Showing papers on "Body mass index published in 2006"
TL;DR: These estimates suggest that the increases in body weight are continuing in men and in children and adolescents while they may be leveling off in women; among women, no overall increases in the prevalence of obesity were observed.
Abstract: ContextThe prevalence of overweight in children and adolescents and obesity in adults in the United States has increased over several decades.ObjectiveTo provide current estimates of the prevalence and trends of overweight in children and adolescents and obesity in adults.Design, Setting, and ParticipantsAnalysis of height and weight measurements from 3958 children and adolescents aged 2 to 19 years and 4431 adults aged 20 years or older obtained in 2003-2004 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population. Data from the NHANES obtained in 1999-2000 and in 2001-2002 were compared with data from 2003-2004.Main Outcome MeasuresEstimates of the prevalence of overweight in children and adolescents and obesity in adults. Overweight among children and adolescents was defined as at or above the 95th percentile of the sex-specific body mass index (BMI) for age growth charts. Obesity among adults was defined as a BMI of 30 or higher; extreme obesity was defined as a BMI of 40 or higher.ResultsIn 2003-2004, 17.1% of US children and adolescents were overweight and 32.2% of adults were obese. Tests for trend were significant for male and female children and adolescents, indicating an increase in the prevalence of overweight in female children and adolescents from 13.8% in 1999-2000 to 16.0% in 2003-2004 and an increase in the prevalence of overweight in male children and adolescents from 14.0% to 18.2%. Among men, the prevalence of obesity increased significantly between 1999-2000 (27.5%) and 2003-2004 (31.1%). Among women, no significant increase in obesity was observed between 1999-2000 (33.4%) and 2003-2004 (33.2%). The prevalence of extreme obesity (body mass index ≥40) in 2003-2004 was 2.8% in men and 6.9% in women. In 2003-2004, significant differences in obesity prevalence remained by race/ethnicity and by age. Approximately 30% of non-Hispanic white adults were obese as were 45.0% of non-Hispanic black adults and 36.8% of Mexican Americans. Among adults aged 20 to 39 years, 28.5% were obese while 36.8% of adults aged 40 to 59 years and 31.0% of those aged 60 years or older were obese in 2003-2004.ConclusionsThe prevalence of overweight among children and adolescents and obesity among men increased significantly during the 6-year period from 1999 to 2004; among women, no overall increases in the prevalence of obesity were observed. These estimates were based on a 6-year period and suggest that the increases in body weight are continuing in men and in children and adolescents while they may be leveling off in women.
9,278 citations
01 Jan 2006
2,867 citations
TL;DR: Excess body weight during midlife, including overweight, is associated with an increased risk of death in men and women in the National Institutes of Health–AARP cohort who were 50 to 71 years old at enrollment in 1995–1996.
Abstract: Background Obesity, defined by a body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) of 30.0 or more, is associated with an increased risk of death, but the relation between overweight (a BMI of 25.0 to 29.9) and the risk of death has been questioned. Methods We prospectively examined BMI in relation to the risk of death from any cause in 527,265 U.S. men and women in the National Institutes of Health–AARP cohort who were 50 to 71 years old at enrollment in 1995–1996. BMI was calculated from selfreported weight and height. Relative risks and 95 percent confidence intervals were adjusted for age, race or ethnic group, level of education, smoking status, physical activity, and alcohol intake. We also conducted alternative analyses to address potential biases related to preexisting chronic disease and smoking status. Results During a maximum follow-up of 10 years through 2005, 61,317 participants (42,173 men and 19,144 women) died. Initial analyses showed an increased risk of death for the highest and lowest categories of BMI among both men and women, in all racial or ethnic groups, and at all ages. When the analysis was restricted to healthy people who had never smoked, the risk of death was associated with both overweight and obesity among men and women. In analyses of BMI during midlife (age of 50 years) among those who had never smoked, the associations became stronger, with the risk of death increasing by 20 to 40 percent among overweight persons and by two to at least three times among obese persons; the risk of death among underweight persons was attenuated. Conclusions Excess body weight during midlife, including overweight, is associated with an increased risk of death.
1,919 citations
TL;DR: The better outcomes for cardiovascular and total mortality seen in the overweight and mildly obese groups could not be explaining by adjustment for confounding factors and could be explained by the lack of discriminatory power of BMI to differentiate between body fat and lean mass.
1,481 citations
TL;DR: In this study of a cohort of patients in a large integrated health care system, people with higher body mass index (BMI) at baseline had a higher incidence of end-stage renal disease (ESRD) even af...
Abstract: In this study of a cohort of patients in a large integrated health care system, people with higher body mass index (BMI) at baseline had a higher incidence of end-stage renal disease (ESRD) even af...
1,145 citations
TL;DR: In this article, the authors explored the contribution of changes in weight, diet, and physical activity on the risk of developing diabetes among ILS participants, and found that weight loss was the dominant predictor of reduced diabetes incidence (hazard ratio per 5-kg weight loss 0.42 [95% CI 0.35-0.51]; P < 0.0001).
