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Ard JD, Neeland IJ, Rothberg AE, Chilton RJ, de Luis D, Cohen SS, Johansen OE. The OPTIFAST total and partial meal replacement programme reduces cardiometabolic risk in adults with obesity: Secondary and exploratory analysis of the OPTIWIN study. Diabetes Obes Metab 2024; 26:950-960. [PMID: 38073426 DOI: 10.1111/dom.15392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 02/06/2024]
Abstract
AIM The effects of weight loss with a partial or total meal replacement programme (MRP) on atherosclerotic cardiovascular disease (ASCVD) risk factors are not fully understood, in particular in people at higher CV risk. In the 52-week randomized controlled OPTIWIN study in men and women with obesity, meal replacement programme (total for first 26 weeks, partial for the ensuing 26 weeks) with OPTIFAST (OP) resulted in significantly greater weight loss compared with a low-calorie food-based (FB) dietary plan, both as part of a comprehensive lifestyle intervention [OP (n = 135)/FB (n = 138) week 26: -12.4%/-6.0%, p < .001; week 52: -10.5%/-5.5%, p < .001]. Here, we examined effects on ASCVD risk factors and 10-year ASCVD risk. MATERIALS AND METHODS Participants with body mass index 30-55 kg/m2 and age 18-70 years, and not on anti-obesity medications, were recruited. The effects on systolic and diastolic blood pressure (SBP, DBP), lipid parameters and 10-year ASCVD risk were analysed as changes over time using linear mixed models. Subgroup analyses were conducted for changes in SBP, DBP and ASCVD risk by categories of age (<40, 40-59, ≥60 years), baseline SBP (≥130 mmHg) and sex. RESULTS Baseline characteristics were well balanced (OP/FB females 86%/79%, mean age 47/47 years, body mass index 38.4/39.2 kg/m2 , 10-year ASCVD risk <5% 87%/74%, dysglycaemia 52%/50%). At week 26, SBP/DBP were significantly reduced with OP versus FB, and a greater proportion achieved BP ≤130/80 mmHg [odds ratio 2.11 (95% confidence interval 1.10, 4.03), p = .024]. All lipid parameters as well as 10-year ASCVD risk were significantly improved with OP versus FB. A similar, but slightly attenuated pattern was observed at 52 weeks. Across subgroups, greater reductions for SBP, DBP and ASCVD risk were generally seen with OP versus FB with quantitatively higher baseline SBP and age, and in men. CONCLUSIONS In people with obesity at low ASCVD risk, OP significantly reduced cardiovascular risk factors and 10-year predicted risk for ASCVD.
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Affiliation(s)
- Jamy D Ard
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Robert J Chilton
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Daniel de Luis
- Center of Investigation of Endocrinlogy and Nutrition, University of Valladolid, Hospital clínico Universitario de Valladolid, Valladolid, Spain
| | - Sarah S Cohen
- EpidStrategies, A Division of Tox Strategies Inc., Katy, Texas, USA
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Lewis KH, Gudzune KA, Ard JD. Phentermine in the Modern Era of Obesity Pharmacotherapy: Does It Still Have a Role in Treatment? Curr Obes Rep 2024; 13:132-140. [PMID: 38172485 DOI: 10.1007/s13679-023-00546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review provides an overview of the history, mechanism of action, and expected treatment effects of the anti-obesity medication (AOM), phentermine. It also includes a summary of recent research and practical guidance for prescribing clinicians. RECENT FINDINGS Recent research on phentermine is sparse and consists primarily of observational studies with methodologic limitations. These studies suggest that phentermine use is associated with clinically significant weight loss in adults and that the medication is generally well tolerated. Large-scale observational studies evaluating phentermine's safety have not identified an increased risk of cardiovascular events or elevations in blood pressure. There is no data to support the notion that phentermine is addictive. Although it remains the most commonly prescribed AOM in the USA, phentermine has little rigorous research to support its efficacy and safety in long-term treatment, which creates a dilemma with guideline-recommended chronic use of AOMs. While we await forthcoming conclusive data on this front, clinicians may consider using phentermine long-term in selected patients, if such prescribing is consistent with local regulatory statutes.
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Affiliation(s)
- Kristina H Lewis
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27101, USA.
| | - Kimberly A Gudzune
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy & Management, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Jamy D Ard
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27101, USA
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Lewis KH, Moore JB, Ard JD. Game changers: do new medications make lifestyle-based treatment of obesity obsolete? Obesity (Silver Spring) 2024; 32:237-239. [PMID: 38044481 DOI: 10.1002/oby.23962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/10/2023] [Accepted: 11/05/2023] [Indexed: 12/05/2023]
Abstract
Historically, obesity was viewed as a lifestyle disease, with an associated lifestyle solution, and approaches that embody the "eat less, move more" idea have dominated obesity treatment recommendations for over half a century. Meanwhile, the prevalence and severity of obesity continue to increase globally. Enter the so-called "game changers": glucagon-like peptide-1 receptor agonists. In the media frenzy around these and other new antiobesity medications in the pipeline, lifestyle-based treatment researchers and practitioners may find themselves wondering whether behavioral approaches to obesity will become obsolete in this new therapeutic era. In this Perspective, the authors contend that medical approaches impact physiologic pathways to support the success of behavioral approaches. Similarly, behavioral approaches can improve weight loss-adjacent outcomes that are not addressed by medication. Thus, the two approaches are complementary and must coexist if we are to make a significant, population-level impact on the obesity epidemic.
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Affiliation(s)
- Kristina H Lewis
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Justin B Moore
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jamy D Ard
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Stapleton JR, Ard JD, Beavers DP, Cogdill LS, Fernandez AZ, Howard MJ, Justice JN, Lynch SD, Newman JJ, Weaver AA, Beavers KM. Strategies to reduce the onset of sleeve gastrectomy associated bone loss (STRONG BONES): Trial design and methods. Contemp Clin Trials Commun 2023; 34:101181. [PMID: 37456507 PMCID: PMC10344650 DOI: 10.1016/j.conctc.2023.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/05/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023] Open
Abstract
Background Despite recognized improvements in obesity-related comorbidities, mounting evidence implicates surgical weight loss in the onset of skeletal fragility. Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure and is associated with 3-7% axial bone loss in the year following surgery. Bisphosphonates are FDA-approved medications for the prevention and treatment of age-related bone loss and may represent a strategy to reduce bone loss following SG surgery. Methods The Strategies to Reduce the Onset of Sleeve Gastrectomy Associated Bone Loss (STRONG BONES) trial (NCT04922333) is designed to definitively test whether monthly administration of the bisphosphonate, risedronate, for six months can effectively counter SG-associated bone loss. Approximately 120 middle-aged and older (≥40 years) SG patients will be randomized to six months of risedronate or placebo treatment, with skeletal outcomes assessed at baseline, six, and 12-months post-surgery. The primary outcome of the trial is 12-month change in total hip areal bone mineral density (aBMD), measured by dual energy x-ray absorptiometry (DXA). This will be complemented by DXA-acquired aBMD assessment at other skeletal sites and quantitative computed tomography (QCT) derived changes in bone quality. Change in muscle mass and function will also be assessed, as well as biomarkers of bone health, turnover, and crosstalk, providing mechanistic insight into intervention-related changes to the bone-muscle unit. Discussion Results from the STRONG BONES trial have the potential to influence current clinical practice by determining the ability of bisphosphonate use to mitigate bone loss and concomitant fracture risk in middle-aged and older SG patients.
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Affiliation(s)
- Joshua R. Stapleton
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jamy D. Ard
- Weight Management Center, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Daniel P. Beavers
- Department of Statistical Sciences, Wake Forest University, Winston-Salem, NC, USA
| | - Lori S. Cogdill
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Adolfo Z. Fernandez
- Weight Management Center, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Marjorie J. Howard
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jamie N. Justice
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - S. Delanie Lynch
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jovita J. Newman
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Ashley A. Weaver
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
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Jayaprakash MS, Beavers DP, Miller GD, McNatt S, Fernandez A, Edwards-Hampton SA, Ard JD. Impact on Cardiovascular Health of Using Phentermine/Topiramate in Combination With Laparoscopic Sleeve Gastrectomy in Super Obesity. J Surg Res 2023; 286:41-48. [PMID: 36753948 DOI: 10.1016/j.jss.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/06/2022] [Accepted: 12/24/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Management of patients with BMI≥50 kg/m2 is challenging. In previous work, pre and postoperative pharmacotherapy with phentermine/topiramate plus laparoscopic sleeve gastrectomy (PT + SG) promoted greater weight loss than sleeve gastrectomy (SG) alone at 24 mo postoperatively. This current secondary analysis studied the impact of PT + SG on blood pressure (BP), heart rate, and antihypertensive usage. METHODS Patients with BMI≥50 kg/m2 planning to have SG (n = 13) were recruited from 2014 to 2016, at an academic medical center in Winston-Salem, North Carolina, for this open-label trial. Participants took phentermine/topiramate (PT; 7.5/46-15/92 mg/d) for ≥3 mo preoperatively and 24 mo postoperatively. The control group (n = 40) underwent SG during the same time frame. We used mixed models for BP and heart rate to compare PT + SG versus SG alone over time, adjusted for age, sex, and initial BP. RESULTS By 24 mo postoperatively the model adjusted changes in systolic blood pressure/diastolic blood pressure (SBP/DBP) (mm Hg) were -24.44 (-34.46,-14.43)/-28.60 (-40.74,-16.46) in the PT + SG group versus -11.81 (-17.58,-6.05)/-13.89 (-21.32,-6.46) in the control group (SBP P = 0.02; DBP P = 0.03). At baseline 8 (61.5%) participants in the PT + SG arm and 22 (55.0%) in the control group used antihypertensives. Excluding patients lost to follow-up (n = 3), by 24 mo postoperatively, none of the PT + SG participants were on antihypertensives compared to 14 (41.2%) in the control group (P = 0.01). CONCLUSIONS Patients with BMI≥50 kg/m2 treated with PT + SG had greater improvement in BP with no use of antihypertensive medication at 24 mo postoperatively versus SG alone, where 41% continued medication use. Larger trials are required to evaluate this.
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Affiliation(s)
| | - Daniel P Beavers
- Department of Statistical Sciences, Wake Forest University, Winston Salem, North Carolina
| | - Gary D Miller
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, North Carolina
| | - Stephen McNatt
- Department of General Surgery, Atrium Health Wake Forest Baptist, Weight Management Center, Winston Salem, North Carolina
| | - Adolfo Fernandez
- Department of General Surgery, Atrium Health Wake Forest Baptist, Weight Management Center, Winston Salem, North Carolina
| | - Shenelle A Edwards-Hampton
- Department of General Surgery, Atrium Health Wake Forest Baptist, Weight Management Center, Winston Salem, North Carolina.
| | - Jamy D Ard
- Department of General Surgery, Atrium Health Wake Forest Baptist, Weight Management Center, Winston Salem, North Carolina; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Lofton H, Ard JD, Hunt RR, Knight MG. Obesity among African American people in the United States: A review. Obesity (Silver Spring) 2023; 31:306-315. [PMID: 36695059 PMCID: PMC10107750 DOI: 10.1002/oby.23640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 01/26/2023]
Abstract
Obesity is a growing public health crisis in the United States and is associated with a substantial disease burden due to an increased risk for multiple complications, including cardiovascular and metabolic diseases. As highlighted in this review, obesity disproportionately affects the African American population, women in particular, regardless of socioeconomic status. Structural racism remains a major contributor to health disparities between African American people and the general population, and it limits access to healthy foods, safe spaces to exercise, adequate health insurance, and medication, all of which impact obesity prevalence and outcomes. Conscious and unconscious interpersonal racism also impacts obesity care and outcomes in African American people and may adversely affect interactions between health care practitioners and patients. To reduce health disparities, structural racism and racial bias must be addressed. Culturally relevant interventions for obesity management have been successfully implemented that have shown benefits in weight management and risk-factor reduction. Strategies to improve health care practitioner-patient engagement should also be implemented to improve health outcomes in African American people with obesity. When managing obesity in African American people, it is critical to take a holistic approach and to consider an individual's social and cultural context in order to implement a successful treatment strategy.
