BMI Variables Research Articles

Differences in genetic and environmental variation in adult BMI by sex, age, time period, and region: an individual-based pooled analysis of 40 twin cohorts

Background: Genes and the environment contribute to variation in adult body mass index [BMI (in kg/m2)], but factors modifying these variance components are poorly understood.Objective: We analyzed genetic and environmental variation in BMI between men and women from young adulthood to old age from the 1940s to the 2000s and between cultural-geographic regions representing high (North America and Australia), moderate (Europe), and low (East Asia) prevalence of obesity.Design: We used genetic structural equation modeling to analyze BMI in twins ≥20 y of age from 40 cohorts representing 20 countries (140,379 complete twin pairs).Results: The heritability of BMI decreased from 0.77 (95% CI: 0.77, 0.78) and 0.75 (95% CI: 0.74, 0.75) in men and women 20-29 y of age to 0.57 (95% CI: 0.54, 0.60) and 0.59 (95% CI: 0.53, 0.65) in men 70-79 y of age and women 80 y of age, respectively. The relative influence of unique environmental factors correspondingly increased. Differences in the sets of genes affecting BMI in men and women increased from 20-29 to 60-69 y of age. Mean BMI and variances in BMI increased from the 1940s to the 2000s and were greatest in North America and Australia, followed by Europe and East Asia. However, heritability estimates were largely similar over measurement years and between regions. There was no evidence of environmental factors shared by co-twins affecting BMI.Conclusions: The heritability of BMI decreased and differences in the sets of genes affecting BMI in men and women increased from young adulthood to old age. The heritability of BMI was largely similar between cultural-geographic regions and measurement years, despite large differences in mean BMI and variances in BMI. Our results show a strong influence of genetic factors on BMI, especially in early adulthood, regardless of the obesity level in the population.

Metabolic assessment and quality of life in a sample of patients in treatment with olanzapine depot

Background: Non adherence to medication is a major risk factor contributing to relapse and hospitalization among patients with schizophrenia. Treatment with antipsychotics in depot formulations is recognized as safe and effective for improving medication adherence.(1) Objectives: Metabolic and quality of life assessment of patients treated with olanzapine depot Methods: We studied 24 patients in treatment with olanzapine depot, monitored between 2011-2017. For metabolic assessment we used data from patients' clinical recordings (variation in Blood Pressure, glycaemia, cholesterol, triglycerides, BMI) and for quality of life assessment SF-36.questionnaire and data regarding socio-professional, familial reinsertion, number of relapses and hospitalizations obtained from clinical interview. Results: The studied sample comprised 16 men and 8 women, diagnosed with schizophrenia, most of them being previously treated with oral olanzapine. Most of the patients were under treatment with olanzapine depot 300 mg i.m., two shots per month (at 2 weeks distance). Two patients lost weight, the majority of them had no significant variation in BMI, one patient with increase of 8,4 units in BMI, two patients with stable BMI. 7 of 12 patients had increased cholesterol levels, the rest of biological parameters being normal. Two patients had post-injectional somnolence. 13 patients had no relapses, 3 patients were noncompliant, 3 had relapses, 3 were lost from monitoring and 2 were changed on orally administered olanzapine. 4 patients had total score above 50 at the mental component of SF-36 and 4of them had total score above 50 at the physical component of SF-36. Conclusion: In the studied sample, most of the patients had a favorable evolution regarding clinical aspects, familial and socio-professional reinsertion and metabolic outcomes, which confirms the fact that olanzapine depot is a safe treatment associated with low incidence of relapses. Further studies are needed on large samples, in order to evaluate quality of life in patients treated with olanzapine depot.

