Indices of relative weight and obesity

Hypertension, orthostatic hypotension and the microvascular complications of diabetes

Prevalences of hypertension and orthostatic hypotension and their relationship to the microvascular complications of diabetes were assessed in 702 individuals aged 18-74 years, who had been selected as a representative sample of surviving patients with diabetes diagnosed at the Joslin Clinic between 1939 and 1965. In diabetes of short, long and very long duration, hypertension was 1.7, 1.9 and 2.1 times more frequent, respectively, than in the white U.S. population, regardless of gender. The excess frequency of hypertension in short duration diabetes suggests that some etiologic factor is shared by both conditions, while the magnification of the excess with increasing duration could be explained by an effect of diabetes on the kidney. Hypertension without accompanying proteinuria was not associated with retinopathy. Orthostatic hypotension was observed in 12% of the males and 13% of the females. The magnitude of the fall in systolic blood pressure was correlated with age, postprandial blood glucose, supine diastolic blood pressure, and the presence of retinopathy. Patients with proliferative retinopathy had the largest fall in systolic blood pressure.

Standardization of M-mode echocardiographic left ventricular anatomic measurements

To improve standardization of echocardiographic left ventricular anatomic measurements, echographic left ventricular dimensions and mass were related to body size indexes, sex, age and blood pressure. Independent normal populations comprised 92 hospital-based subjects (64 women, 28 men) and 133 subjects from a population sample (55 women, 78 men). All measurements of chamber size, wall thickness and mass differed between men and women in both series (p less than 0.01 to p less than 0.001). Left ventricular mass was related most closely to body surface area among measurements of body size (r = 0.37, p less than 0.01 to r = 0.57, p less than 0.001) in all four groups. Indexation by body surface area eliminated sex differences in wall thicknesses and internal dimension, but a significant sex difference in left ventricular mass index persisted (89 +/- 21 g/m2 in men versus 69 + 19 g/m2 in women in the entire series, p less than 0.0001). The 97th percentile of left ventricular mass index was identical in both groups of men (136 and 132 g/m2) and women (112 and 109 g/m2). A highly significant difference in lean body mass, estimated from 24 hour urine creatine excretion, was observed between men and women (58 +/- 15 versus 40 +/- 13 kg, p less than 0.001) and no sex difference existed in left ventricular mass indexed by lean body mass (3.4 +/- 1.3 versus 3.5 +/- 1.5 g/kg). Weak correlations were observed between left ventricular mass/lean body mass and systolic or diastolic blood pressure (r = 0.25, p less than 0.05 and r = 0.28, p less than 0.01, respectively) but not age (18 to 72 years).(ABSTRACT TRUNCATED AT 250 WORDS)

Soft-tissue thickness of the wrist

Increase in the soft-tissue thickness of the wrist is said to be a sensitive indicator of early oedema due to generalised or local arthritic disease. No normal values are available. Measurement of the soft-tissue thickness opposite the radial and ulnar styloid processes in a random population demonstrated a large normal range which was not related to obesity. This large normal variation calls into question the accuracy of radiological evaluation of early wrist oedema.

Mechanisms of depressed delayed-type hypersensitivity in rheumatoid arthritis: the role of protein energy malnutrition

The presence of anergy and its relationship to malnutrition was investigated in patients with rheumatoid arthritis (RA) and in controls. A generalised reduction in delayed cutaneous hypersensitivity to 7 recall antigens were found in 104 RA patients compared with 67 controls. No measured of the disease was capable of predicting cutaneous anergy, which was present in 36% of patients but none of the controls. A detailed dietary assessment in 30 RA patients and 30 controls revealed little evidence of clinically important malnutrition. It is therefore concluded that the cutaneous anergy of rheumatoid arthritis is not a consequence of nutritional factors.

The relationship between weight-height indices and the triceps skinfold measure among children age 5 to 12

This study examines several weight for height indices--Quetelet's index W/H2, W/H, and Rohrer's index W/H3--for their appropriateness in estimating adiposity among young children. Data were obtained for a sample of 1,668 children age 5-12 residing in Forsyth County, North Carolina. Although W/H2 was found to be the most useful of these indices, the results suggest that no index, including the tricep skinfold measure, can be considered completely satisfactory in estimating adiposity among children.

