Indices of relative weight and obesity

The impact of D-Trp6 LH-RH on plasma lipid levels

BACKGROUND

There is increasing evidence regarding the correlation between the risk of death from cardiovascular disease and low levels of HDL-cholesterol or high plasma concentrations of LDL-cholesterol, total cholesterol, and triglycerides. Gonadotropin releasing hormone (GhRH) analogues are widely used in assisted reproduction programs. Therefore, it seems important to evaluate possible changes in serum lipoprotein levels following treatment with these compounds.

PURPOSE

Our purpose was to assess possible lipoprotein changes following administration of the long-acting GnRH analogue, D-Trp6 luteinizing hormone-releasing hormone (LH-RH).

DESIGN

Serum levels of cholesterol, HDL-cholesterol, LDL-cholesterol, and triglicerydes were determined before and after 6 weeks of treatment.

RESULTS

No significant changes in either cholesterol or HDL-cholesterol, LDL-cholesterol, or triglicerydes following treatment with D-Trp6 LH-RH were demonstrated in the group of 25 patients investigated.

CONCLUSIONS

Short-term use of D-Trp6 LH-RH is not associated with any significant change in plasma lipid levels. Further studies are still required with patients undergoing repeated treatment cycles, especially those who exhibit elevated pretreatment plasma lipid levels, to confirm the long-term safety of GnRH analogues with respect to lipid metabolism.

Psychomotor retardation found in college students seeking counseling

Psychomotor retardation (PMR) has been documented for inpatient populations. Futterman and Tryon (1994) [Journal of Behavior Therapy and Experimental Psychiatry, 25, 41-48] provided the first report of PMR in a female outpatient sample. Because 8 of their 11 depressed Ss were receiving medication, the possibility remains that Futterman and Tryon's findings were due to medication side effects. The present study documents PMR in a nonmedicated male and female college population. Two-week, 24-h per day, content-valid behavioral measurements were obtained using step-counters from 73 college students seeking counseling. The 20 males and 53 females completed the Inventory to Diagnose Depression, the State-Trait Anxiety Inventory, the Marlowe-Crowne Social Desirability Inventory, and a structured interview. Regression analysis revealed that depression was negatively related to daytime activity. Significant age and gender effects were statistically controlled.

Is body size the cause for poor outcomes of coronary artery bypass operations in women?

Although small body size and coronary artery diameter are recognized as major contributors to the increased risk of coronary artery bypass grafting in women, few studies have established the independent influence of body size and gender on outcome. We studied 7025 consecutive patients (5694 men, 1331 women) undergoing isolated coronary artery bypass grafting between 1990 and 1994. Women were older, had higher preoperative prevalences of urgent operation because of unstable angina, diabetes, peripheral vascular disease, hypertension, and single-vessel coronary artery disease (p < 0.0001), and a lower prevalence of left ventricular ejection fraction 40% or less (p < 0.0001). The prevalences of operative mortality (men, 1.8%; women, 3.5%), low-output syndrome (men, 6.6%; women, 14.8%), and myocardial infarction (men, 2.8%; women, 5.5%) were higher in women (p < 0.0001). Patients were divided into quartiles for body surface area, weight, height, and body mass index. For both men and women, there was no difference in operative mortality between the highest and lowest quartiles of body size. Women, however, had a higher prevalence of operative mortality than men in the lower quartiles of body surface area, height, and weight and in the higher quartiles of body mass index. Among men, the prevalence of low-output syndrome increased (p < 0.0001) with decreasing body surface area, weight, and body mass index, suggesting that body size did influence the prevalence of low-output syndrome. However, women had a higher prevalence of low-output syndrome than men in every category and quartile of body size (p < 0.0001). Multivariable analysis identified gender as a significant determinant of operative mortality (odds ratio 1.83, 95% confidence interval 1.27 to 2.64) and low-output syndrome (odds ratio 2.52, 95% confidence interval 2.05 to 3.11). When multivariable adjustments were made for body size and preoperative risk factors, gender remained a predictor of both operative mortality and low-output syndrome. Multivariable assessment of risk for men and women separately identified that urgent operation was a predictor of operative mortality (odds ratio 2.52, 95% confidence interval 1.32 to 5.61) and low-output syndrome (odds ratio 1.57, 95% confidence interval 1.14 to 2.17) in women but not men. In conclusion, the increased risk of coronary artery bypass grafting in women may be explained in part by dramatic differences in preoperative risk factors between men and women. In both men and women, small body size did not increase the risk of operative mortality, but may have contributed to the risk of low-output syndrome.(ABSTRACT TRUNCATED AT 400 WORDS)

[Lys(B28), Pro(B29)]-human insulin: effect of injection time on postprandial glycemia

BACKGROUND

[Lys(B28), Pro(B29)]-human insulin (lispro) is an insulin analogue with a reduced capacity for self-association and faster absorption from subcutaneous injection sites. We hypothesized that administration of lispro closer to a meal would result in better glucose control than that achieved with regular insulin.

METHODS

This trial used a randomized crossover design that consisted of a period of metabolic stabilization lasting 9 days followed by an evaluation period lasting 5 days. The patients received weight-maintenance diets, and insulin doses were adjusted as needed. Calorie intake, insulin dose, and activities were kept constant once the evaluation period began. During the evaluation period, we varied the time between insulin injection and mealtime and assessed glucose control.

RESULTS

During the evaluation period, the lowest mean glucose concentrations were 117.9 mg/dl for lispro and 119.8 mg/dl (p = 0.817) for regular insulin. To obtain these, we gave lispro, on average, 22.5 minutes before meals and regular insulin 63.8 minutes before meals (p = 0.006). A similar pattern was evident throughout the glucose control parameters. The exception was mean amplitude of glucose excursion, which was lower after lispro (59 versus 75 mg/dl; p = 0.007) compared with regular insulin.

CONCLUSIONS

We achieved equal or slightly better glucose control, as reflected by mean amplitude of glucose excursion, with insulin lispro given much closer to meal time than that achieved with regular insulin. As a result of these findings, we propose that a rapidly absorbed analogue of insulin is capable of achieving better control of postprandial glucose at a more convenient injection time.

