Indices of relative weight and obesity

Correlates of weight-related quality of life among individuals with binge eating disorder before and after cognitive behavioral therapy

Individuals with obesity and binge eating disorder (BED) report poorer weight-related quality of life (WRQOL) compared to individuals with obesity alone. Cognitive behavioral therapy (CBT), the best available treatment for BED, does not consistently produce weight loss or improvements in weight QOL. The purpose of the current study was to examine baseline and longitudinal associations between eating-related and psychosocial variables and dimensions of weight QOL. We examined associations between predictor variables, including body mass index (BMI), eating disorder (ED) psychopathology, and psychosocial factors, in relation to three dimensions of WRQOL among 171 patients whom received CBT for BED. Participants completed interviews and self-report measures at baseline prior to CBT and at end of treatment. At baseline the following associations were significant: BMI, ED psychopathology, and self-esteem were associated with weight-related self-esteem; gender, BMI, and self-esteem were associated with weight-related public distress (i.e., stigma and worry in public because of one's weight); and age, BMI, and ED psychopathology were associated with weight-related physical function. At end of treatment, the following associations were significant: changes in ED psychopathology and coping predicted weight-related self-esteem; changes in coping and self-esteem predicted weight-related public distress; and changes in BMI and subjective binge eating predicted weight-related physical function. Overall, changes in a number of ED and associated symptoms were associated with improvements in WRQOL.

Patterns of neuroendocrine coupling in 9-year-old children: Effects of sex, body-mass index, and life stress

Previous investigations have explored stress and pubertal hormones in parallel; it has been a recent development, however, to explore the relationships between different hormones during puberty, and how this hormonal cross-talk may be influenced by the environment. The current study investigated neuroendocrine coupling, or the extent to which hormones are correlated within the individual, and also investigated early life stressors that may influence coupling. Participants were 405 adrenarcheal children (mean Tanner stage=1.73 for girls and 1.38 for boys) from a longitudinal study who provided saliva samples for analysis of cortisol, dehydroepiandrosterone (DHEA), and testosterone. Saliva was collected when children were 9-years-old, while early life stressors were assessed at each longitudinal assessment (ages 3, 6, and 9). Results from multi-level modeling (MLM) analyses provided evidence of positive cortisol-dehydroepiandrosterone (DHEA) and cortisol-testosterone coupling in middle childhood, and identified body mass index as a predictor of the strength of hormone coordination. While exposure to stressful life events did not impact cortisol-DHEA coupling patterns, stress interacted with sex to predict looser cortisol-testosterone coupling in girls, but not boys. The current study adds to the existing literature on the development of neuroendocrine coupling, and provided further evidence of sex differences in the impact of stress. Furthermore, hormone coupling may be investigated in the future as a mechanism by which puberty is associated with negative behavioral outcomes.

Prognostic value of respiratory quotients in severe polytrauma patients with nutritional support

OBJECTIVE

The association between energy metabolism and prognosis in polytrauma patients has not yet been defined. The aim of this study was to describe energy metabolism and analyze the prognostic value of respiratory quotient (RQ) and nonprotein respiratory quotient (npRQ) in fasting polytrauma patients (fPP) and polytrauma patients with nutritional support (nsPP).

METHODS

Twenty-two polytrauma patients (before and after parenteral nutrition administration) and 22 healthy controls (after overnight fasting) were examined on day 4 (median) after admission to the intensive care unit. To evaluate energy expenditure in nsPP and resting energy expenditure in fPP and controls with RQ and npRQ in all groups, we used indirect calorimetry. With regression analysis, the descriptive models of intensive care unit (ICU) length of stay (LOS) and mechanical ventilation time (VT) were derived.

RESULTS

RQ and npRQ were significantly lower in fPP than in controls (P < 0.05 and P < 0.01, respectively) and in nsPP (P < 0.05). In nsPP, relationships between RQ or npRQ and the ICU LOS or mechanical VT were demonstrated (P < 0.0001, r = -0.78 for RQ and VT; P < 0.0001, r = -0.78 for npRQ and VT; P < 0.001, r = -0.69 for RQ and LOS; P < 0.001, r = -0.72 for npRQ and LOS).

CONCLUSIONS

RQ and npRQ parameters measured by indirect calorimetry in polytrauma patients with parenteral nutrition on the fourth day of ICU stay related to clinical outcomes such as duration of mechanical ventilation and ICU LOS.

Sleep disturbance in men receiving androgen deprivation therapy for prostate cancer: The role of hot flashes and nocturia

BACKGROUND

Patients with prostate cancer receiving androgen deprivation therapy (ADT) are at risk of sleep disturbance; however, to the authors' knowledge, the mechanisms by which ADT may affect sleep are not well understood. The current study compared objective and subjective sleep disturbance in ADT recipients and controls and examined whether sleep disturbance in ADT recipients is attributable to the influence of ADT on hot flashes and nocturia.

METHODS

Patients with prostate cancer were assessed before or within 1 month after the initiation of ADT as well as 6 months and 12 months later (78 patients). Patients with prostate cancer were treated with prostatectomy only (99 patients) and men with no history of cancer (108 men) were assessed at similar intervals. Participants self-reported their sleep disturbance (Insomnia Severity Index) and interference from hot flashes (Hot Flash Related Daily Interference Scale). One hundred participants also wore actigraphs for 3 days at the 6-month assessment to measure objective sleep disturbance and reported their nocturia frequency.

RESULTS

ADT recipients reported worse sleep disturbance, higher rates of clinically significant sleep disturbance, and greater hot flash interference than controls (Ps≤.03). In cross-sectional analyses among those with actigraphy data, ADT recipients had greater objective sleep disturbance and more episodes of nocturia (Ps<.01). Cross-sectional mediation analyses demonstrated that the association between ADT and objectively and subjectively measured sleep disturbance was partly attributable to nocturia and hot flashes (Ps<.05).

CONCLUSIONS

The results of the current study suggest that the association between ADT and sleep may be partly explained by nocturia and hot flash interference. Future studies should examine behavioral and pharmacologic interventions to address these symptoms among ADT recipients. Cancer 2018;124:499-506. © 2017 American Cancer Society.

Body typing of children and adolescents using 3D-body scanning

Three-dimensional (3D-) body scanning of children and adolescents allows the detailed study of physiological development in terms of anthropometrical alterations which potentially provide early onset markers for obesity. Here, we present a systematic analysis of body scanning data of 2,700 urban children and adolescents in the age range between 5 and 18 years with the special aim to stratify the participants into distinct body shape types and to describe their change upon development. In a first step, we extracted a set of eight representative meta-measures from the data. Each of them collects a related group of anthropometrical features and changes specifically upon aging. In a second step we defined seven body types by clustering the meta-measures of all participants. These body types describe the body shapes in terms of three weight (lower, normal and overweight) and three age (young, medium and older) categories. For younger children (age of 5-10 years) we found a common 'early childhood body shape' which splits into three weight-dependent types for older children, with one or two years delay for boys. Our study shows that the concept of body types provides a reliable option for the anthropometric characterization of developing and aging populations.

Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis

INTRODUCTION

Intra-articular corticosteroid injections are often used for short-term pain relief in patients with knee osteoarthritis (OA). This study investigates the efficacy of intra-articular corticosteroid injections in patients with symptomatic knee OA and factors that affect treatment response.

