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PubMed2000

Socioeconomic status, overweight and obesity in prepuberal children: a study in an area of Northern Italy.

The aim of this study was to determine whether socio-economical status (SES) is associated with overweight and obesity in prepuberal children. In an area of North-Western Italy a sample of 1420 children, aged 10-11 years, had his/her height and weight recorded, (overweight and obesity were defined, respectively, as relative body weight > or = 120% and > or = 140%), and parents were requested to compile a questionnaire exploring some demographic and social conditions. 23% of the sample resulted overweight or obese. Prevalence rate ratios (PRR) of overweight and obesity (together) were calculated, adjusting for parents' age, parents' area of birth, and school district. PRR for mother's lowest educational level compared to the highest was 1.59 (95% CI: 1.19-2.13), while for father's education was 1.21 (0.90-1.63). PRRs for 'unemployed' or 'manual' mother compared to 'upper non manual' were respectively 1.83 (1.20-2.79) and 2.20 (1.31-3.68), while for 'unemployed' or 'manual' father were 2.63 (1.97-2.63), and 1.63 (1.27-2.09). The cultural resources of the mother, and the economical resources of the family seem to influence the prevalence of weight gain in prepuberal children. This should be taken into account when planning programs for the prevention or reduction of obesity in children.

Child↗

PubMed1997

Commercial approaches to genetic selection for growth and feed conversion in domestic poultry.

Tremendous genetic progress has been observed historically for growth and feed conversion through the efforts of the primary breeding companies. However, significant between-strain variation still exists due to differences in selection emphasis and selection techniques practiced by these organizations. This paper provides an overview of methods currently employed in commercial poultry breeding with reference to factors complicating program design and future challenges facing the industry. Mass selection for body weight has resulted in a significant reduction in the number of days required to grow bird to market weight with indirect improvements in feed conversion. Direct selection for feed conversion is accomplished through part record testing of males that have been preselected for body weight, conformation, and defect traits. Data are commonly subjected to complex statistical analysis both to correct feed conversion for variation in body weight and to improve the accuracy of breeding value estimates. Feed conversion breeding values of male sibs are sometimes used for the selection of female candidates as well. Selection for growth rate and efficiency has resulted in negative complications, such as ascites, reduced reproductive performance, skeletal abnormalities, and increased carcass fatness. Some of these factors may be partially ameliorated through modified selection practices. If not addressed by the breeding industry, the disruption of physiological homeostasis might ultimately represent economic and genetic barriers to further progress in improving growth and efficiency. Modern techniques in molecular genetics, utilized in conjunction with traditional quantitative genetic approaches, will provide additional opportunities to circumvent these physiological complications associated with genetic selection for growth and feed efficiency.

Animals↗

PubMed1989

Evaluation of a worksite wellness program: impact on exercise, weight, smoking, and stress.

This study evaluated the effects of a wellness program at the workplace in relation to its impact on exercise, weight, smoking, and stress of the employee participants. A quasi-experimental design was selected in which data were collected at three specific intervals: before and immediately after program completion, and three months after program completion. The sample consisted of experimental and control groups. Persons (n = 59) who did participate in the wellness program made up the experimental group, and those (n = 49) who did not participate in the wellness program served as controls. Descriptive statistics were used to summarize the data. No significant differences were noted between participants and nonparticipants in the areas of exercise, weight, smoking, and stress between the initial evaluation and after completing the wellness program. The areas of stress reduction and increased exercise were emphasized more in the participants than the nonparticipants, however.

Adult↗

PubMed2004

A perspective on the current strategies for the treatment of obesity.

