Effect of Different Obesity Phenotypes on Incidence of Chronic Kidney Disease in Tehranian Adults Lifestyle intervention in obese Arab women: a randomized controlled trial. The effectiveness of yoga to prevent diabetes mellitus type 2 Key Steps in Conducting Systematic Reviews for Underpinning Clinical Practice Guidelines: Methodology of the European Association of Urology. Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity among adults Effect of intensive lifestyle intervention on C-reactive protein in subjects with impaired glucose tolerance and obesity. Results from a randomized controlled trial with 5-year follow-up. Metformin in combination with structured lifestyle intervention improved body mass index in obese adolescents, but did not improve insulin resistance The effect of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women: a systematic review protocol Cardiorespiratory Fitness in Childhood and Adolescence Affects Future Cardiovascular Risk Factors: A Systematic Review of Longitudinal Studies Prevention of type 2 diabetes - where is the evidence? Prognostic implications for insulin-sensitive and insulin-resistant normal-weight and obese individuals from a population-based cohort. A Systematic Review of Loneliness and Common Chronic Physical Conditions in Adults Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention Lifestyle changes followed by bariatric surgery lower inflammatory markers and the cardiovascular risk factors C3 and C4. Cold-activated brown adipose tissue in healthy men. Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity amongst children Prevention and Reduction of Obesity through Active Living (PROACTIVE): rationale, design and methods Defining Obesity Cut Points in a Multiethnic Population Consuming More of Daily Caloric Intake at Dinner Predisposes to Obesity. A 6-Year Population-Based Prospective Cohort Study Higher heart rate may predispose to obesity and diabetes mellitus: 20-year prospective study in a general population. Imagine HEALTH: results from a randomized pilot lifestyle intervention for obese Latino adolescents using Interactive Guided ImagerySM The 'Golden Keys' to health - a healthy lifestyle intervention with randomized individual mentorship for overweight and obesity in adolescents. Sources of evidence for systematic reviews of interventions in diabetes.
Background : The aim of this community-based study is to ascertain the effect of different obesity phenotypes on the incidence of chronic kidney disease in Iranian adults . Study Design : A prospect i ve cohort study , the Tehran Lipid Glucose Study ( TLGS ) . Setting and Participants : Adults aged ≥ 20 years with a mean age of 40.38 years ( 54.8 % female ) who were free from chronic kidney disease ( CKD ) at baseline ( phase 1 ) and were followed up at 3 time stages ( phases 2 , 3 , and 4 ) for a mean duration of 9.4 years to assess the risk for CKD . Predictor : Obesity phenotypes . Outcome : Incidence of chronic kidney disease . Measurements : Glomerular filtration rate ( GFR ) was estimated from the simplified equation developed using data from the Modification of Diet in Renal Disease ( MDRD ) Study . Results : CKD events occurred in 1162 participants . The prevalence of the 2 known obesity phenotypes ( metabolically obese normal weight [ MONW ] and metabolically healthy but obese [ MHO ] ) in the overall population was 3.5 % and 8.8 % , respectively . According to Kaplan-Meier curves , rates of freedom from CKD in the MHO and MONW obesity phenotypes were 75.3 % and 60.6 % , respectively ( p < 0.0001 ) . Age- and sex-adjusted ( model 1 ) hazard ratios for participants with MHO or MONW obesity phenotype were 1.14 ( 95 % confidence interval [ CI ] , 0.91–1.43 ) and 1.43 ( 95 % CI , 1.09–1.88 ) , respectively . After further adjustment for confounder variables ( model 2 ) , multivariate-adjusted hazard ratios for CKD for participants with MHO or MONW obesity phenotypes were 1.23 ( 95 % CI , 0.93–1.62 ) and 1.43 ( 95 % CI , 1.08–1.90 ) , respectively . Conclusion : Adults with the MONW obesity phenotype compared to those with MHO obesity phenotype have a higher risk for incidence of CKD . The results indicate that having a normal weight is not the only factor to protect against incidence of CKD BACKGROUND Few r and omized controlled trials on lifestyle interventions have been reported in non-Western population s ; none have been reported in Arab population s. METHODS From 2 Muslim Arab communities in Israel , obese , nondiabetic women aged 35 to 54 years with 1 or more components of the metabolic syndrome were r and omized to either an intensive ( n = 100 ) or a moderate ( control ) ( n = 101 ) 12-month lifestyle intervention . Women in the intensive intervention had 11 individual and 11 group counseling sessions per year with a dietitian and 22 physical activity group sessions per year . Women in the moderate intervention had 3 individual and 2 group dietary counseling sessions per year and no guided physical activity . Cultural issues were addressed in the design and conduct of both interventions . The primary outcome measure was change in the metabolic syndrome and its components . RESULTS At 12 months , the intensive intervention group had median declines of 3.0 mg/dL ( to convert to millimoles per liter , multiply by 0.0555 ) in fasting plasma glucose and 4.5 mg/dL ( to convert to millimoles per liter , multiply by 0.0113 ) in triglyceride levels compared with median increases of 1 mg/dL in fasting plasma glucose and 5.8 mg/dL in triglyceride levels in the moderate intervention group ( P = .01 and P = .02 , respectively ) . The median waist circumference decreased by 5.4 cm in the intensive intervention group and by 3.1 cm in the moderate intervention group ( P = .10 ) . The prevalence of the metabolic syndrome decreased by 4.0 % in the intensive intervention group and increased by 5.2 % in the moderate intervention group ( P = .12 ) . CONCLUSION The 12-month culturally sensitive intensive lifestyle intervention was effective in improving some of the metabolic syndrome components in obese Arab women . Trial Registration clinical trials.gov Identifier : NCT00273572 Background : Type 2 diabetes mellitus ( T2DM ) is becoming a leading problem worldwide . Emerging reports reveal alarming evidence of increasing prevalence of T2DM that has reached p and emic levels . Despite the significant incidence , there are limited reliable data re sources and comprehensive systematic review and meta- analysis on the effects of yoga on people who are a prediabetic or high risk for developing T2DM . Objective : The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the effects of yoga on people who are prediabetes or high risk of developing T2DM . Methods : The articles enrolled in the study will be retrieved from the online data bases between 2002 and the date the search es are executed . The search es will be repeated just before the final analyses and further relevant studies for inclusion . We will conduct a bibliographic search in data bases : Medline / PubMed , Scopus , Cochrane Library , EBSCO , and IndMED using keywords including prediabetes state , high risk for