Biomedical subjects

Mark S Litaker

Publications and source records attributed to Mark S Litaker.

At least 19 recordsLinked to original sources

PubMed2006

Prediction of cervical histologic results using an abbreviated Reid Colposcopic Index during ALTS.

OBJECTIVE: The purpose of this study was to determine the accuracy of an abbreviated Reid Colposcopic Index (RCI) to detect cervical intraepithelial neoplasia (CIN) 2 and CIN 3 during the National Cancer Institute (NCI) ASCUS LSIL Triage Study (ALTS). STUDY DESIGN: Colposcopists from 4 ALTS clinical centers indicated an RCI score after colposcopically examining subjects. Colposcopy quality control reviewers also documented an RCI score for the same subjects after assessing their digitized cervical images. Associations of colposcopist and reviewer RCI scores with histologic results were evaluated. Agreement rates between colposcopists and reviewers were calculated for colposcopic impression. RESULTS: Overall RCI score agreement was poor (weighted Kappa = 0.17). The sensitivity, specificity, positive and negative predictive values of a colposcopist's RCI score of >3/6 to detect CIN 3 or worse were 37.3% (95% CI 32.5%-42.3%), 89.7% (88.6%-90.8%), 30.8% (26.7%-35.2%), and 92.1% (91.1%-93.0%), respectively. The 3 colposcopic signs were not individually sensitive in detecting CIN 3. CONCLUSION: Colposcopists using the RCI in the ALTS trial failed to detect CIN 2/3 at the levels expected.

Colposcopy↗

PubMed2006

Body mass index, sex, interview protocol, and children's accuracy for reporting kilocalories observed eaten at school meals.

This pilot study investigated body mass index (BMI; calculated as kg/m(2)), sex, interview protocol, and children's accuracy for reporting kilocalories. Forty 4th-grade children (20 low-BMI: >or=5th and <50th percentiles, 10 boys, 15 African American; 20 high-BMI: >or=85th percentile, 10 boys, 15 African American) were observed eating school meals (breakfast, lunch) and interviewed either that evening about the prior 24 hours or the next morning about the previous day, with 10 low-BMI (5 boys) and 10 high-BMI (5 boys) children per interview protocol. Five kilocalorie variables were analyzed using separate four-factor (BMI group, sex, race, interview protocol) analyses of variance. No effects were found for reported or matched kilocalories. More kilocalories were observed (P<0.02) and omitted (P<0.05) by high-BMI than low-BMI children. For intruded kilocalories, means were smaller (better) for high-BMI girls than high-BMI boys, but larger for low-BMI girls than low-BMI boys (interaction P<0.04); low-BMI girls intruded the most while high-BMI girls intruded the least. For interview protocol, omitted and intruded kilocalories were higher (worse), although not significantly so (P values <0.11), for interviews about the previous day than the prior 24 hours. These results illuminate relations of BMI, sex, interview protocol, and children's reporting accuracy, and are consistent with results concerning BMI and sex from studies with adults.

Analysis of Variance↗

PubMed2006

Effect of dental practice characteristics on racial disparities in patient-specific tooth loss.

OBJECTIVE: The objective of this study was to test the hypothesis that dental practice characteristics are associated with tooth loss incidence with both tooth-specific and patient-specific characteristics already taken into account. RESEARCH DESIGN: A population-based prospective cohort study was conducted. In-person interviews and clinical examinations were done at baseline, 24, and 48 months, with telephone interviews every 6 months. Practices that coincidentally served participants in the study completed practice characteristics questionnaires. To increase inferential power when testing practice-level effects, detailed tooth-specific and patient-specific data were simultaneously taken into account in tests for association between practice-level effects and tooth loss. SETTING: Data were from the Florida Dental Care Study. The key health outcome was tooth loss, a leading measure of a population's oral health. PARTICIPANTS: Eight hundred seventy-three African-Americans and non-Hispanic whites who had at least 1 tooth. RESULTS: Certain practice characteristics were associated with tooth loss, including the racial mix of the practice's patient population; persons who attended practices with higher percentages of African-Americans were more likely to receive a dental extraction regardless of the individual patient's race. CONCLUSIONS: This is the first longitudinal report of increased risk for tooth loss resulting from practice-level effects. Although a patient-level racial disparity remained evident, and even with detailed tooth-specific and patient-level characteristics taken into account, racial differences in characteristics of practices attended independently contributed to the patient-level racial disparity in health.

