The prevalence of obesity and obesity-related health conditions in a large, multiethnic cohort of young adults in California

Evaluation of socioecological factors on health behaviors and weight change during major life event: A cross-sectional study using data collected during the COVID-19 pandemic

Background

Socioecological factors are associated with key health behaviors that are critical for weight management, and major life events may disrupt engagement in these behaviors. However, the influence of socioecological factors on health behaviors in the midst of major life events is not clear and is difficult to study due to the random and sporadic nature of their occurrence. The COVID-19 pandemic provided a unique opportunity to study a major life event and its impacts on diet, physical activity, and body weight.

Objective

This cross-sectional study aimed to investigate associations between socioecological factors (environmental, interpersonal, and individual) and self-reported weight change during a major life event using data collected during the COVID-19 pandemic, and whether the associations were mediated through self-reported changes in eating and physical activity behaviors.

Methods

Participants self-reported socioecological factors, weight change, and changes in eating behaviors (EB) and physical activity (PA) via online questionnaires between December 2020 and October 2021. Changes in EB and PA were measured using scales with higher scores reflecting more positive changes during the COVID-19 pandemic.

Results

Participants (n = 1283) were mostly female (84.9%) with age 52.1 ± 14.1 years (mean ± SD) and BMI of 32.9 ± 8.2 kg/m2. Stronger healthy eater and exercise identities (individual factors) were associated with higher EB scores (EBS) and PA scores (PAS), respectively (p's < 0.00001). Less discouragement for healthy eating by family/friends (interpersonal factor) was associated with higher EBS (p = 0.002). Higher EBS and PAS were associated with weight loss. The indirect effect of healthy eater identity (-0.72; 95% CI: -0.90, -0.55) and discouragement for diet (0.07; 95% CI: 0.03, 0.12) on weight change through EBS were significant, as was the indirect effect of exercise identity (-0.25; 95% CI: -0.35, -0.15) on weight change through PAS.

Conclusions

Stronger identities and less discouragement from family/friends may support health promoting behaviors and weight loss during a major life event, as well as identify additional behavioral targets for lifestyle interventions.

Clinical Trial Registration

IWCR was registered at ClinicalTrials.gov (NCT04907396).

Psychometric validation of four-item exercise identity and healthy-eater identity scales and applications in weight loss maintenance

BACKGROUND

Identifying as someone who engages in health promoting behaviors like healthy eating and exercising may be associated with sustained engagement in those behaviors, but reliable and valid instruments are needed to improve the rigor of this research. Two studies were conducted to (1) examine the psychometric properties of a four-item exerciser identity measure (4-EI) and an adapted healthy-eater identity measure (4-HEI) and (2) examine differences in identity strengths across categories of weight loss success.

METHODS

Data from 1,709 community dwelling adults in the International Weight Control Registry (IWCR) were used. A random half of the sample was used to assess the proposed unidimensional factor structure of the 4-EI and 4-HEI and examine convergent and discriminant validity using Spearman rank-order correlations. One-way ANOVA was used in the other random half of the sample to compare 4-EI and 4-HEI scores (-3 to + 3) across three self-defined weight loss categories ('Successful', 'Regain', and 'Unsuccessful') and those maintaining ≥ 5% weight loss for > 1 year vs. not.

RESULTS

Results support the unidimensional factor structure with all four items (eigenvalue scores > 2.89) as well as convergent and discriminant validity for both measures. Exercise identity was strongly correlated with self-reported physical activity (r (735) = 0.52, p <.001) and measures of autonomous motivation. Healthy eating identity was moderately correlated with cognitive restraint in eating (r (744) = 0.42, p <.001) and other measures predictive of eating behavior. 4-EI and 4-HEI are stronger in Successful (4-EI: M = 0.90, SD = 1.77; 4-HEI: M = 1.56 SD = 1.37) vs. Regain (4-EI: M=-0.18, SD = 1.68; 4-HEI: M =.57, SD = 1.48) and Unsuccessful (4-EI:M=-0.28, SD = 1.62; 4-HEI: M = 0.51, SD = 1.33) and those maintaining ≥ 5% weight loss (4-EI:M = 0.47, SD = 1.78; 4-HEI: M = 1.13, SD = 1.49) vs. not (4-EI:M=-0.27, SD = 1.66; 4-HEI: M = 0.53, SD = 1.47), p's < 0.001.

CONCLUSIONS

The 4-EI and 4-HEI have acceptable psychometric properties and can advance understanding of the role of identity in exercise and dietary behaviors and weight loss maintenance.

TRIAL REGISTRATION

The parent observational study, International Weight Control Registry (IWCR), for these sub-studies is registered in ClinicalTrials.gov (NCT04907396).

Prevalence and associated clinical factors for overweight and obesity in young first-episode and drug-naïve Chinese patients with major depressive disorder

Background

Obesity and overweight are common in young patients with major depressive disorder (MDD). However, the prevalence and associated clinical factors of obesity/overweight in young first-episode and drug-naïve (FEDN) MDD patients are rarely reported in China.

Methods

A cross-sectional study of 917 young patients (aged 18-35 years) with FEDN MDD was performed. Demographic and clinical data were collected. Depression, anxiety, and psychotic symptoms were assessed using the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), and the Positive and Negative Syndrome Scale (PANSS) positive subscale, respectively.

