Showing papers on "Body mass index published in 1995"

Leptin levels in human and rodent : Measurement of plasma leptin and ob RNA in obese and weight-reduced subjects

Abstract: Leptin, the gene product of the obese gene, may play an important role in regulating body weight by signalling the size of the adipose tissue mass. Plasma leptin was found to be highly correlated with body mass index (BMI) in rodents and in 87 lean and obese humans. In humans, there was variability in plasma leptin at each BMI suggesting that there are differences in its secretion rate from fat. Weight loss due to food restriction was associated with a decrease in plasma leptin in samples from mice and obese humans.

Weight Gain as a Risk Factor for Clinical Diabetes Mellitus in Women

Abstract: Objective: To examine the relation between adult weight change and the risk for clinical diabetes mellitus among middle-aged women. Design: Prospective cohort study with follow-up from 1976 to 1990...

Body mass index reference curves for the UK, 1990.

Abstract: Reference curves for stature and weight in British children have been available for the past 30 years, and have recently been updated. However weight by itself is a poor indicator of fatness or obesity, and there has never been a corresponding set of reference curves to assess weight for height. Body mass index (BMI) or weight/height has been popular for assessing obesity in adults for many years, but its use in children has developed only recently. Here centile curves for BMI in British children are presented, from birth to 23 years, based on the same large representative sample as used to update the stature and weight references. The charts were derived using Cole's LMS method, which adjusts the BMI distribution for skewness and allows BMI in individual subjects to be expressed as an exact centile or SD score. Use of the charts in clinical practice is aided by the provision of nine centiles, where the two extremes identify the fattest and thinnest four per 1000 of the population.

Body weight and mortality among women

Abstract: Background The relation between body weight and overall mortality remains controversial despite considerable investigation. Methods We examined the association between body-mass index (defined as the weight in kilograms divided by the square of the height in meters) and both overall mortality and mortality from specific causes in a cohort of 115,195 U.S. women enrolled in the prospective Nurses' Health Study. These women were 30 to 55 years of age and free of known cardiovascular disease and cancer in 1976. During 16 years of follow-up, we documented 4726 deaths, of which 881 were from cardiovascular disease, 2586 from cancer, and 1259 from other causes. Results In analyses adjusted only for age, we observed a J-shaped relation between body-mass index and overall mortality. When women who had never smoked were examined separately, no increase in risk was observed among the leaner women, and a more direct relation between weight and mortality emerged (P for trend < 0.001). In multivariate analyses of women...

Waist circumference as a measure for indicating need for weight management

Abstract: Objective : To test the hypothesis that a single measurement, waist circumference, might be used to identify people at health risk both from being overweight and from having a central fat distribution. Design : A community derived random sample of men and women and a second, validation sample. Setting : North Glasgow. Subjects : 904 men and 1014 women (first sample); 86 men and 202 women (validation sample). Main outcome measures : Waist circumference, body mass index, waist:hip ratio. Results : Waist circumference >/=94 cm for men and >/=80 cm for women identified subjects with high body mass index (>/=25 kg/m 2 ) and those with lower body mass index but high waist:hip ratio (>/=0.95 for men, >/=0.80 women) with a sensitivity of >96% and specificity >97.5%. Waist circumference >/=102 cm for men or >/=88 cm for women identified subjects with body mass index >/=30 and those with lower body mass index but high waist:hip ratio with a sensitivity of >96% and specificity >98%, with only about 2% of the sample being misclassified. Conclusions : Waist circumference could be used in health promotion programmes to identify individuals who should seek and be offered weight management. Men with waist circumference >/=94 cm and women with waist circumference >/=80 cm should gain no further weight; men with waist circumference >/=102 cm and women with waist circumference >/=88 cm should reduce their weight.

Overweight Prevalence and Trends for Children and Adolescents: The National Health and Nutrition Examination Surveys, 1963 to 1991

Abstract: Objective: To examine prevalence of overweight and trends in overweight for children and adolescents in the US population. Design: Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight. Participants: Between 3000 and 14000 youths aged 6 through 17 years examined in each of five separate national surveys during 1963 to 1965, 1966 to 1970, 1971 to 1974, 1976 to 1980, and 1988 to 1991 (Cycles II and III of the National Health Examination Survey, and the first, second, and third National Health and Nutrition Examination Surveys, respectively). Main Outcome Measures: Prevalence of overweight based on body mass index and 85th or 95th percentile cutoff points from Cycles II and III of the National Health Examination Survey. Results: From 1988 to 1991, the prevalence of over-weight was 10.9% based on the 95th percentile and 22% based on the 85th percentile. Overweight prevalence increased during the period examined among all sex and age groups. The increase was greatest since 1976 to 1980, similar to findings previously reported for adults in the United States. Conclusions: Increasing overweight among youths implies a need to focus on primary prevention. Attempts to increase physical activity may provide a means to address this important public health problem. (Arch Pediatr Adolesc Med. 1995;149:1085-1091)

Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample

Abstract: Objective: To determine the frequency of cardiovascular risk factors in people categorised by previously defined “action g126 levels” of waist circumference. Design: Prevalence study in a random population sample. Setting: Netherlands. Subjects: 2183 men and 2698 women aged 20-59 years selected at random from the civil registry of Amsterdam and Maastricht. Main outcome measures: Waist circumference, waist to hip ratio, body mass index (weight (kg)/height (m2)), total plasma cholesterol concentration, high density lipoprotein cholesterol concentration, blood pressure, age, and lifestyle. Results: A waist circumference exceeding 94 cm in men and 80 cm in women correctly identified subjects with body mass index of >/=25 and waist to hip ratios >/=0.95 in men and >/=0.80 in women with a sensitivity and specificity of >/=96%. Men and women with at least one cardiovascular risk factor (total cholesterol >/=6.5 mmol/l, high density lipoprotein cholesterol /=160 mm Hg, diastolic blood pressure >/=95 mm Hg) were identified with sensitivities of 57% and 67% and specificities of 72% and 62% respectively. Compared with those with waist measurements below action levels, age and lifestyle adjusted odds ratios for having at least one risk factor were 2.2 (95% confidence interval 1.8 to 2.8) in men with a waist measurement of 94-102 cm and 1.6 (1.3 to 2.1) in women with a waist measurement of 80-88 cm. In men and women with larger waist measurements these age and lifestyle adjusted odds ratios were 4.6 (3.5 to 6.0) and 2.6 (2.0 to 3.2) respectively. Conclusions: Larger waist circumference identifies people at increased cardiovascular risks.

Weight, weight change, and coronary heart disease in women. Risk within the 'normal' weight range.

Abstract: Objective. —To assess the validity of the 1990 US weight guidelines for women that support a substantial gain in weight at approximately 35 years of age and recommend a range of body mass index (BMI) (defined as weight in kilograms divided by the square of height in meters) from 21 to 27 kg/m 2 , in terms of coronary heart disease (CHD) risk in women. Design. —Prospective cohort study. Setting. —Female registered nurses in the United States. Participants. —A total of 115 818 women aged 30 to 55 years in 1976 and without a history of previous CHD. Main Outcome Measure. —Incidence of CHD defined as nonfatal myocardial infarction or fatal CHD. Results. —During 14 years of follow-up, 1292 cases of CHD were ascertained. After controlling for age, smoking, menopausal status, postmenopausal hormone use, and parental history of CHD and using as a reference women with a BMI of less than 21 kg/m 2 , relative risks (RRs) and 95% confidence intervals (CIs) for CHD were 1.19 (0.97 to 1.44) for a BMI of 21 to 22.9 kg/m 2 , 1.46 (1.20 to 1.77) for a BMI of 23 to 24.9 kg/m 2 ,2.06 (1.72 to 2.48) for a BMI of 25 to 28.9 kg/m 2 , and 3.56 (2.96 to 4.29) for a BMI of 29 kg/m 2 or more. Women who gained weight from 18 years of age were compared with those with stable weight (±5 kg) in analyses that controlled for the same variables as well as BMI at 18 years of age. The RRs and CIs were 1.25 (1.01 to 1.55) for a 5- to 7.9-kg gain, 1.64 (1.33 to 2.04) for an 8- to 10.9-kg gain, 1.92 (1.61 to 2.29) for an 11-to 19-kg gain, and 2.65 (2.17 to 3.22) for a gain of 20 kg or more. Among women within the BMI range of 18 to 25 kg/m 2 , weight gain after 18 years of age remained a strong predictor of CHD risk. Conclusions. —Higher levels of body weight within the "normal" range, as well as modest weight gains after 18 years of age, appear to increase risks of CHD in middle-aged women. These data provide evidence that current US weight guidelines may be falsely reassuring to the large proportion of women older than 35 years who are within the current guidelines but have potentially avoidable risks of CHD. ( JAMA . 1995;273:461-465)

Body Size and Fat Distribution as Predictors of Coronary Heart Disease among Middle-aged and Older US Men

Abstract: Obesity, android fat distribution, and other anthropometric measures have been associated with coronary heart disease in long-term prospective studies. However, fluctuations in weight due to age-related hormonal changes and changes in lifestyle practices may bias relative risk estimates over a long follow-up period. The authors prospectively studied the association between body mass index (BMI) (kg/m2), waist-to-hip ratio, and height as independent predictors of incident coronary heart disease in a 3-year prospective study among 29,122 US men aged 40-75 years in 1986. The authors documented 420 incident coronary events during the follow-up period. Body mass index, waist-to-hip ratio, short stature, and weight gain since age 21 were associated with an increased risk of coronary heart disease. Among men younger than 65, after adjusting for other coronary risk factors, the relative risk was 1.72 (95% confidence interval (CI) 1.10-2.69) for men with BMI of 25-28.9, 2.61 (95% CI 1.54-4.42) for BMI of 29.0-32.9, and 3.44 (95% CI 1.67-7.09) for obese men with BMI > or = 33 compared with lean men with BMI or = 65 years of age, the association between BMI and risk of coronary heart disease was much weaker. However, in this age group, the waist-to-hip ratio was a much stronger predictor of risk (relative risk = 2.76, 95% CI 1.22-6.23 between extreme quintiles). These results suggest that for younger men, obesity, independent of fat distribution, is a strong risk factor for coronary heart disease. For older men, measures of fat distribution may be better than body mass index at predicting risk of coronary disease.

Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men.

Abstract: Objective : To examine the association between smoking, alcohol consumption, and the incidence of non-insulin dependent diabetes mellitus in men of middle years and older. Design : Cohort questionnaire study of men followed up for six years from 1986. Setting : The health professionals9 follow up study being conducted across the United States. Subjects : 41810 male health professionals aged 40-75 years and free of diabetes, cardiovascular disease, and cancer in 1986 and followed up for six years. Main outcome measure : Incidence of non-insulin dependent diabetes mellitus diagnosed in the six years. Results : During 230 769 person years of follow up 509 men were newly diagnosed with diabetes. After controlling for known risk factors men who smoked 25 or more cigarettes daily had a relative risk of diabetes of 1.94 (95% confidence interval 1.25 to 3.03) compared with non-smokers. Men who consumed higher amounts of alcohol had a reduced risk of diabetes (P for trend Conclusions : Cigarette smoking may be an independent, modifiable risk factor for non-insulin dependent diabetes mellitus. Moderate alcohol consumption among healthy people may be associated with increased insulin sensitivity and a reduced risk of diabetes. Key messages Key messages Epidemiological studies have not adequately examined the independent associations between smoking, alcohol, and the risk of diabetes after accounting for obesity This paper shows that current smoking roughly doubles the risk of diabetes among a healthy population of men Moderate alcohol consumption, however, significantly decreases the risk of diabetes Smoking and alcohol may alter the risk of diabetes through long term effects on insulin secretion and insulin resistance

Prospective study of risk factors for development of non-insulin dependent diabetes in middle aged British men.

Abstract: Objective: To determine the risk factors for non-insulin dependent diabetes in a cohort representative of middle aged British men. Design: Prospective study. Subjects and setting: 7735 men aged 40-59, drawn from one group practice in each of 24 towns in Britain. Known and probable cases of diabetes at screening (n=158) were excluded. Main outcome measures: Non-insulin dependent diabetes (doctor diagnosed) over a mean follow up period of 12.8 years. Results: There were 194 new cases of non-insulin dependent diabetes. Body mass index was the dominant risk factor for diabetes, with an age adjusted relative risk (upper fifth to lower fifth) of 11.6; 95% confidence interval 5.4 to 16.8. Men engaged in moderate levels of physical activity had a substantially reduced risk of diabetes, relative to the physically inactive men, after adjustment for age and body mass index (0.4; 0.2 to 0.7), an association which persisted in full multivariate analysis. A non-linear relation between alcohol intake and diabetes was observed, with the lowest risk among moderate drinkers (16-42 units/week) relative to the baseline group of occasional drinkers (0.6; 0.4 to 1.0). Additional significant predictors of diabetes in multivariate analysis included serum triglyceride concentration, high density lipoprotein cholesterol concentration (inverse association), heart rate, uric acid concentration, and prevalent coronary heart disease. Conclusion: These findings emphasise the interrelations between risk factors for non-insulin dependent diabetes and coronary heart disease and the potential value of an integrated approach to the prevention of these conditions based on the prevention of obesity and the promotion of physical activity. Key messages Key messages This study shows a strong, graded association between body mass index and risk of diabetes in middle aged men, with no evidence of a threshold effect The risk of diabetes is reduced by more than 50% among men who take moderately vigorous exercise Cardiovascular disease risk factors that are linked with insulin resistance, such as hypertriglyceridaemia and hyperuricaemia, predict non-insulin dependent diabetes These findings support an integrated approach to the prevention of non-insulin dependent diabetes and cardiovascular disease based on the prevention of obesity and the promotion of physical activity

Alcohol, Height, and Adiposity in Relation to Estrogen and Prolactin Levels in Postmenopausal Women

Abstract: Background : Alcohol use, height, and postmenopausal adiposity have each been positively associated with postmenopausal breast cancer risk in most epidemiologic studies. The mechanism underlying these associations is unclear, although an effect of these factors on hormone levels has been hypothesized. Few previous studies have evaluated the relationship of either alcohol consumption or height with plasma hormone levels. A positive association between adiposity and plasma estrogen levels in postmenopausal women has been reported consistently. Purpose : Using archived frozen plasma samples and corresponding data from participants in the Nurses' Health Study, we determined plasma hormone levels and assessed these levels in relation to alcohol consumption, height, and adiposity among postmenopausal women. Methods : Blood samples were collected from a subset of participants in the Nurses' Health Study in 1989 and 1990, then stored in liquid nitrogen. Hormone concentrations in 217 archived plasma samples (from healthy postmenopausal women) were analyzed in 1993. Spearman correlation coefficients were calculated to assess the linear association between alcohol consumption during the previous year (mean daily intake in grams per day ascertained from semiquantitative food-frequency questionnaires completed in 1990 or 1991), height, and adiposity (as measured by body mass index [BMI] in kg/m 2 , with weight reported at time of blood collection), and plasma hormone levels. Two-sided P values were also calculated. Results : After controlling for age, height, smoking status, and BMI, alcohol consumption was positively associated with estrone sulfate concentrations (r =.17 ; P =.02) ; no statistically significant association was noted for the other plasma hormones measured. Mean plasma estrone sulfate levels were 159 pg/mL in women who reported no alcohol use versus 211 pg/mL in women consuming 30 g or more of alcohol per day. After adjusting for the other covariates, we observed a strong positive correlation between BMI and plasma estrogens (r ranging from.37 for estrone and estrone sulfate to.63 for bioavailable estradiol, with all P values ≤.01 ; prolactin was the only hormone unassociated with BMI, r = -.01). Height was unrelated to either plasma estrogens or prolactin. Conclusions : BMI and alcohol use were positively associated with postmenopausal plasma estrogen and estrone sulfate levels, respectively. Implications : The association of alcohol consumption and postmenopausal obesity with subsequent breast cancer risk might be mediated, at least in part, through an influence on postmenopausal plasma estrogen levels. Additional studies are needed to further quantify the relationship between alcohol consumption and plasma hormone levels and to elucidate the physiologic basis for this association.

