Age, weight and obesity

Sustained underweight in rural areas and emergence of overweight in urban Ethiopian women: a multivariate analysis of EDHS data 2000-2016

A growing body of evidence indicates the emergence of overweight/obesity in developing countries before the battle against undernutrition has been won. We conducted this study to quantify the reduction of underweight and the emergence of overweight among Ethiopian women from 2000 to 2016 and evaluate factors explaining the progress. We used the four Ethiopian Demographic and Health Surveys (2000-2016) to analyze body mass index (BMI) trends among women. Data from 43,815 non-pregnant, non-puerperal reproductive-age women was used to evaluate the linear change in BMI and changes in the percentage of overweight and underweight over time. Using multivariate decomposition analysis of change in underweight and overweight percentages, we identified sources of change in BMI in the past 16 years of the survey periods. The BMI of Ethiopian reproductive-age women increased by 0.88 kg/m2 from 2000 to 2016. The increment was pronounced in urban areas with 1.46 kg/m2. There has been a significant reduction in underweight women since 2000 (p-value < 0.001), and 87.62% of the changes were attributed to behavioral changes toward weight management. And there was a significant upswing in overweight women from 2000 to 2016 (p-value < 0.001) as well. A compositional change of factors including region, women's age, women's educational status, religion, type of place of residence, and use of contraceptives contributed to 57.51% of the observed increment in the percentage of overweight women. A relatively slow decrease in underweight and an increment in overweight have been observed. This progress can be disaggregated into persistent underweight in the rural and poorest, and swift development of overweight in the urban and richest communities. Targeted nutrition interventions for both underweight and overweight women are mandatory. Nutritional interventions in Ethiopia should focus on behavioral change to reduce hunger and malnutrition as well as to avert the emergence of overweight or obesity in the affected communities.

Rural-urban disparities in nutritional status among women in Ethiopia based on HIV serostatus: a cross-sectional study using demographic and health survey data

BACKGROUND

Ethiopia is one of the sub-Saharan African countries most affected by the human immunodeficiency virus (HIV) epidemic and also by severe undernutrition, which is particularly prevalent among women. HIV infection, reproductive biology, and their role in society increase the vulnerability of women to malnutrition. Various factors including urbanization could cause differences in the nutritional status of rural and urban residents. In this study, we aimed to assess rural-urban disparities in nutritional status among women of reproductive age based on HIV serostatus in Ethiopia.

METHOD

Data from the Ethiopian Demographic and Health Survey (EDHS) conducted in 2016 were used. Among 15,683 women included in the survey, 8822 non-pregnant women aged 15-49 years, including those who gave birth two months before the DHS survey were included in this study. Multinomial logistic regression was used to determine the relative risk ratios (RRR) for the associations between study variables.

RESULTS

Generally, the prevalence of underweight among women of reproductive age was higher in rural residents (28.9%) than in urban residents (12.3%) in Ethiopia. Being overweight was more prevalent among urban women than rural women, (35.1% vs. 4.8%). About 32% of HIV-positive women were underweight in both rural and urban areas. About 29% of HIV-positive urban women were overweight compared to 3.4% of HIV-positive rural women. Among urban residents, HIV-positive women were about 4 times more likely to be underweight than their HIV-negative counterparts, RRR 3.8 (95% CI: 1.58, 9.26). However, there was no significant difference in nutritional status between HIV-positive and HIV-negative women living in rural areas. Anemic women were more likely to be underweight while, wealthy women were less likely to be underweight in both rural and urban areas. Women aged 25-49 years were generally more likely to be overweight/obese and less likely to be underweight compared to younger women aged [Formula: see text]years.

CONCLUSION

Malnutrition was more prevalent among HIV-positive women living in urban Ethiopia. Targeted nutritional interventions for HIV-positive women of reproductive age living in urban areas could be considered. Furthermore, efforts should be made to improve the nutritional status of women of reproductive age across the country.

The association between chemical constituents of ambient fine particulate matter and obesity in adults: A large population-based cohort study

OBJECTIVES

Current evidence demonstrated that ambient fine particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) and its constituents may be obesogenic in children, but evidence from adults is lacking. Our aim was to characterize the association between PM2.5 and its constituents and obesity in adults.

