Indices of relative weight and obesity

Excess Weight Gain After Cure of Hepatitis C Infection with Direct-Acting Antivirals

BACKGROUND

Cure from chronic hepatitis C virus (HCV) infection is readily achievable with direct-acting antivirals (DAA), but little is known about optimal management after treatment. Weight gained after DAA treatment may mitigate benefits or increase risk for liver disease progression. As the single largest sample of HCV-infected individuals receiving DAA treatment in the United States, the Veterans Affairs (VA) Birth Cohort is an ideal setting to assess weight gain after DAA treatment.

METHODS

We performed a prospective study of patients dispensed DAA therapy from January 2014 to June 2015. Weight change was calculated as the difference in weight from sustained virologic response (SVR) determination to 2 years later. Demographic, weight, height, prescription, laboratory, and diagnosis code data were used for covariate definitions. We used multiple logistic regression to assess the association between candidate predictors and excess weight gain (≥ 10 lbs) after 2 years.

RESULTS

Among 11,469 patients, 78.0% of patients were already overweight or obese at treatment initiation. Overall, SVR was achieved in 97.0% of patients. After 2 years, 52.6% of patients gained weight and 19.8% gained excess weight. In those with SVR, weight gain was as high as 38.2 lbs, with the top 10% gaining ≥ 16.5 lbs. Only 1% of those with obesity at treatment initiation normalized their weight class after 2 years. Significant predictors of post-SVR weight gain were SVR achievement, lower age, high FIB-4 score, cirrhosis, and weight class at treatment initiation.

CONCLUSION

Weight gain is common after DAA treatment, even among those who are overweight or obese prior to treatment. Major predictors include age, baseline weight, alcohol, cirrhosis, and SVR. Everyone receiving DAAs should be counseled against weight gain with a particular emphasis among those at higher risk.

Clinical epidemiology studies on potential effects of endocrine disrupting chemicals (EDCs) should exclude subjects with obesity as determined by BMI

Obesity as determined by BMI is a confounder in clinical evaluations of the effects of endocrine disrupting chemicals (EDCs). Validated regulatory tests are used to determine whether a chemical acts via a mode of action (MOA) that affects estrogen, androgen, thyroid or steroidogenic pathways. Test batteries for evaluating EDCs include QSAR, in vitro assays, and animal testing. Studies suggest that EDCs pose the greatest risk during prenatal and early infant development when organ systems are developing. Health effects include lowered fertility, endometriosis, and cancers associated with estrogenic activity. Epidemiology studies on adverse effects of EDCs in the general population are difficult to conduct due to very low exposures of EDCs in non-occupational cohorts, and lack of exposure measurements between cases and controls. In contrast with very low levels of hormonal perturbation from nano-molar to micro-molar exposures to EDCs, adipose tissue in obesity alters estrogen, testosterone, thyroid stimulating hormone, and inflammation levels. Obesity in pregnancy and gestational diabetes are associated with adverse outcomes in infants and children including autism, poor motor skills, lowered IQ, and altered birth weight. Neonatal effects of obesity are confounded by average lower socio-economic status. The already perturbed endocrine balance in overweight or obese persons renders them particularly worthy subjects for clinical epidemiology investigations on the possible effects of endocrine disrupting chemicals. However, inclusion of subjects with obesity requires accounting for potentially confounding effects of the hormonal influences arising from excess adiposity. If subjects with obesity are to be included in clinical epidemiological evaluations related to hormonal effects, the subjects should be classified by body fat percentage rather than by the much less exact measure of body mass index (BMI).

Effects of Sleep Restriction on Food-Related Inhibitory Control and Reward in Adolescents

OBJECTIVE

This experimental study evaluated associations between sleep duration, food-related inhibitory control, and food reward in adolescents aged 12-18 with normal weight and overweight/obesity. The potential moderating effect of weight status on the associations between sleep, inhibitory control, and food reward was also examined.

METHODS

Thirty-two adolescents with normal weight and 32 adolescents with overweight/obesity (ages 12-18) participated in this study. Participants spent 5 hr in bed per night (restricted sleep) or 9 hr in bed per night (habitual sleep) for five nights with experimental periods separated by 3 weeks. Participants completed a food-related inhibitory control task and a questionnaire assessing food reward on the sixth day of each study phase.

RESULTS

Repeated measures analyses of variance revealed that adolescents performed more poorly on a food-related inhibitory control task and had heightened food reward following sleep restriction. Adolescents with overweight/obesity demonstrated heightened food reward compared with adolescents with normal weight; there was no main effect of weight on food-related inhibitory control. There was a significant interaction between sleep condition and weight status on food reward, with adolescents with normal weight demonstrating heightened food reward following sleep restriction. Adolescents with overweight/obesity showed consistently high food reward with no effect of sleep duration.

CONCLUSIONS

When sleep restricted, adolescents demonstrated heightened food reward and were less able to inhibit prepotent responses to food images. Adolescents with normal weight who experience acute sleep restriction may perceive foods to be more rewarding relative to normal sleep.

Does meeting physical activity recommendations ameliorate association between television viewing with cardiovascular disease risk? A cross-sectional, population-based analysis

OBJECTIVES

As a common form of sedentary behaviour, television viewing is associated with an increase in body mass index (BMI) as well as overall cardiovascular disease (CVD) risk. This study examined the extent to which meeting the recommended volume of weekly physical activity (PA) reduced the association between television viewing with the outcomes of BMI and CVD risk. A second aim was to determine the number of hours (ie, cut-point) of daily television viewing that conferred a higher BMI and CVD risk for a large population-based sample of adults.

DESIGN

Population-based, cross-sectional study.

SETTING

UK Biobank recruited across 35 centres in the UK between 2006 and 2010.

PRIMARY OUTCOME

CVD risk, as measured by the 30-year Framingham risk score.

RESULTS

Linear regression models indicated that every additional hour of television viewing per day was associated with a 3% increase in CVD risk (aCoeff=0.03, d=0.16, p<0.0001); the interaction between television viewing with meeting PA guidelines was marginally associated with CVD risk (aCoeff=0.0010, d=0.01, p=0.014). Each additional hour of television viewing per day was associated with a 0.54 increase in BMI (aCoeff=0.54, d=0.13, p<0.0001); the interaction between television viewing with meeting PA guidelines was not significantly associated with BMI. Regression tree models of the study outcomes revealed that 2.5 hours of television viewing was associated with pronounced increases in BMI and CVD risk.

CONCLUSIONS

These data underscore the independent association between television viewing with cardiovascular risk and suggest that reducing television viewing to less than 2.5 hours per day, even in physically active adults, is a clinical and public health priority.

Magnitude and Composition of Sedentary Behavior in Older Adults Living in a Retirement Community

High amount of sedentary behavior (SB) has been associated with a multitude of adverse health events in older adults. There are limited data regarding SB in older adults living in retirement communities (RC). This study described the magnitude and composition of SB [non-screen sedentary time (NSST) and screen sedentary time (SST)] in older adults living in a RC and documented variation in this behavior as a function of demographic, health, health behavior and clinical variables. This cross sectional descriptive study enrolled and assessed 100 older males and females living a RC located in the Midwest region of United States. Participants completed a questionnaire for sample characterization and a SB questionnaire. Metric of SB (i.e., TST, NSST and SST) were analyzed overall and separated by the variables of interest. Participants reported on average 10 h/day of sedentary activity (65% on NSST and 35% on SST). Older adults reported to spend most of their awaking hours in activities such as reading, watching TV and computer use. Significant variations on NSST and SST were observed for gender, BMI, perceived health, mobility aid use and number of chronic diseases. These findings may help in the development of tailored strategies and interventions focusing on reducing SB in this particular under-researched subgroup.

Development of omega-3 rich eggs through dietary flaxseed and bio-evaluation in metabolic syndrome

An egg is a nutrient-dense food that contains protein, fats, vitamins, and minerals. It is proven that the consumption of eggs influences serum lipid concentration. Therefore, a study was conducted to investigate the effect of normal and omega-3 eggs on serum lipids profiles. Lipids were extracted from egg yolks and analyzed for fatty acids content. The present research is a crossover study design in which 20 participants were recruited randomly, and all subjects received three treatments: no eggs, omega-3 eggs, and normal eggs. However, fasting blood was drawn at baseline and the end of each diet period and analyzed for serum lipids, blood glucose, and insulin level. Omega-3 egg treatment showed reduction in the serum total cholesterol by 16.57 mg/dl (p < .001), triglyceride by 17.48 mg/dl, and increase in HDL cholesterol concentration by 0.48 mg/dl (p < .001) as compared to no-egg. A significant (p < .05) reduction in blood pressure by 8.34/8.67 mm/Hg and insulin level was observed due to omega-3 egg consumption which indicates that omega-3 fatty acids improve insulin sensitivity. On the other hand, regular egg intake elevates serum total cholesterol and triglycerides concentration but decreases blood pressure. It was concluded that omega-3-enriched egg consumption had a positive effect on the serum lipid profile and blood pressure of patients with metabolic syndrome as compared to normal eggs.

