Objective: The recent obesity epidemic has been accompanied by a parallel growth in chronic sleep deprivation. Physiologic studies suggest sleep deprivation may influence weight through effects on appetite, physical activity, and/or thermoregulation. This work reviews the literature regarding short sleep duration as an independent risk factor for obesity and weight gain.

Short sleep duration and weight gain : a systematic review

As the obesity epidemic spreads, concern about the significant health and economic consequences has also grown. Obesity has been linked to a variety of chronic diseases, almost 300,000 deaths each year, and $117 billion in direct and indirect annual costs in the United States alone. In this article we review the recent trends in overweight and obesity, summarize the lifestyle factors that influence the increasing prevalence of obesity, and discuss the health and economic impact of the obesity epidemic.

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The epidemic of obesity.

There is scientific consensus that the global climate is changing, with rising surface temperatures, melting ice and snow, rising sea levels, and increasing climate variability. These changes are expected to have substantial impacts on human health. There are known, effective public health responses for many of these impacts, but the scope, timeline, and complexity of climate change are unprecedented. We propose a public health approach to climate change, based on the essential public health services, that extends to both clinical and population health services and emphasizes the coordination of government agencies (federal, state, and local), academia, the private sector, and nongovernmental organizations.

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Climate Change: The Public Health Response

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(05)17911-2.pdf

Age-related cataract.

Importance Data describing the effects of weight gain across adulthood on overall health are important for weight control. Objective To examine the association of weight gain from early to middle adulthood with health outcomes later in life. Design, Setting, and Participants Cohort analysis of US women from the Nurses’ Health Study (1976-June 30, 2012) and US men from the Health Professionals Follow-Up Study (1986-January 31, 2012) who recalled weight during early adulthood (at age of 18 years in women; 21 years in men), and reported current weight during middle adulthood (at age of 55 years). Exposures Weight change from early to middle adulthood (age of 18 or 21 years to age of 55 years). Main Outcomes and Measures Beginning at the age of 55 years, participants were followed up to the incident disease outcomes. Cardiovascular disease, cancer, and death were confirmed by medical records or the National Death Index. A composite healthy aging outcome was defined as being free of 11 chronic diseases and major cognitive or physical impairment. Results A total of 92 837 women (97% white; mean [SD] weight gain: 12.6 kg [12.3 kg] over 37 years) and 25 303 men (97% white; mean [SD] weight gain: 9.7 kg [9.7 kg] over 34 years) were included in the analysis. For type 2 diabetes, the adjusted incidence per 100 000 person-years was 207 among women who gained a moderate amount of weight (≥2.5 kg to Conclusions and Relevance In these cohorts of health professionals, weight gain during adulthood was associated with significantly increased risk of major chronic diseases and decreased odds of healthy aging. These findings may help counsel patients regarding the risks of weight gain.

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Associations of Weight Gain From Early to Middle Adulthood With Major Health Outcomes Later in Life.

An area-level model of vehicle-pedestrian injury collisions with implications for land use and transportation planning

The pesticide p,p'-dichlorodiphenyltrichloroethane (DDT) and its persistent metabolite p,p'-dichlorodiphenyldichloroethylene (DDE) are associated with negative reproductive outcomes in animals. In humans, however, the findings are inconsistent. Using data from the Child Health and Development Studies, a longitudinal study of 20,754 pregnancies among San Francisco Bay Area women from 1959 to 1967, the authors examined the effects of maternal serum DDT and DDE concentrations on preterm birth, small-for-gestational-age birth, birth weight, and gestational age in 420 male subjects. Data were analyzed using multivariate logistic regression for preterm and small-for-gestational-age birth and linear regression for birth weight and gestational age. Median serum concentrations of DDE were 43 mug/liter (interquartile range: 32-57; range: 7-153) and of DDT were 11 mug/liter (interquartile range: 8-16; range: 3-72), several times higher than current US concentrations. The adjusted odds ratio for preterm birth was 1.28 (95% confidence interval (CI): 0.73, 2.23) for DDE and 0.94 (95% CI: 0.50, 1.78) for DDT. For small-for-gestational-age birth, the adjusted odds ratio was 0.75 (95% CI: 0.44, 1.26) for DDE and 0.69 (95% CI: 0.73, 1.27) for DDT; none of the study results achieved statistical significance. Given the persistence of DDT in the environment and its continuing role in malaria control, studies using more robust data should continue to assess this relation.

