Is the obesity epidemic a national security issue around the globe?

Concurrent and longitudinal associations of dissatisfaction with height and weight, body mass index with sleep disturbance among adolescents in China

Sleep disturbance in adolescents is a significant global public health issue that can result in various physical and mental disorders. Height and weight dissatisfaction, as subjective perceptions of body shape, are common in adolescence and may affect individuals' sleep situations. However, the association of them is unclear. This study aimed to examine the cross-sectional and longitudinal associations among height dissatisfaction, weight dissatisfaction, body mass index (BMI), and sleep disturbance in adolescents. A total of 27,260 participants completed measures of sleep disturbance, height and weight satisfaction, and BMI. The cross-sectional and longitudinal effects of height satisfaction, weight satisfaction, and BMI as well as their changes in sleep disturbance over time were tested. Height satisfaction (ps < 0.001) and weight satisfaction (ps < 0.001) were negatively associated with concurrent sleep disturbance after adjusting for socio-demographic covariates and previous sleep disturbance. Height satisfaction (ps < 0.001) and weight satisfaction (ps < 0.001) at T1 as well as their increases (ps < 0.001) over 6 months predicted decreases in sleep disturbance over time. The cross-sectional and longitudinal associations between BMI and sleep disturbance were not significant (ps > 0.42). Moreover, height dissatisfaction (ORs = 1.06 to 1.34) and weight dissatisfaction (ORs = 1.21 to 1.36) were risk factors for concurrent and long-term sleep disturbance while adjusting socio-demographic covariates and previous sleep disturbance. Greater attention to subjective perception of height satisfaction and weight satisfaction, instead of BMI is needed.

Global health security and the health-security nexus: principles, politics and praxis

The past four decades have seen a steady rise of references to 'security' by health academics, policy-makers and practitioners, particularly in relation to threats posed by infectious disease pandemics. Yet, despite an increasingly dominant health security discourse, the many different ways in which health and security issues and actors intersect have remained largely unassessed and unpacked in current critical global health scholarship. This paper discusses the emerging and growing health-security nexus in the wake of COVID-19 and the international focus on global health security. In recognising the contested and fluid concept of health security, this paper presents two contrasting approaches to health security: neocolonial health security and universal health security. Building from this analysis, we present a novel heuristic that delineates the multiple intersections and entanglements between health and security actors and agendas to broaden our conceptualisation of global health security configurations and practices and to highlight the potential for harmful unintended consequences, the erosion of global health norms and values, and the risk of health actors being co-opted by the security sector.

Social Network, Food Patterns, Physical Activity and Associations with Overweight and Obesity in Adolescents from a School in Rural Brazil

The objective of this study was to evaluate the social network, food patterns, physical activity, and their associations with overweight/obesity in adolescents from a school in rural Brazil. Students from a rural school in Northeast Brazil (n = 90) completed questionnaires on sociodemographic characteristics, food consumption, physical activity, and a name generator. Social networks were constructed using students' social proximity ties. Principal component analysis was performed to determine food patterns, and logistic models were used to investigate variables associated with overweight/obesity. Most participants were girls (62.9%), and the proportion of overweight/obesity was 30% among adolescents. Students cited 2070 people from their networks (family, friends at school, friends outside of school, and others). Among them, the family had the highest degree of influence (61%) in the network and had the most shared meals with adolescents (47%). Adolescents' perception of their family members' body size as obese, compared to normal or underweight, was prevalent (51%). Adolescents with unhealthy food patterns were 72% more likely to be categorized as overweight/obese, and eigenvector centrality was also associated with overweight/obesity (OR = 5.88, 95% CI = 1.08-32.03). Adolescents presented a social network with strong family influence, in which a high percentage of overweight/obesity was observed. Adolescents with high eigenvector centrality were more likely to be in the overweight/obesity category. Additionally, overweight/obesity was associated with unhealthy food patterns in the family network.

