Comment on: Schmidt MI, Duncan BB, Vigo A et al (2006) Leptin and incident type 2 diabetes: risk or protection? Diabetologia 49:2086-2096.
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Aged↗
Biomedical subjects
J C Seidell
Publications and source records attributed to J C Seidell.
Polymorphisms in the NPY and AGRP genes and body fatness in Dutch adults.
OBJECTIVE: To investigate the association between DNA polymorphisms in the NPY and AGRP genes and body fatness. DESIGN AND METHODS: The association between the AGRP Ala67Thr or the NPY Leu7Pro polymorphisms and indicators of body fatness (baseline leptin levels, body mass index (BMI) values and prevalence of overweight) are investigated in 582 participants of two large cohorts in The Netherlands (total 18 500 adult men and women), aged 20-40 years whose weight remained relatively constant or whose weight increased substantially (range 5.5-47 kg) during a mean follow-up of 7 years. RESULTS: No consistent associations were found for the indicators of body fatness for men and women. Among women, BMI values, leptin levels and prevalence of overweight were not statistically different for carriers of the mutant alleles compared to that of the non-carriers. Among men, carriers of the Thr67-allele of the AGRP gene had similar leptin levels, but higher BMI values compared to those with the genotyping Ala67/Ala67: mean adjusted BMI 25.6 kg/m2 (95% CI 24.3-27.0) vs 23.9 kg/m2 (23.6-24.3). Also, the risk of being overweight at baseline tended to be higher for male carriers of the Thr67-allele of the AGRP gene (OR 2.52; 95% CI 0.86-7.4). Furthermore, male carriers of the Pro7-allele of the NPY gene had on average higher leptin levels and BMI values vs non-carriers of this allele: 4.7 microg/l (95% CI 3.7-6.0) and 25.7 kg/m2 (95% CI 24.4-27.0) vs 3.1 microg/l (95% CI 2.9-3.4) and 23.9 kg/m2 (95% CI 23.5-24.3), respectively. These male carriers had also a higher risk on being overweight at baseline (OR 3.3 (95% CI 1.2-8.9)) compared to non-carriers of the Pro7-allele. CONCLUSION: The consistent findings among men suggest that the NPY Leu7Pro polymorphism (or another linked marker) might be involved in the development of obesity at younger ages. The findings for the AGRP Ala67Thr were less consistent and need further investigation. Among women, these polymorphisms do not play an important role.
Adult↗
Are malnourished patients complex patients? Health status and care complexity of malnourished patients detected by the Short Nutritional Assessment Questionnaire (SNAQ).
BACKGROUND: This article describes the characteristics of patients identified as malnourished using the Short Nutritional Assessment Questionnaire (SNAQ) in terms of health status (quality of life, functional capacity, and body composition) and care complexity. We expected that by using the quick and easy SNAQ method of screening on malnutrition, inferences could be made about general health status and care complexity. This information can be used for optimal multi-disciplinary treatment of the malnourished patient. METHODS: The research population consisted of a group of 588 patients admitted to internal medicine and surgery wards of the VU university medical center. Patients with a SNAQ score of at least 3 points were considered malnourished. The SNAQ score was compared to the health status, which was determined by serum albumin, hand grip strength, quality of life, body composition, and estimated care complexity. RESULTS: At admission, 172 patients (29%) had a SNAQ score of at least 3 points. These patients had a significantly poorer quality of life, poorer physical functioning, a lower fat free mass index, and higher care complexity. CONCLUSION: These findings confirm our assumption that a considerable proportion of malnourished patients should be considered as complex patients and that malnutrition is an important aspect and indicator of overall health status of the patients. The SNAQ is a simple malnutrition screening tool, applicable in the current complex hospital situation, to identify these complex, malnourished patients.
Journal Article↗
The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes.
