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PubMed1991

[Can the changes in dietary fat intake reduce the risk of onset and development of atherosclerosis and of ischemic cardiopathy in particular?].

In this review we have collected data from epidemiologic studies and clinical trials published from 1968 to 1989 on the relationship between dietary fat and risk of coronary heart disease. Although the reported observational studies of diet and coronary heart disease provide general support for the classic diet-heart hypothesis, evidence of specific dietary lipids is weak. A positive association with saturated fat intake was seen in two prospective studies. A positive association with cholesterol intake was found in only two cohort studies, and an inverse relationship with polyunsaturated fat intake in only one. Clear evidence from dietary trials in the prevention of coronary heart disease has not been found. The analysis of trends in coronary heart disease and stroke mortality of developed countries has shown a discrepancy between fat intakes, cholesterol levels and mortality. The reduction in intake of certain foods "at high risk" such as meat, eggs, milk and cheese, as a preventive intervention, is based on weak scientific evidence. A strategy program has to emphasize the maintenance of ideal body weight by caloric control, an adequate level of physical activity, and the control of other risk factors such as hypertension, hypercholesterolemia, and diabetes.

Arteriosclerosis↗

PubMed1988

Muscle strengthening through high-resistance weight training in patients with neuromuscular disorders.

The effects of weight training on muscle performance were quantified by measuring (1) maximum force (muscle strength), (2) force-time integral--area under force-time plot during 60 seconds of sustained maximum force (work done), and (3) fatigue index--percentage reduction in maximum force. Subjects included 16 patients with gradually progressive neuromuscular disorders. The muscle strength of these patients ranged from 2% to 75% normal before the program. For patients with markedly to moderately weak muscles, maximum force increased by 80% +/- 48%, force-time integral increased by 132% +/- 93%, and mean fatigue index was significantly reduced from 53% +/- 18% to 34% +/- 7.7% during the study period. Severely weak muscles (less than 10% normal strength) generally did not improve. High-resistance weight training can significantly increase muscle performance of patients with neuromuscular disease if disease progression is slow and initial muscle strength is greater than 15% normal.

Adult↗

PubMed2000

[Results of an intensive training program for hypertension at the Institute for Preventive Medicine].

BACKGROUND AND OBJECTIVE: The burden of insufficiently treated arterial hypertension is still underestimated. During 1998 to 1999 we conducted an intensive training program in cooperation with regional practitioners. The aim of this program was to educate the patients about their disease and motivate them to comply with therapy. The effectivity of this program yet needs to be evaluated. PATIENTS AND METHODS: 146 patients (mean age 62 years; 57 male, 89 female) with arterial hypertension were trained. They received 8 training units of 90 min each. Before training and 6 months after training data concerning health status and life style risk factors were assessed with questionnaires. RESULTS: There was a marked reduction in blood pressure after 6 months (152/89 mmHg vs 145/85 mmHg, p < 0.001). The mean body weight also declined on the average by 0.9 kg (p < 0.001). Physical exercise spent per week increased from mean 2.0 to 2.8 hours (p < 0.01). Moreover, knowledge about hypertension increased (p < 0.001). The established questionnaire SF-36 revealed a better score for vitality (p < 0.05) six months after therapy than before. CONCLUSION: Our intensive training program of patients with arterial hypertension has profound effects on their systolic and diastolic blood pressure. It also motivates patients to change life style. Our data suggest that intensive training programs should be developed on a widespread basis.

Adult↗

PubMed1994

[A randomized controlled trail of intensive and usual community-based education for blood pressure control].