Prevalence of overweight and obesity and associated factors among women of childbearing age in Brazil

OBJECTIVE

To assess the factors associated with overweight and obesity among women of childbearing age in Brazil.

DESIGN

Cross-sectional study.

SETTING

Using the National Health Survey (PNS) database, from the year 2013. The socio-economic and demographic factors analysed were age, race/skin colour, region, marital status, education level, employment and family income. Concerning health history, diagnoses of hypertension, diabetes mellitus, high cholesterol, heart attack, stroke, chronic kidney disease, menarche, parity and depression were evaluated. For lifestyle information, health status, alcoholic beverage consumption, smoking and physical activity were included. The outcomes were obesity and overweight. The association of excess weight with socio-economic and demographic factors, health history and lifestyle characteristics was investigated according to the appropriate theoretical-conceptual model for the topic.

PARTICIPANTS

The sample size was 17 109 women aged 18-49 years.

RESULTS

The prevalence of women with excess weight was 55·20 %, with 33·26 % being overweight and 21·94 % with obesity. The factors associated with excess weight were age, non-white skin colour, having a partner, family income of up to two minimum wages, menarche before the age of 12, multiparity, diabetes mellitus, depression, hypertension, high cholesterol, stroke and heart attack.

CONCLUSION

The results showed an association between excess weight and socio-demographic factors, both determinants of general and reproductive health history. Implementation of effective public health policies is necessary to prevent unfavourable outcomes related to the health of women of childbearing age with excess weight.

Interaction of Adipocyte Metabolic and Immune Functions Through TBK1

Adipocytes and adipose tissue play critical roles in the regulation of metabolic homeostasis. In obesity and obesity-associated metabolic diseases, immune cells infiltrate into adipose tissues. Interaction between adipocytes and immune cells re-shapes both metabolic and immune properties of adipose tissue and dramatically changes metabolic set points. Both the expression and activity of the non-canonical IKK family member TBK1 are induced in adipose tissues during diet-induced obesity. TBK1 plays important roles in the regulation of both metabolism and inflammation in adipose tissue and thus affects glucose and energy metabolism. Here we review the regulation and functions of TBK1 and the molecular mechanisms by which TBK1 regulates both metabolism and inflammation in adipose tissue. Finally, we discuss the potential of a TBK1/IKKε inhibitor as a new therapy for metabolic diseases.

Body mass index and waist-to-hip ratio misclassification of overweight and obesity in Chinese military personnel

BACKGROUND

The rising prevalence of obesity in military personnel has raised great concerns. Previous studies suggest that body mass index (BMI)- and waist-to-hip ratio (WHR)-based obesity classifications in US military personnel and firefighters have high false negative and subsequently cause obesity misclassification.

OBJECTIVE

To determine whether BMI and WHR could reflect the fat mass of Chinese military personnel.

METHODS

Three hundred fifty-three male Chinese military personnel and 380 age-matched male adults were recruited. Obesity classification was defined by BMI, WHR, and body fat percentage (BFP).

RESULTS

Chinese military personnel had extremely low obesity rate determined by either BFP (0.3%) or BMI (0.6%). By combining overweight and obese individuals, BMI- and WHR-determined prevalence of overweight/obesity was 22.4% and 17.0% compared to BFP-based standard (4.0%) (P < 0.05). In reference to BFP, BMI and WHR have high false-positive rate compared to the control group. Further analysis showed that Chinese military personnel consisted of high percentage of BFP^lowBMI^high and/or BFP^lowWHR^high subpopulations. Eighty-one percent of BMI^high and 78.3% of WHR^high of them were BFP low.

CONCLUSIONS

Chinese military personnel has extremely low obesity rate. BMI and WHR have high false-positive rates in reference to BFP, which cannot accurately reflect the mass of adipose tissue and leads to obesity misclassification.

