Relation of weight gain and weight loss on subsequent diabetes risk in overweight adults

Functional limitation and chronic diseases are associated with food insecurity among U.S. adults

PURPOSE

This study examined associations of functional limitation due to any health problems and six chronic diseases (arthritis, diabetes, coronary heart disease, heart attack, hypertension, and stroke) with food security among U.S. adults.

METHODS

The 2011 National Health Interview Survey data for 30,010 adults (≥18 years) were used. Adults were categorized into food secure, low food secure, or very low food secure. Multivariable logistic regressions were used to estimate adjusted odds ratio (OR) and 95% confidence interval (CI) for having functional limitation and chronic diseases while adjusting for sociodemographic and lifestyle factors.

RESULTS

The prevalence of functional limitation and the chronic diseases were higher in low-food-secure and very low-food-secure than food-secure adults. The adjusted ORs were significant in both low food secure and very low food secure, respectively, for functional limitation (OR: 1.87; 95% CI: 1.63, 2.14), (OR: 2.20; 95% CI: 1.91, 2.52), inflammatory diseases or joint/muscular pain (OR: 1.42; 95% CI: 1.21, 1.68), (OR: 1.74; 95% CI: 1.49, 2.04), diabetes (OR: 1.26; 95% CI: 1.06, 1.51), (OR: 1.23; 95% CI: 1.02, 1.48), and hypertension (OR: 1.18; 95% CI: 1.04, 1.35), (OR: 1.42; 95% CI: 1.22, 1.65) when compared with food-secure adults.

CONCLUSIONS

Findings indicate that food insecurity is associated with functional limitation and chronic diseases, whereas directionality is unknown. Besides the traditional food assistance program for food-insecure populations, interventions to prevent or manage chronic diseases may be necessary to help them reduce the risk of the diseases and manage their conditions.

Changes in body mass index and incidence of diabetes: A longitudinal study of Alberta's Tomorrow Project Cohort

Although obesity is a known risk factor for diabetes, the impact of body mass index (BMI) changes over time, especially BMI reduction, on diabetes development is less than clear. The objective of this study is to characterize the association between BMI changes over time and incidence of diabetes in a cohort of adults in Alberta. From 2000 to 2008, Alberta's Tomorrow Project (ATP) enrolled participants aged 35-69 to a population-based prospective cohort study. BMI was calculated from self-reported height and weight; change in BMI (∆BMI) was calculated as the difference between baseline and follow-up measurements. Diabetes cases were identified using the Canadian National Diabetes Surveillance System algorithm applied to linked administrative data (2000-2015). Multivariable Cox regression was used to examine the association between ∆BMI and incidence of diabetes. In a subset of the ATP cohort (n=19,164), 1168 incident cases of diabetes were identified during 198,853person-years of follow-up. Overall, BMI increase was associated with increased risk and BMI reduction was associated with reduced risk of diabetes. Particularly, compared to minimal BMI change (±5%), moderate (5%-10%) reduction in BMI was associated with 34% (95% CI: 12%-51%) reduction in risk of diabetes in participants with obesity; whereas 10% or greater increase in BMI was associated with an increased risk of diabetes of 64% or more in participants with overweight and obesity; in participants with normal and underweight, BMI changes was not apparently associated with risk of diabetes. Public health programs promoting weight loss, even at a moderate extent, would reduce risk of diabetes.

Incremental Treatment Costs Attributable to Overweight and Obesity in Patients with Diabetes: Quantile Regression Approach

OBJECTIVE

This study aimed to estimate treatment costs attributable to overweight and obesity in patients with diabetes who were less than 65 years of age in the United States.

METHODS

This study used data from the Medical Expenditure Panel Survey from 2001 to 2013. Patients with diabetes were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification code (250), clinical classification codes (049 and 050), or self-reported physician diagnoses. Total treatment costs attributable to overweight and obesity were calculated as the differences in the adjusted costs compared with individuals with diabetes and normal weight. Adjusted costs were estimated by using generalized linear models or unconditional quantile regression models.

RESULTS

The mean annual treatment costs attributable to obesity were $1,852 higher than those attributable to normal weight, while costs attributable to overweight were $133 higher. The unconditional quantile regression results indicated that the impact of obesity on total treatment costs gradually became more significant as treatment costs approached the upper quantile.

CONCLUSIONS

Among patients with diabetes who were less than 65 years of age, patients with diabetes and obesity have significantly higher treatment costs than patients with diabetes and normal weight. The economic burden of diabetes to society will continue to increase unless more proactive preventive measures are taken to effectively treat patients with overweight or obesity.

Perioperative management of the obese surgical patient

INTRODUCTION

The escalation in the prevalence of obesity throughout the world has led to an upsurge in the number of obese surgical patients to whom perioperative care needs to be delivered.

SOURCES OF DATA

After determining the scope of the review, the authors used PubMed with select phrases encompassing the words in the scope. Both preclinical and clinical reports were considered.

AREAS OF AGREEMENT

There were no controversies regarding preoperative management and the intraoperative care of the obese surgical patient.

AREAS OF CONTROVERSY

Is there a healthy obese state that gives rise to the obesity paradox regarding postoperative complications?

GROWING POINTS

This review considers how to prepare for and manage the obese surgical patient through the entire spectrum, from preoperative assessment to possible postoperative intensive care.

AREAS TIMELY FOR DEVELOPING RESEARCH

What results in an obese patient developing 'unhealthy' obesity?

Impact of body fat percentage change on future diabetes in subjects with normal glucose tolerance

The aim of the work was to determine the effect of body fat change on risk of diabetes in normal glucose tolerance (NGT) population. A total of 1,857 NGT subjects were included and followed up for an average period of 44.57 months. Body fat percentage (BF%) was measured by bioelectrical impedance analysis. Subjects were grouped based on the BF% and/or body mass index (BMI) state. Among all subjects, 28 developed diabetes after follow-up. Compared with subjects with stable normal BF% (control), subjects who became obesity at follow-up were defects in insulin secretion and had a higher risk of developing diabetes (7.102, 95% confidence intervals [CI] 1.740-28.993), while no difference in diabetic risk could be viewed between subjects with abnormal BF% at baseline but normal at the end of follow-up and control subjects after adjustment of confounding factors. Moreover, compared with those keeping normal BF% and BMI both at baseline and follow-up, subjects who had normal BMI at baseline and follow-up, but abnormal BF% at baseline or/and follow-up still had a higher risk to develop diabetes (4.790, 95% CI 1.061-21.621), while those with normal BF% at baseline and follow-up, but abnormal BMI at baseline or/and follow-up had not. Subjects from normal BF% at baseline to obese at follow-up are associated with an increased risk of diabetes. Maintaining normal body fat is more relevant than BMI in preventing diabetes. © 2017 IUBMB Life, 69(12):947-955, 2017.

Effect of pomegranate extract on blood pressure and anthropometry in adults: a double-blind placebo-controlled randomised clinical trial

Pomegranate (Punica granatum), a polyphenol-rich fruit, has been suggested to reduce cardiovascular risk due to its antioxidant properties. Hypertension and obesity are the most preventable cardiovascular risk factors. Few studies on blood pressure and/or body-weight status have been conducted in human subjects. Previous investigations have tended to focus on pomegranate juice. The aim of the present study was to investigate the effect of pomegranate extract (PE) on blood pressure and anthropometric measures in adults with no symptomatic disease. A total of fifty-five participants enrolled in a randomised double-blinded placebo-controlled clinical trial where they were assigned to either PE capsules or placebo capsules for 8 weeks. Blood pressure, body weight, waist circumference, waist:hip ratio (WHR) and body composition (lean body mass, body fat) were measured at baseline, week 4 and week 8. Results showed a significant decrease in diastolic blood pressure after 8 weeks (by 2·79 (sd 5·32) mmHg; P < 0·05), while the decrease in systolic blood pressure did not reach statistical significance (2·57 (sd 7·4) mmHg; P > 0·05). Body fat percentage, lean body mass, waist circumference and WHR did not significantly differ between groups at the end of the intervention. Results suggest that PE may reduce blood pressure and possibly prevent hypertension in the normotensive population. Further large trials are required to elucidate this effect.

The association of betel quid, alcohol, and cigarettes with salivary gland tumor-A case-control study

Background/purpose

Salivary gland tumor (SGT) is a rare disease with a largely unknown etiology. The risks of betel quid chewing, alcohol drinking, and cigarette smoking have been well documented in oral cancer but not in SGT. We aimed to investigate the independent and combined effects of betel quid chewing, cigarette smoking, and alcohol consumption on the incidence of SGT.

