OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002

A systematic review of the literature

BACKGROUND\nObesity in childhood is associated with increased cardiovascular risk. It is uncertain whether this risk is attenuated in persons who are overweight or obese as children but not obese as adults.\n\n\nMETHODS\nWe analyzed data from four prospective cohort studies that measured childhood and adult body-mass index (BMI, the weight in kilograms divided by the square of the height in meters). The mean length of follow-up was 23 years. To define high adiposity status, international age-specific and sex-specific BMI cutoff points for overweight and obesity were used for children, and a BMI cutoff point of 30 was used for adults.\n\n\nRESULTS\nData were available for 6328 subjects. Subjects with consistently high adiposity status from childhood to adulthood, as compared with persons who had a normal BMI as children and were nonobese as adults, had an increased risk of type 2 diabetes (relative risk, 5.4; 95% confidence interval [CI], 3.4 to 8.5), hypertension (relative risk, 2.7; 95% CI, 2.2 to 3.3), elevated low-density lipoprotein cholesterol levels (relative risk, 1.8; 95% CI, 1.4 to 2.3), reduced high-density lipoprotein cholesterol levels (relative risk, 2.1; 95% CI, 1.8 to 2.5), elevated triglyceride levels (relative risk, 3.0; 95% CI, 2.4 to 3.8), and carotid-artery atherosclerosis (increased intima-media thickness of the carotid artery) (relative risk, 1.7; 95% CI, 1.4 to 2.2) (P ≤ 0.002 for all comparisons). Persons who were overweight or obese during childhood but were nonobese as adults had risks of the outcomes that were similar to those of persons who had a normal BMI consistently from childhood to adulthood (P>0.20 for all comparisons).\n\n\nCONCLUSIONS\nOverweight or obese children who were obese as adults had increased risks of type 2 diabetes, hypertension, dyslipidemia, and carotid-artery atherosclerosis. The risks of these outcomes among overweight or obese children who became nonobese by adulthood were similar to those among persons who were never obese. (Funded by the Academy of Finland and others.).

Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors EDITORIAL COMMENT

Objective To review research on consumer use and understanding of nutrition labels, as well as the impact of labelling on dietary habits. Design A systematic review was conducted by searching electronic databases. Relevant articles were screened by two reviewers and included if they met inclusion criteria, including eight methodological criteria. A total of 120 articles were included in the review, including cross-sectional surveys ( n 96), experimental designs ( n 17), ‘natural experiments’ ( n 7) and longitudinal population-based surveys ( n 2). Setting Articles covered seven jurisdictions: USA ( n 88), Europe ( n 12), Canada ( n 9), Australia and New Zealand ( n 4), Norway ( n 2), Thailand ( n 1) and Trinidad ( n 1). Subjects Participants were from a wide range of age groups, socio-economic strata and geographical regions. Results Nutrition labels on pre-packaged foods are among the most prominent sources of nutrition information. Nutrition labels are perceived as a highly credible source of information and many consumers use nutrition labels to guide their selection of food products. Evidence also shows a consistent link between the use of nutrition labels and healthier diets. However, the use of labels varies considerably across subgroups, with lower use among children, adolescents and older adults who are obese. Research also highlights challenges in terms of consumer understanding and appropriate use of labelling information. Conclusions Nutrition labels on pre-packaged foods are a cost-effective population-level intervention with unparalleled reach. However, to capitalize on their potential, governments will need to explore new formats and different types of information content to ensure that nutrition information is accessible and understandable.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/F28676122435F2FC22D404AA268C2DB0/S1368980010003290a.pdf/div-class-title-nutrition-labels-on-pre-packaged-foods-a-systematic-review-div.pdf

Nutrition labels on pre-packaged foods: a systematic review.