Understanding and use of food labeling systems among Whites and Latinos in the United States and among Mexicans: Results from the International Food Policy Study, 2017

BACKGROUND

Obesity and chronic diseases could be prevented through improved diet. Most governments require at least one type of food labeling system on packaged foods to communicate nutrition information and promote healthy eating. This study evaluated adult consumer understanding and use of nutrition labeling systems in the US and Mexico, the most obese countries in the world.

METHODS

Adults from online consumer panels in the US (Whites n = 2959; Latinos n = 667) and in Mexico (n = 3533) were shown five food labeling systems: 1. Nutrition Facts Table (NFT) that shows nutrients of concern per serving; 2. Guideline Daily Amounts (GDA) that shows levels of nutrients of concern; 3. Multiple Traffic-Light (MTL) that color codes each GDA nutrient (green = healthy; yellow = moderately unhealthy; red = unhealthy); 4. Health Star Rating System (HSR) that rates foods on a single dimension of healthiness; 5. Warning Label (WL) with a stop sign for nutrients present in unhealthy levels. Participants rated each label on understanding ("easy"/"very easy to understand" vs "difficult"/"very difficult to understand"), and, for NFTs and GDAs, frequency of use ("sometimes"/"often" vs "never"). Mixed logistic models regressed understanding and frequency of use on indicators of labeling systems (NFT = ref), testing for interactions by ethnicity (US Latinos, US Whites, Mexicans), while controlling for sociodemographic and obesity-related factors.

RESULTS

Compared to the NFT, participants reported greater understanding of the WL (OR = 4.8; 95% CI = 4.4-5.3) and lower understanding of the HSR (OR = 0.34, 95% CI = 0.31-0.37) and the MTL (OR = 0.56, 95% CI = 0.52-0.61), with similar patterns across ethnic subgroups. Participants used GDAs less often than NFTs (OR = 0.48; 95%CI = 0.41-0.55), with the greatest difference among US Whites (OR = 0.10; 95%CI = 0.07-0.14).

CONCLUSIONS

Understanding and use of the GDA was similar to that of the NFT. Whites, Latinos, and Mexicans consistently reported the best understanding for WLs, a FOPL that highlights unhealthfulness of a product. Therefore, a FOPL summary indicator, such as WLs, may be more effective in both the US and Mexico for guiding consumers towards informed food choices.

LDL-C:HDL-C ratio and common carotid plaque in Xinjiang Uygur obese adults: a cross-sectional study

OBJECTIVE

The aim of this study was to explore the relationship between low-density lipoprotein cholesterol:high-density lipoprotein cholesterol (LDL-C:HDL-C) ratio and common carotid atherosclerotic plaque (CCAP) among obese adults of Uygur community in Xinjiang, China.

DESIGN

A hospital-based cross-sectional study.

SETTING

First Affiliated Hospital of Xinjiang Medical University.

PARTICIPANTS

A total of 1449 obese adults of Uygur population who were free of coronary artery disease were included in our study from 1 January 2014 to 31 December 2016.

METHODOLOGY

Lipid profiles, other routine laboratory parameters and intima-media thickness of the common carotid artery were measured in all participants. Multivariate logistic regression analysis was used to examine the association between LDL-C:HDL-C ratio and CCAP.

RESULTS

Four hundred and fifteen (28.64%) participants had CCAP. Participants with CCAP had significantly higher LDL-C:HDL-C ratio compared with those without CCAP (3.21 [2.50, 3.88] vs 2.33 [1.95, 2.97], p<0.001). Multivariate logistic regression analysis showed high LDL-C:HDL-C ratio as independent predictor of CCAP after adjusting for conventional cardiovascular risk factors. The top LDL-C:HDL-C ratio quartile (≥3.25) had an OR of 9.355 (95% CI 6.181 to 14.157) compared with the bottom quartile (<2.07) of LDL-C:HDL-C ratio (p<0.001) after adjustment for age, body mass index, smoking, diabetes mellitus and serum level of total cholesterol.