Dietary factors determining diabetes and impaired glucose tolerance. A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study.

Abstract: OBJECTIVE To investigate the role of diet as a predictor of glucose intolerance and non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS At the 30-year follow-up survey of the Dutch and Finnish cohorts of the Seven Countries Study, in 1989/1990, men were examined according to a standardized protocol including a 2-h oral glucose tolerance test. Information on habitual food consumption was obtained using the cross-check dietary history method. Those 338 men in whom information on habitual diet was also available 20 years earlier were included in this study. Subjects known as having diabetes in 1989/1990 were excluded from the analyses. RESULTS Adjusting for age and cohort, the intake of total, saturated, and monounsaturated fatty acids and dietary cholesterol 20 years before diagnosis was higher in men with newly diagnosed diabetes in the survey than in men with normal or impaired glucose tolerance. After adjustment for cohort, age, past body mass index, and past energy intake, the past intake of total fat was positively associated with 2-h postload glucose level ( P P P CONCLUSIONS Although the regression coefficients were in general not very large, these results indicate that a high intake of fat, especially that of saturated fatty acids, contributes to the risk of glucose intolerance and NIDDM. Foods such as fish, potatoes, vegetables, and legumes may have a protective effect. In addition, the observed inverse association between vitamin C and glucose intolerance suggests that antioxidants may also play a role in the development of derangements in glucose metabolism.

Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma.

Abstract: Adenocarcinomas of the esophagus and gastric cardia were once rare. However, for unknown reasons, their incidence has been increasing rapidly over the past 15 years in the United States and parts of Western Europe. In contrast, the incidence of esophageal squamous cell carcinomas has remained relatively constant. To investigate possible reasons for these diverging incidence rates we analyzed data from two population-based case-control studies of cancers of the esophagus and gastric cardia that were conducted among male and female residents of western Washington between 1983 and 1990. Information on body mass index, cigarette use, alcohol intake, and other possible risk factors was collected via personal interviews with 404 cases or their next of kin (including 298 adenocarcinomas and 106 squamous cell carcinomas) and 724 controls identified by random digit dialing. Use of alcohol and cigarettes were significant risk factors for both histological types. The increase in risk for current smokers of 80 or more pack-years compared to nonsmokers was substantially higher for squamous cell cancer [odds ratio (OR) = 16.9; 95% confidence interval (CI) = 4.1-69.1] than for adenocarcinoma (OR = 3.4; 95% CI = 1.4-8.0), as was the increase for persons who typically drank 21 or more drinks/week compared to those who drank <7/week (OR = 9.5; 95% CI = 4.1-22.3 versus OR = 1.8; 95% CI = 1.1-3.1). For squamous cell carcinoma, body mass index was inversely associated with risk, whereas for adenocarcinoma, the highest risk was observed among persons who were in the highest decile of body mass index (OR = 1.9; 95% CI = 1.1-3.2).(ABSTRACT TRUNCATED AT 250 WORDS)

Prospective Study of Intentional Weight Loss and Mortality in Never-Smoking Overweight US White Women Aged 40–64 Years

Abstract: Although 40% of US women indicate they are currently trying to lose weight, the association between intentional weight loss and longevity is unknown. The authors analyzed prospective data from 43,457 overweight, never-smoking US white women aged 40-64 years who in 1959-1960 completed a questionnaire that included questions on weight change direction, amount, time interval, and intentionality. Vital status was determined in 1972. Proportional hazards regression was used to estimate mortality rate ratios for women who intentionally lost weight compared with women who had no change in weight. Women who died within the first 3 years of follow-up were excluded. Analyses were stratified by preexisting illness and adjusted for age, beginning body mass index, alcohol intake, education, physical activity, and health conditions. In women with obesity-related health conditions (n = 15,069), intentional weight loss of any amount was associated with a 20% reduction in all-cause mortality, primarily due to a 40-50% reduction in mortality from obesity-related cancers; diabetes-associated mortality was also reduced by 30-40% in those who intentionally lost weight. In women with no preexisting illness (n = 28,388), intentional weight loss of > or = 20 lb (> or = 9.1 kg) that occurred within the previous year was associated with about a 25% reduction in all-cause, cardiovascular, and cancer mortality; however, loss of or = 1 year was generally associated with small to modest increases in mortality. The association between intentional weight loss and longevity in middle-aged overweight women appears to depend on their health status. Intentional weight loss among women with obesity-related conditions is generally associated with decreased premature mortality, whereas among women with no preexisting illness, the association is equivocal.

