What childhood obesity prevention programmes work? A systematic review and meta-analysis

Previous reviews of childhood obesity prevention have focused largely on schools and findings have been inconsistent. Funded by the US Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health, we systematically evaluated the effectiveness of childhood obesity prevention programmes conducted in high-income countries and implemented in various settings. We searched MEDLINE®, Embase, PsycINFO, CINAHL®, ClinicalTrials.gov and the Cochrane Library from inception through 22 April 2013 for relevant studies, including randomized controlled trials, quasi-experimental studies and natural experiments, targeting diet, physical activity or both, and conducted in children aged 2-18 in high-income countries. Two reviewers independently abstracted the data. The strength of evidence (SOE) supporting interventions was graded for each study setting (e.g. home, school). Meta-analyses were performed on studies judged sufficiently similar and appropriate to pool using random effect models. This paper reported our findings on various adiposity-related outcomes. We identified 147 articles (139 intervention studies) of which 115 studies were primarily school based, although other settings could have been involved. Most were conducted in the United States and within the past decade. SOE was high for physical activity-only interventions delivered in schools with home involvement or combined diet-physical activity interventions delivered in schools with both home and community components. SOE was moderate for school-based interventions targeting either diet or physical activity, combined interventions delivered in schools with home or community components or combined interventions delivered in the community with a school component. SOE was low for combined interventions in childcare or home settings. Evidence was insufficient for other interventions. In conclusion, at least moderately strong evidence supports the effectiveness of school-based interventions for preventing childhood obesity. More research is needed to evaluate programmes in other settings or of other design types, especially environmental, policy and consumer health informatics-oriented interventions.

A genetic coding variant rs72474224 in GJB2 is associated with clinical features of psoriasis vulgaris in a Chinese Han population

Our recent targeted sequencing study identified a missense single-nucleotide polymorphism rs72474224 (c.324C>T) in GJB2. To investigate the correlation between rs72474224 (c.324C>T) and subphenotypes of psoriasis, genotype data for rs72474224 (c.324C>T, p.Val37Ile) was analyzed in 9946 cases and 9906 controls. The additive model provided the best fit for rs72474224 (P = 7.34 × 10(-9)). The genotypic and allelic frequency distributions were associated with plaque psoriasis in case-only (Pgenotype = 2.67 × 10(-3), Pallele = 6.22 × 10(-4)) and subphenotype-control (Pgenotype = 1.58 × 10(-11), Pallele = 8.16 × 10(-12)) analyses. No other significant difference was found in case-only analyses. Rs72474224 in GJB2 is preferentially associated with plaque psoriasis in Chinese population and might contribute to the complexity of psoriasis clinical features.

Folic acid attenuates dexamethasone-induced placental growth restriction

OBJECTIVE

Intrauterine glucocorticoid (GC) exposure is associated with disturbances in feto-placental growth. This study aimed to investigate whether folic acid supplementation can prevent dexamethasone (Dex)-induced feto-placental growth restriction.

MATERIALS AND METHODS

Female C57BL/6J mice were subject to four different treatments, respectively: normal drinking water plus saline injection (NN), normal drinking water plus Dex injection (ND), drinking water supplemented with folic acid plus saline injection (FN), and drinking water supplemented with folic acid plus Dex injection (FD). Folic acid (100 µg/L) was administrated since 2 weeks before the mating and throughout pregnancy. Dex injection (100 µg/kg•d) was performed from E12.5 to E16.5. The placentas were collected at E17.5.

RESULTS

The parameters including placental and fetal weight, the maximum placental diameter, volume of junctional and labyrinthine zones, and vascular density in the ND group were significantly smaller compared to the NN group. Except the maximum placental diameter, each of the above parameters in the FD group was significantly larger compared to the ND group. The levels of glucocorticoid receptor (GR) protein, and endothelial growth factor A, C (VEGFA, VEGFC) and placental growth factor (PIGF) mRNAs were significantly lower in the ND group compared to NN group. The VEGFA and PIGF mRNA level in the FD group was significantly higher than that in the ND group, as well as VEGFA and VEGFC protein level.