Black or African American↗

PubMed2006

Practice characteristics associated with patient-specific receipt of dental diagnostic radiographs.

OBJECTIVE: To quantify the role of practice characteristics in patient-specific receipt of dental diagnostic radiographic services. DATA SOURCE/STUDY SETTING: Florida Dental Care Study (FDCS). Study Design. The FDCS was a 48-month prospective observational cohort study of community-dwelling adults. Participants' dentists were asked to complete a questionnaire about their practice characteristics. DATA COLLECTION/EXTRACTION METHODS: In-person interviews and clinical examinations were conducted at baseline, 24, and 48 months, with 6-monthly telephone interviews in between. A single multivariate (four radiographic service outcomes) multivariable (multiple explanatory covariates) logistic regression was used to model service receipts. PRINCIPAL FINDINGS: These practice characteristics were significantly associated with patient-specific receipt of radiographic services: number of different practices attended during follow-up; dentist's rating of how busy the practice was; typical waiting time for a new patient examination; practice size; percentage of patients that the dentist reported as interested in details about the condition of their mouths; percentage of African American patients in the practice; percentage of patients in the practice who do not have dental insurance; and dentist's agreement with a statement regarding whether patients should be dismissed from the practice. Effects had differential magnitudes and directions of effect, depending upon radiograph type. CONCLUSIONS: Practice characteristics were significantly associated with patient-specific receipt of services. These effects were independent of patient-specific disease level and patient-specific sociodemographic characteristics, suggesting that practitioners do influence receipt of these diagnostic services. These findings are consistent with the conclusion that practitioners act in response to a mix of patients' interests, economic self-interests, and their own treatment preferences.

Adult↗

PubMed2006

The relationship between sociodemographic factors and oral health-related quality of life in dentate and edentulous community-dwelling older adults.

OBJECTIVES: To quantify the associations between sociodemographic factors and oral health-related quality of life (OHRQoL) in dentate and edentulous community-dwelling older adults. DESIGN: Cross-sectional study using a 54-item OHRQoL questionnaire. SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Hale, Bibb, and Pickens (rural). PARTICIPANTS: Two hundred eighty-eight participants (Dental Study subjects) aged 65 and older were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in older African Americans and non-Hispanic whites. MEASUREMENTS: Dental Study subjects were queried on their OHRQoL and sociodemographic status and classified into two categories: dentate and edentulous. Bivariate analyses were used to quantify associations between sociodemographic variables and OHRQoL after excluding participants with severe depression. Variables included age, sex, race, marital status, veteran status, residence, income, education, and transportation difficulties. RESULTS: Dentate and edentulous subjects had similar OHRQoL across age, sex, marital status, veteran status, and residence. Analyses suggested a strong association between OHRQoL and race, education, income, and transportation difficulties in dentate subjects. Sociodemographic factors were less strongly associated with OHRQoL in edentulous participants. CONCLUSION: OHRQoL decrements were prevalent in dentate and edentulous subjects. Of dentate persons, African Americans and those with a 6th-grade education or less, with income less than 16,000 dollars/year, and with transportation difficulties were more likely to have decrements in OHRQoL. In edentulous persons, these associations were not statistically significant or were weaker. These findings suggest differential associations between sociodemographic factors and OHRQoL when stratified according to dentate status.

Black or African American↗

PubMed2006

Relations of black mothers' and daughters' body fatness, physical activity beliefs and behavior.

