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Biomedical subjects

B L Heitmann

Publications and source records attributed to B L Heitmann.

At least 37 records · Page 2Linked to original sources
PubMed2000

Population studies of diet and obesity.

Population-based research on diet, obesity and the metabolic syndrome is faced with accumulating evidence of biases that may profoundly affect results. One potential source of bias, which is often neglected in nutritional epidemiology, arises from self-selected study populations. Subjects who agree to participate in surveys may be at less risk of metabolic syndrome than those who refuse. Analogous to observations in adult populations, studies of schoolchildren have also yielded clear evidence of self-selection. Whether such selection patterns influence analytical results depends on how the biases relate to the dependent and independent variables being studied. Systematic dietary reporting error is another source of bias in studies of nutritional risk factors for disease. While obesity-related under-reporting bias is now well documented, less is known about whether specific foods and nutrients are disproportionately affected. However, two studies employing biomarkers for protein have suggested that obese subjects under-reported the proportion of energy from fat plus carbohydrate. This should alert epidemiologists to the possibility that a dual reporting bias may be present in studies of diet and disease: general under-reporting among obese subjects compounded by food-specific errors. In summary, biases due to self-selection and selective dietary under-reporting may produce consequences in epidemiological studies that are both unpredictable and complex. We conclude this review with recent findings involving dietary fat intake and regional adiposity in a population-based study of women. These preliminary results may have etiological relevance to the development of metabolic syndrome, but multiple biases of the type described previously may also be operating.

Anthropometry↗
PubMed2000

Mortality associated with body fat, fat-free mass and body mass index among 60-year-old swedish men-a 22-year follow-up. The study of men born in 1913.

OBJECTIVE: To describe differences in the 22 y mortality risk associated with body mass index (BMI), body fat or fat-free mass, in order to examine if the differential health consequences of fat and fat-free mass may be responsible for elevated mortality rates at both high and low BMI. DESIGN: Prospective cohort study, a 22 y follow-up. SETTING: General community. The study of men born in 1913, Gothenburg. SUBJECTS: 787 men aged 60 y. MAIN OUTCOME MEASURES: Number and time of total deaths from 1973 to 1995. RESULTS: The risk of dying was a linear function of percentage fat and fat-free mass, and increased from a relative risk of 1.00 in men belonging to the lowest fifth to 1.4 (95% confidence interval 1.11-1.99) in men in the highest fifth of percentage fat mass. For BMI the lowest risk was observed for men belonging to the middle fifth of BMI. When the relative risk was set at 1.00 for subjects belonging to the middle fifth of BMI the risk associated with the low BMI fifth was 1.3 (95% confidence interval 0.94-1.68) and that with the highest fifth was 1. 5 (95% confidence interval 1.09-1.96). Analyses including both body fat and fat-free mass showed that total mortality was a linear increasing function of high fat and low fat-free mass. CONCLUSION: The apparent U-shaped association between BMI and total mortality may be the result of compound risk functions from body fat and fat-free mass. International Journal of Obesity (2000)24, 33-37

Adipose Tissue↗
PubMed2000

Do we eat less fat, or just report so?

OBJECTIVE: To examine secular trends in diet reporting error. METHODS: Dietary information was obtained from 228 Danish men and women in 1987-88, and from 122 men and women in 1993-94. RESULTS: Bias in dietary reporting of energy and protein intake was assessed by comparing reported intake with intake data, estimated from 24 h nitrogen output, validated by administering P-aminobenzoic acid, and estimated 24 h energy expenditure. Total energy was under-reported more than energy from protein at both surveys, suggesting that energy from other nutrients, like fat and/or carbohydrate, must have been under-reported too. There was a greater under-reporting for energy than for protein in 1993-94 (29%) than in 1987-88 (15%). Obesity was positively associated with under-reporting, both in 1987-88 and in 1993-94. CONCLUSION: The higher macro-nutrient specific error in 1993-94 compared to 1987-88 may reflect a trend to increasingly omitting fat and/or carbohydrate-rich foods in dietary reporting. This may be a consequence of increased awareness of diet intake, which, in turn, may be related to intensified public health campaigns to reduce intake of fat and/or simple carbohydrate. These results may have consequences for our understanding of the apparent decline in dietary fat and associated health benefits.