Abstract: OBJECTIVE —Diabetes Prevention Program (DPP) participants randomized to the intensive lifestyle intervention (ILS) had significantly reduced risk of diabetes compared with placebo participants. We explored the contribution of changes in weight, diet, and physical activity on the risk of developing diabetes among ILS participants.
RESEARCH DESIGN AND METHODS —For this study, we analyzed one arm of a randomized trial using Cox proportional hazards regression over 3.2 years of follow-up.
RESULTS —A total of 1,079 participants were aged 25–84 years (mean 50.6 years, BMI 33.9 kg/m2). Weight loss was the dominant predictor of reduced diabetes incidence (hazard ratio per 5-kg weight loss 0.42 [95% CI 0.35–0.51]; P < 0.0001). For every kilogram of weight loss, there was a 16% reduction in risk, adjusted for changes in diet and activity. Lower percent of calories from fat and increased physical activity predicted weight loss. Increased physical activity was important to help sustain weight loss. Among 495 participants not meeting the weight loss goal at year 1, those who achieved the physical activity goal had 44% lower diabetes incidence.
CONCLUSIONS —Interventions to reduce diabetes risk should primarily target weight reduction.
1,040 citations
TL;DR: The study findings indicate that lower body satisfaction does not serve as a motivator for engaging in healthy weight management behaviors, but rather predicts the use of behaviors that may place adolescents at risk for weight gain and poorer overall health.
963 citations
TL;DR: Assessment of risk for diabetes or cardiovascular disease stratified by body mass index and the presence or absence of metabolic syndrome (MetS) or insulin resistance (IR) found people with normal weight and MetS or IR or with obesity but no MetS and IR were not uncommon in this sample.
Abstract: Context: Metabolic risk conferred by adiposity may be due to associated risk factor clustering. Objective: The objective of this study was to assess risk for diabetes or cardiovascular disease (CVD) stratified by body mass index (BMI) and the presence or absence of metabolic syndrome (MetS) or insulin resistance (IR). Design, Setting, and Participants: This was a community-based, longitudinal study of 2902 people (55% women, mean age 53 yr) without diabetes or CVD in 1989–1992 followed for up to 11 yr. We categorized subjects by normal weight (BMI 25 kg/m 2 ), overweight (25–29.9 kg/m 2 ), or obese (30 kg/m 2 ) and by the National
956 citations
TL;DR: A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.
Abstract: Objective To determine if adolescents who report dieting and different weight-control behaviors are at increased or decreased risk for gains in body mass index, overweight status, binge eating, extreme weight-control behaviors, and eating disorders 5 years later. Design Population-based 5-year longitudinal study. Participants Adolescents (N=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2). Main Outcome Measures Weight status, binge eating, extreme weight control, and self-reported eating disorder. Statistical Analysis Multiple linear and logistic regressions. Results Adolescents using unhealthful weight-control behaviors at Time 1 increased their body mass index by about 1 unit more than adolescents not using any weight-control behaviors and were at approximately three times greater risk for being overweight at Time 2 (odds ratio [OR]=2.7 for girls; OR=3.2 for boys). Adolescents using unhealthful weight-control behaviors were also at increased risk for binge eating with loss of control (OR=6.4 for girls; OR=5.9 for boys) and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics (OR=2.5 for girls; OR=4.8 for boys) 5 years later, compared with adolescents not using any weight-control behaviors. Conclusions Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.
875 citations
TL;DR: It was showed that BMI has significant effects on all of the lung volumes, and the greatest effects were on FRC and ERV, which occurred at BMI values < 30 kg/m2, which will assist clinicians when interpreting PFT results in patients with normal airway function.
874 citations
TL;DR: Underweight, overweight, and obese men and women had higher rates of death than men and girls of normal weight and the relative risk of death associated with BMI declined with increasing age.
Abstract: BACKGROUND Obesity is associated with diverse health risks, but the role of body weight as a risk factor for death remains controversial. METHODS We examined the association between body weight and the risk of death in a 12-year prospective cohort study of 1,213,829 Koreans between the ages of 30 and 95 years. We examined 82,372 deaths from any cause and 48,731 deaths from specific diseases (including 29,123 from cancer, 16,426 from atherosclerotic cardiovascular disease, and 3362 from respiratory disease) in relation to the body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters). RESULTS In both sexes, the average baseline BMI was 23.2, and the rate of death from any cause had a J-shaped association with the BMI, regardless of cigarette-smoking history. The risk of death from any cause was lowest among patients with a BMI of 23.0 to 24.9. In all groups, the risk of death from respiratory causes was higher among subjects with a lower BMI, and the risk of death from atherosclerotic cardiovascular disease or cancer was higher among subjects with a higher BMI. The relative risk of death associated with BMI declined with increasing age. CONCLUSIONS Underweight, overweight, and obese men and women had higher rates of death than men and women of normal weight. The association of BMI with death varied according to the cause of death and was modified by age, sex, and smoking history.
TL;DR: To refine the diagnosis of childhood obesity by creating new sex-specific centile curves for body fat and to base these references on a simple and affordable method that could be widely adopted in clinical practice and surveys.