Hormonal characteristics of women with clinical features of the polycystic ovary syndrome

The aim of the present study was to determine whether a group of patients selected on the basis of clinical features only is characterized by the typical hormonal findings as discussed in the literature concerning the PCO-syndrome. PCO patients had oligomenorrhea, secondary amenorrhea or otherwise evidence of chronic anovulation, as well as hirsutism and/or obesity. Control women had regular menstrual cycles and a normal body weight. Since androgen and estrogen production in women depends on the stage of follicular development, an effort was made to obtain endocrinological data under standardized conditions. Under well-defined circumstances the PCO group (n = 20) had higher LH levels and lower FSH levels as compared with the control group (n = 10). Consequently the LH/FSH ratio was significantly elevated in the PCO group. Serum estrone and estradiol levels were significantly elevated in the PCO group, as were the serum levels of androstenedione and testosterone. Despite these differences a marked degree of overlap existed in the PCO patients and the control women for gonadotropin, estrogen and androgen levels. It was concluded that although the presence of polycystic ovaries in the investigated PCO group of women was not confirmed by laparoscopy, laparotomy or histological examination of the ovaries, these women had basal endocrinological characteristics similar to those found in well-proven PCO patients reported in the literature.

Estimation of body fat in female rhesus monkeys

Measurement of height (crown-rump length), body weight, and abdominal subcutaneous fat depth, based on skinfold thickness taken from 13 female rhesus monkeys comprising two age groups were correlated with body fat values derived from tritiated water determinations of total body water. The manner with which each measure was related to percent body fat differed as a function of age of the animal. In the young, nulliparous females, crown-rump length was the single best predictor of body fat, whereas in the older, multiparous females, skinfold thickness correlated most highly with body fat. When all measurements, including the Quetelet index [(wt/ht)2 x 1,000], were combined statistically and regressed against percent body fat, a significant increase in predictive ability was obtained. When each age group was considered separately, the resulting equations again reflected the age-group biases. In addition, as an internal check on the validity of the regression equations, an additional regression analysis was performed using morphometric data from selected animals in each age group. These equations yielded accurate estimates of body fat when compared to determinations made from total body water. These analyses indicate that the predictive accuracy of morphometric data is greatly enhanced by using these measurements in concert. Furthermore, the utility of such predictions is influenced by the specific physical characteristics of the subject population.

Osteopenia in hypoestrogenic young women with anorexia nervosa

Replacement estrogen therapy for premenopausal women with secondary hypogonadism (exercise/weight loss amenorrheas) remains controversial. In a group of 14 women with anorexia nervosa, amenorrhea, and no evidence of other endocrinopathy or protein-calorie malnutrition, significant osteopenia was demonstrated as assessed by cortical thickness of carpal bones. The degree of bone thinning was related to the duration and age at onset of amenorrhea as well as abnormalities of pubertal milestone progression. In the young women with "constitutionally delayed" menarche, or with secondary amenorrhea and hypogonadism, significant osteopenia may also be present. For those women with (1) hypoestrogenism and amenorrhea of over 36 months' duration, (2) pubertal delay, and (3) early onset of secondary amenorrhea, evaluation of osteopenia radiographically, and serious consideration for estrogen replacement, is important.

Indices of relative body weight and ideal weight charts

Established indices of relative body weight are reviewed and critically evaluated in terms of five criteria: (1) high correlation with obesity, (2) a conceptual interpretation, (3) universality, (4) simplicity of computation, and (5) zero correlation with height. Regression procedures are used to create standard weight charts which are distributed similarly to the body weight of 13,645 Americans, provided by the National Health Survey (NHS), and which have an arithmetic mean equal to the mean of the Metropolitan Life Insurance ( MLI ) table of desirable weights. A similar method is used to create a standard weight table based on body mass index (BMI). Finally, standard body weight charts which are uncorrelated with sex, age, and/or body frame are developed and discussed in terms of their usefulness.