OBJECTIVES: 1) Examine the association between Black mothers' and daughters' body fatness, physical activity (PA) beliefs and levels of PA, and daughters' PA behavior; 2) determine whether family sociodemographic factors influence these relationships. DESIGN AND SETTING: Cross-sectional; Black girls recruited from elementary schools in a low socioeconomic area. Data collected at the Georgia Prevention Institute. PARTICIPANTS: 133 Black girls (8-12 years of age) and their mothers (24-66 years of age). ANALYSES: Spearman correlations, regressions. OUTCOME MEASURES: Body mass index (BMI) as a measure of body fatness. Moderate and vigorous PA collected from a 7-d recall. Beliefs about PA collected from questionnaires. RESULTS: There was a positive relation between mothers' and daughters' BMI (rs=0.34, P<.0001). Mothers' and daughters' PA beliefs were positive but not significantly related. A significant inverse relation was seen between vigorous PA (rs=-0.16, P<.05); and a non-significant correlation between moderate PA (rs=0.05). Mothers' body fatness, PA beliefs and behavior did not predict daughters' PA. The BMI association was stronger when spouse lived in household (P<.01). Daughters' BMI was lower (P<.05) and intent to be active higher (P<.05) when more people lived in the household. Family income accentuated the relation of mothers' belief in the usefulness of PA and daughters' PA physical outcomes beliefs (P=.1). Mothers' age and education had no significant influence on daughters' PA beliefs and behaviors. CONCLUSION: Mothers and daughters believed PA to have beneficial outcomes. Mothers' body fatness, PA beliefs and behaviors were not associated with daughters' PA. Family income and structure appeared to influence these relationships.

Adult↗

PubMed2005

Tanner staging of secondary sexual characteristics and body composition, blood pressure, and insulin in black girls.

OBJECTIVE: To assess Tanner staging (breast and pubic hair development) and its relationship to measures of body composition, blood pressure, and fasting insulin and glucose in young black girls. RESEARCH METHODS AND PROCEDURES: Subjects were 138 black girls, 8 to 12 years of age, recruited from elementary schools in low socioeconomic status neighborhoods. Exclusion criteria included the presence of any acute/chronic medical conditions. Pubertal stages were assessed by one of two pediatricians and analyzed individually, as well as with a composite index (prepubertal, pubertal/premenarcheal, or pubertal/menarcheal). Glucose and insulin were measured after a 12-hour fast. Measures of body composition included height, weight, BMI, waist and hip circumferences, fat mass, fat-free soft tissue, bone mineral density (DXA), and visceral adipose tissue (magnetic resonance imaging). Resting systolic and diastolic blood pressure were measured by Dinamap. RESULTS: With age in the model, breast development explained significant proportions of the variance in height, weight, fat-free soft tissue, bone mineral density, and insulin. Adding pubic hair development or menarche to those models did not significantly increase the proportion of variance that was explained by breast development. Furthermore, using a composite index of pubertal staging explained a smaller proportion of the variance compared with breast development alone. DISCUSSION: Combined with age, breast development was a better predictor of body composition and fasting insulin than was pubic hair development or a composite index of pubertal staging.

Adipose Tissue↗

PubMed2004

Colposcopy quality control by remote review of digitized colposcopic images.

OBJECTIVE: This study was undertaken to estimate the accuracy of colposcopy quality control review of subjects' digitized colposcopic images during the atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion triage study (ALTS). STUDY DESIGN: After colposcopic examination and the acquisition of 2 digitized cervical images, colposcopists recorded colposcopic diagnoses in a standardized computer database. The images were transferred by modem to colposcopy quality control reviewers for a blinded interpretation, including assessment of image quality. Reviewers' and colposcopists' diagnoses were compared with histologic diagnoses using standard contingency table methods. RESULTS: Colposcopists and reviewers underdiagnosed 16.1% and 25.3% of subjects, and overdiagnosed 44.7% and 19.8% of subjects compared with histology, respectively. The sensitivity and specificity for detecting cervical intraepithelial neoplasia 2 or greater were 35.4% versus 23.2%, P < .0001, and 89.9% versus 95.0%, P < .0001, respectively, for colposcopists and reviewers. CONCLUSION: Colposcopy quality control by review of digitized colposcopic images in clinical trials warrants further evaluation if the accuracy can be improved.

Biopsy, Needle↗

PubMed2004

Recency affects reporting accuracy of children's dietary recalls.

PURPOSE: This study evaluated the effect of recency on accuracy of fourth-graders' dietary reports. METHODS: Each of 60 randomly selected children was observed eating school meals (breakfast, lunch) and interviewed to obtain a 24-hour dietary recall using one of six conditions generated by crossing two target periods (previous day, prior 24 hours) with three interview times (morning, afternoon, evening), with 10 children (5 males) per condition. Accuracy of the school meal portions of each recall was assessed by comparing reports to observations. Rates for omissions (items observed but not reported) and intrusions (items reported but not observed) were calculated to determine accuracy for reporting items. A measure of total inaccuracy combined errors for reporting items and amounts. RESULTS: Using the prior 24 hours as the target period yielded better performance than did using the previous day: Omission rates were lower by about one-third, intrusion rates by about one-half, and total inaccuracy by about one-third (all p's<0.01). A marginally significant interaction of target period by interview time was found for omission rate (p=0.08), but not for intrusion rate (p=0.15) or for total inaccuracy (p=0.47). CONCLUSIONS: This provides evidence that recency influences children's recall accuracy and demonstrates the importance of an awareness of principles of memory when designing what are essentially memory tests for epidemiologic studies.