4-Aminobenzoic Acid↗
PubMed2000

Ten-year trends in overweight and obesity among Danish men and women aged 30-60 years.

INTRODUCTION: The prevalence of obesity is increasing worldwide. Published data of the development of obesity among adult Danes is based primarily on self-reported information of body weight and height. The objective of the study was, therefore, to describe the development over 10 y in moderate and severe overweight in Danish adults aged 30-60 y. METHOD: 1,940 men and 1,844 women, born in 1922, 1932, 1942 or 1952, participated in a first survey in 1982. A total of 808 men and 816 women, born in 1932, 1942, 1952 or 1962, were included in a second survey in 1992. The surveys originated in the Danish MONICA studies. Moderate and severe overweight were determined on the basis of body mass index (BMI). RESULTS: The prevalence of severe overweight (BMI > or = 30 kg/m2) increased from approximately 10 to 13% in men and from 9 to 11% in women (both P=0.03), corresponding to an increase in the overweight Danish subjects of about 75,000 in this age group over the period. The increase was most pronounced in the young age groups. The proportion of severe overweight in those 30 y old increased from 3.1 to 7.8% in women (P= 0.006) and from 5.0 to 9.4% in men (P=0.045). In 1992, 8% of men with more than 12 y of schooling were severely overweight, compared to 3% 10 y earlier (P= 0.045). In women with more than 12 y of schooling there was no difference. In the group with less than 7 y schooling, the proportion of severely overweight women increased from 12.8 to 19.8% (P=0.02) and severely overweight men from 15.0 to 21.2% (P= 0.048). After adjustment for differences in age and education the proportion of severely overweight men remained greater in 1992 compared to 1982. In women the proportion of severe overweight had increased among the 30 y olds only, but not the 40-60 y olds. DISCUSSION: The increase in obesity in the Danish population is in line with the general international increase. There is a considerable increase in the proportion of adult Danes with a BMI > or = 30 kg/m2 corresponding to an estimated extra 75,000 severely overweight 30-60 y olds in the period. The study also demonstrates that the increase in severe overweight is most pronounced among the men and the younger women.

Adult↗
PubMed1999

[Occurrence and development of overweight and obesity among adult Danes aged 30-60 years].

The prevalence of obesity is increasing in most countries. So far, measured data on the development in BMI of Danish adults have largely been unavailable. The purpose of the present study was therefore to describe the 10-year trends between 1982-1992 in prevalences of over weight and obesity, measured by BMI, in 30-60 year-old men and women. The study was part of the Danish MONICA project and included 1940 men and 1844 women in 1982, and 808 men and 816 women in 1992. The data showed an increase in the prevalence of obesity (BMI > 30) from 10-13% in men, and from 9-11% in women (both p = 0.03). Increases in the prevalence of obesity were particularly pronounced among younger men and women, and among those with less than seven years of school education. The study demonstrates that trends for obesity in Denmark are comparable to trends in most other Western countries, and, furthermore, that the trend towards an increase in obesity is most pronounced among the socially disadvantaged.

Adult↗
PubMed1999

Consequences of removing iron fortification of flour on iron status among Danish adults: some longitudinal observations between 1987 and 1994.

BACKGROUND: Health authorities recommend that populations consume a diet providing sufficient iron, and in order to prevent iron deficiency, a number of countries have fortified certain foods with iron. In Denmark, flour was fortified with iron from 1954 until 1987, at which time the mandatory fortification was stopped. This study examines the effect of iron fortification on iron status by comparing the intake of iron with serum ferritin over time and in relation to the removal of flour fortification. METHODS: In a cohort of 238 Danish men and women, at baseline ages 35-65 years, dietary intake and serum ferritin were measured, first in 1987/1988 and again in 1993/1994. RESULTS: In 1987/1988 the fortification may have supplied up to 25% of total iron intake, and without this enrichment some 35% of the men and 73% of the women may have had iron intakes lower than 10 mg/day. Assuming that no flour was enriched, iron intake was constant during the 6-year study period. Despite this, after flour fortification was stopped in 1987, serum ferritin increased among both men and postmenopausal women. CONCLUSIONS: Considering that mandatory iron fortification of flour affects the entire population, including subjects who are at risk for chronic diseases because of too-high iron stores, the decision to stop the mandatory fortification in Denmark seems to have been well-founded.