Abstract: Objective: To refine the diagnosis of childhood obesity by creating new sex-specific centile curves for body fat and to base these references on a simple and affordable method that could be widely adopted in clinical practice and surveys. Design: Body fat was measured by bio-impedance in 1985 Caucasian children aged 5-18 years from schools in Southern England. Smoothed centile charts were derived using the LMS method. Results: The new body fat curves reflect the known differences in the development of adiposity between boys and girls. The curves are similar by sex until puberty but then diverge markedly, with males proportionately decreasing body fat and females continuing to gain. These sex differences are not revealed by existing curves based on body mass index. We present charts in which cutoffs to define regions of 'underfat', 'normal', 'overfat' and 'obese' are set at the 2nd, 85th and 95th centiles. These have been designed to yield similar proportions of overweight/overfat and obese children to the IOTF body mass index cutoffs. Conclusions: Direct assessment of adiposity, the component of overweight that leads to pathology, represents a significant advance over body mass index. Our new charts will be published by the Child Growth Foundation for clinical monitoring of body fat, along with the software to convert individual measurements to Z-scores.
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TL;DR: In this article, the authors evaluate more accurate measures of fatness (total body fat, percent body fat and waist circumference) that have greater theoretical support in the medical literature and provide conversion formulas based on NHANES data so that researchers can calculate the estimated values of these more accurate features using the self-reported weight and height available in many social science datasets.
Abstract: Virtually all social science research related to obesity uses body mass index (BMI), usually calculated using self-reported values of weight and height, or clinical weight classifications based on BMI. Yet there is wide agreement in the medical literature that such measures are seriously flawed because they do not distinguish fat from fat-free mass such as muscle and bone. Here we evaluate more accurate measures of fatness (total body fat, percent body fat, and waist circumference) that have greater theoretical support in the medical literature. We provide conversion formulas based on NHANES data so that researchers can calculate the estimated values of these more accurate measures of fatness using the self-reported weight and height available in many social science datasets. To demonstrate the benefits of these alternative measures of fatness, we show that using them significantly impacts who is classified as obese. For example, when the more accurate measures of fatness are used, the gap in obesity between white and African American men increases substantially, with white men significantly more likely to be obese. In addition, the gap in obesity between African American and white women is cut in half (with African American women still significantly more likely to be obese). As an example of the value of fatness in predicting social science outcomes, we show that while BMI is positively correlated with the probability of employment disability in the PSID, when body mass is divided into its components, fatness is positively correlated with disability while fat-free mass (such as muscle) is negatively correlated with disability.
National Institutes of Health1, University of California, San Diego2, University of North Carolina at Greensboro3, RTI International4, University of Arkansas at Little Rock5, Birkbeck, University of London6, University of Texas at Austin7, Centers for Disease Control and Prevention8, Pennsylvania State University9
TL;DR: The data from this study indicate that children with BMI >85th percentile, as well as with BMIs in the high reference range are more likely than children whose BMI is <50th percentile to continue to gain weight and reach overweight status by adolescence.
Abstract: OBJECTIVES.Our aim with this study was to assist clinicians by estimating the predictive value of earlier levels of BMI status on later risk of overweight and obesity during the middle childhood and early adolescent years. METHODS.We present growth data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, a longitudinal sample of 1042 healthy US children in 10 locations. Born in 1991, their growth reflects the secular trend of increasing overweight/obesity in the population. Height and weight of participating children in the study were measured at 7 time points. We examined odds ratios for overweight and obesity at age 12 years comparing the frequency with which children did versus did not reach specific BMI percentiles in the preschool- and elementary-age periods. To explore the question of whether and when earlier BMI was predictive of weight status at age 12 years, we used logistic regression to obtain the predicted probabilities of being overweight or obese (BMI 85%) at 12 years old on the basis of earlier BMI. RESULTS.Persistence of obesity is apparent for both the preschool and elementary school period. Children who were ever overweight (85th percentile), that is, 1 time at ages 24, 36, or 54 months during the preschool period were 5 times as likely to be overweight at age 12 years than those who were below the 85th percentile for BMI at all 3 of the preschool ages. During the elementary school period, ages 7, 9, and 11 years, the more times a child was overweight, the greater the odds of being overweight at age 12 years relative to a child who was never overweight. Sixty percent of children who were overweight at any time during the preschool period and 80% of children who were overweight at any time during the elementary period were overweight at age 12 years. Follow-up calculations showed that 2 in 5 children whose BMIs were 50th percentile by age 3 years were overweight at age 12 years. No children who were 50th percentile for BMI
TL;DR: The meta-analysis shows that exercise significantly improves glycaemic control and reduces visceral adipose tissue and plasma triglycerides, but not plasma cholesterol, in people with type 2 diabetes, even without weight loss.
Abstract: Background
Exercise is generally recommended for people with type 2 diabetes mellitus. However, some studies evaluate an exercise intervention including diet or behaviour modification or both, and the effects of diet and exercise are not differentiated. Some exercise studies involve low participant numbers, lacking power to show significant differences which may appear in larger trials.
Objectives
To assess the effects of exercise in type 2 diabetes mellitus.