diabetes , metabolic syndrome , and yoga . A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies . This study protocol was prepared according to the Preferred Reporting Items for Systematic Review s and Meta- Analysis for Protocol s 2015 guidelines . There will be no language restrictions . Ethics and dissemination : The proposed study will be based on published studies and publicly available anonymized data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee . We published an outline of the protocol in the International Prospect i ve Register of Systematic Review s ( PROSPERO ) in 2018 . We plan to disseminate the findings of this systematic review and meta- analysis through publication in a peer- review ed journal and presentation at relevant conference proceedings . In addition , we believe the results of the systematic review will have implication s for policy and practice . We will prepare policymaker summary using a vali date d format , disseminate through social media and email discussion groups . Review registration number : PROSPERO registration number CRD CONTEXT The findings of systematic review s ( SRs ) and meta-analyses ( MAs ) are used for clinical decision making . The European Association of Urology has committed increasing re sources into the development of high quality clinical guidelines based on such SRs and MAs . OBJECTIVE In this paper , we have summarised the process of conducting SRs for underpinning clinical practice guidelines under the auspices of the European Association of Urology Guidelines Office . EVIDENCE ACQUISITION The process involves explicit methods and the findings should be reproducible . When conducting a SR , the essential first step is to formulate a clear and answerable research question . An extensive literature search lays the foundation for evidence synthesis . Data are extracted independently by two review ers and any disagreements are resolved by discussion or arbitration by a third review er . EVIDENCE SYNTHESIS In SRs , data for particular outcomes in individual r and omised controlled trials may be combined statistically in a meta- analysis to increase power when the studies are similar enough . Biases in studies included in a SR/MA can lead to either an over estimation or an under estimation of true intervention effect size , result ing in heterogeneity in outcome between studies . A number of different tools are available such as Cochrane Risk of Bias assessment tool for r and omised controlled trials . In circumstances where there is too much heterogeneity , or when a review has included nonr and omised comparative studies , it is more appropriate to conduct a narrative synthesis . The GRADE tool for assessing quality of evidence strives to be a structured and transparent system , which can be applied to all evidence , regardless of quality . A SR not only identifies , evaluates , and summarises the best available evidence , but also the gaps to be targeted by future studies . CONCLUSIONS SRs and MAs are integral in developing sound clinical practice guidelines and recommendations . PATIENT SUMMARY Clinical practice guidelines should be evidence based , and systematic review s and meta-analyses are essential in their production . We have discussed the key steps of conducting systematic review s and meta-analyses in this paper Background Socioeconomic inequalities in obesity and associated risk factors for obesity are widening throughout developed countries worldwide . Tackling obesity is high on the public health agenda both in the United Kingdom and internationally . However , what works in terms of interventions that are able to reduce inequalities in obesity is lacking . Methods / Design The review will examine public health interventions at the individual , community and societal level that might reduce inequalities in  obesity among adults aged 18 years and over , in any setting and in any country . The following electronic data bases will be search ed : MEDLINE , EMBASE , CINAHL , PsycINFO , Social Science Citation Index , ASSIA , IBSS , Sociological Abstract s , and the NHS Economic Evaluation Data base . Data base search es will be supplemented with website and gray literature search es . No studies will be excluded based on language , country or publication date . R and omized and non-r and omized controlled trials , prospect i ve and retrospective cohort studies ( with/without control groups ) and prospect i ve repeat cross-sectional studies ( with/without control groups ) that have a primary outcome that is a proxy for body fatness and have examined differential effects with regard to socioeconomic status ( education , income , occupation , social class , deprivation , poverty ) or where the intervention has been targeted specifically at disadvantaged groups or deprived areas will be included . Study inclusion , data extraction and quality appraisal will be conducted by two review ers . Meta- analysis and narrative synthesis will be conducted . The main analysis will examine the effects of 1 ) individual , 2 ) community and 3 ) societal level public health interventions on socioeconomic inequalities in adult obesity . Interventions will be characterized by their level of action and their approach to tackling inequalities . Context ual information on how such public health interventions are organized , implemented and delivered will also be examined . Discussion The review will provide evidence , and reveal any gaps in the evidence base , of public health strategies which reduce and prevent inequalities in the prevalence of obesity in adults and provide information on the organization , implementation and delivery of such interventions . Systematic review registration PROSPERO registration number : C-reactive protein ( CRP ) is a marker of metabolic and cardiovascular disease . To study the effects of lifestyle on CRP in a high-risk population we conducted a r and omized controlled trial on 200 obese subjects ( BMI > 27 kg m(-2 ) ) with impaired glucose tolerance recruited from primary care setting s. They were r and omized to either a 1-month stay at a wellness centre focusing on diet , exercise and stress management ( intervention group ) or 30 - 60 min of oral and written information on lifestyle intervention ( control group ) . A significant reduction of CRP was observed after 1 month and 1 year in the intervention group . They reduced their CRP levels more than the control group 1 year after intervention ( p=0.004 ) . In conclusion lifestyle intervention can decrease CRP  in obese individuals with impaired glucose tolerance for up to 1 year . Further research is needed to evaluate whether the CRP level reduction translates into a decreased risk for cardiovascular morbidity This study assessed the efficacy of adding metformin to a structured lifestyle intervention in reducing BMI in obese adolescents with insulin resistance . Obese adolescents ( 25 ) aged 10–16 years with a body mass index ( BMI ) > 95th percentile and insulin resistance ( Homeostasis Model Assessment —HOMA ) > 3.0 were assessed in a community clinic . A structured lifestyle intervention comprising nutritional and exercise education and motivational support in both individual and group sessions was delivered over 6 months . Subjects were r and omized to lifestyle intervention alone or with metformin ( 1500 g daily ) . The primary outcome measures were a change in BMI and modification of metabolic risk factors , including insulin resistance , plasma lipids and adipocytokines .  