Normal plasma lipoproteins and fertility in gene-targeted mice homozygous for a disruption in the gene encoding very low density lipoprotein receptor

The very low density lipoprotein (VLDL) receptor is a recently cloned member of the low density lipoprotein (LDL) receptor family that mediates the binding and uptake of VLDL when overexpressed in animal cells. Its sequence is 94% identical in humans and rabbits and 84% identical in humans and chickens, implying a conserved function. Its high level expression in muscle and adipose tissue suggests a role in VLDL triacylglycerol delivery. Mutations in the chicken homologue cause female sterility, owing to impaired VLDL and vitellogenin uptake during egg yolk formation. We used homologous recombination in mouse embryonic stem cells to produce homozygous knockout mice that lack immunodetectable VLDL receptors. Homozygous mice of both sexes were viable and normally fertile. Plasma levels of cholesterol, triacylglycerol, and lipoproteins were normal when the mice were fed normal, high-carbohydrate, or high-fat diets. The sole abnormality detected was a modest decrease in body weight, body mass index, and adipose tissue mass as determined by the weights of epididymal fat pads. We conclude that the VLDL receptor is not required for VLDL clearance from plasma or for ovulation in mice.

The correlates of binge eating in two nonpatient samples

Binge eating in two nonpatient samples was examined as a function of actual body weight (expressed as BMI), attempts to control eating, food/weight preoccupation, and neuroticism. All of these factors were univariately associated with binge eating, but multivariate analyses indicated that food/weight preoccupation was the most powerful predictor, accounting for much of the common variance shared by the various correlates. This replicates previous work and suggests that the dynamics of subclinical bingeing are substantially similar to that found in the full DSM-III-R syndrome of bulimia nervosa.

Cardiovascular recovery from laboratory stress: biopsychosocial concomitants in older adults

Although cardiovascular recovery may be important to long term cardiovascular health, its biopsychosocial correlates have received much less attention than the correlates of cardiovascular reactivity. Of the few studies that have examined recovery, fewer still have examined men and women over 60 yr of age. This study examined relationships of psychosocial factors (e.g. state anxiety, anger, avoidance coping, Type A behavior, etc.) with recovery in 186 older married men (n = 63) and women (n = 123) (mean age = 69.7 +/- 6.1 yr). Regressions were performed to explain recovery variability in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) in response to emotional and cognitive tasks. In each analysis, we controlled for the effects of gender, type of task, reactivity to the task, and other important covariates. Individuals with slower recovery had higher scores on anxiety (for SBP, p < 0.03 and DBP, p < 0.01), higher scores on avoidance coping (for DBP and HR, p < 0.01), and lower scores on anger held in (for DBP, p < 0.01). Psychosocial factors may be important in explaining recovery in older adults.

Effects of low-dose estrogen oral contraceptives on weight, body composition, and fat distribution in young women

OBJECTIVE

To determine prospectively whether the use of low-dose estrogen oral contraceptives (OC) is associated with changes in weight, body composition, or fat distribution.

DESIGN

Anthropometric measurements were performed in 49 healthy young (16 to 21 years old) women before commencement of OC use (30 micrograms ethinyl estradiol [EF2] plus 75 micrograms gestodene) and after three and six treatment cycles. Thirty one age- and weight-matched women who were not using OC served as controls.

SETTING

Outpatient gynecological clinic of Hadassah Medical Center, a tertiary level hospital, and the "Shilo" voluntary service for the prevention of unwanted pregnancy.

MAIN OUTCOME MEASURES

Anthropometric measurements included body mass index (BMI), waist-to-hip girth ratio, and body composition (the percentage of body fat and water), estimated by mean of infrared interactance.

RESULTS

In the group of OC users, baseline BMI, percent fat, percent water, and waist-to-hip girth ratio were 21.1 +/- 0.32 (kg/m2), 23.8% +/- 0.63%, 57.4% +/- 0.39%, and 0.73 +/- 0.01, respectively, and did not change significantly after six cycles (20.6 +/- 0.41 [kg/m2], 23.9% +/- 0.57%, 58.1% +/- 0.49%, and 0.72 +/- 0.03, respectively). These measurements were not significantly different when compared with the nonusers. Fifteen OC users (30.6%) gained weight (> 0.5 kg). Weight gain was due to a significant accumulation of fat (from 22.5% +/- 1.1% to 25.6% +/- 0.74%), whereas the percentage of body water remained stable. The waist-to-hip girth ratio also was not changed significantly. Similarly, 11 nonusers (35.4%) gained weight because of similar nonabdominal fat accumulation. Ten OC users (20.4%) lost weight (57 kg +/- 1.51 to 55.4 +/- 1.47 [mean +/- SEM]) and 6 nonusers (19.3%) also lost weight (59 kg +/- 1.42 to 57.3 +/- 1.92). In both groups the loss of weight was not associated with significant change in body composition.

CONCLUSIONS

The use of low-dose OC (EE2 plus gestodene) was not associated with overall impact on weight, body composition, or fat distribution. However, when weight gain did occur during OC use, it was due to increase in body fat and not in volume of body water, and it was not associated with changes in fat distribution.

Ten-year follow-up of anorexia nervosa: clinical course and outcome

The clinical course and outcome of anorexia nervosa are presented in a 10-year follow-up study of 76 severely ill females with anorexia nervosa who met specific diagnostic criteria and had participated in a well-documented hospital treatment study. Information was obtained on 100% of the subjects. A comprehensive assessment was made in 93% of the living subjects in specific categories of weight, eating and weight control behaviours, menstrual function, anorexic attitudes, and psychological, sexual, social and vocational adjustment. Five subjects had died, which gives a crude mortality rate of 6.6%. Standardized mortality rates demonstrated an almost 13-fold increase in mortality in the anorexia nervosa subjects. Only eighteen (23.7%) were fully recovered. Sixty-four per cent developed binge-eating at some time during their illness, 57% at least weekly. Twenty-nine (41%) were still bulimic at follow-up. The high frequency and chronicity of the bulimic symptoms plus the high rate of weight relapse (42% during the first year after hospital treatment) suggest that intensive intervention is needed to help anorexics restore and maintain their weight within a normal range and to decrease abnormal eating and weight control behaviours.