Diet and physical activity intervention effectiveness in acute mental patients, during hospitalization: A matched case-control study

IntroductionDiet and physical activity interventions are effective in psychiatric outpatients that suffer from obesity, namely those treated with antipsychotic drugs. However, there is less evidence related to these interventions in hospitalised acute patients.AimTo evaluate the effect of a diet and physical activity program on weight and BMI variation in acute psychiatric patients during hospitalisation.MethodsMatched case-control study from January to September 2016. Inclusion criteria: patients with at least 15 days of hospitalisation in an acute psychiatry ward, evaluated by a nutritionist in the admission and medical discharge. The intervention consisted in a diet and physical activity program, with total restriction to visitors to bring food to the patients. Statistical analysis was done with T-student and multiple linear regression taking into account the effect of age, sex, daily dose of antipsychotics, and days of hospitalisation.ResultsSixty-six patients were studied (34 cases and 32 controls). Groups were statistically similar concerning the average of age, daily dose of antipsychotics, days of hospitalisation and sex. The differences of weight gain during hospitalisation were 0.088 kg (cases) versus 1484 kg (controls), P < 0.05. And the differences of the increased BMI during the hospitalisation were 0.041 kg/m2 (cases) versus 0.509 kg/m2 (controls), P < 0.05.ConclusionsObesity presents challenging health problems for individuals with severe mental illness that require inpatient treatment. This study provides evidence that individuals with acute mental illness can benefit from weight control interventions during their hospitalisation, in special a total restriction to visitors to bring food to the patients.

Factors influencing diurnal variation in height among adults

This study evaluates height loss during the day in light of variables assessable through participant self-report. Participants were 19 female and 15 male staff and students who met with us twice with a mean interval between measurement sessions of 6.96h (SD=0.86). Hypotheses were evaluated using two-stage least squares regression analysis (SYSTAT 10). Males and females lost similar amounts of height between sessions (male,x¯=6.9 mm;female,x¯=7.4 mm). Among factors considered to impact overall height loss, sleep duration (Adj. R2=0.181, p=0.022) and height (Adj. R2=0.121, p=0.048) were useful in univariate analyses, though they were not significant in any models that included variables other than sex. Judging from log-transformed BMI variation, heavier males and females lost more height (F(2, 31)=4.59, Adj. R2=0.179, p=0.018). Among factors anticipated to reduce height loss by acting prior to morning measurements, only time spent walking was significantly associated (β=2.6±0.8mm, t=3.16, p=0.004) when included as a predictor along with sex (p=0.17) and log-BMI (p=0.003). This model explained about 38% of height loss variance. None of the factors considered as potentially acting between measurement sessions showed statistically significant influences when included in the model just described, though predictor coefficients were in the anticipated direction. Results suggest that self-reported activities may be an important supplement to anthropometric studies, both for planning and later evaluation, particularly in large studies.

Influence of systemic bone mineral density on atlantoaxial subluxation in patients with rheumatoid arthritis.

Cervical spine involvement in rheumatoid arthritis (RA) patients may cause serious adverse effects on quality of life and overall health. This study aimed to evaluate the association between atlantodental interval (ADI), atlantoaxial subluxation (AAS), and systemic bone mineral density (BMD) based on BMI variations among established patients with RA. The ADI was transformed to the natural log scale to normalize distributions for all analyses. Multivariable linear regression analyses were used to identify independent predictive factors for ADI based on each BMD classification. Multivariate Cox regression analyses were also performed to identify independent predictive factors for the risk of AAS, which were classified by tertile groups of BMI. A total of 1220 patients with RA who had undergone at least one or more cervical radiography and BMD assessments were identified and enrolled. We found that the association between BMD and ADI (β, -0.029; 95% CI, -0.059 to 0.002; p=0.070) fell short of achieving statistical significance. However, the ADI showed a 3.6% decrease per 1 BMI increase in the osteoporosis group (β, -0.036; 95% CI, -0.061 to -0.011; p=0.004). The osteopenia and osteoporosis groups showed about a 1.5-fold and a 1.8-fold increased risk of AAS occurrence among the first tertile of the BMI group. Our study showed a possible association between lower BMD and AAS occurrence in patients with RA with lower BMI. Further studies are needed to confirm our findings.

