Body Mass Index Strata Research Articles

Efectividad de una estrategia de intervención preventiva, basada en entrevistas telefónicas estructuradas, en una población laboral con riesgo cardiovascular moderado/alto

Objective This study assesses the effectiveness of a structured telephone survey on cardiovascular prevention, in modifying lifestyle, on cardiovascular risk parameters, percentage of smoking cessation and overall cardiovascular risk (CVR). Design Quasi-experimental study of preventive intervention. Setting Ibermutuamur (Spanish Accident and Health Insurance Company). Centres established throughout Spain. Participants A total of 4,792 workers with moderate/high cardiovascular risk who had agreed to be contacted by phone. Subjects with a previous diagnosis of cardiovascular disease and those receiving treatment for hypertension, hypercholesterolemia or diabetes were excluded. Intervention A final total of 3,085 workers were contacted and were followed up by telephone surveys on the first, fourth and eighth month after the initial check up (CU) in order to emphasise cardiovascular health advice (Group A); we failed to contact 1,707 workers, who only attended the baseline and one year CUs (Group B). Principal outcomes CUs included medical records and physical examination, with two blood pressure measurements, Body Mass Index (BMI), and biochemical parameters. Cardiovascular risk was stratified following the European cardiovascular SCORE. Individuals with a relative risk higher than 4 were also considered as high-risk. All workers were informed about their cardiovascular risk profile (CVRF) and healthy cardiovascular lifestyle measures. They were also given a letter for their General Practitioner (GP) to inform them on the worker's cardiovascular risk level. Results A total of 71.5% of the workers were over 45 years, 95.0% males, 76.6% manual workers (“Blue Collar”) and 69.7% smokers. Both groups showed improvement in lipid parameters, blood pressure, smoking cessation and overall cardiovascular risk in the second CU. There were significant differences in favour of Group A as regards blood pressure, lipids (except HDL cholesterol), BMI, glycaemia, smoking cessation (A: 23.5%/B: 19.44%, P=0.001) and CVR stratum improvement (A: 46.6%/B: 37.7%, P=0.0001). The large majority (85%) of workers read preventive recommendations; 33% knew their risk level and 73% knew their CVRF. 52.9% gave the letter to the GP, which led them to start therapies on diet (47%), hypertension (19.5%), dyslipidaemia (16.7%), diabetes (4.4%) and smoking (2.9%) and no changes were made in 36.5% of cases. Conclusions The results of this study suggests that cardiovascular prevention strategy based on structured telephone surveys on high/moderate CVR subjects to promote lifestyle changes could be effective at reducing CVR. A clinical trial is required for confirmation. Sending information on CVRF following routine medial CUs and Primary Care involvement, could contribute to the positive changes observed.

Aspirin and risk of endometrial cancer: a case–control study from Italy

Data on the role of aspirin on endometrial cancer risk are scanty. Here we provide additional information on the issue, using data from a multicentric Italian case-control study. The study was conducted between 1992 and 2006 in three Italian areas, on 442 cases with histologically confirmed endometrial cancer and 676 control women admitted to the same hospitals as cases for a wide spectrum of acute, non-neoplastic, non-gynaecological, non-hormone-related conditions, providing information on aspirin use. Odds ratios (OR) of endometrial cancer and corresponding 95% confidence intervals were calculated using multiple logistic regression models, including terms for sociodemographic characteristics, body mass index and hormonal and reproductive factors. Regular aspirin use was reported by 28 (6.3%) cases and 46 (6.8%) controls, corresponding to a multivariate OR of 0.65 (95% confidence interval 0.37-1.11). There was no consistent pattern of risk with duration of use, nor with age at first use, time since first use or time since last use. Further, there was no difference in risk estimates across strata of body mass index. This study--the first one from a population outside North America--adds relevant information on the absence of a consistent association between aspirin use and endometrial cancer risk, even in high-risk overweight and obese women.

