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PubMed2005

Obesity-related beliefs predict weight loss after an 8-week low-calorie diet.

The objective of this study was to examine whether beliefs about the cause, consequences, time line, and control of obesity are predictors of the amount of weight loss after an 8-week, low-calorie diet consisting of meal replacements. Forty-eight women and 18 men, mean age=45.9 (range=23 to 73 years) years and body mass index between 30 and 50 participated in a weight-loss program. Beliefs were measured at baseline by the Obesity Cognition Questionnaire and by an eating behavior self-efficacy scale. Correlational and regression analyses were performed to examine whether beliefs predicted weight change. Changes in body mass index, waist circumference, and blood pressure were significant (P <.001). Less weight reduction was associated with poor self-efficacy (r =-0.34, P <.01) and the beliefs that obesity had a physical origin (r =0.27, P =.04) and was not under behavioral control (r =-0.25, P =.04). Self-efficacy remained a significant predictor in regression analysis. The results suggest that the outcome of dietary interventions may be improved when adjusting beliefs, especially self-efficacy.

Adult↗

PubMed2002

Noninvasive pacemaker stress echocardiography for diagnosis of coronary artery disease: a multicenter study.

OBJECTIVE: We evaluated the feasibility, safety, and diagnostic accuracy of noninvasive pacemaker stress echocardiography (PASE) test as a potential alternative to exercise or pharmacologic stress in patients with suspected or known coronary artery disease (CAD). BACKGROUND: Transesophageal atrial pacing echocardiography is an accurate test for detection of CAD, but its practical impact has been blunted by semi-invasiveness. In the expanding population of patients with permanent pacemakers (PMs), a pacing stress test can be administered noninvasively by external programming of the PM. METHODS: In a prospective, multicenter, international study design, transthoracic stress-pacing echocardiography was performed in 46 consecutive patients with a permanent PM (33 men, 13 women; age 66.6 +/- 11.1 years) with suspected or known CAD. All patients underwent noninvasive PM-stress test by external programming (10 beats/min increments up to ischemia or target heart rate). Coronary angiography was performed in all patients independently of test results. Significant CAD was defined as >/=50% visually assessed diameter reduction in at least one major epicardial coronary artery. All coronary angiograms were scored by Duke prognostic weight values. RESULTS: Fifteen patients were stimulated in atrial, and the remaining 31 in ventricular mode during stress. No significant side effects were observed. Echocardiographic images were interpretable in all patients. The average duration of stress was 8.9 +/- 3.5 min. Significant CAD was found in 27 patients. Sensitivity of PASE for identifying patients with significant CAD was 70%, specificity was 90%, and accuracy was 78%. When any abnormal wall motion at rest that remained unchanged at peak stress was regarded as a positive result of PASE, then the sensitivity, specificity, and accuracy levels for identifying patients with significant CAD were 85%, 84%, and 85%, respectively. Four of the eight patients with a false negative did not reach the target heart rate. The Duke values had significant correlation with values of wall motion score index at peak stress (r = 0.67) and with peak heart rate (r = -0.3). CONCLUSIONS: Noninvasive PASE is a simple, rapid, safe, and diagnostically efficient option for patients with permanent PM and suspected or known CAD.

Aged↗

PubMed2002

Effects of spray-dried whole egg and biotin in calf milk replacer.

Holstein bull calves (n = 120) were fed milk replacers containing 0, 10, or 20% of the formulation (0, 22, or 44% of crude protein) as spray-dried whole egg powder in a 56-d feeding trial. Milk replacer was medicated with oxytetracycline and neomycin and was fed from d 1 to 42 of the study in a phase-fed program. All experimental milk replacers were supplemented with B vitamins, except biotin. One half of all calves were supplemented with 1 mg/kg of supplemental biotin to determine whether avidin in the egg protein product inhibited growth. Increasing spray-dried whole egg caused a linear reduction in body weight, body weight gain at 28 and 56 d of the study, calf starter intake, and feed efficiency. Calves fed milk replacers containing 0, 10, and 20% spray-dried whole egg gained an average of 486, 369, and 302 g/d, respectively, during the 56-d trial. Efficiency of feed utilization was 446, 318, and 231 g of body weight gain per kilogram of dry matter intake. Improvement in body weight and feed efficiency occurred when calves began consuming calf starter on d 29. Digestibility of protein or fat from egg may have been reduced during the trial; however, the addition of biotin to the milk replacer did not influence animal performance, suggesting that avidin in spray-dried whole egg was not responsible for impaired performance. The spray-dried whole egg product used in this study did not provide nutrients to support adequate growth of milk-fed calves.

