Overweight children have poor bone strength relative to body weight, placing them at greater risk for forearm fractures

Introduction: Obesity is thought to be a protective factor for bones in adults but not in children based on the evidence of the greater incidence of forearm fractures in obese children. Our objective was to investigate the effect of adiposity on bone strength in relation to the mechanical challenge placed onto the forearm bones in case of a fall.

Methods: Cross sectional areas (CSA) were obtained at the mid- and distal radius by peripheral quantitative computed tomography in 486 children (241 boys), mean age 8.3 years (range 6.9–9.7), participating in the LOOK Project. The following parameters were measured: bone mass and bone CSA (both sites), and muscle and fat CSA (mid-forearm only). Bone strength indices combining bone size and total volumetric density were calculated at each site.

Results/Discussion: Overweight children (BMI > percentile equivalent to 25 kg/m² in adults) have higher bone parameters than normal-weight peers (Z-scores +0.6 to +0.9SD, p < 0.0001). These differences disappear after adjustment for muscle CSA. Adiposity (fat CSA/muscle CSA) was negatively correlated with bone mass, size and strength at the distal radius only (r = −0.1, p < 0.05). After adjustment for body weight (estimate of the load during a fall), the negative correlations were stronger and observed at both the mid- and distal radius (r = −0.37 to −0.55, p < 0.0001).

Conclusion. Overweight children have stronger bones due to greater muscle size. However, children with high fat mass relative to muscle mass (increased adiposity) have poorer bone strength, independent of weight, which may contribute to the increased risk of fracture in obese children.

Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes : modeled lifetime analysis

OBJECTIVE--To estimate the cost-effectiveness of surgically induced weight loss relative to conventional therapy for the management of recently diagnosed type 2 diabetes in class VII obese patients.

RESEARCH DESIGN AND METHODS--This study builds on a within-trial cost-efficacy analysis. The analysis compares the lifetime costs and quality-adjusted life-years (QALYs) between the two intervention groups. Intervention costs were extrapolated based on observed resource utilization during the trial. The proportion of patients in each intervention group with remission of diabetes at 2 years was the same as that observed in the trial. Health care costs for patients with type 2 diabetes and outcome variables required to derive estimates of QALYs were sourced from published literature. A health care system perspective was adopted. Costs and outcomes were discounted annually at 3%. Costs are presented in 2006 Australian dollars (AUD) (currency exchange: 1 AUD = 0.74 USD).

RESULTS--The mean number of years in diabetes remission over a lifetime was 11.4 for surgical therapy patients and 2.1 for conventional therapy patients. Over the remainder of their lifetime, surgical and conventional therapy patients lived 15.7 and 14.5 discounted QALYs, respectively. The mean discounted lifetime costs were 98,900 AUD per surgical therapy patient and 101,400 AUD per conventional therapy patient. Relative to conventional therapy, surgically induced weight loss was associated with a mean health care saving of 2,400 AUD and 1.2 additional QALYs per patient.

CONCLUSIONS--Surgically induced weight loss is a dominant intervention (it both saves health care costs and generates health benefits) for managing recently diagnosed type 2 diabetes in class IBI obese patients in Australia.

Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes : a randomized controlled trial

OBJECTIVE -- To determine the within-trial cost-efficacy of surgical therapy relative to conventional therapy for achieving remission of recently diagnosed type 2 diabetes in class I and II obese patients.

RESEARCH DESIGN AND METHODS -- Efficacy results were derived from a 2-year randomized controlled trial. A health sector perspective was adopted, and within-trial intervention costs included gastric banding surgery, mitigation of complications, outpatient medical consultations, medical investigations, pathology, weight loss therapies, and medication. Resource use was measured based on data drawn from a trial database and patient medical records and valued based on private hospital costs and government schedules in 2006 Australian dollars (AUD). An incremental cost-effectiveness analysis was undertaken.

