bluuebunny/crossref_metadata_2025 huggingface dataset:
Parent Overweight Predicts Daughters’ Increase in BMI and Disinhibited Overeating from 5 to 13 Years
Authors: Francis Lori A. , Ventura Alison K. , Marini Michele , Birch Leann L.
Published: July 2008

Objective: To assess whether parental overweight status and disinhibited overeating are predictive of daughters’ accelerated weight gain and disinhibited overeating.

Research Methods and Procedures: Participants were part of a longitudinal study of girls (N = 197) and their parents. Measured height and weight were used to calculate BMI [weight (kilograms)/height (meters)2]. Parents’ disinhibited eating behavior was assessed using the Eating Inventory. Girls’ disinhibited eating was assessed using a behavioral protocol to measure eating in the absence of hunger. Girls were classified based on parental overweight at study entry into four groups: neither, mother only, father only, or both parents overweight.

Results: Girls with both parents overweight had the most rapid increases in BMI from 5 to 13 years of age; BMI increased most slowly among the neither parent overweight group, with intermediate increases in BMI among mother only and father only overweight groups. Daughters with both parents overweight at study entry were eight times more likely to be overweight at age 13, controlling for daughters’ weight at age 5. Girls with both parents overweight had higher levels of disinhibited eating across all ages than all other groups. Although girls in all parental weight status groups showed increases in disinhibited eating over time, girls with both parents overweight had larger increases in disinhibited eating over time compared with all other groups.

Discussion: Girls growing up in families differing in parental overweight had divergent developmental trajectories for BMI and disinhibited overeating. Findings reveal the need to focus prevention efforts on overweight parents of young children.
Hispanic and Asian Pubertal Girls Have Higher Android/Gynoid Fat Ratio Than Whites
Authors: Novotny Rachel , Going Scott , Teegarden Dorothy , Van Loan Marta , McCabe George , McCabe Linda , Daida Yihe G. , Boushey Carol J. ,   The ACT Research Team
Published: July 2008

Objective: To examine differences in body size, composition, and distribution of body fat among Hispanic, white, and Asian adolescents.

Research Methods and Procedures: This included cross‐sectional data from the baseline sample of the Adequate Calcium Today trial. Participants included 180 Asian, 234 Hispanic, and 325 white girls 11.8 ± 0.05 years of age from Arizona, California, Hawaii, Indiana, Ohio, and Nevada. Anthropometric and DXA measurements (Lunar Prodigy) were standardized across sites. Tanner pubertal stage was self‐selected from line drawings. Physical activity was assessed by a validated questionnaire. Comparisons between ethnic groups were examined using contrasts in the context of a general linear model.

Results: Controlling for pubertal stage and study site only, Asians weighed less than Hispanics and were shorter than Hispanics and whites. Controlling for pubertal stage, height, weight, and study site, Asians had shorter leg lengths, smaller waist circumference, longer trunk lengths, more lean mass, less total fat mass, and less gynoid fat mass than Hispanics and whites; Asians had larger bitrochanteric width than whites; Asians had smaller DXA‐derived android fat mass than Hispanics; and whites had smaller mean android/gynoid fat ratio than Hispanics. However, whites had a smaller android/gynoid fat ratio than both Asians and Hispanics in a model that adjusted for ethnicity, pubertal stage, bitrochanteric width, waist circumference, trunk length, log of physical activity, and study site, which explained 77% of the variation.

Discussion: Ethnic differences in fat distribution are partially explained by differences in skeletal dimensions.
Abdominal Fat and Risk of Coronary Heart Disease in Patients with Peripheral Arterial Disease
Authors: Brouwer Beate G. , Visseren Frank L.J. , Stolk Ronald P. , van, Der Graaf Yolanda ,   For the SMART Study Group
Published: July 2008

Objective: We investigated whether the presence of concomitant coronary heart disease (CHD) in patients with peripheral arterial disease (PAD) can be explained by intra‐abdominal fat accumulation and compared different measures of adiposity as predictors of CHD in patients with PAD.

Research Methods and Procedures: Data were collected from patients enrolled in the Second Manifestations of ARTerial disease (SMART) study, an ongoing prospective cohort study of patients with manifest vascular disease or vascular risk factors at the University Medical Centre Utrecht. The current analysis includes 315 patients, mean age 59 ± 10 years, who had PAD with (n = 79) or without (n = 236) CHD. Parameters of adiposity were measured, and intra‐abdominal fat and subcutaneous fat were measured ultrasonographically. Metabolic syndrome was defined according to Adult Treatment Panel III.

Results: The prevalence of metabolic syndrome was higher among patients with CHD (63%) than among patients without CHD (48%). All parameters of adiposity indicated more fat in patients with CHD, except for subcutaneous fat. Waist circumference was associated with 64% higher prevalence of CHD (confidence interval, 20% to 123%) per 1 standard deviation increase in waist circumference after adjustment for age and sex. The odds ratio for waist circumference remained virtually the same after additional adjustment for the components of the metabolic syndrome and smoking.