Search methods
Trials were identified through the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and manual searches of bibliographies.
Selection criteria
All randomised controlled trials comparing any type of well-documented aerobic, fitness or progressive resistance training exercise with no exercise in people with type 2 diabetes mellitus.
Data collection and analysis
Two authors independently selected trials, assessed trial quality and extracted data. Study authors were contacted for additional information. Any information on adverse effects was collected from the trials.
Main results
Fourteen randomised controlled trials comparing exercise against no exercise in type 2 diabetes were identified involving 377 participants. Trials ranged from eight weeks to twelve months duration. Compared with the control, the exercise intervention significantly improved glycaemic control as indicated by a decrease in glycated haemoglobin levels of 0.6% (-0.6 % HbA1c, 95% confidence interval (CI) -0.9 to -0.3; P < 0.05). This result is both statistically and clinically significant. There was no significant difference between groups in whole body mass, probably due to an increase in fat free mass (muscle) with exercise, as reported in one trial (6.3 kg, 95% CI 0.0 to 12.6). There was a reduction in visceral adipose tissue with exercise (-45.5 cm2, 95% CI -63.8 to -27.3), and subcutaneous adipose tissue also decreased. No study reported adverse effects in the exercise group or diabetic complications. The exercise intervention significantly increased insulin response (131 AUC, 95% CI 20 to 242) (one trial), and decreased plasma triglycerides (-0.25 mmol/L, 95% CI -0.48 to -0.02). No significant difference was found between groups in quality of life (one trial), plasma cholesterol or blood pressure.
Authors' conclusions
The meta-analysis shows that exercise significantly improves glycaemic control and reduces visceral adipose tissue and plasma triglycerides, but not plasma cholesterol, in people with type 2 diabetes, even without weight loss.
TL;DR: This prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality.
Abstract: ContextBoth comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment.ObjectiveTo develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report.Design, Setting, and ParticipantsUsing the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling US adults older than 50 years, we developed the prognostic index from 11 701 individuals and validated the index with 8009. Individuals were asked about their demographic characteristics, whether they had specific diseases, and whether they had difficulty with a series of functional measures. We identified variables independently associated with mortality and weighted the variables to create a risk index.Main Outcome MeasureDeath by December 31, 2002.ResultsThe overall response rate was 81%. During the 4-year follow-up, there were 1361 deaths (12%) in the development cohort and 1072 deaths (13%) in the validation cohort. Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, >85 years, 7 points and male sex, 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index <25, 1 point), and difficulty with 4 functional variables (bathing, 2 points; walking several blocks, 2 points; managing money, 2 points, and pushing large objects, 1 point. Scores on the risk index were strongly associated with 4-year mortality in the validation cohort, with 0 to 5 points predicting a less than 4% risk, 6 to 9 points predicting a 15% risk, 10 to 13 points predicting a 42% risk, and 14 or more points predicting a 64% risk. The risk index showed excellent discrimination with a cstatistic of 0.84 in the development cohort and 0.82 in the validation cohort.ConclusionThis prognostic index, incorporating age, sex, self-reported comorbid conditions, and functional measures, accurately stratifies community-dwelling older adults into groups at varying risk of mortality.
TL;DR: The associations were linearly related to the amount of weight change and were also noted in women who had a healthy prepregnancy BMI for both pregnancies, and suggest that modest increases in BMI before pregnancy could result in perinatal complications, even if a woman does not become overweight.
TL;DR: Assessment of the prevalence and impact of overweight and obesity in an Australian obstetric population finds that women are more likely to be overweight or obese than the general population.
Abstract: Objective: To assess the prevalence and impact of overweight and obesity in an Australian obstetric population. Design, setting and participants: The Mater Mother's Hospital (MMH), South Brisbane, is an urban tertiary referral maternity hospital. We reviewed data for the 18401 women who were booked for antenatal care at the MMH, delivered between January 1998 and December 2002, and had a singleton pregnancy. Of those women, 14 230 had an estimated pre-pregnancy body mass index (BMI) noted in their record; 2978 women with BMI 40 kg/m(2)). Main outcome measures: Prevalence of overweight and obesity in an obstetric population; maternal, peripartum and neonatal outcomes associated with raised BMI. Results: Of the 14230 women, 6443 (45%) were of normal weight, and 4809 (34%) were overweight, obese or morbidly obese. Overweight, obese and morbidly obese women were at increased risk of adverse outcomes (figures represent adjusted odds ratio [AOR] [95% Cl]): hypertensive disorders of pregnancy (overweight 1.74 [1.45-2.15], obese 3.00 [2.40-3.74], morbidly obese 4.87 [3.27-7.24]); gestational diabetes (overweight 1.78 [1.25-2.52], obese 2.95 [2.05-4.25], morbidly obese 7.44 [4.42-12.54]); hospital admission longer than 5 days (overweight 1.36 [1.13-1.63], obese 1.49 [1.21-1.86], morbidly obese 3.18 [2.19-4.61]); and caesarean section (overweight 1.50 [1.36-1.66], obese 2.02 [1.79-2.29], morbidly obese 2.54 [1.94-3.321). Neonates born to obese and morbidly obese women had an increased risk of birth defects (obese 1.58 (1.02-2.46], morbidly obese 3.41 [1.67-6.94]); and hypoglycaemia (obese 2.57 [1.39-4.78], morbidly obese 7.14 [3.04-16.74]). Neonates born to morbidly obese women were at increased risk of admission to intensive care (2.77 [1.81-4.25]); premature delivery (< 34 weeks' gestation) (2.13 [1.13-4.01]); and jaundice (1.44 [1.09-1.89]). Conclusions: Overweight and obesity are common in pregnant women. Increasing BMI is associated with maternal and neonatal outcomes that may increase the costs of obstetric care. To assist in planning health service delivery, we believe that BMI should be routinely recorded on perinatal data collection sheets
TL;DR: Data is summarized from many studies evaluating the impact of obesity on mortality and morbidity, some controversies are discussed, practical guidelines for managing obese patients are provided and behavioural and environmental influences predominate.