Eleven adolescents receiving lifestyle and metformin intervention and 14 receiving lifestyle alone completed the study .  BMI decreased by 1.8 kg/m2 with lifestyle and metformin but did not change with lifestyle alone . HOMA was significantly decreased in the lifestyle intervention group , but not following metformin , while the adiponectin/leptin ratio improved significantly in both groups . Dyslipidemic profiles improved most significantly with metformin . We conclude that metformin in combination with a 6-month structured lifestyle intervention is effective in reducing BMI in obese adolescents but did not improve insulin resistance . Lifestyle intervention , with or without metformin , improved metabolic risk factors such as plasma lipids and adipocytokines Review question / objective What are the effects of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women ? The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aim ed at limiting gestational weight gain and postpartum weight retention in women . The second objective of this systematic review is to investigate included intervention components with respect to effect on weight‐related outcomes . This may include , but is not limited to : length of intervention , use of face‐to‐face counselling , group or individual consultations , use of other interventions components including exercise , use of goals and use of support tools like food diaries , coaching , including email or text message support . Background Around half of all women of reproductive age are either overweight or obese,1,2,3 with women aged 25‐34 years having a greater risk of substantial weight gain compared with men of all ages.1,4 Excessive gestational weight gain ( GWG ) and postpartum weight retention ( PPWR ) may play a significant role in long term obesity . Having one child doubles the five‐ and 10‐year obesity incidence for women , with many women who gain excessive weight during pregnancy remaining obese permanently.5 Excessive GWG and /or PPWR can also significantly contribute to short‐ and long‐term adverse health outcomes for mother , baby and future pregnancies.6,7 Maternal obesity increases the risk of pregnancy related complications such as pre‐eclampsia , gestational diabetes mellitus , stillbirth and the rate of caesarean section.8 Childhood obesity is a further long term complication of maternal obesity for offspring , which may persist in to adulthood.9 Excess GWG is also a risk factor for PPWR both in the short and long‐term.10,11 Nehring et al. conducted a meta‐ analysis with over 65,000 women showing that , compared to women who gained weight within recommendations during pregnancy , women with GWG above Institute of Medicine weight gain recommendations , 12 retained an additional 3.1 kg and 4.7 kg after three and greater than or equal to 15 years postpartum , respectively.13 The health risk associated with PPWR is highlighted in a study of 151,025 Swedish women followed between 1992 and 2001.The study identified the risk of adverse pregnancy outcomes for those who gained three or more units of Body Mass Index ( kg/m2 ) between consecutive pregnancies ( an average of two years ) was much higher compared with women whose BMI changed from ‐1.0 and 0.9 units.14 Long‐term chronic disease risk may also be affected by PPWR as weight retention at the end of the first year post‐partum has been found to be a predictor of maternal overweight 15 years later.15With around 14‐20 % of women retaining 5 kg or more 12 months postpartum,16,5 the risk of developing conditions like diabetes , metabolic syndrome and cardiovascular disease may be increased.17 It becomes evident that interventions which aim to support attainment of healthy weight both in the antenatal and postpartum periods are key health priorities for women during this life stage . Lifestyle factors of overweight , having poor diet quality , and not undertaking enough moderate‐to‐vigorous physical activity are amongst the top five predictors of mortality in women.18 Additionally it is noted that , for many women , pregnancy and the postpartum period are associated with a reduction in physical activity.19 It is known that a combination of poor dietary choices , an increase in sedentary time and reduction in physical activity are all contributors to the development of overweight and obesity . With this in mind , current research has focused on lifestyle interventions to limit GWG and PPWR . Thangaratinam et al. review ed 44 r and omized controlled trials ( 7278 women ) where interventions including diet , physical activity or both were evaluated for their influence on maternal weight during  pregnancy.20 Results indicate that all were significantly effective in reducing GWG compared with the control group . More specifically , dietary interventions were the most effective in reducing weight gain , with a mean weight loss of ‐3.84 kg compared with ‐0.72 kg and ‐1.06 kg for physical activity and the mixed ( diet plus physical activity ) approach , respectively.20 This finding is supported by Hill and colleagues ' recent systematic review of theory based interventions to limit GWG.21 Included studies in this review reported an underpinning theory base and were classified as adopting a dietary , physical activity or mixed approach . Hill et al. concluded that studies which included a diet intervention were significantly more effective at limiting GWG.21 In 2011 Tanentsapf et al. review ed the effect of dietary interventions alone for reducing GWG in normal weight , overweight and obese pregnant women.22 This review analysed 13 r and omized controlled trials and quasi‐r and omized controlled trials with a dietary intervention to prevent excessive GWG in women . The review concluded that dietary interventions during pregnancy were effective in reducing GWG with an effect of ‐1.92 kg ( n=1434 ) compared with the control group.22 Tanentsapf et al. identified that trials differed in the conduct of the interventions with various diet and non‐diet related components utilised . Dietary approaches were highly variable with some trials focusing only on calorie restriction and others included additional target macronutrient distribution for intake . Some trials further provided feedback based on maternal weight gain guidelines .12 Interventions also varied in delivery method with a variety of modes used , including face‐to‐face , individual or group consultations and /or written correspondence . The frequency of communication , despite the type or mix , also changed from trial to trial with additional methods via telephone , posted material s , feedback or food diaries utilised . The inclusion of physical activity in addition to diet intervention was also common . Whilst the recent review by Tanentsapf et al.22 identified that dietary interventions are effective in reducing GWG , the review did not investigate the impact that different intervention components , delivery methods or dietary counselling approaches had on gestational weight management . It remains unclear as to which intervention components optimize GWG in women . The impact of lifestyle interventions has also been investigated in the postpartum period . The recent systematic review from van der Pligt et al. reported seven of 11 studies review ed were successful in limiting PPWR.23 As with studies aim ed at limiting GWG , interventions included in van der Pligt et al. 