Cross-cultural comparison of the sleep-disordered breathing prevalence among Americans and Japanese

The aim of the present study was to compare the prevalence of sleep-disordered breathing among Hispanic and white Americans and Japanese. A 1-night sleep study using a single-channel airflow monitor was performed on 211 Hispanics and 246 Whites from the Minnesota field centre (St Paul, MN, USA) of the Multi-Ethnic Study of Atherosclerosis (MESA), and 978 Japanese from three community-based cohorts of the Circulatory Risk in Communities Study (CIRCS) in Japan. The respiratory disturbance index and sleep-disordered breathing, defined as a respiratory disturbance index of > or =15 events x h(-1), were estimated. The prevalence of sleep-disordered breathing was higher in males (34.2%) than females (14.7%), and among Hispanics (36.5%) and Whites (33.3%) than among Japanese (18.4%), corresponding to differences in body mass index. Within body mass index strata, the race difference in sleep-disordered breathing was attenuated. This was also true when body mass index was adjusted for instead of stratification. The strong association between body mass index and sleep-disordered breathing was similar in Japanese and Americans. The prevalence of sleep-disordered breathing was lower among Japanese than among Americans. However, the association of body mass index with sleep-disordered breathing was strong, and similar among the race/ethnic groups studied. The majority of the race/ethnic difference in sleep-disordered breathing prevalence was explained by a difference in body mass index distribution.

Aldosterone Contributes to Blood Pressure Variance and to Likelihood of Hypertension in Normal-Weight and Overweight African Americans

Hypertension and obesity are highly prevalent among African Americans (AAs). We have previously reported that both plasma aldosterone (PA) and body mass index (BMI) are higher in hypertensive than in normotensive AAs. This study evaluates the relative contributions of adiposity and PA to hypertension in AAs. A total of 466 AAs (50% hypertensive, 51% women) were evaluated in a Clinical Research Center by stratifying them into three subgroups based on BMI (normal weight, overweight, and obese). Anthropometric measurements, ambulatory blood pressure (BP), fasting glucose, insulin, 24-h urine sodium and potassium, creatinine clearance, standing PA and plasma renin activity (PRA) were measured. Insulin resistance was estimated by the homeostasis model assessment. Compared to normotensives, hypertensives had higher BMI, waist circumference (WC), and were more insulin resistant (P < or = 0.01). When stratified by BMI, hypertensives in each BMI strata had higher PA (P < or = 0.05) and lower PRA (P < or = 0.01) compared to normotensives. Compared to normotensives, WC was greater in overweight and obese hypertensives, but not in normal-weight hypertensives. In the overall sample, age, WC, PA, and PRA were the major contributors to BP variance and to hypertension. Among normal-weight subjects, PA and PRA significantly predicted BP and the odds ratio for hypertension, whereas WC had no predictive value. PA, but not WC, is associated with BP and likelihood of hypertension in normal-weight AAs, whereas both WC and PA are predictive of hypertension in overweight and obese individuals. This suggests that aldosterone antagonists may be useful for the treatment of hypertension among AAs, regardless of BMI.

Green Tea Consumption and Hematologic Malignancies in Japan: The Ohsaki Study

Several biologic studies have reported that green tea constituents have antitumor effects on hematologic malignancies. However, the effects in humans are uncertain. The authors used data from the Ohsaki National Health Insurance Cohort Study in Japan to evaluate the association between green tea consumption and the risk of hematologic malignancies. Study participants were 41,761 Japanese adults aged 40-79 years without a history of cancer at baseline who answered a food frequency questionnaire survey in 1994. During 9 years of follow-up beginning in 1995, the authors documented 157 hematologic malignancies, including 119 cases of lymphoid neoplasms and 36 cases of myeloid neoplasms. Hazard ratios were calculated by using the Cox proportional hazards regression model. Risk of hematologic malignancies was inversely associated with green tea consumption. The multivariate-adjusted hazard ratio of hematologic malignancies for 5 cups/day or more compared with less than 1 cup/day of green tea was 0.58 (95% confidence interval: 0.37, 0.89). The corresponding risk estimate was 0.52 (95% confidence interval: 0.31, 0.87) for lymphoid neoplasms and 0.76 (95% confidence interval: 0.32, 1.78) for myeloid neoplasms. This inverse association was consistent across sex and body mass index strata. In conclusion, green tea consumption was associated with a lower risk of hematologic malignancies.