Abstract: The prevalence of overweight and obesity is increasing worldwide.1 A comparison of data from 1976–802 with that from 1999–2000 shows that the prevalence of overweight (defined as body mass index, BMI, of 25–29.9 kg/m2) increased from 46% to 64.5%, and the prevalence of obesity (BMI ⩾ 30 kg/m2) doubled to 30.5%. The epidemic of obesity is not just isolated to the US, but is worldwide,3,,4 including less affluent countries.4
Obesity and overweight have many causes, including genetic, metabolic, behavioural and environmental. The rapid increase in prevalence suggests that behavioural and environmental influences predominate, rather than biological changes.
We summarize data from many studies evaluating the impact of obesity on mortality and morbidity, discuss some controversies and provide practical guidelines for managing obese patients.
Direct associations between obesity and several diseases, including diabetes mellitus, hypertension, dyslipidaemia and ischaemic heart disease, are well recognized. Despite this, the relationship between body weight and all-cause mortality is more controversial. A very high degree of obesity (BMI ⩾35 kg/m2) seems to be linked to higher mortality rates,5 but the relationship between more modest degrees of overweight and mortality is unclear.
Initial data from actuarial studies of more than 4 million men and women showed a direct positive association between body weight and overall mortality rates.6 Subsequent studies confirmed increased mortality risk above a certain threshold, but found a U-shaped association between weight and mortality.7,,8 In the Build study,9 there was a higher mortality in lean subjects, but there was no adjustment for smoking. The American Cancer Society found a much stronger association between leanness and mortality, specifically cancer mortality, in the group of smokers compared to non-smokers.10
The Harvard Alumni Study11 was a prospective cohort study of more than 19 000 middle-aged …
Address correspondence to Dr S.D.H. Malnick, Department of Internal Medicine C, Kaplan Medical Centre, Rehovot 76100, Israel. email: stevash{at}trendline.co.il
TL;DR: In the U.S., people are classified as "normal weight" if their body mass index (BMI) is between 18 kg/m2 and 25 kg /m2, and as "overweight" or obese if their BMI is greater than 25 kg/ m2 as discussed by the authors.
Abstract: 1Following the guidelines of the World Health Organization (WHO), people are classified as “normal weight” if their body mass index (BMI) is between 18 kg/m2 and 25 kg/m2, as “overweight” if their BMI is greater than 25 kg/m2, and as “obese” if their BMI is greater than 30 kg/m2. The BMI is computed as the ratio of weight, measured in kilograms, to squared height, measured in meters. Food companies are on trial for contributing to the growing problem of obesity in the United States and abroad. They have been threatened with taxes, fines, restrictions, legislation, and the possibility of being “the tobacco industry of the new millennium” (Nestle 2002). Labeling is an area of critical concern among regulators such as the U.S. Food and Drug Administration (FDA). Although much is known about how nutrition labels influence health beliefs and purchase intentions (e.g., Moorman et al. 2004), the pressing issue for the FDA is how relative nutrition claims (e.g., low fat) influence single-occasion intake (Blakely 2005). A particularly acute concern is that low-fat labels may lead to the overconsumption of nutrient-poor and calorie-rich snack foods by the 65% of U.S. consumers who are already overweight (Hedley et al. 2004).1
TL;DR: The beneficial effect on body weight of reducing SSB consumption increased with increasing baseline body weight, offering additional support for American Academy of Pediatrics guidelines to limitSSB consumption.