CONCLUSIONS

Folic acid may attenuate Dex-induced restriction on placental growth by elevating the expression of VEGFA and PIGF, and further raising vascular density.

Measuring extension of the lumbar-pelvic-femoral complex with the EOS® system

INTRODUCTION

Sagittal balance of the coxofemoral joint in standing position and its extension capacity determine hip/spine adaptation, especially in relation to pelvic retroversion, which may be age-associated or follow either spinal arthrodesis or vertebral osteotomies. The concept of extension reserve is essential for assessing posterior hip impingement. The global visualization of the lumbar-pelvic-femoral complex obtained by EOS(®) imaging enables this sagittal analysis of both the subpelvic region and lumbar spine by combining the reference standing position and the possibility of dynamic tests.

MATERIALS AND METHODS

We studied 46 patients and their 92 hips. The EOS(®) radiography was performed in neutral standing position and with one foot on a step, alternately the right and left feet. Pelvic incidence, sacral slope, pelvic version, and femoral version were measured twice by two operators. The global extension reserve (GER) was defined by the sum of the intrinsic extension reserve (allowed by the hips, IER) and the extrinsic extension reserve (allowed by the spine, EER). The IER for each hip corresponds to the difference in the sacrofemoral angle (SFA) for each of the two positions. The EER was measured by the difference in the sacral slope. A descriptive study was performed, together with studies of inter- and intra-observer reproducibility, right/left symmetry, and an analysis according to age, sex, and BMI.

RESULTS

The mean femoral version in the reference position was 11.7° (SD 14.3°). The reproducibility of the SFA measurement was statistically verified. The IER (mean 8.8°), EER (mean -0.7°), and GER (mean 8.2°) all differed significantly between the two sides for each patient and were not associated with age, sex, or BMI.

DISCUSSION

The femoral axis is not perpendicular to the ground in neutral position, contrary to the conventional view of this position. The measurements proposed for dynamic sagittal analysis of the hip are reproducible and make it possible to identify the IER within the GER of the spinal-pelvic-femoral complex.

CONCLUSION

The assessment of the lumbar-pelvic-femoral complex by EOS imaging makes it possible to define the intrinsic and extrinsic extension reserves to describe the reciprocal adaptive capacities of the hips and spine.

LEVEL OF EVIDENCE

IV.

Time course of clinical and neuroradiological effects of delayed-release dimethyl fumarate in multiple sclerosis

BACKGROUND AND PURPOSE

Delayed-release dimethyl fumarate (DMF, also known as gastro-resistant DMF), demonstrated efficacy and safety in relapsing-remitting multiple sclerosis in the 2-year, randomized, placebo-controlled, phase 3 DEFINE and CONFIRM trials. A post hoc analysis of integrated data from DEFINE and CONFIRM was conducted to determine the temporal profile of the clinical and neuroradiological effects of DMF.

METHODS

Eligible patients were randomized to receive placebo, DMF 240 mg twice (BID) or three times (TID) daily or glatiramer acetate (GA; reference comparator; CONFIRM only) for up to 96 weeks. Patients in the GA group were excluded from this analysis.

RESULTS

A total of 2301 patients were randomized and received treatment with placebo (n = 771) or DMF BID (n = 769) or TID (n = 761). DMF significantly reduced the annualized relapse rate beginning in weeks 0-12 (BID, P = 0.0159; TID, P = 0.0314); the proportion of patients relapsed beginning at week 10 (BID, P = 0.0427) and week 12 (TID, P = 0.0451); and the proportion of patients with 12-week confirmed disability progression beginning at week 62 (BID, P = 0.0454) and week 72 (TID, P = 0.0399), compared with placebo. These effects were sustained throughout the 2-year study period. DMF significantly reduced the odds of having a higher number of gadolinium-enhancing lesions by 88% (BID) and 75% (TID) and the mean number of new or enlarging T2 lesions by 72% (BID) and 67% (TID), from the first post-baseline magnetic resonance imaging assessment at 24 weeks (all P < 0.0001 versus placebo).