RESULTS -- Mean 2-year intervention costs per patient were 13,400 AUD for surgical therapy and 3,400 AUD for conventional therapy, with laparoscopic adjustable gastric band (LAGB) surgery accounting for 85% of the difference. Outpatient medical consultation costs were three times higher for surgical patients, whereas medication costs were 1.5 times higher for conventional patients. The cost differences were primarily in the first 6 months of the trial. Relative to conventional therapy, the incremental cost-effectiveness ratio for surgical therapy was 16,600 AUD per case of diabetes remitted (currency exchange: 1 AUD = 0.74 USD).

CONCLUSIONS -- Surgical therapy appears to be a cost-effective option for managing type 2 diabetes in class I and II obese patients.

Immunostimulatory polysaccharides from Chlorella pyrenoidosa. A new galactofuranan. Measurement of molecular weight and molecular weight dispersion by DOSY NMR.

Fractionation of the hot water extract of Chlorella pyrenoidosa was performed using a combination of ethanol precipitation, size exclusion chromatography, and anion exchange chromatography. One fraction contained a new polysaccharide, and this compound was shown to be a 1→2-linked β-d-galactofuranan from its 1D and 2D 1H and 13C NMR spectra, with a molecular weight of 15 kDa from DOSY NMR measurements. A number of other fractions were shown to have the same repeating unit as the previously identified arabinogalactan. However, arabinogalactans from different fractions were shown by DOSY NMR to have different molecular weights, which ranged from 27 to 1020 kDa. Agreement with molecular weights measured for some of these fractions by SEC-MALS was very good, further confirming the relationship established by Viel et al. between molecular weights of neutral polysaccharides and self-diffusion coefficients. The smaller molecular weight polysaccharides, the galactofuranan and the 27 and 50 kDa arabinogalactans, were shown to be close to monodisperse by analysis of the distributions of the self-diffusion coefficients for the polymers. The larger arabinogalactans had considerable variation in their molecular weights (188 ± 109 kDa and 1020 ± 370 kDa). Only the two larger arabinogalactans showed immunostimulatory activity.

Health implications of body size perception and weight tolerance in older adults

Obesity is a well-recognized risk factor for Type II diabetes and cardiovascular disease. In this study a high percentage of older adults were either overweight or obese. The aims were to assess older adults' tolerance for excess weight, and to compare self-perceptions of an acceptable weight with national guidelines. Participants were 76 males and females aged between 65 and 97 years. Results indicated that 60 per cent accurately identified their own body size. Further, participants were more tolerant of excess weight in males compared to females, regardless of age. It was concluded that this cohort remains vulnerable to weight-related illnesses.

Weight, physical activity and dietary behavior change in young mothers : short term results of the HeLP-her cluster randomized controlled trial

Background
Preventing weight gain rather than treating established obesity is an important economic and public health response to the rapidly increasing rates of obesity worldwide. Treatment of established obesity is complex and costly requiring multiple resources. Preventing weight gain potentially requires fewer resources to reach broad population groups, yet there is little evidence for successful interventions to prevent weight gain in the community. Women with children are an important target group because of high rates of weight gain and the potential to influence the health behaviors in family members.

Methods
The aim of this cluster randomized controlled trial was to evaluate the short term effect of a community-based self-management intervention to prevent weight gain. Two hundred and fifty mothers of young children (mean age 40 years ± 4.5, BMI 27.9 kg/m2 ± 5.6) were recruited from the community in Melbourne, Australia. The intervention group (n = 127) attended four interactive group sessions over 4 months, held in 12 local primary schools in 2006, and was compared to a group (n = 123) receiving a single, non-interactive, health education session. Data collection included self-reported weight (both groups), measured weight (intervention only), self-efficacy, dietary intake and physical activity.