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Affiliation(s)
- Holly Lofton
- NYU Grossman School of Medicine, New York, New York, USA
| | - Jamy D Ard
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rameck R Hunt
- Penn Medicine Princeton Health, Plainsboro Township, New Jersey, USA
- Rutgers RWJ Medical School, New Brunswick, New Jersey, USA
| | - Michael G Knight
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Flores LE, Beavers KM, Beavers DP, Greene KA, Madrid DA, Miller RM, Ard JD, Bilek LD, Weaver AA. Risedronate use may blunt appendicular lean mass loss secondary to sleeve gastrectomy: Results from a pilot randomized controlled trial. JCSM Rapid Commun 2023; 6:18-25. [PMID: 37273449 PMCID: PMC10236921 DOI: 10.1002/rco2.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/22/2022] [Indexed: 06/06/2023]
Abstract
Background Despite robust weight loss and cardiometabolic benefit, lean mass loss following sleeve gastrectomy (SG) confers health risk. Bisphosphonates are a potential therapeutic agent for lean mass maintenance. Thus, our objective was to explore the effect of six months of risedronate (vs placebo) on change in dual energy x-ray absorptiometry (DXA) and computed tomography (CT) derived lean mass metrics in the year following SG. Methods 24 SG patients were randomized to six months of 150 mg oral risedronate or placebo capsules (NCT03411902). Body composition was assessed at baseline and six months with optional 12-month follow-up using whole-body DXA and CT at the lumbar spine and mid-thigh. Group treatment effects and 95% CIs were generated from a mixed model using contrast statements at six and 12 months, adjusted for baseline values. Results Of 24 participants enrolled [55.7±6.7 years (mean±SD), 79% Caucasian, 83% women, body mass index (BMI) 44.7±6.3kg/m2], 21 returned for six-month testing, and 14 returned for 12-month testing. Six-month weight loss was -16.3 kg (-20.0, -12.5) and -20.9 kg (-23.7, -18.1) in the risedronate and placebo groups, respectively (p=.057). Primary analysis at six-months revealed a non-significant sparing of appendicular lean mass in the risedronate group compared to placebo [-1.2 kg (-2.3, -0.1) vs -2.1 kg (-3.0, -1.2)]; p=.20. By 12-months, the risedronate group displayed no change in appendicular lean mass from baseline [-0.5 kg (-1.5, 0.6)]; however, the placebo group experienced significantly augmented loss [-2.9 kg (-3.6, -2.1)]. Conclusion Pilot data indicate risedronate treatment may mitigate appendicular lean mass loss following SG. Further study is warranted.
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Affiliation(s)
- Laura E. Flores
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Daniel P. Beavers
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katelyn A. Greene
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Diana A. Madrid
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ryan M. Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jamy D. Ard
- Department of Bariatric and Weight Management Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Laura D. Bilek
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ashley A. Weaver
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Senkus KE, Crowe-White KM, Locher JL, Ard JD. Relative fat mass assessment estimates changes in adiposity among female older adults with obesity after a 12-month exercise and diet intervention. Ann Med 2022; 54:1160-1166. [PMID: 35471192 PMCID: PMC9126590 DOI: 10.1080/07853890.2022.2067352] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/OBJECTIVES/INTRODUCTION It is imperative to accurately estimate whole body fat percentage (%fat) to understand the deleterious nature of excess adiposity on cardiometabolic disease risk. Cost and accessibility often preclude the use of advanced imaging methods like dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). Relative fat mass (RFM) is an emerging estimator of whole body %fat based on waist circumference, height, and biological sex. The purpose of this ancillary study was to examine the relationship between RFM and gold-standard measures of adiposity among community-dwelling older adults with obesity and to evaluate if changes in RFM reflect changes in %fat following a 12-month lifestyle intervention (clinicaltrials.gov #NCT00955903). PATIENTS/MATERIALS AND METHODS Participants (N = 163, 37.4% male, 70.3 ± 4.7 years) were randomized to the exercise only group, exercise + nutrient-dense weight maintenance group, or exercise + nutrient-dense energy restriction of 500 kcal/d group. Total and regional adiposity assessed by DXA and MRI, as well as anthropometrics, were evaluated at baseline and 12 months. RESULTS RFM was significantly positively correlated with DXA whole body %fat and DXA trunk %fat at baseline. Equivalence testing revealed that RFM was considered equivalent to DXA whole body %fat for females only. Additionally, from baseline to 12 months, a significant reduction in RFM was observed among female participants in the exercise + energy restriction group only. Changes in RFM were significantly correlated with changes in DXA whole body %fat, DXA trunk fat, and total abdominal fat tissue determined by MRI. CONCLUSION Results support the use of RFM as an estimate of whole body %fat where advanced imaging techniques are not feasible. Furthermore, results suggest that this index is sensitive to changes in fat mass over 12 months in female older adults with obesity. KEY MESSAGESRelative fat mass (RFM), an emerging estimator of whole body %fat based on waist circumference, height, and biological sex, was intentionally developed to be a simple estimate of adiposity that overcomes limitations of measures like body mass index.In the current study, results from correlations and agreement analyses support the use of RFM to estimate whole-body fat percentage in a community-dwelling older adult population with obesity when advanced methods, namely dual-energy X-ray absorptiometry, are not feasible.Significant reductions in RFM were also observed over a 12-month period that was significantly correlated with changes in whole body fat percentage; thus, supporting the sensitivity of RFM to lifestyle changes.
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Affiliation(s)
- Katelyn E. Senkus
- Department of Human Nutrition, The University of Alabama, Tuscaloosa, AL, USA
| | | | - Julie L. Locher
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Carson TL, Buro AW, Miller D, Peña A, Ard JD, Lampe JW, Yi N, Lefkowitz E, William VDP, Morrow C, Wilson L, Barnes S, Demark-Wahnefried W. Rationale and study protocol for a randomized controlled feeding study to determine the structural- and functional-level effects of diet-specific interventions on the gut microbiota of non-Hispanic black and white adults. Contemp Clin Trials 2022; 123:106968. [PMID: 36265810 PMCID: PMC10095329 DOI: 10.1016/j.cct.2022.106968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Colorectal cancer (CRC), the third leading cause of cancer-related deaths in the US, has been associated with an overrepresentation or paucity of several microbial taxa in the gut microbiota, but causality has not been established. Black men and women have among the highest CRC incidence and mortality rates of any racial/ethnic group. This study will examine the impact of the Dietary Approaches to Stop Hypertension (DASH) diet on gut microbiota and fecal metabolites associated with CRC risk. METHODS A generally healthy sample of non-Hispanic Black and white adults (n = 112) is being recruited to participate in a parallel-arm randomized controlled feeding study. Participants are randomized to receive the DASH diet or a standard American diet for a 28-day period. Fecal samples are collected weekly throughout the study to analyze changes in the gut microbiota using 16 s rRNA and selected metagenomics. Differences in bacterial alpha and beta diversity and taxa that have been associated with CRC (Bacteroides, Fusobacterium, Clostridium, Lactobacillus, Bifidobacterium, Ruminococcus, Porphyromonas, Succinivibrio) are being evaluated. Covariate measures include body mass index, comorbidities, medication history, physical activity, stress, and demographic characteristics. CONCLUSION Our findings will provide preliminary evidence for the DASH diet as an approach for cultivating a healthier gut microbiota across non-Hispanic Black and non-Hispanic White adults. These results can impact clinical, translational, and population-level approaches for modification of the gut microbiota to reduce risk of chronic diseases including CRC. TRIAL REGISTRATION This study was registered on ClinicalTrials.gov, identifier NCT04538482, on September 4, 2020 (https://clinicaltrials.gov/ct2/show/NCT04538482).
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Affiliation(s)
- Tiffany L Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America.
| | - Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Darci Miller
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Alissa Peña
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Johanna W Lampe
- Public Health Science Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Nengjun Yi
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Elliot Lefkowitz
- Center for Clinical and Translational Sciences, University of Alabama at Birmingham, Birmingham, AL, United States of America; Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Van Der Pol William
- Center for Clinical and Translational Sciences, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Casey Morrow
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Landon Wilson
- Department of Pharmacology and Toxicology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America; Targeted Metabolomics and Proteomics Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Stephen Barnes
- Department of Pharmacology and Toxicology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America; Targeted Metabolomics and Proteomics Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America
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Bragg AE, Crowe-White KM, Ellis AC, Studer M, Phillips F, Samsel S, Parton J, Locher JL, Ard JD. Changes in Cardiometabolic Risk Among Older Adults with Obesity: An Ancillary Analysis of a Randomized Controlled Trial Investigating Exercise Plus Weight Maintenance and Exercise Plus Intentional Weight Loss by Caloric Restriction. J Acad Nutr Diet 2022; 122:354-362. [PMID: 34486528 PMCID: PMC8792147 DOI: 10.1016/j.jand.2021.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 07/07/2021] [Accepted: 07/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obesity imposes risk to cardiometabolic health; however, intentional weight loss among older adults with obesity remains controversial. OBJECTIVE To explore the influence of exercise plus weight maintenance and exercise plus intentional weight loss by caloric restriction on changes in cardiometabolic risk among older adults with obesity assessed by four risk-scoring tools. DESIGN Using longitudinal data from the Calorie Restriction and Changes in Body Composition, Disease, Function, and Quality of Life in Older Adults study (CROSSROADS) (ClinicalTrials.gov identifier: NCT00955903; May 2009 to October 2014), scores were calculated using baseline and 12-month data according to criteria from the International Diabetes Federation, National Cholesterol Education Program's Adult Treatment Panel, Framingham Risk Score, and Cardiometabolic Disease Staging. PARTICIPANTS AND SETTING Participants (39% men, 23% African American, aged 70.2 ± 4.7 years) were randomized to exercise (n = 48), exercise plus nutrient-dense weight maintenance diet (n = 44), or exercise plus weight loss by moderate caloric restriction (n = 42). MAIN OUTCOME MEASURES To evaluate effects of exercise plus weight maintenance and exercise plus intentional weight loss on changes in cardiometabolic risk. STATISTICAL ANALYSES PERFORMED Generalized estimating equations were used to assess changes in risk with ethnicity, biological sex, and age as covariates. RESULTS Group-time interaction was only significant for Framingham and Cardiometabolic Disease Staging (P = 0.005 and 0.041, respectively). Upon post hoc analysis, significant within-group improvements in Framingham scores were observed for exercise plus weight maintenance (P < 0.001; r = -1.682) and exercise plus weight loss (P = 0.020; r = -0.881). In analysis of between-group differences in Framingham scores, significant decreases were observed in the exercise plus weight maintenance group (P = 0.001; r = -1.723) compared with the exercise group. For Cardiometabolic Disease Staging, the exercise plus weight loss group had significant within-group improvements (P = 0.023; r = -0.102). For between-group differences in Cardiometabolic Disease Staging, the exercise plus weight loss group showed significant risk reduction (P = 0.012; r = -0.142) compared with the exercise group. CONCLUSIONS Among risk scores evaluated, Framingham and Cardiometabolic Disease Staging showed significantly greater sensitivity to change in cardiometabolic risk. Older adults with obesity can significantly lower cardiometabolic risk through exercise plus weight maintenance or exercise plus weight loss by moderate caloric restriction.