Results

Among the young MDD patients, the prevalence of obesity and overweight was 4.14 and 52.89%, respectively. Compared to normal-weight patients, overweight patients were older, had a greater age of onset, and had higher TSH and TG levels. Male MDD patients had a higher risk of obesity than female patients. Compared to obese patients, normal-weight and overweight patients had significantly lower HAMD scores, TC levels, and rates of TSH abnormalities. Logistic regression analysis showed that age, age of onset, and sex were independently associated with obesity, and TSH was independently associated with both obesity and overweight, in young MDD patients.

Conclusion

Our findings suggest a high prevalence of overweight and obesity in young FEDN MDD patients. Several demographic and clinical variables are independently associated with overweight/obesity in these young MDD patients.

Childhood maltreatment predicts physical health in college students

Objective: Childhood maltreatment (CM) is associated with physical health problems throughout the lifespan, yet more research is needed regarding the trajectory of health problems (e.g., onset of health risk indicators) in young adults. The current study examined whether college students self-reporting higher levels of CM exhibited poorer physical health outcomes. Method: Young adults in college (N = 100) completed a physical health assessment (heart rate, body mass index (BMI), blood pressure, blood sugar, waist circumference), self-reported measures of health (symptoms of illness), and CM during spring semester 2018. Results: CM scores predicted higher heart rate and increased symptoms of illness. Females with maltreatment history presented higher levels of obesity and more metabolic syndrome conditions than their peers. Conclusions: Findings support the importance of examining the trajectory of CM to chronic disease, as health risk indicators are present in young adults.

Weight Gain and Change in Body Mass Index after Age 20 in the Brazilian Population and Associated Sociodemographic Factors: Data from the National Health Survey

Obesity is considered one of the main contemporary public health problems. We aim to assess changes in body weight and nutritional status in adulthood and the associated sociodemographic variables. We use data from the 2013 National Health Survey (n = 21,743). Changes in weight and body mass index (BMI) were calculated based on mean difference between measurements at age 20 and data collected at the interview, stratified by sex. The association was analyzed using linear regression. Mean weight gain was greater among women than men. The largest gain was verified among the younger adults for both sexes. Age was found to be associated with weight and BMI change in men and women where, for every additional year of age, there was an increase in weight and BMI of 0.10 kg and 0.04 kg/m2 in men and of 0.22 kg and 0.09 kg/m2 in women, respectively. For education, a direct association was found for men and an inverse for women. Association with area of residence was significant among males only, where rural men gained less than their urban counterparts. Weight gain was progressive, being more marked in the younger group, and was associated with education differently according to sex.

Factors Associated with Home Food Environment in Low-Income Overweight or Obese Pregnant Women

Limited research has examined factors associated with home food availability. This study investigated the associations among demographics, body mass index category, stress, and home food availability among low-income overweight or obese pregnant women. This cross-sectional study enrolled 332 participants who were non-Hispanic black or white. We performed logistic regression modeling for unprocessed food, processed food, overall ultra-processed food, and three subcategories of ultra-processed food (salty snacks, sweet snacks and candies, and soda). Black women were less likely than white women to have large amounts of processed foods (OR = 0.56), salty snacks (OR = 0.61), and soda (OR = 0.49) available at home. Women with at least some college education or at least a college education were more likely to have large amounts of unprocessed food (OR = 2.58, OR = 4.38 respectively) but less likely to have large amounts of soda (OR = 0.44; OR = 0.22 respectively) available at home than their counterparts. Women with higher stress were less likely to have large amounts of unprocessed food available at home (OR = 0.58) than those with lower stress. Home food availability varied by race, education, and levels of stress in low-income overweight or obese pregnant women.

Geographic Variation in Obesity at the State Level in the All of Us Research Program

INTRODUCTION

National obesity prevention strategies may benefit from precision health approaches involving diverse participants in population health studies. We used cohort data from the National Institutes of Health All of Us Research Program (All of Us) Researcher Workbench to estimate population-level obesity prevalence.

METHODS

To estimate state-level obesity prevalence we used data from physical measurements made during All of Us enrollment visits and data from participant electronic health records (EHRs) where available. Prevalence estimates were calculated and mapped by state for 2 categories of body mass index (BMI) (kg/m2): obesity (BMI >30) and severe obesity (BMI >35). We calculated and mapped prevalence by state, excluding states with fewer than 100 All of Us participants.

RESULTS

Data on height and weight were available for 244,504 All of Us participants from 33 states, and corresponding EHR data were available for 88,840 of these participants. The median and IQR of BMI taken from physical measurements data was 28.4 (24.4- 33.7) and 28.5 (24.5-33.6) from EHR data, where available. Overall obesity prevalence based on physical measurements data was 41.5% (95% CI, 41.3%-41.7%); prevalence of severe obesity was 20.7% (95% CI, 20.6-20.9), with large geographic variations observed across states. Prevalence estimates from states with greater numbers of All of Us participants were more similar to national population-based estimates than states with fewer participants.

CONCLUSION

All of Us participants had a high prevalence of obesity, with state-level geographic variation mirroring national trends. The diversity among All of Us participants may support future investigations on obesity prevention and treatment in diverse populations.