Results
Mean measured weight decreased significantly in the intervention group (-0.78 kg 95% CI; -1.22 to -0.34, p < 0.001). Comparing groups using self-reported weight, both the intervention and comparison groups decreased weight, -0.75 kg (95% CI; -1.57 to 0.07, p = 0.07) and -0.72 kg (95% CI; -1.59 to 0.14 p = 0.10) respectively with no significant difference between groups (-0.03 kg, 95% CI; -1.32 to 1.26, p = 0.95). More women lost or maintained weight in the intervention group. The intervention group tended to have the greatest effect in those who were overweight at baseline and in those who weighed themselves regularly. Intervention women who rarely self-weighed gained weight (+0.07 kg) and regular self-weighers lost weight (-1.66 kg) a difference of -1.73 kg (95% CI; -3.35 to -0.11 p = 0.04). The intervention reported increased physical activity although the difference between groups did not reach significance. Both groups reported replacing high fat foods with low fat alternatives and self-efficacy deteriorated in the comparison group only.

Conclusion
Both a single health education session and interactive behavioral intervention will result in a similar weight loss in the short term, although more participants in the interactive intervention lost or maintained weight. There were small non-significant changes to physical activity and changes to fat intake specifically replacing high fat foods with low fat alternatives such as fruit and vegetables. Self-monitoring appears to enhance weight loss when part of an intervention.

Longitudinal examination of the family food environment and weight status among children

Objective. To examine whether aspects of the family food environment were associated with body mass index (BMI) z-score and weight status in children, cross-sectionally and prospectively over 3 years.

Methods. Four aspects of the family food environment (breakfast eating patterns, food consumption while watching television, parental provision of energy-dense foods and child consumption of energy-dense food at home and away from home) were assessed with a questionnaire completed by parents of 161 children aged 5-6 years and 132 children aged 10-12 years in Melbourne, Australia in 2002/03. In 2002/03 and 2006, children's BMI z-score and weight status (non-overweight or overweight) was calculated from measured height and weight. Results. At baseline, 19% of younger and 21% of older children were overweight. Three years later, a greater proportion of younger (now aged 8-9 years) compared with older (aged 13-15 years) children were classified as overweight (28% versus 18%). Few of the family food environment variables were associated with children's BMI z-score and weight status cross-sectionally and longitudinally. However, among older children, more frequent dinner consumption while watching television was associated with a higher BMI z-score longitudinally (B = 0.3, 95% CI = 0.0, 0.6), less frequent breakfast consumption was associated with higher odds of overweight longitudinally (OR = 2.2, 95% CI = 1.1-4.7), and more frequent fast food consumption at home was associated with higher odds of overweight cross-sectionally (OR = 3.1, 95% CI = 1.4-7.0).

Conclusions. This study found few significant associations between aspects of the family food environment and BMI z-score or weight status in a sample of Australian children.

Women's work. Maintaining a healthy body weight

This study describes women's perceptions of the supports and barriers to maintaining a healthy weight among currently healthy weight women from urban and rural socio-economically disadvantaged areas. Using focus groups and interviews, we asked women about their experiences of maintaining a healthy weight. Overwhelmingly, women described their healthy weight practices in terms of concepts related to work and management. The theme of ‘managing health’ comprised issues of managing multiple responsibilities, time, and emotions associated with healthy practices. Rural women faced particular difficulties in accessing supports at a practical level (for example, lack of childcare) and due to the gendered roles they enacted in caring for others. Family background (in particular, mothers’ attitudes to food and weight) also appeared to influence perceptions about healthy weight maintenance. In the context of global increases in the prevalence of obesity, the value of initiatives aimed at supporting healthy weight women to maintain their weight should not be under-estimated. Such initiatives need to work within the social and personal constraints that women face in maintaining good health.

Television viewing time and weight gain in colorectal cancer survivors : a prospective population-based study

Objective To investigate the prospective relationships between television viewing time and weight gain in the 3 years following colorectal cancer diagnosis for 1,867 colorectal cancer survivors (body mass index (BMI) ≥ 18.5 kg/m2).

Methods BMI, television viewing time, physical activity, and socio-demographic and clinical covariates were assessed at baseline (5 months), 24 months and 36 months post-diagnosis. Multiple linear regression was used to study independent associations between baseline television viewing time and BMI at 24 and 36 months post-diagnosis.