Overweight and obesity are serious, large-scale, global, public health concerns requiring population-based childhood overweight and obesity prevention. The overall objective of this review is to identify aspects of successful childhood overweight prevention programmes. This objective will be met by assessing existing interventions quantitatively as well as qualitatively, identifying efficacy, effectiveness and implementation, and evaluating potential adverse effects of previous studies. This review was limited to school-based studies with a quantitative evaluation using anthropometric outcomes and that intervene on diet or activity-related behaviours. Quantitative and qualitative approaches are used to identify factors related to successful interventions as well as adverse consequences. Sixty-eight per cent of the interventions, or 17 of the 25, were 'effective' based on a statistically significant reduction in body mass index (BMI) or skin-folds for the intervention group. Four interventions were effective by BMI as well as skin-fold measures. Of these, two targeted reductions in television viewing. The remaining two studies targeted direct physical activity intervention through the physical education programme combined with nutrition education. Of the interventions reported here, one was effective in reducing childhood overweight but was also associated with an increase in underweight prevalence. Few other studies reported outcomes for underweight. The majority of overweight/obesity prevention programmes included in this review were effective. Physical education in schools and reducing television viewing are two examples of interventions that have been successful. Because few studies report on underweight prevalence, this review recommends giving more attention to preventing adverse outcomes by reporting the intervention impact on the frequency distribution for both BMI and adiposity measures.
Adolescent↗
What aspects of body fat are particularly hazardous and how do we measure them?
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Adipose Tissue↗
Low subcutaneous thigh fat is a risk factor for unfavourable glucose and lipid levels, independently of high abdominal fat. The Health ABC Study.
AIMS: We investigated whether low subcutaneous thigh fat is an independent risk factor for unfavourable glucose and lipid levels, and whether these associations differ between sexes, and between white and black adults. Our secondary aim was to investigate which body composition characteristics (lean tissue, fat tissue) are reflected by anthropometric measures (waist and thigh circumference). METHODS: Anthropometric measurements and computed tomography of the abdomen and of the thigh were performed for all participants of the Health, Aging and Body Composition Study, who were aged 70-79 years. Fasting glucose, triglycerides and HDL-cholesterol, and 2-h postload glucose were determined. RESULTS: After excluding those already diagnosed with diabetes or dyslipidaemia, we analysed data from 2,106 participants. After adjustment for abdominal subcutaneous and visceral fat, and intermuscular thigh fat, larger thigh subcutaneous fat area was statistically significantly associated with lower ln-transformed triglycerides [standardised beta (95% CI) -0.12 (-0.20 to -0.04) in men and -0.13 (-0.21 to -0.05) in women] and higher ln-HDL-cholesterol [0.10 (0.02 to 0.19) and 0.09 (0.01 to 0.18), respectively]. The associations with lower glucose levels were strong in men [-0.11 (-0.20 to -0.02) for fasting and -0.14 (-0.23 to -0.05) for postload glucose], but not statistically significant in women [-0.02 (-0.10 to 0.07) and -0.04 (-0.13 to 0.05), respectively]. There were no differences in the associations between white and black persons. Waist circumference was more strongly associated with abdominal subcutaneous fat, and this association became stronger with increasing BMI, whereas the association with visceral fat became weaker. Thigh circumference was equally dependent on thigh fat and thigh muscle in men, whereas in women the fat component was the main contributor. CONCLUSION: Larger subcutaneous thigh fat is independently associated with more favourable glucose (in men) and lipid levels (in both sexes) after accounting for abdominal fat depots, which are associated with unfavourable glucose and lipid levels. Anthropometric measures reflect different fat depots at different levels of BMI at the abdomen, and reflect both fat and lean tissue at the thigh. These results emphasise the importance of accurate measures of regional body composition when investigating potential health risks.
Abdomen↗
Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ).