A 1.5 year community-based hypertension education program was conducted and evaluated for the feasibility and effectiveness as a program for primary prevention of cardiovascular disease. The subjects were determined to be hypertensive from cardiovascular examinations and composed of 104 untreated men and women aged 35-69 whose blood pressure levels were between 140 and 179 mmHg for systolic and/or between 90 and 109 mmHg for diastolic and who had no evidence of hypertensive end organ effects in the 1990 examination. They were randomly assigned to either an intensive education (IE) group (n = 53) or a usual education (UE) group (n = 51) and invited to education classes six months later. The IE consisted of four education classes in the first six months and another 4 classes in the next 12 months. For the UE, one class in the first 6 months and another class in the next 12 months were held. Health education was focused on reduction of sodium intake, a 30 minutes of walking, and if necessary, reduction of alcohol and sugar intake. Mean (SD) values of systolic blood pressure at the start of the education program were 144.8 (11.7) mmHg in IE and 144.5 (12.2) mmHg in UE. The respective diastolic means (SD) were 80.6 (7.8) mmHg and 80.3 (8.6) mmHg. The proportion of persons who started to receive antihypertensive medication was 8-9% in both groups at six months, and 13% in IE and 29% in UE at 1.5 years. IE showed a 6 mmHg greater reduction in mean systolic blood pressure than UE at both six months and 1.5 years. No significant difference was found in diastolic blood pressure levels over time between the two groups. Dietary improvements related to reduction of salt intake were more evident in IE than in UE. There was no significant changes in means and distributions of relative weight index and alcohol intake in either group. Subgroup analysis according to antihypertensive medication use indicated that reduction of systolic blood pressure levels was significantly larger in IE than in UE for both no medication and medication subgroups at 6 months and 1.5 years. While it was difficult to evaluate an effect of the program at 1.5 years because of the difference in the proportion of medication use between IE and UE, the results at 6 months suggest that this community-based program was effective in reducing systolic blood pressure levels.

Adult↗

PubMed1999

Improved control of type 2 diabetes mellitus: a practical education/behavior modification program in a primary care clinic.

BACKGROUND: This study was done to determine the efficacy and ease of administration of education/behavior modification classes, provided by a nurse and a dietitian in a primary care clinic for improving control of type 2 diabetes mellitus. METHODS: Patients were divided randomly into two groups. Eighteen patients completed 6 months of structured, office-based classes, and 20 similar patients served as control subjects. All were patients of the same group practice and had their usual office visits. Glycemic control, lipid levels, body weight, knowledge about diabetes, medication requirements, and symptoms were monitored during the 6 months, with follow-up at 12 months. RESULTS: At the end of 6 months, the intervention group had significant reductions in mean fasting blood glucose, glycosylated hemoglobin, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) values. Their mean body weight was significantly reduced at 12 months, and their knowledge of diabetes was improved. Control patients had significant improvement only in glycosylated hemoglobin and body weight at 6 months. Minimal physician time was required. CONCLUSION: The education/behavior modification program was clinically worthwhile, and it was easy to administer.

Aged↗

PubMed2004

Peri-implantation undernutrition programs blunted angiotensin II evoked baroreflex responses in young adult sheep.

An adverse environment around conception and implantation influences later fetal growth and development to term in humans and sheep. Indeed, preimplantation undernutrition of rats elevated the systolic blood pressure of the resultant adult offspring. In this study, adult cardiovascular function is examined in a slower growing, non-litter-bearing species after peri-implantation undernutrition. Eight ewes were fed to 50% equivalent food intake of 12 control ewes from 1 to 30 days (term approximately 147 days) only. Following consumption of an adequate diet to term, natural lambing, and then weaning, resting cardiovascular status and baroreflex function were examined in the resultant young adult offspring. Birth weight and postnatal growth to 1 year of age were unaffected by early undernutrition; however, nutrient-restricted sheep had increased pulse pressure, a reduced rate pressure product, and a leftward shift in their baroreflex function curve. Baroreflex sensitivity during angiotensin II infusion was also blunted in early nutrient-restricted sheep but the tachycardia following a reduction in central blood pressure appeared potentiated, relative to controls. The data suggest that peri-implantation undernutrition may program long-term cardiovascular dysfunction that ultimately increases the risk of hypertension later in life. An increase in regional angiotensin II activity during this critical early phase of development is a likely candidate mechanism for the effects observed. The data have broad implications for the health outcome of those offspring from mothers who were poorly nourished during early, often unknown pregnancy and for embryos artificially manipulated because of infertility treatment.

Angiotensin II↗

PubMed1983

Effects of repetitive exercise on neonatal rat skeletal muscle oxidative capacity.