Side Effects of Anabolic Steroids in Weight-Trained Men

In brief: This study documents the patterns of use of anabolic steroids in 32 body builders and power lifters. These subjects and seven control athletes who had never used steroids were interviewed and underwent a medical examination including 28 diagnostic blood tests and a urinalysis. Gynecomastia was detected in 4 of the 20 current users and 1 of the other 19 subjects. Sixty-seven percent of users reported temporary changes in libido, and 56% reported a temporary increase in irritability or aggressive behavior. Physicians should tell patients about the possible adverse side effects of such agents.

Respiratory complications following surgery. Improved prediction with preoperative spirometry

Patients who are old, overweight, who smoke and/or have symptoms of respiratory disease have an increased risk of atelectases and/or arterial hypoxemia in conjunction with surgery. The present study in 53 middle-aged men, operated on for gallbladder or peptic ulcer disease, illustrates how spirometry can be used to improve the prediction of respiratory complications. The relative risk of atelectases was greater in patients with functional residual capacity-closing capacity (FRC-CC) below -0.11 and the risk prediction based on age, body weight, smoking habits and respiratory symptoms was improved by adding information on FRC-CC. Arterial hypoxemia was more common in patients with wash-out volumes (WOV) above than below 35 l. The preoperative identification in high-risk patients of arterial hypoxemia based on the above-mentioned risk factors, was improved by adding information on WOV.

A prospective survey for insulinomas in a neurology department

Purpose

Obesity is associated with both obstructive sleep apnea (OSA) and obesity hypoventilation. Differences in adipose tissue distribution are thought to underlie the development of both OSA and hypoventilation. We explored the relationships between the distribution of upper airway, neck, chest, abdominal and muscle fat in very obese individuals.

Methods

We conducted a cross-sectional cohort study of individuals presenting to a tertiary sleep clinic or for assessment for bariatric surgery. Individuals underwent magnetic resonance (MR) imaging of their upper airway, neck, chest, abdomen and thighs; respiratory polygraphy; 1 week of autotitrating CPAP; and morning arterial blood gas to determine carbon dioxide partial pressure and base excess.

Results

Fifty-three individuals were included, with mean age of 51.6 ± 8.4 years and mean BMI of 44.3 ± 7.9 kg/m²; there were 27 males (51%). Soft palate, tongue and lateral wall volumes were significantly associated with the AHI in univariable analyses (p < 0.001). Gender was a significant confounder in these associations. No significant associations were found between MRI measures of adiposity and hypoventilation.

Conclusions

In very obese individuals, our results indicate that increased volumes of upper airway structures are associated with increased severity of OSA, as previously reported in less obese individuals. Increasingly large upper airway structures that reduce pharyngeal lumen size are likely to lead to OSA by increasing the collapsibility of the upper airway. However, we did not show any significant association between regional fat distribution and propensity for hypoventilation, in this population.

Electronic supplementary material

The online version of this article (10.1007/s11325-017-1599-x) contains supplementary material, which is available to authorized users.

Influence of severe obesity on peripheral hormone concentrations in pre- and postmenopausal women

To investigate the influence of obesity on hormonal parameters in 186 apparently healthy women and in 176 women suffering from severe obesity the serum concentrations of FSH, LH, estrone (E1), estradiol (E2), androstenedione (A) and testosterone (T) were determined radioimmunologically. The climacteric onset of increased FSH production is 4 yr earlier (P less than 0.001) in obese than in normal women. Parallel to the rise of FSH there is a significantly premature decrease of the E1 and E2 concentrations in obese women. The typical elevation of the LH was found similar and not significantly different in the two collectives. The mean A levels are significantly lower (P less than 0.01) in obese than in normal women in all age groups. The T concentrations do not depend on the age of the women during the investigated period (41 to 60 yr) and are significantly higher (P less than 0.001) in the obese than in the normal women. There is a significant (P less than 0.001) correlation between the concentrations of A and E1 both in the obese and the normal women. An increased conversion of androgens to estrogens by adipose tissue is not revealed by the peripheral serum concentrations. Our data clearly demonstrate that in obese women the onset of ovarian insufficiency is significantly earlier than in normal women.