Risk factors for eating disorders in Greek- and Anglo-Australian adolescent girls

Past research indicates ethnicity may be related to eating disorder and related risk factors. The present study examines risk factors for eating disorders in 50 Anglo- and 50 Greek-Australian girls (mean age = 13.5 years). The variables assessed included bulimic tendencies, body dissatisfaction, use of extreme weight loss behaviors (EWLBs), self-esteem, depression and family cohesion and adaptability. Cultural eating patterns were also explored. A stepwise discriminant function analysis to examine whether the two groups could be discriminated on these variables was significant and correctly classified 73.9% of the sample, the chief discriminating variables being Pressure to Eat, EWLBs, and Family Adaptability. Univariate analyses indicated differences between the groups on Pressure to Eat, Family Adaptability, and Mother's Shape. Although the groups were discriminable, a number of variables generally associated with eating disorder did not contribute to the function. These data are discussed in terms of cultural assimilation.

Overweight, underweight and mortality among the aged

OBJECTIVE

To clarify the influence of overweight and underweight on the total mortality as well as on different causes of death in an unselected population of old people.

DESIGN

The cohort of the aged population was examined in 1971. The survival time of the cohort was followed for ten years.

SETTINGS

Rural commune of Hankasalmi in Central Finland.

PARTICIPANTS

721 (80% of total aged population) subjects aged 65 years or over (310 men and 411 women).

OUTCOME MEASURES

10 years survival rate and causes of death by body mass index quartiles and sex.

RESULTS

The women in the lowest BMI quartile had the highest mortality in ten-year follow-up (a 26% decrease in survival time). The differences between the total mortality of the other quartiles were small. In the lowest BMI quartile there was overmortality from respiratory diseases and tumours, and undermortality from cardiovascular diseases. In the highest BMI quartile the main groups of causes of death did not differ essentially from those in the whole cohort.

CONCLUSION

Underweight was as strong a predictor of mortality, and even stronger, than overweight.

Weight-loss strategies and beliefs in high and low socioeconomic areas of Melbourne

Overweight is a serious health risk and is prevalent in Australia. This study explored sex, socio-economic status and age differences in body mass index, the perceived effectiveness of weight-loss strategies and the frequency of their use, and awareness of the risks of obesity in a random sample of adult men (n = 457) and women (n = 537) from higher and lower socioeconomic areas. According to self-reports, 37 per cent of the sample were overweight or obese. More men than women, and more older than younger respondents, were overweight. There were no sex differences in the frequency of obesity. There were significantly more obese individuals in the lower than in the higher socioeconomic area. Women more frequently put themselves in a higher weight category while men more frequently put themselves in a lower weight category. Fifty-eight per cent of respondents reported the desire to lose weight and 24 per cent of the sample were trying to lose weight on the survey day; 46.9 per cent had attempted to lose weight in the previous 12 months, and these were more likely to be female, younger and obese or overweight. Only minor differences according to sex or socioeconomic status were found in beliefs about the effectiveness of different weight-loss strategies. However, older respondents were less likely to have exercised recently as a means of weight reduction. There was good recognition of diseases made worse by being overweight, although the health risk of male fat distribution patterns was not widely known.

Relationship of body fat distribution with cardiovascular risk factors in healthy Chinese

The relationships between six body girths (shoulder, midarm, waist, hip, thigh, and calf) and cardiovascular risk factors (systolic and diastolic blood pressures and glucose, triglyceride, lipoprotein cholesterol, and apolipoprotein levels) were examined in 407 healthy Chinese urban workers in Taipei, Taiwan who were between 40 to 59 years old. Canonical correlation analysis revealed significant associations of upper body adiposity (shoulder, midarm, and waist girths) with cardiovascular risk factors in all subgroups assessed: men, premenopausal women, and postmenopausal women. Waist girth and hip girth were consistent and important variables, and weighted in the opposite direction. Waist-hip ratio (WHR) was the best descriptor of centralized adiposity. Centralized fat distribution was positively associated with blood pressure and glucose, triglyceride, and apolipoprotein (apo) B levels, and negatively associated with high-density-lipoprotein (HDL) cholesterol and apo A-I levels in this population. Body fat distribution had an effect independent of body mass index and accounted for some of the differences in triglyceride, HDL cholesterol, apo A-I, and apo B concentrations among men, premenopausal women, and postmenopausal women. Our findings in a Chinese population are similar to data from other studies in Western populations, and are consistent with the hypothesis that centralized adiposity is related to cardiovascular risk factors independent of general obesity.

Pharmacokinetic disposition of loracarbef in healthy young men and women at steady state

The pharmacokinetic disposition of 200- and 400-mg doses of a novel carbacephem, loracarbef, was determined over a dose interval on day 8, after ingestion of drug doses twice daily for 7 days, in 20 young, healthy volunteers of both genders. Drug was analyzed in plasma, urine, saliva, vaginal secretions, and fecal filtrate. Peak plasma concentration was proportional to dose for both men (4.0 +/- 1.3 and 8.8 +/- 3.4 mg/L) and women (8.0 +/- 5.6 and 15.3 +/- 3.3 mg/L), and the observed time to peak increased from 1 to 2 hours with the increased dose. Apparent volume of distribution was greater in men than women (0.385 +/- 0.114 versus 0.270 +/- 0.075 L/kg; P < .03). The drug was virtually quantitatively excreted unchanged in urine, and its renal clearance exceeded creatinine clearance in all subjects. Renal loracarbef clearance correlated with neither weight-corrected dose nor creatinine clearance in these healthy subjects. There was no evidence for drug accumulation in the body with chronic ingestion. Loracarbef was detected in the fecal filtrate of seven volunteers, but did not account for more than 7% of the daily dose. Loracarbef was detected in vaginal secretions of two of five volunteers who ingested the 400-mg dose. No drug was detected in saliva obtained just before dose ingestion. These data are consistent with complete bioavailability for an oral beta-lactam antibiotic drug that is virtually completely eliminated unchanged by the kidney.