's review differed greatly in their conduct . Six of these seven studies included both dietary and physical activity components for the intervention , with the final successful study including a diet only intervention . Five of the successful studies recruited overweight or obese women only . Intervention time varied considerably in successful studies with some running for as little at ten days , and others up to six months . Bertz et al. demonstrated that their 12‐week behavior modification intervention which targeted diet alone or diet and exercise , including two individual sessions with a dietitian and physical therapist , provision of scales for weight self‐monitoring and bi‐weekly text messages was successful in achieving significant weight loss following the intervention , and sustained at one year.24 The diet intervention and the diet and exercise intervention  yielded significant weight loss compared to the control . Following 12 weeks a reduction of ‐8.3 + /‐ 4.2 kg for diet intervention and ‐6.9 + /‐ 3.0 kg for diet and exercise was observed . Additionally after one year , the diet intervention showed ‐10.2 + /‐ 5.7 kg reduction and ‐7.3 + /‐ 6.3 kg for the diet and exercise intervention (p<0.001).24 Colleran et al. also found significant weight change results by implementing a 16‐week intervention which consisted of weekly individual sessions with a dietitian regarding calorie restriction , two additional home visits regarding exercise , weekly food diary completion and email support.25 The intervention group had greater weight loss compared to the control group ( ‐5.8 kg + /‐ 3.5 kg vs ‐1.6 kg + /‐ 5.4 kg ) . It can be seen that various methods have been utilized in investigating the impact of diet and physical activity interventions on PPWR . The review by van der Pligt et al.23 highlights the impact successful lifestyle interventions can have on postpartum weight change . However , this review did not investigate the different intervention strategies utilized . It remains unclear as to the optimal setting , delivery method , diet strategy , contact frequency or intervention length to limit PPWR . Previous systematic review s for both GWG and PPWR have focused on the effectiveness of lifestyle interventions as a whole for weight management in pregnant and postpartum women.20,23 And despite Tanentsapf et al. 's focus on dietary interventions for GWG,22 much is still unknown about the effectiveness of differing diet interventions over the antenatal and postpartum period . Specifically , the impact of differing diet intervention strategies on maternal weight gain is not known . Firstly , this systematic review will focus on whether  weight management interventions which include a dietary component  are effective in pregnant and postpartum women . In addition to this , this review will investigate the different intervention strategies utilized and their effectiveness in maternal weight management . A search of systematic review protocol data bases has shown that there is no current review underway for this topic Background Although cardiorespiratory fitness ( CRF ) in childhood and adolescence may be linked to future cardiovascular health , there is currently limited evidence for a longitudinal association . Objectives To provide a systematic review on the prospect i ve association between CRF in childhood and adolescence and cardiovascular disease ( CVD ) risk factors at least 2 years later . Methods Using a systematic search of Medline , Embase , and SPORTD iscus , relevant articles were identified by the following criteria : generally healthy children and adolescents between 3 and 18 years of age with CRF assessed at baseline , and a follow-up period of ≥ 2 years . The outcome measures were CVD risk factors . We appraised quality of the included articles with STROBE and QUIPS checklists . Results After screening 7524 titles and abstract s , we included 38 articles , assessing 44,169 children and adolescents followed up for a median of 6 years . Eleven articles were of high quality . There was considerable heterogeneity in methodology , measurement of CRF , and outcomes , which hampered meta- analysis . In approximately half of the included articles higher CRF in childhood and adolescence was associated with lower body mass index ( BMI ) , waist circumference , body fatness and lower prevalence of metabolic syndrome in later life . No associations between CRF in childhood and adolescence and future waist-to-hip ratio , blood pressure , lipid profile , and glucose homeostasis were observed . Conclusion Although about half of the included articles reported inverse associations between CRF in childhood and adolescence and future BMI , body fatness , and metabolic syndrome , evidence for other CVD risk factors was unconvincing . Many articles did not account for important confounding factors such as adiposity . Recommendations for future research include st and ardizing the measurement of CRF , i.e. by reporting VO2max , using st and ardized outcome assessment s , and performing individual patient data meta-analyses Diabetes is an “ old disease ” . The first description of diabetes written on papyrus about 3500 years ago is found in the Ebers papyrus  , which was discovered in Egypt in 1873 by the German archeologist Georg Ebers . Humans , like most mammals , may develop diabetes , if sufficient environmental exposure to physical inactivity , unhealthy diet and obesity are present . Genetic effects are important for the individual risk of type 2 diabetes ( T2D ) but twin studies have shown that the genetic effects combined explain less than 50 % of the risk of T2D ( 1 ) . Today we know almost 100 susceptibility genes associated with T2D but the relative importance of each of these genes is low ( 2 ) , and together they explain only a small part of the disease risk . Thus , genetic screening can not be used for the prediction of T2D for individuals . On the other h and , healthy lifestyle can also prevent T2D in people who are genetically at high risk , e.g. those with positive family history ( 3 ) . Thus , the importance of lifestyle factors for the development and prevention of T2D is overwhelming . The strongest evidence in medicine is considered to come from r and omized controlled trials ( RCTs ) . They are also important in providing the link to causal inference that in most observational studies can not be derived . At the same time , observational studies are necessary for the identification of factors associated with an increased or decreased risk of a disease , and for