Discussion: An increased waist circumference, a crude measure of intra‐abdominal fat, is associated with an increased risk of concomitant CHD in patients with PAD.
Common STAT3 Variants Are Not Associated With Obesity or Insulin Resistance in Female Twins
Authors: Jamshidi Yalda , Kyriakou Theodosios , Gooljar Sakina B. , Collins Laura J. , Lane Carl A. , Snieder Harold , Wang Xiaoling , Spector Tim D. , O'Dell Sandra D.
Published: July 2008

In animal models, STAT3 action in the hypothalamus and liver appears essential for normal body weight and glucose homeostasis in response to insulin. We hypothesized that variation in the STAT3 gene may be associated with body fat and/or insulin resistance in the general population. Five tagging SNPs spanning the STAT3 gene, rs8074524, rs2293152, rs2306580, rs6503695, and rs7211777 were genotyped in 2776 white female twins (mean age, 47.4 ± 12.5 yrs) from the St Thomas’ United Kingdom Adult Twin Registry (Twins UK). Minor allele frequencies were as follows: rs8074524 (0.19), rs2293152 (0.37), rs2306580 (0.06), rs6503695 (0.35), and rs7211777 (0.34). The minor allele of rs2293152 was associated with higher homeostasis model assessment index of insulin resistance (p = 0.013) in the full cohort and confirmed in sib‐transmission/disequilibrium test (TDT): (p = 0.015; n = 60). However, there were no associations with fasting serum insulin or glucose or with obesity variables. Although defective STAT3 action results in obesity and insulin resistance in animal models, we failed to establish any indicative associations with common SNPs in this human study.
Trans Fat Diet Induces Abdominal Obesity and Changes in Insulin Sensitivity in Monkeys
Authors: Kavanagh Kylie , Jones Kate L. , Sawyer Janet , Kelley Kathryn , Carr J. Jeffrey , Wagner Janice D. , Rudel Lawrence L.
Published: July 2008

Objective: There is conflicting evidence about the propensity of trans fatty acids (TFAs) to cause obesity and insulin resistance. The effect of moderately high intake of dietary monounsaturated TFAs on body composition and indices of glucose metabolism was evaluated to determine any pro‐diabetic effect in the absence of weight gain.

Research Methods and Procedures: Male African green monkeys (Chlorocebus aethiops; n = 42) were assigned to diets containing either cis‐monounsaturated fatty acids or an equivalent diet containing the trans‐isomers (∼8% of energy) for 6 years. Total calories were supplied to provide maintenance energy requirements and were intended to not promote weight gain. Longitudinal body weight and abdominal fat distribution by computed tomography scan analysis at 6 years of study are reported. Fasting plasma insulin, glucose, and fructosamine concentrations were measured. Postprandial insulin and glucose concentrations, and insulin‐stimulated serine/threonine protein kinase (Akt), insulin receptor activation, and tumor necrosis factor‐α concentrations in subcutaneous fat and muscle were measured in subsets of animals.

Results: TFA‐fed monkeys gained significant weight with increased intra‐abdominal fat deposition. Impaired glucose disposal was implied by significant postprandial hyperinsulinemia, elevated fructosamine, and trends toward higher glucose concentrations. Significant reduction in muscle Akt phosphorylation from the TFA‐fed monkeys suggested a mechanism for these changes in carbohydrate metabolism.

Discussion: Under controlled feeding conditions, long‐term TFA consumption was an independent factor in weight gain. TFAs enhanced intra‐abdominal deposition of fat, even in the absence of caloric excess, and were associated with insulin resistance, with evidence that there is impaired post‐insulin receptor binding signal transduction.
Baroreflex Sensitivity in Obesity: Relationship With Cardiac Autonomic Nervous System Activity
Authors: Skrapari Ioanna , Tentolouris Nicholas , Perrea Despoina , Bakoyiannis Christos , Papazafiropoulou Athanasia , Katsilambros Nicholas
Published: July 2008

Objective: The aim of this study was to test the hypothesis that baroreflex sensitivity (BRS), assessed by indirect measurement of aortic pressure, is blunted in obesity. Additionally, the potential effect of cardiac autonomic nervous system (ANS) activity, aortic compliance, and metabolic parameters on BRS of obese subjects was investigated.

Research Methods and Procedures: A group of 30 women with BMI >30 kg/m2 and a group of 30 controls with BMI <25 kg/m2 were examined. BRS was estimated by the sequence technique, cardiac ANS activity by short‐term spectral analysis of heart rate variability (HRV), and aortic compliance by the method of applanation tonometry.

Results: BRS was lower in obese women (9.18 ± 3.77 vs. 19.63 ± 9.16 ms/mm Hg, p < 0.001). The median values (interquartile range) of the power of both the high‐frequency and low‐frequency components of the HRV were higher in the lean than in the obese participants [1079.2 (202.7 to 1716.9) vs. 224.1 (72.7 to 539.6) msec2, p = 0.001 and 411.8 (199.3 to 798.0) vs. 235.8 (99.4 to 424.5) msec2, p = 0.01 respectively]. Low‐to‐high‐frequency ratio values were higher in the obese subjects [0.82 (0.47 to 2.1) vs. 0.57 (0.28 to 0.89), p = 0.02]. Aortic augmentation values were not significantly different between lean and obese subjects. Multivariate analysis demonstrated a significant and independent association between BRS and age (p = 0.003), BMI (p < 0.001), and high‐frequency power of HRV (p < 0.001). These variables explained 72% of the variation of BRS values.

Discussion: BRS is severely reduced in obese subjects. BMI, age, and the parasympathetic nervous system activity are the main determinants of BRS. Baroreflex behavior is of clinical relevance because an attenuated BRS represents a negative prognostic factor in cardiovascular diseases, which are common in obesity.
Leptin and Coronary Heart Disease Risk: Prospective Case Control Study of British Women
Authors: Lawlor Debbie A. , Smith George Davey , Kelly Anne , Sattar Naveed , Ebrahim Shah
Published: July 2008

Objective: Prospective studies have shown a positive association between leptin concentrations and coronary heart disease (CHD) in men, but its effect in women is unclear. Our objective was to examine the association of serum leptin levels with CHD in a prospective study of women.

Research Methods and Procedures: We conducted a prospective (4 year) case (N = 165) control (N = 335) study nested within a cohort of 4286 British women.