Influence of macronutrients on adiposity development: a follow up study of nutrition and growth from 10 months to 8 years of age.

Abstract: OBJECTIVE : To investigate the relationship between early nutrient intake and adiposity development. DESIGN : A follow up study of nutrition and growth carried out in a sample of 112 French children from 10 months to 8 years of age. MEASUREMENTS : Nutritional intakes at the age of 2 years and anthropometric measurements : Body Mass Index (BMI), subscapular and triceps skinfolds at the age of 8 years, and age at adiposity rebound assessed on the basis of BMI development. RESULTS : The BMI at the age of 8 years is positively correlated with energy intake at the age of 2 years, but this correlation becomes non significant after adjustment for BMI at 2 years. Protein (% of energy) intake at the age of 2 years is positively correlated with BMI and subscapular skinfold at 8 years after adjustment for energy intake at 2 years and parental BMI. The percentage of protein at 2 years is negatively associated with age at adiposity rebound, i.e. the higher the protein intake at 2 years, the earlier the adiposity rebound and the higher the subsequent BMI level. CONCLUSION : Protein at the age of 2 years is the only nutrient intake associated with fatness development pattern. A high protein intake increases body fatness at 8 years of age, via an early adiposity rebound. The association between protein intake and obesity is consistent with the increased stature and accelerated growth of obese children. A high fat low protein diet (such as human milk) is adapted to high energy demand for growth in early childhood. Our results suggest that high protein diet early in life could increase the risk of obesity and other pathologies later in life.

Coronary Heart Disease Risk Factors in Women With Polycystic Ovary Syndrome

Abstract: The goal of the study was to compare cardiovascular heart disease risk factors in women with polycystic ovary syndrome (PCOS) and matched control subjects. Women with PCOS have risk factors, including anovulation, hyperandrogenism, and insulin resistance, that suggest a male coronary heart disease risk-factor profile. A total of 206 women with PCOS were recruited by using records from a large reproductive endocrinology practice. A clinical diagnosis of PCOS was made if there was a history of chronic anovulation in association with either clinical evidence of androgen excess (hirsutism) or if total testosterone level was >2 nm/L or the luteinizing hormone/follicle-stimulating hormone ratio was greater than 2. The overall response rate for cases was 76%. A control population was obtained by using a combination of area voters’ registration tapes and directories of households. A control subject was matched to each case subject by age±5 years, race, and neighborhood. The response rate for recruitment of the first or second eligible control subject was 83.6%. The average age at initial interview was 35.9±7.4 years for case and 37.2±7.8 years for control subjects. Women with PCOS had significantly increased cardiovascular disease risk factors compared with control women. These included increases in body mass index, insulin, and triglyceride levels ( P 2 levels ( P P 2 , LDL cholesterol, and triglycerides were still significant between case and control subjects. These risk factors were especially elevated in PCOS women in the early premenopausal years compared with control women, indicating that women with PCOS should be monitored for early detection and considered for appropriate clinical interventions.

The influence of smoking cessation on the prevalence of overweight in the United States.

Abstract: Background The proportion of U.S. adults 35 to 74 years of age who were overweight increased by 9.6 percent for men and 8.0 percent for women between 1978 and 1990. Since the prevalence of smoking declined over the same period, smoking cessation has been suggested as a factor contributing to the increasing prevalence of overweight. Methods To estimate the influence of smoking cessation on the increase in the prevalence of overweight, we analyzed data on current and past weight and smoking status for a national sample of 5247 adults 35 years of age or older who participated in the third National Health and Nutrition Examination Survey, conducted from 1988 through 1991. The results were adjusted for age, sociodemographic characteristics, level of physical activity, alcohol consumption, and (for women) parity. Results The weight gain over a 10-year period that was associated with the cessation of smoking (i.e., the gain among smokers who quit that was in excess of the gain among continuing smokers) was 4.4 k...

Fetal and infant growth and cardiovascular risk factors in women.

Abstract: Objective: To examine whether cardiovascular risk factors in women are related to fetal and infant growth. Design: Follow up study of women born 1923-30 whose birth weights and weights at one year were recorded. Setting: Hertfordshire. Subjects: 297 women born and still living in East Hertfordshire. Main outcome measures: Plasma glucose and insulin concentrations during a standard oral glucose tolerance test; fasting plasma proinsulin and 32-33 split proinsulin concentrations; blood pressure; fasting serum total, low density lipoprotein and high density lipoprotein cholesterol, triglyceride, and apolipoprotein A I and B concentrations; and plasma fibrinogen and factor VII concentrations. Results: Fasting plasma concentrations of glucose, insulin, and 32-33 split proinsulin fell with increasing birth weight (P=0.04, P=0.002, and P=0.0002 respectively, when current body mass index was allowed for). Glucose and insulin concentrations 120 minutes after an oral glucose load showed similar trends (P=0.03 and P=0.02). Systolic blood pressure, waist:hip ratio, and serum triglyceride concentrations also fell with increasing birth weight (P=0.08, P=0.07, and P=0.07 respectively), while serum high density lipoprotein cholesterol concentrations rose (P=0.04). At each birth weight women who currently had a higher body mass index had higher levels of risk factors. Conclusion: In women, as in men, reduced fetal growth leads to insulin resistance and the associated disorders: raised blood pressure and high serum triglyceride and low serum high density lipoprotein cholesterol concentrations. The highest values of these coronary risk factors occur in people who were small at birth and become obese. In contrast with men, low rates of infant growth did not predict levels of risk factors in women. Key messages Key messages They have increased levels of cardiovascular risk factors associated with insulin resistance The highest levels of these risk factors are in people who were small at birth and obese as adults Unlike in men, low rates of growth in infancy are not linked to coronary heart disease in women

