Racial/ethnic disparities in weight or BMI change in adulthood and pancreatic cancer incidence: The multiethnic cohort

INTRODUCTION

Compared to non-Hispanic Whites, Japanese Americans, Native Hawaiians, and African Americans have higher incidences of pancreatic cancer (PCa) that are not entirely explained by rates of obesity but may be explained by weight changes throughout adulthood.

METHODS

The multiethnic cohort is a population-based prospective cohort study that has followed 155,308 participants since its establishment between 1993 and 1996. A total of 1,328 incident cases with invasive PCa were identified through 2015. We conducted separate multivariable Cox proportional hazards models for self-reported weight-change and BMI-change (age 21 to cohort entry) to determine the association with PCa risk, adjusting for potential confounders including weight or BMI at age 21.

RESULTS

The mean age at cohort entry was 59.3 years (SD 8.9). An increased risk of PCa was associated with: 1) weight (HR per10 lbs = 1.06; 95% CI = 1.03-1.09) or BMI (HR per kg/m2  = 1.04; 95% CI = 1.02-1.05) at age 21; and 2) weight (HR per 10 lbs = 1.03; 95% CI = 1.01-1.05) or BMI (HR = 1.02; 95% CI = 1.00-1.03) at cohort entry. We found increased risk of PCa between weight (HR per 10 lbs = 1.03; 95% CI = 1.01-1.05) and BMI (HR per 5 kg/m2  = 1.08; 95% CI = 1.01-1.15) change from age 21 to baseline. There were significant interactions between race/ethnicity and weight (p = 0.008) or BMI (p = 0.03) at baseline, and weight (p = 0.02) or BMI (p = 0.02) change. Weight and BMI change through adulthood significantly increased the risk of PCa for Japanese Americans and Latinos, but not for African American, White, or Hawaiian participants.

CONCLUSION

Our findings indicate that weight or BMI gain has a significant and independent impact on PCa risk, specifically among Latinos and Japanese Americans.

Sex and racial/ethnic differences in sleep quality and its relationship with body weight status among US college students

Objective: To examine sex and racial/ethnic differences in sleep quality and the association between sleep quality and body weight status among US college students. Participants: A nationally representative sample (N = 324,767) of college students from 2011 to 2015. Methods: A secondary data analysis of cross-sectional data. Results: Women showed poorer sleep quality (nights per week getting enough sleep to feel rested) than men (4.00 versus 4.34 days; p < .001). In both men and women, compared with non-Hispanic whites, racial/ethnic minorities showed lower sleep quality (p < .001). Compared with normal weight participants, overweight participants had poorer sleep quality (p = .007) among men, and both overweight (p = .004) and obese participants (p < .001) had lower sleep quality among women. Conclusions: Understanding sex and racial/ethnic sleep differences and the association between sleep and body weight status is important for colleges to promote college students' healthy sleep.

Comparison of Early Life Obesity-Related Risk and Protective Factors in Non-Hispanic Black Subgroups

OBJECTIVES

Previous obesity prevention studies in preschool-age children have included non-Hispanic Black (NHB) children, but few have investigated between-subgroup differences even though there may be cultural risk and protective practice differences, challenging the generalizability of findings. The purpose of this study was to examine differences in early childhood obesity-related factors in NHB subgroups (Haitian, other Caribbean Islander and African-American [AA]) children.

METHODS

Baseline data from two randomized controlled trials in 52 childcare centers of which 35 had data to test a preschool-based obesity prevention intervention was analyzed. The sub-sample included 370 caregiver-child dyads; 209 self-identified as AA, 120 as Haitian and 41 as Caribbean Islander/West Indian or mixed race. Multilevel regression models generated outcome estimates for group differences in body mass index (BMI) percentile, birthweight, breastfeeding initiation and duration, bottle feeding duration and age when solid foods were introduced.

RESULTS

Mean BMI percentile was similar for AA, Haitian and Caribbean Islander/West Indian/Multiracial (60.1th percentile, 60.8th percentile, 62.8th percentile, respectively) as was birthweight (6.3, 6.8, and 6.6 lb, respectively). Children of US-born caregivers had significantly lower BMI percentiles (9.13 percentile points) versus foreign-born caregivers. Haitian women were significantly more likely to initiate breastfeeding (64.9%) versus AA (47.6%) and Caribbean Islander/West Indian/Multiracial (62.2%) (p < .01). No significant group differences were found in breastfeeding or bottle feeding duration or age solid foods were introduced.

CONCLUSIONS

Findings here suggest that NHB race classification can identify important subgroup behavioral similarities which in turn may inform culturally sensitive strategies to promote early childhood healthy weight. Foreign-born caregivers may benefit from healthy weight promotion information, and as early as possible in their child's development.

Analysis of Health-Related Behaviors of Adult Korean Women at Normal BMI with Different Body Image Perceptions: Results from the 2013-2017 Korea National Health and Nutrition Examination Survey (KNHNES)

The tendency of misperceiving one's body image was found to be higher among those at normal body mass index (BMI). Thus, the present study aims to provide basic data to seek solutions for ideal physical activities and right body image perception by comparing health-related behaviors of women at normal BMI. Among the 39,225 respondents from the Korea National Health and Nutrition Examination Survey (KNHNES) conducted from 2013 to 2017, 10,798 adult women with World Health Organization (WHO) BMI Classifications of 18.5 ≤ BMI < 25 (Asia-Pacific) were considered, from which pregnant and breast-feeding women and women whose body image perception was not identified were excluded, leading to a total of 9288 women. Data were analyzed utilizing SAS ver. 9.4 for frequency analysis, cross tabulation, GLM (generalized linear model), and logistic regression analysis with complex samples design, in conformity with the guidelines of the KNHNES. The results showed that approximately most (87.6%) of adult Korean women misperceived their body image. Misperception of body image was related to inappropriate health-related behaviors such as smoking, insufficient sleeping, and excessive body weight management; those who had underestimated their body image (≤64 odds ratio (OR) (0.718 (confidence interval (C.I.) 0.594-0.866))) carried out fewer health-related behaviors, while women aged 65 or above engaged in more health-related behaviors when they perceived themselves as obese (OR 1.683 (C.I. 1.260-2.248; overestimation)). To sum up, it was found that lack of health management, inappropriate body weight control, and health-related behaviors are related to body image misperception compared with real BMI. As such, it is necessary to have educational programs to encourage building proper perception of one's body image and body weight, and to carry out health-related behaviors.

Anthropometric Characteristics of Tunisian Population in Comparison to the World

BACKGROUND

Anthropometry is the one and only universally applicable, inexpensive and non-invasive method for studying the proportions of the human body. Anthropometric measurements reflect nutritional status and health, but can also be used to predict skills, health status and survival. It is therefore a reliable tool, but currently underused, to guide public health policies.

AIM

Therefore, this study investigated anthropometric characters of Tunisian people and compared it with those of other nationalities.

METHODS

429 subjects have participated in this study (322 men and 107 women), aged between 20 and 85. Anthropometric measurements used in this study were body mass, body size, thigh circumference, lower limbs length and body mass index.

RESULTS

With an average body size of 171 cm for men and 157 cm for women, Tunisians were close to neighboring countries. Nevertheless, with a body mass of 77.23 kg and 72.66 kg and a BMI of 26.48 and 29.18 respectively for men and women, Tunisia has the highest prevalence of obesity in the region, especially for women. Several anthropometric correlations have also been noticed such as relationships between thigh circumference, BMI, body mass, lower limbs length, and body size.

CONCLUSION

Obesity is proving to be a public health problem for which effective strategies and measures are needed.

Weight and economic development: current net nutrition in the late 19th- and early 20th-century United States

When traditional measures for material and economic welfare are scarce or unreliable, height and the body mass index (BMI) are now widely accepted measures that represent cumulative and current net nutrition in development studies. However, as the ratio of weight to height, BMI does not fully isolate the effects of current net nutrition. After controlling for height as a measure for current net nutrition, this study uses the weight of a sample of international men in US prisons. Throughout the late 19th- and early-20th centuries, individuals with darker complexions had greater weights than individuals with fairer complexions. Mexican and Asian populations in the US had lower weights and reached shorter statures. Black and white weights stagnated throughout the late 19th- and early-20th centuries. Agricultural workers' had greater weights than workers in other occupations.