Child↗

PubMed2004

Cerebral vasoreactivity in children and adolescents with type 1 diabetes mellitus.

It is well established in clinical and experimental settings that diabetes mellitus, especially if long lasting, impairs autoregulation of cerebral blood flow (CBF). However, the onset and the course of development of this dysfunction remain unknown. We hypothesized that assessment of autoregulatory functions of cerebral arteries in children with relatively short duration of type 1 diabetes mellitus may provide an insight into the pathophysiology of the development of impaired autoregulation of CBF. Such a dysfunction of vasodilation of cerebral arteries can be assessed by transcranial Doppler. Therefore, to examine whether and when autoregulation of CBF becomes affected by diabetes, we used transcranial Doppler and a pCO2 challenge in 17 males between the ages of 12-20 years with type 1 diabetes mellitus of 0.2-16 years duration and with varying degrees of glucose control. The results were compared with age-matched, healthy, nondiabetic controls. The CO2 challenge increased cerebral blood-flow velocities and decreased the pulsatility index. These changes were not influenced by the presence or duration of diabetes, insulin dose, or degree of diabetic control.

Adolescent↗

PubMed2004

Telemedicine network telecolposcopy compared with computer-based telecolposcopy.

OBJECTIVES: To compare computer-based telecolposcopy with telemedicine network telecolposcopy. MATERIALS AND METHODS: An on-site expert and local clinician at two rural sites conducted colposcopic examinations on 264 women. Colposcopic images were captured and transmitted to two other experts at a remote location using a statewide telemedicine system and a computer and modem-based system. Sensitivity and specificity, agreement of examination adequacy and management, effects of delayed interpretations, and costs were compared for each system. RESULTS: A greater rate of satisfactory colposcopy results was reported by the telemedicine network (66.1%) compared with computer-based (43.6%) telecolposcopy (p < .0001). Greater rates of cervical biopsy (p = .005) and endocervical curettage (p = .03) were required by delayed telecolposcopy compared with immediate telecolposcopic services. There were no significant differences in sensitivity of detecting cervical neoplasia among the types of the telecolposcopy. Computer-based telecolposcopy cost 28 dollars less per patient than telemedicine network telecolposcopy. CONCLUSIONS: Computer-based telecolposcopy may be a reasonable, cost-effective adjunct to on-site colposcopy for evaluating women in medically underserved areas. Synchronous telecolposcopic examination minimizes histologic sampling and improves consultation.

Journal Article↗

PubMed2003

Reverse versus forward order reporting and the accuracy of fourth-graders' recalls of school breakfast and school lunch.

BACKGROUND: Do children recall school breakfast and school lunch intake during 24-h recalls more accurately when prompted to report meals and snacks in reverse versus forward order? METHODS: One hundred twenty-one fourth-graders stratified by race (Black, White) and gender were each observed and interviewed twice (once per order) regarding the previous day's intake. Omission and intrusion rates determined accuracy for reporting items. Total inaccuracy determined accuracy for reporting items and amounts. RESULTS: Results failed to indicate significant effects of interviewer, weekday, sequence (first or second recall), or race on omission rates, intrusion rates, or total inaccuracy. A significant order by gender interaction was found for omission rates, which were lower (i.e., better) for males for reverse (53%) versus forward recalls (62%), but not females (61 versus 53%) (P < 0.008). Intrusion rates were acceptable for males for 54% of reverse recalls and 40% of forward recalls (P = 0.095). Means were 57 and 32%, and 6.4 servings for omission rate, intrusion rate, and total inaccuracy for reverse recalls, and 56 and 39%, and 6.9 servings for forward recalls. CONCLUSIONS: Prompting children to report in reverse versus forward order improved omission and intrusion rates for males more so than females. Regardless of reverse or forward order, children reported <50% of items observed; furthermore, >30% of items reported were not observed. Research is needed to enhance accuracy of children's dietary recalls.