Body mass index in amputees

Whereas estimates of percent deviation of body weight from ideal (F delta weight) are corrected for amputation, those of body mass index (BMI) are not, creating discrepancies in evaluating obesity. A correction of the BMI formula for amputation is proposed. The formula for BMI was corrected for amputation mathematically. The mathematical model predicts that the uncorrected BMI formula underestimates body fat in unilateral amputees and overestimates body fat in subjects with bilateral amputations at the same length of the legs. F delta weight and corrected and uncorrected BMI estimates were computed in 15 subjects with unilateral leg amputation and in 8 subjects with multiple amputations. BMI estimates were as follows: in unilateral amputees, corrected 24.1 +/- 4.1 kg/m2, uncorrected 22.2 +/- 3.9 kg/m2 (p < .001); and in multiple amputees, corrected 21.6 +/- 2.4 kg/m2, uncorrected 32.6 +/- 11.8 kg/m2 (p = .043). Linear regressions of F delta weight obtained from standard nutrition assessment on F delta weight computed from uncorrected and corrected BMI values were as follows: in unilateral amputees, uncorrected F delta weight = -0.079 + 0.932 x actual F delta weight, r = .974, p < .01, and corrected F delta weight = 0.002 + 1.005 x actual F delta weight, r = .997, p < .01; in multiple amputees, uncorrected F delta weight = 0.528 + 1.930 x actual F delta weight, r = .607, p is not significant, and corrected F delta weight = -0.010 + 0.920 x actual F delta weight, r = .936, p < .01.(ABSTRACT TRUNCATED AT 250 WORDS)

Dyslipidaemia and obesity

Obesity is frequently associated with a dyslipidaemic state. Several metabolic and epidemiological studies published in the 1980s have, however, emphasized the importance of considering the regional distribution of body fat in the assessment of the health hazards of obesity. The development of imaging techniques such as computed tomography has also allowed it to be established that the fat located in the abdominal cavity, i.e. the visceral adipose tissue, was the critical correlate of the metabolic complications found in abdominal obesity which include insulin resistance and hyperinsulinaemia, glucose intolerance, hypertriglyceridaemia, hypoalphalipoproteinaemia and increased concentrations of dense LDL particles. Furthermore, since several genes are involved in the regulation of plasma lipoprotein-lipid levels and they have been reported to show polymorphism, visceral obesity should be considered as a permissive factor that exacerbates an individual's susceptibility to dyslipidaemia and premature coronary heart disease rather than a primary regulator of the dyslipidaemic state observed in visceral obese patients. Finally, as insulin resistance and the level of visceral adipose tissue are two main correlates of the dyslipidaemic state which characterizes abdominal obesity, treatment should be aimed at reducing visceral fat and improving insulin sensitivity. Prospective studies are clearly warranted to evaluate the potential benefits of such interventions on the incidence of coronary heart disease.

Factors associated with eating disorder symptoms in a community sample of 6th and 7th grade girls

Nine hundred thirty-nine 6th and 7th grade girls participated in the baseline phase of a prospective study designed to examine a set of potential risk factors for the development of eating disorders. Of the 939,839 girls (89%) completed the bulimia nervosa section of the Structured Clinical Interview for DSM-III-R disorders. One girl received the diagnosis of bulimia nervosa, another 35 were classified as a symptomatic group. Using analysis of covariance (ANCOVA), controlling for age and stage of sexual maturation, symptomatic and asymptomatic groups were compared on the following measures: Eating Disorders Inventory (EDI), BMI, triceps skinfold thickness, waist-to-hip ratio, depression symptoms (CES-D and DSRS), Restraint Scale, and a measure of family adaptability and cohesion (FACES). Symptomatic girls were more developmentally mature, significantly heavier, reported greater fear of weight gain, experienced greater dysphoria, indicated increased body dissatisfaction, and reported greater feelings of inadequacy and personal worthlessness. Their status on these dimensions may indicate potential vulnerability to eating disorders and, ultimately, suggest the choice of targets for intervention. Our future goal is to conduct the prospective analyses needed to confirm the hypothesized linkages.

Role of common genetic polymorphisms in the LDL receptor gene in affecting plasma cholesterol levels in the general population

A large number of rare mutations in the low-density lipoprotein (LDL) receptor gene cause the autosomal dominant disorder familial hypercholesterolemia. In addition, a number of common DNA polymorphisms have been identified in the LDL receptor gene, but their significance in affecting plasma cholesterol levels in the general population has not been studied widely. We investigated the role of two common DNA polymorphisms, Ava II (exon 13) and Nco I (exon 18), at the LDL receptor locus in affecting plasma lipid profiles in normolipidemic Hispanics (n = 385) and non-Hispanic whites (NHWs; n = 543) from the San Luis Valley, Colorado. While the distribution of the Nco I polymorphism was comparable between Hispanics and NHWs, the allele frequencies at the Ava II restriction site differed significantly between the two ethnic groups (P < .001). The Ava II and Nco I polymorphisms were in linkage disequilibrium (P < .05) in both Hispanics and NHWs. Both polymorphisms revealed a gender-specific effect on total and LDL cholesterol (LDL-C) confined to women only in both ethnic groups. The AVA II polymorphism was associated significantly with total cholesterol and LDL-C in NHW women (P = .001 and P = .014) and in Hispanic women (P = .011 and P = .057). The effect of the Nco I polymorphism was significant on total cholesterol and LDL-C (P = .019 and P = .035) in Hispanic women only. Although a similar trend was observed in NHW women, the effect was not significant at the 5% level.(ABSTRACT TRUNCATED AT 250 WORDS)

Dual-energy X-ray absorptiometry in neuromuscular diseases

Body components were measured noninvasively in patients with neuromuscular disease by using dual-energy X-ray absorptiometry (DXA), capable of separately analyzing fat, bone, and muscle content. In all patients with muscle atrophy of myogenic or neurogenic origin, muscle mass was markedly reduced. Although all three components (fat, muscle, and bone) were decreased in neurogenic atrophy patients, fat mass alone was increased significantly in myogenic atrophy patients. The fat/muscle ratio (f/m) was significantly higher in myogenic atrophy patients than in the normal controls and neurogenic atrophy patients. The higher f/m ratio in myogenic atrophy patients seems to reflect a marked fat infiltration into atrophied skeletal muscles of patients with primary muscular disease. Using DXA, it is possible to distinguish clearly between myogenic atrophy from neurogenic atrophy, opening the way to an evaluation of the severity of quantitative and qualitative muscle changes in neuromuscular disease.

Plasma oestrogens in postmenopausal women with endometrial cancer

OBJECTIVE

To study plasma levels of estrogens and androgens, sex hormone-binding globulin (SHBG) and follicle stimulating hormone (FSH) in postmenopausal patients with endometrial cancer.

DESIGN

Patients and controls were matched for age, body mass index, parity and years since menopause.