Results: With mutual adjustment for each other and age, social class, smoking, and physical activity, leptin was positively associated with BMI, fasting insulin, total cholesterol, low‐density lipoprotein‐cholesterol, triglycerides, and hypertension and was inversely associated with homeostasis model assessment insulin sensitivity. Leptin was not associated with CHD risk (age‐adjusted relative risk for a doubling of leptin: 1.08 [95% confidence interval (CI): 0.91, 1.29]). This changed little with adjustment for childhood and adult social class, smoking, alcohol, and physical activity but attenuated to 1.00 (95% CI: 0.80, 1.26) with further adjustment for other metabolic risk factors (waist‐to‐hip ratio, low‐density lipoprotein‐cholesterol, triglycerides, C‐reactive protein, fasting insulin, hypertension).

Discussion: We found no strong statistical evidence that leptin is associated with CHD risk in this study population of older British women. Further research is needed to compare associations of leptin with CHD in men and women and to determine whether the effect varies by gender.
Cognitive Behavioral Therapy and Fluoxetine for Binge Eating Disorder: Two‐year Follow‐up
Authors: Devlin Michael J. , Goldfein Juli A. , Petkova Eva , Liu Linxu , Walsh B. Timothy
Published: July 2008

Objective:This study assessed the long‐term effects of group behavioral treatment plus individual cognitive behavioral therapy (CBT) and/or fluoxetine in binge eating disorder (BED) patients.

Research Methods and Procedures:A total of 116 individuals were randomized to an initial five‐month trial and were followed up over two years. Assessments, including binge frequency, weight, and self‐report measures, were administered at pre‐treatment, post‐treatment, and ∼6, 12, 18, and 24 months after initial treatment.

Results:Across treatment groups, there was overall improvement over 29 months in binge frequency and in binge abstinence. The odds of binge abstinence 2 years post‐treatment were 1.373 times the odds of binge abstinence immediately post‐treatment. There was no significant change in weight over the two‐year period. Subjects who received individual CBT evidenced lower binge frequency over the two‐year follow‐up period than patients who had not received individual CBT. Similarly, CBT was associated with increased rates of binge abstinence. There were no main effects of treatment assignment on weight over the two‐year follow‐up period. There was a significant advantage for fluoxetine assignment over the two‐year follow‐up period on depressive symptoms.

Discussion:The major significance of the study rests in its examination of the long‐term effects of standardized interventions for BED. Our findings provide support for the ideas that short‐term treatment may confer long‐term benefit and that not all treatments are equivalent in the benefits they confer.
Randomized Controlled Trials of the D1/D5 Antagonist Ecopipam for Weight Loss in Obese Subjects
Authors: Astrup Arne , Greenway Frank L. , Ling Walter , Pedicone Lisa , Lachowicz Jean , Strader Catherine D. , Kwan Rudolf ,   Ecopipam Obesity Study Group
Published: July 2008

Objective: To evaluate the efficacy and safety of the selective dopamine D1/D5 antagonist ecopipam for the treatment of obesity.

Research Methods and Procedures: Four randomized, double‐blind, multicenter trials compared ecopipam (n = 1667) and placebo (n = 1118) in obese subjects including type 2 diabetic subjects. Subjects received oral ecopipam 10, 30, or 100 mg daily for 12 weeks (Phase 2) or 50 or 100 mg daily for 52 weeks (Phase 3) combined with a weight loss program. Primary efficacy variables were the proportion of subjects with ≥5% weight loss from baseline at 12 weeks (Phase 2) or the distribution of percentage weight loss from baseline at 52 weeks (Phase 3).

Results: In the Phase 2 study, 26% of subjects administered ecopipam 100 mg vs. 6% of placebo subjects achieved ≥5% weight loss after 12 weeks (p < 0.01). In the Phase 3 studies, ecopipam 100 mg produced a 3.1% to 4.3% greater weight loss than placebo at 52 weeks. More subjects administered ecopipam vs. placebo achieved a 5% to 10% or >10% weight loss in two non‐diabetic phase 3 trials. Ecopipam‐treated subjects also maintained more weight loss compared with placebo subjects at 52 weeks. Phase 3 studies were discontinued because of unexpected psychiatric adverse events (ecopipam 31% vs. placebo 15%), including depression, anxiety, and suicidal ideation.

Discussion: Ecopipam was effective for achieving and maintaining weight loss in obese subjects, including type 2 diabetic subjects; however, the adverse effects on mood observed in the Phase 3 studies exclude its projected use in weight management.
A Novel Obesity Locus on Chromosome 4q: The Strong Heart Family Study
Authors: Almasy Laura , Göring Harald H.H. , Diego Vincent , Cole Shelley , Laston Sandra , Dyke Bennett , Howard Barbara V. , Lee Elisa T. , Best Lyle G. , Devereux Richard , Fabsitz Richard R. , MacCluer Jean W.
Published: July 2008

Objective: Obesity is a growing and important public health problem in Western countries and worldwide. There is ample evidence that both environmental and genetic factors influence the risk of developing obesity. Although a number of genes influencing obesity and obesity‐related measures have been localized, it is clear that others remain to be identified. The rate of obesity is particularly high in American Indian populations. This study reports the results of a genome‐wide scan for loci influencing BMI and weight in 963 individuals in 58 families from three American Indian populations in Arizona, Oklahoma, and North and South Dakota participating in the Strong Heart Family Study.

Research Methods and Procedures: Short tandem repeat markers were genotyped, resulting in a marker map with an average spacing of 10 centimorgans. Standard multipoint variance component linkage methods were used.