Materials and methods

We conducted a case–control study of 1845 patients aged 35–65 years, including 239 patients with pathologically proven SGT and 1606 controls from the health examination clinics of the same hospital during 2005–2014 to examine the association of these three risk factors with SGT in Taiwan. Adjusted odds ratio (aOR) and their 95% confidence interval for the association of risk factors to SGT were analyzed.

Results

After adjusting for covariates, aOR of cigarette smoking, alcohol drinking, and betel quid chewing were 2.50, 1.27, and 3.38, respectively for SGT. The significantly increased risk for SGT was observed in cigarette smoking (P < 0.001). Cigarette smoking was also found to increase risks in subgroups of SGT (aOR = 5.24, 2.41, 2.63, and 2.04 in minor, major, benign, and malignant SGT, respectively).

Conclusion

Our study provided the first evidence to show the independent and combined impact of betel quid chewing with cigarette smoking and alcohol drinking on the SGT, and support the concept that cigarette smoking may associate with SGT carcinogenesis.

The Association of Percent Body Fat and Lean Mass With HbA1c in US Adults

CONTEXT

Body fat and body composition distribution patterns affect diabetes risk and glycemic control, but most studies use proxy measures (e.g., body mass index).

OBJECTIVE

This study examined the association of percent body fat and lean mass with glycated hemoglobin (HbA1c) in US adults.

DESIGN

The National Health and Nutrition Examination Survey (NHANES) is a program of cross-sectional studies that enroll nationally representative samples of the US civilian noninstitutionalized population.

SETTING

NHANES is designed to assess the health status of adults and children throughout the United States.

PARTICIPANTS

This study included 11,125 participants aged 18 to 69 years from the 1999 through 2006 NHANES, comprising 846 persons with diagnosed diabetes and 10,125 without diabetes.

MAIN OUTCOME MEASURES

Total and abdominal (trunk) percent body fat and lean mass were measured using dual-energy x-ray absorptiometry. Linear and logistic regression analyses were used to examine their association with HbA1c.

RESULTS

Among those without diagnosed diabetes, total and trunk percent body fat, as well as trunk and total lean mass, were strongly associated with elevated HbA1c; odds ratios per 5% increment for the association of percent body fat with HbA1c >5.7% (39 mmol/mol) ranged from 1.60 to 2.01 across age and sex categories. Among adults with diabetes, higher total percent fat was associated with higher HbA1c in males age <40 years and higher trunk fat was associated with higher HbA1c in females across age categories.

CONCLUSIONS

Lifestyle interventions to lower HbA1c should consider targeting both weight loss and body composition.

Obesity and Physical Activity

Some clinical manifestations of obesity include nonalcoholic fatty liver disease, type 2 diabetes, and cardiovascular disease. Calorie restriction may aid in weight loss in the short term. Exercise and physical activity are other means of weight loss. However, the efficacy of exercise and physical activity in weight reduction in obese populations is still unknown. In this review, we discuss the effects of exercise and physical activity in obese and overweight populations. We also discuss the effects of aerobic exercise and/or resistance training in weight loss and maintenance.

Weight change and risk of hyperglycaemia in elderly women

BACKGROUND

Hyperglycaemia increases the risk of type 2 diabetes, heart disease and stroke, and is influenced by weight. However, the impact of preceding weight change on blood glycemia levels in late-life is less well understood.

AIM

We studied the interplay between weight change and risk of hyperglycaemia in a prospective cohort of elderly women.

METHODS

Elderly Caucasian women (age: 67.1 years at baseline, n = 1173) enrolled in the Prospective Epidemiological Risk Factor study with baseline and 13-year follow-up measurements of BMI and fasting glucose levels (FPG) and no previous history of diabetes or impaired fasting glucose. Multivariate logistic regression was used to determine risk of hyperglycaemia (FPG ≥ 5.6 mmol/L or HbA1c ≥ 42 mmol/mol) in normalweight (BMI ≤ 25 kg/m²), overweight (BMI = 25-29.9 kg/m²) and obese (BMI ≥ 30 kg/m²) women who either lost weight, were weight-stable or had gained weight at follow-up.

RESULTS

Overweight and obese elderly women who had gained weight at follow-up presented an increased risk of hyperglycaemia, OR = 2.7 (1.6-4.6) and OR = 3.2 (1.5-6.8), compared to weight-stable normalweight women. Overweight and obese women who lost weight decreased their risk of hyperglycaemia to a level comparable to weight-stable normalweight women. Overweight and obese women with stable weight presented a two-fold increased risk of hyperglycaemia compared to normalweight weight-stable women.

CONCLUSIONS

Losing weight in late life had a positive effect on the risk of hyperglycaemia in overweight and obese women, while further, weight gain increased the risk of hyperglycaemia. The study highlights that strategies to reduce weight in obese and overweight elderly women could have a positive influence on disease burden in late-life.

Duration and degree of weight change and risk of incident diabetes: Japan Epidemiology Collaboration on Occupational Health Study

We prospectively examined diabetes risk in association with a summary measure of degree and duration of weight change. The study participants were 51,777 employees from multiple companies in Japan, who were aged 30-59years, free of diabetes at baseline, and followed up for 7years (2008-2015). Exposure was cumulative body mass index (BMI)-years, which was defined as the area of BMI units above or below baseline BMI during follow-up, and was treated as a time-dependent variable in the Cox proportional hazards regression models. During the 263,539 person-years of follow-up, 3465 participants developed diabetes. The adjusted hazard ratio (HR) of diabetes for a 1-unit increase in cumulative BMI-years was 1.11 (95% confidence interval (CI): 1.09, 1.12). The association was more pronounced among overweight (HR=1.11; 95% CI: 1.08, 1.14) and obese (HR=1.12; 95% CI: 1.08, 1.15) adults compared with normal- and under-weight (HR=1.07; 95% CI: 1.03, 1.11) adults (P for interaction of cumulative BMI-years X baseline BMI-group=0.002). The association of higher cumulative BMI-years with incident diabetes did not substantially differ by metabolic phenotype. The present results emphasize the importance of avoiding additional weight gain over an extended period of time for the prevention of type 2 diabetes, especially among overweight and obese adults, irrespective of metabolic health status.

Is Childhood Socioeconomic Status Independently Associated with Adult BMI after Accounting for Adult and Neighborhood Socioeconomic Status?

Childhood socioeconomic status (SES) is inversely associated with adult weight in high income countries. Whether the influence of childhood SES on adult weight is best described using a critical period model or an accumulation of risk model is not yet settled. This research tests whether childhood SES is associated with adult BMI and likelihood of obesity independent of adult socioeconomic status and neighborhood characteristics. Data on individual childhood and adult characteristics come from the Health and Retirement Study (N = 13,545). Data on neighborhood characteristics come from the 2000 Decennial Census and American Community Survey (2005-2009). In the fully adjusted models, perceived financial hardship before the age of sixteen and having a father who was unemployed are associated with higher BMI among males and, among females, paternal education remains associated with adult BMI. However, childhood SES is not associated with likelihood of obesity after fully adjusting for adult SES and neighborhood characteristics, suggesting that the direct effects of early childhood SES on BMI are small relative to the other factors associated with obesity in adulthood.

Delayed insulin secretion response during an OGTT is associated with an increased risk for incidence of diabetes in NGT subjects

AIMS

This study aimed to assess whether insulin secretion patterns during oral glucose tolerance tests (OGTTs) could predict future type 2 diabetes (T2D) in Chinese normal glucose tolerance (NGT) subjects.

METHODS

A total of 558 NGT, 419 newly diagnosed impaired glucose tolerance, and 694 newly diagnosed T2D patients were assessed. NGT subjects were grouped based on the time of peak insulin secretion during a 3h- OGTT; at 30min (InsP30), 60min (InsP60), 120min (InsP120), or 180min (InsP180), respectively. NGT subjects were followed up for an average duration of 5.58±1.08years. Beta-cell function was estimated by Stumvoll insulin secretion.

RESULTS

The InsP120 and InsP180 groups had lower Stumvoll first-phase insulin secretion levels compared with InsP30. At 5.58±1.08years, 25 (5.39%) NGT subjects had developed T2D. The cumulative incidence rate of diabetes was higher in the InsP120 and InsP180 groups (8.94%), compared with InsP30 (1.48%) (P<0.05). The adjusted relative risk for incident diabetes was 7.30 (95% CI: 1.53-34.72) times higher in the InsP120 and InsP180 groups.