generation of hypotheses on potential means for prevention based on modifiable risk factors . Observational studies have by now identified a large number of factors that are associated with the development of T2D or with the protection against it . Most of them are related to physical activity , diet and obesity . It has also been shown unequivocally that exposures ( poor nutrition , infections , smoking , etc . ) during fetal life and early infancy result ing in insufficient development ( often shown as low birth weight ) also predict T2D later in life ( 4 ) . Traditionally , T2D has been considered to be a disease of the elderly . However , with increasing obesity and sedentary lifestyle in children , there are increasing numbers of cases of T2D already occurring at a young age in many population s ( 5 ) . In the past two decades several innovative RCTs have repeatedly shown that interventions on modifiable risk factors can reduce the incidence of diabetes in high-risk groups . The evidence has been summarized in several systematic review s and meta-analyses ( 6,7 ) . There is compelling scientific evidence from RCTs that T2D can be prevented or its onset delayed . The key for prevention is a multimodal package of lifestyle changes that is a sum outcome of dietary and physical activity behaviours . The power of lifestyle was dramatically illustrated by the Finnish Diabetes Prevention Study ( DPS ) that explicitly showed that when the study participants with impaired glucose tolerance reached all five modest lifestyle intervention targets , none of them progressed to T2D ( 8) . Importantly , lifestyle intervention lasting for 3–6 years has been shown to have a carry-over effect on T2D incidence that lasts for several years ; up to 15 in the Finnish Diabetes Prevention Study ( 9 ) and 20 years in the China Da Qing Diabetes Prevention Study ( 10 ) . The observed sustained risk reduction seems to be a result of sustained lifestyle changes , but the legacy effect of improved glycaemia during the early intervention may also have contributed to the long-term effect . The follow-up data from the Chinese study indicate moreover that vascular risks are also reduced by lifestyle management . Several prognostic question naires exist for detecting people at risk of T2D ( 11 ) . One of the screening tools with an adequately high sensitivity and specificity is the Finnish Diabetes Risk Score ( FINDRISC ) developed in Finl and ( 12 ) . The FINDRISC has been successfully implemented in the Finnish primary health care system and used also in many other countries . The FINDRISC was also tested in the Omani population and as a result a slightly modified Omani Diabetes Risk Score was developed ( 13 ) which may be a suitable screening tool for the Arab population s in the Middle East . Lifestyle interventions aim ing at translating evidence from efficacy RCTs on T2D prevention into “ real world ” intervention programmes have also been carried out in various population s. Such data were recently combined in a meta- analysis considering the relationship between intervention effectiveness and adherence to guidelines ( 14 ) . The primary meta- analysis included 22 studies with outcome data for weight loss at 12 months . The pooled result of the direct pairwise meta- analysis shows that BACKGROUND There are few prospect i ve data on the prognosis of insulin-sensitive and insulin-resistant normal-weight ( NW ) or obese individuals . OBJECTIVES The estimated liver fat content , incidences of hyperglycemia and cardiovascular disease , and all-cause and cardiovascular mortality rates were investigated in a population -based cohort of 1658 individuals who were categorized according to BMI and insulin resistance as defined by HOMA-IR values ≥2.5 and the presence of metabolic syndrome . DESIGN This was a prospect i ve cohort study with a 9-y follow-up . Anthropometric values , blood pressure , and blood metabolic variables were measured , and information on vital status was collected from demographic files at follow-up . RESULTS A total of 137 of 677 NW individuals ( 20 % ) were classified as insulin resistant and normal weight ( IR-NW ) , and 72 of 330 obese individuals ( 22 % ) were classified as insulin sensitive and obese ( IS-obese ) . Incidences of diabetes , impaired fasting glucose , and cardiovascular events were 0.4 % , 6.3 % , and 3.3 % , respectively , in insulin-sensitive and normal-weight ( IS-NW ) individuals ( reference category ) ; 5.8 % , 10.2 % , and 6.6 % , respectively , in IR-NW individuals ; and 5.6 % , 8.3 % , and 8.3 % , respectively , in IS-obese individuals . In a multiple logistic regression model , risks of incident hyperglycemia and cardiovascular events increased in both groups compared with in the reference category [ HR ( 95 % CI ) : 2.54 ( 1.42 , 4.55 ) and 1.98 ( 0.86 , 4.54 ) in IR-NW subjects ; 2.16 ( 1.01 , 4.63 ) and 2.76 ( 1.05 , 7.28 ) in IS-obese subjects ] . The estimated liver fat content significantly increased during follow-up only in the IR-NW group in the same model . Cardiovascular mortality was 2 - 3-fold higher in IR-NW and IS-obese than in IS-NW individuals in a Cox regression model . CONCLUSIONS Our data refute the existence of healthy obese phenotypes because IS-obese individuals  showed increased cardiometabolic risk . The existence of unhealthy NW phenotypes is supported by their increased risk of incident hyperglycemia , fatty liver , cardiovascular events , and death Loneliness is a prevalent and global problem for adult population s and has been linked to multiple chronic conditions in quantitative studies . This paper presents a systematic review of quantitative studies that examined the links between  loneliness  and common chronic conditions including : heart disease , hypertension , stroke , lung disease , and metabolic disorders . A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness population s.  Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease , hypertension , stroke , and lung disease . The relationships among loneliness , obesity , and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons . Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions . Future longitudinal r and omized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care Objective Weight reduction improves several obesity-related health conditions . We aim ed to compare the effect of bariatric surgery and comprehensive lifestyle intervention on type 2 diabetes and obesity-related cardiovascular risk factors . Design One-year controlled clinical trial ( Clinical Trials.gov identifier NCT00273104 ) . Methods Morbidly obese subjects ( 19–66 years , mean ( s.d . ) body mass index 45.1 kg/m2 ( 5.6 ) , 103 women ) were treated with either Roux-en-Y gastric bypass surgery ( n=80 ) or intensive lifestyle intervention at a rehabilitation centre ( n=66 ) . The dropout rate within both groups was 5 % . Results Among the 76 completers in the surgery group and the 63 completers in the lifestyle group , mean ( s.d . ) 1-year weight loss was 30 % ( 8) and 8 % ( 9 ) respectively . Beneficial effects on glucose metabolism , blood pressure , lipids and low- grade inflammation were observed in both groups . Remission rates of type 2 diabetes and hypertension were significantly higher in the surgery group than the lifestyle intervention group ; 70 vs 33 % , P=0.027 , and 49 vs 23 % , P=0.016 . The improvements in glycaemic control and blood pressure were mediated by weight reduction . The surgery group experienced a significantly greater reduction in the prevalence of metabolic syndrome , albuminuria and electrocardiographic left ventricular hypertrophy than the lifestyle group . Gastrointestinal symptoms and symptomatic postpr and ial hypoglycaemia developed more frequently after gastric bypass surgery than after lifestyle intervention . There were no deaths . Conclusions Type 2 diabetes and obesity-related cardiovascular risk factors were improved after both treatment strategies . However , the improvements were greatest in those patients treated with gastric bypass surgery BACKGROUND Morbidly obese patients are at risk of developing insulin resistance and cardiovascular disease . Low- grade systemic inflammation is an important factor for this development . We evaluated the effect of bariatric surgery on markers of inflammation , coagulation and glucose metabolism . METHODS Ninety-seven morbidly obese patients and 17 lean subjects ( control group ) participated .  Anthropometric measurements  as well as  fasting blood sample s  were obtained at first admission , prior to surgery , and 1 year after surgery . RESULTS At admission , the morbidly obese group had significantly elevated levels of the complement components C3 and C4 compared to the lean control group ( P<0.0001 ) . Levels of C3 and C4 dropped significantly in the morbidly obese group over time ( P<0.0001 ) , and , 1 year after the operation , levels were comparable to those of the control group . The same changes were seen for markers of inflammation ( high-sensitivity C-reactive protein , tumor necrosis factor-α , interferon-γ , interleukin-1 receptor antagonist , IL-6 , and IL-13 ) , coagulation ( fibrinogen and plasminogen activator inhibitor-1 ) , and glucose metabolism ( leptin and insulin ) . There was a positive correlation between changes in C3 and body mass index , weight , coagulation parameters , inflammatory parameters , and leptin , respectively . CONCLUSIONS Bariatric surgery in morbidly obese patients  reduced weight effectively . Even more importantly , the increased levels of several risk factors associated with diabetes and cardiovascular co-morbidity normalized 1 year after surgery BACKGROUND Studies in animals indicate that brown adipose tissue is important in the regulation of body weight , and it is possible that individual variation in adaptive thermogenesis can be attributed to variations in the amount or activity of brown adipose tissue . Until recently , the presence of brown adipose tissue was thought to be relevant only in small mammals and infants , with negligible physiologic relevance in adult humans . We performed a systematic examination of the presence , distribution , and activity of brown adipose tissue in lean and obese men during exposure to cold temperature .  Brown-adipose-tissue activity was studied in relation to body composition and energy metabolism . METHODS We studied 24 healthy men--10 who were lean ( body-mass index [ BMI ] [ the weight in kilograms divided by the square of the height in meters ] , < 25 ) and 14 who were overweight or obese ( BMI , > or = 25)--under thermoneutral conditions ( 22 degrees C ) and during mild cold exposure ( 16 degrees C ) . Putative brown-adipose-tissue activity was determined with the use of integrated (18)F-fluorodeoxyglucose positron-emission tomography and computed tomography .  Body composition and energy expenditure were measured with the use of dual-energy x-ray absorptiometry and indirect calorimetry . RESULTS Brown-adipose-tissue activity was observed in 23 of the 24 subjects ( 96 % ) during cold exposure but not under thermoneutral conditions . The activity was significantly lower in the overweight or obese subjects than in the lean subjects ( P=0.007 ) . BMI and percentage of body fat both had significant negative correlations with brown adipose tissue , whereas resting metabolic rate had a significant positive correlation . CONCLUSIONS The percentage of young men with brown adipose tissue is high , but its activity is reduced in men who are overweight or obese . Brown adipose tissue may be metabolically important in men , and the fact that it is reduced yet present in most overweight or obese subjects may make it a target for the treatment of obesity Background There is growing evidence of the impact of overweight and obesity on short- and long-term functioning , health and well-being . Internationally , childhood obesity rates continue to rise in some countries ( for example , Mexico , India , China and Canada ) , although there is emerging evidence of a slowing of this increase or a plateauing in some age groups . In most European countries , the United States and Australia , however , socioeconomic inequalities in relation to obesity and risk factors for obesity are widening . Addressing inequalities in obesity , therefore , has a very high profile on the public health and health services agendas . However , there is a lack of accessible policy-ready evidence on what works in terms of interventions to reduce inequalities in obesity . Methods and design This article describes the protocol for a National Health Service Trust ( NHS ) National Institute for Health Research -funded systematic review of public health interventions at the individual , community and societal levels which might reduce socioeconomic inequalities in relation to obesity amongst children ages 0 to 18 years . The studies will be selected only if ( 1 ) they included a primary outcome that is a proxy for body fatness and ( 2 ) examined differential effects with regard to socioeconomic status ( education , income , occupation , social class , deprivation and poverty ) or the intervention was targeted specifically at disadvantaged groups ( for example , children of the unemployed , lone parents , low income and so on ) or at people who live in deprived areas . A rigorous and inclusive international literature search will be conducted for r and omised and nonr and omised controlled trials , prospect i ve and retrospective cohort studies ( with and /or without control groups ) and prospect i ve repeat cross-sectional studies ( with and /or without control groups ) . The following electronic data bases will be search ed : MEDLINE , Embase , CINAHL , PsycINFO , Social Science Citation Index , ASSIA , IBSS , Sociological Abstract s and the NHS Economic Evaluation Data base . Data base search es will be supplemented with website and grey literature search es . No studies will be excluded on the basis of language , country of origin or publication date . Study inclusion , data extraction and quality appraisal will be conducted by two review ers . Meta- analysis and narrative synthesis will be conducted . The main analysis will examine the effects of ( 1 ) individual , ( 2 ) community and ( 3 ) societal level public health interventions on socioeconomic inequalities in childhood obesity . Interventions will be characterised by their level of action and their approach to tackling inequalities . Context ual information on how such public health interventions are organised , implemented and delivered will also be examined . Discussion In this review , we consider public health strategies which reduce and prevent inequalities in the prevalence of childhood obesity , highlight any gaps in the evidence base and seek to establish how such public health interventions are organised , implemented and delivered . PROSPERO registration number : The Prevention and Reduction of Obesity through Active Living ( PROACTIVE ) is a r and omised controlled trial to evaluate the effectiveness of a behaviourally based physical activity and diet composition programme to prevent and reduce obesity and related comorbidities in a primary healthcare setting . 