Denominational and Gender Differences in Hypertension Among African American Christian Young Adults

Hypertension, a major cardiovascular disease risk factor, is disproportionately prevalent among African American young adults. Religion and spirituality (R/S) have been studied for their potential effect on blood pressure (BP) outcomes. Despite their disproportionate hypertension risk and high levels of R/S engagement, limited research explores BP differences among religious African Americans. This study investigates whether denominational affiliation predicts within-group differences in odds of having hypertension among African American Christian young adults. Data from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were used to examine hypertension differences between 1932 African American young adults based on self-reported religious denomination. Gender-separated logistic regressions included religious service attendance and coping measures, as well as personal characteristics and health behaviors to adjust for potential effects on BP. The odds of having hypertension were higher for Pentecostal women compared to Baptist and Catholic women. Hypertension odds for women who reported attending services more than once weekly were lower than those who never attended church. For women, frequent use of religious coping predicted higher odds of having hypertension than seldom or never using religious coping. R/S variables did not predict significant differences among men. The health benefits of R/S do not appear to be consistent within African American Christian young adults. Religion may be viewed as a source of BP risk and resilience, especially among African American young women.

Intrapartum Antibiotic Exposure and Body Mass Index in Children

BACKGROUND

Intrapartum antibiotic prophylaxis (IAP) reduces a newborn's risk of group B streptococcal infection (GBS) but may lead to an increased childhood body mass index (BMI).

METHODS

This was a retrospective cohort study of infants (n = 223 431) born 2007-2015 in an integrated healthcare system. For vaginal delivery, we compared children exposed to GBS-IAP and to any other type or duration of intrapartum antibiotics to no antibiotic exposure. For cesarean delivery, we compared children exposed to GBS-IAP to those exposed to all other intrapartum antibiotics, including surgical prophylaxis. BMI over 5 years was compared using nonlinear multivariate models with B-spline functions, stratified by delivery mode and adjusted for demographics, maternal factors, breastfeeding, and childhood antibiotic exposure.

RESULTS

In vaginal deliveries, GBS-IAP was associated with higher BMI from 0.5 to 5.0 years of age compared to no antibiotics (P < .0001 for all time points, ΔBMI at age 5 years 0.12 kg/m2, 95% confidence interval [CI]: .07-.16 kg/m2). Other antibiotics were associated with higher BMI from 0.3 to 5.0 years of age. In cesarean deliveries, GBS-IAP was associated with increased BMI from 0.7 years to 5.0 years of age (P < .05 for 0.7-0.8 years, P < .0001 for all other time points) compared to other antibiotics (ΔBMI at age 5 years 0.24 kg/m2, 95% CI: .14-.34 kg/m2). Breastfeeding did not modify these associations.

CONCLUSIONS

GBS-IAP was associated with a small but sustained increase in BMI starting at very early age. This association highlights the need to better understand the effects of perinatal antibiotic exposure on childhood health.

Obesity and related conditions and risk of inflammatory breast cancer: a nested case-control study

PURPOSE

Inflammatory breast cancer (IBC) is a rare, poorly understood and aggressive tumor. We extended prior findings linking high body mass index (BMI) to substantial increased IBC risk by examining BMI associations before and after adjustment for well-characterized comorbidities using medical record data for diabetes, insulin resistance, and disturbances of cholesterol metabolism in a general community healthcare setting.

METHODS

We identified 247 incident IBC cases diagnosed at Kaiser Permanente Northern California between 2005 and 2017 and 2470 controls matched 10:1 on birth year and geographic area and with ≥ 13 months of continuous enrollment prior to diagnosis/index date. We assessed exposures from 6 years up to one year prior to the diagnosis/index date, using logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

Before adjustment for comorbidities, ORs (95% CIs) for BMI of 25-< 30, 30-< 35, and ≥ 35 compared to < 25 kg/m² were 1.5 (0.9-2.3), 2.0 (1.2-3.1), and 2.5 (1.4-4.4), respectively. After adjustment for pre-diabetes/diabetes, HDL-C and triglyceride levels, and dyslipidemia, corresponding ORs were 1.3 (0.8-2.1), 1.6 (0.9-2.9), and 1.9 (1.0-3.5). The OR for HDL-C levels < 50 mg/dL compared to ≥ 65 mg/dL was 2.0 (1.2-3.3) in the adjusted model. In a separate model the OR for a triglyceride/HDL-C ratio ≥ 2.50 compared to < 1.62 was 1.7 (1.1-2.8) after adjustment for BMI, pre-diabetes/diabetes, and dyslipidemia. Results did not differ significantly by estrogen receptor status.

CONCLUSIONS

Obesity and measures of insulin resistance independently increased IBC risk as did obesity and low HDL-C levels. These findings, if confirmed, have implications for IBC prevention.

Alcohol Use Among U.S. Adults by Weight Status and Weight Loss Attempt: NHANES, 2011-2016

INTRODUCTION

Past research examining the relationship between alcohol use and weight status has not differentiated among classes of obesity. There is limited research investigating whether adults trying to lose weight consume less alcohol.

METHODS

In 2018-2019, the authors analyzed 2011-2016 National Health and Nutrition Examination Survey data for nonpregnant adults aged ≥20 years with BMI ≥18.5 kg/m². Multinomial and binomial logistic regression and linear regression were used to test associations between (1) past-year alcohol use and current weight status, differentiating among Class 1, 2, and 3 obesity, and (2) past-year weight loss attempt and alcohol use, controlling for potential confounders. Analyses were stratified by sex.