METHODS

We included 68,914 participants from the China Multi-Ethnic Cohort (CMEC) baseline survey. Three-year average concentrations of PM2.5 and its constituents were evaluated by linking pollutant estimates to the geocoded residential addresses. Obesity was defined as body mass index (BMI) ≥ 28 kg/m2. Logistic regression was used to examine the relationship between PM2.5 and its constituents and obesity. We performed weighed quantile sum (WQS) regression to get the overall effect of PM2.5 and its constituents and the relative contribution of each constituent.

RESULTS

Per-SD increase in PM2.5 (odds ratio [OR] = 1.43, 95% confidence interval [CI]: 1.37-1.49), black carbon (BC) (1.42, 1.36-1.48), ammonium (1.43, 1.37-1.49), nitrate (1.44, 1.38-1.50), organic matter (OM) (1.45, 1.39-1.51), sulfate (1.42, 1.35-1.48), and soil particles (SOIL) (1.31, 1.27-1.36) were positively associated with obesity, and SS (0.60, 0.55-0.65) was negatively associated with obesity. The overall effect (OR = 1.34, 95% CI: 1.29-1.41) of the PM2.5 and its constituents was positively associated with obesity, and ammonium made the most contribution to this relationship. Participants who were older, female, never smoked, lived in urban areas, had lower income or higher levels of physical activity were more significantly adversely affected by PM2.5, BC, ammonium, nitrate, OM, sulfate and SOIL compared to other individuals.

CONCLUSION

Our study revealed that PM2.5 constituents except SS were positively associated with obesity, and ammonium played the most important role. These findings provided new evidence for public health interventions, especially the precise prevention and control of obesity.

Nutritional paradox in Ethiopian women: Multilevel multinomial analysis

BACKGROUND

Nutrition-related diseases have emerged at a faster rate in lower economic conditions before the battle against poverty and undernutrition has been won. In Ethiopia, the double burden of malnutrition seems to come sooner. The present study aims to determine the prevalence and identify the determinants of malnutrition among reproductive-age women using the 2016 Ethiopian Demographic and Health Survey dataset.

METHODS

Data from Ethiopian Demographic and Health Survey 2016 were used to identify individual and community-level associated factors of malnutrition among reproductive-age women. Nonpregnant, non-puerperal women aged 15-49 were included. Six hundred forty-two communities and 11,513 women were involved from this nationally representative data. The analysis was done using multi-level mixed-effects multinomial logistic regression to determine fixed effects of individual and community-level factors and random intercept of between characteristics.

RESULTS

Thirty-seven percent of the women had malnutrition generally. One-quarter of Ethiopian women were underweight and 11.8% were overweight/obese. Household wealth, women's age and contraceptive use were individual factors negatively associated with undernutrition. Region, place of residence and community-level wealth were cluster characteristics associated with undernutrition. On the other hand, the educational status of women, household wealth index, women's age, contraceptive use, breastfeeding, region and place of residence were the factors associated with overweight. Wealthier women had lowest of the odds for undernutrition OR = 0.84 (95% CI, 0.71, 0.98: P-value < 0.05). Middle-aged women had lower odds of being underweight, whereas reproductive-age extremities on both ends were prone to malnutrition. Modern contraceptive use had decreased the odds of being underweight OR = 0.71 (95% CI 0.63, 0.81 P-value <0.05). Women residing in rural areas had higher odds for undernutrition OR = 1.31 (95% CI 1.10, 1.56: p-value <0.001). In the same scenario, wealthier cluster had lower odds for undernutrition as rivalled with poorer clusters OR = 0.75 (95% CI 0.65, 0.87: P-value < 0.0001).

CONCLUSION

Nutritional paradox in the form of overweight/obesity and underweight exists in Ethiopian women. Underweight has a high prevalence and it is in a serious situation, whereas, the burden of overweight/obesity is rising. Both individual and community-level characteristics were significant predictors of malnutrition in Ethiopian women. Besides, the individual-level factors, interventions should also consider community-level associates in tackling malnutrition.