Sociocultural influences on eating attitudes and behaviors, body image, and psychological functioning: A comparison of African‐American, Asian‐American, and Caucasian college women

Abstract: Eating attitudes and behaviors, body image, and psychological functioning were evaluated in 98 female college students: 36 African-Americans, 34 Asian-Americans, and 28 Caucasians. African-Americans had significantly higher body mass index than either Asian-American or Caucasians. In contrast, Caucasians reported greater levels of disordered eating and dieting behaviors and attitudes and greater body dissatisfaction than did Asian-Americans and African-Americans who differed little on these measures. The nature of variability in these eating behaviors and attitudes and body image was also examined within each of the three groups. A generally consistent pattern emerged within each racial group: low self-esteem and high public self-consciousness were associated with greater levels of problematic eating behaviors and attitudes and body dissatisfaction. A history of being teased about weight and size was associated with problematic eating behaviors and attitudes and body dissatisfaction in African-Americans and Caucasians but not in Asian-Americans. The findings suggest that there exist important racial differences on various aspects of eating, dieting, and body image in college women. Contrary to hypothesis, the degree of acculturation and assimilation within the African-American and Asian-American groups was unrelated to variability in these domains.

The nutrition transition in Brazil.

Abstract: OBJECTIVE To describe and analyse changes in child and adult nutritional status in Brazil during the past several decades. DESIGN Two large nationally representative cross-sectional anthropometric surveys undertaken in 1974 and 1989 are the primary source of information. Child nutritional status was described based on weight-for-age and weight-for-height indices using NCHS/WHO standards. Body mass index was employed to assess adult nutritional status. SUBJECTS 27,960 children and 94,699 adults in 1974 and 5969 children and 23,544 adults in 1989. SETTING All regions in Brazil. RESULTS Undernutrition, although still relevant particularly in children from lower income families, is declining among adults and children of all economic strata. Concurrent increases in adult obesity have been occurring among all groups of men and women with a higher proportion of increase among lower income families. A profound change in the income-obesity relationship determines that in the most recent survey: (1) income and body mass index are inversely related among the 30% richest women; (2) a higher prevalence of female obesity (15.4%) occurs for the 40% middle-income group; and (3) the 30% poorest Brazilian women (9.7% prevalence) can no longer be considered to be protected from obesity. CONCLUSION Brazil is rapidly shifting from the problem of dietary deficit to one of dietary excess.

Prevalence of fatty liver in Japanese children and relationship to obesity. An epidemiological ultrasonographic survey.

Abstract: The prevalence of fatty liver in children is unknown and its relationship to obesity is poorly defined. The present study of 810 northern Japanese children (4-12 years old) determined the prevalence of fatty liver in the pediatric population and its relationship to obesity. Diagnosis of fatty liver was based on established real-time ultrasonographic criteria. The overall prevalence of fatty liver was 2.6% and was higher for boys (3.4%) than for girls (1.8%), although not statistically significant (P = 0.15). Fatty liver was found in children as young as 6 years of age. There was no significant association between the prevalence of fatty liver and height (physical growth). There was a strong positive correlation between fatty liver prevalence and established obesity indices: Rohrer's Index--chi 2 linear trend = 59.2, P < 0.0001; body mass index--chi 2 linear trend = 91.6, P < 0.0001; and age-gender-adjusted Japanese standard index of weight for height--chi 2 linear trend = 93.2, P < 0.0001. However, direct measurement of abdominal subcutaneous fat thickness by ultrasonography was the best predictor of fatty liver: chi 2 linear trend = 159, P < 0.0001. These results indicate that fatty liver may develop very early in life, and there is a direct relationship between degree of obesity and fatty liver in children.

Mortality in Sleep Apnea Patients: A Multivariate Analysis of Risk Factors

Abstract: During 1976-1988 we diagnosed sleep apnea syndrome (SAS) in 1,620 adult men and women monitored in the Technion sleep laboratories. Their age at the time of diagnosis ranged between 21 and 79 years. Fifty-seven patients (53 men and 4 women) had died by 1990, 53% due to respiratory-cardiovascular causes. The observed/expected (O/E) mortality rates, calculated for men only, revealed excess mortality of patients under 70 years old. Excess mortality was significant in the fourth and fifth decades (3.33, p < 0.002; 3.23, p < 0.0002, respectively). In patients older than 70 O/E was 0.33 (p < 0.0007). Hierarchical multivariate analysis with four fixed variables [age, body mass index (BMI), hypertension and apnea index] and four additional variables added manually one at a time (heart disease, lung disease, diabetes, apnea duration) was used to determine the predictors of death from all causes, cardiopulmonary causes and from myocardial infarction (MI). All four major variables were found to be significant predictors of mortality from all causes, in addition to lung disease and heart disease. Only age and BMI were significant predictors of cardiopulmonary deaths in addition to lung disease. Age, BMI and hypertension predicted MI deaths in addition to lung disease. These results were interpreted to suggest that SAS affects death indirectly, most probably by being a risk factor for hypertension.

