Adult Weight Change Research Articles

Abstract P092: Age and Gender-specific Associations of Diet Quality and 4-year Weight Change in Non-obese Adults of the Dutch Lifelines Cohort

Introduction: Diet is an important lifestyle factor in strategies for overweight prevention, but little is known about its dependency on contextual factors like age and gender. Hypothesis: We assessed the hypothesis that the strength of the association between diet quality and 4-year weight change differed among age categories and between genders. Methods: From the Dutch Lifelines Cohort, 85.618 non-obese, adult participants were included in the study. At baseline, diet was assessed with a 110-item food frequency questionnaire. The Lifelines Diet Score, based on established evidence-based food groups for the prevention of chronic diseases, was calculated to assess diet quality. For analyses, the score was divided in quintiles. Body weight was objectively measured at baseline and after a median follow-up of 44 months (25th-75th percentile: 35-51 months). In between, body weight was self-reported twice. Linear mixed models were used to investigate the association between diet quality and weight change in 6 age categories (18-29 to 70+) and stratified by gender. Results: Mean 4-year weight change decreased over age categories. Confounder adjusted linear mixed model analyses showed that the association between diet quality and weight change was dependent on age, more so in women (p INTERACTION =0.001). Poor diet quality (quintile 1 vs. quintile 5) was most strongly related to 4-year weight gain in young men (estimated mean +1.62 kg) and young women (estimated mean +1.13 kg). In contrast, in women aged 70+, poor diet quality was associated with weight loss (estimated mean -1.80 kg). Conclusions: Poor diet quality was prospectively related to higher weight gain, especially in young adults. Oppositely, among women aged 70+, better diet quality was related to less weight loss. Therefore, a healthful diet is a promising target for unintentional weight changes in both directions.

Resting Energy Expenditure and Metabolic Adaptation in Adolescents at 12 Months After Bariatric Surgery

Evidence suggests that metabolic adaptation occurs after bariatric surgery such that resting energy expenditure (REE) declines more than accounted for by body weight or body composition changes in adults. Little is known about REE and metabolic adaptation among adolescents after bariatric surgery. To examine changes in REE and metabolic adaptation among adolescents at 12 months (12M) after bariatric surgery. Pediatric hospital, Canada. Adolescents undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were followed. Bioelectrical impedance analysis and indirect calorimetry were completed to measure body composition and REE, respectively. Predicted REE was calculated using the Mifflin equation before and after bariatric surgery and a predictive equation using preoperative data. Among 20 patients (15 girls), the mean age and body mass index at surgery were 17.2 ± 0.8 years and 48.7 ± 7.4 kg/m2, respectively. REE had decreased by 548.3 kcal/d at 12M postoperatively (P < 0.001). Metabolic adaptation, determined by two procedures, was negative and significantly different from baseline (P < 0.05). When stratified by surgery type, REE change at 12M was not significantly different (RYGB, -494.0 ± 260.9 kcal/d, n = 11; SG, -614.6 ± 344.4 kcal/d, n = 9; P = 0.384). Among 13 patients with REE data at 6 and 12M, no statistically significant difference was found (P = 0.368). Predicted and measured REE was 19% and 25% lower at 12M, respectively, irrespective of bariatric surgery type. Metabolic adaptation might predispose adolescents to weight regain after bariatric surgery and warrants careful nutritional management and counseling.