During the past decade, rates of food insecurity and obesity have risen, and an association has been made between these two seemingly paradoxical states Although this relationship has not been repeatedly seen in men, research suggests a correlation in women Studies have not been able to consistently show a relationship in children, because findings differ based on age, race/ethnicity, household income, and sex Several proposed hypotheses explain why a correlation between food insecurity and obesity exists in adults—especially women—but not in children This review proposes a conceptual framework linking the Food Stamp Program and other coping strategies to the food insecurity–obesity relationship This link has implications for Food Stamp Program policy changes, welfare reform, and poverty prevention

The Food Insecurity–Obesity Paradox: A Review of the Literature and the Role Food Stamps May Play

The effects of nutrition knowledge on food label use. A review of the literature

The purpose of this article is to emphasize the value of the family as a source of behavior change, particularly with respect to attaining achievable goals of weight loss and regular physical activity for youth and their families. We present a review of the literature, providing support for the value of the family in influencing children to form good diet and exercise behaviors and as a source of support and motivation for individuals seeking to lose or control their weight and to start and maintain a physically active lifestyle. Recognizing the importance of family behavior in the development of weight control and weight loss activities is essential. Future work should focus on identifying measurable parameters of family-level weight control behaviors and ways to apply those parameters to help create new interventions that use the strengths of the family for achieving weight control goals.

/pdf/using-the-family-to-combat-childhood-and-adult-obesity-1iph6wudl6.pdf

Using the family to combat childhood and adult obesity.

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

/pdf/are-nutrition-knowledge-attitudes-and-beliefs-associated-16jnnsv1g8.pdf

Are Nutrition Knowledge, Attitudes, and Beliefs Associated with Obesity among Low-Income Hispanic and African American Women Caretakers?

Hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes.

https://journals.sagepub.com/doi/pdf/10.1177/2333794X15625159

Risk Factors in Adolescent Hypertension

We analyzed the 1994-1996 Continuing Survey of Food Intake by Individuals and the Diet and Health Knowledge Survey (DHKS) to examine whether the relationship between income and dietary quality is modified by food label (FL) use among 20- to 60-y old DHKS respondents who were either household meal preparers, meal planners or food shoppers (n = 2952). Multivariate logistic regression results indicated that the influence of income on dietary quality is mediated by FL use. Those who were wealthier and used FL were significantly less likely to have a lower Healthy Eating Index (HEI) compared with the reference group formed by those in the lower income category who did not use FL [OR = 0.42; 95% confidence interval (CI): 0.31, 0.56]. By contrast, those who were wealthier but did not use FL were as likely as the reference group to have a low HEI (OR = 1.08; 95% CI: 0.74, 1.54). Those who were poorer but used FL were significantly less likely to have a low HEI compared with the reference group (OR = 0.62; 95% CI: 0.48, 0.80). Thus, FL use is associated with improved dietary quality among all income groups with a greater benefit of use among higher income individuals. Income is not associated with improved dietary quality in the absence of FL use.

Food Label Use Modifies Association of Income with Dietary Quality

The goal of the present study was to examine the association of the Food Stamp Program with the food security and dietary intake of low-income children from Hartford, CT, who were enrolled in the Supplemental Food Program for Women, Infants, and Children (WIC). We compared the food and nutrition situation of low-income preschoolers who received food stamps (FS, n = 59) with that of those who did not receive food stamps (NFS, n = 40). Children were an average age of 2.7 +/- 0.6 y, and 95% were receiving WIC benefits at the time of the study. Groups were comparable in demographic characteristics, but the socioeconomic status of the FS group was lower than that of the NFS group (P < 0.05). Food security was assessed with the Radimer/Cornell hunger scale, and dietary intake was assessed with a single 24-h recall and a 14-item food frequency questionnaire. Multivariate analyses within the FS group indicated that a monthly duration of food stamps of <4 wk was a predictor of household food security (odds ratio 0.10, 95% confidence interval 0.02-0.56). Food stamp use was associated with above-median energy-adjusted intakes of vitamin B-6 (3.13, 1.16-8.45), folate (2.92, 1.09-7.81) and iron (3.72, 1.31-10.54). The NFS children were more likely to consume <8 mg iron/d (3.73, 1.09-12.80). These results suggest that the Food Stamp Program is associated with food security and preschoolers' micronutrient intake.

Lauren Haldeman

Papers

Using the family to combat childhood and adult obesity.

Are Nutrition Knowledge, Attitudes, and Beliefs Associated with Obesity among Low-Income Hispanic and African American Women Caretakers?

Risk Factors in Adolescent Hypertension

Food Label Use Modifies Association of Income with Dietary Quality

Food Stamps Are Associated with Food Security and Dietary Intake of Inner-City Preschoolers from Hartford, Connecticut