OBJECTIVE: For the early detection and treatment of malnourished hospital patients no valid screening instrument for the Dutch language exists. Calculation of percentage weight loss and body mass index (BMI) by the nurse at admission to the hospital appeared to be not feasible. Therefore, the short, nutritional assessment questionnaire (SNAQ), was developed. RESEARCH, DESIGN AND METHODS: Two hundred and ninety one patients on the mixed internal and surgery/oncology wards of the VU University medical center were screened on nutritional status and classified as well nourished (<5% weight loss in the last 6 months and BMI>18.5), moderately malnourished (5-10% weight loss in the last 6 months and BMI>18.5) or severely malnourished (>10% weight loss in the last 6 months or >5% in the last month or BMI<18.5). All patients were asked 26 questions related to eating and drinking difficulties, defecation, condition and pain. Odds ratio, binary and multinomial logistic regression were used to determine the set of questions that best predicts the nutritional status. Based on the regression coefficient a score was composed to detect moderately (2 points) and severely (3 points) malnourished patients. The validity, the nurse-nurse reproducibility and nurse-dietitian reproducibility was tested in another but similar population of 297 patients. RESULTS: The questions 'Did you lose weight unintentionally?'. 'Did you experience a decreased appetite over the last month?' and 'Did you use supplemental drinks or tube feeding over the last month?' were most predictive of malnutrition. The instrument proved to be valid and reproducible. CONCLUSION: SNAQ is an easy, short, valid and reproducible questionnaire for early detection of hospital malnutrition.
Body Mass Index↗
Netherlands research programme weight gain prevention (NHF-NRG): rationale, objectives and strategies.
OBJECTIVE: To outline the rationale, objectives and strategies used in a systematically designed research programmme to study specific weight gain-inducing behaviours, their social-psychological as well as environmental determinants, and the effects of interventions aimed at the prevention of weight gain. DESIGN: The evidence for potential behavioural determinants and strategies to prevent weight gain was reviewed, and the methods applied within the Netherlands Research programme weight gain prevention (NHF-NRG) project were described. The project is designed according to the Intervention Mapping protocol. SETTING: The Netherlands. SUBJECTS: The main target groups are (a) adolescents (12-16 y) in secondary school, (b) young adults (20-40 y) at the workplace and (c) recently retired people (55-65 y) at home. INTERVENTIONS: Each intervention includes an individual component, in which computer-tailored information is provided. Additionally, interventions are aimed at changing environmental components. RESULTS: The short-term results of this project can be expected by the beginning of 2005. Guidelines for nationwide weight gain prevention, based on this research programme, will become available in 2007. CONCLUSIONS: Based on the few interventions that were evaluated to date, no robust conclusions can be drawn regarding the effectiveness of obesity prevention. The systematic and multidisciplinary design of the NHF-NRG programme enables the identification of potentially effective methods and strategies for the prevention of weight gain.
Adolescent↗
Common variants in the ATP-sensitive K+ channel genes KCNJ11 (Kir6.2) and ABCC8 (SUR1) in relation to glucose intolerance: population-based studies and meta-analyses.
AIMS: To evaluate the relation between common variants in the ATP-sensitive K+ channel genes and glucose intolerance. METHODS: We conducted a meta-analysis of reported association studies in Caucasian populations for common variants in the ABCC8 (exons 16 and 18) and the KCNJ11 (E23K) gene and examined sources of heterogeneity in the results. The meta-analysis was based on 7768-10216 subjects (depending on the gene variant), and included two new population-based studies in the Netherlands with 725 cases and 742 controls. RESULTS: For the KCNJ11 variant, the summary odds ratio (OR) for glucose intolerance was 1.12 (1.01-1.23, P=0.03) for the EK genotype and 1.44 (1.17-1.78, P=0.0007) for the KK genotype, as compared with the EE genotype. For the ABCC8 exon 16 variant, the OR was 1.06 (0.94-1.19, P=0.34) for ct and 0.93 (0.71-1.20, P=0.56) for tt, as compared with the cc genotype. For ABCC8 exon 18, the OR was 1.20 (0.97-1.49, P=0.10) for CT/TT, as compared with the CC genotype. Studies of the ABCC8 variants that were published first or had smaller sample sizes (for the exon 18 variant) showed stronger associations, which may indicate publication bias. For the ABCC8 exon 18 and the KCNJ11 variant, associations were stronger for studies of clinical diabetes than newly detected glucose intolerance. The population attributable risk for clinical Type 2 diabetes was 6.2% for the KCNJ11 KK genotype and 10.1% for the KCNJ11 EK and KK genotype combined. CONCLUSIONS: The common KCNJ11 E23K gene variant, but not the ABCC8 exon 16 or exon 18 variant, was consistently associated with Type 2 diabetes.