Metabolic Syndrome, Physical Activity, and Medication-Related Expenditures: A Longitudinal Analysis

Background: Metabolic syndrome (MetS) is a combination of risk factors for cardiovascular disease and type 2 diabetes mellitus. The prevalence of MetS worldwide is increasing. There is no study investigating the economic burden of MetS, especially in developing countries, on medication-related expenditure. The aim of this study was to investigate the association of medication-related expenditures with MetS and to explore how physical activity (PA) may influence this association. Methods: A total of 620 participants, 50 years or older, randomly selected in the city of Bauru, Brazil. Participants were followed from 2010 to 2014, and data on health care expenditure were collected annually. PA questionnaire was applied at baseline, 2 (2012), and 4 (2014) years later. Results: Mean age was 64.7 (95% confidence interval, 64.1–65.3). MetS was associated with higher medication expenditure related to diseases of the circulatory (P <.01) and endocrine (P <.01) systems. MetS explained 17.2% of medication-related expenditures, whereas PA slightly attenuated this association, explaining 1.1% of all health care costs. Conclusion: This study demonstrates that MetS has a significant burden on health care expenditures among adults, whereas PA seems to affect this phenomenon significantly, but in low magnitude.

Effects of thyroid diseases on pregnancy outcomes

The current study aimed to analyze the effects of thyroid diseases on pregnancy outcomes and investigate the effects of levothyroxine (L-T4) tablets in the treatment of hypothyroidism. The current study determined the prevalence of thyroid diseases using two diagnostic criteria, the prevalence of thyroid diseases among pregnant women recruited in 2010 and 2014 were initially determined by the 2011 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum (2011 ATA Guidelines). Subjects were categorized into six groups: Normal, hypothyroxinemia, hypothyroidism, subclinical hypothyroidism (SCH), hyperthyroidism and subclinical hyperthyroidism. L-T4 was administered in the thyroid-insufficient groups and the prevalence rates of these categories were obtained using the diagnostic criteria from the 2011 ATA Guidelines and the 2012 Chinese Guidelines for the Diagnosis and Treatment of Thyroid Disease During Pregnancy and Postpartum (2012 Chinese Guidelines). The results of the current study demonstrated that the screening of thyroid function was significantly increased in 2014 (thyroid dysfunction rate, 82.4% vs. 29.1%; P<0.001). Hypothyroxinemia, hypothyroidism, SCH, hyperthyroidism and subclinical hyperthyroidism increased the likelihood of certain adverse outcomes and complications. L-T4 decreased the odds of gestational hypertension, premature birth and low birth weight or very low birth weight in the hypothyroidism group. A statistically significant difference was identified between thyroid disease incidences as determined by the 2011 ATA Guidelines 2012 Chinese Guidelines. In conclusion, abnormal thyroid levels increased the odds of adverse pregnancy outcomes, L-T4 administration improved pregnancy outcomes and the 2012 Chinese Guidelines may provide a better reference for Chinese pregnant women with subclinical hyperthyroidism.

Effect of adiponectin level and genetic variation of its receptors on diabetic retinopathy: A case-control study

Adiponectin (APN) and its receptors have been reported to be associated with metabolic phenotypes. To better understand the effects of APN levels and its receptors on diabetic retinopathy (DR), we investigated the association of the plasma APN level and variations in APN-related genes with DR, individually and in combination.Patients with type 2 diabetes (T2D; N = 1604), above 20 years of age from the Taiwanese population participated in the study. Demographic information, blood pressure, and serological markers were recorded at enrollment. Genomic DNA was isolated and genotyped. The plasma APN levels were measured by enzyme-linked immunosorbent assay.T2D patients with DR (N = 632) had diabetes for a longer duration, and had higher HbA1c, and systolic and diastolic blood pressure compared to those without DR (N = 972) (P < .001, for all the parameters). Overall, 10 single nucleotide polymorphisms (SNPs) in ADIPOQ and CDH13 susceptibility loci were associated with DR. Gene risk score (GRS) was calculated based on 10 SNPs for each subject and the cumulative effect of genes was observed. Among the subjects with plasma APN level (N = 518), natural logarithm (LN) of APN (LN [APN]; odds ratio [OR] = 1.63, 95% confidence interval [CI] = 1.19-2.25) and GRS (OR = 1.90, 95% CI = 1.11-3.26 for middle range of GRS, and OR = 2.61, 95% CI = 1.48-4.59 for high range of GRS) were independent risk factors for DR after adjustment for other parameters.In conclusion, the plasma APN level and the genetic variations in adiponectin receptors were associated with DR.