Pre- and postoperative lung function in sitting and supine position related to postoperative chest X-ray abnormalities and arterial hypoxaemia

Spirometry in both sitting and supine position was performed before and 3-5 days after elective upper abdominal surgery in 53 men, aged 41-72 years. The results were related to postoperative respiratory complications as defined by chest radiography and to measurements of the arterial oxygen tension. Preoperative total lung capacity (TLC), functional residual capacity (FRC) and wash-out volume (WOV) were lower in both positions among patients who were to develop major chest X-ray abnormalities than among patients with normal chest radiographs postoperatively. All patients who developed major chest X-ray abnormalities had a negative value for FRC - closing capacity (CC) in the supine position preoperatively, indicating 'airway closure' during tidal breathing. Preoperative WOV and lung clearance index (LCI) were higher in both sitting and supine positions in patients who developed postoperative hypoxaemia than in patients who did not. The postoperative decrease in TLC, FRC and WOV in the sitting position was greater among patients with major X-ray abnormalities and/or arterial hypoxemia postoperatively than among patients without these complications. According to our results, conventional spirometry in the supine position is not superior to conventional spirometry in the sitting position as part of pre- or post-operative assessment of patients. On the other hand, both preoperative 'airway closure' and arterial oxygen tension, measured in the supine position, showed a correlation with postoperative chest X-ray abnormalities.

Relative body weight as a factor in the decision to abort

Abortion referral data of 692 pregnant women visiting a large urban planned parenthood clinic were analyzed to determine whether relative weight, as measured by an adiposity index, as well as other variables, were associated with a decision to terminate or not terminate a pregnancy. Relative weight, length of pregnancy, education, age, ethnicity, and marital status were found to be associated with the decision to abort. While most of these variables have previously been shown to be related to the decision to terminate or not terminate a pregnancy, a relationship between relative weight and abortion has not previously been reported. In the analyses of all the women in this study and of a subsample consisting only of those in the early stages of their pregnancies, increased relative weight was associated with a decrease in the likelihood of termination of pregnancy. Possible reasons for this relationship and the evolutionary implications are discussed.

Smoking, lung function, and body weight

In a cross-sectional study of steelworkers aged 45-55 years, smokers (n = 105; mean weight 76.1 kg) were found to weigh significantly less than non-smokers (n = 54; 81.6 kg) and ex-smokers (n = 51; 82.6 kg). The lower weight of smokers was attributable to a group with airflow obstruction (n = 37; forced expiratory volume in one second/vital capacity (FEV1/VC) less than 66%), who weighed less (4.8 kg; p less than 0.05) than smokers with normal FEV1/VC (n = 68). In smokers, but not in ex-smokers or non-smokers, body mass index and FEV1/VC ratio were closely related (r = 0.34; p less than 0.001). This association was apparently not due to an effect of body weight on lung function. Weight loss in smokers may be the consequence of impaired lung function or reflect the effect of cigarette smoking on both the respiratory tract and metabolism in susceptible subjects.

Fluorescence polarization as a parameter of plasma lipids in patients with hematologic malignancies

Abnormal diphenylhexatriene fluorescence polarization measurements (FP values) of plasma have previously been reported in patients with hematologic malignancies. However, the biological significance of this measurement is unclear. We have prospectively studied plasma from 39 patients with leukemia and lymphoma as well as normal donors for total cholesterol, total triglyceride, and lipoprotein-cholesterol fractions, and correlated these values with measured FP values. Total triglyceride, very low density lipoproteins (VLDL), high density lipoprotein (HDL) levels, and FP values were all strongly correlated with clinical and biochemical measures of tumor burden and varied directly with the presence of malignancy. Although the presence of abnormal FP values was confirmed in patients with leukemia and lymphoma, it was not a particularly sensitive measure for minimal tumor and it appeared to correlate directly with other measures of lipids and cholesterol, particularly triglyceride. It is suggested that further studies of conventional plasma lipids and lipoproteins be pursued in order to elucidate the apparently pervasive alterations in lipid metabolism present in these patients.

Body Composition Methodology in Sports Medicine

In brief Because of its noninvasive approach, anthropometry is one of the oldest and most popular methods of estimating body composition. However, this practical approach is often misused and misinterpreted by both clinicians and researchers. This article reviews the major methods for estimating body composition in various populations, with emphasis on anthropometry. Steps that will help clinicians select an appropriate anthropometric equation and reduce errors include using the same measurement procedures described in the original study and making sure the equation is based on a similar sample of 50 to 150 subjects in terms of age, sex, and activity levels.