The Impact of Physical Education on Childhood Obesity in Ohio School Children: A Hierarchical Analysis

Obesity that starts in childhood or adolescence creates greater risk for adult health problems such as heart disease, arthritis, stroke, and cancer. The literature shows that childhood obesity increases most rapidly during the early elementary school years. The current investigation examines the issue of obesity using a systematic stratified random sample of Ohio schools that reported their 3<sup>rd</sup> grader’s BMI scores for the 2009-2010 school year to the Ohio Department of Health. The sample included 25 schools and 1,006 students. Those schools selected were contacted via phone to ask how many minutes per week schools allocated for physical education in grades K-3, and how many minutes per day was allotted for recess in grades K-3. The analysis also examined potential moderators including the percentage of students receiving free or reduced lunch and the school building academic performance designations as indicated on the Ohio Department of Education webpage. The results suggest that the model run at the student level accounts for approximately 1% of the variation in BMI; the model run at the school level was not a significant predictor of the variance.While the model included for Ohio students did not indicate a strong predictor for childhood obesity, schools can play a significant role in addressing the childhood obesity issue.

The Impact of Physical Education on Childhood Obesity in Ohio School Children: A Hierarchical Analysis

Obesity that starts in childhood or adolescence creates greater risk for adult health problems such as heart disease, arthritis, stroke, and cancer. The literature shows that childhood obesity increases most rapidly during the early elementary school years. The current investigation examines the issue of obesity using a systematic stratified random sample of Ohio schools that reported their 3<sup>rd</sup> grader’s BMI scores for the 2009-2010 school year to the Ohio Department of Health. The sample included 25 schools and 1,006 students. Those schools selected were contacted via phone to ask how many minutes per week schools allocated for physical education in grades K-3, and how many minutes per day was allotted for recess in grades K-3. The analysis also examined potential moderators including the percentage of students receiving free or reduced lunch and the school building academic performance designations as indicated on the Ohio Department of Education webpage. The results suggest that the model run at the student level accounts for approximately 1% of the variation in BMI; the model run at the school level was not a significant predictor of the variance.While the model included for Ohio students did not indicate a strong predictor for childhood obesity, schools can play a significant role in addressing the childhood obesity issue.

Variation of height and BMI within school classes in 14-year-old children.

The aim of the study was to analyze the variation of height and weight of 14-year-old children within classes of primary schools in Wroclaw. All children were attending the 7th grade of primary schools in Wroclaw, and underwent a medical examination as part of a project (the Health Card of the Child) of the city of Wroclaw. The data were collected between January and December of 1997. The present study included height and weight of 1810 children (917 boys and 893 girls). For analyses, individual height and BMI [kg m-2] were standardized based on mean and SD of the whole population separately for boys and girls. The SDs of height and BMI in each class were tested by Student-t test for one sample to check the difference in comparison to population with SD equal 1. Additionally, the nested analysis of variance was used, where height and BMI were dependent variables, and classes were nested into schools. SDs of height and BMI within classes are significantly lower than for the whole population in boys and girls, whereas the means did not differ significantly from the whole population. Nested analysis of variance showed a significant effect of class for girls (for height and BMI) but not for boys. Also variation of height significantly differed between schools in girls but not in boys. It is hypothesized that decrease of variation within classes might be caused by the community effect.

An observational study of haemostatic changes, leptin and soluble endoglin during pregnancy in women with different BMIs

Obesity increases the risk of venous thromboembolism (VTE) in pregnancy. The pathogenesis is hypothesized to be because of multiple factors including prothrombotic changes, but there has been minimal haemostatic research looking at the combined state of obesity and pregnancy. We aimed to determine whether variation in BMI in the third trimester of pregnancy was associated with prothrombotic changes. We recruited 110 women into four groups depending on their BMI at first antenatal appointment: normal, overweight, obese and morbidly obese. Women with increased risk of VTE, and/or receiving thromboprophylaxis, and/or more than 35 years and those in labour were excluded. Thromboelastography, platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, prothrombin fragment 1 + 2, free and total protein S, plasminogen activator inhibitor type 1, tissue plasminogen activator antigen, D-dimers, soluble endoglin and leptin levels were measured. There were no significant differences in haemostatic measures with changing BMI. There was a positive correlation between BMI and both platelet count (correlation coefficient r = 0.214, P = 0.036) and leptin (r = 0.435, P < 0.001), but only leptin had a significant association with BMI once adjusted for age, gestation and parity. Despite recruitment into the morbidly obese group being suboptimal, these findings suggest that in pregnancy, the increased risk of VTE seen in obese mothers is not mediated through increased prothrombotic changes, and thus the increased risk of VTE in obese pregnant women may be because of other mechanisms, for example endothelial dysfunction, inflammation and venous stasis.