CONCLUSION

CCAP is highly prevalent in Uygur obese adults. A high LDL-C:HDL-C ratio is an independent predictor of CCAP. It may help identify obese individuals who are at high risk of CCAP and who may benefit from intensive LDL-lowering therapy.

Yellow Oleander Seed, or "Codo de Fraile" (Thevetia spp.): A Review of Its Potential Toxicity as a Purported Weight-Loss Supplement

The Dietary Supplements and Health Education Act (DSHEA), passed by the United States Congress in October of 1994, defines herbal products as nutritional supplements, not medications. This opened the market for diverse products made from plants, including teas, extracts, essential oils, and syrups. Mexico and the United States share an extensive border, where diverse herbal products are available to the public without a medical prescription. Research undertaken in the neighboring cities of Ciudad Juarez, Mexico, and El Paso, Texas, USA, shows the use of herbs is higher in this border area compared to the rest of the United States. A portion of the population is still under the erroneous impression that "natural" products are completely safe to use and therefore lack side effects. We review the dangers of ingesting the toxic seed of Thevetia spp. (family Apocynaceae), commonly known as "yellow oleander" or "codo de fraile," misleadingly advertised on the Internet as an effective and safe dietary supplement for weight loss. Lack of proper quality control regarding herbs generates a great variability in the quantity and quality of the products' content. Herb-drug interactions occur between some herbal products and certain prescription pharmaceuticals. Certain herbs recently introduced into the U.S. market may not have been previously tested adequately for purity, safety, and efficacy. Due to the lack of reliable clinical data regarding the safe use of various herbal products currently available, the public should be made aware regarding the possible health hazards of using certain herbs for therapeutic purposes. The potentially fatal toxicity of yellow oleander seed is confirmed by cases reported from various countries, while the purported benefits of using it for weight loss have not been evaluated by any known clinical trials. For this reason, the use of yellow oleander seed as a dietary supplement should be avoided.

Metabolomics, Nutrition, and Potential Biomarkers of Food Quality, Intake, and Health Status

Diet, dietary patterns, and other environmental factors such as exposure to toxins are playing an important role in the prevention/development of many diseases, like obesity, type 2 diabetes, and consequently on the health status of individuals. A major challenge nowadays is to identify novel biomarkers to detect as early as possible metabolic dysfunction and to predict evolution of health status in order to refine nutritional advices to specific population groups. Omics technologies such as genomics, transcriptomics, proteomics, and metabolomics coupled with statistical and bioinformatics tools have already shown great potential in this research field even if so far only few biomarkers have been validated. For the past two decades, important analytical techniques have been developed to detect as many metabolites as possible in human biofluids such as urine, blood, and saliva. In the field of food science and nutrition, many studies have been carried out for food authenticity, quality, and safety, as well as for food processing. Furthermore, metabolomic investigations have been carried out to discover new early biomarkers of metabolic dysfunction and predictive biomarkers of developing pathologies (obesity, metabolic syndrome, type-2 diabetes, etc.). Great emphasis is also placed in the development of methodologies to identify and validate biomarkers of nutrients exposure.

Discretionary Foods Have a High Contribution and Fruit, Vegetables, and Legumes Have a Low Contribution to the Total Energy Intake of the Mexican Population

BACKGROUND

Overweight and obesity prevalences in Mexico are among the highest in the world, with dietary factors being the third-leading category of risk contributing to the burden of disease. Consequently, studying the compliance of the Mexican population to food-based dietary recommendations is essential for informing nutritional policies.

OBJECTIVES

We described the energy contribution of food groups to total dietary energy intake of the Mexican population and by sociodemographic subgroups and compared these results with Mexican dietary recommendations.