Effect of age on glucose tolerance, insulin secretion, and in vivo insulin action

The effect of age on glucose tolerance, insulin secretion, and in vivo insulin action (insulin clamp) was studied in 48 nonobese subjects, all of whom were fully ambulatory and in good general health. The observed age-related increase in fasting plasma glucose (r = 0.35, P less than 0.01) was not due to an increase in relative body weight (RBW). Plasma insulin levels, both fasting and postprandial, tended to rise with age, but these changes were not significant. There was a marginally significant correlation (r = -0.21) between age and insulin-stimulated glucose utilization, which fell to -0.13 when controlled for RBW. However, steady-state insulin levels during the insulin-clamp period were higher in the older subjects, suggesting that age leads to an impairment in insulin catabolism; thus it is likely that the impairment of in vivo insulin action with age was underestimated. The variation in in vivo action between individuals was much greater among the older subjects. It was concluded that the glucose intolerance associated with aging is of relatively minor magnitude when ambulatory, generally healthy, nonobese, and nondiabetic subjects are studied. The cause of the glucose intolerance associated with aging seems to be loss of normal in vivo insulin action. On the other hand, this defect is not shared by all older persons, and in many over the age of 70, glucose transport is as efficient as in persons in their 20s.

Anthropometrics revisited

This paper has discussed some of the anthropometric techniques currently used for assessing nutritional state. Most of the measurements are easy to perform and a large amount of reference information is available, and yet an accurate and clinically useful method for nutritional assessment (especially for the elderly) has yet to be achieved. At present the best compromise would appear to be the use of measurements of weight, height and skinfold thickness at several sites to estimate the individual's body fat (and hence estimate 'energy reserves') from regression equations, or in conjunction with a prediction of their usual percentile, from national surveys, to try and gauge losses or gains in fat. The estimation of 'degrees' of malnutrition is not recommended.

Body fatness, relative weight and frame size in young adults

1. Body-weight, body height, knee width, wrist width and skinfold measurements were made on males (n 139) and females (n 167) in three age-groups (20-22, 25-27 and 30-32 years). Percentage of body fat was calculated from skinfold thicknesses using regression equations according to Durnin & Womersley (1974). Three indices of relative weight were calculated: W/H2, W/Hp and W/W, where W is body-weight, H is body height, p is the exponent that made the index of relative weight independent of height and W is the weight estimated from body height and frame size. 2. The standard error of the estimate of body-weight was only reduced by 5% in males and by 13% in females when, in addition to body height, knee width was taken into account. The addition of wrist width did not improve the accuracy of estimation of body-weight in either sex. Therefore in further analyses W was estimated from body height and knee width. In the present population the exponent p was 1.7 in males and 1.6 in females. 3. The correlations between the percentage of body fat and the indices, W/H2, W/Hp, and W/W, were all very similar, being approximately 0.8 in both sexes. 4. A positive relationship was observed between percentage of body fat and knee width in females, which may be explained by an artifact of measurement. 5. In conclusion it can be stated that the accuracy of estimation of percentage of body fat was not improved when the index of relative weight was adjusted for knee width or wrist width in the present population. The W/H2 was the most preferable of the three indices which were calculated.

Synergy between thinness and intensive sports activity in delaying menarche

In a study to assess the effects of intensive physical activity and thinness on menarche records of 648 girls aged 10-14 were analysed. The girls were classified as thin or not thin on the basis of their body mass index, and whether or not they engaged in intensive sports activity was established. The presence of either thinness or intensive sports activity was associated with roughly a twofold decrease in the proportion of girls who had reached menarche; the presence of both factors was associated with roughly a fourfold decrease. These results did not appear to depend on age. Thus intensive sports activity and thinness appear to have a synergistic effect in delaying menarche.