Child↗

PubMed2003

Impaired pressure natriuresis in obese youths.

OBJECTIVE: To compare the response and recovery of blood pressure (BP) and sodium excretion (U(Na)V) in response to a behavioral stressor in overweight/obese and lean adolescents. RESEARCH METHODS AND PROCEDURES: Twenty-five lean (12% to 20% body fat) and 59 overweight/obese (>25% body fat) normotensive adolescents were provided all meals for 3 days (average sodium intake, 4000 +/- 200 mg/d), before performing the stressor on the third day. There was a 2-hour pre-stress rest, followed by a 1-hour stress (involving a video game task), and a 2-hour recovery. Percentage of body fat was obtained from DXA. U(Na)V was measured hourly, whereas systolic BP and diastolic BP measurements were obtained at 15-minute intervals, and averaged for each 1-hour period. RESULTS: There was no significant difference between the lean and overweight/obese group for the response of systolic BP and diastolic BP (group by time interaction, p = 0.60 and p = 0.64, respectively). However, the lean group had a significantly greater increase in U(Na)V in response to the stressor compared with the overweight/obese group (p = 0.02). U(Na)V remained elevated compared with baseline in both groups at the 1-hour (p <or= 0.0001) and 2-hour (p <or= 0.0001) post-time points. Furthermore, there was a tendency for a larger number of sodium retainers in the overweight/obese group compared with the lean group (39.0% vs. 20.0%; chi(2) = 2.85, df = 1, p = 0.09). DISCUSSION: This study provided evidence that sodium regulation was impaired during a behavioral stress in overweight/obese individuals compared with lean individuals.

Absorptiometry, Photon↗

PubMed2003

Comparison of Hologic QDR-1000/W and 4500W DXA Scanners in 13- to 18-Year Olds.

OBJECTIVE: Body composition measurements made using Hologic QDR-1000/W pencil-beam and QDR-4500W fan-beam scanners (Bedford, MA) were compared in a sample of 13- to 18-year-old white and black youth (n = 219). RESEARCH METHODS AND PROCEDURES: Total fat (FAT), fat-free soft tissue (FFST), bone mineral content (BMC), bone mineral density (BMD), and percent body fat (%BF) were compared between repeated measurements using the QDR-4500 and between the two scanners using mixed model ANOVA. Intraclass correlation coefficients and Bland-Altman limits of agreement were used to evaluate inter- and intrascanner reliability. RESULTS: Intraclass correlation coefficients for repeated measurements using the QDR-4500 ranged from 0.997 to 0.999 for FAT, %BF, FFST, and BMC and 0.987 for BMD. Mean measurements made using the two scanners differed significantly for FAT, %BF, BMC, and BMD (p < 0.0001), and scan by sex interactions were significant (all p < 0.0005). There were no significant differences in mean measurements between repeat scans using the QDR-4500 (all p > 0.19). Limits of agreement for measurements of FAT, FFST, and %BF made using the two scanners were approximately three times as wide as those for two measurements using the QDR-4500. For lower values of FAT and %BF, the QDR-4500 gave higher measurements than the QDR-1000, whereas at higher values, this relationship was reversed. The QDR-1000 tended to give higher BMC measurements, with larger differences for higher values. DISCUSSION: Using different models of DXA scanners within a study may reduce precision of body composition measurement. This issue needs to be considered in the design of longitudinal studies.

Absorptiometry, Photon↗

PubMed2003

Psychological effects women experience before and after a colposcopic examination and primary care appointment.