METHODS

This prospective, multicentered cohort study had 100 participants with radiographic evidence of knee OA enrolled. Participants received one corticosteroid injection into the affected knee and were evaluated before the injection (baseline) and at 3 weeks, 6 weeks, 3 months, and 6 months after the injection.

RESULTS

Participants' Visual Numeric Scale and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores improved at all time points except for the Visual Numeric Scale score at 6 months, compared with baseline scores (P < 0.001). Participants with Kellgren-Lawrence grade 1 or 2 OA saw clinical improvement in the WOMAC scores at all time points, compared with the baseline score (P < 0.01). Compared with all other subgroups, obese patients with Kellgren-Lawrence grade 3 or 4 OA had significantly worse WOMAC scores at baseline, 6 weeks, and 3 months (P < 0.01 and P < 0.01, respectively).

DISCUSSION

Our findings validate previously established guidelines for nonsurgical management of knee OA and suggest that intra-articular corticosteroid injections may be an acceptable short-term management option in patients unwilling or unable to undergo surgical treatment. Obesity and OA severity affect the efficacy of intra-articular corticosteroid injections.

CONCLUSION

Patients receiving intra-articular corticosteroid injections had improved pain and function. Clinicians should expect less improvement in patients with obesity and/or advanced arthritis. Clinical benefits of intra-articular injections in these patients are less predictable.

A neural signature of food semantics is associated with body-mass index

Visual recognition of objects may rely on different features depending on the category to which they belong. Recognizing natural objects, such as fruits and plants, weighs more on their perceptual attributes, whereas recognizing man-made objects, such as tools or vehicles, weighs more upon the functions and actions they enable. Edible objects are perceptually rich but also prepared for specific functions, therefore it is unclear how perceptual and functional attributes affect their recognition. Two event-related potentials experiments investigated: (i) whether food categorization in the brain is differentially modulated by sensory and functional attributes, depending on whether the food is natural or transformed; (ii) whether these processes are modulated by participants' body mass index. In experiment 1, healthy normal-weight participants were presented with a sentence (prime) and a photograph of a food. Primes described either a sensory feature ('It tastes sweet') or a functional feature ('It is suitable for a wedding party') of the food, while photographs depicted either a natural (e.g., cherry) or a transformed food (e.g., pizza). Prime-feature pairs were either congruent or incongruent. This design aimed at modulating N400-like components elicited by semantic processing. In experiment 1, N400-like amplitude was significantly larger for transformed food than for natural food with sensory primes, and vice versa with functional primes. In experiment 2, underweight and obese women performed the same semantic task. We found that, while the N400-like component in obese participants was modulated by sensory-functional primes only for transformed food, the same modulation was found in underweight participants only for natural food. These findings suggest that the level of food transformation interacts with participants' body mass index in modulating food perception and the underlying brain processing.

A requiem for BMI in the clinical setting

PURPOSE OF REVIEW

Quetelet reported in the nineteenth century that body weight varies across adults with the square of height. Quetelet's index, now known as BMI, is accepted by most health organizations as a first-level measure of body fat and as a screening tool for diagnosing excess adiposity. Modern imaging methods now, however, indicate that BMI has limited predictive value for estimating body fat and lean mass at the individual level. The use of BMI as a measure of body composition in the clinical setting should therefore be challenged.

RECENT FINDINGS

Recent studies enrolling cancer and surgical patients reported discrepant outcomes when BMI was used as a body composition surrogate. Sarcopenia, loss of muscle mass and function, which affects the elderly and those with chronic and acute diseases, is not accurately diagnosed with BMI. The distribution of adipose tissue is not characterized by BMI, specific measures of which have greater predictive value for metabolic impairments and clinical outcomes.

SUMMARY

BMI, as the traditional tool for assessing malnutrition and obesity, is not appropriate to accurately differentiate between important body weight components and therefore should not be used for making clinically important decisions at the individual patient level.

Relationship between Corneal Thickness and Radius to Body Height

PURPOSE

To investigate the possible association between body stature (height) and corneal thickness and radius in younger-adult Caucasians, especially within the context of previously published literature.

METHODS

Body height and weight were measured in 109 healthy subjects, with an average age of 24 ± 6 years (mean ± SD). Subjects underwent an ophthalmic assessment including anterior segment imaging by Scheimpflug topography and specular microscopy. Central and peripheral corneal thickness and corneal radius were analyzed. The relationship between body stature and corneal parameters was assessed using simple and multiple regression analysis. Effect size was determined by generating regression and correlation coefficients.

RESULTS

Body height ranged from 1.54 to 1.86 m (mean ± SD 1.67 ± 0.08 m), central corneal thickness from 465 to 629 μm (554 ± 33 μm), whereas corneal radius measured between 7.16 and 8.49 mm (7.75 ± 0.24 mm). Body height was weakly associated with central corneal thickness and peripheral corneal thickness (r ≥ -0.180), and moderately with corneal radius (r = 0.351). Based on the regression equations, central corneal thickness decreases by 8 μm, whereas corneal radius increases by 0.11 mm for each 0.1-m difference in body height. No significant correlations were found for similar assessments using body weight or body mass index.

CONCLUSIONS

Differences in corneal radius and corneal thickness can be linked to body stature. However, effect sizes were consistently small and no more than 13% of the variability in corneal curvature could be explained by variations in body stature.

The association between patient participation and functional gain following inpatient rehabilitation

OBJECTIVES

To evaluate patients' participation during physical therapy sessions as assessed with the Pittsburgh rehabilitation participation scale (PRPS) as a possible predictor of functional gain after rehabilitation training.

METHODS

All patients aged 65 years or older consecutively admitted to a Department of Rehabilitation and Aged Care (DRAC) were evaluated on admission regarding their health, nutritional, functional and cognitive status. Functional status was assessed with the functional independence measure (FIM) on admission and at discharge. Participation during rehabilitation sessions was measured with the PRPS. Functional gain was evaluated using the Montebello rehabilitation factor score (MRFS efficacy), and patients stratified in two groups according to their level of functional gain and their sociodemographic, clinical and functional characteristics were compared. Predictors of poor functional gain were evaluated using a multivariable logistic regression model adjusted for confounding factors.

RESULT

A total of 556 subjects were included in this study. Patients with poor functional gain at discharge demonstrated lower participation during physical therapy sessions were significantly older, more cognitively and functionally impaired on admission, more depressed, more comorbid, and more frequently admitted for cardiac disease or immobility syndrome than their counterparts. There was a significant linear association between PRPS scores and MRFS efficacy. In a multivariable logistic regression model, participation was independently associated with functional gain at discharge (odds ratio 1.51, 95 % confidence interval 1.19-1.91).

CONCLUSION

This study showed that participation during physical therapy affects the extent of functional gain at discharge in a large population of older patients with multiple diseases receiving in-hospital rehabilitation.

Methods for classifying obesity in spinal cord injury: a review

STUDY DESIGN

Narrative review.

OBJECTIVES

Review methods used to measure and classify obesity in individuals with spinal cord injuries (SCI). Outline the strengths and weaknesses of each method used to measure obesity in individuals with SCI.