The prevalence in obesity has increased dramatically over the past 30 years, more than double in the United States alone. Obesity is associated with an increased risk for type 2 diabetes mellitus, dyslipidemia, hypertension, biliary disease, obstructive sleep apnea, and certain types of cancer. The pathophysiology of obesity is complex, involving behavioral, environmental, and genetic factors. Current treatment options include behavior modification and lifestyle changes which incorporate weight-reducing diets and physical activity, FDA approved long-term anti-obesity pharmacological agents sibutramine and orlistat, non-FDA approved over-the-counter (OTC) supplements and nutriceuticals, and, when appropriate, bariatric surgery. Without adequate prevention and treatment of obesity, government agencies have suggested that the direct and indirect costs associated with obesity may overwhelm the healthcare system. This brief review explores the current data available on treatments for the obese patient including the relative merits of different types of macronutrient composition (e.g., low carbohydrate vs. high carbohydrate diets) of weight-reducing diets, the value of resistance/ strength training in physical activity programs designed for the obese patient, the safety and efficacy associated with OTC supplements and nutriceuticals for weight reduction (e.g., Ephedra, conjugated linoleic acid (CLA), Garcinia cambogia/ hydroxycitric acid (HCA), chromium, pyruvate), the safety and efficacy of FDA-approved long-term obesity treatments sibutramine and orlistat, and bariatric surgery.

Anti-Obesity Agents↗

PubMed1984

A pilot study of medication and group therapy for obesity in a group of physicians.

This pilot study evaluated group therapy and the appetite suppressant activity of phenylpropanolamine in a group of juvenile-onset obese physicians. In spite of their educational level and their medical sophistication, they were not previously successfully motivated to lose weight. Twelve obese but otherwise healthy physicians participated in a program using phenylpropanolamine one or two times per day and attending weekly group therapy that focused on weight reduction, dietary compliance, physical appearance, and psychodynamics of obesity. Those who continued participation in both the medication and group discussions showed significant weight loss, an average of 23.3 pounds at the end of 12 weeks, 33.2 pounds at 22 weeks and continued weight loss maintenance for up to two years.

Adult↗

PubMed1998

Evaluation of a public-private certified nurse-midwife maternity program for indigent women.

OBJECTIVES: This study assessed the impact of a public-private certified nurse-midwife program on prenatal and delivery outcomes among medically indigent women. METHODS: A population-based quasi-experimental design was used to compare 1 intervention county with 2 nonintervention counties. RESULTS: The program significantly reduced the number of women who received no prenatal care and the risk of acquiring less than adequate prenatal care. Reductions in the proportion of infants born premature or with low birth-weights were of borderline significance. The use of induction and/or stimulation of labor was statistically elevated. CONCLUSIONS: These results suggest that the intervention program was instrumental in reducing some, but not all, negative prenatal and delivery outcomes.

Adult↗

PubMed1991

Effects of exercise and other nonpharmacological measures on blood pressure and cardiac hypertrophy.

Reversal of left ventricular hypertrophy (LVH) is an important target of antihypertensive therapy. Nonpharmacological approaches such as weight reduction and exercise training have favorable effects on other risk factors. However, there are few data on their effects on LVH. Athletes have eccentric rather than concentric LVH. A 12-month exercise program in 13 unmedicated hypertensive subjects altered LV geometry, reducing LV wall thickness and increasing LV internal diameters (LVID). LV mass was unchanged, and the thickness/radius fell by 9%. Shorter-term studies have shown that the cardiac structural changes with a moderate exercise program occur rapidly and their onset lags only about 2 weeks behind blood pressure (BP) effects. Assessment of weight loss effects on LVH is complicated by the strong relationship between body weight and ventricular wall thickness. LVID, and LV mass. To some extent, this can be overcome by arbitrarily indexing to body surface area or height. The wall thickness/radius ratio is not related to body size. Weight reduction reduces BP and thickness/radius by 10% in controlled trials. Small studies have also reported reduction in LV mass after sodium restriction in hypertensive subjects. Studies with other nonpharmacological measures could make a substantial contribution to knowledge of their efficacy.

Blood Pressure↗

PubMed1999

Impact of augmented prenatal care on birth outcomes of Medicaid recipients in New York City.