491 abdominally obese men and women 25–75 years of age who were patients of primary care physicians were r and omly assigned to either a usual care group ( N = 242 ) or a behavioural intervention group ( N = 249 ) . Those in usual care received general advice from the physician regarding the merits of physical activity and a healthy diet as a strategy for obesity reduction . Those in the behavioural intervention group received an individually design ed counselling programme from a specially trained health educator , with respect to physical activity , diet and obesity reduction . The study was design ed to provide 95 % power in both men and women to detect a 2 % ( 2 cm ) difference in waist circumference and 80 % power to identify a 15 % reduction in the prevalence of the metabolic syndrome , the two primary outcomes . PROACTIVE is the first behavioural intervention study to assess the effects of physical activity and diet on abdominal obesity and associated metabolic risk factors in a primary healthcare setting , include a generalised sample of men and women and examine long-term ( 24 months ) effects . PROACTIVE has the potential to provide the basis for changing clinical practice ( primary care ) with respect to the prevention and reduction of obesity and related health risks . The purpose of this report is to present and discuss the rationale , design and methods of PROACTIVE Background — Body mass index ( BMI ) is widely used to assess risk for cardiovascular disease and type 2 diabetes . Cut points for the classification of obesity ( BMI > 30 kg/m2 ) have been developed and vali date d among people of European descent . It is unknown whether these cut points are appropriate for non-European population s. We assessed the metabolic risk associated with BMI among South Asians , Chinese , Aboriginals , and Europeans . Methods and Results — We r and omly sample d 1078 subjects from 4 ethnic groups ( 289 South Asians , 281 Chinese , 207 Aboriginals , and 301 Europeans ) from 4 regions in Canada . Principal components factor analysis was used to derive underlying latent or “ hidden ” factors associated with 14 clinical and biochemical cardiometabolic markers . Ethnic-specific BMI cut points were derived for 3 cardiometabolic factors . Three primary latent factors emerged that accounted for 56 % of the variation in markers of glucose metabolism , lipid metabolism , and blood pressure . For a given BMI , elevated levels of glucose- and lipid-related factors were more likely to be present in South Asians , Chinese , and Aboriginals compared with Europeans , and elevated levels of the blood pressure – related factor were more likely to be present among Chinese compared with Europeans . The cut point to define obesity , as defined by distribution of glucose and lipid factors , is lower by ≈6 kg/m2 among non-European groups compared with Europeans . Conclusions — Revisions may be warranted for BMI cut points to define obesity among South Asians , Chinese , and Aboriginals . Using these revised cut points would greatly increase the estimated burden of obesity-related metabolic disorders among non-European population Background / Objectives It has been hypothesized that assuming most of the caloric intake later in the day leads to metabolic disadvantages , but few studies are available on this topic . Aim of our study was to prospect ively examine whether eating more of the daily caloric intake at dinner leads to an increased risk of obesity , hyperglycemia , metabolic syndrome , and non-alcoholic fatty liver disease  (  NAFLD ) . Subjects/ Methods 1245 non-obese , non-diabetic middle-aged adults from a population -based cohort underwent a 3-day food record question naire at enrollment . Anthropometric values , blood pressure , blood metabolic variables , and estimated liver fat were measured at baseline and at 6-year follow-up . Design Prospect i ve cohort study . Results Subjects were divided according to tertiles of percent daily caloric intake at dinner . A significant increase in the incidence rate of obesity ( from 4.7 to 11.4 % ) , metabolic syndrome ( from 11.1 to 16.1 % ) , and estimated NAFLD ( from 16.5 to 23.8 % ) was observed from the lower to higher tertile . In a multiple logistic regression model adjusted for multiple covariates , subjects in the highest tertile showed an increased risk of developing obesity ( OR = 2.33 ; 95 % CI 1.17–4.65 ; p = 0.02 ) , metabolic syndrome ( OR = 1.52 ; 95 % CI 1.01–2.30 ; p = 0.04 ) , and NAFLD ( OR = 1.56 ; 95 % CI 1.10–2.22 ; p = 0.01 ) . Conclusions Consuming more of the daily energy intake at dinner is associated with an increased risk of obesity , metabolic syndrome , and NAFLD BACKGROUND Emerging evidence indicates an association between sympathetic activation and metabolic syndrome . However , sympathetic activation in metabolic syndrome may be a cause , consequence , or just epiphenomenon . To eluci date this issue , the predictive power of resting heart rate for the development of abnormal glucose and lipid metabolisms after 20 years was evaluated in a general population . METHODS A total of 637 participants ( > 20 years old ) underwent a health examination in 1979 including measurements of blood chemistries . Resting heart rate ( bpm ) was measured by an electrocardiogram .  In 1999 , all of the study participants again underwent a health examination , including electrocardiogram and blood chemistries .  