Results: Significant evidence of linkage was observed in the overall sample, including all three study sites, for a locus on chromosome 4q35 [logarithm of the odds (LOD) = 5.17 for weight, 5.08 for BMI]. Analyses of the three study sites individually showed that the greatest linkage support for the chromosome 4 locus came from Arizona (LOD = 2.6 for BMI), but that LOD scores for weight were >1 in all three samples. Suggestive linkage signals (LOD >2) were also observed on chromosomes 5, 7, 8, and 10.

Discussion: The chromosome 4 locus detected in this scan is in a region lacking any obvious positional candidate genes with known functions related to obesity. This locus may represent a novel obesity gene.
Moderate Exercise and Bright Light Treatment in Overweight and Obese Individuals
Authors: Dunai Andrea , Novak Marta , Chung Sharon A. , Kayumov Leonid , Keszei Andras , Levitan Robert , Shapiro Colin M.
Published: July 2008

Objective: Increased physical activity is important given the concern over the growing rates of obesity. The aim of this study is to conduct a controlled investigation of the effects of bright light therapy and exercise on weight loss and body composition in overweight and obese individuals.

Research Methods and Procedures: Twenty‐five overweight and obese subjects were assigned to 6 weeks of moderate exercise with or without bright light treatment. Outcome measure included changes in body mass and body composition and ratings of mood, seasonality, and sleep.

Results: Body weight decreased significantly with exercise in subjects in the light and non‐light treatment groups, but the change was not significantly different between the groups. Similar results were found for BMI. With exercise, body fat decreased significantly only in the light treatment group. There was a significant effect of the interaction of group by time on body fat composition, but the group by time interaction failed to reach statistical significance for body weight and BMI. Mood scores improved significantly with exercise in the light group, but no significant changes were noted regarding sleep.

Discussion: This preliminary study is the first to show that addition of bright light treatment to a 6‐week moderate exercise program can alter body composition by significantly reducing body fat. The reduction in body fat mass is of particular importance, because visceral fat has been particularly implicated as a major factor in the development of the metabolic syndrome. This study is an important step toward finding ways to maximize the effects of exercise.
Alcohol Consumption and Type 2 Diabetes Among Older Adults: The Cardiovascular Health Study
Authors: Djoussé Luc , Biggs Mary L. , Mukamal Kenneth J. , Siscovick David S.
Published: July 2008

Objective: The objective was to examine the role of total and beverage‐specific alcohol consumption on the incidence of type 2 diabetes mellitus (DM) among elderly men and women.

Research Methods and Procedures: We studied prospectively 4655 participants of the Cardiovascular Health Study who were free of DM at baseline. Alcohol consumption was obtained at baseline and during follow‐up examinations. DM was defined using fasting glucose and/or use of hypoglycemic medications. We used Cox proportional hazard models to estimate adjusted relative risks of diabetes across alcohol categories.

Results: During a mean follow‐up of 6.3 years, 234 incident cases of DM were documented. Compared with never drinkers, hazard ratios [95% confidence interval (CI)] for DM were 0.7 (0.3 to 1.4), 0.5 (0.3 to 0.9), 0.6 (0.4 to 1.1), and 0.8 (0.4 to 1.3) for former drinkers and current drinkers of <1, 1 to 6, and 7+ drinks per week, respectively, for men after adjustment for age, BMI, education, and smoking. Corresponding values for women were 1.2 (0.6 to 2.3), 0.7 (0.4 to 1.1), 0.6 (0.3 to 1.1), and 0.4 (0.2 to 1.0), respectively. A reduced risk of DM was observed with all types of beverage consumed. Similar findings were observed when we repeated the above analyses using simple or weighted cumulative alcohol update and covariates over time.

Discussion: Light to moderate alcohol consumption was associated with a lower incidence of DM among elderly people, irrespective of the type of beverage consumed.
Impact of Psychosocial Factors on Quality of Life in Overweight Youth
Authors: Janicke David M. , Marciel Kristen K. , Ingerski Lisa M. , Novoa Wendy , Lowry Kelly W. , Sallinen Bethany J. , Silverstein Janet H.
Published: July 2008

Objective: The psychosocial functioning of overweight youth is a growing concern. Research has shown that overweight children report lower quality of life (QOL) than their non‐overweight peers. This study sought to extend the literature by examining the association between peer victimization, child depressive symptoms, parent distress, and health‐related QOL in overweight youth. Mediator models are used to assess the effect of child depressive symptoms on the relationship between psychosocial variables and QOL.

Research Methods and Procedures: The sample consisted of 96 overweight and at‐risk‐for‐overweight children (mean age = 12.8 years) and their parents who were recruited from a Pediatric Endocrinology Obesity Clinic. Parents completed a demographic questionnaire, the Pediatric Quality of Life Inventory–parent‐proxy version, and the Brief Symptom Inventory. Children completed the Children's Depression Inventory–Short Form, the Schwartz Peer Victimization Scale, and the Pediatric Quality of Life Inventory.

Results: Increased parent distress, child depressive symptoms, and peer victimization were associated with lower QOL by both parent‐proxy and self‐report. Child depressive symptoms mediated the relationship between psychosocial variables (parent distress and peer victimization) for self‐reported QOL but not for parent‐proxy‐reported QOL.

Discussion: This study documented the important impact of peer victimization and parental distress on the QOL of overweight children. Expanding our understanding of how overweight children experience and interact with their environment is critical. Further research is needed to examine the mechanisms by which parent distress and peer victimization impact the development of depressive symptoms in overweight children, including coping and support strategies that may buffer these children against the development of depressive symptoms and ultimately lower QOL.
Assessment of Hyperphagia in Prader‐Willi Syndrome
Authors: Dykens Elisabeth M. , Maxwell Melissa A. , Pantino Elizabeth , Kossler Rebecca , Roof Elizabeth
Published: July 2008

Objective: Prader‐Willi syndrome (PWS), the leading known genetic cause of obesity, is characterized by intellectual disabilities, maladaptive and compulsive behaviors, and hyperphagia. Although complications of obesity resulting from hyperphagia are the leading cause of death in PWS, quantifying this drive for food has long been an unmet research need. This study provides factor‐analytic and within‐syndrome analyses of a new measure of hyperphagia in PWS.