Body image, body dissatisfaction and weight status of Pacific adolescents from different ethnic communities: a cross-sectional study in New Caledonia

Objective(s): The prevalence of adolescent obesity is high among the various ethnic groups native to the Pacific region (European, Melanesian and Polynesian). An important factor of weight gain or loss is body size satisfaction; however, little is known about adolescent body self-perception in the Pacific region.Design: Body dissatisfaction was evaluated using the Stunkard Figure Rating Scale in a sample of 699 adolescents from rural and urban areas of New Caledonia. The socio-demographic factors associated with higher body dissatisfaction were determined by multiple linear regression modeling.Results: Our results showed a high rate of body dissatisfaction (over 70%) in the adolescents. Body dissatisfaction was strongly related to the body mass index z-score. Melanesians boys had higher body dissatisfaction scores when they felt 'too thin' while Melanesian girls showed lower body dissatisfaction when they felt 'too fat.'.Conclusion: These results showed that social pressure for thinness or musculature may be different among adolescents living in New Caledonia. These results should be taken into account in education overweight prevention programs.

Efficacy and Safety of Semaglutide for Type 2 Diabetes by Race and Ethnicity: A Post Hoc Analysis of the SUSTAIN Trials

CONTEXT

Variations in the prevalence and etiology of type 2 diabetes (T2D) across race and ethnicity may affect treatment responses. Semaglutide is a glucagon-like peptide-1 analog approved for once-weekly, subcutaneous treatment of T2D.

OBJECTIVE

To compare semaglutide efficacy and safety in race and ethnicity subgroups across the SUSTAIN trials.

DESIGN

Post hoc analysis of data from phase 3 randomized SUSTAIN 1-5 and 7 (pooled), and SUSTAIN 6 trials.

PARTICIPANTS

3074 subjects (SUSTAIN 1-5 and 7) and 1648 subjects (SUSTAIN 6).

INTERVENTIONS

Semaglutide 0.5 or 1.0 mg, placebo, or active comparator (sitagliptin 100 mg, exenatide extended release 2.0 mg, insulin glargine 100IU/ml and dulaglutide 0.75 or 1.5 mg).

MAIN OUTCOME MEASURES

Change in hemoglobin A1C (HbA1c) and body weight from baseline to weeks 30, 40 and 104, and other efficacy and safety endpoints.

RESULTS

HbA1c was reduced from baseline by 1.0 to 1.5 percentage points and 1.3 to 2.0 percentage points, and body weight was reduced by 2.3 to 4.7 kg and 3.6 to 6.1 kg with semaglutide 0.5 and 1.0 mg, respectively, across race and ethnicity subgroups. Minor changes in blood pressure and lipid profiles were observed. Adverse events (AEs) were reported in similar proportions of subjects across trials. More Asian versus other race subgroups discontinued treatment prematurely due to AEs. The most commonly reported AEs were gastrointestinal disorders.

CONCLUSIONS

In this SUSTAIN trials post hoc analysis, semaglutide was associated with consistent and clinically relevant reductions in HbA1c and body weight in subjects with T2D, with minor variations in efficacy and safety outcomes associated with race or ethnicity.

Comparison of Dietary Micronutrient Intakes by Body Weight Status among Mexican-American and Non-Hispanic Black Women Aged 19-39 Years: An Analysis of NHANES 2003-2014

The objective of the current study was to examine micronutrient intake from foods in women of childbearing age and to better understand potential nutritional problems varied by body weight status in minority women. A sample of women aged 19–39 years from the National Health and Nutrition Examination Surveys (NHANES) 2003–2014 was analyzed. Dietary intakes of 13 micronutrients were estimated using the National Cancer Institute method. Mexican-American and non-Hispanic Black women were categorized into normal/under-weight, overweight, or obese groups according to their body mass index (BMI). Mexican-American and non-Hispanic Black women had lower dietary intakes for vitamins A, B₂, B₆, B₁₂, and D, folate, calcium, and magnesium than non-Hispanic Whites. Among Mexican-Americans, obese women had the lowest dietary intake of vitamins A, B₂, C and D. Obese non-Hispanic Black women had significantly lower dietary intakes of iron and zinc than their normal/under-weight counterparts. Comparable percentages (>30%) of Mexican-American and non-Hispanic Black women had dietary intake less than the Estimated Average Requirements (EARs) for several key nutrients including vitamin A, C and D, folate, calcium and magnesium, and the percentages varied by body weight status. These results indicate micronutrient inadequacies persist among and within racial/ethnic and body weight groups.

Neighborhood racial/ethnic segregation and BMI: A longitudinal analysis of the Multi-ethnic Study of Atherosclerosis

BACKGROUND

Current knowledge regarding the relationship between segregation and body weight is derived mainly from cross-sectional data. Longitudinal studies are needed to provide stronger causal inference.

METHODS

We use longitudinal data from the Multi-Ethnic Study of Atherosclerosis and apply an econometric fixed-effect strategy, which accounts for all time-invariant confounders, and compare results to conventional cross-sectional analyses. We examine the relationship between neighborhood-level racial/ethnic segregation, neighborhood poverty, and body mass index (BMI) separately for blacks, Hispanics, and whites. Segregation*gender interactions are included in all models. Neighborhood segregation was operationalized by the local Gi* statistic, which assesses the extent to which a neighborhood's racial/ethnic composition is under (Gi* statistic < 0) or over (Gi* statistic > 0) represented, given the composition in the broader (e.g., county) area. For black, Hispanic, and white stratified models, the Gi* statistic reflects the level of black, Hispanic, and white segregation, respectively. The Gi* statistic was scaled such that a unit change represents a 1.96 difference in the score.

RESULTS

Cross-sectional models indicated higher segregation to be negatively associated with BMI for white females and positively associated for Hispanic females. No association was found for black females or males in general. In contrast, fixed-effect models adjusting for neighborhood poverty, higher segregation was positively associated with BMI for black females (coeff = 0.25 kg/m2; 95% CI = [0.03, 0.46]; p-value = 0.03) but negatively associated for Hispanic females (coeff = -0.17 kg/m2; 95% CI = [-0.33, -0.01]; p-value  = 0.04) and Hispanic males (coeff = -0.20; 95% CI = [-0.39, -0.01]; p-value = 0.04). Further controls for socioeconomic factors fully explained the associations for Hispanics but not for black females.

CONCLUSIONS

Fixed-effect results suggest that segregation's impacts might not be universally harmful, with possible null or beneficial impacts, depending on race/ethnicity. The persistent associations after accounting for neighborhood poverty indicate that the segregation-BMI link may operate through different pathways other than neighborhood poverty.

Long-term neighborhood ethnic composition and weight-related outcomes among immigrants: The Multi-Ethnic Study of Atherosclerosis

Weight among immigrants in the United States (US) is lower than among the US-born on average, but higher among long-term immigrants than the newly arrived. Neighborhood coethnic concentration-the proportion of neighborhood residents of the same ethnic background-may influence weight among immigrants via behavioral norms and market-driven community resources. However, the relevant exposure timeframe may be far longer than is captured by existing cross-sectional and short-term studies. Using detailed historical residential address information on 1449 older Latino and Chinese long-term immigrants, we investigated associations of 10-20-year neighborhood coethnic concentration trajectories with current waist circumference and weight-related behaviors (diet, physical activity, and sedentary time). Among Chinese participants, compared to persistent low coethnic concentration, increasing coethnic concentration was associated with higher waist circumference (difference = 1.45 cm [0.51, 2.39]). In contrast, both increasing coethnic concentration and persistent high coethnic concentration were associated with a healthier diet. Among Latino participants, trajectories characterized by higher coethnic concentration were associated with higher waist circumference (e.g., difference = 2.11 cm [0.31, 3.91] for persistent high vs. persistent low) and low physical activity. Long-term patterns of neighborhood coethnic concentration may affect weight-related outcomes among immigrants in complex ways that differ by ethnicity and outcome.