ATP-Binding Cassette Transporters↗
[The value and limitations of the body mass index (BMI) in the assessment of the health risks of overweight and obesity].
--The Body Mass Index (BMI) is used as a measure of overweight and obesity. In epidemiological studies age, sex and ethnic background all have to be taken into consideration, particularly when determining the health risk caused by the amount of body fat. --Caution should be observed when using the BMI as a measure for interpreting overweight and obesity as body composition can be highly variable yet have the same BMI. Therefore, BMI is not a reliable measurement of body composition in individuals particularly in older and younger people. --Excess body fat in the visceral depot poses a separate health risk. The BMI does not give any insight into regional body fat distribution. Waist circumference is a valid index of visceral fat accumulation and can therefore be used as an indicator of health risks associated with visceral obesity.
Adipose Tissue↗
[Overweight and obesity in children and adolescents and preventative measures].
The prevalence of overweight and obesity in children is increasing rapidly. This is alarming because obesity is associated with severe chronic diseases, such as type 2 diabetes mellitus. Obesity at young age is related to obesity at adult age. Consequently, the prevention of overweight from childhood onwards is an important issue. Apart from diabetes mellitus type 2 there is an increased risk of orthopaedic complications, respiratory problems, fertility problems, cardiovascular diseases and psychosocial consequences in the form of a negative self-image, emotional and behavioural problems and depression. Environmental and behavioural factors are regarded as the most important causes of the rapid increase in the prevalence of overweight and as the most important starting points for prevention. Most prevention programmes are still in the initial stages. Prevention programmes aimed at stimulating breast feeding and daily physical activity (playing outside) and the restriction of sweetened drinks and watching TV are very promising. With such preventive measures the involvement of both the school and the parents is important.
Adolescent↗
Independent and opposite associations of waist and hip circumferences with diabetes, hypertension and dyslipidemia: the AusDiab Study.
OBJECTIVE: Fat distribution as measured by waist-to-hip ratio has been shown to be an important independent predictor of glucose intolerance. Few studies, however, have considered the contributions of the waist and hip circumferences independently. The aim of this study was to investigate the independent associations of waist and hip circumference with diabetes in a large population-based study, and to investigate whether they also apply to other major components of the metabolic syndrome (hypertension and dyslipidemia). In addition, as previous studies were performed in older persons, we investigated whether these associations were present across adult age groups. METHODS: Weight, height, waist and hip circumferences were measured in 11 247 participants of the nationally representative Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. HDL-cholesterol, triglycerides, fasting and 2-h postload glucose were determined, and diastolic and systolic blood pressure was measured. After exclusion of persons already known to have diabetes, hypertension or dyslipidemia, logistic and linear regression were used to study cross-sectional associations of anthropometric variables with newly diagnosed diabetes, hypertension and dyslipidemia, and with continuous metabolic measures, all separately for men (n=3818) and women (n=4582). Analyses were repeated in the same population stratified for age. RESULTS: After adjustment for age, body mass index and waist, a larger hip circumference was associated with a lower prevalence of undiagnosed diabetes (odds ratio (OR) per one s.d. increase in hip circumference 0.55 (95% CI 0.41-0.73) in men and 0.42 (0.27-0.65) in women) and undiagnosed dyslipidemia (OR 0.58 (0.50-0.67) in men and 0.37 (0.30-0.45) in women). Associations with undiagnosed hypertension were weaker (OR 0.80 (0.69-0.93) in men and 0.88 (0.70-1.11) in women). As expected, larger waist circumference was associated with higher prevalence of these conditions. Similar associations were found using continuous metabolic variables as outcomes in linear regression analyses. Height partly explained the negative associations with hip circumference. When these analyses were performed stratified for age, associations became weaker or disappeared in the oldest age groups (age > or =75 y in particular), except for HDL-cholesterol. CONCLUSION: We found independent and opposite associations of waist and hip circumference with diabetes, dyslipidemia and less strongly with hypertension in a large population-based survey. These results emphasize that waist and hip circumference are important predictors for the metabolic syndrome and should both be considered in epidemiological studies. The associations were consistent in all age groups, except in age > or =75 y. Further research should be aimed at verifying hypotheses explaining the 'protective' effect of larger hips.