CONCLUSIONS

In phase 3 clinical trials, DMF demonstrated rapid and sustained clinical and neuroradiological efficacy in relapsing-remitting multiple sclerosis.

White-matter tract integrity in late-life depression: associations with severity and cognition

BACKGROUND

Although significant changes in both gray and white matter have been noted in late-life depression (LLD), the pathophysiology of implicated white-matter tracts has not been fully described. In this study we examined the integrity of specific white-matter tracts in LLD versus healthy controls (HC).

METHOD

Participants aged ⩾60 years were recruited from the community. The sample included 23 clinically diagnosed individuals with LLD and 23 HC. White-matter integrity metrics [fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD)] were calculated in the bilateral cingulum and uncinate fasciculus. Depression severity was measured using the Center for Epidemiological Studies Depression Scale (CESD). Composite scores for learning and memory and executive function were created using standardized neuropsychological assessments.

RESULTS

White-matter integrity was lower in LLD versus HC in the bilateral cingulum and right uncinate fasciculus (p⩽0.05). In the whole sample, depression severity correlated with integrity in the bilateral cingulum and right uncinate fasciculus (p ⩽0.05). In patients, depression severity correlated with the integrity of the left uncinate fasciculus (p = 0.03); this tract also correlated with executive function (p = 0.02). Among HC, tract integrity did not correlate with depression scores; however, learning and memory correlated with integrity of the bilateral uncinate fasciculus and bilateral cingulum; executive function correlated with the right uncinate and left cingulum (p ⩽0.05).

CONCLUSIONS

White-matter tract integrity was lower in LLD than in HC and was associated with depression severity across all participants. Tract integrity was associated with cognition in both groups but more robustly among HC.

KIR and HLA interactions are associated with control of primary CMV infection in solid organ transplant recipients

Cytomegalovirus (CMV) infection remains a major source of morbidity and mortality in solid organ transplant recipients. Killer immunoglobulin-like receptors(KIR) are genetically polymorphic natural killer(NK) cell receptors important in antiviral responses. A retrospective, single-center cohort study was performed to study the interaction of KIR genotype and primary control of CMV infection after transplantation.Time to first CMV viremia was determined for a cohort of 531 CMV serology donor positive/recipient negative solid organ transplant recipients. Of the KIR genes,KIR2DL3 and KIR2DS2 were most strongly associated with time to CMV viremia in random survival forest analysis. As KIR2DL3 and KIR2DS2 both interact with HLA-C1, these interactions were evaluated. Seventy six recipients were found to be positive for both KIR2DL3 and KIR2DS2 and expressed only HLA-C1 antigens in both recipient and donor. These patients had a substantially reduced hazard of CMV viremia in the first year after solid organ transplantation (hazard ratio 0.44, 95% CI 0.27–0.72, p=0.0012). In KIR2DL3+/KIR2DS2+/HLA-C1/1 recipients who received an organ from a non-C1/1 donor, this protective effect was not observed. These results improve our understanding of human NK cell function in primary CMV infection after transplant.

Kinetics of serological responses in influenza A(H7N9)-infected patients correlate with clinical outcome in China, 2013

The novel avian influenza A(H7N9) infection has recently emerged to cause severe respiratory illness in China. The objectives of this study were to define the kinetics of the antibody responses in patients with influenza A(H7N9) disease and to correlate these kinetics with clinical outcome. Serial serum samples were obtained at intervals of three to four days from 18 patients with virologically confirmed A(H7N9) disease in Shanghai. We determined the kinetics of the haemagglutination inhibition (HI) and A(H7H9) pseudotype neutralisation antibody (Nab) responses and correlated these with clinical outcomes. Most patients had robust serological responses by both HI and Nab tests. Taking into account censoring due to time of testing and death, the median time from onset of illness to Nab titre ≥1:40 was 14 days (95% confidence interval (CI): 11–18 days) in the fatal cases and 10.5 days (95% CI: 7–12) in the survivors (p=0.003). The two groups did not differ in initial Nab titres, but the rate of increase in Nab titres was significantly faster for survivors by approximately 10-fold per 15 days (p=0.007). Early and rapid induction of Nab was correlated significantly with better clinical outcome.