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Affiliation(s)
- Anna E. Bragg
- The University of Alabama, Department of Human Nutrition, Russell Hall, Box 870311, Tuscaloosa, AL 35487
| | - Kristi M. Crowe-White
- Department Chair at The University of Alabama, Department of Human Nutrition, Russell Hall, Box 870311, Tuscaloosa, AL 35487
| | - Amy C. Ellis
- The University of Alabama, Department of Human Nutrition, Russell Hall, Box 870311, Tuscaloosa, AL 35487
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11
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Beavers KM, Beavers DP, Fernandez AZ, Greene KA, Swafford AA, Weaver AA, Wherry SJ, Ard JD. Risedronate use to attenuate bone loss following sleeve gastrectomy: Results from a pilot randomized controlled trial. Clin Obes 2021; 11:e12487. [PMID: 34569167 PMCID: PMC8563448 DOI: 10.1111/cob.12487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to explore the efficacy of 150 mg once monthly oral risedronate use in the prevention of sleeve gastrectomy (SG) associated bone loss. Twenty-four SG patients (56 ± 7 years, 83% female, 21% black) were randomized to risedronate or placebo for 6 months, with an optional 12-month assessment. Outcome measures included 6 (n = 21) and 12 (n = 14) month change in dual energy x-ray absorptiometry-acquired regional areal bone mineral density (aBMD). Six-month treatment effect estimates [mean (95% CI)] revealed significant between group aBMD differences at the femoral neck [risedronate: +0.013 g/cm2 (-0.021, 0.046) vs. placebo: -0.041 g/cm2 (-0.067, -0.015)] and lumbar spine [risedronate: +0.028 g/cm2 (-0.006, 0.063) vs. placebo: -0.029 g/cm2 (-0.054, -0.004)]; both p ≤ 0.02. When followed postoperatively to 12 months, differential aBMD treatment effects were observed at the total hip [risedronate: -0.035 g/cm2 (-0.061, -0.009) vs. placebo: -0.072 g/cm2 (-0.091, -0.052)] and lumbar spine [risedronate: +0.012 g/cm2 (-0.038, 0.063) vs. placebo: -0.052 g/cm2 (-0.087, -0.017)]; both p < 0.05. Preliminary treatment effect estimates signal 6 months of risedronate use may be efficacious in reducing aBMD loss at the axial skeleton post-SG, with benefit largely maintained throughout the 1-year postoperative period. Confirmatory data from an adequately powered trial are needed.
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Affiliation(s)
- Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Daniel P. Beavers
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Adolfo Z. Fernandez
- Weight Management Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katelyn A. Greene
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ashlyn A. Swafford
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Ashley A. Weaver
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sarah J. Wherry
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jamy D. Ard
- Weight Management Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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12
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Hall ME, Cohen JB, Ard JD, Egan BM, Hall JE, Lavie CJ, Ma J, Ndumele CE, Schauer PR, Shimbo D. Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association. Hypertension 2021; 78:e38-e50. [PMID: 34538096 DOI: 10.1161/hyp.0000000000000202] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hypertension is a major risk factor for cardiovascular and renal diseases in the United States and worldwide. Obesity accounts for much of the risk for primary hypertension through several mechanisms, including neurohormonal activation, inflammation, and kidney dysfunction. As the prevalence of obesity continues to increase, hypertension and associated cardiorenal diseases will also increase unless more effective strategies to prevent and treat obesity are developed. Lifestyle modification, including diet, reduced sedentariness, and increased physical activity, is usually recommended for patients with obesity; however, the long-term success of these strategies for reducing adiposity, maintaining weight loss, and reducing blood pressure has been limited. Effective pharmacotherapeutic and procedural strategies, including metabolic surgeries, are additional options to treat obesity and prevent or attenuate obesity hypertension, target organ damage, and subsequent disease. Medications can be useful for short- and long-term obesity treatment; however, prescription of these drugs is limited. Metabolic surgery is effective for producing sustained weight loss and for treating hypertension and metabolic disorders in many patients with severe obesity. Unanswered questions remain related to the mechanisms of obesity-related diseases, long-term efficacy of different treatment and prevention strategies, and timing of these interventions to prevent obesity and hypertension-mediated target organ damage. Further investigation, including randomized controlled trials, is essential to addressing these questions, and emphasis should be placed on the prevention of obesity to reduce the burden of hypertensive cardiovascular and kidney diseases and subsequent mortality.
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13
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English LK, Ard JD, Bailey RL, Bates M, Bazzano LA, Boushey CJ, Brown C, Butera G, Callahan EH, de Jesus J, Mattes RD, Mayer-Davis EJ, Novotny R, Obbagy JE, Rahavi EB, Sabate J, Snetselaar LG, Stoody EE, Van Horn LV, Venkatramanan S, Heymsfield SB. Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review. JAMA Netw Open 2021; 4:e2122277. [PMID: 34463743 PMCID: PMC8408672 DOI: 10.1001/jamanetworkopen.2021.22277] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022] Open
Abstract
Importance The 2020 Dietary Guidelines Advisory Committee conducted a systematic review of existing research on diet and health to inform the current Dietary Guidelines for Americans. The committee answered this public health question: what is the association between dietary patterns consumed and all-cause mortality (ACM)? Objective To ascertain the association between dietary patterns consumed and ACM. Evidence Review Guided by an analytical framework and predefined inclusion and exclusion criteria developed by the committee, the US Department of Agriculture's Nutrition Evidence Systematic Review (NESR) team searched PubMed, the Cochrane Central Register of Controlled Trials, and Embase and dual-screened the results to identify articles that were published between January 1, 2000, and October 4, 2019. These studies evaluated dietary patterns and ACM in participants aged 2 years and older. The NESR team extracted data from and assessed risk of bias in included studies. Committee members synthesized the evidence, developed conclusion statements, and graded the strength of the evidence supporting the conclusion statements. Findings A total of 1 randomized clinical trial and 152 observational studies were included in the review. Studies enrolled adults and older adults (aged 17-84 years at baseline) from 28 countries with high or very high Human Development Index; 53 studies originated from the US. Most studies were well designed, used rigorous methods, and had low or moderate risks of bias. Precision, directness, and generalizability were demonstrated across the body of evidence. Results across studies were highly consistent. Evidence suggested that dietary patterns in adults and older adults that involved higher consumption of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish, and lean meat or poultry (when meat was included) were associated with a decreased risk of ACM. These healthy patterns were also relatively low in red and processed meat, high-fat dairy, and refined carbohydrates or sweets. Some of these dietary patterns also included intake of alcoholic beverages in moderation. Results based on additional analyses with confounding factors generally confirmed the robustness of main findings. Conclusions and Relevance In this systematic review, consuming a nutrient-dense dietary pattern was associated with reduced risk of death from all causes.
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Affiliation(s)
- Laural K. English
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
- Panum Group, Bethesda, Maryland
| | - Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Marlana Bates
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
- Panum Group, Bethesda, Maryland
| | - Lydia A. Bazzano
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Carol J. Boushey
- Epidemiology Program, University of Hawai’i Cancer Center, Honolulu
| | | | - Gisela Butera
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
- Panum Group, Bethesda, Maryland
| | - Emily H. Callahan
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC
| | - Richard D. Mattes
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Elizabeth J. Mayer-Davis
- Departments of Nutrition and Medicine, The University of North Carolina at Chapel Hill, Chapel Hill
| | - Rachel Novotny
- Nutritional Sciences, Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai’i at Mānoa, Honolulu
| | - Julie E. Obbagy
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
| | | | - Joan Sabate
- Center for Nutrition, Healthy Lifestyles, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, California
| | | | | | - Linda V. Van Horn
- Nutrition Division, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sudha Venkatramanan
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
- Panum Group, Bethesda, Maryland
| | - Steven B. Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge
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14
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Bailey RL, Ard JD, Davis TA, Naimi TS, Schneeman BO, Stang JS, Dewey KG, Donovan SM, Novotny R, Snetselaar LG, de Jesus J, Casavale KO, Pannucci T, Stoody EE. A Proposed Framework for Identifying Nutrients and Food Components of Public Health Relevance in the Dietary Guidelines for Americans. J Nutr 2021; 151:1197-1204. [PMID: 33693925 PMCID: PMC8324230 DOI: 10.1093/jn/nxaa459] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/11/2020] [Accepted: 12/31/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Identification of nutrients of public health concern has been a hallmark of the Dietary Guidelines for Americans (DGA); however, a formal systematic process for identifying them has not been published. OBJECTIVES We aimed to propose a framework for identifying "nutrients or food components" (NFCs) of public health relevance to inform the DGA. METHODS The proposed framework consists of 1) defining terminology; 2) establishing quantitative thresholds to identify NFCs; and 3) examining national data. The proposed framework utilizes available data from 3 key data sources or "prongs": 1) dietary intakes; 2) biological endpoints; and 3) clinical health consequences such as prevalence of health conditions, directly or indirectly through validated surrogate markers. RESULTS In identifying potential NFCs of public health concern, the 2020 DGA Committee developed a decision-tree framework with suggestions for combining the 3 prongs. The identified NFCs of public health concern for Americans ≥1 y old included fiber, calcium (≥2 y old), vitamin D, and potassium for low intakes and sodium, added sugars, and saturated fats (≥2 y old) for high intakes that were associated with adverse health consequences. Iron was identified among infants ages 6-12 mo fed human milk. For reproductive-aged and pregnant females, iron (all trimesters) and folate (first trimester) were identified for low intake, based on dietary and biomarker data (iron) or the severity of the consequence (folic acid and neural tube defects). Among pregnant women, low iodine was of potential public health concern based on biomarker data. Other NFCs that were underconsumed, overconsumed, and pose special challenges were identified across the life course. CONCLUSIONS The proposed decision-tree framework was intended to streamline and add transparency to the work of this and future Dietary Guidelines Advisory Committees to identify NFCs that need to be encouraged or discouraged in order to help reduce risk of chronic disease and promote health and energy balance in the population.
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Affiliation(s)
- Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Teresa A Davis
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Tim S Naimi
- Section of General Internal Medicine, Boston University Medical Center, Boston, MA, USA
| | - Barbara O Schneeman
- (Emeritus) Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Jaime S Stang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota—Twin Cities, Minneapolis, MN, USA
| | - Kathryn G Dewey
- (Emeritus) Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Sharon M Donovan
- Department of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign, IL, USA
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaiʻi at Mānoa, Honolulu, HI, USA
| | - Linda G Snetselaar
- Department of Preventive Nutrition Education, University of Iowa, Iowa City, IA, USA
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion, NIH, US Department of Health and Human Services, Rockville, MD, USA
| | - Kellie O Casavale
- Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, FDA, US Department of Health and Human Services, College Park, MD, USA
| | - TusaRebecca Pannucci
- Center for Nutrition Policy and Promotion, Food and Nutrition Services, USDA, Alexandria, VA, USA
| | - Eve E Stoody
- Center for Nutrition Policy and Promotion, Food and Nutrition Services, USDA, Alexandria, VA, USA
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15
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Schneeman BO, Ard JD, Boushey CJ, Bailey RL, Novotny R, Snetselaar LG, de Jesus JM, Stoody EE. Perspective: Impact of the National Academy of Sciences, Engineering, and Medicine Report on the Process for the 2020 Dietary Guidelines Advisory Committee. Adv Nutr 2021; 12:1051-1057. [PMID: 33734285 PMCID: PMC8382515 DOI: 10.1093/advances/nmab023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 11/14/2022] Open
Abstract
The National Academy of Sciences, Engineering, and Medicine (NASEM) recommended steps to redesign the process of developing the Dietary Guidelines for Americans (DGA) are based on 5 guiding principles (enhance transparency; promote diversity of expertise and experience; support a deliberative process; manage biases and conflicts of interest; and adopt state-of-the-art processes and methods). Using these principles and recommendations, the USDA and HHS updated the process for developing the 2020-2025 Dietary Guidelines, including the process for appointing members and managing the work of the 2020 Dietary Guidelines Advisory Committee. Modifications included having public comment on the topics and questions to be addressed by the Federal Advisory Committee, reviewing professional and financial activities on potential appointees to the committee prior to their appointment, redesigning the website to provide status updates on the work of the committee as analytical frameworks and draft conclusions were developed, strengthening the approaches for conducting systematic reviews, and adding a public meeting for discussion of the final report before its submission to the Secretaries of the USDA and HHS. Because the DGA is reviewed and updated every 5 y, it is possible to learn from each cycle what works well and where improvements in the process can be implemented. The current article illustrates, from the perspective of the advisory committee, the impact of the NASEM report on the development of the scientific report by examining changes in the process consistent with the 5 principles.