Metabolically Healthy Obesity: Criteria, Epidemiology, Controversies, and Consequences

PURPOSE OF REVIEW

To present a comprehensive overview regarding criteria, epidemiology, and controversies that have arisen in the literature about the existence and the natural course of the metabolic healthy phenotype.

RECENT FINDINGS

The concept of metabolically healthy obesity (MHO) implies that a subgroup of obese individuals may be free of the cardio-metabolic risk factors that commonly accompany obese subjects with adipose tissue dysfunction and insulin resistance, known as having metabolic syndrome or the metabolically unhealthy obesity (MUO) phenotype. Individuals with MHO appear to have a better adipose tissue function, and are more insulin sensitive, emphasizing the central role of adipose tissue function in metabolic health. The reported prevalence of MHO varies widely, and this is likely due the lack of universally accepted criteria for the definition of metabolic health and obesity. Also, the natural course and the prognostic value of MHO is hotly debated but it appears that it likely evolves towards MUO, carrying an increased risk for cardiovascular disease and mortality over time. Understanding the pathophysiology and the determinants of metabolic health in obesity will allow a better definition of the MHO phenotype. Furthermore, stratification of obese subjects, based on metabolic health status, will be useful to identify high-risk individuals or subgroups and to optimize prevention and treatment strategies to compact cardio-metabolic diseases.

Social jetlag, eating behaviours and BMI among adolescents in the USA

There is a lack of research on associations of social jetlag with eating behaviours and obesity among adolescents. We examined the associations of social jetlag with eating behaviours and BMI in adolescents before and after adjustment for potential confounders. Self-report data were collected from 3060 adolescents (48·1 % female, mean age 15·59 (sd 0·77) years) from the Fragile Families and Child Wellbeing Study. In regression models, social jetlag predicted odds of consumption of breakfast, fruits/vegetables, fast food and sweetened drinks and BMI percentile. Primary models adjusted for school night sleep duration, sex, age, household income and youth living arrangements; secondary models further adjusted for race/ethnicity. In fully adjusted models, greater social jetlag was associated with lower odds of consumption of breakfast (OR = 0·92, P = 0·003) and fruits/vegetables (OR = 0·92, P = 0·009) and higher odds of consumption of fast food (OR = 1·18, P < 0·001) and sweetened drinks (OR = 1·18, P < 0·001). Social jetlag was positively associated with BMI percentile after additional adjustment for eating behaviours (b = 0·84, P = 0·037), but this relationship was attenuated after adjustment for race/ethnicity (b = 0·72, P = 0·072). Ethnoracial differences in social jetlag may attenuate the association of social jetlag with BMI and should be considered in future studies of circadian misalignment, eating behaviours and obesity markers.

Obesity Phenotypes, Diabetes, and Cardiovascular Diseases

This review addresses the interplay between obesity, type 2 diabetes mellitus, and cardiovascular diseases. It is proposed that obesity, generally defined by an excess of body fat causing prejudice to health, can no longer be evaluated solely by the body mass index (expressed in kg/m²) because it represents a heterogeneous entity. For instance, several cardiometabolic imaging studies have shown that some individuals who have a normal weight or who are overweight are at high risk if they have an excess of visceral adipose tissue-a condition often accompanied by accumulation of fat in normally lean tissues (ectopic fat deposition in liver, heart, skeletal muscle, etc). On the other hand, individuals who are overweight or obese can nevertheless be at much lower risk than expected when faced with excess energy intake if they have the ability to expand their subcutaneous adipose tissue mass, particularly in the gluteal-femoral area. Hence, excessive amounts of visceral adipose tissue and of ectopic fat largely define the cardiovascular disease risk of overweight and moderate obesity. There is also a rapidly expanding subgroup of patients characterized by a high accumulation of body fat (severe obesity). Severe obesity is characterized by specific additional cardiovascular health issues that should receive attention. Because of the difficulties of normalizing body fat content in patients with severe obesity, more aggressive treatments have been studied in this subgroup of individuals such as obesity surgery, also referred to as metabolic surgery. On the basis of the above, we propose that we should refer to obesities rather than obesity.

Effects of active commuting to work for 12 months on cardiovascular risk factors and body composition

Active commuting has the potential to decrease cardiovascular risk by increasing physical activity. We aimed to investigate the effects of active commuting to work for 12 months on body composition and cardiovascular risk factors. Therefore, 73 hospital employees (age: 46 ± 9 years, 36% males), with a predominantly passive way of commuting, were randomly assigned to an intervention group (IG) and a control group (CG) in a 2:1 fashion. The IG was further divided into a public transportation plus active commuting group (IG‐PT) and a cycling group (IG‐C). Both IGs were prompted to reach 150 min/wk of moderate intensity exercise. Daily self‐reported commuting details were verified by GPS tracking. All subjects underwent assessment of body composition, resting blood pressure, glycemic control, and lipid profile at the beginning and end of the study. Data for final analyses were available in 62 subjects. Commuting details indicated that the subjects randomized to IG changed their commuting habits. HbA1c decreased by 0.2% [95%CI: −0.3, −0.2] in IG‐PT but was not statistically different between groups (P = .06). LDL cholesterol decreased in IG‐C by 0.8 mmol/L [−1.1, −0.4] and by 0.6 mmol/L [−1.2, 0.1] in IG‐PT which can be considered biologically relevant but did not yield statistical significance. Body composition and blood pressure did not differ between groups. Active commuting to work for 12 months did not change body composition but yielded relevant changes in lipid profile and glycemic control. Health benefits of active commuting should be addressed by healthcare professionals when counseling individuals that seek to improve their cardiovascular risk profile.

The aging human body shape

Body shape and composition are heterogeneous among humans with possible impact for health. Anthropometric methods and data are needed to better describe the diversity of the human body in human populations, its age dependence, and associations with health risk. We applied whole-body laser scanning to a cohort of 8499 women and men of age 40–80 years within the frame of the LIFE (Leipzig Research Center for Civilization Diseases) study aimed at discovering health risk in a middle European urban population. Body scanning delivers multidimensional anthropometric data, which were further processed by machine learning to stratify the participants into body types. We here applied this body typing concept to describe the diversity of body shapes in an aging population and its association with physical activity and selected health and lifestyle factors. We find that aging results in similar reshaping of female and male bodies despite the large diversity of body types observed in the study. Slim body shapes remain slim and partly tend to become even more lean and fragile, while obese body shapes remain obese. Female body shapes change more strongly than male ones. The incidence of the different body types changes with characteristic Life Course trajectories. Physical activity is inversely related to the body mass index and decreases with age, while self-reported incidence for myocardial infarction shows overall the inverse trend. We discuss health risks factors in the context of body shape and its relation to obesity. Body typing opens options for personalized anthropometry to better estimate health risk in epidemiological research and future clinical applications.

BMI and inverted BMI as predictors of fat mass in young people: a comparison across the ages

Background: The use of body mass index (BMI) could lead to over/under estimation of fat mass percentage (FM%). An alternative index (inverted BMI, iBMI) has been proposed as a better estimator of FM% in adults, while its practical feasibility in children and adolescents has not been fully investigated.Aim: To examine if iBMI can better estimate FM% than BMI in children/adolescents.Subjects and methods: Height, weight, and triceps and subscapularis skinfolds were measured in 6686 schoolchildren aged 11-14-years-old. BMI and iBMI (squared height/weight) were calculated; FM% was estimated by skinfold thicknesses. The Pearson correlation coefficient and the coefficient of determination were obtained to test the best regression model between the indexes and FM%.Results: FM% was linearly related to both indexes with R2 values that were overall > 0.7. No significant differences among the R2 values were found (p value = .2, ANOVA).Conclusion: BMI persists as a robust index for health surveillance screening in children/adolescents, being very intuitive and ready-to-use. Inverted BMI may be more accurate within a cohort of adults who experience only ponderal modifications, directly implicated in the variation of FM. In conclusion, the BMI remains a quick, handy and intuitive predictor of FM%.

Relative Body Weight and Standardised Brightness-Mode Ultrasound Measurement of Subcutaneous Fat in Athletes: An International Multicentre Reliability Study, Under the Auspices of the IOC Medical Commission

INTRODUCTION

Fat is a metabolic fuel, but excess body fat is ballast mass, and therefore, many elite athletes reduce body fat to dangerously low levels. Uncompressed subcutaneous adipose tissue (SAT) thickness measured by brightness-mode ultrasound (US) provides an estimate of body fat content.