Propensity for Intra-abdominal and Hepatic Adiposity Varies Among Ethnic Groups

We compared fat storage in the abdominal region among individuals from 5 different ethnic-racial groups to determine whether fat storage is associated with disparities observed in metabolic syndrome and other obesity-associated diseases. We collected data from 1794 participants in the Multiethnic Cohort Study (60-77 years old; of African, European [white], Japanese, Latino, or Native Hawaiian ancestry) with body mass index values of 17.1-46.2 kg/m2. From May 2013 through April 2016, participants visited the study clinic to undergo body measurements, an interview, and a blood collection. Participants were evaluated by dual-energy x-ray absorptiometry and abdominal magnetic resonance imaging. Among ethnic groups, we compared adiposity of the trunk, intra-abdominal visceral cavity, and liver, adjusting for total fat mass; we evaluated the association of adult weight change with abdominal adiposity; and we examined the prevalence of metabolic syndrome mediated by abdominal adiposity. Relative amounts of trunk, visceral, and liver fat varied significantly with ethnicity-they were highest in Japanese Americans, lowest in African Americans, and intermediate in the other groups. Compared with African Americans, the mean visceral fat area was 45% and 73% greater in Japanese American men and women, respectively, and the mean measurements of liver fat were 61% and 122% greater in Japanese American men and women. The visceral and hepatic adiposity associated with weight gain since participants were 21 years old varied in a similar pattern among ethnic-racial groups. In the mediation analysis, visceral and liver fat jointly accounted for a statistically significant fraction of the difference in metabolic syndrome prevalence, compared with white persons, for African Americans, Japanese Americans, and Native Hawaiian women, independently of total fat mass. In an analysis of data from the participants in the Multiethnic Cohort Study, we found extensive differences among ethnic-racial groups in the propensity to store fat intra-abdominally. This observation should be considered by clinicians in the prevention and early detection of metabolic disorders.

Adult weight change and the risk of pre- and postmenopausal breast cancer in the Chinese Wuxi Exposure and Breast Cancer Study.

The accumulating evidence indicates that weight gain in adulthood is more predictive of breast cancer risk than absolute body weight. However, the relative impact of timing of weight gain in adulthood on breast cancer as well as other characteristics of the association between weight and breast cancer has not been well documented. This population-based case-control study of breast cancer included 818 patients with newly diagnosed primary breast cancer and 935 residence and age-matched healthy controls. The body weight values at 18years old, 1 year before diagnosis, and at menopause were obtained during in-person interviews. Unconditional logistic regression was used to estimate the effects of the weight change over adulthood on breast cancer risk. Linear mixed-effects regression was also applied as a secondary analysis. We found that the increased risk of breast cancer was associated with the weight gain in adulthood among postmenopausal women (OR 1.23; 95% CI 1.10-1.37 per 5kg increase) but not in the premenopausal women. The risk associated with weight gain since menopause (OR 1.65; 95% CI 1.28-2.14 a 5-kg increase) was higher than that from age 18 to menopause (OR 1.14; 95% CI 1.02, 1.28 a 5-kg increase). The association tended to be stronger in those with higher waist circumference and who had never used hormone replacement therapy (HRT). Women who had never used HRT, the increased risk of breast cancer associated with weight gain was more consistent in leaner women at age 18 (BMI < 18.5) or at menopause (BMI < 24). Our findings indicated that weight gain has significant impact on postmenopausal breast cancer risk. The time periods of weight gain, central body fat, and HRT may affect the observed association, which should be further studied.

Associations Among Dietary Fat Oxidation Responses to Overfeeding and Weight Gain in Obesity-Prone and Resistant Adults.

OBJECTIVE:We tested the hypothesis that three days of overfeeding (OF) decreases dietary fat oxidation and predicts longitudinal weight change in adults classified as obesity-prone (OP) and obesity-resistant (OR) based on self-identification, personal and family weight history. Changes in diurnal profiles of plasma metabolites and hormones were measured to probe mechanisms.METHODS:Adults identified as OP (n=22; BMI: 23.9 ± 2.4 kg/m2) and OR (n=30; BMI: 20.5 ± 2.2 kg/m2) completed 3 days of eucaloric (EU) feeding and 3 days of OF. On day three, 24-hr total and dietary fat oxidation were measured using room calorimetry and an oral 14C tracer. Plasma glucose, insulin, triglycerides (TG), and non-esterified fatty acid (NEFA) concentrations were frequently sampled over 24-hr. Body composition was measured annually for 4.0 ± 1.4 years in a sub-sample (n=19 OP and 23 OR).RESULTS:Dietary fat oxidation over 24-hr was not altered by OF versus EU (P=0.54). Weight gain in OP correlated with lower nocturnal NEFA concentrations during OF (r=−0.60, P=0.006) and impaired fuel selection over 24-hr (metabolic inflexibility, wake RQ-sleep RQ) (r=−0.48, P=0.04).CONCLUSIONS:Short-term OF did not alter dietary fat oxidation. Lower nocturnal NEFA availability and metabolic inflexibility to overfeeding may be factors contributing to weight gain.