Anti-obesity effect in high-fat-diet-induced obese C57BL/6 mice: Study of a novel extract from mulberry (Morus alba) leaves fermented with Cordyceps militaris

The therapeutic effects of mulberry (Morus alba) leaves on lipid metabolism, including lipogenesis, lipolysis and hyperlipidemia are widely known, although their fermented products are yet to be applied. To investigate the therapeutic effects of a novel extract of mulberry leaves fermented with Cordyceps militaris (EMfC) on lipid metabolism, the lipid profile of serum, lipid accumulation, lipolytic activity and lipogenesis regulation were measured in high fat diet (HFD)-induced obese C57BL/6 mice treated with EMfC for 12 weeks. Briefly, the concentrations of low-density lipoprotein, triglyceride, total cholesterol and glucose significantly decreased in the serum of the HFD+EMfC treated group when compared with the HFD+Vehicle treated group, while the levels of high-density lipoprotein increased in the HFD+EMfC group. The amount of abdominal fat and the size of adipocytes were significantly lower in the HFD+EMfC treated group when compared with the HFD+Vehicle treated group. The weight and number of lipid droplets of liver tissue exhibited a similar decrease. Furthermore, the mRNA levels of peroxisome proliferator-activated receptor-γ for adipogenesis as well as adipocyte protein 2 and Fas cell surface death receptor for lipogenesis reduced following EMfC treatment for 12 weeks. Phosphorylation of perilipin and hormone-sensitive lipase, and in the adipose triglyceride lipase expression showed a significant increase in the HFD+EMfC treated group. These results indicated that EMfC may prevent fat accumulation in the HFD-induced obese C57BL/6 mice through the inhibition of lipogenesis and by stimulating lipolysis. Thus, the results provide evidence for the potential use of EMfC as an anti-obesity complex in the treatment of obesity.

Application of the Marginal Beta-Binomial Model in Estimation the Overall Odds of Obesity Among Iranian Adults: Meta-Analysis Method

CONTEXT

To obtain accurate and reliable estimation of overall obesity odds ratio (OR) a statistical method is needed to be designed to account for heterogeneity among studies. The marginal beta-binomial model is a new method with attractive features that make it robust for meta-analysis.

OBJECTIVES

The aim of this study is the estimation of overall obesity OR among Iranian adults with particularly attention to age, sex, place of residence, and smoking status.

DATA SOURCES

We systematically reviewed all studies regarding obesity in Iranian adults in national and international journals that are published between 1990 and 2017, including PubMed, Scopus, SID, Google Scholar, Magiran, and IranMedex. The R software was used for data analysis and obtaining overall obesity OR using the marginal beta-binomial model.

RESULTS

A total of 18 studies, with a sample size of 258283, were included in our analysis. Results showed that increasing age, female sex, and residence in urban areas increases the odds of obesity. Using the age group 20 - 30 years as the reference, the overall obesity ORs for 30 - 40, 40 - 50, 50 - 60, and 60+ years were 2.13, 3.33, 3.15, and 2.33, respectively. The overall obesity OR for women was 2.35, compared with men. The estimated odds of obesity were 53% higher for urban adults. Smoking has a negative effect on obesity; the OR of obesity for smokers was 0.48 compared with non-smokers.

CONCLUSION

Consistent results in our research can be used as a basis to reinforce health programs for prevention and treatment of obesity in Iran.

Gut microbiota changes in the extreme decades of human life: a focus on centenarians

The gut microbiota (GM) is a complex, evolutionarily molded ecological system, which contributes to a variety of physiological functions. The GM is highly dynamic, being sensitive to environmental stimuli, and its composition changes over the host's entire lifespan. However, the basic question of how much these changes may be ascribed to variables such as population, diet, genetics and gender, and/or to the aging process per se is still largely unanswered. We argue that comparison among studies on centenarians-the best model of healthy aging and longevity-recruited from different geographical areas/populations (different genetics and dietary habits) can help to disentangle the contribution of aging and non-aging-related variables to GM remodeling with age. The current review focuses on the role of population, gender and host genetics as possible drivers of GM modification along the human aging process. The feedback impact of age-associated GM variation on the GM-brain axis and GM metabolomics is also discussed. We likewise address the role of GM in neurodegenerative diseases such as Parkinson's and Alzheimer's, and its possible therapeutic use, taking advantage of the fact that centenarians are characterized by an extreme (healthy) phenotype versus patients suffering from age-related pathologies. Finally, it is argued that longitudinal studies combining metagenomics sequencing and in-depth phylogenetic analysis with a comprehensive phenotypic characterization of centenarians and patients using up-to-date omics (metabolomics, transcriptomics and meta-transcriptomics) are urgently needed.