Ethnic differences in metabolic cardiovascular risk among normal weight individuals: Implications for cardiovascular risk screening. The HELIUS study

BACKGROUND AND AIMS

Cardiovascular disease (CVD) risk factors may occur among a substantial proportion of normal weight individuals, particularly among some ethnic minorities. It is unknown how many of these individuals would be missed by commonly applied eligibility criteria for cardiovascular risk screening. Thus, we aim to determine cardiovascular risk and eligibility for cardiovascular risk screening among normal weight individuals of different ethnic backgrounds.

METHODS AND RESULTS

Using the HELIUS study (Amsterdam, The Netherlands), we determined cardiovascular risk among 6910 normal weight individuals of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Moroccan and Turkish background. High cardiovascular risk was approximated by high metabolic risk based on blood pressure, HDL, triglycerides and fasting glucose. Eligibility criteria for screening were derived from Dutch CVD prevention guidelines and include age ≥ 50 y, family history of CVD, or current smoking. Ethnic group comparisons were made using logistic regression. Age-adjusted proportions of high metabolic risk ranged from 12.6% to 38.4% (men) and from 2.7% to 11.5% (women). This prevalence was higher among most ethnic minorities than the Dutch, especially among women. For most ethnic groups, 79.9%-86.7% of individuals with high metabolic risk were eligible for cardiovascular risk screening. Exceptions were Ghanaian women (58.8%), Moroccan men (70.9%) and Moroccan women (45.0%), although age-adjusted proportions did not differ between groups.

CONCLUSION

Even among normal weight individuals, high cardiovascular metabolic risk is more common among ethnic minorities than among the majority population. Regardless of ethnicity, most normal weight individuals with increased risk are eligible for cardiovascular risk screening.

Mean Body Weight, Height, Waist Circumference, and Body Mass Index Among Adults: United States, 1999-2000 Through 2015-2016

Objectives-This report presents trends in mean weight, height, waist circumference, and body mass index (BMI) among adults in the United States from 1999-2000 through 2015-2016. Methods-Data were obtained from physical examinations of a nationally representative sample of adults aged 20 and over in the National Health and Nutrition Examination Surveys during 1999-2016. The tables present means and standard errors of the mean for weight (n = 45,047), height (n = 46,481), waist circumference (n = 43,169), and BMI (n = 44,859) separately for men and women overall, by age group, and by race and Hispanic origin for each 2-year survey period. Changes in these body measures over time were evaluated using linear regression. Results-Since 1999, mean weight, waist circumference, and BMI increased for all age groups, for non-Hispanic white and Mexican-American men and women, and for non-Hispanic black women. Among non-Hispanic black men, weight, waist circumference, and BMI increased until 2005-2006 and then remained level. No change in height was seen over time except for a decrease in crude estimates among all women, a decrease among men and women aged 40-59, and an increase in both crude and age-adjusted estimates of mean height for men followed by a decrease after 2003-2004. No significant trends were seen in any of the four body measures for non-Hispanic Asian men and women (data available only for 2011-2016).

Racial Differences in Relative Skeletal Muscle Mass Loss During Diet-Induced Weight Loss in Women

OBJECTIVE

It is unclear whether there are race-specific differences in the maintenance of skeletal muscle during energy restriction. Changes in relative skeletal muscle index (RSMI; limb lean tissue divided by height squared) were compared following (1) diet alone, (2) diet + aerobic training, or (3) diet + resistance training.

METHODS

Overweight, sedentary African American (AA; n = 72) and European American (EA; n = 68) women were provided an 800-kcal/d diet to reduce BMI < 25 kg/m² . Regional fat-free mass was measured with dual-energy x-ray absorptiometry. Steady-state VO₂ and heart rate responses during walking were measured.

RESULTS

AA women had greater RSMI and preserved RSMI during diet alone, while RSMI was significantly reduced among EA women (EA women -3.6% vs. AA women + 1.1%; P < 0.05). Diet + resistance training subjects retained RSMI (EA women + 0.2% vs. AA women + 1.4%; P = 50.05), whereas diet + aerobic training subjects decreased RSMI (EA women -1.4% vs. AA women -1.5%; P < 0.05). Maintenance of RSMI was related to delta walking ease and economy.

CONCLUSIONS

Compared with AA women, EA women are less muscular and lose more muscle during weight loss without resistance training. During diet-induced weight loss, resistance training preserves skeletal muscle, especially among premenopausal EA women. Maintenance of muscle during weight loss associates with better ease and economy of walking.

Racial/ethnic differences in body weight perception among U.S. college students

OBJECTIVE

To examine racial/ethnic differences in weight perception by sex among U.S. college students.

PARTICIPANTS

a national sample (N = 70,267) of college students selected from 2- and 4-year postsecondary institutions (N = 62) during the Fall semester from 2011 to 2014.

METHODS

This is a secondary data analysis using 4 years of American College Health Association-National College Health Assessment IIb data. Sex-stratified multinomial logistic regression was performed to investigate racial/ethnic differences in body weight perception.

RESULTS

Compared with non-Hispanic whites, non-Hispanic black men and women were more likely to underestimate their body weight (p < .01). Asian men and women were more likely to overestimate their body weight than non-Hispanic whites (p < .001).

CONCLUSIONS

Weight-related interventions should take into account racial/ethnic differences in body weight perception.

Physical self-concept and body dissatisfaction among Special Olympics athletes: A comparison between sex, weight status, and culture

BACKGROUND

Little research has looked at the associations between sex, weight status and culture, and the physical self-perceptions and body dissatisfaction of individuals with intellectual disabilities (ID) involved in Special Olympics (SO) sports.

AIMS

To examine sex- (male vs female), weight status- (non-overweight/obese vs. overweight/obese), and culture-based (North American vs. Asian) differences in physical self-concept and body dissatisfaction among SO athletes.

METHODS AND PROCEDURES

A total of 139 SO athletes (aged 12-30 years) with ID participated in this study and completed measures of physical self-perceptions and body dissatisfaction. Differences according to sex, weight status, culture, and their interactions were examined.

OUTCOMES AND RESULTS

Males SO athletes presented higher levels of self-perceived physical strength and ideal body shape than females. Additionally, non-overweight/obese SO athletes presented higher levels of self-perceived physical appearance and physical condition than their overweight/obese counterparts, as well as lower actual body shape perceptions and body dissatisfaction. Moreover, North-American SO athletes presented higher levels of self-perceived physical appearance and sport competence than their Asians counterparts, as well as lower actual body shapes perceptions and body dissatisfaction.

CONCLUSION AND IMPLICATIONS

This study reveals substantial sex-, weight status-, and culture-based differences in the physical self-concept and body dissatisfaction of SO athletes.

BMI 35 kg/m2 does not fit everyone: a modified STOP-Bang questionnaire for sleep apnea screening in the Chinese population

PURPOSE

The STOP-Bang questionnaire is the most widely used to detect surgical patients at high risk of obstructive sleep apnea (OSA). However, the body mass index (BMI) cutoff value in the original STOP-Bang questionnaire is 35 kg/m²; the BMI in the Chinese population is lower than that. We aimed to establish a more appropriate BMI cutoff value in the STOP-Bang questionnaire for Chinese patients.

METHODS

A total of 790 consecutive patients scheduled to undergo surgery at our hospital were included in this prospective study. All patients were asked to complete the STOP-Bang questionnaire and undergo a 7-h overnight polysomnography (PSG). The ability of STOP-Bang questionnaire to detect moderate to severe OSA (AHI ≥ 15 events/h) was assessed.

RESULTS

When the BMI cutoff value was set at 28 kg/m², the questionnaire had the highest Youden index, although no significant differences were found in the sensitivity of the test compared with the original BMI cutoff in total and in male patients. In females, changing the BMI cutoff value from 35 to 28 kg/m² resulted in the sensitivity of the test significantly increasing from 79.2% (74.9-83.5) to 89.3% (84.4-94.1), while the decrease in specificity was minor (from 43.6% [41.2-46.0] to 38.2% [36.1-40.3]), and the Youden index was highest (0.27) at this cutoff value. When the STOP-Bang questionnaire score was 4, the highest Youden index was obtained.