SETTING

Department of Obstetrics and Gynaecology, Hvidovre Hospital, Denmark.

SUBJECTS

Fifty postmenopausal patients with endometrial cancer and 54 matching controls.

MEASUREMENTS

Plasma levels of SHBG, FSH, oestrone, oestradiol, oestrone-sulphate, dehydro-epiandrosterone sulphate, testosterone, and androstenedione were measured by radio-immunoassays. Free fractions of oestradiol and testosterone were calculated according to levels of SHBG and albumin.

RESULTS

The levels of oestradiol, free oestradiol, and oestrone were elevated (P < 0.001) in patients compared with controls (oestradiol: 51 (45-59) vs 37 (34-41) pmol/l; free oestradiol: 0.69 (0.59-0.80) vs 0.48 (0.42-0.54) pmol/l; oestrone: 180 (159-204) vs 119 (107-133) pmol/l (mean values (95% CI) in patients vs controls)). Furthermore, an increased oestrone:androstenedione ratio (0.095 vs 0.072, P < 0.01) was found in patients. SHBG correlated negatively (P < 0.001) with body mass, while the free fractions of oestradiol and testosterone correlated positively (P < 0.01) with body mass, in both patients and controls. Multiple regression analysis showed that the differences in oestrogen levels between the two groups persisted when controlling for the effect of body mass, age, years since menopause, parity, and levels of SHBG and FSH.

CONCLUSION

Patients with endometrial cancer exhibit increased plasma levels of oestradiol and oestrone. Speculatively, these oestrogens may result from an increased oestrone conversion from androstenedione, an increased ovarian and adrenal secretion of androstenedione, or alternative oestrogen production routes. The present findings support the hypothetical role for oestrogens in the aetiology of endometrial cancer.

Health habits and risk factors among truck drivers visiting a health booth during a trucker trade show

PURPOSE

The purpose of this report is to provide general information on the personal characteristics, health status, and health interests reported by long-haul truck drivers.

DESIGN

A cross-sectional survey was conducted based on a convenience sample. Statistical independence between comparison groups for driver type, age, and gender were tested with the Pearson chi-square test.

SETTING

The study population consisted of truck drivers who stopped at one of 65 truck stops participating in a trucker trade show.

SUBJECTS

Subjects were 2,945 male self-identified truck drivers and 353 female self-identified truck drivers who visited health booths at the trade show. It was estimated that two thirds of visitors to the health booth participated.

MEASURES

A self-administered, close-ended questionnaire recorded the participant's personal characteristics, health status, and health interests. Blood pressure was measured by trained volunteers.

RESULTS

A large percentage of male truck drivers smoked cigarettes (54% vs. 30% of U.S. white males), did not exercise regularly (92%), were overweight (50% vs. 25% of U.S. white males), and/or were not aware they had high blood pressure (66% vs. 46% of U.S. population). Also, 23% of surveyed truck drivers tested positive on one measure of alcoholism.

CONCLUSIONS

Although a scientific sample frame was not used, the health status and lifestyle observed in this study suggest truck drivers would clearly benefit from a health education and promotion program. The truck stops should be evaluated as a possible setting for such a program.

Plasma lipoprotein and apolipoprotein levels in Taipei and Framingham

We compared the plasma lipoprotein cholesterol, triglyceride, apolipoprotein (apo) A-I, apoB, and lipoprotein(a) [Lp(a)] concentrations in a low coronary heart disease (CHD) risk population (n = 440) in Taipei with a high CHD risk population (n = 428) in Framingham matched for age, sex, and menopausal status. Taipei men had significantly lower low-density lipoprotein cholesterol (LDL-C) (-20 mg/dL, -14%, P < .01) and apoB (-7 mg/dL, -6%, P < .05) levels and significantly higher high-density lipoprotein cholesterol (HDL-C) levels (6 mg/dL, 13%, P < .01) than Framingham men. Taipei women had significantly lower LDL-C (-18 mg/dL, -15%, P < .01) and higher HDL-C (4 mg/dL, 7%, P < .01) levels than Framingham women. Median concentrations and distributions of Lp(a) by sex were similar in Taipei and Framingham. After adjusting for body mass index and smoking status, only differences in total cholesterol and LDL-C levels remained significantly different for both sexes between the two populations (P < .01). Gender differences for lipids within populations were similar. After adjusting for age, body mass index, and smoking status, women in both Taipei and Framingham had significantly lower mean triglyceride, LDL-C, and apoB levels and significantly higher HDL-C and apoA-I levels than men. Postmenopausal women in Taipei had significantly higher mean total cholesterol, LDL-C, HDL-C, apoA-I, apoB, and Lp(a) levels than premenopausal women (P < .05), whereas in Framingham postmenopausal women had significantly higher total cholesterol, triglyceride, LDL-C, and apoB levels than premenopausal women (P < .05). Our data are consistent with the concept that plasma lipoprotein cholesterol levels (especially LDL-C) but not apolipoprotein values explain some of the twofold difference in age-adjusted CHD mortality between these two populations.

Self-esteem, parental appraisal and body size in children

This study investigates the influence of body size, parental appraisal of body size, and children's beliefs about parental appraisal, on self-esteem in children from 9 to 11 years old. Parents' and children's responses to a matched question about body size suggest that children are accurate predictors of parental evaluation and that their self-esteem scores are influenced both by actual parental dissatisfaction and beliefs about parental dissatisfaction. For boys, lower self-esteem is associated both with thinness and being perceived as too thin. For girls, lower self-esteem is more associated with fatness.