Animal Feed↗

PubMed1986

Nonpharmacological approaches to the control of high blood pressure. Final report of the Subcommittee on Nonpharmacological Therapy of the 1984 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.

This report reviews a variety of nonpharmacological approaches used to control arterial blood pressure. Of all the modalities considered, only three had sufficient scientific support to warrant recommendation for inclusion in hypertension treatment programs. Each of these three modalities--weight control, alcohol restriction, and sodium restriction--was found to be capable not only of independently controlling blood pressure (particularly in patients with mild hypertension) but also of reducing the number and dosage of prescribed pharmacological agents, should their prescription be indicated. Weight reduction was found to reduce the risk from elevated arterial pressure as well as overall cardiovascular morbidity and mortality. However, because the rate of recidivism was exceedingly high in these studies, close and continuous patient follow-up is considered necessary. Excessive alcohol intake is associated in many studies with proportionally higher arterial pressures and an increased prevalence of hypertension. Therefore, the recommendation of moderation in alcohol consumption to less than 2 oz of ethanol daily for patients with hypertension is supported. Restriction of dietary sodium to less than 2 g/day was the only other nonpharmacological approach with sufficient support to be recommended as a treatment for hypertension. Although long-term studies are sorely lacking, sodium restriction has been shown to be manageable and safe and probably will benefit those hypertensive patients who are sodium-sensitive.

Alcohol Drinking↗

PubMed2001

Differing influences on Aboriginal and non-Aboriginal neonatal phenotypes: a prospective study.

OBJECTIVE: To understand the differences, if any, in major influences on birth phenotype between Aboriginal and non-Aboriginal neonates. DESIGN: Prospective study of a cohort of pregnant Aboriginal women presenting for antenatal care before 20 weeks' gestation (ultrasound proven), and a reference cohort of pregnant non-Aboriginal women. Comparison of the phenotypic and demographic characteristics of the women, their pregnancies and their babies. PARTICIPANTS: 96 Aboriginal and 96 non-Aboriginal women with no known medical factors affecting fetal growth or gestation. SETTING: Four remote far north Queensland communities served by the Far North Regional Obstetric and Gynaecological Service (FROGS) and the antenatal clinic at Cairns Base Hospital. MAIN OUTCOME MEASURES: Neonatal birth weight, length, head circumference, abdominal circumference, mid-arm circumference and triceps skinfold thickness, and derived ponderal index (weight/length3), head:abdomen circumference ratio and head:mid-arm circumference ratio. RESULTS: The Aboriginal neonates were on average almost 450 g lighter than their non-Aboriginal counterparts. They were also slightly shorter, with smaller head, abdomen and mid-arm circumferences and lower mean ponderal indices and triceps skinfold thickness. The gestational characteristics of the two groups were not significantly different. Neonatal phenotype was significantly associated with maternal body mass index and maternal age in both groups. Alcohol use in pregnancy was associated with a significant reduction in Aboriginal neonatal size, while tobacco use was significantly associated with size reductions in non-Aboriginal babies. CONCLUSIONS: Culturally appropriate antenatal care programs targeting the effects of poor nutrition and excessive alcohol use are needed if the excess incidence of low birthweight in Aboriginal people is to be reduced.

Adult↗

PubMed2004

Effect of weight reduction on respiratory function and airway reactivity in obese women.