CONCLUSIONS

We recommend using a BMI cutoff value (28 kg/m²), and a STOP-Bang score ≥ 4 allows the anesthetist to identify patients with high risk of OSA.

Caregiver feeding practices and weight status among African American adolescents: The Jackson Heart KIDS Pilot Study

Adolescence is a stage in the life course during which youth become more autonomous in their health behaviors. Overweight and obesity during this developmental period are associated with short- and long-term physical and emotional morbidity, and African American youth are at pronounced risk for these health outcomes. The style of parenting employed by caregivers influences health behaviors in children, though the persistence of this influence into adolescence is not clear. This study examined associations among caregiver feeding practices, body mass index z-score (zBMI), and waist circumference (WC) in a cohort of 212 African American adolescents (50.5% girls; Mage=15.16years). Participants were children and grandchildren of individuals enrolled in the Jackson Heart Study, a prospective epidemiologic evaluation of cardiovascular disease among African Americans based in Jackson, Mississippi. Youth zBMI and WC were primary outcomes, and caregivers completed the Child Feeding Questionnaire, an assessment of attitudes, beliefs, and practices related to obesity proneness. Regression analyses revealed that while controlling caregiver feeding practices were associated with zBMI and WC, perceived responsibility for the type and amount of food provided to adolescents was not related to weight status. Among younger adolescents, more oversight of their eating practices was related to higher zBMI. Similarly, boys whose intake of unhealthy foods was restricted were more likely to have higher zBMI and WC. Results suggest that caregiver feeding practices continue to be associated with weight status during adolescence, and underscore the importance of culturally and developmentally appropriate prevention and intervention efforts targeting overweight and obesity.

Combination Therapy of PEG-HM-3 and Methotrexate Retards Adjuvant-Induced Arthritis

At present, the early phenomenon of inflammatory angiogenesis is rarely studied in Rheumatoid arthritis (RA). Previous research found that PEG-HM-3, an integrin inhibitor, possessed anti-angiogenesis and anti-rheumatic activity. In this study, the advantages of inhibiting angiogenesis and immune cell adhesion and migration, as well as the benefits of anti-arthritis effects, were evaluated using a combination of PEG-HM-3 and methotrexate (MTX). In vitro, spleen cell proliferation and the levels of tumor necrosis factor α (TNF-α) in macrophage supernatant were assessed. Hind paw edema, arthritis index, clinical score, body weight and immunohistochemistry (IHC) of the spleen, thymus, and joint cavity were evaluated in vivo in adjuvant-induced arthritis rats. Joints of the left hind paws were imaged by X-ray. The expression of the toll-like receptor 4 (TLR-4) protein was assessed in lipopolysaccharide (LPS)-induced synoviocytes. PEG-HM-3 combined with MTX significantly reduced primary and secondary swelling of the hind paws, the arthritis index, the clinical score and bone erosion. The results of IHC showed that the levels of interleukin-6 (IL-6) in spleens and the levels of TNF-α, CD31 (cluster of differentiation 31), and CD105 in the joint cavity were decreased. The body weight of rats was maintained during combination therapy. Ankle cavity integrity, and bone erosion and deformity were improved in combination treatment. The expression of TLR-4 was significantly reduced with combination treatment in rat synoviocytes. Co-suppression of both inflammation and angiogenesis in arthritis was achieved in this design with combination therapy. The activity of nuclear transcription factor (NF-κB) and the expression of inflammatory factors were down regulated via integrin αvβ₃ and TLR-4 signaling pathways. In the future, the application of this combination can be a candidate in early and mid-term RA therapy.

Video consultations as add-on to standard care among patients with type 2 diabetes not responding to standard regimens: a randomized controlled trial

OBJECTIVE

To examine whether video consultations preceded by measurements of blood glucose, weight and blood pressure as add-on to standard care could contribute to achieving and maintaining good diabetes control among patients with poorly regulated type 2 diabetes (T2D).

DESIGN

Randomized controlled trial.

METHODS

165 patients with T2D were randomized 1:1 to telemedicine intervention as add-on to clinic-based care or control (clinic-based care). The intervention consisted of monthly video conferences with a nurse via a tablet computer and lasted for 32 weeks. Regularly self-monitored measurements of blood sugar, blood pressure and weight were uploaded and visible to patient and nurse. Both groups were followed up six months after the end of the intervention period.

PRIMARY ENDPOINT

HbA1c after eight months.

RESULTS

Video conferences preceded by uploads of measurements as add-on to clinic-based care led to a significant reduction of HbA1c compared to that in standard care (0.69% vs 0.18%, P = 0.022). However, at six-month follow-up, the inter-group difference in HbA1c-reduction was no longer significant. Non-completers had higher HbA1c levels at baseline and a lower degree of education.

CONCLUSION

Video consultations preceded by uploading relevant measurements can lead to clinically and statistically significant improvements in glycemic control among patients who have not responded to standard regimens. However, continuing effort and attention are essential as the effect does not persist when intervention ends. Furthermore, future studies should focus on differentiation as the most vulnerable patients are at greater risk of non-adherence.

The effects of prospective mate quality on investments in healthy body weight among single women

This paper examines how a single female's investment in healthy body weight is affected by the quality of single males in her marriage market. A principle concern in estimation is the presence of market-level unobserved heterogeneity that may be correlated with changes in single male quality, measured as earning potential. To address this concern, we employ a differencing strategy that normalizes the exercise behaviors of single women to those of their married counterparts. Our main results suggest that when potential mate quality in a marriage market decreases, single black women invest less in healthy body weight. For example, we find that a 10 percentage point increase in the proportion of low quality single black males leads to a 5-10% decrease in vigorous exercise taken by single black females. Results for single white women are qualitatively similar, but not consistent across specifications. These results highlight the relationship between male and female human capital acquisition that is driven by participation in the marriage market. Our results suggest that programs designed to improve the economic prospects of single males may yield positive externalities in the form of improved health behaviors, such as more exercise, particularly for single black females.

Fit to WHO weight standard of European infants over time

OBJECTIVES

The 2006 WHO growth charts were created to provide an international standard for optimal growth, based on healthy, breastfed populations, but it has been suggested that Northern European children fit them poorly. This study uses infant weight data spanning 50 years to determine how well-nourished preschool children from different eras fit the WHO standard, and discuss the implications of deviations.

DESIGN

Four longitudinal datasets from the UK and one from Finland were used comprising over 8000 children born between 1959 and 2003. Weights from birth to 2 years were converted to age-sex-adjusted Z scores using the WHO standard and summarised using Generalized Additive Models for Location, Scale and Shape.

RESULTS

Weights showed a variable fit to the WHO standard. Mean weights for all cohorts were above the WHO median at birth, but dipped by up to 0.5 SD to a nadir at 8 weeks before rising again. Birth weights increased in successive cohorts and the initial dip became slightly shallower. By age 1 year, cohorts were up to 0.75 SD above the WHO median, but there was no consistent pattern by era.

CONCLUSIONS

The WHO standard shows an acceptable, but variable fit for Northern European infants. While birth weights increased over time, there was, unexpectedly, no consistent variation by cohort beyond this initial period. Discrepancies in weight from the standard may reflect differences in measurement protocol and trends in infant feeding practice.

The relationship of social support with treatment adherence and weight loss in Latinos with type 2 diabetes

OBJECTIVE

Little is known about the effects of social support on weight loss in Latinos. This study determined whether sex moderated and treatment adherence mediated the association between social support and weight loss.

METHODS

Data from 278 Latino males and females with type 2 diabetes in the Intensive Lifestyle Intervention of the Look AHEAD trial were analyzed. Multivariable modeling tested for moderation and parallel multiple mediator modeling simultaneously tested the mediating effects of adherence to physical activity, diet, and session attendance on the relationship between baseline social support and percent weight loss at 1 year.