Research Methods and Procedure: A 13‐item informant measure, the Hyperphagia Questionnaire, was developed and administered to the parents of 153 persons with PWS, 4 to 51 years of age. The intelligence quotients, genetic subtypes of PWS, and BMIs of offspring were obtained, as were measures of their non‐food problem behaviors.

Results: Factor analyses with varimax rotation produced three statistically and conceptually robust factors that accounted for 59% of the variance: Hyperphagic Behaviors, Drive, and Severity. Hyperphagic Behavior increased with age, whereas Drive remained stable, and Severity dipped in older adults. Hyperphagic Drive and Severity were positively correlated with non‐food behavior problems, and Hyperphagic Drive differentiated the 36% of participants with extreme obesity from those who had overweight/obese (48%) or healthy (16%) BMI classifications.

Discussion: The Hyperphagia Questionnaire is a robust tool for relating breakthroughs in the neurobiology of hyperphagia to in vivo food‐seeking behavior and for examining the psychological and developmental correlates of hyperphagia in PWS. The Hyperphagia Questionnaire also offers a nuanced, real‐life outcome measure for future clinical trials aimed at curbing the life‐threatening drive for food in PWS.
Morbidity and Mortality Risk Associated With an Overweight BMI in Older Men and Women
Authors: Janssen Ian
Published: July 2008

Background: There is controversy as to whether older adults with a BMI in the overweight range (25 to 29.9 kg/m2) are at increased health risk and whether they should be encouraged to lose weight. The purpose of this study was to determine whether older adults with a BMI in the overweight range are at increased morbidity and mortality risk.

Methods: Participants consisted of 4968 older (≥65 years) men and women from the Cardiovascular Health Study limited access dataset. Based on BMI (kg/m2), participants were grouped into normal‐weight (20 to 24.9 kg/m2), overweight (25 to 29.9 kg/m2), and obese (≥30 kg/m2) categories. Participants were followed for up to 9 years to determine if they developed 10 weight‐related health outcomes that are pertinent to older adults. Cox proportional hazards models were used to estimate the hazards ratios of morbidity and mortality after adjusting for age, sex, income, smoking, and physical activity.

Results: Compared with the normal‐weight group, the risks of myocardial infarction, stroke, sleep apnea, urinary incontinence, cancer, and osteoporosis were not different in the overweight group (p > 0.05). The risks for arthritis and physical disability were modestly increased in the overweight group (p < 0.05), whereas the risk for type 2 diabetes was increased by 78% in the overweight group (p < 0.01). After adjusting for all relevant covariates, all‐cause mortality risk was 11% lower in the overweight group (p < 0.05).

Conclusions: A BMI in the overweight range was associated with some modest disease risks but a slightly lower overall mortality rate. These findings suggest that a BMI cut‐off point of 25 kg/m2 may be overly restrictive for the elderly.
Liver Enzymes as a Predictor for Incident Diabetes in a Japanese Population: The Hisayama Study
Authors: Doi Yasufumi , Kubo Michiaki , Yonemoto Koji , Ninomiya Toshiharu , Iwase Masanori , Tanizaki Yumihiro , Shikata Kentaro , Iida Mitsuo , Kiyohara Yutaka
Published: July 2008

Objective: We studied the relationship between liver enzymes and the development of diabetes in a general Japanese population.

Research Methods and Procedures: A total of 1804 non‐diabetic subjects 40 to 79 years of age were followed‐up prospectively for a mean of 9.0 years.

Results: During the follow‐up, 135 subjects developed diabetes. In both sexes, the age‐adjusted cumulative incidence of diabetes increased significantly with elevating quartiles of serum γ‐glutamyltransferase (GGT) and alanine aminotransferase (ALT) levels. This pattern was also observed in aspartate aminotransferase (AST) quartiles for men but not for women. In multivariate analyses after adjusting for comprehensive risk factors and other liver enzymes, the risk of developing diabetes was significantly higher in the highest GGT quartile than in the lowest quartile [odds ratio (OR), 2.54; 95% confidence interval (CI), 1.03 to 6.26 for men; OR, 5.73; 95% CI, 1.62 to 20.19 for women]. Similar results were observed in ALT quartiles (OR, 2.32; 95% CI, 0.91 to 5.92 for men; OR, 4.40; 95% CI, 1.38 to 14.06 for women) but not in AST quartiles in either sex. Significant positive associations of GGT and ALT with diabetes were seen within each stratified category of risk factors, namely fasting insulin, BMI, waist‐to‐hip ratio, high‐sensitivity C‐reactive protein, and alcohol consumption. In receiver operating characteristic analyses, the areas under the receiver operating characteristic curve of GGT and ALT were significantly larger than that of AST, fasting insulin, waist‐to‐hip ratio, or C‐reactive protein.

Discussion: Our findings suggest that serum GGT and ALT concentrations are strong predictors of diabetes in the general population, independent of known risk factors.
Overall and Central Obesity and Risk of Type 2 Diabetes in U.S. Black Women
Authors: Krishnan Supriya , Rosenberg Lynn , Djoussé Luc , Cupples L. Adrienne , Palmer Julie R.
Published: July 2008

Objective: Obesity has risen to epidemic proportions in the United States, leading to an emerging epidemic of type 2 diabetes. African‐American women are disproportionately affected by both conditions. While an association of overall obesity with increasing risk of diabetes has been documented in black women, the effect of fat distribution, specifically abdominal obesity, has not been studied. We examined the association of BMI, abdominal obesity, and weight gain with risk of type 2 diabetes.