Long sleep duration predicts a higher risk of obesity in adults: a meta-analysis of prospective cohort studies.

The connections between long sleep duration and obesity or weight gain warrant further examination. This meta-analysis aimed to evaluate whether long sleep duration was associated with the risk of obesity, weight gain, body mass index (BMI) change or weight change in adults. PubMed, Embase, Cochrane Library, Elsevier Science Direct, Science Online, MEDLINE and CINAHL were searched for English articles published before May 2017. A total of 16 cohort studies (n = 329 888 participants) from 8 countries were included in the analysis. Pooled relative risks (RR) or regression coefficients (β) with 95% confidence intervals (CI) were estimated. Heterogeneity and publication bias were tested, and sensitivity analysis was also performed. We found that long sleep duration was associated with higher risk of obesity (RR [95% CI] = 1.04 [1.00-1.09], P = 0.037), but had no significant associations with weight gain, BMI change or weight change. Long sleep duration increased the risk of weight gain in three situations: among men, in studies with <5 years follow-up, and when sleep duration was 9 or more hours. Long sleep duration was associated with risk of obesity in adults. More cohort studies with objective measures are needed to confirm this relationship.

Adult weight change in relation to visceral fat and liver fat at middle age: The Netherlands epidemiology of obesity study.

We aimed to investigate the associations between weight change during adulthood and the amount of abdominal subcutaneous fat, visceral fat, and liver fat at middle age. The Netherlands Epidemiology of Obesity (NEO) study is a population-based cohort of 6671 middle-aged men and women. We calculated the percentage of weight change during adulthood based on body weight at middle age and recalled body weight at age 20. Abdominal subcutaneous and visceral adipose tissue were assessed by magnetic resonance imaging (MRI), in addition to hepatic triglyceride content by 1H-MR spectroscopy in a random subgroup (maximum of n = 2580). With multivariable linear regression analysis, we examined the associations between categories of adult weight change, body mass index (BMI) at age 20 and measures of abdominal adiposity at middle age, adjusted for age, sex, ethnicity, lifestyle factors, menopausal status, parity, use of medication and total body fat at middle age. In 2399 participants (54% women), individuals who gained more than 50% of body weight during adulthood had 1.96 (95% CI: 1.64; 2.33) times more visceral adipose tissue at middle age and 2.39 (95% CI: 1.70, 3.36) times more hepatic triglyceride content than weight maintainers (weight change between -5% and 5%). Associations with abdominal subcutaneous adipose tissue were weaker: participants who gained more than 50% of their body weight had 1.54 (95% CI: 1.38, 1.72) times more abdominal subcutaneous adipose tissue compared with weight maintainers. In this population-based study, adult weight gain was associated with relatively more visceral adipose tissue and hepatic triglyceride content at middle age than abdominal subcutaneous adipose tissue. Overall, our study suggests that weight maintenance during adulthood plays an important role in limiting excess visceral adipose tissue and hepatic triglyceride content at middle age.

Improved Access to and Impact of Registered Dietitian Nutritionist Services Associated with an Integrated Care Model in a High-Risk, Minority Population

BackgroundIntegrated health care models create opportunities for registered dietitian nutritionists (RDNs) to provide nutrition-related care and engage in multidisciplinary teams to improve clinical outcomes. While benefits of integrated care (IC) have been reported, little is known about the impact of the RDN within an IC model. ObjectiveOur primary objective was to identify whether IC vs traditional care (TC) increases the number of RDN patient visits. Our secondary objective was to evaluate clinical outcomes of patients seeing an RDN vs not, regardless of care model. DesignThis was a retrospective cohort study. Participants/settingPatients were aged 3 to 94 years and from a patient-centered medical home in Boston, MA. Main outcome measuresWe measured 3-month total and average number of patients seen by the RDN in TC vs IC. Changes in adult hemoglobin A1c, weight, and pediatric body mass index (measured as kg/m2) among high-risk patients seen by an RDN compared to patients not seen by an RDN. Statistical analysisData were obtained from electronic medical records and analyzed utilizing Mann-Whitney U test, analysis of covariance, and paired sample t tests. ResultsThe RDN saw 145 patients (137 adult, 8 pediatric) in the TC model compared to 185 patients (135 adult, 50 pediatric) in the IC model. Mean number of patients seen per session was 3.20 in the TC model vs 4.63 in the IC model (P=0.004). Adult hemoglobin A1c within-group differences decreased by 0.42%±1.49% (P=0.007) for patients seen by an RDN and decreased 0.15%±1.47% (P=0.012) for patients not seen by an RDN. Adult weight within-group differences decreased 1.0±7.2 kg (P=0.15) for patients seen by a RDN and increased 0.1±5.6 kg (P=0.70) for patients not seen by a RDN. Pediatric BMI showed no change between or within groups. ConclusionsThe IC model increased 3-month total number of patients seen by an RDN. High-risk patients who saw an RDN had a significant decrease in hemoglobin A1c.