Prognostic significance of obesity in high-grade serous carcinoma of the ovary

e16528 Background: Obesity is an epidemic public health problem in the United States. In gynecologic oncology, obesity is an established risk factor for endometrial cancer. However, its role in the pathogenesis and survival in ovarian cancer is debated. Recent studies have attempted to elucidate a possible relationship, but variations in design and heterogeneity in patient characteristics make it difficult to draw definitive conclusions. The purpose of our study was to determine if body mass index at the time of treatment initiation for high grade serous ovarian carcinoma has an effect on patient outcome. Methods: Nine-hundred four patients treated for ovarian cancer at M.D. Anderson Cancer Center were identified between 2002 and 2007. Patients were excluded for low grade or non-serous histology, neoadjuvant treatment, or if presenting with recurrent disease. Clinicopathologic data were extracted by retrospective chart review. Patients were stratified by body mass index (BMI) as normal (BMI&lt;25), overweight (BMI 25-&lt;30), or obese (BMI&gt;30). All were treated with primary cytoreduction and standard platinum/taxane chemotherapy. Chemotherapy was dosed using adjusted body weights. Outcomes included time to recurrence, overall survival, success of surgical debulking, and chemotherapeutic toxicities. Statistical analysis was performed using Fisher's exact test, Wilcoxon test, and Kaplan-Meier estimates. Results: A total of 127 patients were included for analysis. Patients were followed for a mean of 37 months (range 3–86 months). Twenty-one patients were obese (16.5%), and 35 were overweight (27.5%). Diabetes was more prevalent in the obese cohort (p = 0.0038). There was a trend towards greater likelihood of suboptimal debulking in obese patients, but this did not reach statistical significance (p = 0.06). BMI had no effect on recurrence-free survival (HR 0.69 [CI 0.39–1.23], p = 0.21) or overall survival (HR 0.95 [CI 0.68–2.43], p = 0.91). There was no difference in chemotherapy side effects or chemoresistance across BMI strata. Conclusions: Body mass index has no effect on survival in women with high grade serous ovarian cancer. Effectively managing comorbidities and ensuring adequate chemotherapy dosing in the obese patient is crucial for optimizing outcome. No significant financial relationships to disclose.

Compatibility of different methods for the measurement of visceral fat in different body mass index strata

Obesity, particularly visceral obesity, is associated with increased risk of cardiovascular morbidity and mortality. Therefore, cardiovascular risk should be determined by evaluating visceral fat tissue not only in obese individuals but also in non-obese individuals. We aimed to evaluate the comparison of visceral fat tissue measurement methods with computed tomography (CT). One hundred four participants, 19 to 58 years of age (21 males, 83 females) were enrolled in this study. Participants underwent anthropometric evaluation, bioelectrical impedance analysis (BIA), ultrasonography (US), and CT examinations on the same day. The mean body mass index (BMI) was 31.2 +/- 8.7 kg/m2 (73 individuals [70.2%] had BMI > or =30, and 31 individuals [29.8%] had BMI < 30). The non-obese group (BMI < 30) that showed the best correlation coefficient values were for visceral fat area (VFA) by BIA in all participants, males and women (r = 0.902, P < 0.001; r = 0.994, P < 0.001; r = 0.645, P = 0.01, respectively); in case of BMI > or =30 the best correlation coefficient values were for VFA by BIA (r = 0.774, P < 0.001) for all participants, and visceral fat thickness by US for males (r = 0.851, P < 0.001), and BMI (r = 0.786, P < 0.001) for females. Using multiple stepwise regression analysis, the methods best reflecting VFA by CT were as follows: In subjects with BMI < 25, BIA correlated best with CT measures of VFA; while in subjects with BMI > 30 waist-to-hip ratio showed the best correlation with CT measures of VFA. The method best reflecting VFA by CT was visceral thickness by US in males; and the method best reflecting VFA by CT in females was visceral thickness by US, BMI and waist circumference. Anthropometric measurements and visceral fat tissue measurement methods such as US and BIA exhibit differences with respect to compliance with CT results in visceral fat tissue measurements by gender and BMI levels.

Association between C‐reactive protein and pre‐diabetic status in a Chinese Han clinical population