METHODS

The accuracy for determining tissue borders is about 0.1-0.2 mm and reliability (experienced measurers) was within ± 1.4 mm (95% limit of agreement, LOA). We present here inter- and intra-measurer scores of three experienced US measurers from each of the centres C1 and C2, and of three novice measurers from each of the centres C3-C5. Each of the five centres measured 16 competitive adult athletes of national or international level, except for one centre where the number was 12. The following sports were included: artistic gymnastics, judo, pentathlon, power lifting, rowing, kayak, soccer, tennis, rugby, basketball, field hockey, water polo, volleyball, American football, triathlon, swimming, cycling, long-distance running, mid-distance running, hurdles, cross-country skiing, snowboarding, and ice hockey. SAT contour was detected semi-automatically: typically, 100 thicknesses of SAT at a given site (i.e., in a given image), with and without fibrous structures, were measured.

RESULTS

At SAT thickness sums DI (of eight standardised sites) between 6.0 and 70.0 mm, the LOA of experienced measurers was 1.2 mm, and the intra-class correlation coefficient ICC was 0.998; novice measurers: 3.1 mm and 0.988. Intra-measurer differences were similar. The median DI value of all 39 female participants was 51 mm (11% fibrous structures) compared to 17 mm (18%) in the 37 male participants.

DISCUSSION

DI measurement accuracy and precision enables detection of fat mass changes of approximately 0.2 kg. Such reliability has not been reached with any other method. Although females' median body mass index and mass index were lower than those of males, females' median DI was three times higher, and their percentage of fibrous structures was lower. The standardised US method provides a highly accurate and reliable tool for measuring SAT and thus changes in body fat, but training of measurers is important.

Differences in the relationship of weight to height, and thus the meaning of BMI, according to age, sex, and birth year cohort

Background: Weight can be adjusted for height using the Benn parameter (kg/mB), where B is the power that minimises the correlation with height.Aim: To investigate how the Benn parameter changes across age (10-65 years) and time (1956-2015) and differs between sexes.Subjects and methods: The sample comprised 49,717 individuals born in 1946, 1958, 1970 or 2001. Cross-sectional estimates of the Benn parameter were produced and cohort differences at ages 10/11 and 42/43 years were examined using linear regression. Multilevel modelling was used to develop trajectories showing how the Benn parameter changed over age from childhood to mid-adulthood in the three older cohorts.Results: The Benn parameter was closest to 2 in childhood but consistently lower across adulthood, particularly in females and the most recent cohort. At ages 10/11 years, the Benn parameter was greater than 3 in both sexes in the 2001 cohort but between 2.2 and 2.7 in the three older cohorts. This difference was estimated to be +0.67 (0.53, 0.81) in males and +0.53 (0.38, 0.68) in females, compared to the 1946 cohort, and was driven by a much higher weight SD in the 2001 cohort. Conversely, at ages 42/43 years, the Benn parameter was lowest in the 1970 cohort due to a slightly lower weight-height correlation. This difference was estimated to be -0.12 (-0.34, 0.10) in males and -0.15 (-0.42, 0.13) in females, compared to the 1946 cohort.Conclusions: Changes over time in the obesogenic environment appear to have firstly reduced the Benn parameter due to a lowering of the weight-height correlation but secondly and more drastically increased the Benn parameter due to increasing weight variation.

Resting Energy Expenditure in Peritoneal Dialysis Patients

Objectives

This study aimed to evaluate whether resting energy expenditure (REE) of patients undergoing peritoneal dialysis (PD) therapy differs from that of healthy individuals, as well as to investigate the factors associated with REE in this sample of patients.

Design

Cross-sectional study.

Setting

Dialysis Unit of the Nephrology Division, Federal University of Sao Paulo–Oswaldo Ramos Foundation, Brazil.

Subjects and Methods

The study examined the REE of 37 patients (20 males, age 44.5 ± 13 years) undergoing PD therapy. Only patients older than 18 years, on PD for at least 3 months, without catabolic illness, and with normal thyroid function were included. Patients were pair matched for age and gender with 37 healthy individuals. REE was measured by indirect calorimetry. Body composition was assessed by dual-energy x-ray absorptiometry in the patients and by bioelectrical impedance in the healthy individuals.

Results

The REE of PD patients was similar to that of pair-matched controls (1372 ± 266 and 1453 ± 252 kcal/day respectively, p = 0.13) even when adjusted for lean body mass and gender ( p = 0.56). The REE of PD patients was positively correlated with lean body mass ( r = 0.60, p < 0.01), fat mass ( r = 0.43, p < 0.01), body mass index (r = 0.60, p < 0.01), serum glucose (r = 0.36, p < 0.05), and protein equivalent of nitrogen appearance (PNA; r = 0.42, p < 0.01). There were no correlations between REE and glucose absorption, dialysis-related parameters, C-reactive protein, and energy or protein intake by 3-day food diary. In the multiple linear regression analysis, using REE as the dependent variable, the final model showed that lean body mass and female gender were determinants of REE in PD patients ( R2 = 0.44). When separate analysis by gender was performed, REE correlated directly with body fat in female patients (r = 0.70, p < 0.01) but not in male patients ( r = 0.29, p = 0.21). On the other hand, lean body mass was significantly correlated with REE in male patients ( r = 0.78, p < 0.01) but not in female patients ( r = 0.47, p = 0.06).

Conclusions

This study showed that REE of PD patients did not differ from that of healthy individuals. The strong association between body fat and REE in female patients remains to be further investigated.

Herbal supplements interactions with oral oestrogen-based contraceptive metabolism and transport

The increased use of herbal supplements as complementary or alternative medicines has become a clinical conundrum due to the potential for herb-drug interactions. This is exacerbated by an increased supply of new herbal supplements in the market claiming various health advantages. These herbal supplements are available as over-the-counter self-medications. Herbal supplements are generally perceived as efficacious without side effects commonly associated with conventional drugs. However, despite regulations, claims related to their therapeutic effects are mostly unsupported by scientific evidence. These products often lack suitable product quality controls, labelled inadequately and with batch to batch variations, potentially compromising the safety of the consumer. Amongst health practitioners, the greatest concern is related to the lack of chemical characterization of the active compounds of the herbal supplements. The interaction between these different active components and their concomitant effects on other conventional drugs is generally not known. This review will focus on herbal supplements with the potential to effect pharmacokinetic and pharmacodynamic properties of oestrogen-based oral contraceptives. The use of herbal supplements for weight management, depression, and immune boosting benefits were selected as likely herbal supplements to be used concomitantly by women on oral contraceptives.

Efficacy of extended, comprehensive outpatient cardiac rehabilitation on cardiovascular risk factors: A nationwide registry

Aim

Cardiac rehabilitation (CR) is a key component of the treatment of cardiac diseases. The Austrian outpatient CR model is unique, as it provides patients with an extended professionally supervised, multidisciplinary program of 4–6 weeks of phase II (OUT-II) and 6–12 months of phase III (OUT-III) CR. The aim of this analysis was to assess the efficacy of the Austrian outpatient CR model using a nationwide registry.

Methods

Data of all consecutive patients ( N = 7560) who completed OUT-II and/or OUT-III between 1 January 2005 and 31 December 2015 were entered prospectively into a registry. OUT-III patients were analyzed separately according to whether the preceding phase II was performed as outpatient (OUT-II/OUT-III, N = 2403) or in-patient (IN-II/OUT-III, N = 2789). All patients underwent assessment of anthropometry, resting blood pressure, lipid profile, fasting blood glucose, exercise capacity, quality of life, anxiety and depression.

Results

During OUT-II, patients significantly improved their metabolic risk factor profile and increased exercise capacity by 14.3%. OUT-II/OUT-III patients achieved an additional increase in exercise capacity by 10%, further improvement in high-density lipoprotein (HDL) and stabilization of the remaining risk factors. IN-II/OUT-III patients increased their maximal exercise capacity by 18.4% and there was improvement in blood pressure, HDL, low-density lipoprotein and glucose levels.

Conclusion

Extended, professionally supervised, multidisciplinary outpatient CR in a large nationwide registry of consecutive patients consistently improved maximal exercise capacity and relevant modifiable cardiovascular risk factors beyond effects seen after IN- or OUT-II alone.

Mid- and Late-Life Leisure-Time Physical Activity and Global Brain Amyloid Burden: The Atherosclerosis Risk in Communities (ARIC)-PET Study

BACKGROUND

Physical activity (PA) may slow the development of dementia by reducing the accumulation of amyloid.