I examine whether New York State's Prenatal Care Assistance Program (PCAP) is associated with greater use of prenatal services and improved birth outcomes. PCAP is New York State's augmented prenatal care initiative that became a part of the Medicaid program after expansion in income eligibility thresholds in January, 1990. Data are from the linkage of Medicaid administrative files with New York City birth certificates (N = 23,249). For women on cash assistance, I find PCAP is associated with a 20% increase in the likelihood of enrollment in WIC, an increase in mean birth weight of 35 g and a 1.3 percentage point drop in the rate of low birth weight. Associations between PCAP and improved birth outcomes for women on medical assistance are similar, but appear contaminated by selection bias. Reductions in newborn costs associated with PCAP participation are modest, between US$100-300 per recipient, and are insufficient to offset program expenditures.

Female↗

PubMed1995

Treatment of obesity by personality classification-oriented program.

It is apparent that personality is related to the pathogenesis of obesity, and that understanding the personality of the patient may be a key to successful treatment of the disease. Using the Rorschach test and interviews by a psychiatrist, the types of personality were classified into four groups according to the healthiness of personalities. The judgment of healthiness was based mainly on the scores obtained from the Rorschach test. This classification revealed that the occurrence of mental and physical symptoms during therapy with a very low calorie diet (VLCD) and subsequent rebound of bodyweight were more frequently observed in patients with relatively less healthy personalities. We used this classification to adapt our program to treat obese patients. In this program, severe diet restrictions were applied to patients with relatively healthy personalities. These restrictions were applied with modifications to patients with less healthy personality, because severe restrictions would be possibly very stressful for them and would bring about an undesirable reaction. For strengthening the patients' motivation for therapy, the significance of body weight reduction was explained in different ways to patients with different types of personality. The target of bodyweight reduction, reward for patients with successful weight reduction, and the duration of therapy were set up differently for patients with different personalities types. The results showed that bodyweight rebound one or two years after treatment was reduced with the personality-oriented therapy program compared to that observed with the previous conventional therapies. Also, the incidence of psychological problems was remarkably decreased.

Adult↗

PubMed1986

Dispositional and situational correlates of long-term weight reduction in obese children.

Two samples of obese children were studied in order to investigate the extent to which four classes of variables were associated with weight reduction outcomes: use of self-control techniques, degree of social support, attributional style, and self-reinforcement style. One sample participated in a program in Wisconsin (n = 22) 1-2 years before assessment, whereas the second sample completed a similar program in Pittsburgh (n = 17) 3 months prior to assessment. Children and parents were individually interviewed using structured protocols, and children also completed a block design task. Children's self-reinforcement and attributional styles, motivation to change, problem-solving style, family environment, and intellectual skills were assessed. Regression analyses selected a subset of variables which were clearly associated with change in percent overweight and Feinstein indices, computed from pretreatment and from posttreatment to time of assessment. Substantial proportions of outcome variance were accounted for in the Wisconsin sample but not in the Pittsburgh sample. The results suggest that obese children who terminate ineffective problem-solving efforts quickly and who make more adaptive weight reduction attributions may be more likely to succeed in long-term weight reduction. The differential results in the two samples suggest that variables investigated in this study may play a greater role in maintenance than in initial behavior change.

Adolescent↗

PubMed2000

Relationship between different subcutaneous adipose tissue layers, fat mass, and leptin in response to short-term energy restriction in obese girls.