SETTING

International.

METHODS

PubMed was used to identify articles before 2016. Search terms ('obesity' or 'weight status' and 'spinal cord injury'). Filters: adults, English and human. Studies were retained that (1) included participants, 18 years or older, with SCI; (2) took place in inpatient, outpatient or community-based settings and (3) measured obesity status. Unique methods for classifying individuals with SCI as obese were identified and examples are presented.

RESULTS

Methods identified for classifying obesity were as follows: World Health Organization body mass index (BMI) cutoff⩾30 kg m^-2, BMI cutoff ⩾25-29 kg m^-2, and SCI-specific BMI cutoff ⩾22 kg m^-2, waist circumference cutoff (women >102 cm, men >88 cm), percent body fat cutoffs ⩾25% using bioelectrical impedance analysis and dual-energy X-ray absorptiometry, computerized tomography scan visceral fat area ⩾100 cm² and percentage of ideal body weight.

CONCLUSIONS

BMI is the most widely used measure of obesity in the SCI literature. Although some studies identified alternative cutoffs or other metrics, there is no standardized obesity classification in SCI. However, research is needed to determine and validate obesity classification specific to SCI due to physiological changes that occur following injury. We recommend that researchers and clinicians proceed with caution and use methodology based on the purpose of measurement.

Cognitive impacts of ambient air pollution in the National Social Health and Aging Project (NSHAP) cohort

BACKGROUND

Pathways through which air pollution may impact cognitive function are poorly understood, particularly with regard to whether and how air pollution interacts with social and emotional factors to influence cognitive health.

OBJECTIVE

To examine the association between air pollutant exposures and cognitive outcomes among older adults participating in the National Social Life, Health, and Aging Project (NSHAP) cohort study.

METHODS

Measures of cognitive function, social connectedness, and physical and mental health were obtained for each NSHAP participant starting with Wave 1 of the study in 2005. Cognitive function was assessed using the Chicago Cognitive Function Measure (CCFM) for 3377 participants. Exposures to fine particles (PM_2.5) were estimated for each participant using GIS-based spatio-temporal models, and exposures to nitrogen dioxide (NO₂) were obtained from the nearest EPA monitors.

RESULTS

In adjusted linear regression models, IQR increases in 1 to 7year PM_2.5 exposures were associated with a 0.22 (95% CI: -0.44, -0.01) to a 0.25 (95% CI: -0.43, -0.06) point decrease in CCFM scores, equivalent to aging 1.6years, while exposures to NO₂ were equivalent to aging 1.9years. The impacts of PM_2.5 on cognition were modified by stroke, anxiety, and stress, and were mediated by depression. The impacts of NO₂ were mediated by stress and effect modification by impaired activities of daily living for NO₂ was found.

CONCLUSIONS

Exposures to long-term PM_2.5 and NO₂ were associated with decreased cognitive function in our cohort of older Americans, and individuals who experienced a stroke or elevated anxiety were more susceptible to the effects of PM_2.5 on cognition. Additionally, mediation results suggest that PM_2.5 may impact cognition through pathways related to mood disorders.

The impact of patient weight on burn resuscitation

BACKGROUND

Optimal fluid resuscitation of burn patients with burns greater than 20% total body surface area is critical to prevent burn shock during the initial 24 hours to 48 hours postburn. Currently, most resuscitation formulas incorporate the patient's weight when estimating 24-hour fluid requirements. The objective of this study was to determine the impact of weight on fluid resuscitation requirements and outcomes during the initial 24 hours after admission.

METHODS

We performed a retrospective review of patients admitted to our burn intensive care unit from December 2007 to April 2013, resuscitated with a computerized decision support system. We classified patients into body mass index (BMI) categories of underweight (BMI: <18.5), normal (BMI: 18.5-24.9), overweight (BMI: 25.0-29.9), or obese (BMI: >30.0). We also calculated the percent difference from ideal body weight (IBW) and compared 24-hour fluid volumes received.

RESULTS

Patients with missing weight and/or height values were excluded from the study, resulting in a final cohort of 161 patients for analysis. Mean total body surface area was 42 ± 20% with a full thickness burn of 18 ± 23%. Mean age, weight, and height were 47 ± 19 years, 83 ± 19 kg, and 68 ± 4 inches, respectively. IBW for this cohort was 68 ± 11 kg with a BMI of 28 ± 6. Univariate analysis showed significant differences in 24-hour resuscitation volumes (mL/kg) between normal and obese patients (p < 0.05). Further analysis revealed that increasing percent difference from IBW was associated with lower fluid volumes. Although obesity was not associated with inhalation injury or renal replacement therapy, it was correlated to an increased risk for mortality (p < 0.05).

CONCLUSION

This analysis showed that increasing weight was associated with lower fluid resuscitation volume requirements and a higher mortality rate, despite the low incidence of inhalation injury and renal replacement therapy in our obese patients. The use of actual body weight to drive resuscitation volumes may result in overresuscitation of obese patients, depending on the resuscitation formula. Further studies are needed to better explain the relationship between mortality and obesity in burn patients.

LEVEL OF EVIDENCE

Therapeutic/care management, level IV.

Gender and social mobility modify the effect of birth weight on total and central obesity

BACKGROUND

Little is known about the interaction between gender and low birth weight (LBW) and lifelong social mobility as an explanation of the etiology of obesity. The aim of the present study was to evaluate total and central obesity according to gender, LBW and social mobility, within the context of the epidemiological transition in middle-income countries. We hypothesize that there are more pronounced metabolic consequences of social mobility for women born with LBW.

METHODS

We used data from a birth cohort study conducted in Ribeirão Preto, São Paulo, Brazil. Data regarding anthropometric measurements, schooling and smoking status were collected at 23-25 years of age. Social mobility was determined based on maternal and adult offspring schooling and categorized as Low-Low, Low-High and High-High. Analysis of covariance was performed to assess the association between social mobility and body mass index (BMI) or waist circumference (WC) in adulthood, stratified by LBW and gender.

RESULTS

Data on 6827 singleton pregnancies were collected at birth in 1978/79 and a sample was followed up in 2002/04. A total of 2063 subjects were included in the study. Mean age was 23.9 ± 0.7 years, 51.8% (n = 1068) were female and the LBW was 6.2% (n = 128). There was a triple interaction between social mobility, LBW and gender. Among women born without LBW, BMI and WC were higher in the Low-Low group compared to High-High schooling group. Among LBW women, BMI and WC were higher in the Low-Low group compared to the Low-High group.

CONCLUSIONS

Women born with LBW belonging to the low schooling group in early adulthood had high BMI and WC, compared to the Low-High social mobility group.

Comparison of three methods for measuring height in rehabilitation inpatients and the impact on body mass index classification: An open prospective study

AIM

To compare standing height, estimated current height and demi-span estimated height and examine their impact on body mass index (BMI) classification.

METHODS

Cross-sectional data was collected on 104 patients admitted to an adult rehabilitation ward and seen by the dietitian. Patient's standing, estimated current height and demi-span estimated height were collected and grouped by age: 19-64 and ≥65 years.