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Association of DDT and DDE with Birth Weight and Length of Gestation in the Child Health and Development Studies, 1959–1967

BACKGROUND: Obesity may influence several physiologic processes involved in cataract formation such as oxidative stress, glycosylation and osmotic stress. OBJECTIVE: To examine the association between increased body mass index (BMI) and the incidence of cataract extraction. DESIGN AND SETTING: The Nurses' Health Study and the Health Professionals Follow-up Study, both prospective cohort studies of US women and men. SUBJECTS: A total of 87 682 women and 45 549 men aged 45 y and older who did not have diagnosed cataract or cancer at baseline (1980 for women, 1986 for men). MEASUREMENTS: Cataract extractions occurring between baseline and 1996, confirmed by medical records. RESULTS: During 16 y of follow-up in the women, and 10 y in the men, (1 097 997 person-y), 4430 incident cases were documented. Compared to participants with BMI less than 23 kg/m2, those with BMI greater than or equal to 30 kg/m2 had 36% higher risk of any type of cataract (pooled multivariate relative risk (RR), 1.36; 95% CI, 1.23–1.49) after adjusting for smoking, age and lutein/zeaxanthin intake. The association was strongest for posterior subcapsular (PSC) cataract (pooled multivariate RR, 1.99; 95% CI, 1.55–2.55). With adjustment for diabetes, the RR of obesity associated with posterior subcapsular cataract was 1.68 (95% CI, 1.30–2.17). Obesity was not significantly associated with nuclear cataract. CONCLUSION: Obesity increases the risk of developing cataract overall, and of PSC cataract in particular; the etiology of PSC cataract may be mediated at least in part by glucose intolerance and insulin resistance, even in the absence of clinical diabetes.

A prospective study of the relationship between body mass index and cataract extraction among US women and men.

Syndromic surveillance is the gathering of data for public health purposes before laboratory or clinically confirmed information is available. Interest in syndromic surveillance has increased because of concerns about bioterrorism. In addition to bioterrorism detection, syndromic surveillance may be suited to detecting waterborne disease outbreaks. Theoretical benefits of syndromic surveillance include potential timeliness, increased response capacity, ability to establish baseline disease burdens, and ability to delineate the geographical reach of an outbreak. This review summarises the evidence gathered from retrospective, prospective, and simulation studies to assess the efficacy of syndromic surveillance for waterborne disease detection. There is little evidence that syndromic surveillance mitigates the effects of disease outbreaks through earlier detection and response. Syndromic surveillance should not be implemented at the expense of traditional disease surveillance, and should not be relied upon as a principal outbreak detection tool. The utility of syndromic surveillance is dependent on alarm thresholds that can be evaluated in practice. Syndromic data sources such as over the counter drug sales for detection of waterborne outbreaks should be further evaluated.

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Review of syndromic surveillance: implications for waterborne disease detection

Although the observational evidence linking cigarette smoking with risk of senile cataract is well-established, it is unclear whether any benefit is obtained from quitting smoking. Therefore, in this study, the authors examined the association between time since quitting smoking and incidence of cataract extraction in women and men enrolled in the Nurses' Health Study and the Health Professionals Follow-up Study, respectively. There were 4,281 incident physician-confirmed cases of cataract and 1,038,493 accumulated person-years of follow-up. Compared with current smokers, former smokers who had quit smoking 25 or more years previously had a 20% lower risk of cataract extraction after adjustment for age, average number of cigarettes smoked per day, and other potential risk factors (relative risk (RR) = 0.80, 95% confidence interval (CI): 0.71, 0.91). However, risk among past smokers did not decrease to the level seen among never smokers (for never smokers, RR = 0.64, 95% CI: 0.52, 0.79). The observed relation was similar when data were examined by cataract subtype (>25 years since quitting vs. current smoking: primarily nuclear cataract, RR = 0.82, 95% CI: 0.68, 0.97; primarily posterior subcapsular cataract, RR = 0.90, 95% CI: 0.71, 1.13). These findings suggest that any healing from damage due to cigarette smoking occurs at a very modest pace, and they emphasize the importance of never starting to smoke or quitting early in life.

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June M. Weintraub

Papers

An area-level model of vehicle-pedestrian injury collisions with implications for land use and transportation planning

Association of DDT and DDE with Birth Weight and Length of Gestation in the Child Health and Development Studies, 1959–1967

A prospective study of the relationship between body mass index and cataract extraction among US women and men.

Review of syndromic surveillance: implications for waterborne disease detection

Smoking Cessation and Risk of Cataract Extraction among US Women and Men