Association of the melanocortin 4 receptor gene rs17782313 polymorphism with rewarding value of food and eating behavior in Chilean children.

Studies conducted in monozygotic and dizygotic twins have established a strong genetic component in eating behavior. Rare mutations and common variants of the melanocortin 4 receptor (MC4R) gene have been linked to obesity and eating behavior scores. However, few studies have assessed common variants in MC4R gene with the rewarding value of food in children. The objective of the study was to evaluate the association between the MC4R rs17782313 polymorphism with homeostatic and non-homeostatic eating behavior patterns in Chileans children. This is a cross-sectional study in 258 Chilean children (44% female, 8-14years old) showing a wide variation in BMI. Anthropometric measurements (weight, height, Z-score of BMI and waist circumference) were performed by standard procedures. Eating behavior was assessed using the Eating in Absence of Hunger Questionnaire (EAHQ), the Child Eating Behavior Questionnaire (CEBQ), the Three-Factor Eating Questionnaire (TFEQ), and the Food Reinforcement Value Questionnaire (FRVQ). Genotype of the rs17782313 nearby MC4R was determined by a Taqman assay. Association of the rs17782313 C allele with eating behavior was assessed using non-parametric tests. We found that children carrying the CC genotype have higher scores of food responsiveness (p value=0.02). In obese girls, carriers of the C allele showed lower scores of satiety responsiveness (p value=0.02) and higher scores of uncontrolled eating (p value=0.01). Obese boys carrying the C allele showed lower rewarding value of food in relation to non-carriers. The rs17782313 C allele is associated with eating behavior traits that may predispose obese children to increased energy intake and obesity.

Temporal trends, regional variation and socio-economic differences in height, BMI and body proportions among German conscripts, 1956-2010.

We analyse temporal trends and regional variation among the most recent available anthropometric data from German conscription in the years 2008-2010 and their historical contextualization since 1956. Design/setting/subjects The overall sample included German conscripts (N 13 857 313) from 1956 to 2010. German conscripts changed from growing in height to growing in breadth. Over the analysed 54 years, average height of 19-year-old conscripts increased by 6·5 cm from 173·5 cm in 1956 (birth year 1937) to 180·0 cm in 2010 (birth year 1991). This increase plateaued since the 1990s (1970s birth years). The increase in average weight, however, did not lessen during the last two decades but increased in two steps: at the end of the 1980s and after 1999. The weight and BMI distributions became increasingly right-skewed, the prevalence of overweight and obesity increased from 11·6 % and 2·1 % in 1984 to 19·9 % and 8·5 % in 2010, respectively. The north-south gradient in height (north = taller) persisted during our observations. Height and weight of conscripts from East Germany matched the German average between the early 1990s and 2009. Between the 1980s and the early 1990s, the average chest circumference increased, the average difference between chest circumference when inhaling and exhaling decreased, as did leg length relative to trunk length. Measuring anthropometric data for military conscripts yielded year-by-year monitoring of the health status of young men at a proscribed age. Such findings contribute to a more precise identification of groups at risk and thus help with further studies and to target interventions.

PROGNOSTIC FACTORS AND SURVIVAL ANALYSIS IN ESOPHAGEAL CARCINOMA.