RESULTS

Social support for physical activity (having family and friends join in physical activity) was related to weight loss. Adherence to physical activity was related to both social support for physical activity and weight loss. Sex did not moderate these relationships. Adherence to physical activity completely mediated the relationship between social support for physical activity and weight loss.

CONCLUSIONS

Increasing companionship for physical activity may be an effective intervention strategy to promote behaviors important for weight loss among Latinos.

Weight status and bullying behaviors among Chinese school-aged children

This study was to examine the relationship between measured weight status and three experiences as victims, bullies and bully-victims. The participants were 10,587 Chinese school-aged students (girls: 5,527, boys: 5,060) who ranged in age from 7 to 18 years old. Height and weight were measured. Bullying behavior was obtained by one-to-one interview in 7-10 years older students and group-administered surveys in 11-18 years older students. The results showed that, obese girls were more likely to be victimized (OR=1.73, CI: 1.16-2.59) compared to normal students. For boys, obesity was not associated with victimization, but obese boys (OR=1.45, CI: 1.04-2.03), especially 7-13 years old boys (OR=1.98, CI: 1.35-2.90) were more likely to bully others; obese boys also were more likely to be victim/bullies (OR=1.67, CI: 1.05-2.64). Weight victimization in Chinese school-aged children is not as common as in the west countries, but obese girls clearly realize more victimization, and obese younger boys show obvious aggression. Related departments should provide specific intervention for school bullying according students' weight status, age and gender.

Do ethnic differences in cord blood leptin levels differ by birthweight category? Findings from the Born in Bradford cohort study

BACKGROUND

There is evidence that South Asian individuals have higher fat mass for a given weight than Europeans. One study reported that the greater fatness for a given birthweight may increase with increasing birth weight, suggesting that any attempt to increase mean birth weight in South Asians would markedly increase their fatness.

OBJECTIVE

Our objective was to examine whether differences in cord leptin values between White British and Pakistani infants vary by birth weight category.

METHOD

We examined the difference in cord leptin levels between 659 White British and 823 Pakistani infants recruited to the Born in Bradford cohort study, by clinical categories and thirds of the birth weight distribution.

RESULTS

Pakistani infants had a lower mean birthweight but higher cord leptin levels than White British infants [ratio of geometric mean(RGM) of cord leptin adjusted for birth weight = 1.36 (95% CI 1.26,1.46)]. Birthweight was positively associated with cord leptin levels in both groups, with no evidence that the regression lines in the two groups diverged from each other with increasing birthweight.The relative ethnic difference in cord leptin was similar in low (<2500 g), normal and high (≥4000 g) birthweight infants(P-value for interaction = 0.91). It was also similar across thirds of the birthweight distribution [RGM (95% CI) in lowest, mid and highest thirds were 1.37 (1.20, 1.57), 1.36 (1.20, 1.54) and 1.31 (1.16, 1.52), respectively, P-interaction = 0.51].

CONCLUSIONS

We found marked differences in cord leptin levels between Pakistani and White British infants but no evidence that this difference increases with increasing birthweight.

Ethnic/racial disparities in adolescents' home food environments and linkages to dietary intake and weight status

Research is needed to confirm that public health recommendations for home/family food environments are equally relevant for diverse populations. This study examined ethnic/racial differences in the home/family environments of adolescents and associations with dietary intake and weight status. The sample included 2374 ethnically/racially diverse adolescents and their parents enrolled in coordinated studies, EAT 2010 (Eating and Activity in Teens) and Project F-EAT (Families and Eating and Activity in Teens), in the Minneapolis/St. Paul metropolitan area. Adolescents and parents completed surveys and adolescents completed anthropometric measurements in 2009-2010. Nearly all home/family environment variables (n=7 of 8 examined) were found to vary significantly across the ethnic/racial groups. Several of the home/family food environment variables were significantly associated with one or more adolescent outcome in expected directions. For example, parental modeling of healthy food choices was inversely associated with BMI z-score (p=0.03) and positively associated with fruit/vegetable consumption (p<0.001). Most observed associations were applicable across ethnic/racial groups; however; eight relationships were found to differ by ethnicity/race. For example, parental encouragement for healthy eating was associated with lower intake of sugar-sweetened beverages only among youth representing the White, African American, Asian, and mixed/other ethnic/racial groups and was unrelated to intake among East African, Hispanic, and Native American youth. Food and nutrition professionals along with other providers of health programs and services for adolescents should encourage ethnically/racially diverse parents to follow existing recommendations to promote healthy eating such as modeling nutrient-dense food choices, but also recognize the need for cultural sensitivity in providing such guidance.

Physical characteristics associated with weight misperception among overweight and obese men: NHANES 1999-2006

OBJECTIVES

The purpose of this study was to (1) determine the prevalence of weight misperception among overweight and obese men with total body fat levels ≥ 25%, and (2) examine associations of weight misperception with anthropometric and body composition measures.

METHODS

Data came from 4,200 overweight or obese men from the 1999 to 2006 National Health and Nutrition Examination Survey. Weight misperception was operationalized as having a dual-energy X-ray absorptiometry-derived total body fat percentage ≥25% and classifying oneself as either "underweight" or "about right weight." Logistic regression was used to determine physical characteristics associated with weight misperception.

RESULTS

Weight misperception was highest among Mexican American (35.9%) followed by Black (30.8%) and White men (22.9%). Physical characteristics (OR, 95% CI) associated with weight misperception were decreased arm fat (0.95, 0.91-0.98), being overweight (9.02, 5.34-15.24), and having a waist circumference ≤ 94 cm (2.31, 1.72-3.09).

CONCLUSIONS

Findings suggest that future research should include a measure of adiposity in the operationalization of weight misperception among male populations.

Factors Associated with Underestimation of Weight Status among Caucasian, Latino, Filipino, and Korean Americans--DiLH Survey

OBJECTIVE

To describe weight misperception and to examine the influence of sociodemographic factors on underestimation of weight status in Caucasian, Latino, Filipino, and Korean Americans.

DESIGN

Data from 886 non-pregnant adults who participated in a cross-sectional survey administered in English, Spanish, and Korean were analyzed. The actual weight status derived from the participants' body mass index (BMI) categories and their perceived weight status were compared. A multiple logistic regression model was used to explore if underestimation of weight status was associated with ethnicity, sex, and education level.

RESULTS

Caucasians, Latinos, Filipinos, and Koreans represented 19.4%, 26.8%, 27.4%, and 26.4%, respectively, of the total sample of 886. Overall, two in three participants correctly perceived their weight status, but 42% of Latinos underestimated their weight status and 22% of Koreans overestimated their weight status. Latino ethnicity, male, and low education (high school) were related to greater underestimation of weight status (P < .05). In contrast, Korean ethnicity was related to less underestimation of weight status (P < .05).

CONCLUSIONS

Misperception of weight status should be counted in any efforts to develop a weight management intervention for Latino and Korean Americans.

Asian American mothers' perception of their children's weight: a comparison with other racial/ethnic groups in Los Angeles

OBJECTIVE

While mother's perception of child's weight is important for the success of early childhood obesity prevention programs, few studies have examined that of Asian Americans. Our study examined their perception and compared it to that of mothers of other racial/ethnic groups.

DESIGN

Cross-sectional study of 2,051 randomly selected mothers of children aged 2-5 years living in Los Angeles County who were enrolled in the Special Supplemental Nutrition Program for Women Infants and Children (WIC).

MAIN OUTCOME MEASURE

The primary outcome was mother's perception of child's weight.

RESULTS

We found that Asian American mothers were 2.12 (95% CI: 1.27-3.54) times as likely as Hispanic mothers to accurately perceive their children's weight, adjusting for child's age, sex and birthweight, and mother's age and education. However, this relationship disappeared after adjusting for mother's BMI. We did not find differences in perception of child's weight among non-Hispanic White, non-Hispanic Black and Hispanic mothers.

CONCLUSION

It appears that Asian American mothers' increased accurate perception of child's weight status can be partially explained by their lower prevalence of obesity. Our findings suggest that early childhood obesity prevention programs should consider the weight status of mothers.