METHODS

Twenty-four-hour dietary recalls for participants aged ≥5 y (n = 7983) from the 2012 Mexican National Health and Nutrition Survey were used. Foods and beverages were classified into 8 groups (the first 6 were called "basic foods" and the last 2 "discretionary foods"), as follows: 1) cereals, 2) legumes, 3) milk and dairy, 4) meat and animal products, 5) fruit and vegetables, 6) fats and oils, 7) sugar-sweetened beverages (SSBs), and 8) products high in saturated fat and/or added sugar (HSFAS). Recommendations were based on the Mexican Dietary Guidelines (MDG). Energy contributions from the food groups by age, sex, region, residence (rural or urban), and socioeconomic status (SES) were estimated.

RESULTS

The highest contribution to total energy intake came from cereals (33%) followed by HSFAS (16%), meat and animal products (14%), and SSBs (9.8%). Fruit and vegetables (5.7%) and legumes (3.8%) had the lowest contribution. Energy contribution of several food groups differed significantly between population subgroups. Overall, discretionary foods contributed more than one-quarter of total energy intake (26%) and were 13 percentage points above the maximum allowed by the recommendations, whereas the intakes of legumes and fruit and vegetables were much lower than recommended.

CONCLUSIONS

Our results show the need to generate a food environment conducive to a healthier diet in the Mexican population.

Effects of cumin on nonalcoholic steatohepatitis: A double blind, randomised, controlled trial

Background:

This study was designed to evaluate the effect of cumin on nonalcoholic steatohepatitis (NASH) in compare to placebo.

Materials and Methods:

One hundred patients with histopathological diagnosis NASH in two groups of case and control received oral cumin capsule or placebo thrice daily for 6 months. Clinical and laboratory data were body mass index (BMI), serum triglyceride, serum total cholesterol, alanine aminotransferase (ALT), aspartate aminotransferase (AST), high-density lipoprotein (HDL), low-density lipoprotein (LDL), fasting blood sugar (FBS), steatosis grade, and side-effects and were measured at baseline and after treatment period using standard clinical chemistry techniques. The grade of steatosis was assessed by liver sonography in 3 stages (mild, moderate and severe).

Results:

Of 100 eligible patients during follow-up 10/50 cases and 9/50 controls were excluded. At baseline and after treatment BMI, triglyceride, cholesterol, ALT, AST, HDL, LDL, and FBS were not statistically significant between groups (P ≥ 0.5). BMI, triglyceride, cholesterol, ALT, AST, LDL, and FBS after treatment decreased compare to baseline but were not statistically significant (P ≥ 0.5). The mean of changes in the level of BMI, triglyceride, cholesterol, ALT, LDL and FBS were not statistically significant (P ≥ 0.5). The mean of changes in AST and HDL between groups was significant (P < 0.05). The grade of steatosis before and after treatment between studied groups was not statistically significant (P ≥ 0.5). Side-effects were not statistically significant among the two groups.

Conclusion:

Findings show that there the effect of cumin in in the treatment of NASH was not significantly different in compare to placebo.

Prevalence and Secular Trends in Obesity Among Chinese Adults, 1991-2011

INTRODUCTION

The prevalence of obesity in Chinese adults increased from 1991 to 2000; however, recent changes in this trend are unclear. This study aims to estimate the current prevalence of obesity and to assess trends in obesity and BMI distribution in Chinese adults from 1991 through 2011.

METHODS

Height and weight measurements of 12,249 Chinese adults from the 2011 China Health and Nutrition Survey were analyzed (in 2013) together with China Health and Nutrition Survey data for 1991-2009. Obesity was defined as BMI≥28.0 kg/m(2) based on the Working Group on Obesity in China criteria.