ABSTRACTBackground: Despite recent advances in diagnosis and treatment, esophageal cancer still has high mortality. Prognostic factors associated with patient and with disease itself are multiple and poorly explored. Aim: Assess prognostic variables in esophageal cancer patients. Methods: Retrospective review of all patients with esophageal cancer in an oncology referral center. They were divided according to histological diagnosis (444 squamous cell carcinoma patients and 105 adenocarcinoma), and their demographic, pathological and clinical characteristics were analyzed and compared to clinical stage and overall survival. Results: No difference was noted between squamous cell carcinoma and esophageal adenocarcinoma overall survival curves. Squamous cell carcinoma presented 22.8% survival after five years against 20.2% for adenocarcinoma. When considering only patients treated with curative intent resection, after five years squamous cell carcinoma survival rate was 56.6 and adenocarcinoma, 58%. In patients with squamous cell carcinoma, poor differentiation histology and tumor size were associated with worse oncology stage, but this was not evidenced in adenocarcinoma. Conclusion: Weight loss (kg), BMI variation (kg/m²) and percentage of weight loss are factors that predict worse stage at diagnosis in the squamous cell carcinoma. In adenocarcinoma, these findings were not statistically significant.

Fertility-related quality of life from two RCT cohorts with infertility: unexplained infertility and polycystic ovary syndrome.

Does fertility-related quality of life (FertiQOL) differ by infertility diagnosis between women with polycystic ovary syndrome (PCOS) and their partners, compared with couples with unexplained infertility (UI)? Women with PCOS report lower QOL than those with UI, whereas males with UI report lower QOL than males with PCOS partners. The fertility-specific QOL survey, FertiQOL, has been used to examine fertility-related QOL in a number of worldwide cohorts. Few data have addressed fertility-related QOL as a function of infertility diagnosis. Overall, men report better QOL than women with infertility, and there is variation in FertiQOL scores across different samples from different countries. This was a prospective, cohort study derived from two concurrent, randomized clinical trials, and designed to examine QOL in infertile females with PCOS and UI at the time of enrollment compared with each other and their male partners; to compare concordance FertiQOL scores in this study across other worldwide cohorts; and to determine if baseline FertiQOL was associated with pregnancy outcome. Women with PCOS and their partners (n = 733 and n = 641, respectively), and couples with UI (n = 865 women and 849 men) completed a validated fertility-specific QOL survey (FertiQOL) at the time of the study screening visit. PCOS women were randomized to either clomiphene citrate or letrozole treatment; couples with UI were randomized to clomiphene citrate, letrozole or gonadotrophin plus IUI. FertiQOL results were compiled by diagnosis (PCOS or UI) and compared by diagnosis and sex using Wilcoxon Rank-Sum testing. Relationships between baseline FertiQOL and pregnancy outcomes were examined using logistic regression. Multivariable models were performed to assess the association between FertiQOL scores and key participant characteristics. Women with PCOS had lower total FertiQOL scores (72.3 ± 14.8) than those with UI (77.1 ± 12.8; P < 0.001); this was true for each domain (except Relational). These differences were largely explained by variation in BMI, hirsutism, household income and age. Women had lower overall FertiQOL scores than their male partners. Males with PCOS partners had higher scores than males with UI (84.9 ± 10.2 versus 83.3 ± 10.8; P = 0.003). Scores were not consistently associated with conception or pregnancy outcome. The use of multiple tests of association may have resulted in spurious statistically significant findings. Inherent sociodemographic differences between women with PCOS and those with UI largely account for the lower QOL in women with PCOS. Our study was unable to assess if changes in QOL affected pregnancy outcome as FertiQOL data were collected prior to treatment. Finally, the participants for both studies represent their local communities, but are not a population-based sample and thus firm conclusions about how representative these couples are to the general population must be made with caution. Women with PCOS with elevated BMI and hirsutism scores and with lower socioeconomic status may require more, targeted psychosocial support than those with other diagnoses. Possible attribution of infertility to the male partner appears to result in a lower QOL. There appears to be substantial national variation in FertiQOL scores, with US-based cohorts reporting overall higher QOL. This work was supported by National Institutes of Health (NIH)/Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Grants U10 HD39005 (to M.D.), U10 HD38992 (to R.S.L.), (to C.C.), U10 HD38998 (to R.A.), U10 HD055942 (to R.D.R.), HD055944 (to P.C.), U10 HD055936 (to G.C.), U10HD055925 (to H.Z.); and U10 U54-HD29834 (to the University of Virginia Center for Research in Reproduction Ligand Assay and Analysis Core of the Specialized Cooperative Centers Program in Reproduction and Infertility Research). Most importantly, this research was made possible by the funding by American Recovery and Reinvestment Act. N.S., E.E., J.C.T., C.G., H.H., R.A., P.C., G.C., C.C., M.D., S.J., W.D.S. and H.Z. report no conflicts of interests/disclosures. L.B.C. reports research support from Ferring Pharmaceuticals and Roche Diagnostics; R.S.L. reports receipt of consulting fees from AstraZeneca, Euroscreen, Sprout Pharmaceuticals, Taken, Kindex, Clarus and Bayer, Inc., and research support from AstraZeneca and Ferring Pharmaceuticals. R.D.R. reports research support from AbbVie. Pregnancy in Polycystic Ovary Syndrome II (PPCOS II), NCT00719186; Assessment of Multiple Intrauterine Gestations in Ovulation Stimulation (AMIGOS) NCT01044862, clinicaltrials.gov. PPCOS II 17 July 2008; AMIGOS 7 January 2010. PPCOS II 19 February 2009; AMIGOS 2 August 2010.