Plasma lipid alterations in leukemia and lymphoma

Plasma lipids and lipoproteins were studied at presentations in 25 patients with acute leukemia and non-Hodgkin's lymphoma. All patients demonstrated an abnormally in at least one plasma lipid fraction, and most exhibited a predictable pattern of lipid alterations that consisted of extremely low levels of high-density lipoprotein cholesterol (median [Xm] = 23), elevated triglyceride (Xm = 165) and elevated very-low-density lipoprotein (Xm = 26). Patients restudied during remission demonstrated a return to normal values. The degree of lipid abnormality was directly related to the underlying tumor burden and particularly to the presence of bone marrow involvement. However, even patients with minimal tumor bulk demonstrated plasma lipid abnormalities. The results suggest that an abnormality in systemic lipid metabolism, possibly in triglyceride clearance, is present in these patients and that its incidence in this population is high.

Insulin stimulation of adipose tissue lipoprotein lipase. Use of the euglycemic clamp technique

The role of insulin in the regulation of adipose tissue lipoprotein lipase activity in humans was investigated in 11 normal subjects and compared with the effects of 0.9% saline infusions in five control subjects. After a basal adipose tissue biopsy for lipoprotein lipase activity, insulin was rapidly infused to achieve and maintain serum levels of approximately 70 microunits/ml while plasma glucose was kept at basal concentrations. Free fatty acids in serum fell to 27 +/- 3% of basal by 20 min (t = 5.19, P less than 0.001) and triglycerides decreased to 77 +/- 3% of basal by 80 min (t = 3.76, P less than 0.01). Adipose tissue lipoprotein lipase activity failed to increase significantly above that measured in controls by the first 3 h of the study. By 6 h of the infusion a stimulatory effect of insulin on adipose tissue lipoprotein lipase was found (t = 3.94, P less than 0.01). There was no relationship between the amount of glucose infused and the insulin effect on the enzyme. The increase in adipose tissue lipoprotein lipase activity at 6 h, however, was inversely related to the basal lipase activity (r = -0.690, P less than 0.02). Thus, insulin appears to stimulate adipose tissue lipoprotein lipase activity in humans. This effect of insulin is delayed when compared with antilipolysis and the fall in plasma triglyceride. The inverse relationship between insulin-stimulated adipose tissue lipoprotein lipase activity and basal enzyme activity suggests that adipose tissue itself is the main regulator of the lipase response to insulin.

[Occupational health studies on airport transport workers. III. Musculoskeletal complaints and orthopedic disorders of airport transport workers (author's transl)]

In an epidemiologic cross-sectional study, 366 transport workers (age-range: 19-61 years) of a big German airport who are engaged in physical heavy work in unfavorable body positions in narrow freight spaces of airplanes, were investigated with regard to their subjective musculoskeletal complaints through a standardized anamnesis in an interview questionnaire. An additional clinical orthopedic examination was performed in 104 of the transport workers. Back pains were the most frequently reported complaints: at the time of examination 66% of the transport workers reported present back complaints. 57% had experienced previous back syndromes. Increasing age and stature were associated with a higher prevalence of these complaints. Years of exposure to transport work correlated positively with the prevalence of back complaints. After back complaints, knee complaints followed in the prevalence of locomotor complaints (41% of the interviewed workers). The prevalence increased with age and body weight significantly. Neck complaints were reported by 33% of the workers, arm complaints by 41%: again, age increased the prevalence of these complaints significantly. In the standardized clinical orthopedic examination, the prevalence of the functional findings were sometimes higher than in the interview. In contrast to the subjective complaints at the interview, individual factors (age, stature, weight, and work experience in the present occupation) had very little influence on the prevalence of objective findings. The clinical, epidemiologic screening methods employed have proved efficacious in detecting orthopedic disorders in an occupational collective. This study has shown that transport workers with wide discrepancies between body length and the space available in airplane cargo bellies, considerable overweight, or a history of former back syndromes should not be employed. Means to alter cargo belly dimensions in airplanes as well as the increased use of mechanical loading aids and additional training of the workers in proper lifting and carrying of cargo should be taken in to consideration.

Race- and sex-specific reference data for triceps and subscapular skinfolds and weight/stature

The best clinical indicators of percentage body fat on statistical grounds are triceps skinfold thickness in females aged 6 to 50.0 yr and boys 6 to 8 yr, and weight/stature 2 (W/S2) in men. The most valid simple clinical estimators of total body fat are W/S2 in females aged 6 to 50.9 yr and adult males 19 yr and older, and subscapular skinfold thickness in boys 6 to 18 yr. This report presents race- and sex-specific reference data for these three measures based on the First Health and Nutrition Examination Survey for individuals 6 to 50.9 yr of age. Data for Blacks and whites are presented separately because of the large differences in their distributions on these measures. When compared to data from the Health Examination Survey, 1960 to 1962, the present data show evidence of a secular trend toward higher values for triceps and subscapular skinfold thickness in the upper percentiles in adults. The tables presented can be used clinically, with the specified reservations to indicate percentage body fat or total body fat for individuals.