Accuracy of self-reported versus measured weight over adolescence and young adulthood: findings from the national longitudinal study of adolescent health, 1996-2008

Many studies rely on self-reports to capture population trends and trajectories in weight gain over adulthood, but the validity of self-reports is often considered a limitation. The purpose of this work was to examine long-term trajectories of self-reporting bias in a national sample of American youth. With 3 waves of data from the National Longitudinal Study of Adolescent Health (1996-2008), we used growth curve models to examine self-reporting bias in trajectories of weight gain across adolescence and early adulthood (ages 13-32 years). We investigated whether self-reporting bias is constant over time, or whether adolescents become more accurate in reporting their weight as they move into young adulthood, and we examined differences in self-reporting bias by sex, race/ethnicity, and attained education. Adolescent girls underreported their weight by 0.86 kg on average, and this rate of underreporting increased over early adulthood. In contrast, we found no evidence that boys underreported their weight either in adolescence or over the early adult years. For young men, self-reports of weight were unbiased estimates of measured weight among all racial/ethnic and educational subpopulations over adolescence and early adulthood.

Accuracy of mothers' perceptions of their child's weight status

The study examined the accuracy of maternal-perceived child weight. Urban affluent mothers of 111 children aged 2-5 years were recruited. Nearly a quarter of mothers overestimated their underweight child as normal weight and all overweight/obese children were perceived as normal weight. Mothers, therefore, were unable to recognize their child's true weight status.

A mixed ecologic-cohort comparison of physical activity & weight among young adults from five populations of African origin

BACKGROUND

Examination of patterns and intensity of physical activity (PA) across cultures where obesity prevalence varies widely provides insight into one aspect of the ongoing epidemiologic transition. The primary hypothesis being addressed is whether low levels of PA are associated with excess weight and adiposity.

METHODS

We recruited young adults from five countries (500 per country, 2500 total, ages 25-45 years), spanning the range of obesity prevalence. Men and women were recruited from a suburb of Chicago, Illinois, USA; urban Jamaica; rural Ghana; peri-urban South Africa; and the Seychelles. PA was measured using accelerometry and expressed as minutes per day of moderate-to-vigorous activity or sedentary behavior.

RESULTS

Obesity (BMI ≥ 30) prevalence ranged from 1.4% (Ghanaian men) to 63.8% (US women). South African men were the most active, followed by Ghanaian men. Relatively small differences were observed across sites among women; however, women in Ghana accumulated the most activity. Within site-gender sub-groups, the correlation of activity with BMI and other measures of adiposity was inconsistent; the combined correlation across sites was -0.17 for men and -0.11 for women. In the ecological analysis time spent in moderate-to-vigorous activity was inversely associated with BMI (r = -0.71).

CONCLUSION

These analyses suggest that persons with greater adiposity tend to engage in less PA, although the associations are weak and the direction of causality cannot be inferred because measurements are cross-sectional. Longitudinal data will be required to elucidate direction of association.

The role of weight, race, and health care experiences in care use among young men and women

OBJECTIVE

Increases in overweight and obesity (O/O)-related morbidities and health care costs raise questions about how weight influences patients' health care use and care experiences. Past research has been inconsistent; however, prior study designs and samples have limited exploration of how this association might be influenced by gender, race, and the joint impact of these factors.

METHODS

This analysis of 1,036 young, relatively healthy, ethnically diverse, insured adults assessed the influence of O/O, gender, and race on, and the role of health care experiences in primary and preventive care use over a 12-month period.

RESULTS

The association of weight status with care use differed by gender. O/O men used more primary care visits; O/O women used fewer preventive care visits than their healthy weight counterparts. O/O men had poorer health care experiences than healthy weight men. African-American women reported poorer experiences, but those who were O/O reported greater trust in their provider. Care experience ratings did not explain the associations between BMI and care use.

CONCLUSIONS

Gender, race, and visit type together provide a context for O/O patient's care that may not be explained by care experiences. This context must be considered in efforts to encourage appropriate use of services.

Nurses' misperceptions of weight status associated with their body weight, demographics and health status

OBJECTIVE

To assess the agreement between self-perceived weight status and BMI status, calculated from self-reported height and weight, in nurses and to evaluate the relationship between weight status misperceptions and personal body weight, demographics and health status.

DESIGN

Cross-sectional questionnaire survey.

SETTING

A large university in London, UK.

SUBJECTS

Four hundred and fifty-six student nurses and 588 qualified nurses attending university were surveyed; 355 student nurses and 409 qualified nurses completed questionnaires representing a response rate of 78 % and 70 %, respectively.

RESULTS

The respondents were mainly female (90·0 %), 66·5 % were white and their mean age was 31 years. Sixty-eight per cent of qualified nurses and 77 % of student nurses correctly perceived their weight status. In logistic regression, (mixed) black ethnicity (OR = 2·53, 95 % CI 1·01, 6·32), overweight by BMI (OR = 3·10, 95 % CI 1·31, 7·33) and ≥3 family histories of obesity co-morbidities (OR = 2·51, 95 % CI 1·04, 6·08) were significantly associated with misperceptions in the sample of student nurses, whereas overweight by BMI (OR = 5·32, 95 % CI 2·66, 10·67) was the only significant variable in the sample of qualified nurses.

CONCLUSIONS

A substantial proportion of nurses misclassified their weight status. Nurses' misperception of weight status was related to their own BMI status, ethnic background and obesity-related family histories. Being aware of this may help nurses not only promote their own healthy weight, but also fulfil their public health role to practise weight management successfully with both patients and the public. While limitations of the sample mean that the study findings cannot be generalized, they do provide grounds for future larger-scale research.

How accurate are Americans' perceptions of their own weight?

As obesity/overweight has increased in the United States (Centers for Disease Control and Prevention, 2009 ), studies have found that Americans' perceptions of their own weight often are not aligned with their actual body mass index (BMI; Brener et al., 2004 ; Christakis, 2003; Johnson-Taylor et al., 2008 ). Taylor, Funk, and Craighill ( 2006 ) found that half of Americans whose BMI indicated they were overweight perceived their weight to be just about right. The purpose of this study was to examine factors that influence the accuracy of weight self-perceptions and whether accuracy influences health behaviors. Using data from the 2007 Health Information National Trends Survey, the authors compared respondents' weight self-perceptions to their actual BMI to determine the accuracy of their weight self-perceptions. About 28%of respondents were obese, 35%were overweight, 35%were of normal weight, and 2%were underweight. About three quarters of the sample's self-perceptions of weight were aligned with their BMI. About 10%of the sample had a BMI that indicated they were overweight, but they perceived themselves to be of normal weight; about 10%were of normal weight but perceived themselves to be overweight; and about 5%of respondents were of normal weight but thought they were underweight. Gender, race, and education were associated with the accuracy of respondents' weight perceptions. Results suggest that asking patients about their weight self-perceptions could be useful in clinical settings and that weight perception accuracy could be used to segment audiences and tailor messages.

An examination of postpartum African American adolescents' sociocultural beliefs, perceptions of body weight, and weight control behaviors

Obesity presents a public health challenge and is a serious chronic medical condition that is associated with multiple co-morbidities and reduced survivability/longevity. African American adolescents who retain weight after pregnancy are at the highest risk of becoming obese adults. Obesity is associated with 300,000 deaths per year and expected to cost the US. health care system over 237 million dollars within the next decade. The prevalence of obesity is cause for concern because of its economic costs and its toll in human suffering due to related morbidity and mortality. This study seeks to understand the meaning or essence of the lived experience of obesity among postpartum African American adolescents based on a literature review indicating the need for such a qualitative research. Understanding the influence of their developmental stage, sociocultural perceptions, and perceptions of postpartum weight retention could help develop population-specific interventions that could reduce the health risk of obesity.