Lipolytic effect of novel extracts from mulberry (Morus alba) leaves fermented with Cordyceps militaris in the primary adipocytes derived from SD rats

Mulberry (Morus alba) leaves are known to have therapeutic effects on lipid metabolism including lipogenesis, lipolysis and hyperlipidemia. However, novel compounds with strong lipolytic ability among 27 extracts of the mulberry leaves fermented with Cordyceps militaris (EMfCs) have not yet been identified. Therefore, the cAMP concentration and cell viability were measured in the primary adipocytes of SD (Sprague Dawley) rats and 3T3-L1 cells after treatment of 27 EMfCs. Briefly, mulberry leaves powders amended with three different concentrations (0, 25 and 50%) of silkworm pupae (SWP) powder were fermented with 10% C. militaris (v/w) during three different periods (3, 4 and 6 weeks). A total of 27 extracts were obtained from the fermented mulberry leaves powders using three different solvents (dH₂O, 50% EtOH and 95% EtOH). Among the 27 EMfCs treated groups, a significant increase in the concentration of cAMP was detected in primary adipocytes treated with 10 extracts when compared with the Vehicle treated group. However, their cAMP concentration did not agree completely with the non-toxicity, although most extracts showed non-toxicity. Furthermore, the concentration of cAMP and level of free glycerol gradually increased in a dose dependent manner (100, 200 and 400 µg/mL) of 4M3-95 contained cordycepin without any significant toxicity. Overall, the results of this study provide strong evidence that 4M3-95 extract derived from EMfCs can stimulate the lipolysis of primary adipocytes at an appropriate concentration and therefore have the potential for use as lipolytic agents to treat obesity.

4-Hydroxyisoleucine from Fenugreek (Trigonella foenum-graecum): Effects on Insulin Resistance Associated with Obesity

Obesity and insulin resistance (IR) are interdependent multifactorial processes that cannot be understood separately. Obesity leads to systemic inflammation and increased levels of free fatty acids that provoke IR and lipotoxicity. At the same time, IR exacerbates adipose cell dysfunction, resulting in chronic inflammation and major lipotoxic effects on nonadipose tissues. 4-Hydroxyisoleucine (4-OHIle), a peculiar nonprotein amino acid isolated from fenugreek (Trigonella foenum-graecum) seeds, exhibits interesting effects on IR related to obesity. 4-OHIle increases glucose-induced insulin release, and the insulin response mediated by 4-OHIle depends on glucose concentration. The beneficial effects observed are related to the regulation of blood glucose, plasma triglycerides, total cholesterol, free fatty acid levels, and the improvement of liver function. The mechanism of action is related to increased Akt phosphorylation and reduced activation of Jun N-terminal kinase (JNK)1/2, extracellular signal-regulated kinase (ERK)1/2, p38 mitogen-activated protein kinase (MAPK), and nuclear factor (NF)-κB. Here, we present a review of the research regarding the insulinotropic and insulin-sensitising activity of 4-OHIle in in vitro and in vivo models.

An Analysis of Contributors to Energy Intake Among Middle Aged and Elderly Adults

Adulthood and middle age is widely recognized as the time of life when unhealthy eating habits may develop. Data from various studies have demonstrated that changes in eating habits may also occur during old age. It is essential to acknowledge that a high consumption of certain food groups such as sweetened beverages, meat and eggs may contribute to an increased energy intake. This obviously results in high body mass index (BMI) and consequently an increased risk of non-communicable diseases (NCDs) and obesity. Energy intake among middle aged and elderly individuals may be influenced by socio demographic factors (for example: age, gender, socio economic status), social factors (for example: marital status), environmental factors like access to food commodities as well as nutrition knowledge and physical activity level. The present review highlights eating habits, contribution of specific food groups to energy intake and the influence of several factors on energy intake among the middle aged and elderly population.

Significance of plasma adiponectin for diagnosis, neurological severity and functional outcome in ischemic stroke - Research for Biomarkers in Ischemic Stroke (REBIOS)

OBJECTIVE

Although adiponectin is a major adipocytokine that affects the pathogenesis of various cardiovascular diseases, its clinical significance in stroke remains controversial. We investigated the clinical significance of plasma adiponectin for the diagnosis, neurological severity and functional outcomes of patients with ischemic stroke.