Research Methods and Procedures: During eight years of follow‐up of 49,766 women from the Black Women's Health Study, 2472 incident cases of diabetes occurred. Cox proportional hazard models were used to estimate incidence rate ratios (IRRs), with control for age, physical activity, family history of diabetes, cigarette smoking, years of education, and time period of data collection.

Results: Sixty‐one percent of participants had a BMI ≥25 kg/m2 (WHO definition of overweight). Compared with a BMI of <23 kg/m2, the IRR for a BMI of >45 kg/m2 was 23 (95% confidence interval, 17.0 to 31.0). The IRR for the highest quintile of waist‐to‐hip ratio relative to the lowest was 2.3 (95% confidence interval, 2.0 to 2.7) after control for BMI. Furthermore, at every level of BMI, an increased risk was observed for high waist‐to‐hip ratio relative to low.

Discussion: Central obesity, as well as overall obesity, is a strong risk factor for diabetes in African‐American women. Efforts to reduce the prevalence of obesity in African‐American women are of paramount importance.
Incremental Hospital Charges Associated With Obesity as a Secondary Diagnosis in Children
Authors: Woolford Susan J. , Gebremariam Achamyeleh , Clark Sarah J. , Davis Matthew M.
Published: July 2008

Objective: The objective was to evaluate the association of obesity as a comorbidity with hospital charges, by comparing charges for pediatric hospitalizations with vs. without obesity as a secondary diagnosis.

Methods: Using the 2000 Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID), a nationally representative sample of pediatric hospital discharges, we identified the most common non‐pregnancy‐related principal diagnoses for children 2 to 18 years of age: asthma, pneumonia, affective disorders, and appendicitis. For each we compared mean charges and mean length of stay for hospitalizations with vs. without obesity as a secondary diagnosis, adjusting for relevant socio‐demographics and hospital type.

Results: Among children's discharges in 2000, 1.1% listed obesity as a secondary diagnosis. These had a disproportionate likelihood of being older, black, Medicaid beneficiaries, and hospitalized at a general hospital. Adjusted mean hospital charges were significantly higher for discharges with obesity as a secondary diagnosis vs. those without: appendicitis ($14,134 vs. $11,049; p < 0.01), asthma ($7766 vs. $6043; p < 0.05), pneumonia ($12,228 vs. $9688; p < 0.05), and affective disorders ($8292 vs. $7769; p < 0.01). Whereas obesity as a secondary diagnosis was associated with a pattern of increased adjusted mean length of stay, only asthma and affective disorders had statistically significant differences (0.6 days) (p < 0.01).

Conclusion: This national analysis suggests obesity as a secondary diagnosis is associated with significantly higher charges for the most common reasons for pediatric hospitalizations. This presents a financial imperative for further research to evaluate factors that contribute to higher inpatient charges related to obesity as a comorbidity and underscores the need for obesity prevention initiatives.
High Childhood Obesity in an Australian Population
Authors: Sanigorski Andrea M. , Bell A. Colin , Kremer Peter J. , Swinburn Boyd A.
Published: July 2008

Objective: The objective was to determine the prevalences of overweight and obesity in regional Australian children and to examine the association between BMI and indicators of socioeconomic status (SES).

Research Methods and Procedures: Regionally representative cross‐sectional survey of 2184 children, 4 to 12 years of age, was conducted, and the socio‐demographic characteristics of their parents from regional Victoria, Australia, 2003 to 2004, were obtained.

Results: The prevalences of overweight and obesity were 19.3 ± 0.8% (proportion ± standard error) and 7.6 ± 0.6%, respectively, using international criteria, and the proportion of overweight/obese girls was significantly higher than that of boys (29.6 ± 1.4% vs. 23.9 ± 1.3%, χ2 = 9.01, p = 0.003). Children from households of lower SES had higher odds of being overweight/obese; lower SES was defined by lower paternal education (adjusted odds ratio, 1.18; 95% confidence interval, 1.08 to 1.30) and lower area‐level SES (adjusted odds ratio, 1.13; 95% confidence interval, 1.02 to 1.25), adjusted for age, gender, height, and clustering by school.

Discussion: The prevalences of overweight and obesity are increasing in Australian children by about one percentage point per year. This equates to ∼40,000 more overweight children each year, placing Australian children among those at highest risk around the world. In addition, girls are more likely to be overweight, and there is a general trend for children of lower SES to be at even greater risk of overweight and obesity.
1α,25‐Dihydroxyvitamin D3 Modulation of Adipocyte Reactive Oxygen Species Production
Authors: Sun Xiaocun , Zemel Michael B.
Published: July 2008

Objective: We have previously shown 1α,25‐dihydroxyvitamin D3 [1α,25‐(OH)2D3] to inhibit mitochondrial uncoupling protein 2 (UCP2) expression in adipocytes and that in vivo suppression of calcitriol levels with calcium‐rich diets increases UCP2 expression. Because UCP2 plays a significant role in the clearance of reactive oxygen species (ROS), we studied the effect of calcitriol on ROS production and ROS‐induced adipocyte proliferation.

Research Methods and Procedures: ROS production in human and murine adipocytes was stimulated by high glucose (30 mM) or H2O2 (100 nM).