BACKGROUND: Population-based studies have documented an association between obesity and an increased prevalence of asthma in women. METHODS: We prospectively studied 58 obese women with a body mass index of > 30 kg/m(2), 24 of whom had asthma, who were enrolled in an intensive 6-month weight loss program to determine whether loss of body mass would be correlated with improvements in bronchial reactivity, lung function, and disease-specific health status. RESULTS: Patients lost an average of 20 kg over the 6-month period. For every 10% relative loss of weight, the FVC improved by 92 mL (p = 0.05) and the FEV(1) improved by 73 mL (p = 0.04), however, bronchial reactivity did not significantly change with weight loss (p = 0.23). Patients who lost > 13% of their pretreatment weight experienced improvements in FEV(1) (p = 0.01), FVC (p = 0.02), and total lung capacity (p = 0.05) compared to patients in the lowest quartile who failed to lose significant amounts of weight. Neither group experienced any significant change in methacholine responsiveness (p = 0.57). Patients who completed the 6-month weight loss program experienced improvements in respiratory health status, irrespective of weight loss. CONCLUSION: We concluded that weight loss can improve lung function in obese women, however, the improvements appear to be independent of changes in airway reactivity.

Adult↗

PubMed1998

Restricting access to neonatal intensive care: effect on mortality and economic savings.

OBJECTIVE: Neonatal intensive care for very low birth weight (VLBW) infants is expensive, and cost-containment policies have been proposed that would restrict care according to birth weight. We examined the potential reduction in neonatal intensive care unit (NICU) VLBW charges and the impact on survivors if care were not offered to infants of extremely low birth weights or gestational ages. DESIGN: We reviewed hospital charges for a retrospective cohort of VLBW infants born during the 5-year period from 1988 to 1992. Local charges and survival statistics were applied to national VLBW birth statistics to estimate the national effects of a birth weight-based rationing program. SETTING: A high-risk perinatal referral center. PATIENTS: A consecutive sample of 1361 VLBW infants was tracked from birth to discharge home, transfer to a level II nursery, or death. MAIN OUTCOME MEASURES: Hospital charges and survival. RESULTS: Mean charges per survivor ranged from $250 654 for infants weighing <500 g to $74 101 for those weighing 1000 to 1500 g. Policies denying care to infants born at <500, 600, or 700 g would lead to total NICU care savings of 0.8%, 3.2%, and 10.3%, respectively. Applying the local birth weight-specific survival rates, such policies applied nationally would not have offered care to 136, 575, and 2689 potential survivors annually. Birth weight-based rationing schemes also are shown to increase further the racial disparity of NICU deaths. CONCLUSIONS: To attain significant reduction in NICU charges, policies offering care to the larger or more mature VLBW infants only will result in denying care to many infants who would otherwise survive.

Birth Weight↗

PubMedDate not supplied

Towards a universal approach for screening of retinopathy of prematurity (ROP).

To improve the cost-benefit ratio of our current screening program for retinopathy of prematurity (ROP), the records of 312 infants who had been screened for ROP were studied retrospectively. Using a safety-index containing three well known risk factors (birthweight, gestational age, oxygen use), infants were classified to be at high risk or low risk for the development of ROP. When all high risk infants would have been screened extensively from the 5th postnatal week onwards and all low risk infants would have been screened once at the 7th postnatal week, a 9.8% reduction of ophthalmological examinations would have been obtained at the expense of missing 2.9% of non vision threatening ROP.

Birth Weight↗

PubMed1983

Reduction of food theft and long-term maintenance of weight loss in a Prader-Willi adult.

Behavioral interventions have had limited success in managing the chronic hyperphagia and obesity that are of presumed organic etiology in Prader-Willi syndrome. Thus, frequent foraging for food and covert consumption continue to be health-threatening problems for many Prader-Willi individuals. This case study was designed to replicate methods for assessment and treatment of food theft. A token program based on differential-reinforcement-of-other-behavior and response-cost eliminated theft in three hospital settings. Prior to discharge, the program was expanded to include contingencies on exercise behavior and weight loss, and staff from the subject's group home residence were trained to implement a modified program in the natural environment. Reduced food theft and continued weight loss were maintained in the group home and an apartment-living arrangement. A total of 81 lb (37 kg) was lost during a 2-yr period.