Since little is known about the training response to exercise in neonatal animals, this study was undertaken to elucidate the potential of oxidative system adaptations in developing skeletal muscle of rats during 50 days of daily treadmill running. The training regimen involved male and female rats (10 days old) initially running 0.1 mph, 0% grade, for 15 min. The program progressed to 1 mph, 25% grade, for 60 min by 50 days of age. At 25 days of age, pyruvate and palmitate oxidative capacity, and citrate synthase activity in red vastus muscle homogenates were elevated in the trained group (T) compared with age- and sex-matched controls (C). These increases were also observed for each subsequent time point tested and occurred in spite of the fact that the peak oxidative capacity of neonatal red vastus muscle was 46% greater than adult values. Further, trained animals tested at 45 days of age responded with a 12% increase in maximal oxygen consumption (Vo2max) compared with controls (P less than 0.05). Assays of muscle phosphofructokinase and of creatine phosphokinase activity conducted at this time point revealed no difference between T and C groups. Collectively, these data suggest that neonatal rats can be successfully trained and that they respond to an endurance-type program qualitatively similarly to adult rats.

Animals↗

PubMedDate not supplied

[Sports and diet--an ambulatory program for obese children].

In an out-patient programme, 18 obese children aged 9-13 years were attended to for 1 year. The project consisted of an exercise programme performed 3 times per week, dietary restriction to 1200 kcal/d and psychological approach. The aim, besides weight reduction and acquisition of a healthy individual nutrition habit, was to improve physical performance and to increase self-confidence. All children improved physical and coordinative capacity and staying power and showed considerably more self-confidence. Weight reduction to a level below 20% overweight was achieved in the group of 12-13 years of age, whereas younger children showed minor weight loss. In the early period of treatment, HDL-cholesterol generally decreased but increased within 4-5 months exceeding pretreatment levels. No vitamin deficiencies occurred.

Child↗

PubMed2003

Effects of exercise intensity on physical fitness and risk factors for coronary heart disease.

OBJECTIVE: To determine whether "low-intensity" exercise (walking) and "high-intensity" exercise (aerobic dance), when added to a weight loss diet, have different effects on coronary heart disease (CHD) risk factors and physical fitness. RESEARCH METHODS AND PROCEDURES: Ninety obese women were divided into diet only (DO), diet plus walking (DW), and diet plus aerobic dance (DA) groups. DXA was used to evaluate segmental body composition. Leg-extension strength and maximal oxygen uptake (VO2max) were the indicators of physical fitness. Blood pressure, lipoproteins, and fasting glucose were used as indices for CHD risk factors. These items were measured before and after a 14-week intervention period. RESULTS: Whole-body plus all segmental fat masses were significantly reduced (p < 0.001). Reductions in whole-body and lower-limb fat- and bone-free masses were significantly less (p < 0.01) in the DA group (-1.5 and -0.1 kg, respectively) compared with the DO (-2.1 and -0.4 kg, respectively) and DW (-2.5 and -0.5 kg, respectively) groups. Improvements in leg-extension strength and VO2max were significantly greater (p < 0.05) in the DA group compared with the DO group. The CHD risk factors clearly improved (p < 0.05) within each group. Reductions in low density lipoprotein-cholesterol and fasting glucose were significantly greater (p < 0.05) in the DA group compared with the DO and DW groups. DISCUSSION: Adding higher intensity aerobic dance to a weight-loss diet program may help maintain fat- and bone-free mass and may be more effective in improving CHD risk factors compared with low-intensity walking.

Adipose Tissue↗

PubMed1991

Effects of exercise training at an intensity relative to lactate threshold in mildly obese women.

To determine the effects of exercise training on the anthropometric and physiologic characteristics, twenty-eight mildly obese women were studied prior to and following a 14-week exercise training program. The present data demonstrated that regular aerobic training at an intensity corresponding to lactate threshold (LT) led to significant improvements in VO2max (12%) and VO2LT (16%) and significant reductions in systolic (5%) and diastolic blood pressure (9%). Weight (5%) and percent body fat (11%) decreased significantly, while LBM remained essentially unchanged. Although the change in HDLC and HDLC/TC did not reach statistical significance, the TC (8%) and LDLC (7%) decreased significantly. These alterations in cardiorespiratory, anthropometric, and metabolic characteristics clearly demonstrate that training intensity relative to LT may be appropriate for obese individuals to improve the aerobic capacity, lipid-lipoprotein metabolism, and anthropometric profile.

Adult↗

PubMedDate not supplied

Polycystic ovary syndrome and severe nonalcoholic steatohepatitis: beneficial effect of modest weight loss and exercise on liver biopsy findings.