Results: Both approaches resulted in increased ROS production by 27% to 100% (p < 0.05) and increased cell proliferation by 15% to 39% (p < 0.03). These effects were augmented by the addition of mitochondrial uncoupling inhibitor guanosine 5′‐diphosphate (GDP; 100 μM) or 1α,25‐(OH)2D3 (10 nM) and attenuated by UCP2 overexpression, suggesting that inhibition of mitochondrial uncoupling suppresses clearance of ROS and increases adipocyte proliferation. The addition of α ± tocopherol (1 μM) inhibited cell proliferation in adipocytes treated with either H2O2 or high glucose, indicating that ROS plays a major role in the regulation of cell proliferation in adipocytes. Moreover, stimulation of ROS with high glucose and H2O2 resulted in a 2‐ to 5‐fold increase in adipocyte intracellular calcium ([Ca2+]i; p < 0.001), and calcium channel antagonism (nifedipine, 10 μM) suppressed ROS induced calcium influx and cell proliferation, indicating that [Ca2+]i may also regulate ROS production and exert a mitogenic effect in adipocytes.

Discussion: These data support a role of 1α,25‐(OH)2D3, UCP2, and [Ca2+]i in the regulation of adipocyte ROS production.
Growth Hormone and Ghrelin Secretion in Severely Obese Women Before and After Bariatric Surgery
Authors: Mora Maria E. Valera , Manco Melania , Capristo Esmeralda , Guidone Caterina , Iaconelli Amerigo , Gniuli Donatella , Rosa Giuseppina , Calvani Menotti , Mingrone Geltrude
Published: July 2008

Objective: The objective was to evaluate ghrelin and growth hormone (GH) interactions and responses to a growth hormone‐releasing hormone (GHRH)/arginine test in severe obesity before and after surgically‐induced weight loss.

Research Methods and Procedures: Our study population included 11 severely obese women 39 ± 12 years of age, with a mean BMI of 48.6 ± 2.4 kg/m2, re‐studied in a phase of stabilized body weight, with a BMI of 33.4 ± 1.2 kg/m2, 18 months after having successfully undergone biliopancreatic diversion (BPD). A GHRH/arginine test was performed before and 18 months after BPD to evaluate ghrelin and GH interactions. Active ghrelin, measured by radioimmunoassay (RIA), and GH, measured by chemiluminescence assay, were assayed before and after the GHRH/arginine test.

Results: Fasting serum GH levels and GH area under the curve (AUC) significantly increased from 0.2 ± 0.05 ng/mL to 1 ± 0.3 ng/mL (p < 0.05) and from 514.76 ± 98.7 ng/mL for 120 minutes to 1957.3 ± 665.1 ng/mL for 120 minutes after bariatric surgery (p < 0.05), respectively. Although no significant change in fasting ghrelin levels was observed (573 ± 77.9 before BPD vs. 574.1 ± 32.7 after BPD), ghrelin AUC significantly increased from −3253.9 ± 2180.9 pg/mL for 120 minutes to 1142.3 ± 916.4 pg/mL for 120 minutes after BPD (p < 0.05). Fasting serum insulin‐like growth factor (IGF)‐1 concentration did not change significantly (133.6 ± 9.9 ng/mL before vs. 153.3 ± 25.2 ng/mL after BPD).

Discussion: Our study demonstrates that the mechanisms involved in ghrelin and GH secretion after the secretagogue stimulus (GHRH/arginine) are consistent with patterns observed in other populations.
NPY5R Antagonism Does Not Augment the Weight Loss Efficacy of Orlistat or Sibutramine
Authors: Erondu Ngozi , Addy Carol , Lu Kaifeng , Mallick Madhuja , Musser Bret , Gantz Ira , Proietto Joseph , Astrup Arne , Toubro Søren , Rissannen Aila M. , Tonstad Serena , Haynes William G. , Gottesdiener Keith M. , Kaufman Keith D. , Amatruda John M. , Heymsfield Steven B.
Published: July 2008

Objective:Central counter‐regulatory mechanisms, including those related to the orexigenic hormone neuropeptide Y (NPY), may limit the weight loss observed with conventional pharmacological monotherapy. This study evaluated whether blockade of the NPY Y5 receptor (NPY5R) with the selective antagonist MK‐0557 potentiates sibutramine and orlistat weight loss effects.

Research Methods and Procedures:Obese patients (497, BMI 30 to 43 kg/m2) were randomized to 1 of 5 treatment arms [placebo,n= 101; sibutramine 10 mg/d,n= 100; MK‐0557 1 mg/d plus sibutramine 10 mg/d,n= 98; orlistat 120 mg TID,n= 99; MK‐0557 1 mg/d plus orlistat 120 mg TID,n= 99] in conjunction with a hypocaloric diet for 24 weeks. The all‐patients‐treated population, imputing missing data using last observation carried forward, was used to assess weight loss from baseline.

Results:The study was completed by 71% of patients in placebo, 76% in sibutramine alone, 79% in MK‐0557 + sibutramine, 69% in orlistat alone, and 76% in MK‐0557 + orlistat groups. Least squares (LS) mean difference [95% confidence interval (CI)] in weight change from baseline between MK‐0557 + sibutramine and sibutramine alone was −0.1 (−1.6, 1.4) kg (p= 0.892) and between MK‐0557 + orlistat and orlistat alone was −0.9 (−2.4, 0.6) kg (p= 0.250). Sibutramine alone induced a LS mean weight loss of −5.9 (−6.9, −4.9) kg vs. −4.6 (−5.7, −3.6) kg for orlistat (p= 0.097). There were no serious drug‐related adverse events and MK‐0557 was well tolerated.

Discussion:Blockade of the NPY5R with the potent antagonist MK‐0557 did not significantly increase the weight loss efficacy of either orlistat or sibutramine monotherapy.
Single Nucleotide Polymorphisms at the Adiponectin Locus and Risk of Coronary Heart Disease in Men and Women
Authors: Pischon Tobias , Pai Jennifer K. , Manson JoAnn E. , Hu Frank B. , Rexrode Kathryn M. , Hunter David , Rimm Eric B.
Published: July 2008

Objective: The objective was to examine the association of 5 common single nucleotide polymorphisms (SNPs) at the adiponectin locus with risk of coronary heart disease (CHD) in men and women.