This study addresses whether the expected relationship of 15 specified subcutaneous adipose tissue layers (SAT layers) from 1-neck to 15-calf and body fat mass (FM) with leptin was influenced by a weight-loss program. In 30 obese girls (10 prepubertal, 15 pubertal, and 5 late/postpubertal) SAT layers were measured by means of the optical device Lipometer. Fat mass (FM) was estimated indirectly by means of bioelectrical impedance. Leptin and insulin were determined by means of radioimmunoassays. All measurements were performed before (pre) and after (post) 3 weeks of low-caloric diet and physical training. At the beginning of the study, there were significant correlations for all estimates of adiposity and leptin (0.67 to 0.79; P < 0.0001). Five SAT layers from the upper body and the trunk (0.48 to 0.67; P < 0.01) but none from the abdominal region and lower extremities were correlated with leptin. FM together with SAT layers 4-upper back and 8-lower abdomen (negative slope) explained 79% of the variation in pre leptin values (P < 0.0001). The weight-loss program significantly reduced leptin (P < 0.0001), insulin (P = 0.04), estimates of adiposity (P < 0.0001), and SAT layers 4-upper back (P = 0.0006), 11-front thigh, 13-rear thigh, and 14-inner thigh (P between <0.03 and <0.01). Although significant, the reductions in the four SAT layers were small. Estimated fat-free mass was significantly increased after three weeks (P < 0.05). Changes in SAT layers from the upper extremities and from the trunk were inversely correlated to the decrease in leptin (P between <0.05 and <0.001). Initial leptin was the best correlate of the decrease in leptin (adj. R(2) = 0.815; P < 0.0001). However, when only changes in adiposity and insulin were considered in the regression model, changes in insulin contributed to the fall in leptin (adj. R(2) = 0.23; P = 0.004). When changes in SAT layers were added to the model, changes in SAT layers 2-triceps and 10-hip (negative slopes) contributed to the decrease in leptin (adj. R(2) = 0.48; P < 0.0001). After weight loss, correlations between estimates of post adiposity and post leptin (0.40, P = 0.01 to 0.57, P = 0.0005) were lower compared with pre values. SAT layers 4-upper back and 3-biceps contributed independently to post leptin values (adj. R(2) = 0.50; P < 0.0001). It is suggested that fat mass and SAT layers from the upper body are the main determinants of leptin in obese girls before weight loss. The diet and sports intervention program reduced leptin independent of the reduction in adiposity. The distribution of subcutaneous fat might be a stable correlate of circulating leptin after a short-term reduction in energy intake. Am. J. Hum. Biol. 12:803-813, 2000. Copyright 2000 Wiley-Liss, Inc.

Journal Article↗

PubMed1999

A review of the effects of hazardous waste on reproductive health.

Approximately 1 in 4 Americans lives within 4 miles of a hazardous waste site according to the Environmental Protection Agency. In light of this large proportion and the public's high level of concern that hazardous waste causes health problems, it is important for primary care physicians and other health care providers to know that residential proximity to some kinds of hazardous waste sites is associated with adverse reproductive effects. Findings from both state-based surveillance programs and studies of individual hazardous waste sites have shown increased risk of congenital malformations and reductions in birth weight among infants born to parents living near hazardous waste sites. This article summarizes salient literature on human health effects of hazardous waste and suggests actions for primary care providers to consider.

Canada↗

PubMed2004

Effect of fish diets and weight loss on serum leptin concentration in overweight, treated-hypertensive subjects.

BACKGROUND: Leptin, a circulating hormone secreted from adipocytes, is an index of adiposity and is reduced by caloric restriction and weight loss. A recent population study suggested that dietary-derived omega3 fatty acids lower leptin levels independent of body fat. OBJECTIVE: To examine whether dietary fish enhanced the effects of weight loss on serum leptin levels, in 69 overweight, treated hypertensive men and women. METHODS: Participants were randomized to a daily fish meal, a weight-reduction regimen, the two regimens combined or a control group for 16 weeks. RESULTS: A total of 63 individuals completed the study. Weight fell 5.6 +/- 0.8 kg with energy-restriction. Blood pressure (BP) reductions in the combined fish-weight loss group were twice that seen with either intervention alone. At baseline, in all groups combined, serum leptin levels correlated with serum insulin (r = 0.307, P = 0.014), but not with body weight. The greatest change in serum leptin occurred in the fish-weight loss group (control, 0.60 +/- 0.76 ng/ml; fish, 1.20 +/- 0.79 ng/ml; weight loss, -1.40 +/- 1.05 ng/ml; fish-weight loss, -5.08 +/- 1.64 ng/ml). In the fish-weight loss group, the change in serum leptin was predicted by changes in serum insulin (r = 0.488, P = 0.038), 24-h BP (systolic BP (SBP): r = 0.435, P = 0.060; diastolic BP (DBP): r = 0.563, P = 0.018) and 24-h heart rate (0.584, P = 0.028). Using general linear models, there was a significant fish x weight-loss interaction (P = 0.008) on post-intervention serum leptin after adjustment for baseline levels, independent of post-intervention insulin. CONCLUSION: A daily fish meal as part of a weight-reducing regimen was more effective than either measure alone at reducing leptin levels. Reductions in leptin may be related to the substantial fall in BP seen with the fish-weight loss program.