CONCLUSIONS

NGT subjects with late insulin responses had defective early insulin secretion and were at higher risk of developing diabetes. Insulin secretion patterns could be a useful T2D predictor in the Chinese population.

The effects of the aqueous extract and residue of Matcha on the antioxidant status and lipid and glucose levels in mice fed a high-fat diet

Matcha is a kind of powdered green tea produced by grinding with a stone mill. In the present study, the preventive effects of the aqueous extract (water-soluble) and residue (water-insoluble) of Matcha on the antioxidant status and lipid and glucose levels in mice fed a high-fat diet were investigated. Mice were fed seven different experimental diets for 4 weeks: a normal diet control (NC), a high-fat diet (HF), a high-fat diet with 0.025% Matcha (MLD), a high-fat diet with 0.05% Matcha (MMD), a high-fat diet with 0.075% Matcha (MHD), a high-fat diet with 0.05% Matcha aqueous extracts (ME), and a high-fat diet with 0.05% Matcha residues (MR). It was found that serum total cholesterol (TC) and triglyceride (TG) levels of the MHD group were significantly decreased compared to those of the HF group. Furthermore, in the MHD group, the level of high-density lipoprotein-cholesterol (HDL-C) was elevated, on the contrary the level of low-density lipoprotein-cholesterol (LDL-C) was suppressed. Moreover, Matcha could significantly lower the blood glucose levels, and improve the superoxide dismutase (SOD) activity and malondialdehyde (MAD) contents both in serum and liver; besides, the serum GSH-Px activity indicated that the oxidative stress caused by HF could be reversed by administration of Matcha. These findings suggest that Matcha has beneficial effects through the suppression of the blood glucose (BG) accumulation and promotion of the lipid metabolism and antioxidant activities. Moreover, the water-insoluble part of Matcha is suggested to play an important role in the suppression of diet-induced high levels of lipid and glucose.

BMI Trajectories as a Harbinger of Pre-Diabetes or Underdiagnosed Diabetes: an 18-Year Retrospective Cohort Study in Taiwan

BACKGROUND

Although prior studies have examined BMI trajectories in Western populations, little is known regarding how BMI trajectories in Asian populations vary between adults with and without diabetes.

OBJECTIVE

To examine how BMI trajectories vary between those developing and not developing diabetes over 18 years in an Asian cohort.

DESIGN

Multilevel modeling was used to depict levels and rates of change in BMI for up to 18 years for participants with and without self-reported physician-diagnosed diabetes.

PARTICIPANTS

We used 14,490 data points available from repeated measurements of 3776 participants aged 50+ at baseline without diabetes from a nationally representative survey of the Taiwan Longitudinal Study on Aging (TLSA1989-2007).

MAIN MEASURES

We defined development of diabetes as participants who first reported diabetes diagnoses in 2007 but had no diabetes diagnoses at baseline. We defined the reference group as those participants who reported the absence of diabetes at baseline and during the entire follow-up period.

KEY RESULTS

When adjusted for time-varying comorbidities and behavioral factors, higher level and constant increases in BMI were present more than 6.5 years before self-reported diabetes diagnosis. The higher BMI level associating with the development of diabetes was especially evident in females. Within 6.5 years prior to self-reported diagnosis, however, a wider range of decreases in BMI occurred (βdiabetes = 1.294, P = 0.0064; βdiabetes*time = 0.150, P = 0.0327; βdiabetes*time (2) = -0.008, P = 0.0065). The faster rate of increases in BMI followed by a greater decline was especially prominent in males and individuals with BMI ≧24.

CONCLUSIONS

An unintentional decrease in BMI in sharp contrast to the gradually rising BMI preceding that time may be an alarm for undiagnosed diabetes or a precursor to developing diabetes.

Association of Additional Health Risks on Medical Charges and Prevalence of Diabetes within Body Mass Index Categories

Purpose.

The prevalence of obesity and diabetes continues to increase among employee populations. Although medical costs and the prevalence of diabetes have been studied across increasing body mass index (BMI) categories, little attention has been given to the association of additional health risks within those categories. The purpose of this study was to examine the association of health risk levels on medical charges and prevalence of diabetes across BMI categories within an employee population.

Methods.

A cross-sectional study design utilized health risk appraisal data (30% response rate) to measure BMI levels, self-reported diabetes status, and selected additional health risks among 38,841 active employees under age 65 of the General Motors Corporation. Associated average annual medical charges from 1996 to 2000 were calculated for defined health risk levels across five BMI categories (<18.5; 18.5–24.9, 25–29.9, 30–34.9, and ≥35).

Results.

Higher medical charges were significantly associated with additional health risks (zero risks to four or more risks) across each of the BMI categories: $2689 to $7576 (<18.5); $2655 to $6555 (18.5–24.9); $3239 to $7118 (25–29.9); $3579 to $7758 (30–34.9); and $4151 to $8075 (≥35). Likewise, higher prevalence of diabetes was significantly associated with additional health risks (zero risks to four or more risks) across the BMI categories: 2.6% to 7.0% (<18.5); 1.3% to 2.7% (18.5–24.9); 2.4% to 5.3% (25–29.9); 5.5% to 8.3% (30–34.9); and 7.7% to 15.8% (≥35).

Discussion.

Medical costs and the prevalence of diabetes were lower when the numbers of additional health risks were lower, regardless of the BMI category. Programs to promote weight management have largely been unsuccessful in maintaining long-term weight control. The current results suggest that a strategy focused on reducing health risks within any weight category could provide an alternative strategy to achieve medical cost savings and a lower prevalence of diabetes. The implied benefits of risk reduction within BMI categories would need to be confirmed with a longitudinal study.

Cost effectiveness of an internet-delivered lifestyle intervention in primary care patients with high cardiovascular risk

OBJECTIVE

To assess the cost-effectiveness of an online adaptation of the diabetes prevention program (ODPP) lifestyle intervention.

METHODS

ODPP was a before-after evaluation of a weight loss intervention comprising 16 weekly and 8 monthly lessons, incorporating behavioral tools and regular, brief, web-based individualized counseling in an overweight/obese cohort (mean age 52, 76% female, 92% white, 28% with diabetes). A Markov model was developed to estimate ODPP cost effectiveness compared with usual care (UC) to reduce metabolic risk over 10years. Intervention costs and weight change outcomes were obtained from the study; other model parameters were based on published reports. In the model, diabetes risk was a function of weight change with and without the intervention.

RESULTS

Compared to UC, the ODPP in our cohort cost $14,351 and $29,331 per quality-adjusted life-year (QALY) gained from the health care system and societal perspectives, respectively. In a hypothetical cohort without diabetes, the ODPP cost $7777 and $18,263 per QALY gained, respectively. Results were robust in sensitivity analyses, but enrolling cohorts with lower annual risk of developing diabetes (≤1.8%), enrolling fewer participants (≤15), or increasing the hourly cost (≥$91.20) or annual per-participant time (≥1.45h) required for technical support could increase ODPP cost to >$20,000 per QALY gained. In probabilistic sensitivity analyses, ODPP was cost-effective in 20-58% of model iterations using an acceptability threshold of $20,000, 73-92% at $50,000, and 95-99% at $100,000 per QALY gained.

CONCLUSIONS

The ODPP may offer an economical approach to combating overweight and obesity.

Impact of Improving Home Environments on Energy Intake and Physical Activity: A Randomized Controlled Trial

OBJECTIVES

We assessed the effectiveness of an intervention targeting home food and activity environments to reduce energy intake and increase physical activity among overweight and obese patients from 3 community health centers in rural Georgia.

METHODS

We conducted a randomized controlled trial (n = 349) from 2011 to 2013, with follow-up at 6 and 12 months. Health coaches delivered the 16-week intervention by using tailored home environment profiles showing areas in need of improvement and positive aspects of the home environment, behavioral contracts for healthy actions, and mailed support materials.

RESULTS

Participants were mostly African American women (84.8%), with a mean age of 50.2 years and a mean body mass index (weight in kilograms divided by the square of height in meters) of 38.3. Daily energy intake decreased more for the intervention than control group at 6 (-274 vs -69 kcal) and 12 months (-195 vs -76 kcal). We observed no change for either objective or self-reported physical activity. At 12 months, 82.6% of intervention participants had not gained weight compared with 71.4% of control participants.