OBJECTIVE

We tested the hypothesis that higher levels of leisure-time PA in mid- or late-life were associated with lower brain amyloid burden in late-life among 326 non-demented participants from the Atherosclerosis Risk in Communities Study of brain florbetapir positron emission tomography (ARIC-PET) ancillary.

METHODS

Self-reported PA was quantified using a past-year recall, interviewer-administered questionnaire in mid-life (1987-1989, aged 45-64 years) and late-life (2011-2013, aged 67-89 years). Continuous PA estimates were classified as 1) any leisure-time PA participation (yes/no); 2) meeting the 2018 United States' PA guidelines (yes/no); and 3) per 1 standard deviation (SD) higher metabolic equivalent of task (MET) minutes per week (MET·min·wk-1). A brain magnetic resonance imaging scan with Florbetapir PET was performed in late-life. Adjusted odds ratios (OR) of elevated amyloid burden, defined as a global cortical standardized uptake value ratio (>1.2), compared to no elevated amyloid burden were estimated according to PA measures.

RESULTS

Among the 326 participants (mean age: 76 years, 42% male, 41% Black), 52% had elevated brain amyloid burden. Mid-life leisure-time PA did not show a statistically significant lower odds of elevated late-life amyloid burden (OR = 0.71, 95% CI: 0.43-1.18). A 1 SD (970 MET. min. wk-1) higher PA level in mid-life was also not significantly associated withelevated amyloid burden (OR = 0.89, 95% CI: 0.69-1.15). Similar estimates were observed for meeting versus not meeting PA guidelines in both mid- and late-life.

CONCLUSION

Self-reported higher mid- and late-life leisure-time PA were not significantly associated with lower amyloid burden. Data show a trend of an association, which is, however, imprecise, suggesting replication in larger studies.

Optimum waist circumference-height indices for evaluating adult adiposity: An analytic review

Phenotyping adults for excess adiposity and related health risks usually include three body size measurements: height, weight and waist circumference (WC). Height and weight are now widely used as components of the body shape measure, body mass index (BMI, weight/height² ), with the height power referred to as the scaling factor, α. At present, WC is usually not adjusted for height or is expressed as WC/height in which α = 1. Although other α values have been proposed, a critical review of these shape measures is lacking. Here, we examine classical pathways by which the scaling exponent for height used in BMI was developed and then apply this strategy to identify the optimum WC index characteristic of adult shape. Our analyses explored anthropometric, body composition and clinically-relevant data from US and Korean National Health and Nutrition Surveys. Our findings provide further support for the WC index of WC/height^0.5 as having the strongest associations with adiposity while having the weakest correlations with height across non-Hispanic white and black, Mexican American and Korean men and women. The WC index, defined as WC/height^0.5 , when combined with BMI, can play an important role when phenotyping adults for excess adiposity and associated health risks in research and clinical settings.

Motor intervention with and without Nintendo® Wii for children with developmental coordination disorder: protocol for a randomized clinical trial

BACKGROUND

Despite the benefits highlighted by motor interventions based on virtual reality for children with Developmental Coordination Disorder (DCD), there are still doubts as to whether these are greater than those obtained with conventional interventions due to the absence of systematized protocols, and lack of evidence. Here, we present a protocol to systematically compare the effects of two motor-training programs (one Nintendo® Wii-based and the other no-Wii motor activities) on the motor learning in children with DCD.

METHODS/DESIGN

Two intervention protocols (one based on Nintendo® Wii and the other no-Wii motor activities) will be carried out, with interventions occurring twice a week in 60-min sessions, with a minimum of 12 and a maximum of 16 sessions per child. The protocols were developed based on the domains of the Movement Assessment Battery for Children - Second Edition (MABC-2) (Manual Dexterity, Aiming and Catching, Balance), with two activities for each of the MABC - two domains. The study will include children aged 7 to 10 years with a total MABC-2 score ≤ 16, and a Developmental Coordination Disorder Questionnaire (DCDQ) score < 46 (age of 7 years), score < 55 (age group of 8 to 9 years and 11 months), or score < 57 (age of 10 years) as scored by the parents. Children will be randomly allocated by draw in one of the two intervention protocols. MABC-2 and DCDQ will be applied before and after intervention to evaluate the effects of the interventions on motor performance and parents' perception, respectively. Motor learning will be assessed by means of the scores obtained in the games. Evaluators and therapists will be trained and evaluators will be blind regarding the data of the children in the study.

DISCUSSION

Owing to its motivating aspects, training with Nintendo® Wii may be particularly beneficial for children with DCD. The results of this study protocol should help researchers and therapists to better understand the benefits of Nintendo® Wii-based motor intervention over those obtained with no-Wii interventions in children with DCD. It should also create references about more systematized protocols for replication in clinical practice, seeking the improvement of the motor components of these children.

TRIAL REGISTRATION

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Comparison of 14 body size variables on adult skeletal age methods: how body mass, BMI, fat and muscle influence age estimations

Background: Skeletal age estimations consistently under-age individuals with low body mass and over-age individuals with high body mass.Aim: To assess the directional biases of body size variables, including fat and muscle tissue, on skeletal age estimates.Subjects and methods: CT scans of 420 age- and size-selected cadavers were assessed using the fourth rib and pubic symphysis age estimation methods. MANCOVA was used to test the effects of stature, body mass, circumference, and fat and muscle tissue area on age estimation biases.Results: For both methods, there were biases based on body mass, BMI, circumference and fat tissue area. Individuals with the lowest measurements for these variables were under-aged while individuals with the highest measurements were over-aged. Age estimation biases were not affected by stature, muscle area, or skeletal measurements of bi-iliac breadth, femoral head diameter, or femoral length.Conclusion: Increased body mass, and specifically fat tissue, accelerates skeletal ageing. Increased muscle area generally did not show a protective effect on skeletal ageing. The accuracy of age estimations would be improved by factoring in body mass. However, femoral head diameter and bi-iliac breadth are not good proxies for body mass. Osteological markers of obesity offer a promising new approach.

Nrf2, NF-κB and PPARβ/δ mRNA Expression Profile in Patients with Coronary Artery Disease

BACKGROUND

Oxidative stress and inflammation are present in coronary artery disease (CAD) and are linked to the activation of the transcription nuclear factor kappa B (NF-κB). To attenuate these complications, transcription factors like nuclear factor erythroid 2-related factor 2 (Nrf2) and peroxisome proliferator-activated receptor-β/δ (PPARβ/δ) can be activated to inhibit NF-κB. However, the available data on expression of NF-κB, Nrf2 and PPARβ/δ in CAD patients are limited.

OBJECTIVE

To evaluate the expression of the transcription factors NF-κB and Nrf2 and PPAR𝛽/𝛿 in CAD patients.

METHODS

Thirty-five patients (17 men, mean age 62.4 ? 7.55 years) with CAD and twelve patients (5 men, mean age 63.50 ? 11.46 years) without CAD were enrolled. Peripheral blood mononuclear cells (PBMCs) were isolated and processed for mRNA expression of Nrf2, NF-κB, NADPH: quinone oxidoreductase 1 (NQO1) and PPARβ/δ mRNAs using quantitative real-time polymerase chain reaction (qPCR). p < 0.05 was considered statistically significant.

RESULTS

There was no difference in the mRNA expressions of Nrf2 (1.35 ? 0.57), NF-κB (1.08 ? 0.50) or in the antioxidant enzyme NQO1 (1.05 ? 0.88) in the CAD group compared to the group without CAD (1.16 ? 0.76, 0.95 ? 0.33, 0.81 ? 0.55, respectively). However, PPARβ/δ was highest expressed in the CAD group (1.17 ? 0.86 vs. 0.56 ? 0.34, p = 0.008).

CONCLUSION

The main finding of this study was the PPARβ/δ being more expressed in the PBMC of patients with CAD compared to the control group, whereas no differences were observed in Nrf2 or NF-κB mRNA expressions.

Disparity in Adiposity among Adults with Normal Body Mass Index and Waist-to-Height Ratio

Body mass index (BMI) is commonly used to define obesity. However, concerns about its accuracy in predicting adiposity have been raised. The feasibility of using BMI as well as waist-height ratio (WHtR) in assessing adiposity was examined in relation to a more direct measurement of percent body fat (%BF). We analyzed the relation between dual-energy X-ray absorptiometry (DXA)-measured fat mass and BMI and WHtR using the US 1999-2004 National Health and Nutrition Examination Survey (NHANES) data. A considerable proportion of subjects in the healthy BMI range 20-25 were found to have excess adiposity, including 33.1% of males and 51.9% of females. The use of WHtR also supports the notion of normal-weight central obesity (NWCO), which increases with age. These findings have important implications not only for clinical practice but also for many comparative studies where control subjects are usually selected based on age, sex, and BMI.