RESULTS

Male current drinkers versus nondrinkers had lower odds of Class 3 obesity versus healthy weight (AOR=0.62, 95% CI=0.42, 0.92); female current drinkers versus nondrinkers had lower odds of Class 1 (AOR=0.67, 95% CI=0.50, 0.90), Class 2 (AOR=0.62, 95% CI=0.46, 0.83), and Class 3 (AOR=0.66, 95% CI=0.49, 0.89) obesity versus healthy weight. Among current drinkers, less frequent alcohol use was associated with higher odds of Class 1-3 obesity versus healthy weight in both sexes (p<0.05), whereas higher continued volume (heavier drinking) was associated with higher odds of Class 1-3 obesity versus healthy weight in females (p=0.049). Females reporting a weight loss attempt had higher odds of current drinking and more frequent heavy drinking.

CONCLUSIONS

Lower frequency of alcohol use (both sexes) and higher continued volume (female adults only) are associated with higher odds of higher weight status. Female adults trying to lose weight drink more, despite guidelines suggesting reducing caloric intake for weight control.

Do Associations Between Alcohol Use and Alcohol Use Disorder Vary by Weight Status? Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III

BACKGROUND

Understanding whether the associations between alcohol use and alcohol use disorder (AUD) differ by weight status may be useful in screening for AUD in populations where obesity is common. We aimed to determine whether the associations between alcohol use and AUD differ by weight status.

METHODS

A total of 24,869 adult participants of the National Epidemiologic Survey on Alcohol and Related Conditions-III with a body mass index ≥18.5 kg/m² who reported past-year alcohol use were included. The AUD and Associated Disabilities Interview Schedule-5 were administered to identify past-year AUD. Logistic regression was used to test the associations between weight status and levels and patterns of alcohol use with AUD; interactions between weight status and alcohol use variables in relation to AUD were examined. Analyses were stratified by gender.

RESULTS

For males and females, the odds of AUD were higher with greater frequency of any alcohol use and heavy drinking, higher average quantity of drinks per drinking day, and past-year high-risk drinking. Among males, at the same average quantity of drinks per drinking day, frequency of heavy drinking, or presence of high-risk drinking, those with class 3 obesity had higher odds of AUD versus lower classes or no obesity (p for all interactions <0.01). Among females, at the same frequency of any alcohol use, those with healthy weight had the highest odds of AUD, while females with class 3 obesity had the lowest odds of AUD (p for interaction <0.001); interactions between weight status and other alcohol use variables were not significant (p ≥ 0.05).

CONCLUSIONS

The associations between some measures of alcohol use and AUD differed by weight status, with inconsistent results between males and females. Alcohol use thresholds typically used in AUD screening may be too high in males with class 3 obesity.

Relationships between stress, demographics and dietary intake behaviours among low-income pregnant women with overweight or obesity

OBJECTIVE

To identify demographic risk factors associated with high stress and examine the relationships between levels of stress, demographics and dietary fat, fruit and vegetable intakes in low-income pregnant women with overweight or obesity.

DESIGN

A cross-sectional study.

SETTING

Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan, USA.ParticipantsParticipants (n 353) were non-Hispanic Black (black) or White (white).

RESULTS

Women aged 35 years or older (OR=4·09; 95% CI 1·45, 11·51) and who had high school or less education (OR=1·88; 95% CI 1·22, 2·89) or were unemployed (OR=1·89; 95% CI 1·15, 3·12) were significantly more likely to report high stress than women who were younger, had at least some college education or were employed/homemakers. However, race and smoking status were not associated with level of stress. Women with high stress reported significantly lower fruit and vegetable intakes but not fat intake than women with low stress. Women aged 35 years or older reported significantly higher vegetable but not fat or fruit intake than women who were 18-24 years old. Black women reported significantly higher fat but not fruit or vegetable intake than white women. Education, employment and smoking status were not significantly associated with dietary intake of fat, fruits and vegetables.

CONCLUSIONS

Nutrition counselling on reducing fat and increasing fruit and vegetable intakes may consider targeting women who are black or younger or who report high stress, respectively.

Health Status of Young Adults with Insurance Coverage Before and After Affordable Care Act Passage

INTRODUCTION

The purpose of this study was to assess changes in health status of California young adults with insurance coverage before and after passage of the Affordable Care Act (ACA).

METHODS

For this cross-sectional descriptive study, electronic health record information for young adults between ages 18 and 25 years enrolled in a large Southern California Health Plan in 2008, 2010, or 2015 was obtained (N = 665,686). Absolute changes and standardized annual differences in demographics and age-sex-race standardized prevalence of Elixhauser health conditions for pre-ACA (2008-2010) and post-ACA (2010-2015) periods were calculated.

RESULTS

The number of young adults enrolled in the Health Plan increased by 145,000 (65%) during the ACA transition with a shift toward low-income young adults. The increase in high-deductible insurance plans observed pre-ACA stabilized with a standardized annual difference of 0.22 pre-ACA vs 0.05 post-ACA. The prevalences of obesity and other health conditions between pre-ACA and post-ACA periods essentially were unaltered and comparable between young adults who became new members (< 1 year) and those with long-term memberships (≥ 3 years).

CONCLUSION

In this California health care system, the health status of new young adult members was comparable to that of long-term members. Future research should assess whether these young adults retain their health insurance coverage after turning age 26 years and being removed from their parents' insurance plans.