OBJECTIVE: To report a case of biopsy-documented nonalcoholic steatohepatitis (NASH), which improved appreciably through moderate exercise and weight loss in a young woman with polycystic ovary syndrome (PCOS) and insulin resistance. METHODS: We present a detailed case report, including laboratory and pathologic findings. In addition, we review the recent literature regarding the association of insulin resistance with NASH and PCOS. RESULTS: A 24-year-old woman was referred to the Duke Gastroenterology Clinic for evaluation of long-term high serum aminotransferase levels. She also reported a history of chronically irregular menses, infertility, and hirsutism and was diagnosed with PCOS. Subsequent glucose tolerance testing suggested the presence of insulin resistance. Liver biopsy findings were consistent with severe nonalcoholic steatohepatitis. Under the supervision of her physician and an exercise physiologist, the patient initiated a diet and exercise program that resulted in an 11.5% weight loss during approximately 8 months and yielded normalization of her aminotransferase levels. A repeat liver biopsy done 13 months after the initial biopsy revealed a substantial decrease in steatosis and a reduction in inflammation. CONCLUSION: Women with PCOS and insulin resistance have an increased risk of developing many of the consequences of the dysmetabolic syndrome, including type 2 diabetes, hypertension, and hyperlipidemia. This case report suggests that fatty liver and NASH may be other important diseases to identify in such women. It also demonstrates the improvement in this condition with moderate exercise and weight loss.

Adult↗

PubMedDate not supplied

Urea monitoring during dialysis: the wave of the future. A tale of two cities.

The National Cooperative Dialysis Study (NCDS) suggested that the removal of small molecules controls the adequacy of the dialysis prescription, and it would seem appropriate that renal units regularly carry out formal urea kinetic modeling to ensure that the adequacy of dialysis is provided. Current methods of calculating Kt/V (urea) are complex and require the accurate measurement of dialyzer urea clearance and calculation of the volume of distribution of urea. This may be done by the direct measurement of total urea removed or by the use of computer programs that examine plasma urea and weight changes over time. Both methods have inherent problems, and this has stimulated the search for easier "bedside" formulas for the calculation of Kt/V. These newer formulas involve examination of the percentage reduction in blood urea concentration during hemodialysis. Two such formulas were examined and applied to 78 patients undergoing hemodialysis in two centers. One center routinely carried out formal urea kinetic modeling; the other did not. In the first center, it was found that the majority of patients were receiving more dialysis than necessary to achieve Kt/V (urea) = 1 when the latter was judged by those formulas. This suggested the possibility of time savings, with considerable implications for cost efficiency. In the second center, the majority of patients required more dialysis. It was concluded that intermittent formal urea kinetic modeling tends to overshoot the necessary prescription to allow for occasional "imperfect" dialyses and also that it is impossible to base dialysis prescriptions on routine pre-dialysis blood work and a "feel" for patients' needs.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMed1988

Nonpharmacologic treatment of hypertension in the United States.

Although efficacious pharmacologic approaches to the control of high blood pressure are available, concern about risk versus benefit in the use of antihypertensive drug therapy for patients with mild hypertension has led to renewed interest in nonpharmacologic interventions. In the United States, the National High Blood Pressure Education Program, an organization comprised of research scientists and a variety of other professionals concerned with the control of high blood pressure has, through a consensus process, recommended some nonpharmacologic approaches to the treatment of hypertension. These include weight reduction for the obese, moderate sodium restriction (although this is controversial), and restriction of alcohol consumption to less than 1 oz of ethanol daily.

Alcohol Drinking↗

PubMed2004

Independent and additive effects of energy restriction and exercise on glucose and insulin concentrations in sedentary overweight men.