Alcohol use and blood pressure in an unacculturated society

Alcohol intake has been associated with higher blood pressure in acculturated populations but not in unacculturated societies. We performed a cross-sectional survey of a random community sample of 5023 male Yi rural farmers and 1656 Yi and 2173 Han men living in an urban setting. Average alcohol intake among drinkers was 36.4 g/d in Yi farmers, 56.5 g/d in Yi migrants, and 38.7 g/d in Han men. Age-adjusted mean diastolic blood pressure was 66.9, 70.5, and 71.7 mm Hg, respectively. Diastolic blood pressure was higher at higher alcohol intakes in all three groups (all P < .001). After adjustment for age, body mass index, heart rate, smoking, and physical activity, the change (95% confidence interval) in diastolic blood pressure for each standard drink was 0.50 (0.38-0.62), 0.31 (0.18-0.43), and 0.24 (0.07-0.40) mm Hg for Yi farmers, Yi migrants, and Han men, respectively. The percentage of variance in diastolic blood pressure explained by alcohol intake was 5% for Yi farmers, 4% for Yi migrants, and 2% for Han men. In a random sample of 831 men, these associations were independent of urinary sodium, potassium, calcium, and magnesium and sodium-potassium ratio. In the Yi farmers, associations were less strong for systolic blood pressure and no longer significant after adjustment. Approximately 33% of hypertension could be attributed to daily alcohol use in the Yi groups compared with 9.5% in the Han people.(ABSTRACT TRUNCATED AT 250 WORDS)

Patterns of tumor relapse following mastectomy and adjuvant systemic therapy in patients with axillary lymph node-positive breast cancer. Impact of clinical, histopathologic, and flow cytometric factors

BACKGROUND

This analysis was conducted to evaluate the impact of selected clinical, histopathologic, and flow cytometric factors on sites of initial tumor relapse after postmastectomy adjuvant systemic therapy.

METHODS

Five hundred sixty-four patients with axillary node-positive breast cancer were entered in two prospectively randomized trials and received cyclophosphamide, 5-fluorouracil and prednisone with or without tamoxifen as sole adjuvant therapy. These patients were studied to assess the risk of locoregional recurrence and to identify factors that might predict tumor relapse site.

RESULTS

With a median follow-up of 9.3 years, the 8-year cumulative incidences of initial locoregional or distant relapse were 20% and 35%, respectively. Pathologic tumor stage, estrogen receptor content, and number of involved axillary nodes were independent predictive factors for an increased risk of locoregional recurrence. With the exception of tumor stage, these factors also were associated with an increased risk of distant relapse so that tumor stage (T3a) remained the sole factor predictive of increased relative risk for initial locoregional (versus distant) recurrence in patients with tumor progression. Clinical and flow cytometric factors were not predictive of initial locoregional or distant relapse.

CONCLUSIONS

Exploratory data analysis of two prospective trials of postmastectomy adjuvant systemic therapy has demonstrated a significant risk for initial isolated locoregional recurrence in certain patients with node-positive breast cancer. The benefit of improved locoregional tumor control in appropriately selected patients with axillary node-positive breast cancer who receive adjuvant systemic therapy requires additional investigation.

The development of an instrument to measure motivation for marathon running: the Motivations of Marathoners Scales (MOMS)

This study reports the development of an instrument to assess the motives of marathon runners. The Motivations of Marathoners Scales (MOMS) contains 56 items distributed across nine scales. Content areas covered included health orientation, weight concern, self-esteem, life meaning, psychological coping, affiliation, recognition, competition, and personal goal achievement. Adequate internal consistency (Cronbach's alpha range .80 to .93), retest reliability (intraclass Rs range .71 to .90), and factorial validity of the scales were demonstrated. Assessment of the relationship between individual MOMS scales and other variables of conceptual relevance documents early evidence for the convergent and discriminant validity of the instrument. Future uses of the MOMS are discussed in light of theoretical, empirical, and practical considerations.

Number of pregnancies and the subsequent risk of cardiovascular disease

BACKGROUND

Whether increasing parity or gravidity is a risk factor for coronary heart disease has been debated, but the question remains unresolved.

METHODS

We tested the association between the number of pregnancies and a variety of cardiovascular end points in two groups of women who had completed childbearing. One group comprised 2357 women who were followed for 28 years through the Framingham Heart Study, and the other 2533 women followed for at least 12 years through the first National Health and Nutrition Examination Survey National Epidemiologic Follow-up Study (NHEFS).

RESULTS

The rates of coronary heart disease were higher among multigravid women than among women who had never been pregnant, in both the Framingham Heart Study and the NHEFS, but in both studies, the higher rates were statistically significant only in women with six or more pregnancies. For the women in the Framingham Study, the rate ratio adjusted for age and educational level in the group with six or more pregnancies (as compared with women who had never been pregnant) was 1.6 (95 percent confidence interval, 1.1 to 2.2). For the women in the NHEFS, the same adjusted rate ratio was 1.5 (95 percent confidence interval, 1.1 to 1.9). Adjustments for other known cardiovascular risk factors, including weight, did not markedly alter this risk. The rate of total cardiovascular disease was also significantly higher among multigravid women in the Framingham Study than in the women who had never been pregnant.

CONCLUSIONS

In two prospective American studies, having six or more pregnancies was associated with a small but consistent increase in the risk of coronary heart disease and cardiovascular disease. Whether gravidity itself or some other unmeasured factor accounts for the increase in risk that we observed requires further investigation.

An attempt to modify unhealthful eating attitudes and weight regulation practices of young adolescent girls

This is the first long-term, controlled study evaluating the effectiveness of a prevention curriculum designed to modify the eating attitudes and unhealthful weight regulation practices of young adolescent girls. Nine hundred sixty-seven sixth and seventh-grade girls were randomized to experimental healthy weight regulation curriculum or no-treatment control classes. A prevention intervention was developed around three principal components: (1) Instruction on the harmful effects of unhealthful weight regulation; (2) promotion of healthful weight regulation through the practice of sound nutrition and dietary principles and regular aerobic physical activity; (3) development of coping skills for resisting the diverse sociocultural influences that appear linked to the current popular obsessions with thinness and dieting. The intervention failed to achieve the hoped-for impact. We did observe a significant increase in knowledge among girls receiving the intervention and among high-risk students only, there was a small albeit statistically significant effect on body mass index. These findings question the wisdom of providing a curriculum directed at all young adolescents, most of whom are not at risk to develop an eating disorder. Rather than targeting the entire population, a healthy weight curriculum designed to modify the eating attitudes and unhealthful weight regulation practices of young adolescent girls might better focus on "at risk" students.