CONCLUSIONS

The intervention was effective in changing home environments and reducing energy intake.

Movers and stayers: how residential selection contributes to the association between female body mass index and neighborhood characteristics

BACKGROUND/OBJECTIVES

To examine how a woman's current body mass index (BMI) is associated with nonrandom residential migration that is based on the average BMI of her origin and destination neighborhoods.

SUBJECTS/METHODS

Among women having at least two children, all birth certificates from Salt Lake county from 1989 to 2010 (n=34 010) were used to obtain prepregnancy weights before the first and second births, residential location and sociodemographic information. Census data were used for measures of walkability of neighborhoods.

RESULTS

After adjustments for age, education, race/ethnicity and marital status, obese women living in the leanest neighborhoods are found to be three times more likely (odds ratio (OR)=3.03, 95% confidence interval (CI) 2.06-4.47) to move to the heaviest neighborhoods relative to women with healthy weight (BMI between 18 and 25 kg m(-2)). Conversely, obese women in the heaviest neighborhoods are 60% less likely (OR=0.39, 95% CI 0.22-0.69) to move to the leanest neighborhoods relative to healthy weight women. Indicators of relatively greater walkability (older housing, greater proportion of residents who walk to work) and higher median family income characterize leaner neighborhoods.

CONCLUSIONS

The findings are consistent with the hypothesis that nonrandom selection into and out of neighborhoods accounts for some of the association between BMI and neighborhood characteristics.

Different consumed oils and metabolic parameters in type 2 diabetes patients in diabetes society of Natanz

AIMS

This study, for the first time, has investigated the effect of highly consumed oils in Iran on type 2 diabetic patient's blood pressure.

MATERIALS AND METHODS

After measuring height, weight and blood pressure and calculating Body Mass Index (BMI) of 200 patients (30-65 years old) with type 2 diabetes (26.7% men, 73.3% women) in diabetes center of Natanz, their consumed oil was obtained by questionnaire, and their blood lipid and glucose were also measured. Data analyzed by SPSS 16 software, one-way ANOVA, independent T test, and Means procedure statistic tests.

RESULTS

In mean procedure test, the highest average of systolic and diastolic blood pressure was in patients consumed solid and semi-solid oils; and the lowest was in patients consumed vegetable liquid oils. However, women consumed solid vegetable oils have lower systolic and mean arterial pressures. In one-way ANOVA test, there was a significant relation between consumed oil and hemoglobin A1C (p=0.049) and diastolic blood pressure (p=0.032).

CONCLUSION

Consumption of solid and semi-solid oils, especially animal fat, cause increasing in blood pressure of diabetic type 2 patients; but consumption of olive oil, and to a lesser extent liquid vegetable oils, related to lesser increasing in their blood pressure.

Association between the change in body mass index from early adulthood to midlife and subsequent type 2 diabetes mellitus

OBJECTIVE

To clarify the quantitative relationship of body mass index (BMI) change from early adulthood to midlife with presence of type 2 diabetes mellitus (T2DM) after midlife.

METHODS

This study included 120,666 middle-aged and elderly, whose retrospectively self-reported body weight at 20 and 40 years and measured height were available. BMI at 20 and 40 years and BMI change in between were defined as early-adulthood BMI, midlife BMI, and early-adulthood BMI change.

RESULTS

The odds ratio (OR) for T2DM associated with an 1-unit increment of early-adulthood or midlife BMI was 1.08 (95% confidence interval (CI), 1.07-1.08) and 1.09 (95% CI, 1.09-1.10) respectively. In the cross-tabulation of both early-adulthood BMI and BMI change, the prevalence of T2DM increased across both variables. Compared with participants with normal early-adulthood weight and BMI increase/decrease ≤1, the OR (95% CI) for T2DM of participants with early-adulthood overweight/obesity and BMI increase ≥4 kg/m(2) was 3.49 (3.05-4.00). For participants with early-adulthood underweight and BMI increase/decrease ≤ 1, the OR (95% CI) was 0.85 (0.75-0.97). Subgroup analysis according to sex and age showed similar trends.

CONCLUSIONS

Early-adulthood BMI may influence T2DM prevalence after midlife independent of current BMI. T2DM prevalence after midlife was positively associated with early-adulthood weight gain and inversely related to early-adulthood weight loss, while early-adulthood weight loss could not completely negate the adverse effect of early-adulthood overweight/obesity on diabetes.

Annual Average Changes in Adult Obesity as a Risk Factor for Papillary Thyroid Cancer: A Large-Scale Case-Control Study

We evaluated the association between weight change in middle-aged adults and papillary thyroid cancer (PTC) based on a large-scale case-control study. Our study included data from 1551 PTC patients (19.3% men and 80.7% women) who underwent thyroidectomy at the 3 general hospitals in Korea and 15,510 individually matched control subjects. The subjects' weight history, epidemiologic information, and tumor characteristics confirmed after thyroidectomy were analyzed. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were determined for the annual average changes in weight and obesity indicators (body mass index (BMI), body surface area, and body fat percentage (BF%) in subjects since the age of 35 years. Subjects with a total weight gain ≥10 kg after age 35 years were more likely to have PTC (men, OR, 5.39, 95% CI, 3.88-7.49; women, OR, 3.36, 95% CI, 2.87-3.93) compared with subjects with a stable weight (loss or gain <5 kg). A marked increase in BMI since age 35 years (annual average change of BMI ≥0.3 kg/m/yr) was related to an elevated PTC risk, and the association was more pronounced for large-sized PTC risks (<1 cm, OR, 2.34, 95% CI, 1.92-2.85; ≥1 cm, OR, 4.00, 95% CI, 2.91-5.49, P heterogeneity = 0.005) compared with low PTC risks. Weight gain and annual increases in obesity indicators in middle-aged adults may increase the risk of developing PTC.

Obesity, diabetes, and leptin resistance promote tau pathology in a mouse model of disease

Obesity and type 2 diabetes mellitus (T2DM) convey an increased risk for developing dementia. The microtubule-associated protein tau is implicated in neurodegenerative disease by undergoing hyperphosphorylation and aggregation, leading to cytotoxicity and neurodegeneration. Enzymes involved in the regulation of tau phosphorylation, such as GSK3β, are tightly associated with pathways found to be dysregulated in T2DM. We have shown previously that leptin-resistant mice, which develop obesity and a diabetic phenotype, display elevated levels of tau phosphorylation. Here we show cells cultured with leptin, an adipokine shown to have neuroprotective effects, reduces tau phosphorylation. To explore how this mechanism works in vivo we transduced an existing diabetic mouse line (Lepr(db/db)) with a tau mutant (tau(P301L)) via adeno-associated virus (AAV). The resulting phenotype included a striking increase in tau phosphorylation and the number of neurofibrillary tangles (NFTs) found within the hippocampus. We conclude that leptin resistance-induced obesity and diabetes accelerates the development of tau pathology. This model of metabolic dysfunction and tauopathy provides a new system in which to explore the mechanisms underlying the ways in which leptin resistance and diabetes influence development of tau pathology, and may ultimately be related to the development of NFTs.

Health behavior change following a diagnosis of ductal carcinoma in situ: An opportunity to improve health outcomes

Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer that comprises approximately 20% of new breast cancer diagnoses. DCIS is predominantly detected by screening mammography prior to the development of any clinical symptoms. Prognosis following a DCIS diagnosis is excellent, due to both the availability of effective treatments and the frequently benign nature of the disease. However, a DCIS diagnosis and its treatment have psychological and physical impacts that often lead to adverse changes in health-related behaviors, including changes in physical activity, body weight, alcohol intake, and smoking, which may represent a greater threat to the woman's overall health than the DCIS itself. Depending on age at diagnosis, women diagnosed with DCIS are 3-13 times more likely to die from non-breast cancer related causes, such as cardiovascular disease, than from breast cancer. Thus, the maintenance and improvement of healthy behaviors that influence a variety of outcomes after diagnosis may warrant increased attention during DCIS management. This may also represent an important opportunity to promote the adoption of healthy behaviors, given that DCIS carries the psychological impact of a cancer diagnosis but also a favorable prognosis. Particular focus is needed to address these issues in vulnerable patient subgroups with pre-existing higher rates of unhealthy behaviors and demonstrated health disparities.