BACKGROUND: Overweight and inactivity are associated with impaired glucose tolerance, reduced insulin sensitivity, and diabetes. Few controlled trials have assessed the independent and combined effects of energy restriction and exercise on the prevention of these conditions. OBJECTIVE: The objective was to evaluate the independent and additive effects of 16 wk of energy restriction and exercise on glucose and insulin concentrations. DESIGN: Sixty nonsmoking, overweight, sedentary men aged 20-50 y were randomly assigned to either maintain or restrict their energy intake (4186-6279 kJ/d). Within each of these arms, the subjects were further randomly assigned to either a light-intensity (control) or a vigorous-intensity exercise program for 30 min 3 times/wk. RESULTS: Fifty-one subjects completed the study. Maximal oxygen uptake increased ( approximately 24%; P < 0.001) with vigorous but not with light exercise. Significant weight loss was observed with energy restriction (x: 10.12 kg; 95% CI: 8.02, 12.22 kg; P < 0.001) but not with exercise. Vigorous exercise reduced fasting glucose and glucose and insulin areas under the curve (AUCs) by 13% (P = 0.01) and 20% (P = 0.02), respectively. Exercise effects were independent of weight change. Energy restriction resulted in a 40% reduction in the insulin AUC (P = 0.01). Vigorous exercise and energy restriction were additive in reducing the insulin AUC. CONCLUSIONS: Energy restriction and vigorous exercise independently and additively reduce glucose and insulin concentrations in response to an oral-glucose-tolerance test. Both of these lifestyle interventions provide a potent strategy that should be an integral part of any program to reduce the risk of impaired glucose tolerance, insulin resistance, and diabetes in overweight and sedentary persons.

Adult↗

PubMed2002

Detraining produces minimal changes in physical performance and hormonal variables in recreationally strength-trained men.

The object of this study was to examine changes in muscular strength, power, and resting hormonal concentrations during 6 weeks of detraining (DTR) in recreationally strength-trained men. Each subject was randomly assigned to either a DTR (n = 9) or resistance training (RT; n = 7) group after being matched for strength, body size, and training experience. Muscular strength and power testing, anthropometry, and blood sampling were performed before the experimental period (T1), after 3 weeks (T2), and after the 6-week experimental period (T3). One-repetition maximum (1RM) shoulder and bench press increased in RT at T3 (p </= 0.05), whereas no significant changes were observed in DTR. Peak power output and mean power output significantly decreased (9 and 10%) in DTR at T2. Peak torque of the elbow flexors at 90 degrees did not change in the RT group but did significantly decrease by 11.9% at T3 compared with T1 in the DTR group. Vertical jump height increased in RT at T2 but did not change in DTR. Neither group displayed any changes in 1RM squat, body mass, percent body fat, or resting concentrations of growth hormone, follicle-stimulating hormone, luteinizing hormone, sex hormone-binding globulin, testosterone, cortisol, or adrenocorticotropin. These data demonstrate that 6 weeks of resistance DTR in recreationally trained men affects power more than it does strength without any accompanying changes in resting hormonal concentrations. For the recreational weight trainer, losses in strength over 6 weeks are less of a concern compared with anaerobic power and upper arm isometric force production. Anaerobic power exercise with a high metabolic component coming from glycolysis might be of importance for reducing the impact of DTR on Wingate power performances. A minimal maintenance training program is recommended for the recreational lifter to offset any reductions in performance.

Adult↗

PubMed2006

Obesity intervention in persons with spinal cord injury.

STUDY DESIGN: A single group uncontrolled trial. OBJECTIVES: Despite widespread emphasis on the obesity-related health risks in persons with spinal cord injury (SCI), limited research has been carried out to intervene in this problem. This study was conducted to assess the initial effectiveness of a weight loss program on various health outcomes in persons with SCI. SETTING: A rehabilitation center in Birmingham, Alabama, United States. METHODS: A total of 16 individuals with chronic SCI who were overweight or obese participated in a weight management program that consisted of 12 weekly classes, covering nutrition, exercise, and behavior modification. Various outcomes were examined over a 6-month period (baseline, week 12, and week 24), including body composition measured by dual energy X-ray absorptiometry, physiologic measures, diet behavior, and psychosocial and physical functioning. Of these, 13 participants returned for the week 24 follow-up. RESULTS: Weight loss averaged 3.5+/-3.1 kg (3.8% of the initial weight) at week 12 and 2.9+/-3.7 kg (3.0% of the initial weight) at week 24. There was a significant reduction from baseline values at weeks 12 and 24 in body mass index, anthropometric measurements, and fat mass and improvement in diet behavior and psychosocial and physical functioning, while lean mass and blood albumin and hemoglobin levels were maintained. A correlation analysis showed that a greater weight loss was importantly (r>0.4) associated with a greater reduction in total cholesterol at weeks 12 and 24 and in systolic and diastolic blood pressure at week 24. Several factors were important (r>0.4 or r<-0.4) in determining the success in weight loss, including age, race, marital and employment status, family history of overweight/obesity, level and duration of injury, and cholesterol level at baseline. CONCLUSIONS: This is the first demonstration that a carefully planned program with time-calorie displacement diet is effective for overweight/obese individuals with SCI to lose weight without compromising total lean mass and overall health. It provides foundation for a future large clinical trial for weight loss of persons with SCI or other spinal cord dysfunction.