RESULTS

The limits of agreement (95% confidence interval) for estimated current height compared with standing height were +9.9 cm and -7.9 cm, in contrast to +8.7 cm and -14.3 cm for demi-span estimated height. Demi-span underestimated height when compared with standing height in both age groups, 19-64 years: (mean ± SD) 3.0 ± 6.5 cm (P = 0.001, n = 68) and ≥ 65 year age group 4.0 ± 6.0 cm (P < 0.001, n = 36), resulting in a significantly greater mean BMI (analysis of variance P < 0.001, P = 0.02). In the 19-64 and ≥65 year age groups, 3% (2/68) and 10% (4/36) of patients, respectively, had a different BMI classification using demi-span estimated height compared with standing height.

CONCLUSIONS

Estimated current height is a simple and practical alternative if standing height is unable to be obtained when performing a nutrition assessment. Demi-span estimated height should be used with caution when calculating BMI to assess nutritional status, particularly in the elderly.

Human bipedalism and body-mass index

Body-mass index, abbreviated as BMI and given by M/H 2 with the mass M and the height H, has been widely used as a useful proxy to measure a general health status of a human individual. We generalise BMI in the form of M/H p and pursue to answer the question of the value of p for populations of animal species including human. We compare values of p for several different datasets for human populations with the ones obtained for other animal populations of fish, whales, and land mammals. All animal populations but humans analyzed in our work are shown to have p ≈ 3 unanimously. In contrast, human populations are different: As young infants grow to become toddlers and keep growing, the sudden change of p is observed at about one year after birth. Infants younger than one year old exhibit significantly larger value of p than two, while children between one and five years old show p ≈ 2, sharply different from other animal species. The observation implies the importance of the upright posture of human individuals. We also propose a simple mechanical model for a human body and suggest that standing and walking upright should put a clear division between bipedal human (p ≈ 2) and other animals (p ≈ 3).

Waist circumference as a predictor of mortality in peritoneal dialysis patients: a follow-up study of 48 months

Body-fat gain is a common finding among peritoneal dialysis (PD) patients, and the accumulation of adipose tissue occurs predominantly in the abdominal area. Waist circumference (WC) is a reliable marker of abdominal obesity and its association with worse outcomes has been demonstrated in non-dialysis and haemodialysis patients. We aimed at investigating whether WC measurements as well as the changes over time in WC were able to predict mortality in PD patients. This prospective study included 109 patients undergoing PD (57 % male, age 52 (sd 16) years, 32 % diabetics, 48 % BMI≥25 kg/m2). WC was measured at the umbilicus level (empty abdominal cavity), and values >88 cm for women and >102 cm for men were considered high. Nutritional status and laboratory parameters were also evaluated. WC was measured at baseline and after 6 months, and mortality was registered during a period of 48 months. High WC was observed in 55 % of women and in 23 % of men at baseline. After 6 months, 61 % of the patients showed an increased WC. At the end of the study, twenty-seven deaths were registered. A significant increase in WC was observed only in the non-survivor group. In the Cox regression analysis adjusting for sex, age, duration on dialysis, diabetes, BMI, serum albumin and C-reactive protein, high WC at baseline as well as the 6-month increase in WC were independently associated with mortality. This study demonstrated that a high WC and the increase over time in WC were both predictors of mortality in PD patients.

No role for patient body weight on renal function assessment for drug dosing

Objectives

To evaluate the ability of body-weight-driven renal function assessment (RFA) formulae to predict on-target elimination rate ranges for gentamicin in patients with varying degrees of renal function.

Methods

A 6 year retrospective pharmacokinetic study was conducted at a university teaching hospital.

Results

A total of 85 patients met the inclusion criteria and 127 pharmacokinetic files were analysed from patients on medical-surgical wards (53%) and medical-surgical ICUs (13%) receiving intravenous gentamicin for treatment, as well as those for patients receiving it for surgical prophylaxis (34%). Each RFA formula was examined against standard dosing tables for gentamicin. A table of acceptable elimination rates was generated using a traditional peak of 8 mg/L and trough between 0.5 and 2 mg/L associated with each of the dosing interval extensions. The ability of each RFA formula to select on-target elimination rates was evaluated. The RFA formula assuming a normalized body weight of 72 kg and a modified creatinine reagent adjustment factor of 90% provided the most accurate on-target elimination rate selection. This method was superior to dosing interval selection based on the Modification in Diet Renal Disease (MDRD) formula, Sanford's guide method, as well as the Cockcroft-Gault formulae using total body weight, ideal body weight or lean body weight ( P  <   0.0001).

Conclusions

Based on the use of gentamicin as a surrogate guide for renally adjusted drugs, these results support dosing interval selection based on a normalized body weight method and a formula reagent adjustment factor of 90% within the Cockcroft-Gault formula.

Sensitivity of various body indices and visceral adiposity index in predicting metabolic syndrome among Chinese patients with adult growth hormone deficiency

AIM

Adult growth hormone deficiency (AGHD) refers to decreased secretion of growth hormones in the adults, which is associated with increased clustering of conventional cardiovascular risk factors such as central obesity, insulin resistance and dyslipidemia. Metabolic syndrome (MetS), a recognized risk factor of cardiovascluar diseases, shares some clinical features. Given that the prevalence of MetS is on the rise in patients with AGHD, and that cardiovascular disease (CVD) is an important cause of morbidity and mortality in that population, the alternative, simple, non-invasive methods of assessing MetS among this population are needed. This study aims to determine the sensitivity of five anthropometric indices [Body mass index (BMI), Waist circumference (WC), Waist-to-hip ratio (WHR), Waist-to-height ratio (WHtR) and Visceral adiposity index (VAI)] in predicting metabolic syndrome in Chinese population-based patients with adult growth hormone deficiency.

MATERIALS AND METHODS

A total of 96 Chinese patients with adult growth hormone deficiency were included in this study. They were compared with equal number of apparently healthy persons with similar characteristics (matched with age and gender) to the previous group. Anthropometric measurements including weight, height, serum lipids indices, blood pressure (BP), fasting plasma glucose (FPG), WC were measured. BMI, WHR, WHtR, and VAI were calculated.

RESULTS AND DISCUSSION

AGHD patients with MetS had higher WC (91.00 ± 8.28 vs 78.01 ± 7.12), BMI (24.95 ± 2.91 VS 23.30 ± 2.80), WHR (0.92 ± 0.06 VS 0.87 ± 0.07), WHtR (0.53 ± 0.06 VS 0.47 ± 0.05), VAI [(5.59 (4.02, 7.55) VS 1.69 (0.87, 3.05)] levels in comparison to those without MetS. Meantime WC, BMI, WHR, WHtR, VAI was positively correlated to MetS components. ROC curve for participants with AGHD showed that VAI had the highest SS of 92% (BMI 0.812; WHR 0.706; WHtR 0.902; VAI 0.920, respectively) for prediction of MetS in AGHD. The optimal cutoff values for different adiposity markers in predicting MetS were as follows: WC (79.65), BMI (23.46); WHR (0.89); WHtR (0.54); VAI (2.29).

CONCLUSION

In conclusion, our study showed all adiposity measures of interest present themselves as easy and practical tools for use in population studies and clinical practice for evaluating MetS in AGDH and VAI was identified as the best in Chinese AGHD patients among them.