Adult↗
PubMed1999

Patterns of long-term weight changes in overweight developing Danish men and women aged between 30 and 60 years.

OBJECTIVE: To determine, in a retrospective semi-longitudinal study, the pattern of weight changes over 11 y in a population of subjects who developed their overweight as adults. DESIGN: A randomly selected population of 2436 subjects from the County of Copenhagen with ages 30-60 y was followed by body weight determinations on three occasions between the years 1982-83 and 1993-94. SUBJECTS: At the last examination, 660 subjects had attained a body mass index (BMI) of>/=28 kg/m2. Of these subjects, 341 had a self-reported BMI at 25 y of less than 25 kg/m2. RESULTS: In 1994, average yearly weight changes since 1983 ranged between 0.9 and 1.2 kg in the younger (30-40 y) 0.4 and 1.2 kg in the older (50-60 y) men and women during the preceding 11 y. These changes were similar over the two periods of 5 and 6 y. More than half of the subjects had weight gains between 6 and 21 kg, about equally distributed between the two periods. Women displayed larger and more frequent gains than men, as did the younger compared to the older subjects. CONCLUSIONS: The data show that weight changes to attain overweight are highly variable among subjects. However, in most subjects, the weight changes were so small and continuous that simple theories of control by means of fixed 'set points' cannot explain the results. In fact, the weight changes were generally so small that they are unlikely to be reflected in food consumption studies and in studies of macronutrient metabolism.

Aging↗
PubMed1999

Genetic effects on weight change and food intake in Swedish adult twins.

BACKGROUND: Obesity is influenced by genetic and environmental factors. Additionally, synergistic effects of genes and environments may be important in the development of obesity. OBJECTIVE: The aim of this study was to test for genetic effects on food consumption frequency, food preferences, and their interaction with subsequent weight gain. DESIGN: Complete data on the frequencies of consumption of 11 foods typical of the Swedish diet were available for 98 monozygotic and 176 dizygotic twin pairs aged 25-59 y who are part of the Swedish Twin Registry. The data were collected in 1973 as part of a questionnaire study. Body mass index was measured in 1973 and again in 1984. RESULTS: There was some evidence that genetic effects influenced the frequency of intake of some foods. Similarity among monozygotic twins exceeded that among dizygotic twins for intake of flour and grain products and fruit in men and women, intake of milk in men, and intake of vegetables and rice in women, suggesting that genes influence preferences for these foods. Analyses conducted for twins reared together and apart also suggested greater monozygotic than dizygotic correlations, but cross-twin, cross-trait correlations were all insignificant, suggesting that the genes that affect consumption frequencies are not responsible for mediating the relation between the frequency of intake and weight change. CONCLUSIONS: Genetic effects and the frequency of intake are independently related to change in body mass index. However, there was no suggestion of differential genetic effects on weight gain that were dependent on the consumption frequency of the foods studied.

Adult↗
PubMed1999

Independent effects of stable and changing body weight on total mortality.

Most studies find that associations between mortality and either body mass index or weight change are U-shaped. Previous studies, however, have not considered independent effects of weight level and weight change while also controlling for confounding by diseases leading to weight change. We used follow-up data on average 10-year total mortality from a Danish population of 15,113 men and women, who had their weight measured at about 5-year intervals. We obtained information on preexisting disease at surveys and by linkage to hospital discharge registers. We defined subclinical disease as incident disease or death during the first 4 years of follow-up. We decomposed the mortality risk associated with weight change into a static effect, corresponding to the difference in mortality at stable weight at the initial and attained weight, and a dynamic effect, estimated as the difference between mortality after weight change and mortality at stable weight at the attained weight. Both weight level and weight change had independent effects on total mortality, with both these associations being U-shaped. Adjustment for smoking and the exclusion of subjects with preexisting and subclinical disease did not alter the associations.

Adult↗
PubMed1998

Dietary and non-dietary factors associated with iron status in a cohort of Danish adults followed for six years.