Abstract: OBJECTIVE.The role of sugar-sweetened beverages (SSBs) in promoting obesity is controversial. Observational data link SSB consumption with excessive weight gain; however, randomized, controlled trials are lacking and necessary to resolve the debate. We conducted a pilot study to examine the effect of decreasing SSB consumption on body weight. METHODS.We randomly assigned 103 adolescents aged 13 to 18 years who regularly consumed SSBs to intervention and control groups. The intervention, 25 weeks in duration, relied largely on home deliveries of noncaloric beverages to displace SSBs and thereby decrease consumption. Change in SSB consumption was the main process measure, and change in body mass index (BMI) was the primary end point. RESULTS.All of the randomly assigned subjects completed the study. Consumption of SSBs decreased by 82% in the intervention group and did not change in the control group. Change in BMI, adjusted for gender and age, was 0.07 0.14 kg/m 2 (mean SE) for the intervention group and 0.21 0.15 kg/m 2 for the control group. The net difference, 0.14 0.21 kg/m 2 , was not significant overall. However, baseline BMI was a significant effect modifier. Among the subjects in the upper baseline-BMI tertile, BMI change differed significantly between the intervention (0.63 0.23 kg/m 2 ) and control (0.12 0.26 kg/m 2 ) groups, a net effect of 0.75 0.34 kg/m 2 . The interaction between weight change and baseline
Los Angeles Biomedical Research Institute1, University of Münster2, Martin Luther University of Halle-Wittenberg3, Tulane University4, VU University Medical Center5, Bar-Ilan University6, Queen's University7, Saint Louis University8, University of Texas Health Science Center at San Antonio9, University of Giessen10, Manchester Royal Infirmary11
TL;DR: The new ISA, ISSAM, EAU, EAA and ASA recommendations on the investigation, treatment and monitoring of late-onset hypogonadism in males provide updated evidence-based information for clinicians who diagnose and treat patients with adult onset, age related testosterone deficiency.
TL;DR: It is suggested that short sleep duration is associated with a modest increase in future weight gain and incident obesity and further research is needed to understand the mechanisms by which sleep duration may affect weight.
Abstract: Physiologic studies suggest that sleep restriction has metabolic effects that predispose to weight gain. The authors investigated the association between self-reported usual sleep duration and subsequent weight gain in the Nurses' Health Study. The 68,183 women who reported habitual sleep duration in 1986 were followed for 16 years. In analyses adjusted for age and body mass index, women sleeping 5 hours or less gained 1.14 kg (95% confidence interval (CI): 0.49, 1.79) more than did those sleeping 7 hours over 16 years, and women sleeping 6 hours gained 0.71 kg (95% CI: 0.41, 1.00) more. The relative risks of a 15-kg weight gain were 1.32 (95% CI: 1.19, 1.47) and 1.12 (95% CI: 1.06, 1.19) for those sleeping 5 and 6 hours, respectively. The relative risks for incident obesity (body mass index: >30 kg/m(2)) were 1.15 (95% CI: 1.04, 1.26) and 1.06 (95% CI: 1.01, 1.11). These associations remained significant after inclusion of important covariates and were not affected by adjustment for physical activity or dietary consumption. These data suggest that short sleep duration is associated with a modest increase in future weight gain and incident obesity. Further research is needed to understand the mechanisms by which sleep duration may affect weight.
TL;DR: For example, this paper found that among children ages 6 to 11, 15.8% were overweight (≥95th percentile body mass index [BMI] for age) and 31.2% are overweight or at risk for overweight ( ≥85th percentile BMI for age).
Abstract: Schools have played a central role in the provision of physical activity to American children and youth for more than a century. Physical education (PE) has been an institution in American schools since the late 1800s,1 and school sports have been a growing component of the educational enterprise since the early 1900s. Traditionally, students have engaged in physical activity during recess breaks in the school day and by walking or riding bicycles to and from school. However, as we move into the 21st century, alarming health trends are emerging, suggesting that schools need to renew and expand their role in providing and promoting physical activity for our nation’s young people.
Over the past 20 years, obesity rates in US children and youth have skyrocketed. Among children ages 6 to 11, 15.8% are overweight (≥95th percentile body mass index [BMI] for age) and 31.2% are overweight or at risk for overweight (≥85th percentile BMI for age).2 Among adolescents ages 12 to 19, 16.1% are overweight (≥95th percentile BMI for age) and 30.9% are overweight or at risk for overweight (≥85th percentile BMI for age).2 The rapid increase in the prevalence of obesity in American young people has occurred concurrently with other disquieting trends. Between 1991 and 2003, enrollment of high school students in daily PE classes decreased from 41.6% to 28.4%.3 Physically active transport to and from school has declined from previous generations; only one third of trips to school ≤1 mile and <3% of trips ≤2 miles are made by walking or biking.4,5 Even recess has been reduced or eliminated in some elementary schools.6,7
Over the years, many public health, medical, and educational authorities have called on schools to give greater attention to provision of physical activity to students. It has often been recommended …
TL;DR: BMI is associated with symptoms of gastroesophageal reflux disease in both normal-weight and overweight women, and even moderate weight gain among persons of normal weight may cause or exacerbate symptoms of reflux.
Abstract: Background Overweight and obese persons are at increased risk for gastroesophageal reflux disease. An association between body-mass index (BMI) — the weight in kilograms divided by the square of the height in meters — and symptoms of gastroesophageal reflux disease in persons of normal weight has not been demonstrated. Methods In 2000, we used a supplemental questionnaire to determine the frequency, severity, and duration of symptoms of gastroesophageal reflux disease among randomly selected participants in the Nurses' Health Study. After categorizing women according to BMI as measured in 1998, we used logistic-regression models to study the association between BMI and symptoms of gastroesophageal reflux disease. Results Of 10,545 women who completed the questionnaire (response rate, 86 percent), 2310 (22 percent) reported having symptoms at least once a week, and 3419 (55 percent of those who had any symptoms) described their symptoms as moderate in severity. We observed a dose-dependent relationship bet...