Differences in morning-evening type and sleep duration between Black and White adults: Results from a propensity-matched UK Biobank sample

Biological evidence suggests that ethno-racial differences in morning-evening type are possible, whereby Blacks may be more likely to be morning type compared to Whites. However, population-level evidence of ethno-racial difference in morning-evening type is limited. In an earlier study, we reported that morning type was more prevalent in Blacks compared to Whites in the United Kingdom (UK) Biobank cohort (N = 439 933). This study aimed to determine if these ethno-racial differences persisted after accounting for an even broader range of social, environmental and individual characteristics and employing an analytic approach that simulates randomization in observational data, propensity score modeling. Data from UK Biobank participants whose self-identified race/ethnicity was Black/Black British or White; who did not report daytime napping, shift work or night shift work; who provided full mental health information; and who were identified using propensity score matching were used (N = 2044). Each sample was strongly matched across all social, environmental and individual characteristics as indicated by absolute standardized mean differences <0.09 for all variables. The prevalence of reporting nocturnal short, adequate and long sleep as well as morning, intermediate and evening type among Blacks (n = 1022) was compared with a matched sample of Whites (n = 1022) using multinomial logistic regression models. Blacks had a 62% greater odds of being morning type [odds ratio (OR) = 1.620, 95% confidence interval (CI): 1.336-1.964, p < .0001] and a more than threefold greater odds of reporting nocturnal short sleep (OR = 3.453, 95% CI: 2.846-4.190, p < .0001) than Whites. These data indicate that the greater prevalence of morning type and short nocturnal sleep in Blacks compared to Whites is not fully explained by a wide range of social and environmental factors. If sleep is an upstream determinant of health, these data suggest that ethno-racially targeted public health sleep intervention strategies are needed.

Validity and intraobserver reliability of three-dimensional scanning compared with conventional anthropometry for children and adolescents from a population-based cohort study

BACKGROUND

Conventional anthropometric measurements are time consuming and require well trained medical staff. To use three-dimensional whole body laser scanning in daily clinical work, validity, and reliability have to be confirmed.

METHODS

We compared a whole body laser scanner with conventional anthropometry in a group of 473 children and adolescents from the Leipzig Research Centre for Civilization Diseases (LIFE-Child). Concordance correlation coefficients (CCC) were calculated separately for sex, weight, and age to assess validity. Overall CCC (OCCC) was used to analyze intraobserver reliability.

RESULTS

Body height and the circumferences of waist, hip, upper arm, and calf had an "excellent" (CCC ≥ 0.9); neck and thigh circumference, a "good" (CCC ≥ 0.7); and head circumference, a "low" (CCC < 0.5) degree of concordance over the complete study population. We observed dependencies of validity on sex, weight, and age. Intraobserver reliability of both techniques is "excellent" (OCCC ≥ 0.9).

CONCLUSION

Scanning is faster, requires less intensive staff training and provides more information. It can be used in an epidemiologic setting with children and adolescents but some measurements should be considered with caution due to reduced agreement with conventional anthropometry.

Changes in body mass, stature and BMI in South African elite U18 Rugby players from different racial groups from 2002-2012

The purpose of this study was to determine whether there are differences between racial groups for body mass, stature and body mass index (BMI) in South African elite U18 rugby players and whether there were significant changes in these measurements between 2002 and 2012. Self-reported body mass and stature were obtained from U18 players (n = 4007) who attended the national tournament during this period. BMI was calculated for each player.White players were 9.8 kg heavier than black players, who were 2.3 kg heavier than coloured players (P < 0.0001). The body mass of all groups increased from 2002 to 2012 (P < 0.0001). White players were 7.0 cm taller than black players who were 0.5 cm taller than coloured players (P < 0.0001). Players' stature measurements did not change significantly during the study period. The average BMI of white players was 0.9 kg·m^-2 greater than black players who were on average 0.7 kg·m^-2 greater than coloured players (P < 0.0001). The BMI of all groups changed similarly over the study period. The body mass, stature and BMI of elite under-18 rugby players in South Africa were significantly different between racial groups. This has implications for transforming the game to make it representative of the South African population.

Higher than recommended dosages of antipsychotics in male patients with schizophrenia are associated with increased depression but no major neurocognitive side effects: Results of a cross-sectional pilot naturalistic study

INTRODUCTION

The current small pilot naturalistic cross-sectional study assesses whether higher dosages of antipsychotics are related to a satisfactory outcome concerning symptoms of schizophrenia but also to a worse outcome in terms of adverse events and neurocognitive function.

MATERIAL AND METHODS

41 male stabilized hospitalized schizophrenic patients were assessed by PANSS, Calgary Depression Rating Scale, UKU and Simpson-Angus Scale and a battery of neurocognitive tests. Medication and dosage was prescribed according to clinical judgement of the therapist.

RESULTS

Clinical variables and adverse events did not differ between patients in the recommended vs high dosage groups. Higher dosage correlated with depressive symptoms but there was no correlation with neurocognitive measures except for impaired concentration.

DISCUSSION

Results suggest that it is possible to achieve a good clinical response in refractory patients by exceeding recommended antipsychotic dosages at the price of depression and possible mild isolated concentration deficits but not other neurocognitive or extrapyramidal adverse events. Currently clinicians prefer first-generation antipsychotics when high dosages are prescribed, but considering the more favorable adverse effects profile of newer agents, it is important to study higher dosages of these agents and to test whether they should be preferably given when high dosages are necessary.

Nutritional Assessment Score: A new tool derived from Subjective Global Assessment for hospitalized adults

BACKGROUND & AIMS

There is no method to be used as a reference standard for nutritional assessment. This study aims to develop and verify the performance of a new tool, based on the Item Response Theory (IRT), from the Subjective Global Assessment (SGA) questionnaire, in hospitalized adult patients.

METHODS

Retrospective cohort study, composed by secondary database, formed by patients included from October 2005 to June 2006. The new tool presented was developed through the usage of cumulative models from the IRT. Out of 1503 evaluated patients, 2/3 were randomly selected to the development sample of the new tool and 1/3 to the performance verification sample.

RESULTS

After item adjustments, the "Nutritional Assessment Score" (NAS) was proposed, with reduced number of questions, and, in comparison to SGA, less polytomic items. NAS demonstrates association to variables that are clinically relevant (hospital mortality, long hospital stay, serum albumin and body mass index) and has shown itself to be more precise to patients with the worst degrees of nutritional status.

CONCLUSIONS

Results point to the validation of the NAS in detecting, accurately, the nutritional status of hospitalized patients.

Inaccuracy and bias in adult skeletal age estimation: Assessing the reliability of eight methods on individuals of varying body sizes

Accurate age estimations are essential for identifying human skeletal remains and narrowing missing persons searches. This study examines how BMI, body mass, and stature influence inaccuracy and bias in adult skeletal age estimations obtained using eight methods. 746 skeletons from the Hamann-Todd and William Bass Collections were used. Underweight BMI, light body mass, and short-stature individuals have the most error associated with their age estimates and are consistently under-aged between 3 to 13years. Obese BMI, heavy body mass, and tall-stature individuals are consistently over-aged between 3 to 8.5years. The most reliable methods for smaller-bodied individuals are Kunos et al. (first rib) and Buckberry-Chamberlain (auricular surface); for individuals in the average range, İşcan et al. (fourth ribs) and Passalacqua (sacrum); and for larger-bodied individuals, İşcan et al., Passalacqua, and Rougé-Maillart et al. (auricular surface and acetabulum). Lovejoy et al. (auricular surface) and Suchey-Brooks (pubic symphysis) produce consistent inaccuracy and bias scores across all body size groups. The least reliable method for smaller-bodied individuals is İşcan et al.; for larger-bodied individuals, Buckberry-Chamberlain; and across all body size groups, DiGangi et al. (first rib).