Fast Food Intake in Relation to Employment Status, Stress, Depression, and Dietary Behaviors in Low-Income Overweight and Obese Pregnant Women

Objective This study explored fast food intake as a potential mediator of the relationships among employment status; stress; depression; and fruit, vegetable, and fat intakes by race (African American vs. Non-Hispanic White) and body mass index (BMI category: overweight vs. obesity). Methods Low-income overweight and obese pregnant women (N = 332) were recruited from the Special Supplemental Nutrition Program for Women, Infants and Children in Michigan. Path analysis was performed to explore mediation effects by race and BMI category. Results Fast food intake mediated the relationship between employment status and fat intake (p = 0.02) in Non-Hispanic White women, but no mediation effect was detected in African American women. For overweight women, fast food intake mediated the relationship between employment status and fat intake (p = 0.04) and the relationship between depression and vegetable intake (p = 0.01). Also, fast food intake partially mediated the relationship between depression and fat intake (p = 0.003). For obese women, fast food intake mediated the relationship between employment status and fat intake (p = 0.04). Conclusion Fast food is an important topic for nutrition education for overweight and obese pregnant women. Future interventions may be more successful if they address issues associated with employment status (e.g., lack of time to plan and cook healthy meals) and depressive mood (e.g., inability to plan meals or shop for groceries when coping with negative emotions).

Obstacles to Translating Genotype-Phenotype Correlates in Metabolic Disease

Type 2 diabetes mellitus is a polygenic disease with a variable phenotype. Many genetic associations have been described; however, understanding their underlying pathophysiological role in Type 2 diabetes mellitus is important for development of future therapeutic targets. Here, we review the physiological mechanisms of diabetes-associated variants that affect glycemia.

Race and Obesity in Adolescent Hypertension

BACKGROUND AND OBJECTIVES

The overall prevalence of essential hypertension in adolescents may be growing. Differences in blood pressure (BP) are well established in adults, but are less clear in adolescents. We hypothesize that the prevalence of hypertension differs by race/ethnicity among adolescents at school-based screenings.

METHODS

We performed school-based BP screening in over 20 000 adolescents from 2000 to 2015. Race/ethnicity was self-reported. Height and weight were measured to determine BMI, and BP status was confirmed on 3 occasions to diagnose sustained hypertension according to Fourth Working Group Report criteria.

RESULTS

We successfully screened 21 062 adolescents aged 10 to 19 years (mean, 13.8 years). The final prevalence of sustained hypertension in all subjects was 2.7%. Obesity rates were highest among African American (3.1%) and Hispanic (2.7%) adolescents. The highest rate of hypertension was seen in Hispanic (3.1%), followed by African American (2.7%), white (2.6%), and Asian (1.7%) adolescents (P = .019). However, obese white adolescents had the highest prevalence of sustained hypertension (7.4%) compared with obese African American adolescents (4.5%, P < .001). At lower BMI percentiles (<60th percentile), Hispanic adolescents actually had the lowest predicted prevalence of hypertension among the 4 groups.

CONCLUSIONS

The prevalence of hypertension varies among different race/ethnicities. Although obesity remains the strongest predictor of early hypertension, the strength of this relationship is intensified in Hispanic and white adolescents, whereas it is lessened in African American adolescents.

Accuracy of different cutoff points of body mass index to identify overweight according to body fat values estimated by DEXA

OBJECTIVE

To evaluate the sensitivity and specificity of different cutoff points of body mass index for predicting overweight/obesity according to body fat values estimated by DEXA among Brazilian adolescents.

METHODS

Cross-sectional study including 229 male adolescents aged 10-15 years, in which body adiposity and anthropometric measures were assessed. Nutritional status was classified by BMI according to cutoff points described in scientific literature.

RESULTS

Moderate agreements were observed between body fat estimated by DEXA and cutoffs proposed by Cole et al. (K=0.61), Conde and Monteiro (K=0.65), Must et al. (K=0.61) and WHO (K=0.63). The BMI in continuous form showed good agreement with the Dexa (ICC=0.72). The highest sensitivity was observed for cutoff by Conde and Monteiro (0.74 [0.62, 0.84]) and the highest specificity by Cole et al. (0.98 [0.94, 0.99]). For the areas under the ROC curve of cutoff points analyzed, significant difference comparing the cutoff points by Cole et al. and Conde and Monteiro (0.0449 [0.00294, 0.0927]) was observed.

CONCLUSIONS

The cutoff proposed by Conde and Monteiro was more sensitive in identifying overweight and obesity when compared to the reference method, and the cutoff proposed by Cole et al. presented the highest specificity for such outcomes.

Recruitment Challenges and Enrollment Observations from a Community Based Intervention (Mothers In Motion) for Low-Income Overweight and Obese Women

BACKGROUND

Mothers In Motion (MIM), a randomized controlled trial, aimed to help young, low-income overweight and obese mothers prevent weight gain by promoting stress management, healthy eating, and physical activity. This paper describes MIM recruitment challenges and reports demographic characteristics affecting enrollment.

METHODS

Participants who were African American or Non-Hispanic White were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Michigan. We faced numerous recruitment challenges and learned that several strategies facilitated recruitment. Logistic regression analyses were performed to examine demographic characteristics that affect enrollment.

RESULTS

Women who had a higher body mass index (BMI, OR 1.06, 95% CI 1.02 - 1.10); were at late postpartum, (OR 1.24, 95% CI 1.10 - 1.40), were breastfeeding (OR 5.0, 95% CI 2.34 -10.65); or were at early postpartum and breastfeeding (OR 0.42, 95% CI 0.22 - 0.81) were more likely to enroll than their counterparts. Compared to African American women, Non-Hispanic White women were more likely to enroll (OR 1.77, 95% CI 1.29 - 2.42). Also, women who were non-smokers (OR 0.54, 95% CI 0.40 - 0.73) or had a higher education were more likely to enroll (OR 1.21, 95% CI 1.04 - 1.42) than those who smoked or had a lower education.