Human Body Composition and the Epidemiology of Chronic Disease

Abstract: Obesity and body fat distribution (FD) are established risk factors for chronic diseases. The body mass index (BMI) and the waist/hip circumference ratio (WHR) are used conventionally as indices of obesity and FD in epidemiological studies. Although some general limitations of these indices are recognized, others that affect their use in relative risks for disease are not well recognized. These include effects of sex, ethnicity, and especially age on the relationships between these indices and body composition, which can result in substantial misclassification of obesity and FD. There is considerable variability in body composition for any BMI, and some individuals with low BMIs have as much fat as those with high BMIs. This results in poor sensitivity for classifying levels of body fatness (e.g., too many "false negatives," or overweight individuals classified as not overweight), and relative risks are attenuated across all categories of BMI. A more serious problem, however, is that at different ages the same levels of BMI correspond to different amounts of fat and fat-free mass. Data from the Rosetta Study and the New Mexico Aging Process Study show that older adults have, on average, more fat than younger adults at any BMI, due to the loss of muscle mass with age. As a result, the sensitivity of BMI cutpoints with respect to body fatness decreases with age, and the use of a fixed cutpoint for all ages results in "differential misclassification bias." Taken together, these issues suggest that the increases with age in the prevalences of overweight and obesity, and in the risks for chronic diseases, may be mis-estimated using BMI. Similar issues may affect the use of WHR for estimating prevalences and associated risks of FD. New field methods for estimating body composition are available that can be applied in large, epidemiologic follow-up studies of chronic diseases. These methods will allow epidemiologists to consider, for example, whether it is increased fat, or the replacement of fat-free mass with fat, with age that is associated with risk for chronic disease.

Adenocarcinoma of the Esophagus: Role of Obesity and Diet

Abstract: BACKGROUND In the United States, the incidence of adenocarcinoma of the esophagus, including the esophagogastric junction, has been increasing rapidly over the past two decades. Except for an association with Barrett's esophagus, little is known about the etiology of these cancers. PURPOSE Our purpose was to investigate dietary and nutritional risk factors for adenocarcinoma of the esophagus. METHODS A population-based, case-control interview study of 174 white men with adenocarcinoma of the esophagus and 750 control subjects living in three areas of the United States was conducted during 1986 through 1989. RESULTS Risk was significantly elevated for subjects in the heaviest quartile compared with the lightest quartile of body mass index (odds ratio [OR] = 3.1; 95% confidence interval [CI] = 1.8-5.3). No significant associations were seen with total calories from food, number of meals eaten per day, level of fat intake, or consumption of coffee and tea. Risks were highest for those consuming the least amount of vegetables, with some evidence of a dose response for the subcategories of cruciferous vegetables (P for trend < .001) and vegetables consumed raw (P for trend = .10). A significantly elevated risk was also seen for those consuming the least amount of raw fruit (P for trend = .05). No clear associations were reported for intake of particular micronutrients overall or in supplements, but a significant protective effect was associated with increasing intake of dietary fiber (P for trend = .004). CONCLUSIONS The findings of an increased risk with obesity and decreased risks with intake of raw fruits and vegetables and dietary fiber provide useful directions to pursue in further investigations of this malignancy. IMPLICATIONS The finding with respect to obesity is particularly noteworthy, since it may explain at least a portion of the recent epidemic increases reported in the incidence of this tumor.

Free insulin-like growth factors in human obesity

Abstract: It is well established that spontaneous and stimulated growth hormone (GH) secretion is diminished in human obesity. In contrast to classic GH deficiency, obesity is not associated with hypopituitary levels of circulating total (extractable) insulin-like growth factor-I (IGF-I) and reduced somatic growth. Thus, the riddle of “normal growth without GH” in obese children and the mechanisms behind the GH suppression have remained unsolved. Insulin reduces hepatic production of IGF-binding protein-1 (IGFBP-1), an in vitro inhibitor of IGF bioactivity, and it has been suggested that the obesity-related hyperinsulinemia may increase free (bioactive) IGF in vivo by reducing the concentration of IGFBP-1. We have recently developed a method that during near in vivo conditions isolates the free, unbound fractions of IGF-1 and IGF-II in human serum. Using this method, we have determined overnight fasting serum levels of free IGFs in obese subjects and compared the results with levels of total (extractable) IGFs, IGFBPs, GH, and insulin. The study included 92 healthy subjects (56 males and 36 females) allocated to three age-matched groups depending on body mass index (BMI): 31 controls (BMI ≤ 25), 33 subjects with moderate obesity (25 < BMI < 30), and 28 subjects with severe obesity (BMI ≥ 30). Fasting serum insulin correlated positively (r = .61, P < .0001) with BMI and was significantly elevated in moderate and severe obesity (P < .05). In contrast, levels of serum GH and IGFBP-1 were suppressed in both obese groups (P < .05), and the latter inversely correlated (r = - .60, P < .001) with BMI. Serum free IGF-I was 470 ± 50 ng/L (mean ± SEM) in controls, and was elevated in moderate obesity by 47% (690 ± 90 ng/L, P < .05) and in severe obesity by 72% (810 ± 90 ng/L, P < .05), whereas levels of total IGF-I were unaltered. In addition, serum free IGF-I was inversely correlated with IGFBP-1 (r = - .47, P < .001). Serum IGFBP-3 and total IGF-II were both increased (P < .05) in obese subjects, whereas serum free IGF-II was unaltered. All phenomena were more pronounced in males than in females. We conclude that in obesity, the concentration of free IGF-I in fasting serum is increased. This is likely a result of decreased circulating IGFBP-1, again caused by hyperinsulinemia. Elevated serum free IGF-I may, by feedback, explain the low levels of GH and may be responsible for the normal growth without GH in obese children. Increased levels of IGFBP-3 and normal levels of serum total IGF-I support the interpretation that obese subjects are hypersensitive to the actions of GH.