Anthropometric and metabolic indices in assessment of type and severity of dyslipidemia

Background

It has been shown that obesity is associated with increased rates of dyslipidemia. The present work revisits the association between plasma lipid levels and classical indicators of obesity including body mass index (BMI). The significance of various anthropometric/metabolic variables in clinical assessment of type and severity of dyslipidemia was also determined. Recently described body indices, a body shape index (ABSI) and body roundness index (BRI), were also assessed in this context.

Methods

For the present cross-sectional analytical study, the participants (n = 275) were recruited from the patients visiting different health camps. Participants were anthropometrically measured and interviewed, and their fasting intravenous blood was collected. Plasma lipid levels were accordingly determined.

Results

The values for different anthropometric parameters are significantly different between dyslipidemic and non-dyslipidemic participants. Receiver operating characteristics curve analyses revealed that all the tested variables gave the highest area under the curve (AUC) values for predicting hypertriglyceridemia in comparison to other plasma lipid abnormalities. BRI gave slightly higher AUC values in predicting different forms of dyslipidemia in comparison to BMI, whereas ABSI gave very low values.

Conclusions

Several anthropometric/metabolic indices display increased predictive capabilities for detecting hypertriglyceridemia in comparison to any other form of plasma lipid disorders. The capacity of BRI to predict dyslipidemia was comparable but not superior to the classical indicators of obesity, whereas ABSI could not detect dyslipidemia.

Electronic supplementary material

The online version of this article (doi:10.1186/s40101-017-0134-x) contains supplementary material, which is available to authorized users.

Win Ratio -An Intuitive and Easy-To-Interpret Composite Outcome in Medical Studies

In medical studies with multiple outcomes, researchers always need to make choices as to whether to use a composite outcome (after combining multiple outcomes) as their primary outcome. In this paper we review a new measurement of the treatment effect - win ratio, which can be easily used in studies with prioritized multiple outcomes. We also propose some research topics to be done in this area.

Erectile dysfunction and exposure to ambient Air pollution in a nationally representative cohort of older Men

BACKGROUND

Little is known about the association between air pollution and erectile dysfunction (ED), a disorder occurring in 64% of men over the age of 70, and to date, no studies have been published. To address this significant knowledge gap, we explored the relationship between ED and air pollution in a group of older men who were part of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative cohort study of older Americans.

METHODS

We obtained incident ED status and participant data for 412 men (age 57-85). Fine particulate matter (PM_2.5) exposures were estimated using spatio-temporal models based on participants' geocoded addresses, while nitrogen dioxide (NO₂) and ozone (O₃) concentrations were estimated using nearest measurements from the Environmental Protection Agency's Air Quality System. The association between air pollution and incident ED (newly developed in Wave 2) was examined and logistic regression models were run with adjusted models controlling for race, education, season, smoking, obesity, diabetes, depression, and median household income of census tract.

RESULTS

We found positive, although statistically insignificant, associations between PM_2.5, NO₂, and O₃ exposures and odds of incident ED for each of our examined exposure windows, including 1 to 7 year moving averages. Odds ratios (OR) for 1 and 7 year moving averages equaled 1.16 (95% CI: 0.87, 1.55) and 1.16 (95% CI: 0.92, 1.46), respectively, for an IQR increase in PM_2.5 exposures. Observed associations were robust to model specifications and were not significantly modified by any of the examined risk factors for ED.

CONCLUSIONS

We found associations between PM_2.5, NO₂, and O₃ exposures and odds of developing ED that did not reach nominal statistical significance, although exposures to each pollutant were consistently associated with higher odds of developing ED. While more research is needed, our findings suggest a relationship between air pollutant exposure and incident cases of ED, a common condition in older men.

Comparison of Visceral Fat Accumulation and Metabolome Markers among Cats of Varying BCS and Novel Classification of Feline Obesity and Metabolic Syndrome

As in humans, obesity and its associated diseases represent the most significant threat to the health of veterinary populations. Previous human studies have provided insights into the risk factors of obesity, complex pathogenesis of obesity-associated diseases, and their life-threatening consequences. In humans, the “metabolic syndrome” represents a cluster of metabolic risk factors associated with the development of cardiovascular disease. Risk factors for metabolic syndrome, such as diabetes, obesity, high blood pressure, and its complications increase health-care utilization and medical expenses. Early diagnosis and intervention through preemptive approach is in need, and the new International Diabetes Federation definition of MS serves as the universally accepted diagnostic tool that is accessible in clinical settings. In veterinary populations, especially in cats, similar pathophysiological path and disease progression to the development of MS, such as adipokine dysregulations, chronic inflammation, lipotoxicity, are expected. The aim of this manuscript is twofold. First of all, it presents our preliminary feline obesity study that serves as the basis for discussion of obesity and its metabolic impact on feline population. In this study, we observed the effects of weight gain on energy metabolism using metabolome markers, such as adiponectin (ADN) and proinflammatory cytokines, in correlation with other common biochemical parameters in 14 clinically healthy cats of varying weight status. Further, we evaluated the visceral fat accumulation in three subjects of varying Body Condition Scores via computed tomography imaging and laparoscopic examination, and assessed the adipocyte type and size histologically. Mutually antagonizing changes in ADN and visceral adipose tissue (VAT) reflected the pathophysiological derangements leading to MS earlier than the common biochemical predictors such as glucose, liver values, and lipid markers. Second, it proposes the novel diagnostic and classification method of feline obesity and MS, based on the established diagnostic criteria of human MS and the presented study results. The results supported our novel “classification of feline obesity” and “Feline MS diagnostic criteria,” suggesting the need to complement ADN measurement with VAT volume to better understand the pathogenesis of metabolic disturbances in the feline population.

Comparison of 3D laser-based photonic scans and manual anthropometric measurements of body size and shape in a validation study of 123 young Swiss men

Background

Manual anthropometric measurements are time-consuming and challenging to perform within acceptable intra- and inter-individual error margins in large studies. Three-dimensional (3D) laser body scanners provide a fast and precise alternative: within a few seconds the system produces a 3D image of the body topography and calculates some 150 standardised body size measurements.

Objective

The aim was to enhance the small number of existing validation studies and compare scan and manual techniques based on five selected measurements. We assessed the agreement between two repeated measurements within the two methods, analysed the direct agreement between the two methods, and explored the differences between the techniques when used in regressions assessing the effect of health related determinants on body shape indices.

Methods

We performed two repeated body scans on 123 volunteering young men using a Vitus Smart XXL body scanner. We manually measured height, waist, hip, buttock, and chest circumferences twice for each participant according to the WHO guidelines. The participants also filled in a basic questionnaire.