Because four of them had atrial fibrillation , and 19 subjects were taking antihypertensive medication in 1979 , they were excluded from analysis . Therefore , a complete data set of 614 subjects was available . RESULTS As was reported in our previous article , in 1999 we found a linear and significant ( P < 0.05 ) cross-sectional relationship between resting heart rate and a cluster of cardiometabolic risk factors ( blood pressure ( BP ) , free fatty acid ( FFA ) , plasma glucose , and homeostasis model assessment ( HOMA ) index ) . Baseline higher heart rate ( heart rate > or=80 bpm in 1979 ) predicted the development of obesity , diabetes mellitus ( DM ) , and insulin resistance in 1999 after adjustments for age , sex , and other confounders . CONCLUSION This is one of the first prospect i ve reports demonstrating that higher heart rate may predispose to the development of obesity and DM , suggesting that the sympathetic nerve system may play a role in the development of obesity and DM Background There is an urgent need for innovative and developmentally appropriate lifestyle interventions to promote healthy lifestyle behaviors and to prevent the early onset of type 2 diabetes and cardiovascular disease risk in obese Latino adolescents . Guided imagery offers promise to reduce stress and promote lifestyle behavior change to reduce disease risk in obese adolescents . Our objectives were : 1 ) To pilot test a new 12-wk lifestyle intervention using a r and omized trial design in obese Latino adolescents , in order to determine the effects of the mind-body modality of Interactive Guided ImagerySM ( IGI ) , over and above those of a didactic lifestyle education , on insulin resistance , eating and physical activity behaviors , stress and stress biomarkers ; and 2 ) To explore the role of intervention-related changes in stress and stress biomarkers on changes in metabolic outcomes , particularly insulin resistance . Methods Obese ( BMI > 95th percentile ) , Latino adolescents ( n = 35 , age 14 - 17 ) were r and omized to receive either 12 weekly sessions of a lifestyle education plus guided imagery program ( GI ) , or lifestyle education plus a digital storytelling computer program ( DS ) . Between-group differences in behavioral , biological , and psychological outcomes were assessed using unpaired T-tests and ANCOVA in the 29 subjects who completed the intervention . Results The GI group demonstrated significant reductions in leisure sedentary behavior ( p < .05 ) and increases in moderate physical activity ( p < .05 ) compared to DS group , and a trend toward reduced caloric intake in GI vs DS ( p = .09 ) . Salivary cortisol was acutely reduced by stress-reduction guided imagery ( p < .01 ) . There were no group differences in adiposity , insulin resistance , perceived stress , or stress biomarkers across the 12-week intervention , though decrease in serum cortisol over the course of the intervention was associated with improved insulin sensitivity ( p = .03 ) independent of intervention group and other relevant co-variates . Conclusions The improvements in physical activity and stress biomarkers following this pilot intervention support the role of guided imagery in promoting healthy lifestyle behavior change and reducing metabolic disease risk in obese Latino adolescent population s. Future investigations will be needed to determine the full effects of the Imagine HEALTH intervention on insulin resistance , stress , and stress biomarkers . Trial registration Clinical trials.gov Registry # : OBJECTIVE To conduct a pilot study design ed to measure the impact of a healthy lifestyle intervention with or without individualized mentorship on adiposity , metabolic profile , nutrition and physical activity in overweight teens . METHODS A total of 38 overweight adolescents ( body mass index above the 85th percentile ) 12 to 16 years of age , who were enrolled in a healthy lifestyle intervention program for six months , were r and omly assigned to a nonmentored or individualized mentored intervention . RESULTS For the entire cohort ( final n=32 ) , there was a nonstatistically significant reduction in mean ( ± SD ) body mass index z score ( 2.08±0.38 to 2.01±0.47 , P=0.07 ) and waist circumference ( 98±10 cm to 96±11 cm , P=0.08 ) , and significant improvements in high-density lipoprotein level ( 1.08±0.24 mmol/L to 1.20±0.26 mmol/L , P<0.001 ) , and low-density lipoprotein/high-density lipoprotein ratio ( 2.55±0.84 to 2.26±0.87 , P<0.001 ) from baseline to the end of the intervention . Subjects consumed fewer high-calorie foods ( 3.9±1.9 to 3.0±1.5 servings/day , P=0.01 ) and snacks ( 9.7±5.5 to 6.8±4.0 servings/day , P=0.02 ) , made fewer fast food restaurant visits ( 1.4±1.3 to 0.8±0.9 visits/week , P=0.02 ) , and had less screen time ( 8.3±3.8 to 6.9±3.6 h/day , P=0.01 ) . In addition , mentorship was found to be a feasible approach to supporting weight management in obese teens . Our study was underpowered to determine treatment effect , but promising modifications to lifestyle were observed despite the absence of statistically significant improvements in outcomes . CONCLUSIONS The healthy lifestyle intervention improved subjects ' lifestyles and lipid profiles , and the addition of mentorship in this context is feasible . A larger study with a longer intervention time is required to determine whether behavioural changes are associated with clinical improvement and to determine the role of mentorship in promoting lifestyle change AIMS To analyse the effect on systematic review s in diabetes interventions of including only trials that are indexed in medline , and to assess the impact of adding trials from other data bases and the grey literature . METHODS All systematic review s of diabetes interventions which included a meta- analysis of r and omized controlled trials , and were published since 1996 , were selected . The impact on the meta- analysis of including only those trials indexed in medline , and the effect of then adding trials from other sources , was assessed . Where possible this was measured quantitatively , by redoing the meta- analysis , otherwise a qualitative estimate was made . RESULTS Forty-four systematic review s met our inclusion criteria . There were 120 articles reporting trial data which were not indexed in medline . These came from 52 % of the review s. In 34 % of the review s , basing a meta- analysis on a search of only medline would miss trials that could affect the result . Sources of non- medline data which had the biggest effect on the meta-analyses were journal articles from central and embase ( mainly in Diabetes , Nutrition and Metabolism ) and unpublished data ( mainly from industry ) . The exceptions were journal articles on herbal medicine , mostly indexed in Chinese language data bases . CONCLUSIONS A search of only the medline data base is insufficient for systematic review s of diabetes , because in about 34 % of review s the missed trials could affect the results of the meta- analysis . It is recommended that central ( on the Cochrane Library ) also be search ed . Scanning meeting abstract s , and seeking unpublished data are also recommended if the intervention has only recently been introduced
Following intervention , there was certain and significant improvement of metabolic state for metabolically abnormal obesity ( MAO ) subjects .
Only diastolic blood pressure had reduced for MHO individuals after intervention .
Conclusions : Almost one-third of the obese individuals are in metabolic health .
However , they are still at higher risk of advancing to unhealthy state .
Background : We conducted a systematic review and meta- analysis to firstly obtain a reliable estimation of the prevalence of metabolically healthy obese ( MHO ) individuals in obesity , then assessed the risk of developing metabolic abnormalities ( MA ) among MHO individuals .
At last , we evaluated the effects of traditional lifestyle interventions on metabolic level for MHO subjects .