Obesity, weight change, and mortality in older adults with metabolic abnormalities

Background and aimsIt is expected that older adults with metabolic abnormalities may benefit from weight loss; however, data on this population are limited. Our study was to assess the effect of obesity and weight change on mortality risk in older adults with metabolic abnormalities. Methods and resultsA total of 3649 Chinese older adults aged 60–90 years with metabolic abnormalities were included between 2000 and 2014. Weight change between two health checkup periods was calculated. During a median follow-up period of 37 months, 503 all-cause mortality and 235 cardiovascular disease mortality occurred. Death rate was the lowest in overweight participants and in the participants with weight stability. After adjustment for covariates, hazard ratios (95% confidence intervals) of overweight participants for all-cause mortality and cardiovascular mortality were 0.71 (0.59, 0.86) and 0.72 (0.55, 0.95), respectively, whereas obesity was not significantly associated with mortality risk. Furthermore, relative to weight stability, risks of mortality significantly increased with the increase in weight loss or weight gain, except small weight gain. These associations were unchanged when the participants were stratified by baseline covariates and even when several definitions of weight change were considered. ConclusionsOverweight was associated with less mortality risk, and obesity was not associated with mortality risk in older adults with metabolic abnormalities. Mortality risk increased with the increase in weight loss or weight gain, regardless of body weight levels at the baseline. These findings suggest that maintaining a stable weight may be the best choice in older adults with metabolic abnormalities.

Free-Living Responses in Energy Balance to Short-Term Overfeeding in Adults Differing in Propensity for Obesity.

ObjectiveFree-living adaptive responses to short term overfeeding were explored as predictors of longitudinal weight change in adults recruited as obesity-resistant (OR) or obesity-prone (OP) based on self-identification and personal/family weight history.MethodsAdults identified as OP (n=21; BMI: 23.8±2.5 kg/m2) and OR (n=20; BMI: 20.2±2.1 kg/m2) completed 3 days of eucaloric (EU, 100% of energy needs) and 3 days of overfeeding (OF, 140% of energy needs). Following each condition, adaptive responses in physical activity (PA), total daily energy expenditure (TDEE), ad libitum energy intake (EI), and energy balance were objectively measured for 3 days in a free-living environment. Body mass and composition (DXA) were measured annually for 5 years. Adaptive responses to overfeeding were correlated with 5-year changes in body mass and composition.ResultsIncreases in sedentary time correlated with longitudinally measured changes in fat mass (r=0.34, p=0.04) in the cohort taken as a whole. OP reduced their levels of PA following overfeeding while OR maintained or increased their PA. No other variables were found to correlate with weight gain.ConclusionFailure to decrease sedentary behavior following short-term overfeeding is one mechanism that may be contributing to fat mass gain.

Adult weight management across the community: population-level impact of the LOSE IT to WIN IT challenge.

SummaryObjectiveExcess body weight negatively impacts health, but there are few evaluations of low‐intensity weight management challenge programs in defined populations. This study examined weight change in adults who participated in the LOSE IT to WIN IT (LIWI) health challenge in a US community. The community‐level impact on body mass index was also explored.MethodsBody weight was analysed over 1 year in the cohort of LIWI enrolees, stratified by participants who were healthy weight or overweight/obese at baseline. Secondarily, a multiple cross‐sectional analysis compared the 2.5‐year trends in body mass index between community adults who did vs. did not participate in LIWI.ResultsLOSE IT to WIN IT participants who were overweight/obese lost a mean (95% confidence interval) 1.6 (1.2, 2.0) kg (~2%) over 1 year (p < 0.001), whereas healthy weight participants lost 0.7 (0.3, 1.1) kg. Across the community, LIWI participants and non‐participants both gained 0.4 kg m−2 over the 2.5‐year study period (p = 0.884).ConclusionsLOSE IT to WIN IT was modestly effective among enrolees, resulting in a small weight loss of 2% over 1 year among those who were overweight/obese. However, LIWI did not impact weight gain in the community. To slow such community‐level weight gain trends, weight management challenges must reach larger fractions of the populations that they target.