Ablation of TRPM5 in Mice Results in Reduced Body Weight Gain and Improved Glucose Tolerance and Protects from Excessive Consumption of Sweet Palatable Food when Fed High Caloric Diets

The calcium activated cation channel transient receptor potential channel type M5 (TRPM5) is part of the downstream machinery of the taste receptors and have been shown to play a central role in taste signalling. In addition it is also found in other types of chemosensory cells in various parts of the body as well as in pancreatic β-cells. The aim of this study was to investigate the effects of TRPM5 gene ablation on body weight, insulin sensitivity and other metabolic parameters in long-term high caloric diet induced obesity. Trpm5^-/- mice gained significantly less body weight and fat mass on both palatable carbohydrate and fat rich cafeteria diet and 60% high fat diet (HFD) and developed less insulin resistance compared to wild type mice. A main finding was the clearly improved glucose tolerance in Trpm5^-/- mice compared to wild type mice on cafeteria diet, which was independent of body weight. In addition, it was shown that Trpm5^-/- mice consumed the same amount of calories when fed a HFD only or a HFD in combination with a palatable chocolate ball, which is in contrast to wild type mice that increased their caloric intake when fed the combination, mainly due to excessive consumption of the chocolate ball. Thus the palatable sugar containing diet induced overeating was prevented in Trpm5^-/- mice. This indicates that sweet taste induced overeating may be a cause for the increased energy intake and glucose intolerance development seen for wild type mice on a sugar and high fat rich cafeteria diet compared to when on a high fat diet. This study point to an important role for the taste signalling system and TRPM5 in diet induced glucose intolerance.

Talking About Type 2 Diabetes: Family Communication From the Perspective of At-Risk Relatives

PURPOSE

The purpose of this study was to describe type 2 diabetes (T2DM) communication and risk reduction recommendations from the perspective of family members at risk for T2DM based on family history.

METHODS

Semistructured qualitative interviews were conducted with 33 individuals with a first-degree relative with T2DM. Participants were recruited from the community and a previous pharmacogenetics study. Deductive and inductive codes were applied to the transcripts.

RESULTS

Conversations with family members with and without T2DM focused on symptoms and disease management of the family member with T2DM. With at-risk relatives, conversations also focused on prevention. Lack of perceived relevance to family members without T2DM was a barrier to communication. Recommendations to facilitate communication included education of an at-risk family member to increase awareness of risk, followed by sharing of learned information with others.

CONCLUSION

Efforts are needed to increase awareness and improve communication about T2DM risk factors, familial risk, and risk reduction behaviors within families with a family history of T2DM. Family members with and without T2DM should be encouraged to communicate with their relatives about T2DM and the risk to family members. Identification of family members who can facilitate communication, education, and modeling of healthy behaviors may increase awareness and motivate at-risk individuals to engage in risk-reducing behaviors.

Potential Bioactive Compounds from Seaweed for Diabetes Management

Diabetes mellitus is a group of metabolic disorders of the endocrine system characterised by hyperglycaemia. Type II diabetes mellitus (T2DM) constitutes the majority of diabetes cases around the world and are due to unhealthy diet, sedentary lifestyle, as well as rise of obesity in the population, which warrants the search for new preventive and treatment strategies. Improved comprehension of T2DM pathophysiology provided various new agents and approaches against T2DM including via nutritional and lifestyle interventions. Seaweeds are rich in dietary fibres, unsaturated fatty acids, and polyphenolic compounds. Many of these seaweed compositions have been reported to be beneficial to human health including in managing diabetes. In this review, we discussed the diversity of seaweed composition and bioactive compounds which are potentially useful in preventing or managing T2DM by targeting various pharmacologically relevant routes including inhibition of enzymes such as α-glucosidase, α-amylase, lipase, aldose reductase, protein tyrosine phosphatase 1B (PTP1B) and dipeptidyl-peptidase-4 (DPP-4). Other mechanisms of action identified, such as anti-inflammatory, induction of hepatic antioxidant enzymes’ activities, stimulation of glucose transport and incretin hormones release, as well as β-cell cytoprotection, were also discussed by taking into consideration numerous in vitro, in vivo, and human studies involving seaweed and seaweed-derived agents.

Ursolic acid increases energy expenditure through enhancing free fatty acid uptake and β-oxidation via an UCP3/AMPK-dependent pathway in skeletal muscle

SCOPE

Ursolic acid (UA) is a triterpenoid compound with multifold biological functions. Our previous studies have reported that UA protects against high-fat diet-induced obesity and improves insulin resistance (IR). However, the potential mechanisms are still undefined. Free fatty acid (FFA) metabolism in skeletal muscle plays a central role in obesity and IR. Therefore, in this study, we investigated the effect and the potential mechanisms of UA on skeletal muscle FFA metabolism.

METHODS AND RESULTS

In diet-induced obese rats, 0.5% UA supplementation for 6 weeks markedly reduced body weight, increased energy expenditure, decreased FFA level in serum and skeletal muscle and triglyceride content in skeletal muscle. In vitro, the data provided directly evidence that UA significantly increased fluorescently labeled FFA uptake and (3) H-labeled palmitic acid β-oxidation. UA-activated AMP-activated protein kinase (AMPK) and downstream targets were involved in the increase of FFA catabolism. Moreover, upregulated uncoupling protein 3 (UCP3) by UA contributed to AMPK activation via elevating adenosine monophosphate/adenosine triphosphate ratio.

CONCLUSION

UA increases FFA burning through enhancing skeletal muscle FFA uptake and β-oxidation via an UCP3/AMPK-dependent pathway, which provides a novel perspective on the biological function of UA against obesity and IR.

Depressive and anxiety disorders: Associated with losing or gaining weight over 2 years?

This longitudinal study examines to what extent different depressive and anxiety disorders and clinical characteristics are associated with subsequent weight change, while controlling for baseline weight, sociodemographics, health status, psychotropic medication use and (un)healthy lifestyle factors. Data are from a sample of 2447 respondents aged 18-65 years of the Netherlands Study of Depression and Anxiety (NESDA). Baseline depressive disorders and anxiety disorders were determined with the Composite International Diagnostic Interview (CIDI). Weight at baseline and after 2 years was measured and analyzed as continuous change score (mean change in weight 1kg) and in categories of significant weight loss (<1S.D. weight change equaling <4kg), weight maintenance and weight gain (>1S.D., >6kg). After full adjustment for covariates baseline comorbid anxiety and depressive disorder and baseline Major Depressive Disorder (MDD) were associated with significant 2-year weight gain. Both current and remitted MDD at baseline and a baseline dysthymia, but none of the anxiety disorders, were associated with significant weight loss. This longitudinal study confirms a U-curved link between depression and weight change over 2 years. Furthermore, a dose-response effect of depression severity on 2-year weight gain was found.

Long-term risk of type 2 diabetes mellitus in relation to BMI and weight change among women with a history of gestational diabetes mellitus: a prospective cohort study

AIMS/HYPOTHESIS

Women with a history of gestational diabetes mellitus (GDM) are advised to control their weight after pregnancy. We aimed to examine how adiposity and weight change influence the long-term risk of developing type 2 diabetes after GDM.

METHODS

We included 1,695 women who had incident GDM between 1991 and 2001, as part of the Diabetes & Women's Health study, and followed them until the return of the 2009 questionnaire. Body weight and incident type 2 diabetic cases were reported biennially. We defined baseline as the questionnaire period when women reported an incident GDM pregnancy. We estimated HRs and 95% CIs using Cox proportional hazards models.

RESULTS

We documented 259 incident cases of type 2 diabetes during up to 18 years of follow-up. The adjusted HRs of type 2 diabetes associated with each 1 kg/m(2) increase in BMI were 1.16 (95% CI 1.12, 1.19) for baseline BMI and 1.16 (95% CI 1.13, 1.20) for most recent BMI. Moreover, each 5 kg increment of weight gain after GDM development was associated with a 27% higher risk of type 2 diabetes (adjusted HR 1.27; 95% CI 1.04, 1.54). Jointly, women who had a BMI ≥30.0 kg/m(2) at baseline and gained ≥5 kg after GDM had an adjusted HR of 43.19 (95% CI 13.60, 137.11), compared with women who had a BMI <25.0 kg/m(2) at baseline and gained <5 kg after GDM.

CONCLUSIONS/INTERPRETATION

Baseline BMI, most recent BMI and weight gain after GDM were significantly and positively associated with risk of progression from GDM to type 2 diabetes.