METHODS

We prospectively enrolled 171 patients with ischemic stroke and 171 age- and sex-matched healthy controls. Blood samples and clinical information were obtained at day 0, 3, 7, 14 and 90 after stroke onset.

RESULTS

Average adiponectin values at day 0 did not significantly differ between the controls and the patients, but were significantly lower and higher in patients with atherothrombotic brain (ATBI) (p=0.047) and cardioembolic (CE) (p=0.008) infarction, respectively, than in the controls. Multivariate logistic regression analyses showed that the adiponectin value at day 0 could predict ATBI (odds ratio, 0.75; 95% confidence interval, 0.58 to 0.91, p=0.009, per 1-μg/mL increase). Adiponectin values at day 0 were positively associated with neurological severity as evaluated by the National Institute of Health Stroke Scale upon admission (r=0.420, p=0.003) and were higher in the groups with poor outcomes (modified Rankin Scale (mRS) ≥ 3 on day 90) than in those with good ones (mRS ≤ 2) in all stroke subtypes, with statistical significance in ATBI (p=0.015).

CONCLUSIONS

Plasma adiponectin values may help to classify stroke subtypes and predict neurological severity and functional outcome in ischemic stroke patients.

Proteomic analysis of mature adipocytes from obese patients in relation to aging

Obesity and aging are interrelated conditions that both cause changes in adipocyte metabolism and affect the distribution of fat in both subcutaneous and visceral depots. In addition, both weight gain and aging can lead to similar clinical outcomes such as insulin resistance, cardiovascular disease, type 2 diabetes mellitus, atherosclerosis and stroke. Our objective was to examine the changes in protein expression within the subcutaneous adipose tissue of obese patients, matched for BMI, in relation to age. Mature adipocytes were isolated from liposuction samples of abdominal subcutaneous adipose tissue collected from both young (26.2±4.3 (mean age±SD); n=7) and old (52.2±4.7 (mean age±SD); n=7) obese individuals. Total protein extracts were then compared by two-dimensional difference in gel electrophoresis (2D DIGE). Thirty differentially expressed protein spots (ANOVA test, p≤0.05; fold-change ≥1.8) were detected, of which, 15 were identified by MALDI-TOF mass spectrometry. These were comprised of a total of thirteen unique protein sequences. Nine proteins were more abundant in the adipocytes isolated from old vs. young individuals. These proteins included prohibitin 1, protein disulphide isomerase A3, beta actin, profilin, aldo-ketoreductase 1 C2, alpha crystallin B and the annexins A1, A5 and A6. Four other proteins were less abundant in the adipocytes from old, obese subjects and these included keratin type 2 cytoskeletal 1, keratin type 2 cytoskeletal 10 and hemoglobins A and B. The differentially abundant proteins were investigated by Ingenuity Pathway Analysis (IPA) to reveal their associations with known biological functions. This analysis identified signal transducer and activator of transcription 3 as the central molecule in the connectivity map and the apoptotic pathway as the pathway with the highest score. Differences in the abundances of several proteins were confirmed by immunoblotting: i.e., prohibitin 1, protein disulphide isomerase A3, beta actin, profilin and signal transducer and activator of transcription 3 proteins. In conclusion, proteomic analysis of subcutaneous adipose tissue reveals differences in the abundance of proteins in adipocytes isolated from young vs. old individuals. These differentially abundant proteins are involved in the regulation of apoptosis, cellular senescence and inflammatory response. All these are common pathologic events in both obesity and aging.

Obesity and diabetes as accelerators of functional decline: can lifestyle interventions maintain functional status in high risk older adults?

Obesity and diabetes are known risk factors for the development of physical disability among older adults. With the number of seniors with these conditions rising worldwide, the prevention and treatment of physical disability in these persons have become a major public health challenge. Sarcopenia, the progressive loss of muscle mass and strength, has been identified as a common pathway associated with the initial onset and progression of physical disability among older adults. A growing body of evidence suggests that metabolic dysregulation associated with obesity and diabetes accelerates the progression of sarcopenia, and subsequently functional decline in older adults. The focus of this brief review is on the contributions of obesity and diabetes in accelerating sarcopenia and functional decline among older adults. We also briefly discuss the underexplored interaction between obesity and diabetes that may further accelerate sarcopenia and place obese older adults with diabetes at particularly high risk of disability. Finally, we review findings from studies that have specifically tested the efficacy of lifestyle-based interventions in maintaining the functional status of older persons with obesity and/or diabetes.