Animals↗

PubMedDate not supplied

Nutrition intervention and health risk reduction in childhood: creating healthy adults.

Reducing health risk factors in childhood is a critical component of well-child pediatric care. Risks to eventual adult health status must be considered with equal importance as risks to the child's immediate health. Heart disease, cancer and stroke risk begins in childhood, when risk factors, especially obesity and positive family history, may easily be identified. Obese children (and those at high risk of obesity based on parental obesity) constitute a special group of children for whom chronic disease risk factor evaluation is of particular importance. This is based on observations that cardiovascular risk factors tend to aggregate among obese children (similar to adults), particularly with respect to elevated blood pressure, elevated serum cholesterol and triglycerides, and decreased cardiovascular response to exercise. In addition, many obese adolescents adopt cigarette smoking with the notion that it may aid weight reduction, thereby compounding their risk status. Risk reduction in childhood can be successfully approached both through school-based programs incorporating risk evaluation with health education curricula, or by relatively simple office- or clinic-based procedures designed to evaluate and track risk status over time. Such practices, though not currently prevalent, are increasingly being incorporated into routine pediatric care, especially following the American Association of Pediatrics Nutrition Committee's recommendations with respect to children with positive family histories for early coronary events.

Anthropometry↗

PubMed2002

CINI's approaches to intervention: an innovative strategy to combat malnutrition in India.

The Child in Need Institute (CINI) has been working toward sustainable health and nutrition development for women and children for the last twenty-six years. During the initial stages, the Institute focused on treatment and prevention of malnutrition in children under five years of age. Over the years, the program strategies have shifted to a more holistic lifecycle approach. This approach targets individuals during crucial periods of their lives--pregnant women, children (0-2 years of age) and adolescents (10-19 years of age)--as well as other vulnerable segments of the population. To reach out to these target groups, the Institute uses a three-pronged strategy that includes case management, behavior change communication, and linkage formation. Programs are either community- or center-based depending upon the need of the populations. CINI's current strategy has shown positive trends in improving the health and nutrition status of women, children, and adolescents in the community. Results include reduction of low birth weight babies, increase in proper antenatal care, reduction of severely malnourished children, decrease in maternal and infant mortality and morbidity rates, and improvement in community involvement in all reproductive and child health programs. CINI is currently monitoring its performance and activities to carry out operations research for providing further evidence for the effectiveness of its interventions.

Adolescent↗

PubMed1996

[Modification of the lipid profile in coronary patients undergoing cardiac rehabilitation].