Behavioral response of grape root borer (Lepidoptera: Sesiidae) neonates to grape root volatiles

Grape root borer, Vitacea polistiformis (Harris), is an oligophagous and potentially destructive pest of grape in commercial vineyards throughout much of the eastern United States. Larvae feed on vine roots, although little is known about their below-ground interactions with host plants. The behavioral response of groups of grape root borer neonates to stimuli from host and nonhost roots was evaluated in single and paired stimuli bioassays in which stimuli were presented in opposing wells attached to the bottom of petri dish arenas. Stimulus sources included root pieces and root headspace volatiles from 3309 and 420-A grape rootstocks (host) and apple (nonhost) and ethanol-based extracts of 3309 and 420-A roots. In single stimulus assays, significantly more larvae were recovered from wells containing grape roots, apple roots, grape extracts, and grape root volatiles than from control wells, but there was no significant response to volatiles collected from the headspace of apple roots. In paired stimuli assays, significantly more larvae were recovered from wells containing grape than apple roots. There was no difference in larval distribution between wells when 420-A and 3309 roots were presented simultaneously, although a significantly greater response to 3309 than 420-A root extract was recorded. When soil was added to the assays, significantly more larvae were recovered from wells containing grape roots than from those containing only soil, but this response was not detected in assays using buried apple roots. These results are discussed in relation to the plant-insect interactions between grape root borer larvae and their Vitaceae hosts.

The role of lanierone in the chemical ecology ofIps pini (Coleoptera: Scolytidae) in California

Five doses of lanierone (2-hydroxy-4,4,6-trimethyl-2,5-cyclohexadien-1-one) were tested with one dose of enantiomerically pure [99.4% (4R)-(-)] ipsdienol (2-methyl-6-methylene-2,7-octadien-4-ol) for activity as an aggregation pheromone ofIps pini (Say) in California. The response ofI. pini to 1 mg/day ipsdienol + 20 μg/day lanierone was significantly greater than the response to ipsdienol alone, but the response pattern did not demonstrate a clear dose-response relationship. The response to the highest dose of lanierone (2 mg/day) was significantly lower than the response to ipsdienol alone. Ipsdienol attracted significantly moreI. pini than a male-infested log. Lanierone did not alter the percentage of maleI. pini responding to ipsdienol alone. Neither sex ofI. pini orDendroctonus brevicomis LeConte from California produced detectable amounts of lanierone, but myrcene-aerated maleD. brevicomis produced 97.8%-(4S)-(+)-ipsdienol. The black-bellied clerid,Enoclerus lecontei (Wolcott) (Coleoptera: Cleridae) was attracted to lanierone when released with ipsdienol. Neither compound was attractive when released alone, proving synergism for the kairomone of this predator. Lanierone did not influence the response of the predatorsTemnochila chlorodia (Mannerheim) (Coleoptera: Trogositidae) andEnoclerus sphegeus (F.) (Coleoptera: Cleridae), which were attracted to all treatments containing ipsdienol.Tomicobia tibialis Ashmead (Hymenoptera: Pteromalidae) responded in significantly greater numbers to the male-infested log than it did to ipsdienol or ipsdienol + 20 μg/day lanierone.