Association of Sarcopenia With Nutritional Parameters, Quality of Life, Hospitalization, and Mortality Rates of Elderly Patients on Hemodialysis

OBJECTIVE

This study aimed to assess whether diminished muscle mass, diminished muscle strength, or both conditions (sarcopenia) are associated with worse nutritional status, poor quality of life (QoL), and hard outcomes, such as hospitalization and mortality, in elderly patients on maintenance hemodialysis (MHD).

DESIGN AND SUBJECTS

This is a multicenter observational longitudinal study that included 170 patients on MHD (age 70 ± 7 years, 65% male) from 6 dialysis centers.

MAIN OUTCOME MEASURE

The European Working Group on Sarcopenia in Older People defines sarcopenia as the presence of both low muscle mass by appendicular skeletal + low muscle function by handgrip strength. This study evaluated the clinical and nutritional status (laboratory, anthropometry, dual-energy X-ray absorptiometry, 7-point subjective global assessment) and QoL (Kidney Disease Quality of Life) at baseline. Hospitalization and mortality were recorded during 36 months.

RESULTS

Reduced muscle mass was observed in 64% of the patients, reduced muscle strength in 52%, and sarcopenia in 37%. The group with sarcopenia was older, had a higher proportion of men and showed worse clinical and nutritional conditions when compared with patients without sarcopenia. Although reduced muscle mass was strongly associated with poor nutritional status, low muscle strength was associated with worse QoL domains. In the multivariate Cox analyses adjusted by age, gender, dialysis vintage, and diabetes mellitus, low muscle strength alone and sarcopenia were associated with higher hospitalization, and sarcopenia was a predictor of mortality.

CONCLUSION

In conclusion, in this sample, comprised of elderly patients on MHD, sarcopenia was associated with worse nutritional and clinical conditions and was a predictor of hospitalization and mortality.

Physical exercise and body-mass index in young adults: a national survey of Norwegian university students

Background

Physical inactivity and obesity pose a major public health challenge. The aim of this study was to describe the level of physical exercise and body-mass index in college and university students, as well as to examine potential changes from 2010 to 2018.

Methods

Data stem from the SHoT study, a national student health survey for higher education in Norway, conducted at 4-year intervals. The SHOT studies conducted so far in 2010, 2014 and 2018, included 6053, 13,525 and 50,054 fulltime students (aged 18–35), respectively. Exercise frequency (average number of times exercising each week) was assessed in all three waves, and was used for the trend analysis. The last wave in 2018 also assessed the average intensity and duration of the exercise.

Results

Overall, students exercised less in 2018 compared to 2014, but comparable to level in 2010. The prevalence of overweight increased substantially from 2010 to 2018, but especially in the last 4 years and among older female students. Less than one of four male, and one of five female students, met the recommended criteria for both exercise frequency, intensity and duration. As expected, the associations between exercise and overweight/obesity were in a dose-response manner, and strong across all three waves.

Conclusions

Our findings show that the large majority of young adults fail to meet international recommendations on exercise, and that the proportion of overweight is increasing in both genders and across all age groups. We conclude that there is an urgent need for a broad approach to achieve a paradigm shift in supporting our college and university students to become more active.

Amikacin Initial Dose in Critically Ill Patients: a Nonparametric Approach To Optimize A Priori Pharmacokinetic/Pharmacodynamic Target Attainments in Individual Patients

Amikacin is commonly used for probabilistic antimicrobial therapy in critically ill patients with sepsis. Its narrow therapeutic margin makes it challenging to determine the right individual dose that ensures the highest efficacy target attainment rate (TAR) in this setting. This study aims to develop a new initial dosing approach for amikacin by optimizing the a priori TAR in this population. A population pharmacokinetic model was built with a learning data set from critically ill patients who received amikacin. It was then used to design an initial dosing approach maximizing a priori TAR for a target ratio of ≥8 for the peak concentration to the MIC (C _max/MIC) or of ≥75 for the ratio of the area under the concentration-time curve from 0 to 24 h to the MIC (AUC_0-24/MIC). In the 166 patients included, 53% had amikacin C _max of ≥64 mg/liter with a median dose of 23.4 mg/kg. A two-compartment model with creatinine clearance and body surface area as covariates best described the data and showed good predictive performance. Our dosing approach was successful in optimizing TAR for C _max/MIC, with a rate of 92.9% versus 67.9% using a 30-mg/kg regimen, based on an external subset of data and assuming a MIC of 8 mg/liter. Mean optimal doses were higher (3.5 ± 0.5 g) than with the 30-mg/kg regimen (2.1 ± 0.3 g). Suggested doses varied with the MIC, the target index, and desired TAR threshold. A dosing algorithm based on the method is proposed for a large range of patient covariates. Clinical studies are necessary to confirm efficacy and safety of this optimized dosing approach.

Machine learning of human plasma lipidomes for obesity estimation in a large population cohort

Obesity is associated with changes in the plasma lipids. Although simple lipid quantification is routinely used, plasma lipids are rarely investigated at the level of individual molecules. We aimed at predicting different measures of obesity based on the plasma lipidome in a large population cohort using advanced machine learning modeling. A total of 1,061 participants of the FINRISK 2012 population cohort were randomly chosen, and the levels of 183 plasma lipid species were measured in a novel mass spectrometric shotgun approach. Multiple machine intelligence models were trained to predict obesity estimates, i.e., body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and body fat percentage (BFP), and validated in 250 randomly chosen participants of the Malmö Diet and Cancer Cardiovascular Cohort (MDC-CC). Comparison of the different models revealed that the lipidome predicted BFP the best (R2 = 0.73), based on a Lasso model. In this model, the strongest positive and the strongest negative predictor were sphingomyelin molecules, which differ by only 1 double bond, implying the involvement of an unknown desaturase in obesity-related aberrations of lipid metabolism. Moreover, we used this regression to probe the clinically relevant information contained in the plasma lipidome and found that the plasma lipidome also contains information about body fat distribution, because WHR (R2 = 0.65) was predicted more accurately than BMI (R2 = 0.47). These modeling results required full resolution of the lipidome to lipid species level, and the predicting set of biomarkers had to be sufficiently large. The power of the lipidomics association was demonstrated by the finding that the addition of routine clinical laboratory variables, e.g., high-density lipoprotein (HDL)- or low-density lipoprotein (LDL)- cholesterol did not improve the model further. Correlation analyses of the individual lipid species, controlled for age and separated by sex, underscores the multiparametric and lipid species-specific nature of the correlation with the BFP. Lipidomic measurements in combination with machine intelligence modeling contain rich information about body fat amount and distribution beyond traditional clinical assays.

Pharmacokinetics of 17 alpha hydroxyprogesterone caproate in singleton pregnancy and its influence of maternal body size measures

BACKGROUND

Reducing spontaneous preterm deliveries is a worldwide public health priority. Although many interventions have been studied, 1 of the most effective treatments to decrease recurrent preterm birth is the use of weekly 17 alpha hydroxy progesterone caproate. Previous studies on the influence of excessive adipose tissue and obesity on the use of 17 alpha hydroxyprogesterone caproate for the prevention of recurrent spontaneous preterm deliveries have shown conflicting findings.

OBJECTIVE

To estimate the pharmacokinetics of weekly17 alpha hydroxyprogesterone caproate in singleton and to evaluate the effect of maternal body size on the pharmacokinetics parameters.

STUDY DESIGN

A prospective, open-label, longitudinal design was implemented for this population pharmacokinetic study. Plasma samples and clinical variables were collected in pregnant women between 16 and 36 weeks' gestational age, carrying a singleton pregnancy and receiving 17 alpha hydroxyprogesterone caproate, 250 mg intramuscularly weekly for the prevention of recurrent spontaneous preterm birth. Pharmacokinetics parameters and significant clinical covariates were estimated using mixed effect modeling. Four body size indicators were used in the model to predict pharmacokinetics parameters: lean body weight, total body weight, body mass index, and body surface area.