C-reactive protein (CRP) has been showed to be associated with type 2 diabetes mellitus, but whether CRP underlies glucose disorders in Asian people is still unclear, for they have much lower body mass index (BMI) levels than these Westerns in previous studies. In this clinical-based cross-sectional study, the association between CRP and hyperglycaemia in different BMI levels and different gender was compared among 1730 Chinese Han men and women, including 1258 subjects with normal glucose tolerance (NGT), 126 subjects with impaired fasting glucose (IFG) and 346 subjects with impaired glucose tolerance (IGT). Subjects with isolated IFG or IGT were all newly diagnosed and did not use anti-diabetic drugs. Compared with subjects with NGT, BMI, fasting blood glucose, homoeostasis model assessment insulin resistance (HOMA-IR), blood pressure, dyslipidemia, and serum CRP levels were increased in subjects with IGT and IFG. In stratified analyses, increasing CRP levels were strongly associated with prevalence of IGT and IFG in different BMI strata. After adjustment for sex, age, BMI, education, alcohol consumption, smoking, hypertension status, recreational physical activity and occupational physical activity, the ORs across quartiles of CRP were 1.00, 1.43, 2.14 and 2.29 for IFG (P for trend: 0.025) and 1.00, 1.85, 2.32 and 2.79 for IGT (P for trend: 0.012). These results support the hypothesis that chronic inflammation may be involved in the development of hyperglycaemia, even though in a thinner and healthy population.

The effect of obesity on survival in patients with ovarian cancer

Objective Data has suggested obesity as an independent prognostic factor for lower survival in patients with epithelial ovarian cancer (EOC). We sought to determine if obesity portends a disadvantage to surgical outcomes at the time of initial surgery affecting survival. Methods A retrospective chart review of patients diagnosed with EOC was performed. All patients underwent primary cytoreductive surgery followed by taxane/platinum-based chemotherapy. Patient demographics, surgicopathologic and survival data were evaluated. Patients were compared based on body mass index (BMI) (< 30 vs. ≥ 30) and BMI strata (underweight, normal weight, overweight, obese and morbidly obese). Survival analyses were performed with the Kaplan Meier method and compared using the log rank test, χ 2 test, and Fischer's exact test. Results 304 patients were identified. 71 patients (23%) were obese (BMI > 30). The groups were similar in regard to stage, grade, histology, and chemotherapy administered. In regard to surgical outcomes, no difference was seen in estimated blood loss (EBL), operating room (OR) time, or operative complications excluding wound complications. Optimal debulking rates were similar in obese and non-obese patients (52% vs. 51% respectively, p = 0.88). There was no statistical difference in progression free survival (17 vs. 11 months) or overall survival (48 vs. 40 months) between the two groups or across BMI strata. Conclusion Although obesity has been reported as an independent prognostic factor for survival, this data demonstrates that survival rates are similar between obese and non-obese patients when optimal debulking statuses are the same. Therefore, maximal effort should be directed towards optimal debulking obese patients with EOC.

Excess risk of diabetes in persons with hypertension

Problem Persons with hypertension appear to be at increased risk of diabetes, an important predictor of cardiovascular disease. Whether, and to what extent, this risk may vary across subgroups defined on the basis of important clinical characteristics has not been well characterized. Methods Study population included members of Kaiser Permanente Northwest Region, a large health maintenance organization, aged ≥35 years and free of diabetes in 1998. Persons in the study population were stratified based on whether or not they had hypertension, and onset of diabetes was ascertained over a 6-year period beginning January 1999. Excess risk of diabetes was characterized in terms of risk differences between persons with and without hypertension, and was estimated on an overall basis and for subgroups defined on the basis of age, sex, and body mass index (BMI). Results Study population totaled 104,368; 44% had hypertension. Relative risk (RR) of developing diabetes was 2.7 (95% CI: 2.6–2.8) for those with vs. without hypertension [21.0 (95% CI: 20.7–21.4) vs. 7.8 (95% CI: 7.6–8.0) per 1000 person-years, respectively]. Adjusted for age, sex, and BMI, RR of diabetes was 1.8 (95% CI: 1.7–1.9). With one exception (men, aged ≥75 years), risk of diabetes was higher across all age and BMI strata for both men and women with vs. without hypertension; differences in risk were greatest among those with high BMI (≥35 kg/m 2). Across BMI strata, RR of developing diabetes was generally higher at younger ages. Conclusion All persons with hypertension, irrespective of age, sex, and BMI, are at elevated risk of developing diabetes. Men and women with hypertension who are overweight or obese are at substantially elevated risk of diabetes, regardless of age, and should be monitored especially closely for the development of this disease.