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Affiliation(s)
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School
of Medicine, Winston Salem, NC, USA
| | | | - Regan L Bailey
- Department Human Nutrition Food and Animal Science, University
of Hawaiʻi at Mānoa, Honolulu, HI, USA
| | - Rachel Novotny
- Department of Nutrition Science, Purdue
University, West Lafayette, IN, USA
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health,
University of Iowa, Iowa City, IA, USA
| | - Janet M de Jesus
- Office of Disease Prevention and Health Promotion, US
Department of Health and Human Services, Rockville, MD,
USA
| | - Eve E Stoody
- Center for Nutrition Policy and Promotion, Food and Nutrition
Services, US Department of Agriculture, Alexandria, VA,
USA
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16
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Dainelli L, Luo DR, Cohen SS, Marczewska A, Ard JD, Coburn SL, Lewis KH, Loper J, Matarese LE, Pories WJ, Rothberg AE. Health-Related Quality of Life in Weight Loss Interventions: Results from the OPTIWIN Trial. Int J Environ Res Public Health 2021; 18:ijerph18041785. [PMID: 33673158 PMCID: PMC7917903 DOI: 10.3390/ijerph18041785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/02/2022]
Abstract
Obesity is highly prevalent and associated with several adverse outcomes including health-related quality-of-life (HRQoL), work productivity, and activity impairment. The objective of this study is to examine group differences in HRQoL and labor-related health outcomes among participants in the OPTIWIN program, which compared the effectiveness of two intensive behavioral weight loss interventions. Participants (n = 273) were randomized to OPTIFAST®(OP) or food-based (FB) dietary interventions for 52 weeks. HRQoL and labor-related health outcomes were measured at baseline, week 26, and week 52, using two questionnaires. At baseline, there were no differences between groups on the Impact of Weight on Quality-of-Life Questionnaire (IWQOL-Lite). At week 26, the OP group had statistically significant differences towards better HRQoL for Physical Function, Self-Esteem, and the total score compared with the FB group. At week 52, the OP group showed better HRQoL in the total score (p = 0.0012) and in all but one domain. Moreover, the adjusted change-from-baseline normalized total score at week 52 was −5.9 points (p = 0.0001). Finally, the mean IWQOL-Lite normalized score showed that HRQoL improves by 0.4442 units (p < 0.0001) per kg lost, and that greater weight reduction was positively associated with better HRQoL. No statistically significant group differences were found with the Work Productivity and Activity Impairment (General Health) (WPAI-GH) Questionnaire. HRQoL improves with highly intensive, well-structured weight loss interventions. Greater weight loss lead to larger improvements. The lack of negative effect on productivity and activity suggests that these interventions may be compatible with an active work lifestyle.
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Affiliation(s)
- Livia Dainelli
- Nestlé Research, Nestlé, 1000 Lausanne, Switzerland; (L.D.); (D.R.L.)
| | - Dan Roberto Luo
- Nestlé Research, Nestlé, 1000 Lausanne, Switzerland; (L.D.); (D.R.L.)
| | | | | | - Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; (J.D.A.); (K.H.L.)
| | | | - Kristina H. Lewis
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; (J.D.A.); (K.H.L.)
| | - Judy Loper
- The Central Ohio Nutrition Center, Inc., Gohanna, OH 43230, USA;
| | - Laura E. Matarese
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC 27101, USA; (L.E.M.); (W.J.P.)
| | - Walter J. Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC 27101, USA; (L.E.M.); (W.J.P.)
| | - Amy E. Rothberg
- Department of Nutritional Sciences, School of Public Health and Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Harbour, MI 48109-2029, USA
- Correspondence:
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17
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Abstract
Long-standing systemic inequalities-fueling unequal access to critical resources such as healthcare, housing, education, and employment opportunities-are largely responsible for the significant race disparities in obesity and COVID-19. Because of this legacy, public health emergencies like the COVID-19 pandemic disproportionately impact communities of color, exacerbated by high rates of pre-existing chronic diseases like obesity. Learning from this history is instructive for understanding our present situation and for crafting effective solutions that promote health equity. Critical action is needed now to meaningfully address the disproportionate impact of these major public health problems on Black and Brown populations.
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Affiliation(s)
- Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
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18
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Ard JD, Lewis KH, Cohen SS, Rothberg AE, Coburn SL, Loper J, Matarese L, Pories WJ, Periman S. Differences in treatment response to a total diet replacement intervention versus a food-based intervention: A secondary analysis of the OPTIWIN trial. Obes Sci Pract 2020; 6:605-614. [PMID: 33354339 PMCID: PMC7746973 DOI: 10.1002/osp4.444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/30/2020] [Accepted: 07/25/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE For every weight loss treatment, there are usually groups of people who lose less than expected. This study sought to determine if response rates to a total diet replacement (TDR) differed from those of a calorie-restricted, food-based (FB) diet. METHODS Data from OPTIWIN, a 12-month multicenter trial in adults with a BMI of 30-55 kg/m2, with 26-week weight-loss and weight-maintenance phases, were utilized. Participants (n = 330) were randomized to the OPTIFAST programme (OP) or to a reduced-energy FB diet. Treatment non-responders were defined as those who lost <3% of initial weight at months 6 or 12. RESULTS There were 103 (76%) responders in the OP compared with 78 (57%) in the FB group at 12 months. The odds of treatment response at 12 months among participants who were non-responders at 3 months was not significantly different between the OP and FB groups (p = 0.64). Race, type 2 diabetes status and previous weight loss attempts were significantly associated with responder status. OP responders had higher meal plan adherence and non-caloric fluid intake compared with FB responders. CONCLUSION Early treatment response is more likely and better sustained with TDR compared with an FB diet. Individual and treatment level factors appear to influence early treatment response to behavioural interventions for weight reduction.
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Affiliation(s)
- Jamy D. Ard
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Kristina H. Lewis
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | | | - Amy E. Rothberg
- Department of Internal MedicineMichigan MedicineAnn ArborMichiganUSA
| | | | - Judy Loper
- The Central Ohio Nutrition Center, Inc.GahannaOhioUSA
| | - Laura Matarese
- Department of SurgeryEast Carolina University Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Walter J. Pories
- Department of SurgeryEast Carolina University Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Seletha Periman
- Nestlé Health Science, Global Research & DevelopmentBridgewaterNew JerseyUSA
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19
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Swafford AA, Ard JD, Beavers DP, Gearren PC, Fernandez AZ, Ford SA, Greene KA, Kammire DE, Nesbit BA, Reed KK, Weaver AA, Beavers KM. Risedronate to Prevent Bone Loss After Sleeve Gastrectomy: Study Design and Feasibility Report of a Pilot Randomized Controlled Trial. JBMR Plus 2020; 4:e10407. [PMID: 33103032 PMCID: PMC7574708 DOI: 10.1002/jbm4.10407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022] Open
Abstract
Mounting evidence implicates bariatric surgery as a cause of increased skeletal fragility and fracture risk. Bisphosphonate therapy reduces osteoporotic fracture risk and may be effective in minimizing bone loss associated with bariatric surgery. The main objective of this pilot randomized controlled trial (RCT; Clinical Trial No. NCT03411902) was to determine the feasibility of recruiting, treating, and following 24 older patients who had undergone sleeve gastrectomy in a 6 month RCT examining the efficacy of 150‐mg once‐monthly risedronate (versus placebo) in the prevention of surgical weight‐loss–associated bone loss. Feasibility was defined as: (i) >30% recruitment yield, (ii) >80% retention, (iii) >80% pills taken, (iv) <20% adverse events (AEs), and (v) >80% participant satisfaction. Study recruitment occurred over 17 months. Seventy participants were referred, with 24 randomized (34% yield) to risedronate (n = 11) or placebo (n = 13). Average age was 56 ± 7 years, 83% were female (63% postmenopausal), and 21% were black. The risedronate group had a higher baseline BMI than the placebo group (48.1 ± 7.2 versus 41.9 ± 3.8 kg/m2). The 10‐year fracture risk was low (6.0% major osteoporotic fracture, 0.4% hip fracture); however, three individuals (12.5%, all risedronate group) were osteopenic at baseline. Twenty‐one participants returned for 6‐month follow‐up testing (88% retention) with all (n = 3) loss to follow‐up occurring in the risedronate group. Average number of pills taken among completers was 5.9 ± 0.4 and 6.0 ± 0.0 in the risedronate and placebo groups, respectively (p = 0.21), with active participants taking >80% of allotted pills. Five AEs (3.7% AE rate) were reported; one definitely related, four not related, and none serious. All participants reported high satisfaction with participation in the study. Use of bisphosphonates as a novel therapeutic to preserve bone density in patients who had undergone a sleeve gastrectomy appears feasible and well‐tolerated. Knowledge gained from this pilot RCT will be used to inform the design of an appropriately powered trial. Clinical Trial Registration http://clinicaltrials.gov/show/NCT03411902. Weight Loss With Risedronate for Bone Health. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Ashlyn A Swafford
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Jamy D Ard
- Weight Management Center Wake Forest Baptist Medical Center Winston-Salem NC USA
| | - Daniel P Beavers
- Department of Biostatistics and Data Science Wake Forest School of Medicine Winston-Salem NC USA
| | - Peri C Gearren
- Weight Management Center Wake Forest Baptist Medical Center Winston-Salem NC USA
| | - Adolfo Z Fernandez
- Weight Management Center Wake Forest Baptist Medical Center Winston-Salem NC USA
| | - Sherri A Ford
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Katelyn A Greene
- Department of Biomedical Engineering Wake Forest School of Medicine Winston-Salem NC USA
| | - Daniel E Kammire
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Beverly A Nesbit
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Kylie K Reed
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Ashley A Weaver
- Department of Biomedical Engineering Wake Forest School of Medicine Winston-Salem NC USA
| | - Kristen M Beavers
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
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Beavers KM, Neiberg RH, Kritchevsky SB, Nicklas BJ, Kitzman DW, Messier SP, Rejeski WJ, Ard JD, Beavers DP. Association of Sex or Race With the Effect of Weight Loss on Physical Function: A Secondary Analysis of 8 Randomized Clinical Trials. JAMA Netw Open 2020; 3:e2014631. [PMID: 32821924 PMCID: PMC7442923 DOI: 10.1001/jamanetworkopen.2020.14631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Consideration of differential treatment effects among subgroups in clinical trial research is a topic of increasing interest. This is an especially salient issue for weight loss trials. OBJECTIVE To determine whether stratification by sex and race is associated with meaningful differences in physical function response to weight loss among older adults. DESIGN, SETTING, AND PARTICIPANTS This pooled analysis used individual-level data from 8 completed randomized clinical trials of weight loss conducted at Wake Forest University or Wake Forest School of Medicine, Winston-Salem, North Carolina. Data were housed within the Wake Forest Older Americans Independence Center data repository and provided complete exposure, outcome, and covariate information. Data were collected from November 1996 to March 30, 2017, and analyzed from August 15, 2019, to June 10, 2020. EXPOSURES Treatment arms within each study were collapsed into caloric restriction (CR [n = 734]) and non-CR (n = 583) categories based on whether caloric restriction was specified in the original study protocol. MAIN OUTCOMES AND MEASURES Objectively measured 6-month change in weight, fast-paced gait speed (meters per second), and Short Physical Performance Battery (SPPB) score. RESULTS A total of 1317 adults (mean [SD] age, 67.7 [5.4] years; 920 [69.9%] female; 275 [20.9%] Black) with overweight or obesity (mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 33.9 [4.4]) were included at baseline. Six-month weight change achieved among those randomized to CR was -7.7% (95% CI, -8.3% to -7.2%), with no difference noted by sex; however, White individuals lost more weight than Black individuals assigned to CR (-9.0% [95% CI, -9.6% to -8.4%] vs -6.0% [95% CI, -6.9% to 5.2%]; P < .001), and all CR groups lost a significantly greater amount from baseline compared with non-CR groups (Black participants in CR vs non-CR groups, -5.3% [95% CI, -6.4% to -4.1%; P < .001]; White participants in CR vs non-CR groups, -7.2% [95% CI, -7.8% to -6.6%; P < .001]). Women experienced greater weight loss-associated improvement in SPPB score (CR group, 0.35 [95% CI, 0.18-0.52]; non-CR group, 0.08 [95% CI, -0.11 to 0.27]) compared with men (CR group, 0.23 [95% CI, 0.00-0.46]; non-CR group, 0.34 [95% CI, 0.09-0.58]; P = .03). Black participants experienced greater weight loss-associated improvement in gait speed (CR group, 0.08 [95% CI, 0.05-0.10] m/s; non-CR group, 0.02 [95% CI, -0.01 to 0.05] m/s) compared with White participants (CR group, 0.07 [95% CI, 0.06-0.09] m/s; non-CR group, 0.06 [95% CI, 0.04-0.08] m/s; P = .02). CONCLUSIONS AND RELEVANCE The association of weight loss on physical function in older adults appears to differ by sex and race. These findings affirm the need to consider biological variables in clinical trial design.