RESULTS

A total of 56 pregnant women, aged 18-44 years with body mass index of 14.5-54.6 kg/m², provided 114 17 alpha hydroxyprogesterone caproate plasma samples concentration for analysis. A 1-compartment model with first-order absorption satisfactorily described 17 alpha hydroxyprogesterone caproate pharmacokinetics. Compared to other body size indicators, lean body weight best explained intersubject variability. Age, race, and gestational age did not influence 17 alpha hydroxyprogesterone caproate pharmacokinetics. Lean body weight was the best descriptor for the influence of body size on 17 alpha hydroxyprogesterone caproate apparent clearance. Simulations showed that administration of a standard fixed dose of 250 mg intramuscularly produced substantially lower 17 alpha hydroxyprogesterone caproate plasma concentrations in pregnant women with body mass index >30 kg/m² compared to those with body mass index <30 kg/m². Conversely, adjustment of the standard dose for differences in total body weight among women resulted in markedly higher 17 alpha hydroxyprogesterone caproate concentrations in women with body mass index >30 kg/m² compared to women with lower body mass index. Administration of doses adjusted for lean body weight produced nearly identical 117 alpha hydroxyprogesterone caproate plasma concentrations in both the low- and high-body mass index groups.

CONCLUSION

Population pharmacokinetics analysis indicates the clearance significantly increases with increasing lean body mass. Higher 17 alpha hydroxyprogesterone caproate doses, adjusted by maternal lean body mass, may be required in patients with a body mass index >30 to achieve equivalent plasma concentrations in pregnant women with a body mass index <30. Adjustment of 17 alpha hydroxyprogesterone caproate doses for lean body weight produces equivalent systemic 17 alpha hydroxyprogesterone caproate exposure in pregnant women regardless of body size.

Body shape: Implications in the study of obesity and related traits

OBJECTIVES

The diagnosis and treatment of obesity are usually based on traditional anthropometric variables including weight, height, and several body perimeters. Here we present a three-dimensional (3D) image-based computational approach aimed to capture the distribution of abdominal adipose tissue as an aspect of shape rather than a relationship among classical anthropometric measures.

METHODS

A morphometric approach based on landmarks and semilandmarks placed upon the 3D torso surface was performed in order to quantify abdominal adiposity shape variation and its relation to classical indices. Specifically, we analyzed sets of body cross-sectional circumferences, collectively defining each, along with anthropometric data taken on 112 volunteers. Principal Component Analysis (PCA) was performed on 250 circumferences located along the abdominal region of each volunteer. An analysis of covariance model was used to compare shape variables (PCs) against anthropometric data (weight, height, and waist and hip circumferences).

RESULTS

The observed shape patterns were mainly related to nutritional status, followed by sexual dimorphism. PC1 (12.5%) and PC2 (7.5%) represented 20% of the total variation. In PCAs calculated independently by sex, linear regression analyses provide statistically significant associations between PC1 and the three classical indexes: body mass index, waist-to-height ratio, and waist-hip ratio.

CONCLUSION

Shape indicators predict well the behavior of classical markers, but also evaluate 3D and geometric features with more accuracy as related to the body shape under study. This approach also facilitates diagnosis and follow-up of therapies by using accessible 3D technology.

Low expression of brown and beige fat genes in subcutaneous tissues in obese patients

INTRODUCTION

The molecular mechanisms behind obesity pathogenesis remain largely undefined. Impairment in the browning process of subcutaneous tissues proposed to contribute to obesity pathogenesis. In the current study, we aimed to assess whether the expression of brown fat genes in subcutaneous tissues in obese patients is altered as compared to non-obese patients.

MATERIAL AND METHODS

Participants were recruited from patients undergoing general surgeries. At the same site of surgery, biopsies were taken from the abdominal subcutaneous tissues from each participant, along with a venous blood sample. The expression of BAT genes was measured using a real-time PCR method. Serum FGF21 was measured using an ELISA kit, and the serum blood lipid profile was measured using the Dimension VistaTM 1500 System.

RESULTS

A total of 58 surgical patients was involved. A low expression of BAT genes was observed in the groups with higher body mass index (BMI) (< 30 kg/m²) as compared to the groups with lower BMI (> 30 kg/m²). The expression of CIDEA and CITED1 was significantly higher in the patients with normal weight as compared to obese (p = 0.01 and p = 0.02, respectively). A significant negative correlation was found between the expression of BAT genes and BMI in patients with BMI < 35 kg/m². However, the strongest negative correlation was observed in the expression of CIDEA (r = -0.5, p = 0.004), followed by TBX1 (r = -0.4, p = 0.01), CITED1, and ZIC1 (r = -0.4, p = 0.03). Whereas the correlation of UCP1 with BMI remained insignificant (r = -0.29, p = 0.08). When including patients with BMI > 35 kg/m², the correlation decreased and became insignificant (p = 0.08). No significant correlation was found between the expression of BAT genes and blood lipid profiles (p > 0.05). Serum FGF21 was positively and significantly correlated to the expression of UCP1 (r = 0.56, p = 0.02) and TBX1 (r = 0.62, p = 0.01), however, this correlation was missing in patients with severe obesity.

CONCLUSIONS

Our data suggested that brown and beige genes expression in abdominal subcutaneous tissues is dysregulated in patients with obesity. Further studies are needed to investigate the role of browning of subcutaneous tissues in regulating body weight and metabolism in human.

The influence of Body Roundness Index on sensorial block level of spinal anaesthesia for elective caesarean section: an observational study

In this prospective trial, we investigate the effectiveness of maternal Body Roundness Index in predicting the spread of spinal anaesthesia and vasopressor requirement in parturients receiving spinal anaesthesia during the elective caesarean section. We prospectively enrolled 175 parturients. Spinal anaesthesia performed with 10 mg 0.5% hyperbaric bupivacaine at the L3-L4 intervertebral space and the optimal cut-off points of the BRI evaluated as 6.59 by receiver operating characteristic analysis calculating area under the curve. Parturients were divided into two groups with BRI <6.59 and BRI ≥6.59 for analyses. Multivariate logistic regression analysis was used to test for a relationship between variables and maximum sensory block level and vasopressor requirement. BRI was found as an independent risk factor associated with maximum sensory block level (OR = 1.378, 95% CI: 1.125-1.687, p = 0.002). Hypotension and bradycardia events after spinal anaesthesia was not associated with BRI and other variables. The present study indicates that BRI was a practical tool to predict spinal drug distribution in term parturients undergoing caesarean delivery.Impact statementWhat is already known on this subject? Spinal anaesthesia is a commonly used anaesthetic technique for the caesarean section. However, the spinal drug distribution is highly unpredictable. Anthropometric variables may predict the intrathecal drug distribution in parturients. Body Roundness Index (BRI) captures body circumference regarding height to predict body fat percentage, consider the shape of the human body as an ellipse. An ellipsoid body shape might affect the spread of spinal anaesthesia.What do the results of this study add? Our results show that the BRI was as an independent risk factor associated with maximum sensory block level in term parturients undergoing caesarean delivery.What are the implications of these findings for future clinical practice and/or further research? A future study would present the possibility to design a formula for the exact amount of local anaesthetic to be used in spinal anaesthesia with the aid of maternal BRI.

Body Shape Index Predicts Metabolic Syndrome and Insulin Resistance in Renal Transplant Recipients

Obesity is one of the most important metabolic diseases around the world. There are no reliable and inexpensive methods to evaluate obesity. All of the anthropometric measurements used have some limitations. In 2012, Krakauer et al developed a new method, called A Body Shape Index (ABSI), to identify abdominal obesity that is derived from weight, height, and waist circumference. In this study, we aimed to investigate the clinical usefulness of the ABSI to predict the presence of insulin resistance (IR) and metabolic syndrome (MetS) in renal transplant recipients. A total of 155 patients were included in the study. Prevalence of IR was 17.4%, and MetS was 62.6%. ROC results demonstrated the power of all anthropometric indices to discriminate patients with and without MetS and IR in the renal transplant populations. ROC curves showed that waist-to-height ratio (WHtR) had the optimal power to discriminate MetS and IR in women. WC had higher area under curve than all other anthropometric indices to predict MetS and IR in men. WC in men and WHtR in women has higher discriminatory capacity to predict MetS and IR in renal transplant recipients. An obvious difference was observed in the optimal anthropometric measures between the 2 sexes, suggesting that sex-specific measures should be used in practice. In order to evaluate the value of ABSI in determining metabolic risk factors, studies with larger, randomized, controlled body fat ratios are needed.

Unmet Acute Treatment Needs From the 2017 Migraine in America Symptoms and Treatment Study

Objectives

To characterize unmet treatment needs in a sample of Migraine in America Symptoms and Treatment (MAST) Study participants using oral, acute prescription migraine medications.

Background

The MAST Study is a 2017 study of US adults with migraine that profiles current treatment patterns and identifies and quantifies unmet treatment needs.