Androgens regulate prostate cancer cell growth via an AMPK-PGC-1α-mediated metabolic switch

Prostate cancer is the most commonly diagnosed malignancy among men in industrialized countries, accounting for the second leading cause of cancer-related deaths. Although we now know that the androgen receptor (AR) is important for progression to the deadly advanced stages of the disease, it is poorly understood what AR-regulated processes drive this pathology. Here we demonstrate that AR regulates prostate cancer cell growth via the metabolic sensor 5'-AMP-activated protein kinase (AMPK), a kinase that classically regulates cellular energy homeostasis. In patients, activation of AMPK correlated with prostate cancer progression. Using a combination of radiolabeled assays and emerging metabolomic approaches, we also show that prostate cancer cells respond to androgen treatment by increasing not only rates of glycolysis, as is commonly seen in many cancers, but also glucose and fatty acid oxidation. Importantly, this effect was dependent on androgen-mediated AMPK activity. Our results further indicate that the AMPK-mediated metabolic changes increased intracellular ATP levels and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α)-mediated mitochondrial biogenesis, affording distinct growth advantages to the prostate cancer cells. Correspondingly, we used outlier analysis to determine that PGC-1α is overexpressed in a subpopulation of clinical cancer samples. This was in contrast to what was observed in immortalized benign human prostate cells and a testosterone-induced rat model of benign prostatic hyperplasia. Taken together, our findings converge to demonstrate that androgens can co-opt the AMPK-PGC-1α signaling cascade, a known homeostatic mechanism, to increase prostate cancer cell growth. The current study points to the potential utility of developing metabolic-targeted therapies directed toward the AMPK-PGC-1α signaling axis for the treatment of prostate cancer.

Blend chemistry and field attraction of commercial sex pheromone lures to grape berry moth (Lepidoptera: Tortricidae), and a nontarget tortricid in vineyards

Anecdotal reports by scientists and growers suggested commercial sex pheromone lures were ineffective with monitoring field populations of grape berry moth, Paralobesia viteana (Clemens), in vineyards. This study addressed the need to evaluate commercial sex pheromone lures for chemical purity and efficacy of attracting grape berry moth and a nontarget tortricid, the sumac moth, Episumus argutanus (Clemens). The percentage of chemical components from a set of eight lures from each manufacturer was found using gas chromatography-mass spectrometry and confirmed by chemical standards. No lures adhered to the 9:1 blend of (Z)-9-dodecenyl acetate (Z9-12:Ac) to (Z)-11-tetradecenyl acetate (Z11-14:Ac), though Suterra (9.1:1), ISCA (5.7:1), and Trécé (5.4:1) lures were closest. The Trécé lures contained ≍98 μg Z9-12:Ac, which is 3-51 times more than the other lures. The Suterra and ISCA lures were loaded with ≍29 and 33 μg Z9-12:Ac, and the Alpha Scents lures only contained ≍2 μg Z9-12:Ac. An antagonistic impurity, (E)-9-tetradecenyl acetate (E9-12:Ac), was found in all manufacturer lures at concentrations from 3.2 to 4.8%. Field attraction studies were done in summer 2010, and again in 2011, to evaluate commercial lures for their potential to attract P. viteana and E. argutanus in the presence of lures from other manufacturers. Separate experiments were established in two vineyards in Augusta County, VA, one with open and the other with wooded surroundings. In field experiments, Suterra lures detected P. viteana most often, Trécé lures detected more E. argutanus, and ISCA lures detected P. viteana in the open vineyard the least, while Alpha Scents lures were least attractive to E. argutanus in both environments. Fewer P. viteana were captured in the wooded versus open vineyard, which may limit the potential for sex pheromone monitoring of P. viteana in wooded vineyards.