CONCLUSION

Future lifestyle behavioral intervention studies for similar target audiences may consider tailoring their recruitment messages based on relevant participant demographic characteristics identified as potential determinants of enrollment in this study.

Body mass index and all-cause mortality among older adults

OBJECTIVE

To examine the association between baseline body mass index (BMI, kg/m(2) ) and all-cause mortality in a well-characterized cohort of older persons.

METHODS

The association between BMI (both as a categorical and continuous variable) and all-cause mortality was investigated using 4,565 Geisinger Rural Aging Study participants with baseline age 74.0 ± 4.7 years (mean ± SD) and BMI 29.5 ± 5.3 kg/m(2) over a mean of 10.9 ± 3.8 years of follow-up.

RESULTS

The relationship between BMI (as a continuous variable) and all-cause mortality was found to be U-shaped (P nonlinearity <0.001). Controlling for age, sex, smoking, alcohol, laboratory values, medications, and comorbidity status, underweight (BMI <18.5 kg/m(2) ) individuals had significantly greater adjusted risk of all-cause mortality than persons of BMI 18.5 to 24.9 kg/m(2) (reference range). Participants with overweight (BMI 25.0-29.9 kg/m(2) ) and class I obesity (BMI 30.0-34.9 kg/m(2) ) had significantly lower adjusted-risk of all-cause mortality. Those with classes II/III obesity (BMI ≥ 35.0 kg/m(2) ) did not have significantly greater adjusted-risk of all-cause mortality. Findings were consistent using propensity score weights and among never-smokers with 2- and 5-year lag analysis and among those with no identified chronic disease.

CONCLUSIONS

A U-shaped association was observed between BMI and all-cause mortality with lower risk among older persons with overweight and class I obesity in comparison with those with BMI 18.5 to 24.9 kg/m(2) .

Overweight and Obesity in Young Adulthood and the Risk of Stroke: a Meta-analysis

BACKGROUND

A systematic review assessing the association between overweight and obesity in young adulthood and stroke risk is lacking. Therefore, we conducted a meta-analysis to evaluate the association between overweight and obesity in young adulthood and stroke risk.

METHODS

We systematically searched PubMed and Embase databases for related studies of human subjects in the English language. Two investigators independently selected original studies in a 2-step process. Fixed- and random-effects models were used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs). Subgroup analyses were also performed.

RESULTS

Eight studies met the inclusion criteria. The pooled adjusted RR of stroke was 1.36 (95% CI: 1.28-1.44) for overweight in young adulthood and 1.81 (95% CI: 1.45-2.25) for obesity in young adulthood. In subgroup analyses, overweight and obesity in young adulthood increased the risk of stroke in most groups, except for the group of stroke subtype. For ischemic stroke, the adjusted RR was 1.40 (95% CI: 1.24-1.58) for overweight in young adulthood and 1.78 (95% CI: 1.003-3.16) for obesity in young adulthood, whereas adjusted RR for hemorrhagic stroke was 1.25 (95% CI: .83-1.90) for overweight in young adulthood and 1.80 (95% CI: .97-3.35) for obesity in young adulthood.

CONCLUSIONS

Overweight and obesity in young adulthood are associated with an increased risk of stroke, probably, independent of other cardiovascular risk factors. The risk effect gradually increases with increasing body weight.

Long-term weight change: association with impaired glucose metabolism in young Austrian adults

Little is known about the associations between long-term weight change and the natural history of impaired fasting glucose (IFG) in young adults. We investigated the association between long-term body mass index (BMI) change and the risk of IFG using data of 24,930 20- to 40-year-old participants from the Vorarlberg Health Monitoring and Promotion Program (VHM&PP) cohort. Poisson models were applied to estimate the 10-year risk for new development of IFG (≥ 5.6 mmol/L), and persistence of IFG. Over 10 years, most men (68.2%) and women (70.0%) stayed within their initial BMI category. The risk for incident IFG was highest for men and women with persisting obesity (37.4% and 24.1%) and lowest with persisting normal weight (15.7% and 9.3%). Men transitioning from normal to overweight increased their risk of incident IFG by factor 1.45 (95%-CI: 1.31, 1.62), women by 1.70 (95%-CI: 1.50, 1.93), whereas transitioning from overweight to normal weight decreased the risk in men by 0.69 (95%-CI: 0.53, 0.90) and 0.94 (95%-CI: 0.66, 1.33) in women. Relative risks for men and women transitioning from obesity to overweight were 0.58 and 0.44, respectively. In conclusion, 10 year weight increase was associated with an increased IFG risk, weight decrease with a decreased risk of IFG in young adults.

Dietary inflammation potential and postmenopausal breast cancer risk in a German case-control study