Seasonal cycles in food purchases and changes in BMI among South Africans participating in a health promotion programme.

Improving diet quality is a key factor for promoting population health. Social norms can support or undermine these efforts. The present study aimed to investigate the relationship between seasonal variation in food purchases and BMI. The study population comprises members of a South African health promotion programme. Data come from scanner data of food purchases by 400 000 enrolled households at supermarkets and repeated individual surveys (about 500 000 participants) between 2009 and 2013. Members in the health promotion programme spent 16·7 % of total food expenditure on nutritionally undesirable foods (sugar-sweetened beverages, candy, ice cream, etc.) and 24·7 % on healthy foods (fruit/vegetables, whole grains, non-fat dairy, etc.). Fruits and vegetables accounted for 13·5 % of purchases (half of all healthy food spending). Yet there were pronounced seasonal variations, with December being the peak month for unhealthy food purchases, which were 40 % higher than in January. This holiday peak was associated with short-term weight gain, but average body mass did not revert to pre-holiday levels. From 2009 to 2013, respondents gained about 0·13 BMI units per year (0·43 kg for men, 0·30 for women). From November to January alone, the increase was 0·1 BMI units for men (0·35 kg) and 0·8 BMI units for women (0·20 kg). Purchases of nutritionally undesirable foods peak in December and are accompanied by weight gain from November to January. Despite weight loss after January, the November to January weight gain accounts for 60-70 % of the annual gain.

Influence of the Home Environment and Nutrition Knowledge on Diet Quality of Adolescents

The objective of this research was to examine psychological, social, and environmental features in the home and their impact on diet quality and weight status of adolescents. A secondary goal was to explore the role of the comprehensive home environment as a mediator of maternal nutrition knowledge and diet quality. A sample of 206 mothers and adolescents (11–14 years) completed the Multidimensional Home Environment Scale, a Food Frequency Questionnaire, and a Nutrition Knowledge survey. Body mass index‐for‐age percentiles were derived from measurements of weight and height obtained by researcher; diet quality was estimated via the Healthy Eating Index‐2010. Adolescents consumed diets below recommendations for total fruit (68.1%), total vegetable (55.7%), greens and beans (52.9%), whole grains (15.3%), dairy (55%), seafood and plant protein (38.1%), fatty acids (8.8%), sodium (55.3%), empty calories (67.1%), and total HEI‐2010 (53.6%). The final model of the home environment on diet quality included availability of healthy foods (p=0.00), healthy eating attitude (p=0.01), and accessibility to unhealthy foods (p=0.04), explaining 28% of the variance. Equations that contained the strongest predictor variables, self‐efficacy (β=−0.24, p=0.02) and availability of healthy foods (β=−0.24, p=0.02) were retained and accounted for 16% of variation in BMI. Inclusion of the mediator in the model yielded significant estimates of the indirect effect (β=0.61, 95% CI: 0.3–1.0) and a 65.2% reduction in the model, suggesting a critical role of the home environment as a partial mediator. These results emphasize the importance of the home environment in determination of diet quality and BMI. Additionally, the findings suggest that proficient maternal knowledge in nutrition may be linked to a healthier home environment, ultimately contributing to enhanced diet quality of adolescents.Support or Funding InformationBess Heflin Centennial Professorship in Nutrition