Methods

Cross‐sectional data from an online survey of US adults meeting ICHD‐3 beta criteria for migraine. For inclusion in this paper, respondents self‐reported a history of 3 or more monthly headache days (MHDs) in the past 3 months and at least 1 MHD in the past 30 days, and current use of orally administered acute prescription medication for headache. Three domains of unmet need were identified: inadequate treatment response (ie, inadequate 2‐hour pain freedom, recurrence within 24 hours of initial relief), demanding attack characteristics (rapid onset of attack, headache associated with sleep), and unique patient characteristics (opioid or barbiturate overuse, cardiovascular comorbidity). Sociodemographics, oral medication use, and coexisting conditions and symptoms (ie, level of treatment optimization, psychological symptoms, attack‐related cutaneous allodynia, and migraine symptom severity) were assessed for each domain and by the number of unmet need domains.

Results

Overall, 15,133 respondents met inclusion criteria, 26.0% (3930/15,133) reported current use of oral acute prescription medication to treat headache. Eligible participants had a mean age of 45.0 years, 73.6% [2892/3930] were women and 81.1% [3186/3930]) were White. A total of 95.8% (3765/3930) of respondents had at least 1 unmet acute treatment need; 89.5% (3516/3930) reported demanding attack characteristics, 74.1% (2912/3930) reported inadequate treatment response, and 16.1% (634/3930) presented with unique patient characteristics. Common areas of unmet need were rapid headache onset (65.3% [2567/3930]), moderate to severe disability (55.6% [2187/3930]), inadequate 2‐hours pain freedom (49.0% [1892/3930]), and headache recurrence within 24 hours (38.0% [1493/3930]). An increasing number of unmet treatment need domains was associated with worsening psychological symptoms, attack‐related cutaneous allodynia and migraine symptom severity.

Conclusion

Nearly all MAST Study respondents using acute oral prescription medications for migraine reported at least 1 unmet treatment need. As unmet needs increased, so did coexisting conditions and symptom severity.

The Risk Assessment and Prediction Tool (RAPT) after Hip and Knee Replacement: A Systematic Review

Purpose  The Risk Assessment and Prediction Tool (RAPT) is an interesting instrument for predicting the discharge destination and length of stay (LOS) for patients after hip or knee arthroplasty. The aim of this review is to describe its predictive ability, current utilization, and future prospects through the analysis of scientific literature.

Methods  The databases of PubMed, Web of Sciences, Cochrane Library, and Pedro were searched for English studies on RAPT prediction capacity. Only original prospective or retrospective articles that analyze specifically the use of RAPT were included, whereas those concerned with other preoperative prediction tools or those only considering other aspects of recovery after joint replacements were excluded.

Results  A total of 27 references were retrieved, and 8 studies were selected. All analyzed studies demonstrated that RAPT could reduce LOS and accurately predict discharge disposition especially for high- and low-risk patients. In the intermediate risk category, a targeted intensive postoperative rehabilitation program has demonstrated good results in reducing the uncertain outcome.

Conclusion  Although contrarily to many of the other scores, the RAPT has been validated in multiple countries with relatively similar results between different institutions; however, its validity has yet to be tested and adapted in every nation context. Further studies confirming the predictive accuracy of RAPT at other institutions are needed as well as studies assessing the effect of using RAPT to identify patients for targeted interventions in terms of LOS, discharge disposition, clinical outcomes, and financial impact.

Level of Evidence  This is a level IV, systematic review of level III and IV study.

Determining overweight and underweight with a new weight-for-height index in captive group-housed macaques

Housing primates in naturalistic groups provides social benefits relative to solitary housing. However, food intake may vary across individuals, possibly resulting in overweight and underweight individuals. Information on relative adiposity (the amount of fat tissue relative to body weight) is needed to monitor overweight and underweight of group-housed individuals. However, the upper and lower relative adiposity boundaries are currently only known for macaques living solitarily in small cages. We determined the best measure of relative adiposity and explored the boundaries of overweight and underweight to investigate their incidence in group-housed adult male and female rhesus macaques and long-tailed macaques living in spacious enclosures at the Biomedical Primate Research Centre (BPRC), the Netherlands. During yearly health checks different relative adiposity measures were obtained. For long-tailed macaques, comparable data on founder and wild animals were also available. Weight-for-height indices (WHI) with height to the power of 3.0 (WHI3.0) for rhesus macaques and 2.7 (WHI2.7) for long-tailed macaques were optimally independent of height and were highly correlated with other relative adiposity measures. The boundary for overweight was similar in group-housed and solitary-housed macaques. A lower boundary for underweight, based on 2% body fat similar to wild primates, gave a better estimate for underweight in group-housed macaques. We propose that for captive group-housed rhesus macaques relative adiposity should range between 42 and 67 (WHI3.0) and for long-tailed macaques between 39 and 62 (WHI2.7). The majority of group-housed macaques in this facility have a normal relative adiposity, a considerable proportion (17-23%) is overweight, and a few (0-3%) are underweight.

Body mass index to predict fat mass and metabolic syndrome severity: should it really be specific to sex, age and ethnicity? A NHANES study (1999-2014)

Background: Body mass index (BMI) is often criticised since it doesn't consider sex, age and ethnicity, which may affect the height scaling exponent of the equation.Aims: First, to identify specific height scaling exponents (α) based on sex, age and ethnicity. Second, to assess the performance of the current vs the proposed BMI equations (1) to predict total fat mass (TFM) and metabolic syndrome (MetS) severity and (2) to correctly identify obese individuals and those having MetS.Methods: In total, 41,403 individuals aged 20-80 years (NHANES, 1999-2014) were studied. Specific "α" were identified using the Benn formula. Various statistical approaches were performed to assess performances of the current vs the proposed-BMIs.Results: The proposed "α" varies from 1.2 to 2.5, after considering sex, age and ethnicity. BMIs calculated using the proposed "α" showed a similar capacity to predict TFM and MetS severity and to correctly identify obese individuals and those having MetS compared to the current BMI.Conclusions: Despite sex, age and ethnicity modulating the height scaling exponent of the BMI equation, using these proposed exponents in the BMI equation didn't improve the capacity to predict TFM and MetS severity, suggesting that the current BMI remains a valid clinical tool.

Obesity in children and adolescents: diagnosis criteria

Currently in the world the main diagnostic parameter for assessing obesity is the magnitude of body mass index. In children, taking into account the growth and body weight indicators that dynamically change as the child grows up, it is common to use not absolute, but relative values of body mass index percentiles or standard deviations. The lecture examined various systems and methods for assessing the physical development of children in the world and in Russia domestic ones, R.N. Dorokhova and I.I. Bakhraha, World Health Organization (WHO), International Group for the Study of Obesity. A comparative analysis of the existing systems and the validity of the currently adopted Federal recommendations on the diagnosis of obesity in children based on the recommendations of WHO has been carried out.

Predicting cardiometabolic markers in children using tri-ponderal mass index: a cross-sectional study

OBJECTIVE

To model the development of the tri-ponderal mass index (TMI, kg/m³) throughout childhood and adolescence and to compare the utility of the TMI with that of the body mass index (BMI, kg/m²) to predict cardiometabolic risk in a population-based sample of Canadian children and youth.

METHODS

We used data from the Canadian Health Measures Survey to model TMI from 6 to 19 years of age. Percentile curves were developed using the LMS method. Logistic regression was used to predict abnormal levels of cardiometabolic markers; predictive accuracy was assessed using the area under the ROC curve (AUC).

RESULTS

Mean TMI was relatively stable from ages 6 to 19 years for both sexes, but variability increased with age. There was no notable difference in AUC values for prediction models based on BMI z-score compared with TMI for any of the outcomes. For both BMI z-score and TMI, prediction accuracy was good for homeostasis model assessment insulin resistance and having ≥3 abnormal tests (AUC>0.80), fair for C-reactive protein and poor for the remainder of the outcomes.

CONCLUSIONS

The use of a single sex-specific TMI cut-off for overweight or obesity is hampered by the increasing variability of the measure with age. Weight-for-height indices likely have only limited ability to predict cardiometabolic marker levels, and changing the scaling power of height is unlikely to improve predictive accuracy.

Unintentional weight loss, its associated burden, and perceived weight status in people with cancer

Purpose

Unintentional weight loss (UWL) is a prevalent problem in people with cancer and is associated with poorer psychosocial outcomes. A gap exists in understanding whether and how perceived and/or weight status impacts experiences of UWL. Thus, we sought to examine subjective experiences of UWL in people with cancer, and whether perceived and/or actual weight status impacts these experiences.

Methods

Participants were recruited through Cancer Support Community’s Cancer Experience Registry® and related networks. Participants completed an online survey that included the FAACT Anorexia-Cachexia subscale, and 19 items that captured six themes related to “beliefs and concerns” (positive beliefs, psychosocial impact, physical impact, cancer outcomes, self-esteem, relationships with others). Perceived weight status (PWS) was assessed using a single item. Body mass index (BMI) was calculated using self-reported weight and height measurements.