OBJECTIVE: To examine the association between food intake and serum ferritin over time. DESIGN: Two hundred and thirty-eight individuals, at baseline aged 35, 45, 55 and 65 y, had their food intake assessed by a short food frequency questionnaire and a diet history interview, and serum ferritin measured, first in 1987/88, and again in 1993/94. SETTING: The County of Copenhagen, Denmark. RESULTS: Apart from intake frequencies of alcoholic beverages dietary items were poor predictors of serum ferritin. Besides food intake serum ferritin was associated with blood donation in men, and with menopausal status in women. CONCLUSIONS: For this middle-aged population, information on alcohol intake and blood loss may be used to rank individuals in relation to iron status, whereas information on intake frequency of dietary items may not.

Adult↗
PubMed1998

Composition of body weight differences in subjects with the same body height.

OBJECTIVE: To determine the composition of body weight differences in men and women with the same height. DESIGN: A study of a random population sample of Danish subjects, aged 35-65 y. SUBJECTS: An age and sex stratified random sample of 3608 subjects of which 2987 (83%) subjects appeared for study. Of these, 548 men and 498 women were randomly selected for this present work based on their heights. RESULTS: The mean values of the slope of body fat against body fat free mass were 2.88 (s.e.m. = 0.09) in women and 1.84 (s.e.m. = 0.07) in men. There were no significant differences between the different body height classes. CONCLUSIONS: See results.

Adipose Tissue↗
PubMed1998

Symptoms of depression and changes in body weight from adolescence to mid-life.

OBJECTIVE: To investigate the relationship of symptoms of depression to weight changes in healthy individuals of normal weight across a follow-up of over 20 y. PARTICIPANTS AND DESIGN: College students (3885 men and 841 women) were administered a self-report depression measure in the mid-1960s. Their baseline body mass index (BMI) was calculated from their college medical records. Participants were contacted by mail in the late 1980s and asked to report their current height and weight as well as their smoking and exercise habits. Another measure of depressive symptoms was obtained from 3560 individuals at follow-up. Multiple regression models were used to relate changes in weight to depression scores while controlling for background (gender, baseline BMI and the gender by BMI interaction) and behavioral (exercise and smoking) predictors. RESULTS: The relationship between depressive symptoms and body weight change took the form of an interaction with baseline BMI (P < 0.001). Those with high baseline depression scores gained less weight than their nondepressed counterparts if they were initially lean, but more if they were initially heavy. This trend was especially strong in those with high depression scores at both baseline and follow-up. CONCLUSIONS: The findings support the hypothesis that depression exaggerates pre-existing weight change tendencies. This pattern would not have been detected by an examination of main effects alone, illustrating the need to move toward more complicated interactive models in the study of psychological factors and weight.

Adolescent↗
PubMed1998

Secular increases in waist-hip ratio among Swedish women.

INTRODUCTION: Secular increases in obesity have been documented in numerous populations. However, little is known about trends in fat distribution. Because men and women with elevated waist-hip ratios (WHR) constitute a high cardiovascular risk group, it is relevant to document secular changes in WHR. This paper compares WHR in three cohorts of women, one cohort recruited in the late 1960s and the others after 12 y and 24 y intervals. SUBJECTS AND METHODS: In 1968-1969, a randomly selected sample of women aged of 38 y and 50 y, was given anthropometric examinations (n = 761, total). The same measurements were taken on representative cohorts aged 38 y and 50 y in 1980-1981 (n = 677) and 1992-1993 (n = 167). All analyses of trends in WHR as a function of time are age-specific and body mass index (BMI)-adjusted. RESULTS: An interesting feature of this population is that BMI was stable from 1968-1969 to 1992-1993. However, WHR increased significantly in those aged 38 y and 50 y, independent of BMI (P = 0.001, both ages). The source of these changes in WHR was a combination of increasing waist circumferences and decreasing hip circumferences. Skinfold measurements, taken only at the first two examinations, also increased significantly. CONCLUSIONS: This female population appears to have experienced some changes in body shape and composition. However, we cannot explain the increasingly centralized fat patterning by changes in BMI, subcutaneous skinfold thickness or those obesity-related aspects of the modern lifestyle that we were able to measure.

Adult↗