TL;DR: Obesity seems to be an important-and potentially preventable-risk factor for CRF, and the strongest association was with diabetic nephropathy, but two- to three-fold risk elevations were observed for all major subtypes of CRF.
Abstract: Few large-scale epidemiologic studies have quantified the possible link between obesity and chronic renal failure (CRF) This study analyzed anthropometric data from a nationwide, population-based, case-control study of incident, moderately severe CRF Eligible as cases were all native Swedes who were aged 18 to 74 yr and had CRF and whose serum creatinine for the first time and permanently exceeded 34 mg/dl (men) or 28 mg/dl (women) during the study period A total of 926 case patients and 998 control subjects, randomly drawn from the study base, were enrolled Face-to-face interviews, supplemented with self-administered questionnaires, provided information about anthropometric measures and other lifestyle factors Logistic regression models with adjustments for several co-factors estimated the relative risk for CRF in relation to body mass index (BMI) Overweight (BMI>or=25 kg/m2) at age 20 was associated with a significant three-fold excess risk for CRF, relative to BMI or=30) among men and morbid obesity (BMI>or=35) among women anytime during lifetime was linked to three- to four-fold increases in risk The strongest association was with diabetic nephropathy, but two- to three-fold risk elevations were observed for all major subtypes of CRF Analyses that were confined to strata without hypertension or diabetes revealed a three-fold increased risk among patients who were overweight at age 20, whereas the two-fold observed risk elevation among those who had a highest lifetime BMI of >35 was statistically nonsignificant Obesity seems to be an important-and potentially preventable-risk factor for CRF Although hypertension and type 2 diabetes are important mediators, additional pathways also may exist
TL;DR: The capability of the most commonly used methods to assess total adiposity and fat distribution is summarized, and it has been shown that in particular the visceral fat depot is associated with metabolic disease risk.
Abstract: Numerous techniques are available to estimate body composition and fat distribution, and the method to use will depend on the aim of the study, economic resources, availability, time, and sample size. 6–8 Multi-compartment models, such as underwater weighing, dilution techniques and dual-energy X-ray absorptiometry (DXA) are all reliable methods to obtain accurate measures of total body fat. However, because of their costs in terms of time andmoney, thesemethods are not practical in large epidemiological studies and for routine clinical use. In these situations, body mass index (BMI) is often used and assumed to represent the degree of body fat. BMI, however, does not distinguish between fat mass and lean (non-fat) mass. For example, well-trained body builders have a very low percentage of body fat, but their BMI may be in the overweight range because of their large lean (muscle) mass. In addition, in the elderly and non-Caucasian populations, the relationship between BMI and body fatness may be different as compared with younger Caucasian populations. 9–14 Another potential limitation of the BMI is that the distribution of fat over the body is not captured. Many studies have shown that an abdominal fat distribution, independent of overall obesity, is associated with metabolic disturbances and increased disease risk. 15–23 An increased abdominal fat accumulation is largely caused by the accumulation of visceral (or intraabdominal) fat (for distinction of these fat depots, see Figure 1). Owing tometabolic differences between different fat depots, they differ in their role of predicting metabolic disturbances and diseases. Table 1 summarizes the capability of the most commonly used methods to assess total adiposity and fat distribution. Abdominal obesity is usually assessed by the easily measured waist circumference, the waist-to-hip circumference ratio (WHR), or the less-commonly used sagittal abdominal diameter (SAD). By the use of sophisticated imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT), different fat depots can be distinguished at the waist level, and it has been shown that in particular the visceral fat depot is associated with metabolic disease risk. 24–30 Because the SAD or waist circumference alone are more strongly correlated with visceral fat than the WHR, 31–35 guidelines tend to focus onwaist circumference to estimate disease risk as suggested by Lean et al. 36 These widely used cut-points (i.e. 102 cm formen and 88 cm for women) were originally based on a replacement of the classification of BMI, 36 but other cut-points have also been suggested on the basis of relationships with visceral fat area. 37
International Agency for Research on Cancer1, Aalborg University2, Institut Gustave Roussy3, German Cancer Research Center4, National and Kapodistrian University of Athens5, Imperial College London6, University of Turin7, University of Naples Federico II8, Utrecht University9, Umeå University10, Lund University11, University of Oxford12, Medical Research Council13, University of Cambridge14
TL;DR: In this paper, the authors used multivariable adjusted Cox proportional hazards models to examine the association between anthropometric measures and risks of colon and rectal cancer among 368 277 men and women who were free of cancer at baseline from nine countries of the European Prospective Investigation Into Cancer and Nutrition.
