemia-reperfusion components of the CABG procedure.