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Affiliation(s)
- Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Rebecca H. Neiberg
- Department of Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen B. Kritchevsky
- Sections of Gerontology and Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Barbara J. Nicklas
- Sections of Gerontology and Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dalane W. Kitzman
- Sections of Gerontology and Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen P. Messier
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel P. Beavers
- Department of Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Swafford AA, Ard JD, Gearren PC, Fernandez AZ, Ford SA, Nesbit BA, Reed KK, Beavers KM. Feasibility Of Using A Bisphosphonate In Sleeve Gastrectomy Patients For Bone Loss Prevention. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000670828.79400.b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dilley JR, Singletary CR, Ard JD, Giles S, Skelton JA, Heboyan V, Jake-Schoffman DE, Turner-McGrievy G, McGrievy M, Ip EH, Moore JB. Protocol for a randomized controlled feasibility study of a coordinated parent/child weight loss intervention: Dyad Plus. Transl J Am Coll Sports Med 2020; 5:e000136. [PMID: 33928189 PMCID: PMC8078845 DOI: 10.1249/tjx.0000000000000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The prevalence of in youth with overweight and obesity is a global health concern, necessitating clinical interventions to treat obesity effectively through lifestyle modification. Interventions in adolescents have demonstrated improvements in healthy eating and physical activity with only modest weight loss outcomes. Consequently, there is growing interest in developing strategies to enhance the effectiveness of clinical interventions in adolescents. Targeting the family system can be an effective approach, but existing studies have failed to examine the impact of co-enrolling both the adolescent and adult in individually tailored weight loss programs and coordinating the adolescent/adult weight loss efforts. PURPOSE This paper reports on the design and conceptual framework of the Dyad Plus study, which utilizes two weight loss clinics of the Wake Forest Baptist Medical Center: Brenner Families in training (Brenner FIT®; adolescents) and By Design (adults). Dyad Plus is a coordinated program designed to facilitate self-monitoring, positive communication, joint problem solving, and social support to increase physical activity, healthy eating, and weight loss relative to Brenner FIT alone. METHODS A total of 45 parent/adolescent dyads are randomized to one of three conditions (n = 15 for each): Brenner FIT only, Dyad (adolescent and parent both enroll simultaneously in the age appropriate program), and Dyad Plus (both parent and adolescent enroll simultaneously, but with a coordinated component for adolescent and caregiver). This study aims to develop and pilot the coordinated intervention, establish feasibility of the intervention, and determine costs associated with implementation. RESULTS The results of the study are expected in winter of 2021. CONCLUSION If proven feasible and acceptable, Dyad Plus will be tested for effectiveness in a large-scale implementation-effectiveness clinical trial.
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Affiliation(s)
- Joshua R. Dilley
- Department of Plastic Surgery, Wake forest School of Medicine, Winston-Salem, NC, USA
| | - Camelia R. Singletary
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jamy D. Ard
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven Giles
- Department of Communication, Wake Forest University, Winston-Salem, NC, USA
| | - Joseph A. Skelton
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Vahé Heboyan
- Department of Interdisciplinary Health Sciences, Augusta University, Augusta, GA, USA
| | | | - Gabrielle Turner-McGrievy
- Department of Health Promotion, Education & Behavior, University of South Carolina, Columbia, SC, USA
| | | | - Edward H. Ip
- Department of Biostatistics & Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Justin B. Moore
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Family & Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Ahmad MI, Mongraw-Chaffin M, Lewis KH, Chen H, Ard JD, Soliman EZ. Association of Obesity Phenotypes with Electrocardiographic Markers of Poor Outcomes in the General Population. Obesity (Silver Spring) 2019; 27:2076-2083. [PMID: 31657153 DOI: 10.1002/oby.22647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/11/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study aimed to investigate the association of metabolically healthy obesity (MHO) and other obesity phenotypes with electrocardiographic (ECG) markers to understand the pathophysiological basis of increased cardiovascular disease (CVD) risk associated with these phenotypes. METHODS A total of 3,700 participants (58.7 ± 13.6 years, 52% women) without CVD from the third National Health and Nutrition Examination Survey (NHANES III) were included. Logistic regression was used to examine the cross-sectional association between obesity phenotypes (metabolically healthy without obesity [MHNO; reference], metabolically unhealthy without obesity, MHO, and metabolically unhealthy obesity) with ECG markers (PR interval, P-wave duration, QRS duration, and QT interval). RESULTS Higher odds of prolonged PR interval, P-wave duration, and QRS duration were observed among all phenotypes compared with MHNO, with the highest in participants with obesity with or without metabolic syndrome. However, for QT interval, the trend of association with obesity phenotypes was as follows, from the strongest to the least strong: metabolically unhealthy obesity, metabolically healthy without obesity, and then MHO, compared with MHNO. CONCLUSIONS An association of obesity phenotypes with ECG abnormalities further raises doubt about the concept of MHO as a healthy state. Variations in associations with ECG markers may suggest that metabolic syndrome and obesity have a different relationship with different CVD outcomes and may explain some of the inconsistent CVD estimates for MHO.
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Affiliation(s)
- Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Morgana Mongraw-Chaffin
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kristina H Lewis
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Crowe-White KM, Ellis AC, Mehta T, Locher JL, Ard JD. Dietary Quality Assessed by the HEI-2010 and Biomarkers of Cardiometabolic Disease: An Exploratory Analysis. J Am Coll Nutr 2019; 38:640-647. [PMID: 31145045 DOI: 10.1080/07315724.2019.1580168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: This study explores relationships between cardiometabolic measures of antioxidant capacity or inflammation and diet quality assessed by the Healthy Eating Index (HEI)-2010 which measures conformity to Dietary Guidelines for Americans. This cross-sectional study was an ancillary analysis of baseline data for a randomized controlled trial with older adults at risk for cardiometabolic disease (ClinicalTrials.gov #NCT00955903). Methods: Community-dwelling older adults (n = 133, 49% male, 70.4 ± 4.8 years) with a body mass index of 30-40 kg/m2 provided a fasted blood sample for measurement of antioxidant capacity, high-sensitivity C-reactive protein, tumor necrosis factor-alpha, and interleukin-6. Dietary data were generated from the mean of three 24-hour recalls. Results: After adjustment for potential confounders, HEI-2010 composite scores were not significantly associated with decreased inflammation or greater antioxidant capacity. In analysis of the 12 components composing the HEI-2010, significant positive association was observed between total dairy and total serum antioxidant capacity (0.043; 95% CI, 0.008-0.069). Significant associations observed in inflammatory markers were between total vegetable and tumor necrosis factor-alpha (-0.078; 95% CI, -0.151 to -0.005), sodium and interleukin-6 (0.091; 95% CI, 0.023-0.158), and scores for combined calories from solid fats, alcoholic beverages, and added sugars and interleukin-6 (0.139; 95% CI, 0.027-0.252). In models adjusting for HEI-2010 composite score when significant associations were observed between component scores and biomarkers, two of six associations were strengthened by adding the composite score as a potential confounder. Conclusions: Largely null findings along with those inconsistent with scientific expectations suggest caution in extrapolating adherence to the HEI-2010 with an individual's inflammatory or antioxidant status. Results merit additional investigation with other biomarkers of chronic disease and emphasis on dietary patterns given potential synergy within food combinations.
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Affiliation(s)
- Kristi M Crowe-White
- Department of Human Nutrition, University of Alabama , Tuscaloosa , Alabama , USA
| | - Amy C Ellis
- Department of Human Nutrition, University of Alabama , Tuscaloosa , Alabama , USA
| | - Tapan Mehta
- Nutrition Obesity Research Center, University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Julie L Locher
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine , Winston-Salem , North Carolina , USA
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Tay J, Goss AM, Locher JL, Ard JD, Gower BA. Physical Function and Strength in Relation to Inflammation in Older Adults with Obesity and Increased Cardiometabolic Risk. J Nutr Health Aging 2019; 23:949-957. [PMID: 31781724 PMCID: PMC6996491 DOI: 10.1007/s12603-019-1260-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Inflammation is implicated in functional decline and the development of disability in aging. This study aimed to investigate the association of inflammation with physical function and muscle strength in older adults with obesity and increased cardiometabolic risk. DESIGN In baseline assessments from the CROSSROADS randomized controlled trial, serum interleukin-6 (IL-6), tumor necrosis factor-α (TNFα) and C-reactive protein (hs-CRP) were assayed in 163 older adults (37% males, 24% African American, BMI 34±3, age 70±5yrs) with hypertension, dyslipidemia and/or diabetes. Physical function was assessed by six-minute walk test (6MWT), chair sit-and-reach (CSR), hand-grip and knee-extension strength; specific-strength as muscle strength/mass ratio. Analyses included ANCOVA and multiple linear regression adjusted for thigh skeletal muscle (MRI), arm lean mass (DXA) and moderate-to-vigorous intensity physical activity (MVPA; accelerometry). RESULTS Higher hs-CRP (p<0.01) and IL-6 (p=0.07) were associated with lower 6MWT and CSR, respectively. A composite inflammation score combining all 3 inflammatory markers showed the strongest inverse association with 6MWT (p<0.01). MVPA moderated associations such that amongst participants who engaged in low MVPA, 6MWT distances and CSR scores were significantly lower in those with high IL-6 and TNFα (p<0.05), respectively. In participants with high MVPA, higher hs-CRP (p<0.05) and TNFα (p=0.07) were associated with poorer upper-extremity specific-strength. CONCLUSIONS Chronic inflammation was associated with poorer physical function and specific strength in older adults with obesity and increased cardiometabolic risk. This association was strongest in participants with multiple elevated inflammatory markers. Physical activity levels below current recommendations mitigated the deleterious effects of inflammation on lower body mobility, underscoring the benefits of exercise for preserving physical function with age.
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Affiliation(s)
- J Tay
- Jeannie Tay, Department of Nutrition Sciences, University of Alabama at Birmingham, 514 Webb Building, 1675 University Blvd, Birmingham, AL 35294-3360, USA.
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Ard JD, Lewis KH, Rothberg A, Auriemma A, Coburn SL, Cohen SS, Loper J, Matarese L, Pories WJ, Periman S. Effectiveness of a Total Meal Replacement Program (OPTIFAST Program) on Weight Loss: Results from the OPTIWIN Study. Obesity (Silver Spring) 2019; 27:22-29. [PMID: 30421863 PMCID: PMC6587830 DOI: 10.1002/oby.22303] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to test the effectiveness of the OPTIFAST program (OP), a total meal replacement dietary intervention, compared with a food-based (FB) dietary plan for weight loss. METHODS Participants with BMI 30 to 55 kg/m2 , age 18 to 70 years old, were randomized to OP or FB dietary and lifestyle interventions for 26 weeks, followed by a weight-maintenance phase. Outcomes were percent change in body weight (%WL) from baseline to weeks 26 and 52, associated changes in body composition (using dual energy x-ray absorptiometry), and adverse events. Primary analysis used repeated-measures multivariable linear mixed models to compare outcomes between groups in a modified intention-to-treat fashion (mITT). RESULTS A total of 273 participants (83% of randomized; 135 OP, 138 FB) made up the mITT population. Mean age was 47.1 ± 11.2 years; 82% were female and 71% non-Hispanic white. Baseline BMI was 38.8 ± 5.9 kg/m2 . At 26 weeks, OP %WL was 12.4% ± 0.6% versus 6.0% ± 0.6% in FB (P < 0.001). At 52 weeks, OP %WL was 10.5% ± 0.6% versus 5.5% ± 0.6% in FB (P < 0.001). Fat mass loss was greater for OP; lean mass loss was proportional to total weight loss. There was no difference in serious adverse event rates between groups. CONCLUSIONS Compared with an FB approach, OP was more effective with greater sustained weight loss.