The importance of campaign saliency as a predictor of attitude and behavior change: A pilot evaluation of social marketing campaign Fat Talk Free Week

Fat Talk Free Week (FTFW), a social marketing campaign designed to decrease self-disparaging talk about body and weight, has not yet been evaluated. We conducted a theory-informed pilot evaluation of FTFW with two college samples using a pre- and posttest design. Aligned with the central tenets of the Elaboration Likelihood Model (ELM), we investigated the importance of FTFW saliency as a predictor of fat talk behavior change. Our analytic sample consisted of 118 female participants (83% of original sample). Approximately 76% of the sample was non-Hispanic White, 14% Asian, and 8% Hispanic. At baseline, more than 50% of respondents reported engaging in frequent self fat talk; at posttest, this number dropped to 34% of respondents. Multivariable regression models supported campaign saliency as the single strongest predictor of a decrease in self fat talk. Our results support the social diffusion of campaign messages among shared communities, as we found significant decreases in fat talk among campaign attenders and nonattenders. FTFW may be a promising short-term health communication campaign to reduce fat talk, as campaign messages are salient among university women and may encourage interpersonal communication.

Weight discrepancy and body appreciation among women in Poland and Britain

Previous studies have suggested that the process of transmigration has detrimental effects on the body image of migrants relative to women in the country of origin. In the present work, we examined the body image of Polish migrants in Britain (n=153), Polish women in Poland (n=153), and a comparison group of British White women (n=110). Participants completed a measure of actual-ideal weight discrepancy and the Body Appreciation Scale (BAS). Contrary to hypotheses, our results showed that Polish women in Poland had significantly higher weight discrepancy than their counterparts in Britain. Further analyses showed that the BAS reduced to two dimensions among Polish participants, with Polish participants in Poland having significantly lower body appreciation than Polish migrants. We suggest that the sociocultural changes that have taken place in Eastern Europe may place women in that region at relatively high risk for developing negative body image.

Race/ethnicity-specific associations of urinary phthalates with childhood body mass in a nationally representative sample

BACKGROUND

Phthalates have antiandrogenic effects and may disrupt lipid and carbohydrate metabolism. Racial/ethnic subpopulations have been documented to have varying urinary phthalate concentrations and prevalences of childhood obesity.

OBJECTIVE

We examined associations between urinary phthalate metabolites and body mass outcomes in a nationally representative sample of U.S. children and adolescents.

METHODS

We performed stratified and whole-sample cross-sectional analyses of 2,884 children 6-19 years of age who participated in the 2003-2008 National Health and Nutrition Examination Survey. Multivariable linear and logistic analyses of body mass index z-score, overweight, and obesity were performed against molar concentrations of low-molecular-weight (LMW), high-molecular-weight (HMW), and di-2-ethylhexylphthalate (DEHP) metabolites, controlling for sex, television watching, caregiver education, caloric intake, poverty-income ratio, race/ethnicity, serum cotinine, and age group. We used sensitivity analysis to examine robustness of results to removing sample weighting, normalizing phthalate concentrations for molecular weight, and examining different dietary intake covariates.

RESULTS

In stratified, multivariable models, each log unit (roughly 3-fold) increase in LMW metabolites was associated with 21% and 22% increases in odds (95% CI: 1.05-1.39 and 1.07-1.39, respectively) of overweight and obesity, and a 0.090-SD unit increase in BMI z-score (95% CI: 0.003-0.18), among non-Hispanic blacks. Significant associations were not identified in any other racial/ethnic subgroup or in the study sample as a whole after controlling for potential confounders, associations were not significant for HMW or DEHP metabolites, and results did not change substantially with sensitivity analysis.

CONCLUSIONS

We identified a race/ethnicity-specific association of phthalates with childhood obesity in a nationally representative sample. Further study is needed to corroborate the association and evaluate genetic/epigenomic predisposition and/or increased phthalate exposure as possible explanations for differences among racial/ethnic subgroups.

Describing differences in weight and length growth trajectories between white and Pakistani infants in the UK: analysis of the Born in Bradford birth cohort study using multilevel linear spline models

OBJECTIVE

To describe the growth pattern from birth to 2 years of UK-born white British and Pakistani infants.

DESIGN

Birth cohort.

SETTING

Bradford, UK.

PARTICIPANTS

314 white British boys, 383 Pakistani boys, 328 white British girls and 409 Pakistani girls.

MAIN OUTCOME MEASURES

Weight and length trajectories based on repeat measurements from birth to 2 years.

RESULTS

Linear spline multilevel models for weight and length with knot points at 4 and 9 months fitted the data well. At birth Pakistani boys were 210 g lighter (95% CI -290 to -120) and 0.5 cm shorter (-1.04 to 0.02) and Pakistani girls were 180 g lighter (-260 to -100) and 0.5 cm shorter (-0.91 to -0.03) than white British boys and girls, respectively. Pakistani infants gained length faster than white British infants between 0 and 4 months (+0.3 cm/month (0.1 to 0.5) for boys and +0.4 cm/month (0.2 to 0.6) for girls) and gained more weight per month between 9 and 24 months (+10 g/month (0 to 30) for boys and +30 g/month (20 to 40) for girls). Adjustment for maternal height attenuated ethnic differences in weight and length at birth, but not in postnatal growth. Adjustment for other confounders did not explain differences in any outcomes.

CONCLUSIONS

Pakistani infants were lighter and had shorter predicted mean length at birth than white British infants, but gained weight and length quicker in infancy. By age 2 years both ethnic groups had similar weight, but Pakistani infants were on average taller than white British infants.

Gender and socioeconomic status in relation to weight perception and weight control behavior in Korean adults

AIM

In Korea, obesity is more prevalent among men and lower socioeconomic groups. To explain this obesity disparity, we compared weight perception and weight control behavior across gender and socioeconomic status (SES).

METHODS

We analyzed data from 16,260 participants aged 20 years or older in a nationally representative cross-sectional survey. SES indicators included education and income levels. Weight under-perception was defined when participants considered themselves lighter than their measured BMI status. Either no active or inappropriate weight control (i.e., trying to gain weight in obese individuals) was considered to be unhealthy patterns. Multivariate prevalence ratios were calculated using log-binomial regressions.

RESULTS

Men had a higher prevalence of weight under-perception (24.5 vs. 11.9%) and unhealthy patterns of weight control behavior (57 vs. 40%) than women. Low education level was associated with weight under-perception (ptrend = 0.022 in men, ptrend < 0.001 in women). Both education and income levels were significantly associated with patterns of weight control behavior (for education: ptrend < 0.001 in men and women; for income: ptrend = 0.047 in men, ptrend < 0.001 in women).

CONCLUSION

Weight perception and weight control behavior significantly varied by gender and SES. Public actions should be directed toward improving perception and behavior of high-risk populations.

The association between daily calcium intake and sarcopenia in older, non-obese Korean adults: the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) 2009

Recent data suggest that variations in calcium intake may influence body weight and composition; however, the relationship between daily calcium intake and muscle mass has not been well established. The objective of this study was to assess the relationship between daily calcium intake and sarcopenia. We analyzed data for older adults (over 60 years) from the fourth Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2009. A total of 1339 Non-Obese (BMI between 18.5 and 25 kg/m²), older adults (592 men and 707 women) were enrolled. Dietary variables were assessed using a nutrition survey that used a 24-hour recall method. Daily calcium intake based on the consumption of each food item was calculated. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight less than 2 SD below the sex-specific mean for young adults. We found that daily calcium intake was negatively correlated with total body fat percentage and positively correlated with appendicular skeletal mass (p<0.001). Participants with sarcopenia appear to have significantly lower daily calcium intakes than participants without sarcopenia (p<0.001). The unadjusted prevalence of sarcopenia according to daily calcium intake tertiles were 6.3%, 4.3%, and 2.7% in tertiles 1, 2, and 3, respectively. After adjustment for age, sex, BMI, total energy intake, and lifestyle factors, compared with those in the lowest tertile of daily calcium intake, participants in the highest tertile had an odds ratio for sarcopenia of 0.295 (95% confidence interval, 0.087-0.768; p for trend = 0.014). We found that daily calcium intake, corrected for total energy intake and serum 25(OH)D status, was significantly lower in subjects with sarcopenia than in those without. Our results suggest a strong inverse association between daily calcium intake and sarcopenia in non-obese, older Korean adults.