To assess the effect of continuous and controlled exercise training on the lipid profile of coronary pts. in a cardiac rehabilitation program, we evaluated forty-nine males aged 56.8 +/- 9.6 years, thirty-two with previous surgical myocardial revascularization, two submitted to percutaneous transluminal coronary angioplasty and fifteen on exclusive pharmacological therapy. Patients with changes in drugs that could potentially induce modifications in serum lipid values, were excluded. The values of total cholesterol, triglycerides, HDL-cholesterol, the HDL-cholesterol/total cholesterol ratio, weight and the body mass index at admission of training phase, end of training phase (III)-21 patients (Group I) and maintenance (IV)-28 patients (Group II), were assessed. The training phase (III) had a duration of 3-4 months and maintenance (IV) nine months. In Group I, evaluated at the end of the training period (phase III), there was no significant modification in lipid profile reduction; only 1% and 20% reduction (p = NS) in values of total cholesterol and triglycerides, was detected. The HDL-cholesterol rose 12.5% (p = NS), and the HDL cholesterol/total cholesterol ratio 10.5% (p = NS). In Group II (at the end of the maintenance phase-IV-) there was no important change in total cholesterol levels. The HDL-cholesterol rose 19.5% (p = 0.003) and the HDL-cholesterol/total cholesterol ratio, also increased 33.3% (p < 0.0001). The benefit in relation to triglycerides was restricted to patients with higher values (> 200 mg/dl), where a reduction of 36% (p = 0.004) was found. There was no change in the weight or in body mass index, induced by the program. We concluded that the participation in a cardiac rehabilitation program induces a favourable modification of lipid profile in our population, with potential interest for secondary prevention of coronary heart disease. This change was particularly in serum values of triglycerides, HDL-cholesterol and the ratio HDL-cholesterol/total cholesterol. In what concerns triglycerides, the benefits were seen only in the group of patients with the highest serum values.

Adult↗

PubMedDate not supplied

Health professionals' knowledge of women's health care.

Until 1986, the only issues in women's health which received direct attention were those related to childbearing. At that time the National Institutes of Health made inclusion of women in research a criteria for funding. Since then, the knowledge base to guide disease prevention and treatment of women has grown dramatically. Unfortunately, the incorporation of these data into clinical practice has been much slower. The purpose of this needs assessment was to establish a comprehensive data base on which future programming decisions could be based. Areas of interest identified by health care providers included stress reduction, breast health, prevention of heart disease, and osteoporosis. Other topics that emerged were menopause and reproduction issues, cancer prevention, domestic violence, substance abuse, nutrition, and weight control. These data suggest topics for future programming.

Attitude of Health Personnel↗

PubMed1998

Improved birth outcomes associated with enhanced Medicaid prenatal care in drug-using women infected with the human immunodeficiency virus.

OBJECTIVE: To evaluate the effectiveness of an intervention designed to enhance Medicaid prenatal care in improving birth outcomes of drug-using women infected with the human immunodeficiency virus (HIV). METHODS: Medicaid and vital statistics records were linked for 353 HIV-infected drug-using women delivering in 1993 and 1994 while enrolled in New York State Medicaid. Of these, 68% were treated by providers participating in the Prenatal Care Assistance Program, designed to provide case management, improved continuity, referral services, and behavioral risk reduction counseling. In a series of logistic models, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of low birth weight (less than 2500 g) and preterm delivery (before 37 weeks), comparing women using and not using the program. RESULTS: Women using the Prenatal Care Assistance Program were significantly less likely, after adjustments were made for maternal characteristics, to have low birth weight infants and preterm deliveries (OR 0.52, 95% CI 0.31, 0.89; and OR 0.57, 95% CI 0.34, 0.97, respectively). Adding measures of greater adequacy and continuity of prenatal care to the models explained just over 20% of the Prenatal Care Assistance Program's protective effect. The addition of maternal high-risk behavior, HIV-focused care, and drug use treatment variables altered program effect estimates less profoundly (together accounting for 4 and 9% of the program's protection against low birth weight and preterm delivery, respectively). CONCLUSION: The Prenatal Care Assistance Program appeared to be successful in reducing the incidence of low birth weight and preterm delivery in this high-risk population. The program's success can be attributed, in part, to increased adequacy and continuity of prenatal care and, to a lesser extent, to more frequent receipt of special services and reduced maternal high-risk behaviors.

Adult↗