Objectively-assessed physical activity and weight change in young adults: a randomized controlled trial

Objectively-assessed physical activity and weight change in young adults: a randomized controlled trial

Objectively-assessed physical activity and weight change in young adults: a randomized controlled trial

BackgroundReductions in physical activity (PA) are common throughout young adulthood and low PA is associated with weight gain. The SNAP Trial previously reported that two self-regulation approaches to weight gain prevention reduced weight gain over a 2-year period in 18–35 year olds. Presented here are secondary analyses examining changes in PA and the relationship between PA and weight change over 2 years.Methods599 young adults (age: 27.4 ± 4.4 yrs.; BMI: 25.4 ± 2.6 kg/m2) were randomly assigned to 1 of 3 treatment arms: Small Changes (reduce calorie intake by 100 kcals/day & add 2000 steps/day), Large Changes (lose 2.3–4.5 kg initially & increase PA to ≥250 min/wk), or Self-guided (control condition). Small and Large Changes received 10, face-to-face group sessions (months 1–4), and two 4-week refresher courses each subsequent year. Body weight and PA were objectively-measured at baseline, 4 months, 1 and 2 years. Daily steps and bout-related moderate-to-vigorous intensity PA (MVPA: ≥3 METs, ≥10-min bouts) was calculated.ResultsChanges in bout-related MVPA and daily steps did not differ among treatment groups over the 2-year period (p’s > 0.16). Collapsed across groups, participants gaining >1 lb. (n = 187; 39.6%) had smaller changes in bout-related MVPA at 4 months, 1 and 2 years relative to those maintaining or losing weight (≤1 lb. weight gain; n = 282, 60.4%, p’s < 0.05). Averaged across time points, this difference equated to 47.8 min/week. Those gaining and not gaining >1 lb. did not differ on daily steps (p’s > 0.10). Among participants engaging in ≥250 min/wk. of MVPA at 2 years (n = 181), 30% gained >1 lb. from baseline to 2 years, which was not different from those engaging in 150–250 min/wk. (n = 87; 36%; p = 0.40), but this percentage was significantly lower when compared to those engaging in <150 min/wk. (n = 176; 49%; p < 0.001).ConclusionsOn average, PA differences were not observed between young adults assigned to small or large changes self-regulation interventions to prevent weight gain. Regardless of group assignment, higher levels of MVPA were associated with better weight gain prevention over 2 years. Our data suggest that achieving >150 min/week of MVPA is needed for weight gain prevention and that increasing MVPA, rather than steps, should be targeted.Trial registrationwww.clinicaltrials.gov (NCT01183689). Registered Aug 13, 2010.

Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in children and adults with overweight or obesity.

Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in children and adults with overweight or obesity.

Weight change in older adults and mortality: the Multiethnic Cohort Study.

ObjectiveTo investigate the association between weight change in older adults and mortality in a multiethnic population.MethodsWe performed a prospective analysis using data on weight change between the baseline (1993-1996) and the 10-year follow-up (2003-2007) surveys in relation to subsequent mortality among 63,040 participants in the Multiethnic Cohort Study in Hawaii and California. The participants were African American, Native Hawaiian, Japanese American, Latino, and white, aged 45-75 years at baseline, and did not report heart disease or cancer at either survey.ResultsDuring an average of 7.3 years of follow-up after the 10-year survey, 6,623 deaths were identified. Compared with individuals whose weight remained stable (±2.5 kg), those who lost weight and those with the highest weight gain (>10 kg) were at increased risk of all-cause mortality, with the risks greater for the weight-loss (hazard ratios [HR], 2.86; 95% confidence interval [95% CI], 2.62-3.11 for >10 kg) than the weight-gain group (HR, 1.25; 95% CI, 1.11-1.41 for >10 kg), thus resulting in a reverse J-shaped curve. Japanese Americans and Latinos had stronger associations of weight loss >10 kg with mortality than did African Americans, Native Hawaiians, and whites. The increase in risk with weight gain >10 kg was greater for older (≥55 years at baseline) than younger individuals while the increase in mortality associated with weight loss was greater for the normal weight (<25 kg/m2 at baseline) participants and never smokers, compared with overweight/obese persons and current smokers, respectively.ConclusionsOur findings confirm the association between weight change and a higher mortality in a healthy, multiethnic population, with higher risks for weight loss than weight gain. Based on these observations, public health recommendation should focus on the prevention of weight loss, as well as weight stability within the non-obese range, for middle aged and older adults.