Unhealthy dietary habits can increase the risk for serious medical conditions, such as cancer, yet the association between diet and breast cancer remains unclear. We investigated whether individual diets based on their inflammatory potential are associated with postmenopausal breast cancer risk by employing an energy-adjusted dietary inflammation index. In a German population-based case-control study, 2887 postmenopausal breast cancer patients (aged 50-74 years, first diagnosed between 2002 and 2005) and 5512 healthy age-matched controls provided information on dietary habits for the year prior to diagnosis (cases) or recruitment (controls) using a 176-items food frequency questionnaire. Associations between the energy-adjusted dietary inflammation index (E-DII) score (both as continuous variable and in quintiles) and risk for breast cancer were assessed using conditional logistic regression adjusted for potential confounders. No significant associations between the E-DII score and postmenopausal breast cancer risk were observed (adjusted OR Q5 vs Q1: 1.01, 95% CI: 0.86-1.17). Associations did not differ by estrogen receptor/progesterone receptor status (ER + PR+: adjusted OR Q5 vs Q1: 1.06, 95% CI: 0.88-1.27; ER + or PR+: OR Q5 vs Q1: 1,07, 95% CI: 0.79-1.45; ER-PR-: OR Q5 vs Q1: 0.87 95% CI: 0.63-1.20). Our results regarding E-DII are consistent with previous studies reporting a lack of association between C-reactive protein, a marker of systemic inflammation, and postmenopausal breast cancer risk. The findings may reflect a real absence of association between dietary inflammatory potential and postmenopausal cancer risk or an underestimation of association due to recall bias. Further investigation is warranted in cohort studies.

Validation of PIN 3 physical activity survey in low-income overweight and obese young mothers

Background

Existing physical activity surveys have not been validated for use with low-income overweight and obese young mothers. This study aimed to validate the Pregnancy Infection and Nutrition 3 (PIN3) physical activity survey and to explore whether its validity varied by race/ethnicity and body mass index (BMI) category when including or excluding child and adult care activities in the target population.

Methods

Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and were asked to fill out the PIN3 survey and wear an Actigraph accelerometer. Validity was assessed (N = 42) using Spearman correlation coefficient.

Results

Regardless of inclusion or exclusion of child and adult care activity, the PIN3 survey showed evidence of validity for moderate (correlation coefficients 0.33 [p = 0.03]; 0.40 [p = 0.08]) but not vigorous (−0.01 [p = 0.91]; −0.06 [p = 0.69]) physical activity. The mean minutes per week spent in moderate, vigorous and moderate-vigorous physical activity measured by the PIN3 were substantially higher than when measured by accelerometer, for example, 588 (PIN3) versus 148 (accelerometer) minutes per week. Also, correlations between self-reported and objective monitored activity varied substantially by race/ethnicity and BMI category, for example, 0.29 (p = 0.18) for overweight women versus 0.57 (p = 0.007) for obese women; 0.27 (p = 0.20) for African American versus 0.66 (p = 0.001) for white.

Conclusions

The PIN3 survey may be adequate for many applications where quick and practical assessments are needed for moderate physical activity data in low-income overweight and obese young mothers. The substantial differences in mean minutes per week between the PIN3 and accelerometer may be due to over-reported physical activity by the study participants.

Trial registration

Clinical Trials Number: NCT01839708

Obesity and overweight in ethnic minorities of the Detroit metropolitan area of Michigan

Race, ethnicity and socioeconomic factors influence the prevalence of obesity and overweight, which are major public health problems. Our objectives were (1) to calculate the prevalence of self-reported obesity and overweight in whites, blacks, Chaldeans, and Arabs in the Detroit metropolitan area; and (2) to examine the odds for self-reported overweight and obesity in the racial and ethnic minorities when compared to whites. The responses to a self-administered survey conducted among the adult residents (n = 2,883) of the Detroit metropolitan area of Michigan were analyzed. Prevalence of overweight and obesity were 47.4 and 34.6 % respectively for the whole sample, while it was 39.9 and 43.6 % for whites, 42.3 and 47.8 % for blacks, 46.2 and 30.3 % for Chaldeans, and 52.2 and 28.5 % for Arabs. The odds for obesity was significantly lower in Arabs [odds ratio (OR) 0.31; 95 % confidence interval (CI) 0.13-0.72] and Chaldeans (OR 0.14; 95 % CI 0.06-0.33) when compared to whites. Chaldeans (OR 0.36; 95 % CI 0.15-0.86) had significantly decreased likelihood for being overweight compared to whites. Odds for obesity and overweight can vary in the different ethnic minorities within whites. Sharing similar living conditions decreases the differences in the odds for overweight and obesity between whites and blacks. Taking into consideration the racial and ethnic differences of the target population may help in developing better programs for fighting overweight and obesity.

Bariatric surgery: a safe and effective conduit to cardiac transplantation

BACKGROUND

Obesity and obesity-related co-morbidities, including advanced heart failure, are epidemic. Some of these patients will progress to require cardiac allografts as the only means of long-term survival. Unfortunately, without adequate weight loss, they may never be deemed acceptable transplant candidates. Often surgical weight loss may be the only effective and durable option for these complex patients. The objective of this study was to assess whether bariatric surgery is feasible and safe in patients with severe heart failure, which in turn, after adequate weight loss, would allow these patients to be listed for a heart transplant.

METHODS

Four patients who underwent bariatric procedures, such as laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (SG), for the purpose of attaining adequate weight loss with the goal to improve their eligibility for orthotopic heart transplants are presented.

RESULTS

All patients did well around the time of surgery, and 3 of the 4 progressed to receiving a heart transplant. The fourth patient will be listed pending attaining adequate weight loss.

CONCLUSION

Bariatric surgery may be an important bridge to transplantation for morbidly obese patients with severe heart failure. With the appropriate infrastructure, bariatric surgery is a feasible and effective weight loss method in this population.

Radiation, atherosclerotic risk factors, and stroke risk in survivors of pediatric cancer: a report from the Childhood Cancer Survivor Study

PURPOSE

To test the hypotheses that (1) the increased risk of stroke conferred by childhood cranial radiation therapy (CRT) persists into adulthood; and (2) atherosclerotic risk factors further increase the stroke risk in cancer survivors.