Adult↗

PubMedDate not supplied

Activation of lipoprotein lipase and inhibition of B16 melanoma-induced cachexia in mice by ponalrestat, an aldose reductase inhibitor.

Lipoprotein lipase (LPL) is a key regulatory enzyme responsible for the hydrolysis of triglyceride (TG)-rich lipoproteins. The reduction in LPL activity is observed in tumor bearing animals and cancer patients with cachectic symptoms, suggesting an involvement of LPL in inducing cancer cachexia. During a screening program for anti-cachectic agents we found that ponalrestat, an aldose reductase inhibitor, activates LPL activity. Ponalrestat increased the activity of LPL in adipose tissue in mice. The effect of ponalrestat on B16 melanoma-induced cachectic symptoms was next investigated in mice. The decrease in the weight of epididymal fat, carcass and whole body lipid was observed in mice following intraperitoneal inoculation of B16, compared to mice without the tumor inoculation. Treatment with ponalrestat resulted in the attenuation of the decrease in the tissue weight. The increase in the levels of TG and non-esterified fatty acid, and a decrease in the level of glucose in the blood, which was induced by the presence of tumor, were also restored to those of normal mice following ponalrestat treatment. The reduction in locomotor activity in tumor bearing mice was partially restored by the treatment with ponalrestat. Overall, this study demonstrated that ponalrestat, an aldose reductase inhibitor, possesses potent LPL activating activity and that the cachexia induced by B16 melanoma was alleviated by treatment with 'ponalrestat, suggesting that ponalrestat, a LPL activating agent, has a therapeutic potential for the treatment of cancer cachexia.

3T3 Cells↗

PubMed2006

Preventing diabetes in the clinical setting.

OBJECTIVE: Translating lessons from clinical trials on the prevention or delay of type 2 diabetes to populations in nonstudy settings remains a challenge. The purpose of this paper is to review, from the perspective of practicing clinicians, available evidence on lifestyle interventions or medication to prevent or delay the onset of type 2 diabetes. DESIGN: A MEDLINE search identified 4 major diabetes prevention trials using lifestyle changes and 3 using prophylactic medications. We reviewed the study design, key components, and outcomes for each study, focusing on aspects of the interventions potentially adaptable to clinical settings. RESULTS: The lifestyle intervention studies set modest goals for weight loss and physical activity. Individualized counseling helped participants work toward their own goals; behavioral contracting and self-monitoring were key features, and family and social context were emphasized. Study staff made vigorous follow-up efforts for subjects having less success. Actual weight loss by participants was modest; yet, the reduction in diabetes incidence was quite significant. Prophylactic medication also reduced diabetes risk; however, lifestyle changes were more effective and are recommended as first-line strategy. Cost-effectiveness analyses have shown both lifestyle and medication interventions to be beneficial, especially as they might be implemented in practice. CONCLUSION: Strong evidence exists for the prevention or delay of type 2 diabetes through lifestyle changes. Components of these programs may be adaptable for use in clinical settings. This evidence supports broader implementation and increased reimbursement for provider services related to nutrition and physical activity to forestall morbidity from type 2 diabetes.

Adult↗

PubMed2001

[Long-term weight reduction. Current therapy approaches in obesity].

A large percentage of obese patients can lose weight with a combination of various dietary measures. The following possibilities are available: 1. The fat-reduced, carbohydrate-enhanced diet. 2. Formula diets, which are applied when a mixed diet has failed, or, alternatively, as an "introduction" to a weight-reducing program. In addition, suitable exercise programs and behavior-modifying measures aimed at stabilizing weight losses over the long-term, are also recommended. If this basic program fails, adjunctive drug treatment is indicated. Surgical treatment may be considered when various conservative forms of treatment have proved unsuccessful over a period of years.

Behavior Therapy↗

PubMed1996

[Role of physical activity in the therapy and prevention of Type II diabetes mellitus].