RESULTS

In the 2011 survey, the age-adjusted mean BMI was 23.8 (95% CI=23.7, 23.9) for men and 23.4 (95% CI=23.2, 23.5) for women. The age-adjusted prevalence of obesity was 11.3% (95% CI=10.8%, 11.9%) overall, 11.8% (95% CI=10.8%, 12.6%) among men, and 11.0% (95% CI=10.3%, 11.8%) among women. Estimates of age-adjusted obesity prevalence among the Chinese population were significantly lower than those of the U.S. population (all p<0.05). Over the 20-year period, the prevalence of obesity increased from 2.88% to 11.8% among men (age-adjusted annual change in OR=1.08, 95% CI=1.07, 1.09, p<0.001) and from 4.55% to 11.0% among women (OR=1.05, 95% CI=1.05, 1.06, p<0.001). Similar significant findings were observed for both men and women based on WHO recommendations.

CONCLUSIONS

The prevalence of obesity among both Chinese men and women increased significantly from 1991 through 2011, particularly among men.

Trends in overweight and obesity in soldiers entering the US Army, 1989-2012

OBJECTIVE

The US Army recruits new soldiers from an increasingly obese civilian population. The change in weight status at entry into the Army between 1989 and 2012 and the demographic characteristics associated with overweight/obesity at entry were examined.

METHODS

1,741,070 unique individuals with complete sex, age, and anthropometric information contributed data to linear and logistic regressions examining time trends and associations between demographic characteristics and overweight/obesity.

RESULTS

The prevalence of overweight (body mass index 25-<30 kg/m(2)) generally increased, from 25.8% (1989) to 37.2% (2012), peaking at 37.9% (2011). The prevalence of obesity (body mass index ≥30 kg/m(2)) also increased from 5.6% (1989) to 8.0% (2012), peaking at 12.3% (2009); 2005-2009 annual prevalence exceeded 10%. The most consistent demographic characteristics predicting overweight/obesity were male sex, older age, Hispanic or Asian/Pacific Island race/ethnicity, and being married. There were no distinct geographic trends.

CONCLUSIONS

The US Army is not immune to the US obesity epidemic. Demographic characteristics associated with being overweight or obese should be considered when developing military-sponsored weight management programs for new soldiers.

Perceived health status and cardiometabolic risk among a sample of youth in Mexico

PURPOSE

To examine differences in self-reported perceived mental and physical health status, as well as known cardiometabolic risk factors in a sample of normal weight, overweight, and obese Mexican youths.

METHODS

Cross-sectional analysis of 164 youths aged 11-18 years recruited in Cuernavaca, Mexico. Participants completed a self-administered questionnaire that included measures of generic and weight-specific quality of life, perceived health, physical function, depressive symptoms, and body shape satisfaction. Height, weight, and waist circumference were measured, and body mass index (BMI) was determined. Fasting blood samples from participants yielded levels of glucose, triglycerides, and cholesterol (total, HDL, and LDL).

RESULTS

Nearly 50 % of participants were female, 21 % had a normal BMI, 39 % were overweight, and 40 % were obese. Obese youths reported significantly lower measures of perceived health status (PHS) and showed an increase in cardiometabolic risk, compared with normal weight youths. Physical functioning, generic and weight-specific QoL were inversely associated with BMI, waist circumference, and glucose. Depressive symptoms were positively correlated with BMI, waist circumference, glucose levels, and HDL cholesterol. No correlation was found between PHS and cardiometabolic risk measures after controlling for BMI.

CONCLUSIONS

In this sample of Mexican youths, obesity was associated with a significantly lower PHS and increased cardiometabolic risk.

Adenovirus 36 antibodies associated with clinical diagnosis of overweight/obesity but not BMI gain: a military cohort study

CONTEXT

Obesity is a public health priority, which also threatens national security. Adenovirus 36 (Adv36) increases adiposity in animals and Adv36 antibody status is associated with human obesity, but it is unknown whether infection predicts the development of human adiposity.

OBJECTIVE

The objective of the study was to assess infection status and subsequent weight gain.

DESIGN

The study had a retrospective cohort design.

SETTING

The study was conducted at Air Force fitness testing and clinical encounters.