Are nutrition knowledge, attitudes, and beliefs associated with obesity among low-income Hispanic and African American women caretakers?

The purposes of this descriptive study were to (1) describe nutrition knowledge, attitudes, beliefs (KAB), and self-efficacy among low-income African American and Hispanic women; (2) identify the associations these variables have on diet quality and weight status; (3) identify barriers to healthy eating. Data from three separate studies were combined and analyzed. The total sample included African Americans (N = 92) and Hispanics (N = 272). Descriptive statistics and bivariate analyses were used to identify associations between KAB and body mass index (BMI) and diet quality. The majority of African Americans had good knowledge in nutrition while Hispanics had fair knowledge. Attitudes toward eating a healthy diet were significantly associated with high fiber intake among African Americans and low fat consumption among Hispanics. A computed KAB score showed no significant relation to individuals' weight status or diet quality. However, attitudes and beliefs about healthy foods strongly correlated with participants' weight or diet consumption among Hispanics. The most common barrier to consuming a healthy diet reported by both groups was the cost of healthy foods. It is therefore recommended to address these variables when addressing obesity and poor dietary intake among low-income minority groups.

Underassessment of weight and weight management in patients with diabetes: one more reason in support of weight management advice

AIMS

The purpose of this study was to determine whether underassessment of weight affects weight management behaviors of overweight and obese individuals with diabetes and to determine whether weight management advice from health care professionals modifies the effect of underassessment of weight.

METHODS

Data (n=979) from the 2006 and 2008 National Health and Nutrition Examination Survey were analyzed. Multivariate logistic regression was used to identify factors associated with underassessment of weight, weight management behaviors, and receipt of weight management advice from health care professionals.

RESULTS

Underassessment of weight was common (26%). Men, overweight persons, Blacks and Hispanics were more likely to underassess their weight. Those who underassessed their weight were 53% less likely to report weight management behaviors, odds ratio 0.47 (95% CI=0.31-0.73). Weight management advice increased weight management behaviors among individuals who underassessed their weight, 3.49 (95% CI=1.70-7.18).

CONCLUSIONS

Underassessment of weight can negatively affect weight management behaviors of overweight and obese individuals with diabetes. Weight management advice from health care professionals is important, and can modify the effect of underassessment of weight on weight management behaviors in this high risk group.

Bright Start: Description and main outcomes from a group-randomized obesity prevention trial in American Indian children

The aim of the Bright Start study was to develop and test the effectiveness of a school environment intervention, supplemented with family involvement, to reduce excessive weight gain by increasing physical activity and healthy eating practices among kindergarten and first-grade American Indian children. Bright Start was a group-randomized, school-based trial involving 454 children attending 14 schools on the Pine Ridge Reservation in South Dakota. Children were followed from the beginning of their kindergarten year through the end of first grade. Main outcome variables were mean BMI, mean percent body fat, and prevalence of overweight/obese children. The goals of the intervention were to: increase physical activity at school to at least 60 min/day; modify school meals and snacks; and involve families in making behavioral and environmental changes at home. At baseline, 32% of boys and 25% of girls were overweight/obese. Although the intervention was not associated with statistically significant change in mean levels of BMI, BMI-Z, skinfolds or percentage body fat, the intervention was associated with a statistically significant net decrease of 10% in the prevalence of overweight. Intervention children experienced a 13.4% incidence of overweight, whereas the control children experienced a corresponding incidence of 24.8%; a difference of -11.4% (P = 0.033). The intervention significantly reduced parent-reported mean child intakes of sugar-sweetened beverages, whole milk, and chocolate milk. Changes in duration of school physical activity were not significant. Because obesity is the most daunting health challenge facing American Indian children today, more intervention research is needed to identify effective approaches.

Parity and Body Weight in the United States: Differences by Race and Size of Place of Residence

OBJECTIVE

In women, parity has been studied in relation to body weights. This study examined whether and how relationships between parity and body weight differ by race and size of place of residence, adjusting for sociodemographic factors (age, income, education, working status, and marital status) and health behaviors (alcohol consumption, birth control pills, diet, physical activity, and smoking).

RESEARCH METHODS AND PROCEDURES

A U.S. national sample of 3398 white and black women from the Third National Health and Nutrition Examination Survey was used to study the relationships using multiple linear regression analysis.

RESULTS

The parity-weight relationships varied by race and size of place of residence. After adjusting for the covariates, significant relationships between parity and body weight were found only in black women in metropolitan areas and white women in non-metropolitan areas. Compared with women with no children, white women with two children living in non-metropolitan areas tended to have lower BMIs, whereas black women in metropolitan areas with one or two children showed higher BMIs.

DISCUSSION

Overall, the parity-weight relationships in these groups of women were not strong or linear. The parity-weight relationships of black women in non-metropolitan areas warrant further examination.

Growth centile charts (anthropometric measurement) of Pakistani pediatric population

OBJECTIVE

To measure Anthropometric data (Height and Weight) of Pakistani school children (of different socioeconomic and cultural background) 3-16 year, to develop growth centile charts, based on the above measurement and to document obesity and stunting in Pakistani Paediatric population, based on the above measurement.

METHODS

A Cross-sectional study with multistage stratified sampling was done in a Nationwide project of Higher Education Commission (HEC, Ref no: 20-441/R&D/2008) to develop growth centile charts of Pakistani paediatric population. Study was conducted from 2006-2009. Children studying in private and government schools of the four provinces of Pakistan were included. Prior to starting the study permission from the principal of the respective school and parents was taken. A total of 12837 children with normal birth weight, complete immunization, no history of chronic infection from 36-192 months (3-16 year) were included. Heights (cms), weight (kg), for Body Mass Index (BMI) (kg/m2), 24 hour diet recall was obtained. All socioeconomic groups were included. Food records of the children were subjected to USDA food exchange list.

RESULTS

The average height (cms) of children was 139.11 +/- 18.44, average weight (kg) was 33.21 +/- 11.25 and average BMI was 16.76 +/- 3.22 kg/m2 (range from 11.3-41.98). The 95th centile according to CDC charts for the age groups 3-16 years were calculated. A total of 664 (5.1%) children were found to be obese. In the age group 3-5 years, > 5-10 year and > 10-16 year; 29 (8.1%), 272 (5.1%) and 363 (5.1%) were found to be obese, respectively. CDC height and weight in the three groups of Pakistani children > 3-5 year, > 5-10 year, > 10-16 year were at the 10-25 centile.

CONCLUSION

Overall, the prevalence of stunting was 14%. Height and weight was 10-25 centile of the CDC charts. Obesity was 5%. Pakistani centile charts of healthy children from Pakistan have been made.

Psychosocial correlates of weight maintenance among black & white adults

OBJECTIVES

To investigate (1) weight maintenance among black and white participants and (2) psychosocial correlates (eg, healthy eating barriers, self-efficacy, stress) of weight maintenance 18 months after behavioral weight-loss treatment.

METHODS

Linear and logistic regression examined weight change and unsuccessful weight maintenance (>5% weight gain) among 107 black and white adults.

RESULTS

After controlling for socio-demographics, differences in weight maintenance between ethnicities were not generally noted. Healthy eating barriers and stressful life events were associated with weight gain, P<.04.

CONCLUSIONS

Strategies to cope with stressful events and overcome barriers to eating healthfully are needed for weight maintenance among both ethnicities.

The body mass index of blacks and whites in the United States during the nineteenth century

Body mass index (BMI) values reflect the net balance between nutrition, work effort, and calories consumed to fight disease. Nineteenth-century prison records in the United States demonstrate that the BMI values of blacks and whites were distributed symmetrically; neither underweight nor obese individuals were common among the working class. BMI values declined throughout the nineteenth century. By modern standards, however, nineteenth-century BMIs were in healthy weight ranges, though the biological living standards in rural areas exceeded those in urban areas. The increase in BMIs during the twentieth century did not have its origin in the nineteenth century.