Increased physical activity should be part of the treatment for non insulin-dependent diabetic patients. Increased physical activity delays the onset of non insulin-dependent diabetes mellitus (NIDDM) or even prevents the disease in about 50% of susceptible individuals (positive family history of NIDDM, body-mass index > 25, hypertension or gestational diabetes). Regular exercise has been shown to lower plasma triglyceride and to increase high-density lipoprotein cholesterol levels. Exercise has also beneficial effects on hypertension, body composition and fat distribution. Improved glucose tolerance has been achieved in type II diabetic patients in as little as one week with an exercise program. The beneficial effect of regular exercise on glucose control appears to reflect the cumulative effect of transient improvement in glucose tolerance following each individual bout of exercise. Increased insulin sensitivity is lost after as little as three days of inactivity. Most studies suggest that the maximum benefit from exercise is most likely to occur in patients with mild diabetes in whom insulin resistance and hyperinsulinemia are present (i.e. patients with fasting blood glucose of < 11 mM). The recommended frequency and duration of exercise is three times per week or every other day and, as adjunct for weight reduction, five to seven times per week for 30 to 45 min. at an intensity of 50 to 70% VO2max (or 60 to 80% of maximal the heart rate). Because of the high incidence of ischemic heart disease in type II diabetic patients, patients older than 35 years of age should undergo a graded exercise stress electrocardiogram. Attention should be paid to foot-care and the use of appropriate footwear and diabetic late complications, such as autonomic and peripheral neuropathy. Older obese NIDDM patients can achieve significant metabolic benefits from low-intensity programs, such as daily walking, which can be easily incorporated into daily living. Taking the necessary precautions, most patients with diabetes can take part in a monitored exercise program safely.

Adult↗

PubMed1985

Efficacy of clonidine and of methadone in the rapid detoxification of patients dependent on heroin.

The efficacy of a rapid detoxification schedule (8 to 10 days) with clonidine or methadone was evaluated in 30 patients addicted to heroin. The dose of study drug was preestablished according to the subject's weight and the amount of opioid consumption, and the total daily dose was reduced by approximately 15% during the study. All subjects completed the detoxification program and stayed in the hospital for at least 12 days. Clonidine and methadone therapies proved to be highly effective. There was a marked reduction in anxiety during opioid detoxification, although subjects' experiences differed according to the drug used. On the day of discharge, subjects who had received methadone still had attenuated withdrawal symptoms, whereas there were no such symptoms in the clonidine group. Muscular aching, flatulence, and daily drowsiness were more common among subjects in the methadone group, while subjects in the clonidine group had more sleep disturbances and weeping. Syncopal episodes and bradycardia occurred more frequently in the clonidine group.

Adolescent↗

PubMed2003

Improvement in hypertrophic cardiomyopathy after significant weight loss: case report.

A 17-year-old obese boy found to have familial apical hypertrophic cardiomyopathy on routine screening was enrolled in a weight loss program on the basis of the hypothesis that significant weight loss would improve his cardiac status. He was followed with serial dual-energy x-ray absorptiometry, electrocardiography, echocardiography, and blood pressure and pulse rate measurements. Within 1 year, he lost 49 kg, with a body mass index reduction from 43.6 to 28.1 kg/m2 and associated reductions in systolic blood pressure, diastolic blood pressure, pulse pressure, mean heart rate, rate pressure product, and echocardiographic indices of left ventricular mass that resulted in a change from the initial geometric finding of eccentric left ventricular hypertrophy to a "normal" left ventricular mass with minimal asymmetric apical left ventricular thickening. Significant weight loss in an obese adolescent with presumed familial apical hypertrophic cardiomyopathy was associated with striking improvement in cardiac functional indices, which could have profound implications for long-term cardiovascular risk.

Adolescent↗

PubMed1998

ET-receptor antagonism, myocardial gene expression, and ventricular remodeling during CHF in rats.