PARTICIPANTS

PARTICIPANTS included Air Force male enlistees, aged 18-22 years, with a baseline body mass index (BMI) of 20-30 kg/m(2) followed up from enlistment (beginning in 1995) until 2012 or separation from the Air Force.

EXPOSURE

EXPOSURE included Adv36 infection status at the time of entry.

MAIN OUTCOME MEASURE

Follow-up BMI, the primary outcome, and diagnosis of overweight/obesity by the International Classification of Diseases, ninth revision V85.25+ and 278.0* series (secondary outcome) were recorded.

RESULTS

The last recorded follow-up BMI was similar among infected and uninfected, 26.4 and 27.2 kg/m(2), respectively (P > .05). However, infected individuals had a higher hazard of a medical provider's diagnosis of overweight/obese over time (hazard ratio 1.8, 95% confidence interval 1.0-3.1, P = .04), adjusted for baseline BMI. Additionally, infected individuals who were lean at baseline (BMI of 22.5 kg/m(2)) had a 3.9 times greater hazard of developing an overweight/obese clinical diagnosis (95% confidence interval 1.5-9.7, P = .004) compared with uninfected lean individuals after adjusting for interaction (P = .03) between infection and baseline BMI.

CONCLUSIONS

The presence of Adv36 antibodies was not associated with higher BMI at baseline or follow-up within this military population. However, being infected was associated with developing a clinical diagnosis of overweight/obesity, especially among those lean at baseline.

What is Causing the Worldwide Rise in Body Weight?

The worldwide rise in body weight has reached epidemic proportions and this has serious public health consequences. Despite the universal recognition of this problem, its causes are still debated: some attribute it to excess caloric intake; others blame a lack of physical activity (PA); some implicate specific changes to micro- and macro-nutrients. During the past century, government health agencies have developed guidance on healthy eating. These, along with advances in agriculture and food manufacturing, have largely eliminated nutrient deficiencies and helped reduce the consumption of fat. Over the past 60 years, however, technological advances and shifts in the types of occupations prominent in industrialised as well as developing countries have resulted in well-documented decreases in energy expenditure. Energy intake must be balanced with energy expenditure in order to prevent weight gain, and there is increasing evidence that this balance must be at a relatively high level of energy flux. A programme that was started in São Paulo in 1996 known as 'Agita' has sought to motivate populations to engage in small amounts of physical exercise daily to tackle growing obesity levels. This multi-agency initiative is one example of how to successfully increase exercise within a community and scale both within (e.g. all states in Brazil) and across many nations. Reducing caloric intake in whole populations is challenging especially at relatively low levels of energy expenditure, and evidence suggests that there is a critical energy flux threshold for regulating intake to achieve energy balance. Increasing PA, however, may be more achievable than reducing intake. Activity raises caloric expenditure and can offset excess intake. The implementation of programmes to achieve greater PA is therefore vital if the worldwide rise in body weight is to be halted, while we also need to implement programmes to help people eat smarter.

Effects of a beetroot juice with high neobetanin content on the early-phase insulin response in healthy volunteers

Produce rich in phytochemicals may alter postprandial glucose and insulin responses by interacting with the pathways that regulate glucose uptake and insulin secretion in humans. The aims of the present study were to assess the phytochemical constituents of red beetroot juice and to measure the postprandial glucose and insulin responses elicited by either 225 ml beetroot juice (BEET), a control beverage matched for macronutrient content (MCON) or a glucose beverage in healthy adults. Beetroot juice was a particularly rich source of betalain degradation compounds. The orange/yellow pigment neobetanin was measured in particularly high quantities (providing 1·3 g in the 225 ml). A total of sixteen healthy individuals were recruited, and consumed the test meals in a controlled single-blind cross-over design. Results revealed a significant lowering of the postprandial insulin response in the early phase (0-60 min) (P < 0·05) and a significantly lower glucose response in the 0-30 min phase (P < 0·05) in the BEET treatment compared with MCON. Betalains, polyphenols and dietary nitrate found in the beetroot juice may each contribute to the observed differences in the postprandial insulin concentration.