Results

Mean differences between the two scan measurements were smaller than between the two manual measurements, and precision as well as intra-class correlation coefficients were higher. Both techniques were strongly correlated. When comparing means between both techniques we found significant differences: Height was systematically shorter by 2.1 cm, whereas waist, hip and bust circumference measurements were larger in the scans by 1.17–4.37 cm. In consequence, body shape indices also became larger and the prevalence of overweight was greater when calculated from the scans. Between 4.1% and 7.3% of the probands changed risk category from normal to overweight when classified based on the scans. However, when employing regression analyses the two measurement techniques resulted in very similar coefficients, confidence intervals, and p-values.

Conclusion

For performing a large number of measurements in a large group of probands in a short time, body scans generally showed good feasibility, reliability, and validity in comparison to manual measurements. The systematic differences between the methods may result from their technical nature (contact vs. non-contact).

Comparison of Ideal Body Weight Equations and Published Height-Weight Tables With Body Mass Index Tables for Healthy Adults in the United States

The purpose of this paper was to compare the ideal body weight (IBW) formulas and published height-weight tables for healthy adults in the United States with the body mass index (BMI) of 22 kg/m2, which is associated with lowest mortality. There are numerous formulas and published height-weight tables available to determine IBW, but there are no published studies comparing the validity of formulas with each other or comparing formulas with BMIs. Data from height-weight tables, weight for specific heights determined by IBW formulas, and weight for BMIs of 20, 22, 25, and 30 kg/m2 at different heights were plotted for both men and women. Slopes based on a range of heights were determined for each formula using relational database software. The value for each slope obtained by linear regression was compared with the BMIs to determine which fit best with BMI of 22 kg/m2. Most height-weight tables and formulas predicted IBWs within the range of BMI of 20-25 kg/m2. However, for shorter heights the formulas were closer to BMI 20 kg/m2 and for taller heights, were closer to BMI 25 kg/m2. Height-weight tables' slopes were closer to the BMI slopes than formula slopes. Robinson's formula appears to be the best equation for calculating desirable/healthy weights in men; however, no formula predicted close to a BMI of 22 kg/m2 for women. Thus, in practice it might be more useful to use BMI ranges instead of IBW formulas for men and women.

Quantifying Sarcopenia Reference Values Using Lumbar and Thoracic Muscle Areas in a Healthy Population

BACKGROUND

Sarcopenia is defined as the loss of skeletal muscle mass and function associated with aging. Muscle mass can be reliably and accurately quantified using clinical CT scans but reference measurements are lacking, particularly in healthy US populations.

METHODS

Two-phase CT scans from healthy kidney donors (age 18-40) at the University of Michigan between 1999-2010 were utilized. Muscle mass was quantified using two thoracic and two lumbar muscle cross-sectional area (CSA) measures. Indexed measurements were computed as area divided by height-squared. Paired analyses of non-contrast and contrast phases and different Hounsfield Unit (HU) ranges for muscle were conducted to determine their effect on CSA muscle measures. We report the means, standard deviations, and 2SD sarcopenia cutoffs from this population.

RESULTS

Healthy population CSA (cm2) cutoffs for N=604 males/females respectively were: 34.7/20.9 (T12 Dorsal Muscle), 91.5/55.9 (T12 Skeletal Muscle), 141.7/91.2 (L3 Skeletal Muscle), 23.5/14.3 (L4 Total Psoas Area), and 23.4/14.3 (L4 Psoas Muscle Area). Height-indexed CSA (cm2/m2) cutoffs for males/females respectively were: 10.9/7.8 (T12 Dorsal Muscle), 28.7/20.6 (T12 Skeletal Muscle), 44.6/34.0 (L3 Skeletal Muscle), 7.5/5.2 (L4 Total Psoas Area), and 7.4/5.2 (L4 Psoas Muscle Area). We confirmed that a mask of -29 to 150 HU is optimal and shows no significant difference between contrast-enhanced and non-contrast CT scan CSA measurements.

CONCLUSIONS

We quantified reference values for lumbar and thoracic muscle CSA measures in a healthy US population. We defined the effect of IV contrast and different HU ranges for muscle. Combined, these results facilitate the extraction of clinically valuable data from the large numbers of existing scans performed for medical indications.

Relationship Between Adiposity Indices, Lipodystrophy, and Sarcopenia in HIV-Positive Individuals With and Without Lipodystrophy

Metabolism disorders, as well as body shape abnormalities, have been associated with the introduction of antiretroviral therapy. The objective of this study was to compare the diagnostic ability of adiposity indices and to discuss criteria for the classification of lipodystrophy and sarcopenia (SP) in HIV-positive individuals. Anthropometric measurements were determined in 268 individuals of both genders, also submitted to the dual-energy X-ray absorptiometry exam. The adiposity indices calculated were body mass index, body mass index adjusted for fat mass (BMIfat), body adiposity index, body adiposity Index for the Fels Longitudinal Study sample, and The Clínica Universidad de Navarra body adiposity estimator. The presence of lipodystrophy was evaluated using the fat mass ratio (FMR). SP was classified using the appendicular lean mass/height² ratio. The subjects were divided into 3 groups: HIV⁺LIPO⁺ (n = 41), HIV⁺LIPO^- (n = 65), and control (C, HIV-negative individuals; n = 162). Among the adiposity indices assessed, BMIfat showed the strongest correlation with total body fat (in percent) for men (r = 0.87, p < 0.001) and women (r = 0.92, p < 0.001). The frequency of SP was 44.8% and 41.7% in HIV⁺LIPO⁺, 27.8% and 20.7% in HIV⁺LIPO^- and 63.3% and 45.45% in C, for men and women, respectively. The cutoff point suggested for the diagnosis of lipodystrophy according to the FMR was 1.14. The adiposity indices, particularly the BMIfat, have strong correlation with body fat determined by dual-energy X-ray absorptiometry in HIV-positive patients. The implementation of FMR is recommended for more standardized estimates of the frequency of lipodystrophy.

RETRACTED: Association between peroxisome proliferator-activated receptor, UCP3 and lipoprotein lipase gene polymorphisms and obesity in Chinese adolescents

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). Please note that this retraction notice has been updated in September 2021, as follows: This article has been retracted at the request of the Editors in Chief due to concerns regarding the authorship. Certain individuals were erroneously indicated as co-authors of the article when it was originally published. These individuals have informed the journal that they did not contribute to the article and that they had no knowledge of its submission for publication. We confirm, following investigation, that those individuals previously identified by the submitting author as co-authors did not author, approve or submit this article for publication, and the previous attribution of the article to them was in error. We have not had a response from Dr Mao and Dr Cai regarding authorship. As a result of the correspondence with Associate Professor Z. Zou and Dr L. Wang, we believe that the paper needs to be retracted and have elected to proceed with retraction.

Potential future studies on the nutritional status among indigenous peoples in Alaska and the Russian Far East: preliminary assessment of the Social Transition in the North data set

OBJECTIVE

The purpose of this assessment is to examine the nutrition-related health data collected during the Social Transitions of the North (STN) study for understanding cultural differences between nations and the impact on nutritional status.