How abnormal is the desire for slimness? A survey of eating attitudes and behaviour among Chinese undergraduates in Hong Kong

Using the 40-item Eating Attitudes Test and other self-report questions, a two-stage screening survey of 1020 (F 646, M 374) Chinese bilingual university students in Hong Kong showed that although female students were 'underweight' by Western standard, the majority of them and nearly all female students above a body mass index of 20.5 kg/m2 were cognitively inclined to diet and weigh less, albeit without being driven to actual weight control behaviour. In contrast, most male students and a minority of constitutionally thin female students clearly wished to gain weight. While a number of items were culturally inappropriate, factor analysis supported the overall cross-cultural conceptual validity of the EAT. The principal factor, reflecting dieting concerns, correlated positively with the current body mass index. Among the high scorers, only three female students with partial syndrome bulimia nervosa were identified, yielding a low prevalence of 0.46% for the spectrum of eating disorders. It is argued that the desire for slimness is widespread but its intensity and pathogenic potentiality vary across cultures. In the relative absence of obesity, it may not lead to more eating disorder.

Nerve excitability testing: technical pitfalls and threshold norms using absolute values

Percutaneous stimulation of the facial nerve is used widely in tests to judge the severity and prognosis of facial paralysis. Several test paradigms are used including nerve excitability threshold (NET), the maximum stimulation test (MST), and electroneuronography (EnoG). Consistent technique and careful control of variables are essential to achieve accurate test results. The sources of variability examined in this study were age, gender, body weight, and the use of electrode paste; the NET was used as the test method. The facial NET in 120 adults without a history of facial paralysis increased linearly with age (P = .0004) and with body weight (P < .0001) and was higher in men than in women adjusted for age and weight (P = .0001). The mean NET +/- SD was 0.7 +/- 0.27 mA in the upper division using the eyelid twitch as an end point, and 1.2 +/- 0.40 mA in the lower division. There was no statistically significant difference in the results between sides. The NET was falsely elevated by the use of electrode paste, presumably due to current shunting away from the nerve. Based on the technique described herein, an absolute NET of > or = 1.25 mA in the upper division or an absolute NET > or = 2.0 mA in the lower division of the human facial nerve is statistically abnormal. These norms are not applicable to grossly obese patients or patients with facial edema or inflammation. Statistical norms allow the NET results to be reported on a continuous scale rather than the dichotomous scale used in the past. The predictive power of the NET will be greatly enhanced by basing test interpretation on both statistical and clinical significance.

Obesity: an important prognostic factor in acute pancreatitis

Ninety-nine patients with acute pancreatitis in whom body mass index (BMI = weight (kg)/height2 (m2)) was measured were studied prospectively to determine the importance of obesity as a prognostic factor in this disease. Of 19 obese patients (BMI > or = 30 kg/m2), 12 developed severe pancreatitis; seven had abscesses, of whom five died, and two further patients died. In 80 non-obese patients, the incidence of severe pancreatitis (n = 5), abscess formation (n = 4) and death (n = 4) was significantly less (P = 0.0007). The mean(s.d.) BMI of 17 patients with severe acute pancreatitis was significantly higher than that in 82 patients with mild acute disease (31.2(5.6) versus 23.3(5.6) kg/m2, P < 0.001). As a single prognostic factor, obesity had a sensitivity of 63 per cent and a specificity of 95 per cent for predicting disease severity. When five obese women with gallstone pancreatitis were excluded, the sensitivity of obesity increased to 86 per cent. Severe pancreatitis occurred in all eight obese patients with disease of an alcoholic aetiology. These data suggest that increased fat deposits in the peripancreatic and retroperitoneal spaces in obese patients may increase the risk of peripancreatic fat necrosis, abscess and death. Consideration should be given to including obesity as a prognostic factor in acute pancreatitis.

Secondary immune response to hepatitis B virus vaccine in alcoholics

The efficacy of full vaccination against hepatitis B virus (i.e., including the 1-year booster injection) was evaluated in 28 alcoholic patients with minimal liver disease. Although such patients are reportedly poor responders, the proportion of those protected (anti-HBs titer > = 10 mlU/ml) rose from 42.8% after primary immunization to 82% after the booster. The mean anti-HBs titer, which remained low in the overall group, was significantly lower in the subjects who resumed drinking during the follow-up period than in those who did not. This suggests a direct influence of alcohol itself on the response, because none of our patients had cirrhosis and none were clearly malnourished. Among the 17 patients for whom the 2-year post-booster anti-HBs titer could be determined, all those with a 1-month postbooster titer above 1000 mlU/ml still had a high anti-HBs level (> 100), whereas 80% of those with a 1-month postbooster titer < 1000 had 2 years later only a low (< 100) or even an unprotective anti-HBs level; this means that only the latter should be considered for a new booster injection. Our data indicate that protection against hepatitis B virus can be achieved in a good proportion of alcoholics with a full vaccination protocol. We suggest that efficacy should be evaluated 1 month after the booster, and that patients with low postbooster anti-HBs titers should be tested at regular intervals, because they can also be protected provided an adapted schedule of further injections is conducted.

Association of a PvuII RFLP at the lipoprotein lipase locus with fasting insulin levels in Hispanic men

We present results from an association study between RFLPs in the lipoprotein lipase (LPL) gene and lipid and insulin levels. The study population consisted of 102 Hispanic men and 97 Hispanic women. The subjects were genotyped for two previously reported RFLPs detected with the restriction enzymes HindIII and PvuII. The frequencies of the RFLPs in the Hispanic population are similar to those seen in other Caucasian populations. Strong linkage disequilibrium was detected between the sites in Hispanics. Genotypes were used separately in analyses of variance with fasting serum triglycerides, total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, HDL2/HDL3-cholesterol, and insulin levels, as well as two measures of adiposity: waist-hip ratio and body mass index. Men and women were analyzed separately. Mean fasting insulin levels of the LPL PvuII genotypes were significantly different from each other in Hispanic men. The mean fasting insulin level of men who were homozygous for the presence of the PvuII site (+/+) was 9.20 +/- 0.24 mu units/ml, men who were heterozygous had a mean level of 10.54 +/- 0.20 mu units/ml, and men who were homozygous for the absence of the site (-/-) had a mean of 12.91 +/- 0.30 mu units/ml. This effect was not seen in Hispanic women. These results suggest that the regulation of LPL by insulin may be different in Hispanics with different LPL PvuII genotypes.

The impact of D-Trp6 luteinizing hormone-releasing hormone (LH-RH) on carbohydrate metabolism

BACKGROUND

The population exposed to repeated cycles of gonadotropin-releasing hormone analogue treatment before in vitro fertilization is growing rapidly. Sex steroids have been shown to induce changes in carbohydrate metabolism. In view of the effect of gonadotropin-releasing hormone analogues on sex steroid levels, it seems of interest to investigate carbohydrate metabolism following treatment with these compounds.