Changes in Waist Circumference and the Incidence of Type 2 Diabetes in Community-Dwelling Men and Women: The Suita Study

Backgrounds

The association between weight gain and the incidence of type 2 diabetes is well known. The aim of our study was to investigate the relationship between change in waist circumference (WC) and type 2 diabetes incidence.

Methods

The participants in the Suita Study, a population-based cohort study in an urban area of Japan, underwent a baseline survey between 1989 and 1994 (Exam 1) and were examined at follow-up every 2 years. We performed a 9.3-year cohort study of 946 men and 1327 women with no history of diabetes who underwent Exam 1 and Exam 2 (between 1997 and 1999). Participants were stratified by sex and median WC at Exam 1, and, in each stratum, participants were further classified into three categories by tertile of WC change per year between Exam 1 and Exam 2. Hazard ratios (HRs) and 95% confidence intervals (CIs) for type 2 diabetes incidence were calculated by Cox proportional hazard models. The endpoints were first diagnosis of type 2 diabetes or March 2011.

Results

During follow-up, 287 participants developed type 2 diabetes. In both sexes with median WC or higher, participants in the highest tertile of WC change had a significantly higher risk of developing type 2 diabetes. Multivariable adjusted HRs were 1.84 (95% CI, 1.10–3.08) in men and 2.30 (95% CI, 1.31–4.04) in women. No significant association was observed among participants with WC below median.

Conclusions

Preventing WC gain is important in preventing type 2 diabetes in the Japanese population, especially among individuals with a relatively high WC.

Relationship between postprandial endotoxemia in nonobese postmenopausal women and diabetic nonobese postmenopausal women

Background:

We hypothesised that nonobese postmenopausal women (NoPoW) and diabetic NoPoW (DNoPoW) may be independently associated with postprandial endotoxemia.

Materials and Methods:

NoPoW and DNoPoW were evaluated for weight, eating habits, physical activity, body circumferences, fasting plasma glucose level, postprandial plasma glucose level, and insulin level. The lipopolysaccharide (LPS) levels and circulating LPS-binding protein (LBP) were determined in serum at fasting, 1 h, 2 h, 3 h, and 4 h after meal intake and their levels were co-related in 80 NoPoW and 80 DNoPoW.

Results:

Both DNoPoW group and NoPoW group showed a significant increase (P < 0.05) in LPS levels and circulating LBP in plasma after the meal intake, interestingly the increase was higher in the DNoPoW group.

Conclusions:

Elevated LPS and circulating LBP were associated significantly with DNoPoW group and NoPoW, especially after a meal intake. These findings suggested a role of LPS and LBP in postprandial systemic inflammation in DNoPoW group. Prospective studies are needed to confirm these results.

Central adiposity is significantly higher in female compared to male in Pakistani type 2 diabetes mellitus patients

BACKGROUND

Type 2 diabetes mellitus (DM) rates are increasing rapidly in South Asians. Cardiovascular complications are more frequent and occur earlier in our patients than patients in many other ethnic groups. Reasons for this are not fully understood.

AIMS

The aim of this study is to evaluate the body total and central fat percentage in type 2 Diabetes Mellitus patients and to check correlation with BMI, waist circumference and metabolic profile.

SETTINGS AND DESIGN

A cross-sectional study conducted at endocrine clinic, Aga Khan University Hospital Karachi, Pakistan, from May to December 2012.

MATERIALS AND METHODS

Patients of either gender with type 2 diabetes mellitus were randomly selected. A separate proforma for each patient was recorded for demographics, risk factors, bioelectrical impedance measurement for body fat and investigations.

STATISTICAL ANALYSIS

Correlation between body fat and other covariate were compared by Pearson correlation coefficient test. A P < 0.05 was considered significant. SPSS19.0 was used to analyze the data.

RESULTS

One hundred and seventy five patients (95 male and 80 female) with mean age of 54.1 ± 12 years were evaluated. Mean duration of diabetes was 8.1 years, mean HbA1c was 8.1% and 53.7% were on oral agents and rest were on insulin with or without oral agents. Hypertension was present in 65.7%, 13.7% had known coronary artery disease and 2.3% had cerebrovascular disease. Mean BMI in males was 29.1 ± 4.74 kg/m(2) and females 31.7 ± 5.3 kg/m(2). Mean waist circumference in males was 107.3 ± 16.6 cm and 103 ± 12 cm in females. Total body fat percentage (%BF) in males was 30.9 ± 7.1% and females 40 ± 8.2% with 89% of the total cohort having total body fat percentage above the normal, less than 25% central fat percentage was 13.3 ± 5.2% in males and 14.6 ± 5.5% in females with 79.4% of cohort having increased central fat (normal <9%). Total and central body fat correlated with BMI (r = 0.68, P < 0.001) and waist circumference (r = 0.66, P < 0.001) but not with HbA1c, triglyceride level or with fasting or random blood glucose levels. Women had significantly higher total body fat percentage compared to men (P < 0.001) although central fat percentage was similar in both sexes.

CONCLUSIONS

High body fat percentage, waist circumference are seen especially in woman and central body fat percentage in both sexes among patients with type 2 diabetes mellitus in Pakistan. Body fat percentage should be measured and followed as this may be an important contributing factor to the high macrovascular complication rate in this part of world.

Behavioural weight management programmes for adults assessed by trials conducted in everyday contexts: systematic review and meta-analysis

This systematic review and meta-analysis of effectiveness trials comparing multicomponent behavioural weight management programmes with controls in overweight and obese adults set out to determine the effectiveness of these interventions implemented in routine practice. To be included, interventions must have been multicomponent, delivered by the therapists who would deliver the intervention in routine practice and in that same context, and must be widely available or feasible to implement with little additional infrastructure or staffing. Searches of electronic databases were conducted, and augmented by screening reference lists and contacting experts (November 2012). Data were extracted by two reviewers, with mean difference between intervention and control for 12-month change in weight, blood pressure, lipids and glucose calculated using baseline observation carried forward. Data were also extracted on adverse events, quality of life and mood measures. Although there were many published efficacy trials, only eight effectiveness trials met the inclusion criteria. Pooled results from five study arms providing access to commercial weight management programmes detected significant weight loss at 12 months (mean difference -2.22 kg, 95% confidence interval [CI] -2.90 to -1.54). Results from two arms of a study testing a commercial programme providing meal replacements also detected significant weight loss (mean difference -6.83 kg, 95% CI -8.39 to -5.26). In contrast, pooled results from five interventions delivered by primary care teams showed no evidence of an effect on weight (mean difference -0.45 kg, 95% CI -1.34 to 0.43). One study testing an interactive web-based intervention detected a significant effect in favour of the intervention at 12 months, but the study was judged to be at high risk of bias and the effect did not persist at 18 months. Few studies reported other outcomes, limiting comparisons between interventions. Few trials have examined the effectiveness of behavioural weight loss programmes delivered in everyday contexts. These trials suggest that commercial interventions delivered in the community are effective for achieving weight loss. There is no evidence that interventions delivered within primary care settings by generalist primary care teams trained in weight management achieve meaningful weight loss.

Effects of Kaempferia parviflora rhizomes dichloromethane extract on vascular functions in middle-aged male rat

ETHNOPHARMACOLOGICAL RELEVANCE

In Thai traditional medicine, rhizomes of Kaempferia parviflora (KP) have been used for treating hypertension and for the promotion of longevity with good health and well being. Ageing is one of the most important risk factors for development of cardiovascular disease. To investigate whether a 6 weeks oral administration of a dichloromethane extract of fresh rhizomes of Kaempferia parviflora (KPD) had any effects on vascular functions, on the accumulation of lipid, as well as on any signs of gross organ toxicity in middle-aged rats.

MATERIALS AND METHODS

Fresh rhizomes of Kaempferia parviflora were first macerated twice with 95% ethanol to remove the dark color before extracting three times with 100% dichloromethane. The dichloromethane extract was evaporated under reduced pressure to obtain the dried Kaempferia parviflora dichloromethane extract (KPD). The rats were orally administered with the KPD at a dosage of 100mg/kg body weight, or with the same volume of the vehicle (tween 80, 0.2g: carboxy-methylcellulose sodium, 0.2g: distilled water 10 ml) once or twice a day for 6 weeks. Vascular functions were studied on isolated thoracic aorta and the mesenteric artery. The vascular eNOS enzyme was measured by Western blot analysis. Blood chemistry was measured by enzymatic methods. Liver cell lipid accumulation was measured using oil red O staining.