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Affiliation(s)
- Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Kristina H. Lewis
- Department of Epidemiology and Prevention, Wake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Amy Rothberg
- Department of Internal MedicineUniversity of Michigan Health SystemAnn ArborMichiganUSA
| | - Anthony Auriemma
- AMITA Health, Alexian Brothers Weight Loss SolutionsElk Grove VillageIllinoisUSA
| | | | | | - Judy Loper
- The Central Ohio Nutrition Center, Inc.GahannaOhioUSA
| | - Laura Matarese
- Department of SurgeryEast Carolina University Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Walter J. Pories
- Department of SurgeryEast Carolina University Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Seletha Periman
- Nestlé Health Science, U.S. Clinical OperationsBridgewaterNew JerseyUSA
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Ard JD, Gower B, Hunter G, Ritchie CS, Roth DL, Goss A, Wingo BC, Bodner EV, Brown CJ, Bryan D, Buys DR, Haas MC, Keita AD, Flagg LA, Williams CP, Locher JL. Effects of Calorie Restriction in Obese Older Adults: The CROSSROADS Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2017; 73:73-80. [PMID: 28003374 DOI: 10.1093/gerona/glw237] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/11/2016] [Indexed: 01/27/2023] Open
Abstract
Background We lack a comprehensive assessment of the risks and benefits of calorie restriction in older adults at high risk for cardiometabolic disease. Calorie restriction may reduce visceral adipose tissue (VAT) but also have negative effects on lean mass and quality of life. Methods We conducted a 52-week, randomized controlled trial involving 164 older adults with obesity taking at least one medication for hyperlipidemia, hypertension, or diabetes. Interventions included an exercise intervention alone (Exercise), or with diet modification and body weight maintenance (Maintenance), or with diet modification and energy restriction (Weight Loss). The primary outcome was change in VAT at 12 months. Secondary outcomes included cardiometabolic risk factors, functional status, and quality of life. Results A total of 148 participants had measured weight at 12 months. Despite loss of -1.6% ± 0.3% body fat and 4.1% ± 0.7% initial body weight, Weight Loss did not have statistically greater loss of VAT (-192.6 ± 185.2 cm3) or lean mass (-0.4 ± 0.3 kg) compared with Exercise (VAT = -21.9 ± 173.7 cm3; lean mass = 0.3 ± 0.3 kg). Quality of life improved in all groups with no differences between groups. No significant changes in physical function were observed. Weight Loss had significantly greater improvements in blood glucose (-8.3 ± 3.6 mg/dL, p < .05) and HDL-cholesterol (5.3 ± 1.9, p < .01) compared with Exercise. There were no group differences in the frequency of adverse events. Conclusions While moderate calorie restriction did not significantly decrease VAT in older adults at high risk for cardiometabolic disease, it did reduce total body fat and cardiometabolic risk factors without significantly more adverse events and lean mass loss.
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Affiliation(s)
- Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Barbara Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham
| | - Gary Hunter
- Department of Nutrition Sciences, University of Alabama at Birmingham.,Department of Human Studies, University of Alabama at Birmingham
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - David L Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
| | - Amy Goss
- Department of Nutrition Sciences, University of Alabama at Birmingham
| | - Brooks C Wingo
- Department of Occupational Therapy, University of Alabama at Birmingham
| | - Eric V Bodner
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
| | - Cynthia J Brown
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
| | - David Bryan
- Department of Nutrition Sciences, University of Alabama at Birmingham.,Department of Human Studies, University of Alabama at Birmingham
| | - David R Buys
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Starkville
| | - Marilyn C Haas
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
| | - Akilah Dulin Keita
- Institute for Community Health Promotion, Brown University, Providence, Rhode Island
| | - Lee Anne Flagg
- Department of Sociology, University of Alabama at Birmingham
| | - Courtney P Williams
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
| | - Julie L Locher
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
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Ard JD, Carson TL, Shikany JM, Li Y, Hardy CM, Robinson JC, Williams AG, Baskin ML. Weight loss and improved metabolic outcomes amongst rural African American women in the Deep South: six-month outcomes from a community-based randomized trial. J Intern Med 2017; 282:102-113. [PMID: 28514081 PMCID: PMC6136898 DOI: 10.1111/joim.12622] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Obesity is highly prevalent in African American women, especially those in the rural southern USA, resulting in persistent health disparities. OBJECTIVE To test the effectiveness of an evidence-based behavioural weight loss intervention delivered by community health advisors to African American women in the rural south. DESIGN AND METHODS Overweight or obese African American women (30-70 years) from eight counties in Mississippi and Alabama participated in a 24-month randomized controlled trial of an evidence-based behavioural weight loss programme augmented with community strategies to support healthy lifestyles (Weight Loss Plus, N = 154) compared to the weight loss programme alone (Weight Loss Only, N = 255). This study reports on 6-month outcomes on primary (weight change) and secondary (waist circumference, blood pressure, lipids, fasting blood glucose) outcomes, coinciding with the completion of the intensive weight loss phase. RESULTS Weight Loss Only participants lost an average of 2.2 kg (P < 0.001). Weight Loss Plus participants lost an average of 3.2 kg (P < 0.001). The proportion of the total sample that lost at least 5% of their body weight was 27.1% with no difference between treatment groups. Similarly, we observed statistically significant reductions in blood pressure, waist circumference and triglycerides in each treatment group, with no statistical differences between groups. CONCLUSION Trained lay health staff and volunteers from the rural southern USA were able to deliver a translation of a high-intensity behavioural intervention targeted to African American women, resulting in clinically meaningful weight loss and improvement in other metabolic outcomes in a significant proportion of participants.
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Affiliation(s)
- J D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - T L Carson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Y Li
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C M Hardy
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J C Robinson
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
| | - A G Williams
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M L Baskin
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Ard JD, Emery M, Cook M, Hale E, Frain A, Lewis KH, Song E. Skin in the game: Does paying for obesity treatment out of pocket lead to better outcomes compared to insurance coverage? Obesity (Silver Spring) 2017; 25:993-996. [PMID: 28544796 DOI: 10.1002/oby.21837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/07/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether insurance coverage for medical weight loss treatment was associated with different program engagement and weight loss outcomes compared to those who paid out of pocket. METHODS One-year outcomes from an academic medical weight management program were used to compare two groups: employees (n = 480) with insurance coverage ("covered") versus nonemployees (n = 463) who paid out of pocket ("self-pay"). Demographics and weight were abstracted from medical records. Socioeconomic status was estimated using neighborhood demographics. Group differences in weight were analyzed using generalized linear modeling adjusted for age, baseline BMI, sex, program type, and neighborhood socioeconomic status. RESULTS Covered patients were younger (46.5 ± 10.6 vs. 51.6 ± 12.5) with a lower BMI (38.5 ± 7.5 vs. 41.3 ± 9.9) compared to self-pay (P < 0.001). Self-pay patients resided in higher annual per capita income neighborhoods (+$4,545, P < 0.001). Program dropout was lower for covered patients (12.7% vs. 17.6%, P = 0.03). There was no significant difference in 12-month weight loss between groups in adjusted models; covered patients lost 13.4%, compared to 13.6% for self-pay. CONCLUSIONS Data from an academic medical weight management program suggest that individuals with access to insurance coverage for nonsurgical obesity treatment have lower levels of attrition and similar levels of participation and outcomes as those who pay out of pocket.
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Affiliation(s)
- Jamy D Ard
- Department of Surgery, Weight Management Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Matt Emery
- Department of Surgery, Weight Management Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Miranda Cook
- Department of Surgery, Weight Management Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Erica Hale
- Department of Surgery, Weight Management Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Annette Frain
- Department of Surgery, Weight Management Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kristina H Lewis
- Department of Surgery, Weight Management Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Eunyoung Song
- Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Yetley EA, MacFarlane AJ, Greene-Finestone LS, Garza C, Ard JD, Atkinson SA, Bier DM, Carriquiry AL, Harlan WR, Hattis D, King JC, Krewski D, O'Connor DL, Prentice RL, Rodricks JV, Wells GA. Options for basing Dietary Reference Intakes (DRIs) on chronic disease endpoints: report from a joint US-/Canadian-sponsored working group. Am J Clin Nutr 2017; 105:249S-285S. [PMID: 27927637 PMCID: PMC5183726 DOI: 10.3945/ajcn.116.139097] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Dietary Reference Intakes (DRIs) are used in Canada and the United States in planning and assessing diets of apparently healthy individuals and population groups. The approaches used to establish DRIs on the basis of classical nutrient deficiencies and/or toxicities have worked well. However, it has proved to be more challenging to base DRI values on chronic disease endpoints; deviations from the traditional framework were often required, and in some cases, DRI values were not established for intakes that affected chronic disease outcomes despite evidence that supported a relation. The increasing proportions of elderly citizens, the growing prevalence of chronic diseases, and the persistently high prevalence of overweight and obesity, which predispose to chronic disease, highlight the importance of understanding the impact of nutrition on chronic disease prevention and control. A multidisciplinary working group sponsored by the Canadian and US government DRI steering committees met from November 2014 to April 2016 to identify options for addressing key scientific challenges encountered in the use of chronic disease endpoints to establish reference values. The working group focused on 3 key questions: 1) What are the important evidentiary challenges for selecting and using chronic disease endpoints in future DRI reviews, 2) what intake-response models can future DRI committees consider when using chronic disease endpoints, and 3) what are the arguments for and against continuing to include chronic disease endpoints in future DRI reviews? This report outlines the range of options identified by the working group for answering these key questions, as well as the strengths and weaknesses of each option.
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Affiliation(s)
| | | | | | - Cutberto Garza
- Boston College, Chestnut Hill, MA
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jamy D Ard
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | | | - Dennis M Bier
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | | | | | - Dale Hattis
- The George Perkins Marsh Institute, Clark University, Worcester, MA
| | - Janet C King
- Children's Hospital Oakland Research Institute, Oakland, CA
- Department of Nutritional Sciences, University of California, Berkeley, Berkeley, CA
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ross L Prentice
- Fred Hutchinson Cancer Research Center
- School of Public Health, University of Washington, Seattle, WA
| | | | - George A Wells
- Department of Epidemiology and Community Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Abstract
Obesity is a common disorder with complex causes. The epidemic has spurred significant advances in the understanding of nutritional approaches to treating obesity. Although the primary challenge is to introduce a dietary intake that creates an energy deficit, clinicians should also consider targeted risk factor modification with manipulation of the nutrient profile of the weight-reducing diet. These strategies produce significant weight loss and improvements in cardiometabolic risk factors. Future research is needed to better understand how to personalize nutrient prescriptions further to promote optimal risk modification and maintenance of long-term energy balance in the weight-reduced state.