PURPOSE

Our purpose was to assess possible changes in glucose tolerance following administration of the long-acting gonadotropin-releasing hormone and analogue, D-Trp6 LH-RH.

DESIGN

A 3-hr oral glucose tolerance test with 100 g glucose was performed on all patients, before and after 6 weeks of treatment.

RESULTS

No significant changes in either glucose tolerance or insulin levels following treatment with D-Trp6 LH-RH were demonstrated in the group of 25 women investigated.

CONCLUSION

With respect to carbohydrate metabolism, D-Trp6 LH-RH may safely be administered to healthy women. Further studies are still required to assess the safety of this GnRH analogue when treating potentially diabetic and diabetic patients.

[Body mass index (body mass.body height-2) as indicator of nutritional status in adults: review of the literature]

The limitations and possible uses of the body mass index (BMI) or Quételet index, calculated as the ratio of body mass (kg), and squared stature (m), as an indicator of the nutritional status of adults, are reviewed. The cut-off values for overweight (BMI > or = 25) and chronic energy deficiency (BMI < 18.5) are discussed in the light of the available international literature. Even though BMI does not assess the body composition (BC) of individuals, the case with which it is measured is a strong argument for the use of BMI in epidemiological studies associated otherwise with other anthropometric measurement until such a time as simpler field methods of the assessment of BC are developed.

Comparison of frame size and body mass index methods of assessment in the study of blood lipids

This study compared frame size and body mass index methods of assessment in relation to blood lipid levels. The data were obtained from the records of 84 men and 193 women who voluntarily participated in health fairs held at two suburban hospitals. Significant relationships and differences were found between the anthropometric and lipid variables studied. The two methods of classification denoted moderate association and reflected some divergence in classification between them.

Cardiomyopathy of obesity: a clinicopathologic evaluation of 43 obese patients with heart failure

Right heart hemodynamic and endomyocardial biopsy abnormalities associated with marked obesity were characterized in 43 obese patients who presented with symptoms of congestive heart failure. Marked obesity was defined as a body mass index greater than or equal to 35 kg/m2. They were compared to a group of 409 patients with similar presentations but normal body mass. Analysis of the 519 patients showed that body mass index was positively correlated with right heart pressures and cardiac output (p less than or equal to 0.0001), pulmonary vascular resistance index (p less than or equal to 0.003) and systolic blood pressure (p less than or equal to 0.0006). Obese patients had elevated right heart pressures, cardiac output (p less than or equal to 0.0001) and pulmonary vascular resistance index (p less than or equal to 0.02) when compared with a group of lean patients with a similar degree of cardiomyopathy. After evaluation, a significantly higher percentage of obese patients were found to have idiopathic dilated cardiomyopathy compared with lean patients. A specific etiology was found in 264 (64.5%) of the 409 lean patients compared with 10 (23.3%) of the obese patients (p less than or equal to 0.0001). The most common finding on endomyocardial biopsy in the obese group was mild myocyte hypertrophy (67%). These data suggest that the cardiomyopathy of obesity exists and may play an important role in a population referred for the evaluation of heart failure.

Morbid obesity: selection of patients for surgery

Massive obesity is associated with serious co-morbidities. After failure of extensive conservative measures, surgical procedures have developed as the only successful method for sustained weight loss. Criteria for operation are: presence of serious diseases associated with morbid obesity; greater than 45 kg above ideal weight or body mass index greater than 40 kg/m2 for usually greater than 5 years; failure of sustained weight loss on extensive conservative regimens; commitment to lifelong follow-up; and acceptable operative risk. Angina pectoris itself is not a contraindication to these operations. Patients who do not quite meet the weight criteria may still be candidates for an obesity operation in certain instances, e.g., debilitating musculoskeletal pains in weight-bearing joints, diabetes, significant hypertension, reflux esophagitis, urinary stress incontinence. Although current operations result in lasting weight loss of greater than 50% of excess weight in the majority of patients, the surgical candidate must understand and accept the principles of the procedures, the potential for serious complications, the dietary necessities, and occasional failures.

Predictors of osteopenia in premenopausal women with anorexia nervosa

The study retrospectively evaluated risk factors for osteopenia in anorexia nervosa (AN) patients. Sixty-nine outpatient, female anorexia nervosa patients (age range 20-40 years, mean 27.5) at varying stages of recovery, and 31 controls had lumbar spine trabecular bone density assessed with single energy computed tomography (CT) scans. An investigator-based, semistructured interview assessed weight and menstrual histories from age 10. Current exercise and dietary calcium levels were categorized and lifetime durations in categories were estimated for each subject. Bone density was significantly lower in the patient group (mean 120 mg/cm3) than in the controls (mean 148 mg/cm3, P less than 0.001). Bone density correlated significantly with duration of illness, amenorrhea, and weight histories but not with measures of dietary calcium or exercise histories. The most important predictor of bone loss on stepwise multiple regression analysis was duration of AN (23% of variance, P less than 0.001), and duration of an inadequate calcium intake in adolescence explained a further 5% of the variance (P = 0.052). There was no evidence that regular exercise and adequate dietary calcium prevented bone loss related to prolonged periods of low weight and amenorrhea in these subjects.

Patients' choices and perceptions after an invitation to participate in treatment decisions

Previous search indicates that treatment outcomes may be improved if patients perceive greater control over their treatment, but the practical implications of encouraging patients to take more control have not been investigated. The present study investigated responses of 143 patients in a cardiovascular risk management clinic to an invitation to make a decision about their treatment. Subjects' choices of the target behaviour for their behaviour-change treatment were highly predictable from their state of health, reasons for coming to the clinic, what behaviours they were told they were at risk from, and contacts with health workers. The degree of control that subjects reported they had over the decision varied considerably, being negatively related to blood pressure and positively related to the degree of control that subjects believed they had over their health in general. Issues such as time-demands, the practitioner's job satisfaction, and ethical implications of patient participation are discussed.

The use of the Body Mass Index in studies of abdominal wound infection

Abdominal wound infection rates were significantly related to obesity, as measured by Body Mass Index, in two large clinical trials of prophylactic antibiotics in at-risk abdominal surgery. Obesity is a risk factor that should be taken into account in any study in which wound infection is an outcome measure.