Results At both follow-up time points, there was a significant increase in mean BMI for participants reporting ≥5 h/day of television viewing compared to those watching <3 h/day at baseline (24 months: 0.72 kg/m2 (0.31, 1.12), p < 0.001; 36 months: 0.61 kg/m2 (0.14, 1.07), p = 0.01), independent of baseline BMI, gender, age, education, marital status, smoking, cancer site, cancer disease stage, treatment mode and co-morbidities. Additional adjustment for baseline physical activity did not change results.

Conclusions These findings suggest that a greater emphasis on decreasing television viewing time could help reduce weight gain among colorectal cancer survivors. This, in turn, could contribute to a risk reduction for co-morbid conditions such as type 2 diabetes and cardiovascular disease.

Cardiovascular surveys : manual of operations

Cardiovascular disease (CVD) is the leading cause of death and hospitalization in both men and women in nearly all countries of Europe. The most frequent forms of CVD are those of an atherosclerotic origin, mainly ischaemic heart disease, stroke and heart failure. The magnitude of the problem contrasts with the usual paucity and poor quality of data available on incidence and prevalence of CVD, except for few rigorous but limited studies.

The objectives of the health interview and health examination surveys (HIS/HES) are to evaluate the frequency and the distribution of the disease, to evaluate trends and treatment effectiveness, to estimate risk factors distribution and prevalence of high risk conditions and to monitor prevention programmes.

According to the EUROCISS project (EUROpean Cardiovascular Surveillance Set) recommendations, surveys are aimed at describing the prevalence of the following CVD conditions: myocardial infarction, heart failure, angina pectoris, peripheral arterial disease, stroke, and ischaemic heart disease.

HIS and HES were developed to supplement information collected from routine databases and population-based registers to implement consistent public health policies. HIS can be repeated periodically in a new sample of the population, or can follow up over time the population recruited at baseline. Procedures and methods to collect information from participants include self-administered questionnaires, direct interviewer-administered questions and telephone interviews. A minimum set of questions to be administered every year, along with a longer, more detailed module to be administered periodically are recommended to evaluate CVD prevalence. The addition of HES provides more detailed and objective information that can be used to improve estimates regarding prevalence of both risk factors and disease status.

The selection of more specialized CVD-specific tests will depend on the objective the survey is designed to achieve, the assumed response rate and the cost and time considerations. For HES on CVD the minimum required is to perform the following measurements: height, weight, blood pressure, waist circumference, total and high density lipoprotein-cholesterol and glucose assay in a nonfasting blood sample. The next appropriate step would be to perform an electrocardiogram. High costs usually make HES difficult to carry out.

Standardization of measurements, training of personnel and quality control are essential to assure reliable data. A high response rate is extremely important, as nonrespondents tend to have different health characteristics from the rest of the sample and their omission therefore results in bias.

This manual of operations is intended for health professionals and policy makers and provides a standardized and simple model for the implementation of a CVD survey.

Effects of diets high in whey, soy, red meat and milk protein on body weight maintenance in diet-induced obesity in mice

This study examined the effects of different food sources of protein on energy intake, body weight maintenance, and on the responses of plasma leptin, insulin and adiponectin in chronic high-fat diet-induced obese mice. Obesity was induced in 47 mice with a high-fat diet for 20 weeks. They were divided into five diet groups to test the effects of a higher protein proportion (30% energy), achieved at the expense of carbohydrate. For the next eight weeks, four of the groups were fed diets of chow formulated with whey, soy, red meat or milk while the control group continued on their high-fat diet. The results showed that: (i) increasing the protein : carbohydrate ratio (both at 30% energy) in a high-fat diet did not reduce the level of obesity; (ii) the type of protein added, however, did have a significant effect on the level of obesity attained; (iii) whey protein stabilised weight gain the most, had the strongest satiety effects and also stimulated the highest production of adiponectin; and (iv) whey protein also was associated with the lowest insulin values among all proteins tested. Plasma leptin levels were not affected by any of the diets. Dietary fat remains a potent factor in weight management, but the type and amount of protein may also be important through its effects on food intake. In particular, the apparent decreased appetite associated with increased adiponectin in the whey-based high-protein diet may contribute to stabilised body mass in chronic high-fat diet-induced obesity.