Oral appliance in sleep apnea treatment: respiratory and clinical effects and long-term adherence.

There is an increasing tendency to use oral appliance (OA) as an alternative treatment for sleep apnea. Here we report the long-term adherence and clinical effects of OA therapy. All sleep apnea patients treated at the Department of Dentistry between the years 2006 and 2013 (n = 1208) were reviewed. A questionnaire about OA adherence, asthma symptoms (Asthma Control Test™, ACT), and general health was sent to all patients who continued OA therapy after the 1-month follow-up visit (n = 811). OA was adjusted to obtain at least 70% of the maximal protrusion of the mandible. The response rate was 37.4% (99 women, 204 men). The mean ± SD age and BMI were 58.7 ± 10.3years and 27.3 ± 4.0kg/m(2), respectively. During the mean follow-up period of 3.3years, there was no significant variation in BMI. Forty-one patients abandoned OA therapy yielding an adherence rate of 86%. Ninety-seven percent of patients used OA ≥4h/day, and the mean daily use was 7.2 ± 1.1h. The ACT score improved with OA use from 16.0 ± 5.9 to 20.1 ± 3.8 (p = 0.004), indicating better asthma control. The apnea and hypopnea index decreased significantly from 27 ± 19 at baseline to 10 ± 10 with OA therapy (p = 0.001). After a 1-month trial period, the long-term adherence to oral appliance was good. OA therapy decreased apneas and hypopneas significantly, and its long-term use was associated with an improvement in respiratory and asthma symptoms.

Motivational Interviewing to Treat Overweight Children: 24-Month Follow-Up of a Randomized Controlled Trial

Pediatrician-led motivational interviewing can be an effective way of controlling BMI in overweight children in the short term. Its long-term efficacy is unknown. The primary aim was to determine whether the short-term (12-month) impact of family pediatrician-led motivational interviews on the BMI of overweight children could be sustained in the long term (24 months), in the absence of any other intervention. Children were recruited in 2011 by family pediatricians working in the province of Reggio Emilia, Italy, and randomly allocated to receive either 5 interviews delivered over a 12-month period or usual care. Eligible participants were all 4- to 7-year-old overweight children resident in the province of Reggio Emilia who had been receiving care from the pediatrician for ≥ 12 months. The primary outcome of this study was individual variation in BMI between the baseline visit and the 24-month follow-up, assessed by pediatricians not blinded to treatment group allocation. Of 419 eligible families, 372 (89%) participated; 187 children were randomized to receive intervention and 185 to usual care. Ninety-five percent of the children attended the 12-month follow-up, and 91% attended the 24-month follow-up. After the 12-month intervention period, BMI in the intervention group increased less than in the control group (0.46 and 0.78, respectively; difference -0.32; P = .005). At the 24-month follow-up, the difference had disappeared (1.52 and 1.56, respectively; difference -0.04; P = .986). The intervention lost its effectiveness within 1 year of cessation. Sustainable boosters are required for weight control and obesity prevention.

The relationship between physical activity and quality of life in prisoners: a pilot study.