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Affiliation(s)
- Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA.
| | - Gary Miller
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, USA
| | - Scott Kahan
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Ard JD, Cook M, Rushing J, Frain A, Beavers K, Miller G, Miller ME, Nicklas B. Impact on weight and physical function of intensive medical weight loss in older adults with stage II and III obesity. Obesity (Silver Spring) 2016; 24:1861-6. [PMID: 27430587 PMCID: PMC5536247 DOI: 10.1002/oby.21569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/07/2016] [Accepted: 04/28/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A 6-month pilot trial compared two strategies for weight loss in older adults with body mass indexes (BMIs) ≥35 kg/m(2) to assess weight loss response, safety, and impact on physical function. METHODS Twenty-eight volunteers were randomized to a balanced deficit diet (BDD) (500 kcal/day below estimated energy needs) or an intensive, low-calorie, meal replacement diet (ILCD, 960 kcal/day). Behavioral interventions and physical activity prescriptions were similar for both groups. Primary outcomes were changes in body weight and adverse event frequency; secondary outcomes included measures of physical function and body composition. RESULTS ILCD average weight change was -19.1 ± 2.2 kg or 15.9 ± 4.6% of initial body weight compared with -9.1 ± 2.7 kg or 7.2 ± 1.9% for BDD. ILCD lost more fat mass (-7.7 kg, 95% CI [-11.9 to -3.5]) but had similar loss of lean mass (-1.7 kg, 95% CI [-4.1 to 0.6]) compared with BDD. There were no significant differences in change in physical function or adverse event frequency. CONCLUSIONS Compared with a traditional BDD intervention, older adults who have severe obesity treated with intensive medical weight loss had greater weight loss and decreases in fat mass without a higher frequency of adverse events. In the short term, however, this did not translate into greater improvements in physical function.
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Affiliation(s)
- Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
- Department of Surgery, Weight Management Center, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Miranda Cook
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Julia Rushing
- Department of Biostatistics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Annette Frain
- Department of Surgery, Weight Management Center, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Kristen Beavers
- Department of Geriatrics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Gary Miller
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, North Carolina, USA
| | - Michael E Miller
- Department of Biostatistics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Barb Nicklas
- Department of Geriatrics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
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33
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Corsino L, Chinea FM, Ard JD, Voils CI, Rocha-Goldberg MDP, Svetkey LP. Perception of Obesity in the Latino Population: Implications for Weight Loss Clinical Trials. ABNF J 2016; 27:58-63. [PMID: 29443468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ethnic minorities in the United States have a higher prevalence of obesity, with higher levels reported in Latinos/Hispanics. A qualitative study was done to understand perceptions of obesity and identify factors that may enhance the attractiveness of a behavioral weight-loss intervention in the Latino community. Weight loss trials designed to target the Latino/Hispanic population may benefit by considering the Latino/Hispanic perception of the problem, the barriers to weight loss, and for study participation that may be specific to this population.
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Abstract
There are clear and persistent disparities in obesity prevalence within the USA. Some of these disparities fall along racial/ethnic lines; however, there are a number of other social and demographic constructs where obesity disparities are present. In addition to differing rates of obesity across groups, there is growing evidence that subgroups of patients both seek out and respond to obesity treatment differently. This review article explores the epidemiology of obesity disparities, as well as the existing evidence around how different groups may respond to behavioral, medical, and surgical therapies, and potential reasons for differential uptake and response, from culture, to access, to physiology. We find that the vast majority of evidence in this area has focused on the observation that African Americans tend to lose less weight in clinical trials compared to non-Hispanic whites and mainly pertains to behavioral interventions. Moving forward, there will be a need for studies that broaden the notion of health disparity beyond just comparing African Americans and non-Hispanic whites. Additionally, a more thorough examination of the potential for disparate outcomes after medical and surgical treatments of obesity is needed, coupled with the careful study of possible physiologic drivers of differential treatment response.
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Affiliation(s)
- Kristina H Lewis
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Weight Management Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA
| | - Shenelle A Edwards-Hampton
- Department of General Surgery, Weight Management Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Weight Management Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA.
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Locher JL, Goldsby TU, Goss AM, Kilgore ML, Gower B, Ard JD. Calorie restriction in overweight older adults: Do benefits exceed potential risks? Exp Gerontol 2016; 86:4-13. [PMID: 26994938 DOI: 10.1016/j.exger.2016.03.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/11/2016] [Accepted: 03/15/2016] [Indexed: 02/04/2023]
Abstract
The evidence regarding recommendations of calorie restriction as part of a comprehensive lifestyle intervention to promote weight loss in obese older adults has remained equivocal for more than a decade. The older adult population is the fastest growing segment of the US population and a greater proportion of them are entering old age obese. These older adults require treatments based on solid evidence. Therefore the purpose of this review is three-fold: 1) to provide a more current status of the knowledge regarding recommendations of calorie restriction as part of a comprehensive lifestyle intervention to promote weight loss in obese older adults, 2) to determine what benefits and/or risks calorie restriction adds to exercise interventions in obese older adults, and 3) to consider not only outcomes related to changes in body composition, bone health, cardiometabolic disease risk, markers of inflammation, and physical function, but, also patient-centered outcomes that evaluate changes in cognitive status, quality of life, out-of-pocket costs, and mortality. Seven randomized controlled trials were identified that examined calorie restriction while controlling for exercise intervention effects. Overall, the studies found that calorie restriction combined with exercise is effective for weight loss. Evidence was mixed regarding other outcomes. The risk-benefit ratio regarding calorie restriction in older adults remains uncertain. Greater long-term follow-up is necessary, and complementary effectiveness studies are needed to identify strategies currently used by obese older adults in community settings.
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Affiliation(s)
- Julie L Locher
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, United States; Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL 35294, United States; Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294, United States.
| | - TaShauna U Goldsby
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294, United States; Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Amy M Goss
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294, United States; Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Meredith L Kilgore
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Barbara Gower
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294, United States; Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, United States
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Jerome GJ, Myers VH, Young DR, Matthews-Ewald MR, Coughlin JW, Wingo BC, Ard JD, Champagne CM, Funk KL, Stevens VJ, Brantley PJ. Psychosocial predictors of weight loss by race and sex. Clin Obes 2015; 5:342-8. [PMID: 26486256 PMCID: PMC4715521 DOI: 10.1111/cob.12120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/28/2015] [Accepted: 09/17/2015] [Indexed: 12/15/2022]
Abstract
This paper examined the psychosocial predictors of weight loss among race and sex subgroups. Analyses included overweight and obese participants from the PREMIER study, a previously published randomized trial that examined the effects of two multi-component lifestyle interventions on blood pressure among pre-hypertensive and stage 1 hypertensive adults. Both intervention conditions received behavioural recommendations for weight loss and group sessions. Weight and psychosocial measures of self-efficacy and social support for diet and exercise were assessed at baseline and at 6 months. There were 157 African-American (AA) women, 46 AA men, 203 non-AA women and 182 non-AA men with an average age of 50 years and average body mass index of 34 at baseline. Multiple predictor regression models were performed individually by race and sex subgroup. Among AA women, increases in diet self-efficacy were associated with weight loss. Among AA men, increases in diet-related social support and self-efficacy, along with increases in family support to exercise, were associated with weight loss (all Ps <0.05). Among non-AA women, increases in friends' support to exercise and exercise-related self-efficacy were associated with weight loss, and among non-AA men only increases in diet self-efficacy were associated with weight loss (all Ps <0.05). These results emphasize the need for targeted interventions based on race and sex to optimize the impact of lifestyle-based weight loss programmes.
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Affiliation(s)
- G J Jerome
- Department of Kinesiology, Towson University, Towson, MD, USA
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - V H Myers
- Klein Buendel, Inc., Golden, CO, USA
| | - D R Young
- Kaiser Permanente Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - J W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - B C Wingo
- Department of Occupational Therapy, University of Alabama, Birmingham, AL, USA
| | - J D Ard
- Wake Forest School of Medicine, Department of Epidemiology and Prevention, Medical Center Blvd, Winston Salem, NC, USA
| | - C M Champagne
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - K L Funk
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - V J Stevens
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - P J Brantley
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
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Carson TL, Desmond R, Hardy S, Townsend S, Ard JD, Meneses K, Partridge EE, Baskin ML. A study of the relationship between food group recommendations and perceived stress: findings from black women in the Deep South. J Obes 2015; 2015:203164. [PMID: 25821595 PMCID: PMC4364113 DOI: 10.1155/2015/203164] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/23/2014] [Accepted: 02/14/2015] [Indexed: 11/29/2022] Open
Abstract
Black women in the Deep South experience excess morbidity/mortality from obesity-related diseases, which may be partially attributable to poor diet. One reason for poor dietary intake may be high stress, which has been associated with unhealthy diets in other groups. Limited data are available regarding dietary patterns of black women in the Deep South and to our knowledge no studies have been published exploring relationships between stress and dietary patterns among this group. This cross-sectional study explored the relationship between stress and adherence to food group recommendations among black women in the Deep South. Participants (n = 355) provided demographic, anthropometric, stress (PSS-10), and dietary (NCI ASA-24 hour recall) data. Participants were obese (BMI = 36.5 kg/m(2)) and reported moderate stress (PSS-10 score = 16) and minimal adherence to Dietary Guidelines for Americans food group recommendations (1/3 did not meet recommendations for any food group). Participants reporting higher stress had higher BMIs than those reporting lower stress. There was no observed relationship between stress and dietary intake in this sample. Based on these study findings, which are limited by potential misreporting of dietary intake and limited variability in stress measure outcomes, there is insufficient evidence to support a relationship between stress and dietary intake.
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Affiliation(s)
- Tiffany L. Carson
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA
- *Tiffany L. Carson:
| | - Renee Desmond
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA
| | - Sharonda Hardy
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA
| | - Sh'Nese Townsend
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA
| | - Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, USA
| | - Karen Meneses
- Department of Nursing, School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Edward E. Partridge
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Monica L. Baskin
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA
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Keita AD, Judd SE, Howard VJ, Carson AP, Ard JD, Fernandez JR. Associations of neighborhood area level deprivation with the metabolic syndrome and inflammation among middle- and older- age adults. BMC Public Health 2014; 14:1319. [PMID: 25539758 PMCID: PMC4364504 DOI: 10.1186/1471-2458-14-1319] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/17/2014] [Indexed: 01/01/2023] Open
Abstract
Background The study examines the association of neighborhood socioeconomic deprivation and metabolic syndrome with inflammation. Methods The analysis included 19, 079 black and white participants from the REasons for Geographic And Racial Differences in Stroke Study who were age > 45 years at baseline. Logistic regression examined whether neighborhood deprivation was associated with increased odds of METS and CRP-MetS. Results Among black adults, residing in the most deprived neighborhoods was associated with increased odds of obesity (p < .01), lower HDL (p < .001), high blood pressure (p < .01), elevated fasting glucose (p < .001), inflammation (p < .01), and CRP-MetS (p < .001). Among white adults, neighborhood deprivation was associated with higher waist circumference (p < .001), lower HDL (p < .001), higher triglycerides (p < .01), higher glucose (p < .001), higher BMI (p < .0001), higher blood pressure (p = .01), METS (p < .001), inflammation (p < .01) and CRP-MetS (p < .001). Conclusions These findings highlight the role of neighborhood socioeconomic deprivation on METS and CRP-MetS for black and white adults. Interventions tailored to address the contextual effects of deprived neighborhoods may reduce the observed neighborhood disparities. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1319) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akilah Dulin Keita
- Institute for Community Health Promotion, Brown University, Box G-S121-8, Providence, USA.