Adipose Tissue↗
Time trends (1993-1997) and seasonal variation in body mass index and waist circumference in the Netherlands.
OBJECTIVE: To compare the time trend and seasonal variation in body mass index (BMI) and waist circumference. DESIGN: Continuous monitoring health survey carried out between 1 June 1993 and 31 May 1997. SUBJECTS: A total of 8,186 men and 9,638 women aged 20-59 y from three towns in the Netherlands. MEASUREMENTS: BMI and waist circumference. Obesity was defined as BMI > or =30 kg/m(2), abdominal obesity as waist circumference > or =102 cm for men and > or =88 cm for women. RESULTS: Levels of BMI and waist circumference increased between 1 June 1993 and 31 May 1997. Among women, the time trend in abdominal obesity was stronger than that in obesity. Further, levels of BMI and waist circumference were higher in winter than in summer seasons. The seasonal variation was larger for abdominal obesity than for obesity, among both men and women. CONCLUSIONS: The time trend in women and the seasonal differences in both men and women were stronger for abdominal obesity than for obesity. Surveys on BMI and waist circumference are only comparable if season is taken into account. Furthermore, the waist circumference is a more sensitive indicator of variations in lifestyle and body composition than is body mass index.
Abdomen↗
Diet, nutrition and the prevention of excess weight gain and obesity.
OBJECTIVES: To review the evidence on the diet and nutrition causes of obesity and to recommend strategies to reduce obesity prevalence. DESIGN: The evidence for potential aetiological factors and strategies to reduce obesity prevalence was reviewed, and recommendations for public health action, population nutrition goals and further research were made. RESULTS: Protective factors against obesity were considered to be: regular physical activity (convincing); a high intake of dietary non-starch polysaccharides (NSP)/fibre (convincing); supportive home and school environments for children (probable); and breastfeeding (probable). Risk factors for obesity were considered to be sedentary lifestyles (convincing); a high intake of energy-dense, micronutrient-poor foods (convincing); heavy marketing of energy-dense foods and fast food outlets (probable); sugar-sweetened soft drinks and fruit juices (probable); adverse social and economic conditions-developed countries, especially in women (probable). A broad range of strategies were recommended to reduce obesity prevalence including: influencing the food supply to make healthy choices easier; reducing the marketing of energy dense foods and beverages to children; influencing urban environments and transport systems to promote physical activity; developing community-wide programmes in multiple settings; increased communications about healthy eating and physical activity; and improved health services to promote breastfeeding and manage currently overweight or obese people. CONCLUSIONS: The increasing prevalence of obesity is a major health threat in both low- and high income countries. Comprehensive programmes will be needed to turn the epidemic around.
Beverages↗
The insulin receptor substrate-1 Gly972Arg polymorphism is not associated with Type 2 diabetes mellitus in two population-based studies.