METHODS

The nutrition data in the STN study was collected in two regions of Alaska (Northwest Arctic and the Aleutian Islands) and in two regions of the Russian Far East (Kamchatka and Chukotka). The health questionnaire explored several factors that may contribute to identifying the nutritional status of the study populations. These factors were appetite, weight, subsistence food consumption, vitamin or mineral supplements use self-perception of health, special diets, and number of meals consumed with relatives.

RESULTS

US populations were heavier than the Russian population (p = 0.0001). Both the Alaskan and Russian populations are frequent users of subsistence foods. The US respondents reported consuming 75% or more of the total protein as subsistence protein more often (40%) than the Russian respondents (25%).

CONCLUSION

US respondents perceive themselves as healthier than their Russian counterparts. The US respondents consumed greater amounts of subsistence foods in general, and more of their diet over the year is made up of Native protein.

The idea of uniform change: is it time to revisit a central tenet of Rose's "Strategy of Preventive Medicine"?

A mean-centric view of populations, whereby a change in the mean of a health variable at the population level is assumed to result in uniform change across the distribution, is a core component of Geoffrey Rose's concept of the "population strategy" to disease prevention. This idea also has a critical role in Rose's observation that individuals who are considered abnormal or sick (the rightward tail of the distribution) and those who are considered normal (the center) are very closely related, and that true preventive medicine must focus on shifting the normal or average. In this Perspective, we revisit these core tenets of Rose's concept of preventive medicine after providing an overview of the key concepts that he developed. We examine whether these assumptions apply to population changes in body mass index (BMI) and show that there is considerable evidence of a widening of the BMI distribution in populations over time. We argue that, with respect to BMI, the idea of using statistical measures of a population solely on the basis of means and the assumption that populations are coherent entities that change uniformly over time may not fully capture the true nature of changes in the population. These issues have important implications for how we assess and interpret the health of populations over time with implications for the balance between universal and targeted strategies aimed at improving health.

Mission Impossible? Physical Activity Programming for Individuals Experiencing Homelessness

PURPOSE

A pilot study was conducted to describe the physical activity experiences and perceived benefits of and barriers to physical activity participation for patrons of a homeless shelter. The resulting pilot data may be used to inform the creation of and support for physical activity and sport programs for those experiencing homelessness.

METHOD

Eighteen male patrons of a homeless shelter completed self-report questionnaires to assess psychosocial factors: global self-esteem, general self-efficacy, exercise intention and attitudes, and quality of life. Fitness tests were completed to determine participants' body mass index, cardiorespiratory fitness, flexibility, and general body strength. Interviews probed participants' social support, motivations, perceived benefits, and preferences related to physical activity.

RESULTS

Participants scored far below the acceptable range on the sit-and-reach test of flexibility. There were moderate correlations between several of the psychosocial variables and some of the fitness parameters.

CONCLUSIONS

The participants could benefit from initiating a varied exercise program to increase their flexibility. Future research should explore intervention on psychosocial variables that may influence other psychosocial variables as well as fitness parameters. Despite limitations of a small sample size and limited access to fitness facilities, the preliminary evidence suggests that patrons of a homeless shelter are open to physical activity experiences and that the benefits may go beyond improving physical fitness levels.

A indicator of visceral adipose dysfunction to evaluate metabolic health in adult Chinese

Visceral adipose dysfunction is a major cause of metabolic disorders. However, there is lack of a clinical index for prediction of visceral fat dysfunction in Asians. The present study aims to establish a visceral adiposity index for evaluation of metabolic health status in Chinese, the largest Asian ethnic group. 485 subjects were recruited from Lianqian Community, Xiamen and received abdominal computed tomography(CT) for visceral fat area. A Chinese visceral adiposity index (CVAI) was created using multivariate linear regression analyses, and was further validated in 6495 subjects recruited from Changfeng Community, Shanghai. CVAI was well associated with visceral obesity (r = 0.68, P < 0.001) and HOMA-IR (r = 0.60, P < 0.001). The AUROCs were 0.89(0.88-0.90), 0.72(0.71-0.73), 0.69(0.68-0.71) and 0.67(0.65-0.68) for determination of metabolic syndrome, hypertension, diabetes and prediabetes, respectively. CVAI was more valuable compared to BMI and waist circumference in evaluation of metabolic risks (all P < 0.001), even in subjects with metabolically unhealthy normal weight (MUNW) and metabolically healthy obese/overweight (MHO). This study demonstrates that CVAI is a reliable and applicable index for evaluation of visceral fat dysfunction in Chinese. It might be used to evaluate metabolic health status in Asians.

The SURMetaGIT study: Design and rationale for a prospective pan-omics examination of the gastrointestinal response to Roux-en-Y gastric bypass surgery

Objective

To describe the protocol of the SURgically induced Metabolic effects on the Human GastroIntestinal Tract (SURMetaGIT) study, a clinical pan-omics study exploring the gastrointestinal tract as a central organ driving remission of type 2 diabetes mellitus (T2DM) after Roux-en-Y gastric bypass (RYGB). The main points considered in the study’s design and challenges faced in its application are detailed.

Methods

This observational, longitudinal, prospective study involved collection of gastrointestinal biopsy specimens, faeces, urine, and blood from 25 obese women with T2DM who were candidates for RYGB (20 patients for omics assessment and 5 for omics validation). These collections were performed preoperatively and 3 and 24 months postoperatively. Gastrointestinal transcriptomics; faecal metagenomics and metabolomics; plasma proteomics, lipidomics, and metabolomics; and biochemical, nutritional, and metabolic data were assessed to identify their short- and long-term correlations with T2DM remission.

Results

Data were collected from 20 patients before and 3 months after RYGB. These patients have nearly completed the 2-year follow-up assessments. The five additional patients are currently being selected for omics data validation.

Conclusion

The multi-integrated pan-omics approach of the SURMetaGIT study enables integrated analysis of data that will contribute to the understanding of molecular mechanisms involved in T2DM remission after RYGB.

Perspectives in obesity and pregnancy

Obesity is currently recognized as a health epidemic worldwide. Its prevalence has doubled in the last three decades. Obesity is a complex clinical picture associated with physical, physiologic, hormonal, genetic, cultural, socioeconomic and environmental factors. The rate of obesity is also increasing in the pregnant women population. Maternal obesity is associated with less than optimal obstetrical, fetal and neonatal outcomes. It is also associated with significant adverse long-term effects on both obese parturients and the infants born from obese women. A number of guidelines have been published to educate health care workers and the general population in an attempt to develop effective interventions on a large scale to prevent obesity. These guidelines are multiple, confusing and inconsistent. There are no standard recommendations regarding gestational weight gaining goals, nutrients and additional elements necessary for certain obese women who have been treated with bariatric surgical procedures, screening for metabolic diseases such as diabetes, additional preventive health care services indicated for obese women in the pregnancy planning stages, during prenatal care, in the immediate post-partum period and as a long-term approach for health preservation. In 2013, the American Medical Association supported by several US national medical specialty organizations published Resolution 420 (A-13) recognizing obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to improve its prevention and treatment. The goal of this decision was to encourage a broader spectrum of health care benefits insurance coverage for the prevention and treatment of obesity. There are a number of myths and misconceptions associated with obesity. These perspectives present our views and clinical experience with a partial review of recent bibliography addressing the associations between obese reproductive age women and their risks during pregnancy.