RESULTS

A 6 weeks treatment of KPD once a day had no significant effects on any of the studied parameters. When the KPD was given twice a day, the contractile responses to phenylephrine of the thoracic aorta and mesenteric artery were lower than the vehicle control group, and this effect was abolished by N(G)-nitro-l-arginine or by removal of the vascular endothelium. Vasorelaxation to acetylcholine, but not to glyceryl trinitrate, by the thoracic aortic and mesenteric ring precontracted with phenylephrine was higher from the KPD treated rats than those from the vehicle control groups. Western blot analysis showed a higher quantity of thoracic- and mesenteric-eNOS protein obtained from the KPD treated rats. In addition, the body weight, serum glucose and triglycerides levels, visceral and subcutaneous fat, as well as liver lipid accumulation were all significantly decreased in the KPD treated rats compared to those of the vehicle control. No differences were found between the KPD treated-, and the vehicle-control for animal food intake, internal organ weight, serum ALP, SGOT, SGPT, BUN and creatinine levels, serum cholesterol, HDL-C and LDL-C levels, nor total blood cell counts.

CONCLUSIONS

The chronic oral administration of KPD extract, to middle aged rats, caused a decrease in vascular responsiveness to phenylephrine with an increase in the acetylcholine induced vasorelaxation, due to an increase in nitric oxide production from their blood vessels. The extract also caused a decrease in visceral and subcutaneous fat, fasting serum glucose and triglyceride levels and liver lipid accumulation, with no changes to liver and kidney functions or to total blood cell counts. It is possible that these KPD extracts could be developed as a health product for mid-aged humans to reduce obesity, diabetes type II and cardiovascular disease.

Changing the endpoints for determining effective obesity management

Health authorities worldwide recommend weight loss as a primary endpoint for effective obesity management. Despite a growing public awareness of the importance of weight loss and the spending of billions of dollars by Americans in attempts to lose weight, obesity prevalence continues to rise. In this report we argue that effective obesity management in today's environment will require a shift in focus from weight loss as the primary endpoint, to improvements in the causal behaviors; diet and exercise/physical activity (PA). We reason that increases in PA combined with a balanced diet are associated with improvement in many of the intermediate risk factors including cardiorespiratory fitness (CRF) associated with obesity despite minimal or no weight loss. Consistent with this notion, we suggest that a focus on healthy behaviors for the prevention of additional weight gain may be an effective way of managing obesity in the short term.

Predictors of post-partum weight retention in a prospective longitudinal study

Post-partum weight retention (WR) occurs in 60-80% of women with some retaining ≥10 kg with contributing factors reported as pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and breastfeeding. A longitudinal study of pregnancy, with 12-month post-partum follow-up was conducted to determine factors associated with WR. Pregnant women (n = 152) were recruited from the John Hunter Hospital antenatal clinic in New South Wales, Australia. Pre-pregnancy weight was self-reported; weight was measured four times during pregnancy (for GWG) and in the first 12 months post-partum. Infant feeding data were obtained via questionnaires. Breastfeeding was categorised as exclusive, predominant, complementary or not breastfeeding. Linear mixed models tested the predictors of WR, with and without adjustment for potential confounders. Compared with pre-pregnancy weight, 68% of women retained weight at 12 months, median (interquartile range) [4.5 kg (2.1-8.9)]. After adjustment, GWG was positively associated with WR (P < 0.01), but pre-pregnancy weight did not predict WR. For each additional week of any breastfeeding, 0.04 kg less weight was retained. Compared with women who retained weight, those women who did retain had higher rates of exclusive breastfeeding at three months (P < 0.05), but the number of weeks of exclusive breastfeeding failed to predict WR for all women. WR following childbirth is common and associated with GWG, while the number of weeks of 'any' breastfeeding contributed to post-partum weight loss. Whether these factors are modifiable strategies to optimise the weight status of women at this life stage requires further research.

Six weeks oral gavage of a Phyllanthus acidus leaf water extract decreased visceral fat, the serum lipid profile and liver lipid accumulation in middle-aged male rats

ETHNOPHARMACOLOGICAL RELEVANCE

Advancing age is associated with an increased accumulation of visceral fat and liver lipid which is then responsible for an age-related risk for cardiovascular disease. Looking after ourselves well with suitable micronutrients could prevent disease or prolong our healthy cardiovascular functions. In Thai traditional medicine, leaves of Phyllanthus acidus (PA) have been used for many purposes including as an antihypertensive agent and to provide relief from a headache caused by hypertension. We aimed to investigate the effects of a chronic oral administration of PA extracts to middle-aged (12-14 months) rats on their body weight, food intake, body fats, liver and kidney functions, fasting blood glucose and lipid profiles, liver lipid accumulation and on blood pressure.

MATERIALS AND METHODS

Three different kinds of PA extracts were used: (1) a PA water extract, (2) a heated PA water extract, and (3) an n-butanol fraction of the PA water extract, prepared from fresh leaves of Phyllanthus acidus. The rats were orally gavaged with the three PA extracts at 1.0 g/kg body weight or, as a control, with distilled water once a day for 6 weeks. Fasting blood sugar, lipid profile and ALP, SGOT, SGPT, BUN and creatinine levels were measured by enzymatic methods. Liver lipid accumulation was measured using oil red O staining on fresh thin cryostat liver tissue sections. The animal basal blood pressure and heart rate were measured in anesthetized rats via a common carotid artery using a polygraph.

RESULTS

Results showed that after 6 weeks of treatment using gavaged heated PA extract and PA n-butanol extract there were no changes in any of the parameters studied. However, the initial PA water extract caused a slight decrease in the animal body weight with no change in food intake. No changes were observed in the liver and kidney functions (serum ALP, SGOT, SGPT, BUN and creatinine did not change), nor did the fasting blood sugar or triglyceride levels differ significantly. Serum cholesterol, HDL and LDL levels, as well as visceral and subcutaneous adipose tissue and liver lipid accumulation were significantly decreased compared to that of the control group. There were no differences found in the basal systolic and diastolic blood pressure and the basal heart rate between the PA water extract treatment and the control group.

CONCLUSIONS

These results indicated that the PA water extract had an effect on lipid metabolisms that resulted in a decrease of the serum lipid profile, visceral and subcutaneous fat, as well as on liver lipid accumulation in middle-aged rats. The active component that is responsible for these effects is likely to be a water soluble substance(s) and is heat labile. As a consequence of these beneficial effects of the PA water extract, it would be a good choice for further development for use as a nutraceutical or health product to prevent and/or to slow down the development of obesity and/or cardiovascular disease.

Psychological changes following weight loss in overweight and obese adults: a prospective cohort study

Background

Participation in weight loss programs is often associated with improved wellbeing alongside reduced cardio-metabolic risk. In contrast, population-based analyses have found no evidence of psychological benefits of weight loss, but this may be due to inclusion of healthy-weight individuals. We therefore examined cardio-metabolic and psychological changes following weight loss in a cohort of overweight/obese adults.

Methods

Data were from 1,979 overweight and obese adults (BMI ≥25 kg/m²; age ≥50 y), free of long-standing illness or clinical depression at baseline, from the English Longitudinal Study of Ageing. Participants were grouped according to four-year weight change into those losing ≥5% weight, those gaining ≥5%, and those whose weight was stable within 5%. Logistic regression examined changes in depressed mood (eight-item Center for Epidemiologic Studies Depression score ≥4), low wellbeing (Satisfaction With Life Scale score <20), hypertension (systolic blood pressure ≥140 mmHg or anti-hypertensives), and high triglycerides (≥1.7 mmol/l), controlling for demographic variables, weight loss intention, and baseline characteristics.

Results

The proportion of participants with depressed mood increased more in the weight loss than weight stable or weight gain groups (+289%, +86%, +62% respectively; odds ratio [OR] for weight loss vs. weight stable = 1.78 [95% CI 1.29–2.47]). The proportion with low wellbeing also increased more in the weight loss group (+31%, +22%, −4%), but the difference was not statistically significant (OR = 1.16 [0.81–1.66]). Hypertension and high triglyceride prevalence decreased in weight losers and increased in weight gainers (−28%, 4%, +18%; OR = 0.61 [0.45–0.83]; −47%, −13%, +5%; OR = 0.41 [0.28–0.60]). All effects persisted in analyses adjusting for illness and life stress during the weight loss period.