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Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, Lee IM, Lichtenstein AH, Loria CM, Millen BE, Nonas CA, Sacks FM, Smith SC, Svetkey LP, Wadden TA, Yanovski SZ. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. J Am Coll Cardiol 2014; 63:2960-84. [DOI: 10.1016/j.jacc.2013.11.003] [Citation(s) in RCA: 728] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ, Jordan HS, Kendall KA, Lux LJ, Mentor-Marcel R, Morgan LC, Trisolini MG, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC, Tomaselli GF. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014; 129:S102-S138. [PMID: 24222017 DOI: 10.1161/01.cir.0000437739.71477.ee/-/dc1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Brantley PJ, Stewart DW, Myers VH, Matthews-Ewald MR, Ard JD, Coughlin JW, Jerome GJ, Samuel-Hodge C, Lien LF, Gullion CM, Hollis JF, Svetkey LP, Stevens VJ. Psychosocial predictors of weight regain in the weight loss maintenance trial. J Behav Med 2014; 37:1155-68. [PMID: 24722826 DOI: 10.1007/s10865-014-9565-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/21/2014] [Indexed: 02/07/2023]
Abstract
This study's purpose was to identify psychosocial predictors of weight loss maintenance in a multi-site clinical trial, following a group-based weight loss program. Participants (N = 1025) were predominately women (63%) and 38% were Black (mean age = 55.6 years; SD = 8.7). At 12 months, higher SF-36 mental health composite scores were associated with less weight regain (p < .01). For Black participants, an interaction existed between race and friends' encouragement for exercise, where higher exercise encouragement was related to more weight regain (p < .05). At 30 months, friends' encouragement for healthy eating was associated with more weight regain (p < .05), whereas higher SF-36 mental health composite scores were related to less weight regain (p < .0001). Perceived stress and select health-related quality of life indices were associated with weight regain; this relationship varied across gender, race, and treatment conditions. Temporal changes in these variables should be investigated for their impact on weight maintenance.
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Affiliation(s)
- Phillip J Brantley
- Behavioral Medicine Laboratory, Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, 70808, USA,
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Carson TL, Hidalgo B, Ard JD, Affuso O. Dietary interventions and quality of life: a systematic review of the literature. J Nutr Educ Behav 2014; 46:90-101. [PMID: 24183706 PMCID: PMC3982833 DOI: 10.1016/j.jneb.2013.09.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To systematically review the literature to examine whether there has been adequate assessment of the effects of dietary intervention on quality of life (QOL) independent of weight loss, assess which instruments are being used to measure nutrition-related QOL, identify gaps in the literature, and suggest future directions. DESIGN Systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. RESULTS A total of 24 studies were eligible for inclusion. The Short Form-36 Health Survey was the most widely used instrument to assess QOL. Other disease-specific instruments were used. Several different dietary approaches (eg, low carbohydrate, low calorie, low fat, combinations) were recommended. Across studies, QOL generally improved after participating in behavioral weight loss interventions, but findings revealed a lack of evidence to definitively determine whether reported changes in QOL were a result of weight loss or independent of it. CONCLUSIONS AND IMPLICATIONS It is important to consider how making broad dietary recommendations for all individuals might affect overall QOL in both positive and negative directions when considering factors other than weight loss and health improvement. If dietary interventions are adversely affecting QOL in other domains (eg, social, economic) and this relationship is not being detected or reported by current research practices, barriers for successful and sustainable dietary changes may not be fully understood.
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Affiliation(s)
- Tiffany L Carson
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL.
| | - Bertha Hidalgo
- Department of Biostatistics, Section on Statistical Genetics, University of Alabama at Birmingham; Birmingham, AL
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Olivia Affuso
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, School of Public Health; University of Alabama at Birmingham, Birmingham, AL
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Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Miller NH, Hubbard VS, Lee IM, Lichtenstein AH, Loria CM, Millen BE, Nonas CA, Sacks FM, Smith SC, Svetkey LP, Wadden TA, Yanovski SZ. Reprint: 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. Circulation 2013; 129:e2. [PMID: 24220553 DOI: 10.1161/01.cir.0000437740.48606.d1] [Citation(s) in RCA: 911] [Impact Index Per Article: 82.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol 2013; 63:2985-3023. [PMID: 24239920 DOI: 10.1016/j.jacc.2013.11.004] [Citation(s) in RCA: 1375] [Impact Index Per Article: 125.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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45
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Wingo BC, Desmond RA, Brantley P, Appel L, Svetkey L, Stevens VJ, Ard JD. Self-efficacy as a predictor of weight change and behavior change in the PREMIER trial. J Nutr Educ Behav 2013; 45:314-321. [PMID: 23433966 PMCID: PMC4114041 DOI: 10.1016/j.jneb.2012.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 12/10/2012] [Accepted: 12/17/2012] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Determine whether self-efficacy independently predicted weight loss in a behavioral intervention and explore factors that influence the path between self-efficacy and weight change. DESIGN Secondary analysis of the PREMIER trial, a randomized controlled trial testing effects of lifestyle interventions on blood pressure. SETTING Four academic medical centers. PARTICIPANTS PREMIER recruited adults (n = 810) with pre-hypertension/stage 1 hypertension, not currently receiving medication. This analysis excluded participants in the control arm, resulting in n = 537. INTERVENTIONS Participants were randomly assigned to 1 of 3 groups: advice only, established lifestyle recommendations, or established lifestyle recommendations plus Dietary Approaches to Stop Hypertension dietary pattern. MAIN OUTCOME MEASURES Self-efficacy (dietary self-efficacy [DSE], exercise self-efficacy [ESE]), dietary intake, fitness. ANALYSIS Pearson correlations, 1-way analysis of variance, mediation analyses. RESULTS Despite an overall decrease in DSE/ESE, change in DSE/ESE significantly predicted weight change at 6 (β = -.21, P < .01; β = -.19, P < .01, respectively) and 18 months (β = -.19, P < .01; β = -.35, P < .01). Change in percent calories from fat partially mediated the DSE/weight change relationship at 6 months. Change in fitness partially mediated the ESE/weight change relationship at 18 months. CONCLUSIONS AND IMPLICATIONS Changes in DSE/ESE were not associated with behavior change as hypothesized. Additional research is needed to identify mediators between self-efficacy and adoption of behaviors that influence weight loss.
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Affiliation(s)
- Brooks C Wingo
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Pekmezi D, Marcus B, Meneses K, Baskin ML, Ard JD, Martin MY, Adams N, Robinson C, Demark-Wahnefried W. Developing an intervention to address physical activity barriers for African-American women in the deep south (USA). ACTA ACUST UNITED AC 2013; 9:301-12. [PMID: 23638785 DOI: 10.2217/whe.13.20] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM To address high rates of inactivity and related chronic diseases among African-American women. MATERIALS & METHODS Eleven focus groups on physical activity barriers for African-American women in the deep south (USA) were conducted (n = 56). Feedback guided an intervention development process. The resulting Home-Based Individually Tailored Physical Activity Print intervention was vetted with the target population in a 1-month, single arm, pre-post test demonstration trial (n = 10). RESULTS Retention was high (90%). Intent-to-treat analyses indicated increases in motivational readiness for physical activity (70% of sample) and physical activity (7-day Physical Activity Recall) from baseline (mean: 89.5 min/week, standard deviation: 61.17) to 1 month (mean: 155 min/week, standard deviation: 100.86). Small improvements in fitness (6-Min Walk Test), weight and psychosocial process measures were also found. CONCLUSION Preliminary findings show promise and call for future randomized controlled trials with larger samples to determine efficacy. Such low-cost, high-reach approaches to promoting physical activity have great potential for addressing health disparities and benefiting public health.
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Affiliation(s)
- Dori Pekmezi
- University of Alabama at Birmingham, 1665 University Boulevard, 227 RPHB Birmingham, AL 35293, USA.
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Tyson CC, Appel LJ, Vollmer WM, Jerome GJ, Brantley PJ, Hollis JF, Stevens VJ, Ard JD, Patel UD, Svetkey LP. Impact of 5-year weight change on blood pressure: results from the Weight Loss Maintenance trial. J Clin Hypertens (Greenwich) 2013; 15:458-64. [PMID: 23815533 DOI: 10.1111/jch.12108] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 02/19/2013] [Accepted: 02/21/2013] [Indexed: 01/18/2023]
Abstract
In this secondary analysis of the Weight Loss Maintenance trial, the authors assessed the relationship between blood pressure (BP) change and weight change in overweight and obese adults with hypertension and/or dyslipidemia who were randomized to 1 of 3 weight loss maintenance strategies for 5 years. The participants were grouped (N=741) based on weight change from randomization to 60 months as: (1) weight loss, (2) weight stable, or (3) weight gain. A significant positive correlation between weight change and systolic BP (SBP) change at 12, 30, and 60 months and between weight change and diastolic BP (DBP) change at 30 months was observed. From randomization to 60 months, mean SBP increased to a similar degree for the weight gain group (4.2±standard error=0.6 mm Hg; P<.001) and weight stable group (4.6±1.1 mm Hg; P<.001), but SBP did not rise in the weight loss group (1.0±1.7 mm Hg, P=.53). DBP was unchanged for all groups at 60 months. Although aging may have contributed to rise in BP at 60 months, it does not appear to fully account for observed BP changes. These results suggest that continued modest weight loss may be sufficient for long-term BP lowering.
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Affiliation(s)
- Crystal C Tyson
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC 27705, USA.
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48
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Batch BC, Ard JD, Vollmer WM, Funk K, Appel LJ, Stevens VJ, Samuel-Hodge C, Loria CM, Hollis JF, Svetkey LP. Impact of participant and interventionist race concordance on weight loss outcomes. Obesity (Silver Spring) 2013; 21:712-7. [PMID: 23712973 PMCID: PMC3504135 DOI: 10.1002/oby.20270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 05/23/2012] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We have previously shown that racial composition of behavioral intervention groups does not affect achieved weight loss. However, it is unclear if the race of the interventionist affects intervention outcomes. The objective of this analysis is to estimate the impact of race concordance between participant and interventionist on weight change in the initial weight loss phase (phase I) of the Weight Loss Maintenance trial (WLM). DESIGN AND METHODS A total of 1,685 overweight or obese adults (BMI 25-45 kg/m(2) ) who were taking medication for hypertension and/or dyslipidemia participated in phase I of the WLM trial. All participants received a 6-month intensive behavioral intervention in groups of 15-20 facilitated by a trained interventionist. The main outcome is change in weight at 6 months. RESULTS Participants were on average 55 years of age, 67% female and 44% African American (AA). Three of seventeen interventionists were AA, 14 were non-AA. Seventy-three percent of participants shared race concordance with the interventionist. There was a small but statistically significant difference in weight change of participants who were the same race as the interventionist (-5.84 kg, s.e. 0.17) as compared with those who were not race concordant (-5.04 kg, s.e. 0.33), a difference of 0.8 kg, (P = 0.04). The impact of concordance on weight change differed by race (i.e., interaction of race and concordance was significant, P = 0.02). CONCLUSIONS In a post hoc analysis of a group-based behavioral intervention, race concordance for non-AA participants was associated with slightly greater weight loss. Race concordance was not associated with weight loss for AA participants.
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Affiliation(s)
- Bryan C Batch
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA.
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Abstract
OBJECTIVE To determine if African American (AA) and Caucasian women grouped variables related to race and weight into discrete clusters and if there were discernable response patterns with unique subgroup characteristics. METHODS Women (N=277, 48% AA) completed a card sorting task, ranking 28 variables. We used multidimensional scaling to determine perceived similarities and differences between variables, and latent class analysis to identify subgroups responding similarly. RESULTS We identified 5 clusters of variables and 4 response patterns, which were demographically and anthropometrically distinct. CONCLUSIONS These results can be used for empirical cultural tailoring of behavioral weight loss interventions.
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Affiliation(s)
- Jamy D Ard
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
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50
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Wingo BC, Baskin M, Ard JD, Evans R, Roy J, Vogtle L, Grimley D, Snyder S. Component analysis and initial validity of the exercise fear avoidance scale. Am J Health Behav 2013; 37:87-95. [PMID: 22943105 DOI: 10.5993/ajhb.37.1.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To develop the Exercise Fear Avoidance Scale (EFAS) to measure fear of exercise-induced discomfort. METHODS We conducted principal component analysis to determine component structure and Cronbach's alpha to assess internal consistency of the EFAS. Relationships between EFAS scores, BMI, physical activity, and pain were analyzed using multivariate regression. RESULTS The best fit was a 3-component structure: weight-specific fears, cardiorespiratory fears, and musculoskeletal fears. Cronbach's alpha for the EFAS was α=.86. EFAS scores significantly predicted BMI, physical activity, and PDI scores. CONCLUSION Psychometric properties of this scale suggest it may be useful for tailoring exercise prescriptions to address fear of exercise-related discomfort.
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