Body composition parameters in healthy Brazilian women differ from white, black, and Hispanic American women reference range

Body composition (BC) seems to vary between populations, suggesting the need for regional reference data. The objective of this study was to determine BC in Brazilian women. Five hundred healthy non-black Brazilian women aged 20 yr or older were included. Women with fractures, chronic diseases, medications affecting bone and mineral metabolism, coronary heart disease, pregnancy, silicone prosthesis, and Asians or Indians were excluded. BC by dual-energy X-ray absorptiometry (DXA) included total lean mass, appendicular lean mass, skeletal muscle index, and total body fat (BF). Reference values were made for 10-yr age groups. Lean mass decreased with age reaching the lowest values in women aged 80 yr and older. BF showed a bimodal distribution: increased with age until 50-59 yr, with a slight subsequent decrease. BF in Brazilian women did not differ from American women, except in the age groups 75-79 and 80-84 yr, where BF was lower (p < 0.05). Fat mass index was consistently higher between African and Hispanic American women (p < 0.05). Lean mass was consistently lower in Brazilian women compared with Americans in almost all age and ethnic groups (p < 0.05). BC in Brazilian women differs from American reference data. Our findings support the notion that BC varies according to ethnicity.

Variants of the adiponectin gene and diabetic microvascular complications in patients with type 2 diabetes

OBJECTIVE

The aim of this study was to examine the association between common polymorphisms of the adiponectin gene (ADIPOQ) and microvascular complications in patients with type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS

Rs2241766 and rs1501299 of ADIPOQ were genotyped in 708 patients with T2DM. Fundus photography, nerve conducting velocity, and urine analysis were performed to check for the presence of microvascular complications including diabetic nephropathy, retinopathy and neuropathy.

RESULTS

The prevalence of diabetic nephropathy tended to be different according to rs2241766 genotype (p=0.057) and the GG genotype of rs2241766 was associated with diabetic nephropathy [urine albumin/creatinine ratio (UACR) greater than 30 mg/g] after adjusting for age, sex, body mass index, duration of diabetes, HDL-cholesterol, smoking status, and blood pressure (odds ratio=1.96; 95% confidence interval=1.01-3.82, p=0.049). Also, the G allele of rs2241766 demonstrated a trend to be associated with an increase in UACR (p=0.087). Rs2241766 genotype was not associated with diabetic retinopathy (p=0.955) and neuropathy (p=0.104) or any diabetic microvascular complications (p=0.104). There was no significant association between the rs1501299 genotype of ADIPOQ and the prevalence of diabetic retinopathy and neuropathy or any diabetic microvascular complications even after adjustment.

CONCLUSION

These data suggest that the GG genotype at rs2241766 is implicated in the pathogenesis of risk for diabetic nephropathy defined as UACR greater than 30 mg/day in patients with T2DM.

Influence of education in the prevalence of obesity in Iranian northern adults

BACKGROUND

The main aim of this study was to evaluate whether prevalence of obesity in educational levels is different and some related factors in Iranian northern adults.

MATERIALS AND METHODS

This was a cross-sectional descriptive study based on population and 2452 cases (1224 men and 1228 women) aged 15-65 years were chosen by cluster and stratify sampling. Subjects were randomly chosen from 125 clusters and each cluster included 20 cases. Interviewers recorded the data using a multidimensional questionnaire including socio-demographic indexes.

RESULTS

As a whole, the prevalence of obesity was seen in 24% of subjects (15.5% in male and 32.5% in female) and significantly was seen in 3.1% and 14.1% of uneducated people more than in 1-9 year schooling and in high school or college-educated people, respectively (P = 0.001). The risk of obesity was 2.294 (P = 0.001) in uneducated compared to high school or college-educated people, 1.668 (P = 0.001) in urban area compared to rural area, 2.619 (P = 0.001) in 40-65 year people compared to 15-40 year people, and 1.534 (P = 0.003) in good economic compared to poor economic groups. After adjusted for location area, gender, age, and economic stats, the risk of obesity was 2.044 (P = 0.001) in uneducated people compared to high school or college-educated subjects.

CONCLUSION

The obesity as a health problem in Iranian northern adults supported in this study and it was negatively associated with educational levels. Public health programs that aim to reduce obesity should primarily focus on the illiterate and low-educated people.