Abstract: Background: Body weight and body mass index (BMI) are positively related to risk of colon cancer in men, whereas weak or no associations exist in women. This discrepancy may be related to differences in fat distribution between sexes or to the use of hormone replacement therapy (HRT) in women. Methods: We used multivariable adjusted Cox proportional hazards models to examine the association between anthropometric measures and risks of colon and rectal cancer among 368 277 men and women who were free of cancer at baseline from nine countries of the European Prospective Investigation Into Cancer and Nutrition. All statistical tests were two-sided. Results: During 6.1 years of follow-up, we identified 984 and 586 patients with colon and rectal cancer, respectively. Body weight and BMI were statistically significantly associated with colon cancer risk in men (highest versus lowest quintile of BMI, relative risk [RR] = 1.55, 95% confidence interval [CI] = 1.12 to 2.15; P-trend =.006) but not in women. In contrast, comparisons of the highest to the lowest quintile showed that several anthropometric measures, including waist circumference (men, RR = 1.39,95% CI = 1.01 to 1.93; P-trend = .001; women, RR = 1.48, 95% CI = 1.08 to 2.03; P-trend =.008), waist-to-hip ratio (WHR; men, RR = 1.51, 95% CI = 1.06 to 2.15; P-trend =.006; women, RR = 1.52, 95% CI = 1.12 to 2.05; P-trend =.002), and height (men, RR = 1.40, 95% CI = 0.99 to 1.98; P-trend =.04; women, RR = 1.79, 95% CI = 1.30 to 2.46; P-trend <.001) were related to colon cancer risk in both sexes. The estimated absolute risk of developing colon cancer within 5 years was 203 and 131 cases per 100 000 men and 129 and 86 cases per 100000 women in the highest and lowest quintiles of WHR, respectively. Upon further stratification, no association of waist circumference and WHR with risk of colon cancer was observed among postmenopausal women who used HRT. None of the anthropometric measures was statistically significantly related to rectal cancer. Conclusions: Waist circumference and WHR, indicators of abdominal obesity, were strongly associated with colon cancer risk in men and women in this population. The association of abdominal obesity with colon cancer risk may vary depending on HRT use in postmenopausal women; however, these findings require confirmation in future studies.
TL;DR: Individuals who survive AN and who no longer have body mass indexes in the AN range appear to be at lower risk for the development of overweight, and Prospectively assessed neuroticism was associated with the subsequent development of AN.
Abstract: Context Anorexia nervosa (AN) is a serious mental illness with marked morbidity and mortality. Objective To explore the prevalence, heritability, and prospectively assessed risk factors for AN in a large population-based cohort of Swedish twins. Design During a 4-year period ending in 2002, all living, contactable, interviewable, and consenting twins in the Swedish Twin Registry (N = 31 406) born between January 1, 1935, and December 31, 1958, underwent screening for a range of disorders, including AN. Information collected systematically in 1972 to 1973, before the onset of AN, was used to examine prospective risk factors for AN. Setting Population-based sample of twins in Sweden. Participants Cases of AN were identified as those individuals who met full DSM-IV criteria by means of clinical interview of the Swedish Twin Registry, who had a hospital discharge diagnosis of AN, or who had a cause-of-death certificate including an AN diagnosis. Results The overall prevalence of AN was 1.20% and 0.29% for female and male participants, respectively. The prevalence of AN in both sexes was greater among those born after 1945. Individuals with lifetime AN reported lower body mass index, greater physical activity, and better health satisfaction than those without lifetime AN. Anorexia nervosa was inversely associated with the development of overweight (odds ratio, 0.29; 95% confidence interval [CI], 0.16-0.54 [ P DSM-IV AN (additive genetic effects) was estimated to be a 2 = 0.56 (95% CI, 0.00-0.87), with the remaining variance attributable to shared environment (c 2 = 0.05; 95% CI, 0.00-0.64) and unique environment (e 2 = 0.38; 95% CI, 0.13-0.84). Neuroticism measured about 3 decades before the diagnostic assessment was significantly associated with the development of later AN (odds ratio, 1.62; 95% CI, 1.27-2.05 [ P Conclusions The prevalence of AN was higher in both male and female participants born after 1945. Individuals who survive AN and who no longer have body mass indexes in the AN range appear to be at lower risk for the development of overweight. Prospectively assessed neuroticism was associated with the subsequent development of AN, the liability to which is under considerable genetic influence.
TL;DR: BMI and FFMI were significant predictors of mortality, independent of relevant cov...
Abstract: Rationale: Low body mass index (BMI) is a marker of poor prognosis in chronic obstructive pulmonary disease (COPD). In the general population, the harmful effect of low BMI is due to the deleterious effects of a low fat-free mass index (FFMI; fat-free mass/weight2).Objectives: We explored distribution of low FFMI and its association with prognosis in a population-based cohort of patients with COPD.Methods: We used data on 1,898 patients with COPD identified in a population-based epidemiologic study in Copenhagen. FFM was measured using bioelectrical impedance analysis. Patients were followed up for a mean of 7 yr and the association between BMI and FFMI and mortality was examined taking age, sex, smoking, and lung function into account.Main Results: The mean FFMI was 16.0 kg/m2 for women and 18.7 kg/m2 for men. Among subjects with normal BMI, 26.1% had an FFMI lower than the lowest 10th percentile of the general population. BMI and FFMI were significant predictors of mortality, independent of relevant cov...