OBJECTIVE.: To estimate the psychological impact, health and behavior concerns, and coping styles of women awaiting colposcopic examination compared with women awaiting a scheduled primary care appointment. MATERIALS AND METHODS.: A convenience sample of 150 women presenting for a scheduled colposcopy examination and 201 women scheduled for a primary care appointment were assessed for demographic status, depression (Center for Epidemiologic Studies/Depressed Mood Scale), anxiety, health beliefs and concerns, and coping style (Miller Behavioral Style Score). Subjects also completed a postexamination questionnaire. Mean responses were compared using Wilcoxon rank sum test. RESULTS.: Mean anxiety scores were considered "mild" and equivalent for women in the two groups. Although the colposcopy group had a significantly greater mean depression score (36.3) compared with the noncolposcopy group (33.4, p = .03, Wilcoxon test), both mean scores indicated mild depression. Women undergoing colposcopy reported greater mean scores for concern about their disease, the procedure, and potential consequences (p < .01, Wilcoxon test). CONCLUSION.: Women scheduled for colposcopy have a similar level of mild anxiety and mild depression as women scheduled for a primary care appointment. Consequently, universal, instead of selective, use of anxiolytic agents before colposcopy appears unjustified. Avoidance of triage to colposcopy for atypical squamous cells of undetermined significance Pap smear results may be unwarranted based on concerns for causing excessive anxiety. In fact, colposcopy provides substantial reassurance.

Journal Article↗

PubMed2003

Patient acceptance of fluorescent and reflective spectroscopy as a replacement test for the pap smear.

OBJECTIVE: To determine women's acceptance of fluorescent and reflective spectroscopy (FRS) as a potential replacement test for the Pap smear. MATERIALS AND METHODS: Women scheduled for a colposcopic examination, or a colposcopic and FRS examination, completed a 22-item questionnaire that included demographic data, medical history, and preference-type questions. Data were compared using chi and Wilcoxon's rank sum tests. RESULTS: Women considered accuracy, comfort, and quick results to be the most important characteristics for new cervical cancer tests. Immediate test results were preferred strongly by both groups (control, 84.5%; scanned, 88.6%). Provided FRS was more accurate than the Pap smear, most women (control, 74.7%; scanned, 68.2%) would rather have FRS if it cost the same as a Pap smear. CONCLUSIONS: Women consider accuracy, comfort, and time critical issues with respect to FRS used as a primary screening test. Acceptance of this new technology will be facilitated by designing equipment accordingly to satisfy the concerns of women.

Journal Article↗

PubMed2003

Women's responses to cervical interrogation by fluorescent and reflective spectroscopy.

OBJECTIVE: To determine women's responses to cervical interrogation by fluorescent and reflective spectroscopy (FRS). MATERIALS AND METHODS: A convenience sample of women scheduled for a colposcopic examination was interrogated by a cervical FRS system. Thereafter, women completed a 24-item questionnaire that assessed their responses to the spectroscopic test. Likert-scale responses were compared among subgroups using the chi test for trend. RESULTS: Most women favored FRS used for locating (97.7%; 170/174) and selectively sampling (96.6%; 168/174) cervical neoplasia. Fewer women (81.0%; 141/174) wanted FRS to replace the Pap smear. Most women were neither nervous (73.6%; 128/174) nor bothered (89.1%; 155/174) by the extra time for the FRS assessment. Women's acceptance was substantiated by 84.9% (146/174) and 90.8% (157/173) wanting their doctor to have and insurance company to pay for FRS, respectively. CONCLUSIONS: Use of FRS as a colposcopic adjunct was supported very favorably by women. Fewer women supported FRS replacing Pap smears. These high rates of approval by women should help the implementation of FRS technology.

Journal Article↗

PubMed2003

Influence of physical training on plasma leptin in obese youths.

Little is known about the effects of different intensities of physical training on plasma leptin. This study examined the effect of two intensities of physical training on leptin in obese teenagers, and explored correlates at baseline and in response to 8 months of physical training. The participants were 55 obese youths 12-16 years of age who completed both baseline and posttesting. The youths were randomized to engage in lifestyle education only (LSE), moderate-intensity physical training and LSE, or high-intensity physical training and LSE. Baseline leptin was positively associated with fat mass. Girls had higher leptin levels at lower levels of fasting insulin than boys. The 8-mo physical training doses prescribed to obese teenagers did not result in significant group differences in mean change in leptin, although there was large variability in individual response. The change in leptin was inversely associated with baseline leptin and change in cardiovascular fitness. Diet, physical activity level, visceral adiposity, and glucose concentrations were not associated with leptin, neither at baseline nor in response to physical training. At baseline, total fat mass rather than visceral adiposity was associated with higher leptin levels. Over the 8-mo intervention period, regardless of group membership, youths who had the lowest increase in cardiovascular fitness tended to have the highest increase in leptin.

Adipose Tissue↗