Power of metabolomics in biomarker discovery and mining mechanisms of obesity

Obesity, the prevalence of which is increasing rapidly worldwide, is recognized as a risk factor for diabetes, cardiovascular disease, liver disease and renal disease. Unfortunately, the mechanisms underlying it have not been well characterized. Fortunately, metabolomics - the systematic study of metabolites, which are small molecules generated by the process of metabolism - has been important in elucidating the pathways underlying obesity. Small-molecule metabolites have an important role in biological system and represent attractive candidates to understand obesity phenotypes. Metabolomic analysis is a valid and powerful tool with which to further define the mechanisms. Recent attention has focused on identifying biomarkers that would propose a better non-invasive way to detect or visualize obesity and prevent its events. The discovery of the biomarkers has become a key breakthrough towards a better molecular understanding of obesity. Thus, this review covers how recent metabolomic studies have advanced biomarker discovery and the elucidation of mechanisms underlying obesity and its comorbidities. The importance of identifying metabolic markers and pathways of disease-associated intermediate phenotypes is also emphasized. These biomarkers would be applicable as diagnostic tools in a personalized healthcare setting and may also open door to biomarker discovery, disease diagnosis and novel therapeutic avenues.

Social opportunity causes rapid transcriptional changes in the social behaviour network of the brain in an African cichlid fish

Animals constantly integrate external stimuli with their own internal physiological state to make appropriate behavioural decisions. Little is known, however, about where in the brain the salience of these signals is evaluated, or which neural and transcriptional mechanisms link this integration to adaptive behaviours. We used an African cichlid fish Astatotilapia burtoni to test the hypothesis that a new social opportunity activates the conserved 'social behaviour network' (SBN), a collection of brain nuclei known to regulate social behaviours across vertebrates. We measured mRNA levels of immediate early genes (IEGs) in microdissected brain regions as a proxy for neuronal activation, and discovered that IEGs were higher in all SBN nuclei in males that were given an opportunity to rise in social rank compared to control stable subordinate and dominant individuals. Furthermore, because the presence of sex-steroid receptors is one defining criteria of SBN nuclei, we also tested whether social opportunity or status influenced androgen and oestrogen receptor mRNA levels within these same regions. There were several rapid region-specific changes in receptor mRNA levels induced by social opportunity, most notably in oestrogen receptor subtypes in areas that regulate social aggression and reproduction, suggesting that oestrogenic signalling pathways play an important role in regulating male status. Several receptor mRNA changes occurred in regions with putative homologies to the mammalian septum and extended amygdala, two regions shared by SBN and reward circuits, suggesting an important role in the integration of social salience, stressors, hormonal state and adaptive behaviours. We also demonstrated increases in plasma sex- and stress-steroids at 30 min after a rise in social rank. This rapid endocrine and transcriptional response suggests that the SBN is involved in the integration of social inputs with internal hormonal state to facilitate the transition to dominant status, which ultimately leads to improved fitness for the previously reproductively-suppressed individual.

Development of a dot-immunoenzyme filtration assay for the detection of enterovirus 71 antigen in human serum via immunoglobulin M

OBJECTIVES

This study evaluated the sensitivity and specificity of a rapid, sensitive dot-immunoenzyme filtration assay to detect enterovirus 71 (EV71) antigen in serum samples from paediatric patients with hand, foot and mouth disease (HFMD), through detection of anti-EV71 immunoglobulin (Ig)M.

METHODS

Serum samples from HFMD patients and healthy adult controls were evaluated for the presence of anti-EV71 IgM using a dot-immunoenzyme filtration assay (DIEFA). The results were compared with those obtained using a dot-immunogold filtration assay (DIGFA). The EV71 structural protein VP1 was used as the antigen for both assays.

RESULTS

Serum samples from 72 HFMD patients and 54 healthy controls were evaluated. The DIGFA procedure showed a sensitivity of 98.5% and a specificity of 100%, whereas the DIEFA procedure showed a sensitivity of 98.6% and a specificity of 98.0%. There were no significant differences between the assays in either specificity or sensitivity.

CONCLUSION

The DIEFA procedure developed in this study has potential as a rapid, simple, sensitive and cost-effective screening technique for detecting EV71 antigen in serum samples from patients with HFMD.