Both myocardial and plasma endothelin-1 (ET-1) are elevated in congestive heart failure (CHF). However, the role played by endogenous ET-1 in the progression of CHF remains unknown. The aim of the present study was to investigate and correlate myocardial gene expression programs and left ventricular (LV) remodeling during chronic ET-receptor antagonism in CHF rats. After ligation of the left coronary artery, rats were randomized to oral treatment with a nonselective ET-receptor antagonist (bosentan, 100 mg . kg-1 . day-1, n = 11) or vehicle (saline, n = 13) for 15 days, starting 24 h after induction of myocardial infarction. Bosentan substantially attenuated LV dilatation during postinfarction failure as evaluated by echocardiography. Furthermore, bosentan decreased LV systolic and end-diastolic pressures and increased fractional shortening. Myocardial expression of preproET-1 mRNA and a fetal gene program characteristic of myocardial hypertrophy were increased in the CHF rats and were not affected by bosentan. Consistently, right ventricular-to-body weight ratios, diameters of cardiomyocytes, and echocardiographic analysis demonstrated a sustained hypertrophic response and a normalized relative wall thickness after intervention with bosentan. Thus the modest reduction of preload and afterload provided by bosentan substantially attenuates LV dilatation, causing improved pressure-volume relationships. However, the compensatory hypertrophic response was not altered by ET-receptor antagonism. Therefore, ET-1 does not appear to play a crucial role in the mechanisms of myocardial hypertrophy during the early phase of postinfarction failure.

Angiotensinogen↗

PubMed2004

Improvements in physical fitness in adults with Down syndrome.

The effectiveness of an exercise training program for 52 adults with Down syndrome (M age = 39.4 years) was evaluated. The training program consisted of cardiovascular (30 minutes) and strength exercise (15 minutes) for 12 weeks, 3 days a week for 45-minutes per session. Compared to control subjects, the training group improved significantly in cardiovascular fitness and muscular strength and endurance and had a slight but significant reduction in body weight. Greater effort must be made to promote increases in physical activity participation among persons with Down syndrome and developmental disabilities in order to reduce the potential health risks associated with low fitness and sedentary behavior.

Adult↗

PubMedDate not supplied

Prospective trial of complete decongestive therapy for upper extremity lymphedema after breast cancer therapy.

PURPOSE: Lymphedema is a well-described complication of therapy for breast cancer. Patients who present with lymphedema may experience pain and body image issues and are at increased risk for developing cellulitis. Complete decongestive therapy (CDT) is a four-component therapy for lymphedema. Data regarding CDT as an intervention in the immediate after the diagnosis period and prolonged follow-up are limited; we prospectively analyzed results of CDT in this cohort of patients. MATERIALS AND METHODS: Twenty patients were enrolled in CDT immediately after their diagnosis of lymphedema. The Functional Assessment of Cancer Therapy quality of life (QoL) measure and a visual analogue scale for pain were completed before, on the 10th day of, and on the last day of treatment. Each patient underwent a daily 60- to 90-minute treatment session, 5 days per week for 2-4 weeks. Treatment consisted of skin and nail care, manual lymphatic drainage, a multilayer compression bandage, and therapeutic exercise. Edema of the affected limb was reassessed weekly. On reaching a measurement plateau, the patient was discharged from active treatment and began a maintenance phase. The patient was reassessed for girth, volume, and body weight at 3 months. These measurements plus the QoL and pain measures were also reassessed at 6 months and 1 year after treatment. RESULTS: Patients completed 2-4 weeks of treatment (median, 2 weeks). Those classed as severe decreased from 7 to 1. Median girth reduced 1.5 cm and median volume reduced 138 mL. Decreasing girth correlated significantly with decreasing visual analogue scale scores for pain, but not with increasing QoL. Increasing grade correlated significantly with girth reduction and volume reduction. Compliance with the treatment regimen at home decreased with time on the program. During follow-up, girth and volume reverted slightly but stabilized at about 1 cm and 100 mL below baseline, respectively. Although the increase in QoL was not significant, it was noted that during the entire treatment and follow-up period, QoL consistently increased, ending about 5% above baseline, and pain scores gradually decreased, ending with 54% (and median) of patients at 0 pain. CONCLUSIONS: CDT is effective in treating lymphedema. Success in girth reduction contributes to less pain. Grade is a useful indicator of severity; class is not. Increased number of treatment sessions provides marked improvements in girth, volume, and weight but result in poorer compliance. Longer latency more successfully reduces girth, volume, and pain and increases QoL. QoL and pain are improved by treatment and continue to improve after treatment has ended.

Adult↗