Results

Of 326 respondents, 114 reported experiencing UWL. Over one-third misperceived their weight, with 29% perceiving weight status as below their BMI status. UWL in those with perceived weight status of overweight/obese was associated with positive beliefs. However, being underweight by BMI or perceiving oneself as underweight were both associated with greater concerns about weight loss. Perceived weight status of underweight compared to normal or overweight/obese weight status was associated with poorer psychosocial well-being, personal control, self-esteem, and relationships with others.

Conclusion

In people with cancer, perceived weight status, rather than BMI, had greater impact on negative “beliefs and concerns” about UWL. Findings suggest assessment of both perceived and actual BMI to address the impact of UWL on psychosocial wellbeing.

Which patients benefit from physical activity on prescription (PAP)? A prospective observational analysis of factors that predict increased physical activity

Background

There is robust evidence that regular physical activity (PA) has positive health effects. However, the best PA methods and the most important correlates for promoting PA remain unclear. Physical activity on prescription (PAP) aims to increase the patient’s motivation for and level of PA. This study investigated possible predictive baseline correlates associated with changes in the PA level over a 6-month period of PAP treatment in order to identify the primary care patients most likely to benefit from a PAP intervention.

Methods

The study included 444 patients with metabolic risk factors who were aged 27 to 85 years and physically inactive. The patients received PAP treatment that included individual counseling plus an individually-tailored PA recommendation with a written prescription and individualised structured follow-up for 6 months. Eight baseline correlates of PA were analysed against the PA level at the 6-month follow-up in a predictor analysis.

Results

Five baseline correlates predicted the PA level at the 6-month follow-up: self-efficacy expectations for changing PA; the patient’s preparedness and confidence regarding readiness to change PA; a BMI <  30; and a positive valued physical health. The proportion of patients increasing the PA level and achieving a PA level that was in accordance with public health recommendations was higher with a positive valued baseline correlate. The odds of achieving the recommended PA level increased substantially when 2 to 4 predictive correlates were present. PA levels increased to a greater extent among patients with low PA at baseline than patients with high PA at baseline, especially in combination with 2 to 4 positively-valued correlates (87–95% vs. 62–75%).

Conclusions

This study identified potential predictive correlates of an increased PA level after a 6-month PAP intervention. This contributes to our understanding of PAP and could help individualise PAP support. The proportion of patients with the lowest PA level at baseline increased their PA level in a higher extent (84%) and thus may benefit the most from PAP. These results have clinical implications for behavioural change in those patients having the greatest health gains by increasing their PA level.

Trial registration

ClinicalTrials.gov; NCT03586011. Retrospectively registered on July 17, 2018.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6830-1) contains supplementary material, which is available to authorized users.

Semiautomated Measure of Abdominal Adiposity Using Computed Tomography Scan Analysis

BACKGROUND

The obesity epidemic has prompted the need to better understand the impact of adipose tissue on human pathophysiology. However, accurate, efficient, and replicable models of quantifying adiposity have yet to be developed and clinically implemented. We propose a novel semiautomated radiologic method of measuring the visceral fat area (VFA) using computed tomography scan analysis.

MATERIALS AND METHODS

We obtained a cohort of 100 patients with rectal adenocarcinoma, with a median age of 60.9 y (age range: 35-87 y) and an average body mass index of 28.8 kg/m2 ± 6.56 kg/m2. The semiautomated quantification method of adiposity was developed using a commercial imaging suite. The method was compared to two manual delineations performed using two different picture archiving communication systems. We quantified VFA, subcutaneous fat area (SFA), total fat area (TFA), and visceral-to-subcutaneous fat ratio (V/S ratio) on computed tomography axial slices that were at the L4-L5 intervertebral level.

RESULTS

The semiautomated method was comparable to manual measurements for TFA, VFA, and SFA with intraclass correlation (ICC) of 0.99, 0.97, and 0.96, respectively. However, the ICC for the V/S ratio was only 0.44, which led to the identification of technical outliers that were identified using robust regression. After removal of these outliers, the ICC improved to 0.99 for TFA, VFA, and SFA and 0.97 for the V/S ratio. Measurements from the manual methodology highly correlated between the two picture archiving communication system platforms, with ICC of 0.98 for TFA, 0.98 for VFA, 0.96 for SFA, and 0.95 for the V/S ratio.

CONCLUSIONS

This semiautomated method is able to generate precise and reproducible results. In the future, this method may be applied on a larger scale to facilitate risk stratification of patients using measures of abdominal adiposity.

Whole flour and protein hydrolysate from common beans reduce the inflammation in BALB/c mice fed with high fat high cholesterol diet

Common bean (Phaseolus vulgaris L.) is a source of bioactive peptides, but little is known about its effects on hypercholesterolemia, oxidative stress, and the inflammatory process. Therefore, the aim of this study was to evaluate the effect of whole flour and bean protein hydrolysate of common bean variety Carioca on inflammation and oxidative stress in BALB/c mice. Four experimental groups were included in the study: standard diet (SD), high fat high cholesterol diet (HFC), high fat high cholesterol diet and whole bean flour (HFC-F); and high fat high cholesterol diet and bean protein hydrolysate (HFC-PH). Animals fed with bean protein hydrolysate showed lower weight gain and food intake. Animals fed with whole bean flour showed lower alanine aminotransferase and low-density lipoprotein cholesterol levels than animals fed with bean protein hydrolysate. SOD mRNA was lower in HFC, HFC-F and HFC-PH groups whereas SOD concentration was higher in HFC-F and HFC-PH groups. HSP72 mRNA expression was lower in the HFC-F group in relation to HFC-PH. IL-10 and PPARα mRNA expression was lower in HFC-F and HFC-PH groups in comparison with SD. The whole bean flour and bean protein hydrolysate reduced inflammation and the risk factors for cardiovascular diseases in BALB/c mice.

Sleep duration and social jetlag are independently associated with anxious symptoms in adolescents

Although short total sleep time (TST) is associated with increased anxious symptoms in adolescents, it is unknown whether social jetlag, a misalignment between sleep timing on the weekend and school week, is independently associated with anxious symptoms. In the current study, sleep timing, anxious symptoms, and demographic information were assessed from 3097 adolescents (48% female, mean ± SD age 15.59 ± .77 years) from the age 15 wave of the Fragile Families and Child Wellbeing Study. Social jetlag was calculated as the absolute value of the midpoint of sleep on the weekend minus the midpoint of sleep during the school week. Anxious symptoms were measured through the 6-item anxiety subscale of the Brief Symptom Inventory 18. We assessed associations between sleep variables and anxious symptoms using multiple linear regression. Adjusted analyses controlled for sex, race/ethnicity, age in years, body mass index percentile, number of other children below the age of 18 in the household, and primary caregiver (PCG) married/cohabiting with youth's biological parent, PCG employment status, PCG household income and PCG education level. In fully adjusted models (R² = .034), school night TST (b = -.04, ∆R² = .005, p < .001) was negatively associated with anxiety symptoms, while social jetlag (b = .04, ∆R² = .009, p < .001) was positively and independently associated with anxiety symptoms. Findings indicate small associations of school night TST and social jetlag with anxious symptoms. Thus, maintenance of optimal emotional health in adolescents may require both sufficient sleep duration and regularity of sleep timing across the week.

Sex Moderates Relationships Among School Night Sleep Duration, Social Jetlag, and Depressive Symptoms in Adolescents

Social jetlag, a misalignment between sleep timing on the weekend and during the work week, is associated with depressive symptoms among adults across both sexes. A previous study found that later sleep timing was associated with depressive symptoms in women but not men. To date, however, no research has investigated whether the association between social jetlag and depression varies by sex among adolescents. The current study assessed self-reported sleep, depressive symptoms, and demographic information from 3058 adolescents (48% female, mean [SD] age 15.59 [0.77] years) from the age 15 wave of the Fragile Families and Child Wellbeing Study (FFCWS). Social jetlag was calculated as the absolute value of the midpoint of sleep on the weekend minus the midpoint of sleep during the school week. Depressive symptoms were measured through a modified 5-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). We assessed whether the associations among sleep duration on school nights, social jetlag, and depressive symptoms were similar between male and female adolescents using multiple linear regression. In fully adjusted models, sex moderated the association between school night total sleep time and depressive symptoms ( p < 0.001) and between social jetlag and depressive symptoms ( p = 0.037). In females, but not in males, school night total sleep time was negatively associated with depressive symptoms ( p < 0.001), whereas social jetlag ( p < 0.001) was positively and independently associated with depressive symptoms. The results indicate the importance of regular sleep timing across the week and adequate sleep duration for the maintenance of optimal emotional health among female adolescents.