Adult↗

PubMed2005

Human adenovirus-36 is associated with increased body weight and paradoxical reduction of serum lipids.

BACKGROUND: Human adenovirus-36 (Ad-36) increases adiposity and paradoxically lowers serum cholesterol and triglycerides in chickens, mice, and non-human primates. The role of Ad-36 in human obesity is unknown. OBJECTIVES: To determine the prevalence of Ad-36 antibodies in obese and nonobese humans. To evaluate the association of Ad-36 antibodies with body mass index (BMI) and serum lipids. DESIGN: Cohort study. Volunteers from obesity treatment programs, communities, and a research study. SUBJECTS: Obese and nonobese volunteers at the University of Wisconsin, Madison, WI, and the Bowen Center, Naples, Florida. Obese and thin volunteer research subjects and 89 twin pairs at Columbia University, New York. INTERVENTIONS: Study 1: 502 subjects; serum neutralization assay for antibodies to Ad-2, Ad-31, Ad-36, and Ad-37; serum cholesterol and triglycerides assays. Study 2: BMI and %body fat in 28 twin pairs discordant for Ad-36 antibodies. MAIN OUTCOME MEASURES: Presence of antibodies to adenoviruses, BMI, serum cholesterol and triglycerides levels. RESULTS: Significant (P < 0.001) association of obesity and positive Ad-36 antibody status, independent of age, sex, and collection site. Ad-36 antibodies in 30% of obese, 11% of nonobese. Lower serum cholesterol and triglycerides (P < 0.003) in Ad-36 antibody-positive vs -negative subjects. Twin pairs: antibody-positive twins had higher BMIs (24.5+/-5.2 vs 23.1+/-4.5 kg/m2, P < 0.03) and %body fat (29.6+/-9.5% vs 27.5+/-9.9%, P < 0.04). No association of Ad-2, Ad-31, or Ad-37 antibodies with BMI or serum lipids. CONCLUSIONS: Ad-36 is associated with increased body weight and lower serum lipids in humans. Prospective studies are indicated to determine if Ad-36 plays a role in the etiology of human obesity.

Adenovirus Infections, Human↗

PubMed2004

Insulin sensitivity among obese children and adolescents, according to degree of weight loss.

OBJECTIVE: Insulin sensitivity is impaired among some obese children, reflecting an atherogenic risk factor profile for the affected subjects. This study was performed to examine the amount of weight reduction required to improve insulin sensitivity. METHODS: We studied changes in insulin sensitivity indices (ISIs) for glucose metabolism (homeostasis model assessment and quantitative insulin sensitivity check index) and fat metabolism (free fatty acids) during a 1-year period among obese children who attended an obesity intervention program. The children were divided into 4 groups according to their changes in body mass index (BMI) SD score (SDS), as follows: group I, decrease in SDS-BMI of > or =0.5; group II, decrease in SDS-BMI of > or =0.25 to <0.5; group III, decrease in SDS-BMI of <0.25; group IV, increase in SDS-BMI. RESULTS: Fifty-seven obese children (age range: 6-14 years; median age: 10 years; 46% boys) were included in the study. The 4 groups did not differ with respect to age, gender, degree of overweight (SDS-BMI), or ISI values at baseline. An increase in SDS-BMI (group IV, n = 12) was followed by a significant decrease in ISI values. The ISIs improved for group I (n = 9), whereas there were no significant changes in these parameters for group II (n = 21) and group III (n = 15). CONCLUSIONS: During a 1-year period, an increase in weight among obese children was associated with a decrease in insulin sensitivity. Weight loss was followed by significant improvement in insulin sensitivity for glucose and fat metabolism but only if the SDS-BMI decreased by > or =0.5 during the 1-year period.

Adolescent↗