Conclusions

Weight loss over four years in initially healthy overweight/obese older adults was associated with reduction in cardio-metabolic risk but no psychological benefit, even when changes in health and life stresses were accounted for. These results highlight the need to investigate the emotional consequences of weight loss.

Impact of body mass index, metabolic health and weight change on incident diabetes in a Korean population

OBJECTIVE

The aim of this study was to examine an impact of body mass index (BMI) and weight change on the risk of diabetes according to metabolic health status.

METHODS

Cohort study of 34,999 Korean men and women 30-59 years of age free of diabetes at baseline were followed-up annually or biennially for an average of 5.1 years. Being metabolically healthy was defined as not having any metabolic syndrome component.

RESULTS

During 176,878.6 person-years of follow-up, 889 participants developed diabetes (incidence rate 5.0 per 1000 person-years). Compared to metabolically healthy normal-weight individuals, the adjusted hazard ratios for diabetes in metabolically unhealthy obese and in metabolically healthy obese were 13.7 (95% confidence interval [CI] 9.8-19.0) and 2.7 (95% CI: 1.7-4.3), respectively. The aHR (95% CI) for incident diabetes for weight changes of <-0.9, 0.5 to 2.0, and ≥2.1 kg compared to a weight change of -0.9 to 0.4 kg (reference) were 0.80 (0.66-0.97), 0.99 (0.82-1.20), and 1.24 (1.02-1.49), respectively (P-trend<0.001).

CONCLUSIONS

In this large cohort of young and middle age Koreans, metabolic health status, obesity, and weight change were all independently associated with increased incidence of diabetes over 5 years of follow-up.

Is responsiveness to weight loss diets affected by family history of diabetes?

BACKGROUND

Obesity is associated with many metabolic and chronic diseases, such as diabetes and cardiovascular disease. Family history of diabetes (FHD) is also an important risk factor for type 2 diabetes. Furthermore, the presence of FHD and obesity has a synergic effect on risk of diabetes incidence. The aim of this study was to determine whether FHD influence the weight loss induced by weight loss diet.

METHODS

This study was an intervention between individuals with or without FHD. Seventy-eight positive FHD and 74 negative FHD individuals were participated in this study. Two groups were matched for age, gender, and body mass index (BMI). In the present study, expert interviewers collected socio-demographic data and prescribed dietary recommendations in a face-to-face method.

RESULTS

Dietary intervention significantly reduces the body weight and BMI in both groups, but these reductions were not different between negative and positive FHD groups. This study could not find any significant association between FHD and responsiveness to weight loss diets (β = -0.058; 95% confidence interval, -1.618 to 0.832; P = 0.526).

CONCLUSION

Individuals with FHD have higher risk for obesity and chronic diseases, but in the current study there was no difference in responsiveness to weight loss in individuals with a positive family history and those without a family history.

Quantitative relationship between body weight gain in adulthood and incident type 2 diabetes: a meta-analysis

This meta-analysis quantified the risk of type 2 diabetes mellitus (T2DM) preceded by body weight (BW) gain in the general population. Systematic literature searches retrieved 15 eligible studies. The BW gain was divided into early weight-gain, which was defined as BW gain from early adulthood (18-24 years of age) to cohort entry (≥25 years of age), and late weight-gain, which was defined as BW gain from cohort entry. The pooled relative risk (RR; 95% confidence interval [CI]) of T2DM for an increment of BW gain standardized into a 5-kg m(-2) increment in the body mass index (BMI) was 3.07 (2.49-2.79) for early weight-gain and 2.12 (1.74-2.58) for late weight-gain. When limiting analysis to studies that concurrently examined T2DM risk for current BMI (defined in both groups as BMI at cohort entry), a larger magnitude of T2DM risk was revealed for early weight-gain compared with current BMI (RR [95% CI], 3.38 [2.20-5.18] vs. 2.39 [1.58-3.62]), while there was little difference between late weight-gain (RR [95% CI], 2.21 [1.91-2.56]) and current BMI (RR [95% CI], 2.47 [1.97-3.30]). The meta-analysis suggested that BW gain was a quantifiable predictor of T2DM, as well as current obesity in adults. Particularly, BW gain in early rather than middle-to-late adulthood played an important role in developing T2DM.

Cardiomyocyte health: adapting to metabolic changes through autophagy

Autophagy is important in the heart for maintaining homeostasis when changes in nutrient levels occur. Autophagy is involved in the turnover of cellular components, and is rapidly upregulated during stress. Studies have found that autophagy is reduced in metabolic disorders including obesity and diabetes. This leads to accumulation of protein aggregates and dysfunctional organelles, which contributes to the pathogenesis of cardiovascular disease. Autophagy is primarily regulated by two components: the mechanistic target of rapamycin (mTOR) and AMP-activated protein kinase (AMPK). Although mTOR integrates information about growth factors and nutrients and is a negative regulator of autophagy, AMPK is an energy sensor and activates autophagy when energy levels are low. These pathways therefore present targets for the development of autophagy-modulating therapies.

Dietary quality and 6-year anthropometric changes in a sample of French middle-aged overweight and obese adults

BACKGROUND

Understanding the role of dietary quality in the progression of adiposity in populations already affected by overweight or obesity is crucial for the guidance of secondary prevention strategies.

OBJECTIVE

To examine the association of diet quality, as reflected by the French Nutrition and Health Programme (Programme National Nutrition Santé, PNNS)-Guideline Score (GS), with 6-year-changes in weight and waist circumference.

DESIGN AND METHODS

Subjects were 1029 male and 450 female participants of the SUplémentation en VItamines et Minéraux AntioXydants (SU.VI.MAX) cohort (1994-2002) with anthropometric variables at baseline and follow-up and available data for estimating diet quality at baseline. We employed analysis of variance and covariance models to investigate anthropometric changes (% of the initial value) by categories of the PNNS-GS, which contains both dietary components and a physical activity component, and of a modified score (mPNNS-GS) containing dietary components only.

RESULTS

In men, a low (<6 points) PNNS-GS was associated with greater 6-year weight gain (adjusted mean: 3.63% [95% confidence interval: 2.87%; 4.39%]) as compared to a high (≥9 points) PNNS-GS (2.10% [1.39%; 2.81%]); p = 0.01. Results for the mPNNS-GS were very similar. In women, no associations between diet scores and weight change were observed. No significant relation between dietary quality and change in waist circumference was present among either men or women.

CONCLUSIONS

These results support a beneficial role of high dietary quality--as characterized by good adherence to official French nutritional guidelines--in secondary obesity prevention, among men.

The association of maximum body weight on the development of type 2 diabetes and microvascular complications: MAXWEL study

BACKGROUND

Obesity precedes the development of type 2 diabetes (T2D). However, the relationship between the magnitude and rate of weight gain to T2D development and complications, especially in non-White populations, has received less attention.

METHODS AND FINDINGS

We determined the association of rate and magnitude of weight gain to age at T2D diagnosis (Age(T2D)), HbA1c at T2D diagnosis (HbA1c(T2D)), microalbuminuria, and diabetic retinopathy after adjusting for sex, BMI at age 20 years, lifestyles, family history of T2D and/or blood pressure and lipids in 2164 Korean subjects aged ≥30 years and newly diagnosed with diabetes. Body weight at age 20 years (Wt(20y)) was obtained by recall or from participants' medical, school, or military records. Participants recalled their maximum weight (Wt(max)) prior to T2D diagnosis and age at maximum weight (Age(max_wt)). The rate of weight gain (Rate(max_wt)) was calculated from magnitude of weight gain (ΔWt = Wt(max)-Wt(20y)) divided by ΔTime (Age(max_wt) -20 years). The mean Age(max_wt) and Age(T2D) were 41.5±10.9 years and 50.1±10.5 years, respectively. The Wt(20y) and Wt(max) were 59.9±10.5 kg and 72.9±11.4 kg, respectively. The Rate(max_wt) was 0.56±0.50 kg/year. After adjusting for risk factors, greater ΔWt and higher Rate(max_wt) were significantly associated with earlier Age(T2D), higher HbA1c(T2D) after additional adjusting for Age(T2D), and microalbuminuria after further adjusting for HbA1c(T2D) and lipid profiles. Greater ΔWt and higher Rate(max_wt) were also significantly associated with diabetic retinopathy.

CONCLUSIONS

This finding supports public health recommendations to reduce the risk of T2D and its complications by preventing weight gain from early adulthood.