Methods and Procedures: We genotyped five common SNPs in the adiponectin gene (rs266729, −11365C>G; rs822395, −4034A>C; rs822396, −3964A>G; rs2241766, +45T>G; and rs1501299, +276G>T) in men (Health Professionals Follow‐up Study) and women (Nurses’ Health Study) in a nested case control setting. Among participants free of cardiovascular disease at baseline, 266 men and 249 women developed non‐fatal myocardial infarction or fatal CHD during 6 and 8 years of follow‐up, respectively. In addition, 564 men had coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty. Using risk set sampling, controls were selected 2:1 matched on age, smoking, and date of blood draw.

Results: The −4034CC genotype was related to an increased risk of non‐fatal myocardial infarction or fatal CHD compared with the AA genotype [relative risk (RR), men, 1.69; 95% confidence interval (CI), 0.99 to 2.89; women, 2.04; 95% CI, 1.20 to 3.49); however, this genotype was not related to risk of coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty or to plasma adiponectin levels. Other SNPs or haplotypes defined by the 5 SNPs were not consistently related to risk of CHD in men and women or to plasma adiponectin levels.

Discussion: Our study does not support the hypothesis that these 5 common SNPs in the adiponectin gene play an important role in the development of CHD among men and women, although we cannot exclude an association between the −4034CC genotype and risk of CHD.
Chefs’ Opinions of Restaurant Portion Sizes
Authors: Condrasky Marge , Ledikwe Jenny H. , Flood Julie E. , Rolls Barbara J.
Published: July 2008

Objectives: The objectives were to determine who establishes restaurant portion sizes and factors that influence these decisions, and to examine chefs’ opinions regarding portion size, nutrition information, and weight management.

Research Methods and Procedures: A survey was distributed to chefs to obtain information about who is responsible for determining restaurant portion sizes, factors influencing restaurant portion sizes, what food portion sizes are being served in restaurants, and chefs’ opinions regarding nutrition information, health, and body weight. The final sample consisted of 300 chefs attending various culinary meetings.

Results: Executive chefs were identified as being primarily responsible for establishing portion sizes served in restaurants. Factors reported to have a strong influence on restaurant portion sizes included presentation of foods, food cost, and customer expectations. While 76% of chefs thought that they served “regular” portions, the actual portions of steak and pasta they reported serving were 2 to 4 times larger than serving sizes recommended by the U.S government. Chefs indicated that they believe that the amount of food served influences how much patrons consume and that large portions are a problem for weight control, but their opinions were mixed regarding whether it is the customer's responsibility to eat an appropriate amount when served a large portion of food.

Discussion: Portion size is a key determinant of energy intake, and the results from this study suggest that cultural norms and economic value strongly influence the determination of restaurant portion sizes. Strategies are needed to encourage chefs to provide and promote portions that are appropriate for customers’ energy requirements.
The Relationship Between Parents’ Anti‐fat Attitudes and Restrictive Feeding
Authors: Musher‐Eizenman Dara R. , Holub Shayla C. , Hauser Jessica C. , Young Kathleen M.
Published: July 2008

Objective: Anti‐fat prejudice is a common attitude in our society, and it has implications for those who hold and are targets of this prejudice. Little is known, however, about how parents’ anti‐fat attitudes impact the ways they feed their young children. We hypothesized that parents’ attitudes about weight would predict parents’ restrictive feeding practices above and beyond the effects of the child's actual weight and the parents’ concern about child overweight.

Research Methods and Procedures: A total of 126 mothers and 102 fathers returned surveys about anti‐fat attitudes, feeding practices (restriction for weight and restriction for health), and concern about child overweight.

Results: Parental concern about child overweight was related to higher restrictive feeding practices for both mothers and fathers. Parents’ anti‐fat attitudes also predicted restrictive feeding above and beyond the effects of parent and child BMI and parental concern about overweight.

Discussion: These findings suggest that parents’ anti‐fat attitudes impact the way they feed their children.
Neighborhood Risk Factors for Obesity
Authors: Lopez Russ P.
Published: July 2008

Objective: The goal of this study was to explore neighborhood environmental factors associated with obesity in a sample of adults living in a major U.S. metropolitan area.

Research Methods and Procedures: This was a multi‐level study combining data from the U.S. Behavioral Risk Factor Surveillance System with data from the U.S. Census. A total of 15,358 subjects living in 327 zip code tabulation areas were surveyed between 1998 and 2002. The outcome was obesity (BMI >30), and independent variables assessed included individual level variables (age, education, income, smoking status, sex, black race, and Hispanic ethnicity), and zip code level variables (percentage black, percentage Hispanic, percentage with more than a high school education, retail density, establishment density, employment density, population density, the presence of a supermarket, intersection density, median household income, and density of fast food outlets).

Results: After controlling for individual level factors, median household income [relative risk (RR) = 0.992; 95% confidence interval (CI) = 0.990, 0.994], population density (RR = 0.98; 95% CI = 0.972, 0.990), employment density (RR = 1.004; 95% CI = 1.001, 1.009), establishment density (RR = 0.981 95% CI = 0.964, 0.999), and the presence of a supermarket (RR = 0.893; 95% CI = 0.815, 0.978) were associated with obesity risk. Fast food establishment density was poorly associated with obesity risk.

Discussion: Where one lives may affect obesity status. Given the influence of the presence of a supermarket on obesity risk, efforts to address food access might be a priority for reducing obesity.