Hypertension in obese patients: hemodynamic and volume studies

Distinct hemodynamic and volume characteristics have been suggested for established hypertension in severe obesity, namely, a high cardiac output, and expanded blood volume, and a normal peripheral resistance. To evaluate whether hypertension in moderately obese patients represents a separate entity that can be defined by hemodynamic and volume profiles, we studied these in 50 such patients and compared results with those obtained in 59 nonobese essential hypertensives and 25 normal subjects. Both obese and nonobese hypertensives had a normal cardiac index (men, 2.8 +/- 0.1 vs 2.8 +/- 0.09 liter/min/m2; women, 2.9 +/- 0.1 vs 2.8 +/- 0.1 liter/min/m2, respectively) and similarly elevated total peripheral resistance (men, 47.1 +/- 2.3 vs 46.5 +/- 1.9 U . m2; women, 45.0 +/- 2.4 vs 44.0 +/- 1.3 U . m2, respectively) as compared to normals (cardiac index: men, 2.9 +/- 0.09 liter/min/m2, women, 3.4 +/- 0.2 liter/min/m2; total peripheral resistance: men, 29.4 +/- 1.0 U . m2, women, 28.3 +/- 2.8 U. m2). Volume measurements corrected to body surface area showed that both obese and nonobese hypertensive patients had lower blood volume (men, 2.6 +/- 0.05 vs 2.5 +/- 0.05 liter/m2; women, 2.2 +/- 0.05 vs 2.3 +/- 0.05 liter/m2, respectively) than normals (men, 2.9 +/- 0.08 liter/m2; women, 2.5 +/- 0.08 liter/m2). The results of this study suggest that hypertension in moderately obese subjects is similar in its hemodynamic and volume profiles to hypertension in the nonobese and that the presence of obesity does not alter the hemodynamic characteristics of established essential hypertension.

Indices of obesity and blood pressure in young men followed 32 years

In order to assess the effects of baseline indices of obesity, lean body mass, blood pressure, and weight change on future blood pressure, 112 former college men were examined 20 and 32 years after initial examination at age 20.5 (+/- 2) yr. Baseline body weight, relative body weight, body mass index and body density all showed similar significant correlations with baseline systolic blood pressure (r = 0.35, 0.31, 0.30 - 0.31) but not baseline diastolic blood pressure (r = 0.13, 0.07, 0.10 - 0.11) or follow-up blood pressure. Changes in body weight, relative body weight, body mass index and sum of skinfolds were significantly correlated with change in both systolic and diastolic blood pressure. Baseline systolic blood pressure was the most powerful predictor of 20- and 32-yr follow-up systolic (r = 0.57, 0.42), but baseline diastolic was a much weaker correlate of follow-up diastolic blood pressure (r = 0.24, 0.18).

[Behavior therapeutic training for weight reduction]

A behaviour therapeutic program for weight reduction was worked out by a team of psychologists, dieticians and doctors. A 10 week's course for weight reduction was given by 8 dieticians to a group of 5-7 female overweights (N=50). All dieticians based their work on a written handout. 4 of them had an additional training in behaviour and group therapy prior to the course. During the course all participants showed a significant weight loss and a change in their eating behaviour, the patients counselled by an additionally trained dietician (group E1) showing a significantly greater weight loss than the others (group E2). A follow-up after 3 1/2 months revealed similar differences but subsequent controls after 6 and 20 months showed a gradual decrease of the difference between the two groups. However three different patterns of the patient's weight curve could be distinguished. Pattern a): 26.3% of the participants showed a sinking tendency over all 20 months. Pattern b): 21.4% of the participants showed a significant weight loss over the 20 months with a slight upward tendency after the second follow-up (6 months). Pattern c): 52.3% of the participants lost weight only during the course which was regained in the following 3 months period. In pattern a) and c) group E1 and E2 are evenly represented. Pattern b) was only seen with participants of group E1. The results suggest that there are different characteristics of obese persons which influence the success of weight reduction programs. Further studies will have to describe these characteristics and define their therapeutical implications.