AIMS: The insulin receptor substrate-1 (IRS-1) gene is among the most frequently studied candidate genes for Type 2 diabetes, but findings have been inconsistent. This may have been due to generally small study sizes, or to interaction with body fatness as suggested by studies of insulin sensitivity. The aim of this study was to test the hypothesis that the IRS-1 Gly972Arg variant increases risk of Type 2 diabetes. METHODS: We conducted two large population-based studies including a total of 725 cases and 742 control subjects, who were Caucasian Dutch men and women aged 40-70 years. We calculated odds ratios adjusted for body mass index, study centre, sex and age. RESULTS: Carriers of the Arg allele did not have a higher prevalence of newly detected (OR 0.49, 95% CI 0.24-1.01) or treated (OR 0.71, 0.37-1.35) Type 2 diabetes in the first study, or a higher prevalence of glucose intolerance (OR 1.07, 0.71-1.59) in the second study. The summary odds ratio was 0.86 (0.62-1.17) for carrying the Arg allele as compared with the Gly/Gly genotype. Associations did not differ appreciably by degree of obesity. Also, the Arg variant was not associated with detrimental values for body mass index, waist circumference, plasma HDL-and total cholesterol or hypertension. CONCLUSIONS: Our findings indicate that the IRS-1 Gly972Arg variant does not substantially increase risk of common Type 2 diabetes, or Type 2 diabetes in obese persons.
Amino Acid Substitution↗
[Nutrition and health--obesity].
About 12% of the adult Dutch population is obese (Quetelet Index > or = 30 kg/m2). The prevalence has roughly doubled over the past 20 years. Obesity is strongly associated with a number of chronic diseases, such as type 2 diabetes mellitus, increased healthcare costs and a loss of productivity. Obesity is always the result of a mismatch between energy intake and energy expenditure. Foods with a high percentage of energy derived from fat are associated with weight gain, particularly when the rest of the energy is obtained from products containing little dietary fibre. Foods with a high content of refined added sugars or starch might be unfavourable with respect to the energy balance and the risk for type 2 diabetes mellitus and cardiovascular diseases. Slimming diets should aim for a gradual and sustained weight loss of about 10% of the initial weight over a period of six months, followed by weight maintenance over the next two years. Physical activity is an essential component of a weight loss strategy. Moderate sustained weight loss is associated with a strong reduction in the risk of type 2 diabetes mellitus in people with impaired glucose tolerance.
Adult↗
Leptin and insulin responses to a four-day energy-deficient diet in men with different weight history.
OBJECTIVE: To assess the leptin responses to a 4-day energy-restricted diet in men with different weight history; high retrospective weight gain was expected to be associated with a small decline in leptin. DESIGN: Changes in fasting leptin and insulin were measured during a 4-day controlled intervention, in which men with high retrospective weight gain and men who had stable weight consumed 35% of their estimated energy needs. SUBJECTS: A total of 44 healthy men (age: 31-52 y, BMI: 22.7-39.8 kg/m(2)) were recruited from a cohort study: 22 men who had gained weight (weight change >1 kg/y) and 22 men whose weight had remained stable (weight change +/-0.3 kg/y) between the first (1987-1991) and the second measurement (1993-1997) of the cohort study. The intervention study was carried out in 2001. RESULTS: After intervention, changes in fasting leptin levels were similar for both groups of retrospective weight gain: -2.2 microlU/ml (95% CI: -2.8; -1.7) and -2.4 microlU/ml (95% CI: -3.2; -1.7) respectively (P=0.69). Proportional changes in fasting leptin levels were different: -43.3% (95% CI: -47.8; -38.4) in the participants whose weight had remained stable (n=22) and -35.2% (95% CI: -42.4; -27.1) in those who had gained weight (n=22)(P<0.05). Analyses in a subgroup of men (n=18), in which the contrast in weight history was more pronounced than in the total group, did not show this difference. A higher proportional decrease in insulin levels was seen in men whose weight remained stable than in those who had gained weight: -35.4% (95% CI: -46.9; -21.3) and -12.8% (95% CI: -28.1; 5.7), respectively. The proportional decrease in leptin was positively associated with the proportional decrease in insulin (r=0.52; P<0.05). The decrease in leptin was positively associated with preintervention body weight (r=0.36; P<0.05), BMI (r=0.44; P<0.05), and waist-circumference (r=0.46; P<0.05). CONCLUSION: Although we found that the 4-day energy restriction had a smaller effect on the decrease in leptin in men with retrospective weight gain, our study does not show convincing evidence that men who gained weight are less leptin responsive to changes in energy balance than those who were weight stable.
Adult↗
Prevalence and time trends of obesity in Europe.
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Abdomen↗