METHODS AND MATERIALS

The Childhood Cancer Survivor Study is a multi-institutional retrospective cohort study of 14,358 5-year survivors of childhood cancer and 4023 randomly selected sibling controls with longitudinal follow-up. Age-adjusted incidence rates of self-reported late-occurring (≥5 years after diagnosis) first stroke were calculated. Multivariable Cox proportional hazards models were used to identify independent stroke predictors.

RESULTS

During a mean follow-up of 23.3 years, 292 survivors reported a late-occurring stroke. The age-adjusted stroke rate per 100,000 person-years was 77 (95% confidence interval [CI] 62-96), compared with 9.3 (95% CI 4-23) for siblings. Treatment with CRT increased stroke risk in a dose-dependent manner: hazard ratio 5.9 (95% CI 3.5-9.9) for 30-49 Gy CRT and 11.0 (7.4-17.0) for 50+ Gy CRT. The cumulative stroke incidence in survivors treated with 50+ Gy CRT was 1.1% (95% CI 0.4-1.8%) at 10 years after diagnosis and 12% (95% CI 8.9-15.0%) at 30 years. Hypertension increased stroke hazard by 4-fold (95% CI 2.8-5.5) and in black survivors by 16-fold (95% CI 6.9-36.6).

CONCLUSION

Young adult pediatric cancer survivors have an increased stroke risk that is associated with CRT in a dose-dependent manner. Atherosclerotic risk factors enhanced this risk and should be treated aggressively.

Characteristics of abdominal obesity in persons with spinal cord injury

Objective

To investigate the characteristics of community-dwelling spinal cord injury (SCI) persons with obesity, including diet, socioeconomic factors, weight reduction method, and frequency of body weight and abdominal circumference measurements.

Methods

We developed a questionnaire based on 'the Fourth Korea National Health and Nutrition Examination Survey, 2009'. A total of 371 community-dwelling SCI persons were enrolled in this study. Inclusion criteria were SCI persons older than 20 years with more than 1 year elapsed since the injury. Trained investigators visited SCI persons' home to complete the questionnaire and measure abdominal obesity (AO) as defined by the waist circumference.

Results

Prevalence of AO was 29.2% in SCI persons and 27.4% in the general population (GP), showing no significant difference. Education showed correlation with AO in both SCI persons and the GP. The injury level, type of injury and income did not show any correlation with AO in SCI persons. Only 28.8% and 48.8% of SCI persons measured their waist circumference and body weight within the past year, respectively. Also, SCI persons with AO thought that their body was less obese compared to persons with AO in the GP (p<0.001). The method of weight reduction was diet modification in 53.6% of SCI persons with AO, which was higher than 37.1% of persons with AO in the GP.

Conclusion

In SCI persons, obesity perception as well as socioeconomic factors correlated with AO, but these were not relevant factors in the GP. Therefore, development of a specific and intensive weight control program for SCI persons is necessary.

Association of angiotensin-converting enzyme and angiotensin II type I receptor gene polymorphisms with extreme obesity in Polish individuals

There is strong evidence for the presence of a functional renin-angiotensin system in human adipose tissue. The aim of our study was to investigate the association of polymorphic variants of angiotensin-converting enzyme gene (ACE I/D) and angiotensin II type I receptor gene (AGTR1 A1166C) with extreme obesity and obesity-associated type 2 diabetes mellitus (T2DM) and to examine their combined effect on extremely obese patients. Overall, no significant associations were detected between ACE and AGTR1 gene polymorphisms and extreme obesity. However, extremely obese patients with T2DM showed an increased frequency of ACE II genotype compared with controls (p<0.05) and with non-diabetic extremely obese patients (p<0.01). The results suggest that II genotype of ACE was a significant contributor to extreme obesity in AA homozygotes of AGTR1 gene, regardless of the presence of T2DM. Moreover, the analysis of genetic polymorphisms demonstrated that ACE II and AGTR1 AC genotypes were most frequently observed in patients with extreme obesity and T2DM. On the basis of our results, we suggest that ACE II homozygosity may be a significant predictor of extreme obesity and T2DM and that the interaction between ACE and AGTR1 genes may be considered a predisposing factor for extreme obesity and extreme obesity-associated T2DM development.

Decrease of Obesity by Allantoin via Imidazoline I 1 -Receptor Activation in High Fat Diet-Fed Mice

The activation of the imidazoline I₁-receptor (I₁R) is known to regulate appetite. Allantoin, an active ingredient in the yam, has been reported to improve lipid metabolism in high fat diet- (HFD-)fed mice. However, the effect of allantoin on obesity remains unclear. In the present study, we investigated the effects of allantoin on HFD-induced obesity. The chronic administration of allantoin to HFD-fed mice for 8 weeks significantly decreased their body weight, and this effect was reversed by efaroxan at a dose sufficient to block I₁R. The epididymal white adipose tissue (eWAT) cell size and weight in HFD-fed mice were also decreased by allantoin via the activation of I₁R. In addition, allantoin significantly decreased the energy intake of HFD-fed mice, and this reduction was associated with a decrease in the NPY levels in the brain. However, no inhibitory effect of allantoin on energy intake was observed in db/db mice. Moreover, allantoin lowered HFD-induced hyperleptinemia, and this activity was abolished by I₁R blockade with efaroxan. Taken together, these data suggest that allantoin can ameliorate energy intake and eWAT accumulation by activating I₁R to improve HFD-induced obesity.