Lower obesity rate during residence at high altitude among a military population with frequent migration: a quasi experimental model for investigating spatial causation

We sought to evaluate whether residence at high altitude is associated with the development of obesity among those at increased risk of becoming obese. Obesity, a leading global health priority, is often refractory to care. A potentially novel intervention is hypoxia, which has demonstrated positive long-term metabolic effects in rats. Whether or not high altitude residence confers benefit in humans, however, remains unknown. Using a quasi-experimental, retrospective study design, we observed all outpatient medical encounters for overweight active component enlisted service members in the U.S. Army or Air Force from January 2006 to December 2012 who were stationed in the United States. We compared high altitude (>1.96 kilometers above sea level) duty assignment with low altitude (<0.98 kilometers). The outcome of interest was obesity related ICD-9 codes (278.00-01, V85.3x-V85.54) by Cox regression. We found service members had a lower hazard ratio (HR) of incident obesity diagnosis if stationed at high altitude as compared to low altitude (HR 0.59, 95% confidence interval [CI] 0.54–0.65; p<0.001). Using geographic distribution of obesity prevalence among civilians throughout the U.S. as a covariate (as measured by the Centers for Disease Control and Prevention and the REGARDS study) also predicted obesity onset among service members. In conclusion, high altitude residence predicts lower rates of new obesity diagnoses among overweight service members in the U.S. Army and Air Force. Future studies should assign exposure using randomization, clarify the mechanism(s) of this relationship, and assess the net balance of harms and benefits of high altitude on obesity prevention.

Diabetes in the Western Pacific Region--past, present and future

In the 2013 issue of the International Diabetes Federation (IDF) Diabetes Atlas, the prevalence of diabetes in the Western Pacific (WP) Region was reported to be 8.6% in 2013, or 138 million adults, and estimated to rise to 11.1%, or 201 million adults, in 2035. The prevalence estimates of impaired glucose tolerance in 2013 and 2035 were 6.8% and 9.0%, respectively. Over 50% of people with diabetes were undiagnosed. In 2013, 187 million deaths were attributable to diabetes, 44% of which occurred in the under the age of 60. The WP Region is home to one quarter of the world's population, and includes China with the largest number of people with diabetes as well as Pacific Islands countries with the highest prevalence rates. There is a rapid increase in diabetes prevalence in the young-to-middle aged adults, possibly driven by high rates of childhood obesity and gestational diabetes as well as rapid demographic and sociocultural transitions. Differences in genetics, ethnicity, cultures and socioeconomic development have led to complex host-environment-lifestyle interactions with marked disease heterogeneity, further influenced by access to care and treatment. Despite these challenges, the WP Region has provided notable examples to prevent and control diabetes.

Large-scale mouse knockouts and phenotypes

Standardized phenotypic analysis of mutant forms of every gene in the mouse genome will provide fundamental insights into mammalian gene function and advance human and animal health. The availability of the human and mouse genome sequences, the development of embryonic stem cell mutagenesis technology, the standardization of phenotypic analysis pipelines, and the paradigm-shifting industrialization of these processes have made this a realistic and achievable goal. The size of this enterprise will require global coordination to ensure economies of scale in both the generation and primary phenotypic analysis of the mutant strains, and to minimize unnecessary duplication of effort. To provide more depth to the functional annotation of the genome, effective mechanisms will also need to be developed to disseminate the information and resources produced to the wider community. Better models of disease, potential new drug targets with novel mechanisms of action, and completely unsuspected genotype-phenotype relationships covering broad aspects of biology will become apparent. To reach these goals, solutions to challenges in mouse production and distribution, as well as development of novel, ever more powerful phenotypic analysis modalities will be necessary. It is a challenging and exciting time to work in mouse genetics.