Health care providers' attitudes toward nutrition

A survey questionnaire, assessing general attitudes toward the importance of nutrition in the prevention of disease and the maintenance of good health, was administered to physicians, nurses, dentists, and technicians at five U.S. Army medical centers. The various groups of health care specialists differed significantly on many items concerning the importance of good nutrition and eating habits for maintenance of good health and for recovery from illness, as well as on items concerning the importance of nutrition knowledge and training in their health care professions. More agreement was found among the groups on items concerned with the relationship between disease states and dietary factors and the effectiveness of health education programs in the prevention of various diseases. Self-reports of personal health habits did not correlate with scores on survey items concerned with the importance of good nutrition, suggesting that personal attitudes toward nutrition may be unrelated to other health practices.

Correlates of obesity

Designed to create composites of eating behavior questionnaire items and determine their relationship to an obesity index within three subsamples of participants in three Navy-sponsored weight-reduction programs (N = 1,878). After item and scale analyses were performed on questionnaire items that pertained to eating behaviors, history of weight problems, activities, and feelings about food and dieting, scores for the resultant composites were computed for individuals within the three subsamples. Results of multiple-regression analyses indicated that the strongest correlates of obesity within each subsample were the Overweight History, Food Obsession, and Activities composites; the multiple R was .49 for Marine recruits, .46 for the other male subsample, and .32 for women. The Emotional Eater composite was included in the multiple regression for the women's subsample. Personality characteristics also were found to be associated with the obesity index in the men's and women's subsamples. Future studies will examine the value of these variables as predictors of weight loss and maintenance of weight loss.

The prevalence of obesity and thinness in children from a lower socioeconomic population receiving comprehensive health care

The relative body weights of 1830 children from low-income families ranging in age from 2 months to 18 years were calculated using the weight-for-length index (WLI). The effects of age, sex and race on WLI were tested with a 3-way analysis of variance test. A significant age and race interaction was found for the whole sample, as well as significant age and sex interaction for blacks only. Additional analysis revealed that most of the variance in WLI could be explained by weight variations in black females. When the children were classified as obese, overweight, and thin basedon their WLI scores, black males were found to have the lowest prevalence of obesity followed by slightly higher values for the other groups. When overweight and obese children were combined into one group, black females had the highest prevalence of overweight-obese children followed by white males, black males, and white females. In contrast, white females had the highest prevalence of thinness, followed by white males, black females, and black males. Additional analysis suggested that there are important social and/or environmental factors within this particular socioeconomic group that are interacting with biological processes to influence the prevalence of obesity and thinness within each age group.

Blood pressure studies in rural and urban Western Samoa

Blood pressure was measured in the rural and urban male and female Polynesian populations of Western Samoa to determine if differences existed in mean blood pressures or in the prevalence of hypertension between these groups. It was found that, in the urban population, both males and females had higher mean blood pressures and approximately double the prevalence of hypertension found in their rural counterparts. There was an age-related rise in mean blood pressure and in the prevalence of hypertension in all groups. Approximately half of the difference in mean blood pressure and hypertension prevalence between rural and urban groups appeared to be due to difference in adiposity. Age and body mass index were significantly and independently correlated with systolic and diastolic blood pressure in each group. The prevalence of hypertension was greater in obese subjects.

The Minneapolis childrn's blood pressure study. Part 2: multiple determinants of children's blood pressure

Among 9977 public school children aged 6 to 9 years screened in late winter and spring of 1978 in Minnesota, systolic blood pressure (SBP) and diastolic fourth phase blood pressure (DBP4) were found to be unrelated to age when height and body mass index (kg/m2) were taken into account. Weight was the best single measure of body size for predicing blood pressure. Black and white children had small and inconsistent, although statistically significant, differences in blood pressure after adjusting for other variables. The same was true for boys and girls. The problems of establishing normal blood pressures for children are discussed. The current analyses suggest the use of blood pressure centiles by height.