Imprisoned people have usually a poor health status in comparison with the general population. The aim is to investigate a possible association between the quality of life and physical activity level in male inmates. A cross-sectional pilot study was carried out between 2010 and 2011. A questionnaire contained SF12 and International Physical Activity Questionnaire was administered. Mental Component Score (MCS) and Physical Component Score (PCS) were computed. The physical activity level was measured using Metabolic Equivalents score (MET). 121 inmates entered the survey. MCS is directly correlated to MET of physical activity (β = 0.23; P = 0.03) and negatively to BMI variations (β = -0.24; P = 0.02) and smoking status (β = -0.24; P = 0.02). This pilot study suggests to improve the investigation to support the promotion of physical activity programs in Italian prisons in order to improve inmates QoL and allow a better social integration at the end of detention.

MAFB as a novel regulator of human adipose tissue inflammation.

Dysregulated expression of metabolic and inflammatory genes is a prominent consequence of obesity causing insulin resistance and type 2 diabetes. Finding causative factors is essential to understanding progression of these pathologies and discovering new therapeutic targets. The transcription factor V-maf musculoaponeurotic fibrosarcoma oncogene homologue B (MAFB) is highly expressed in human white adipose tissue (WAT). However, its role in the regulation of WAT function is elusive. We aimed to characterise MAFB expression and function in human WAT in the context of obesity and insulin resistance. MAFB mRNA expression was evaluated in human WAT from seven cohorts with large inter-individual variation in BMI and metabolic features. Insulin-induced adipocyte lipogenesis and lipolysis were measured and correlated with MAFB expression. MAFB regulation during adipogenesis and the effects of MAFB suppression in human adipocytes was investigated. MAFB regulation by TNF-α was examined in human primary adipocytes and THP-1 monocytes/macrophages. MAFB expression in human adipocytes is upregulated during adipogenesis, increases with BMI in WAT, correlates with adverse metabolic features and is decreased after weight loss. MAFB downregulation decreases proinflammatory gene expression in adipocytes and interferes with TNF-α effects. Interestingly, MAFB is differentially regulated by TNF-α in adipocytes (suppressed) and THP-1 cells (upregulated). Further, MAFB is primarily expressed in WAT macrophages/monocytes and its expression correlates with macrophage and inflammatory markers. Our findings indicate that MAFB is a regulator and a marker of adipose tissue inflammation, a process that subsequently causes insulin resistance.

Food, Health & Choices (FHC): School Demographics and Neighborhood Food Environment Explains Variations in BMI Across Schools

To determine how school-level demographics and neighborhood food environment explain the variation in BMI z-score among twenty urban, low-income high-minority schools. Cross-sectional, multilevel analysis of fifth grade students (n=952) from 20 schools. Heights, weights, gender, and age were collected for each student and BMI z-scores were calculated according to CDC recommendations. BMI z-scores showed a moderate intraclass correlation coefficient of 0.031. School-level demographics were obtained from publicly available school records. Counts of fast food and healthy retail outlets (supermarkets, farmers markets, and mobile produce vendors) were obtained from the commercial vendor ReferenceUSA® for the schools’ attendance zone, and density was calculated per square kilometer. We conducted multilevel linear regression models, to determine variance explained of between-school BMI z-scores, in three stages: MODEL 1 included gender (50.8% female) and age (10.6±0.6 years), MODEL 2 added school-level demographic [percent Black (29.6±22.0%), Hispanic (59.0±23.2%), eligible for free/reduced price lunch (86.0±19.3%) and English-language learners (16.6±10.6%)]; and MODEL 3 added fast food restaurants (7.9±5.3; density: 18.31±11.70/km2) and healthy retail options (8.7±6.4; density: 20.10±14.66/km2). Proportion of between-school variation (R-squared of level-two) was calculated. The models explained increasing amounts of BMI z-score between-school variation: MODEL 1 accounted for 0.5%, MODEL 2 accounted for 83.6%, and MODEL 3 accounted for 98.6%. Childhood obesity is of great concern to health practitioners, educators, parents, and policy makers. Understanding the large degree in which school-level demographics and neighborhood food environments explain between-school BMI z-score variance can help inform policies and practices that can lead to decreased childhood obesity rates.