Prospective associations between diet quality and body mass index in disadvantaged women: the Resilience for Eating and Activity Despite Inequality (READI) study.

Dietary patterns that align with recommended guidelines appear to minimize long-term weight gain in the general population. However, prospective associations between diet quality and weight change in disadvantaged adults have not been examined. This study examined associations between concurrent change in diet quality and body mass index (BMI) over 5 years among women living in socioeconomically disadvantaged neighbourhoods. Dietary intake and BMI were self-reported among 1242 women living in disadvantaged neighbourhoods in Victoria, Australia, at three time points from 2007/08 to 2012/13. Diet quality was evaluated using the Australian Dietary Guideline Index (DGI). Associations between concurrent change in diet quality and BMI were assessed over the three time points using fixed effects and mixed models. Models were adjusted for age, smoking, menopausal status, education, marital status, number of births, urban/rural location and physical activity. Average BMI increased by 0.14 kg/m2 per year increase in age in the fixed effects model, and by 0.13 kg/m2 in the mixed model (P < 0.0001). BMI decreased by 0.014 kg/m2 for a woman of average age with each unit increase in DGI score in the fixed effects model (p < 0.0001), and by 0.012 kg/m2 in the mixed model (P = 0.001). The rate of change in BMI with age was greater for those with a lower DGI score than for those with a higher score (P < 0.10). Positive change in diet quality was associated with reduced BMI gain among disadvantaged women. Supporting disadvantaged women to adhere to population-level dietary recommendations may assist them with long-term weight management.

Adult Pre-pregnancy Weight Change and Risk of Developing Hypertensive Disorders in Pregnancy.

While the association of pre-pregnancy body mass index (BMI) and hypertensive disorders in pregnancy (HDP) is well documented, little is known about the relationship between pre-pregnancy weight change and HDP. We examined the impact of adult pre-pregnancy weight change on the development of HDP. We included 2914 women, surveyed about every three years since 1996, from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. Women without hypertension or HDP were followed-up between 2003 and 2012. Generalised estimating equations were used to assess the effect of baseline BMI (mean age 20years) and pre-pregnancy weight change on the incidence of HDP. Over 9years of follow up, 301 incident HDP cases (6.3%) were reported from 4813 pregnancies. Overweight and obese women at the baseline survey were 1.67 (95% CI 1.3, 2.2) and 2.15 (95% CI 1.4, 3.3) times more likely to develop HDP than normal weight women, respectively. Compared with stable weight women, women with small (>1.5-2.5%) or moderate/high (>2.5%) annual weight gain had elevated risk of HDP (RR 1.67 95% CI 1.3, 2.2; RR 2.31, 95% CI 1.8, 3.0, respectively). Women who reported annual weight loss (>1.5%) between baseline and the average age of 24years were 46% (95% CI 0.4, 0.8) less likely to develop HDP. Pre-pregnancy weight gain is associated with an increased risk of HDP, whereas early adult weight loss is associated with lower risk of HDP.

Accelerometer-measured physical activity is not associated with two-year weight change in African-origin adults from five diverse populations.