The effect of zinc supplementation on pregnancy outcome.

Abstract: Objective. —To evaluate whether zinc supplementation during pregnancy is associated with an increase in birth weight. Design. —A randomized double-blind placebo-controlled trial. Setting. —Outpatient clinic and delivery service at the University of Alabama at Birmingham. Patients. —Five hundred eighty medically indigent but otherwise healthy African-American pregnant women with plasma zinc levels below the median at enrollment in prenatal care, randomized at 19 weeks' gestational age. Women were subdivided by the population median body mass index of 26 kg/m 2 into two groups for additional analyses. Intervention. —Women who were taking a non—zinc-containing prenatal multivitamin/mineral tablet were randomized to receive either a daily dose of 25 mg of zinc or a placebo until delivery. Main Outcome Measures. —Birth weight, gestational age at birth, and head circumference at birth. Results. —In all women, infants in the zinc supplement group had a significantly greater birth weight (126 g, P =.03) and head circumference (0.4 cm, P =.02) than infants in the placebo group. In women with a body mass index less than 26 kg/m 2 , zinc supplementation was associated with a 248-g higher infant birth weight ( P =.005) and a 0.7-cm larger infant head circumference ( P =.007). Plasma zinc concentrations were significantly higher in the zinc supplement group. Conclusions. —Daily zinc supplementation in women with relatively low plasma zinc concentrations in early pregnancy is associated with greater infant birth weights and head circumferences, with the effect occurring predominantly in women with a body mass index less than 26 kg/m 2 . ( JAMA . 1995;274:463-468)

Dental Infection and the Risk of New Coronary Events: Prospective Study of Patients with Documented Coronary Artery Disease

Abstract: Several recent studies have suggested that dental infections are associated with coronary artery disease. To further elucidate this association, we conducted a prospective 7-year follow-up study of 214 individuals (182 males and 32 females; mean age, 49 years) with proven coronary artery disease who had undergone a dental examination and evaluation for the classic coronary risk factors at entry. The main outcome measures were the incidence of fatal and nonfatal coronary events and overall mortality. Fifty-two patients met the endpoint criteria during follow-up. Dental health was a significant predictor of coronary events when controlled for the following factors: age, sex, socioeconomic status, smoking, hypertension, the number of previous myocardial infarctions, diabetes, body mass index, and serum lipids. Other significant predictors were the presence of diabetes, the number of previous myocardial infarctions, and the body mass index. Our results give further support to the hypothesis that dental infections are a risk factor for coronary events.

Daily Walking Combined With Diet Therapy Is a Useful Means for Obese NIDDM Patients Not Only to Reduce Body Weight But Also to Improve Insulin Sensitivity

Abstract: OBJECTIVE To evaluate the effects of walking combined with diet therapy (1,000–1,600 kcal/day) on insulin sensitivity in obese non-insulin-dependent diabetes mellitus (NIDDM) patients. RESEARCH DESIGN AND METHODS Subjects were divided into two groups: 10 patients were managed by diet alone (group D), and 14 patients were placed in the diet and exercise group (group DE). Group DE was instructed to walk at least 10,000 steps/day on a flat field as monitored by pedometer (19,200 ± 2,100 steps/day), and group D was told to maintain a normal daily routine (4,500 ± 290 steps/day). A glucose clamp procedure at an insulin infusion rate of 40 mU · m −2 · min −1 was performed before and after the 6-; to 8-week training program. Mean serum insulin concentrations ranged from 720 to 790 pmol/l. RESULTS While body weight (BW) in groups D and DE decreased significantly ( P that in group D (7.8 ± 0.8 vs. 4.2 ± 0.5 kg, P −1 · min −1 ( P −1 · min −1 ( P P = 0.0005) for the improvement of MCR. Significant correlations were also observed between Δ MCR and average steps per day ( r = 0.7257, P CONCLUSIONS Walking, which can be safely performed and easily incorporated into daily life, can be recommended as an adjunct therapy to diet treatment in obese NIDDM patients, not only for BW reduction, but also for improvement of insulin sensitivity.