BackgroundIncreasing population-levels of physical activity (PA) is a controversial strategy for managing the obesity epidemic, given the conflicting evidence for weight loss from PA alone per se. We measured PA and weight change in a three-year prospective cohort study in young adults from five countries (Ghana, South Africa, Jamaica, Seychelles and USA).MethodsA total of 1,944 men and women had baseline data, and at least 1 follow-up examination including measures of anthropometry (weight/BMI), and objective PA (accelerometer, 7-day) following the three-year study period. PA was explored as 1-minute bouts of moderate and vigorous PA (MVPA) as well as daily sedentary time.ResultsAt baseline; Ghanaian and South African men had the lowest body weights (63.4 ± 9.5, 64.9 ± 11.8 kg, respectively) and men and women from the USA the highest (93.6 ± 25.9, 91.7 ± 23.4 kg, respectively). Prevalence of normal weight ranged from 85% in Ghanaian men to 29% in USA men and 52% in Ghanaian women to 15% in USA women. Over the two-year follow-up period, USA men and Jamaican women experienced the smallest yearly weight change rate (0.1 ± 3.3 kg/yr; −0.03 ± 3.0 kg/yr, respectively), compared to South African men and Ghanaian women greatest yearly change (0.6.0 ± 3.0 kg/yr; 1.22 ± 2.6 kg/yr, respectively). Mean yearly weight gain tended to be larger among normal weight participants at baseline than overweight/obese at baseline. Neither baseline MVPA nor sedentary time were associated with weight gain. Using multiple linear regression, only baseline weight, age and gender were significantly associated with weight gain.DiscussionFrom our study it is not evident that higher volumes of PA alone are protective against future weight gain, and by deduction our data suggest that other environmental factors such as the food environment may have a more critical role.

Pre-pregnancy weight change and incidence of gestational diabetes mellitus: A finding from a prospective cohort study

In a population-based cohort study we examined the associations between early adult pre-pregnancy weight change and the risk of gestational diabetes mellitus (GDM). The study included 3111 women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. These women have been surveyed regularly since 1996. Women without diabetes and GDM were followed-up between 2003 and 2012. Generalized estimating equations were used to assess the effect of baseline (1996, mean age 20years) and pre-pregnancy body mass index (BMI) and the pre-pregnancy weight changes on the incidence of GDM. The full models were adjusted for sociodemographic and lifestyle factors. From 2003 to 2012, 229GDM cases (4.4%) were reported in 5242 pregnancies. Relative to normal BMI women, obese women at baseline (RR: 1.8, 95% CI: 1.1, 2.8) and prior to pregnancy (RR: 2.7, 95% CI: 2.0, 3.6) were at greater risk of GDM. Weight gains prior to each study pregnancy were strongly associated with increased GDM risk with an adjusted RR ranging from 2.0 to 2.9. Within under/normal range of BMI, women with a moderate/high (>2.5%/year) weight gain had 2.7 (95% CI: 1.3, 5.5) times the risk of GDM compared with women with stable weight. Early adult weight gain, even within normal BMI range, is an important risk factor for the development of GDM. Weight gain prevention from early adulthood to prior to pregnancy appears to be the main strategy to prevent the incidence of GDM.

Weight Gain Trajectories Associated With Elevated C-Reactive Protein Levels in Chinese Adults.

BackgroundRecent longitudinal work suggests that weight change is an important risk factor for inflammation across the full range of BMI. However, few studies have examined whether the risk of inflammation differs by patterns of weight gain over time. Using latent class trajectory analysis, we test whether patterns of weight gain are associated with elevated high‐sensitivity C‐reactive protein (hs‐CRP 2–10 mg/L).Methods and ResultsData come from China Health and Nutrition Survey (CHNS) participants (n=5536), aged 18 at baseline to 66 years in 2009, with measured weight over 18 years. Latent class trajectory analysis was used to identify weight‐change trajectories in 6 age and sex strata. Multivariable general linear mixed‐effects models fit with a logit link were used to assess the risk of elevated hs‐CRP across weight trajectory classes. Models were fit within age and sex strata, controlling for baseline weight, adult height, and smoking, and included random intercepts to account for community‐level correlation. Steeper weight‐gain trajectories were associated with greater risk of elevated hs‐CRP compared to more moderate weight‐gain trajectories in men and women. Initially high weight gain followed by weight loss was associated with lower risk of elevated hs‐CRP in women aged 18 to 40.ConclusionsLatent class trajectory analysis identified heterogeneity in adult weight change associated with differential risk of inflammation independently of baseline weight and smoking. These results suggest that trajectories of weight gain are an important clinical concern and may identify those at risk for inflammation and the development of cardiometabolic disease.