Single Nucleotide Polymorphisms in Obesity-Related Genes and the Risk of Esophageal Cancers

Rates of adenocarcinoma of the esophagus (EAC) and esophagogastric junction (EGJAC) have been rising rapidly in recent decades, in contrast to the declining rates of esophageal squamous cell carcinomas (ESCC). Obesity is a major risk factor for both EAC and EGJAC, but not ESCC, and there is speculation that obesity promotes adenocarcinoma development through endocrine and related pathways. We therefore compared the prevalence of 12 single nucleotide polymorphisms (SNPs) in nine candidate genes previously implicated in obesity pathways (LEP, LEPR, ADIPOQ, POMC, PPARalpha, PPARgamma, RXRgamma, GHRL, and INSIG2) in a large Australian case-control study comprising DNA samples from 260 EAC cases, 301 EGJAC cases, 213 ESCC cases, and 1,352 population controls. No SNPs were associated with EGJAC or ESCC. Although several SNPs seemed to be associated with EAC on crude analysis [ADIPOQ (rs1501299), LEP (5'-untranslated region), PPARgamma (H447H), and GHRL (M72L)], effect sizes were modest and none of the associations was significant after correcting for multiple comparisons. Further, we found no consistent evidence that any of the genotypes were associated with risk of EAC or EGJAC within strata of body mass index (<25.0 kg/m(2), 25.0-29.9 kg/m(2), >30 kg/m(2)). In conclusion, our data suggest that these SNPs do not play a major role in esophageal carcinogenesis.

Chronic obstructive pulmonary disease and body mass index in five Latin America cities: The PLATINO study

The body mass index (BMI) is a prognostic factor for chronic obstructive pulmonary disease (COPD). Despite its importance, little information is available regarding BMI alteration in COPD from a population-based study. We examined characteristics by BMI categories in the total and COPD populations in five Latin-American cities, and explored the factors influencing BMI in COPD. COPD was defined as a postbronchodilator forced expiratory volume in the first second/forced vital capacity (FEV(1)/FVC) <0.70. BMI was categorized as underweight (< 20 kg/m(2)), normal weight (20-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), and obese (> or = 30.0 kg/m(2)). Interviews were completed in 5571 subjects from 6711 eligible individuals, and spirometry was performed in 5314 subjects. There were 759 subjects with COPD and 4555 without COPD. Compared with the non-COPD group, there was a higher proportion of COPD subjects in the underweight and normal weight categories, and a lower proportion in the obese category. Over one-half COPD subjects had BMI over 25 kg/m(2). No differences in BMI strata among countries were found in COPD subjects. Factors associated with lower BMI in males with COPD were aging, current smoking, and global initiative for chronic obstructive lung disease (GOLD) stages III-IV, whereas wheeze and residing in Santiago and Montevideo were associated with higher BMI. In females with COPD, current smoking, lower education, and GOLD stages II-IV were associated with lower BMI, while dyspnea and wheeze were associated with higher BMI. BMI alterations are common in COPD with no significant differences among countries. Current smoking, age, GOLD stages, education level, residing in Santiago and Montevideo, dyspnea and wheeze were independently associated with BMI in COPD.

Trends in vitamin D intake between 1980 and 2002 among adults in the Minneapolis St Paul, MN metropolitan area

Trends in dietary vitamin D intake from 1980–82 to 2000–02 were examined using data collected from the Minnesota Heart Survey, a surveillance study of trends in risk factors for cardiovascular disease among probability samples of adults in the Minneapolis‐St Paul, MN metropolitan area. Surveys were conducted in 1980–82, 1985–87, 1990–92, 1995–97, and 2000–02. Twenty‐four hour recalls were collected to assess dietary intake, with most data collection procedures employed consistently across survey periods. Results indicate that vitamin D intake from dietary sources decreased between 1980–82 and 2000–02. Among men age‐adjusted mean vitamin D intake decreased from 7.3 mcg/day in 1980–82 to 6.0 mcg/day in 2000–02 (p &lt;0.001). Among women vitamin D intake decreased from 4.8 mcg/day to 4.5 mcg/day over the same time period (p=0.004). These trends were generally consistent across age, education level, race, and body mass index strata. It is possible that declines in vitamin D intake from dietary sources have been offset by increased use of dietary supplements containing vitamin D. However, we were unable to fully explore this possibility due to the limited information available in our survey regarding dietary supplement use. In summary, results suggest that the vitamin D content of the diet has been on the decline over the past twenty years, potentially contributing to the resurfacing of vitamin D deficiency in the U.S.

Low high-density lipoprotein-cholesterol is the most prevalent metabolic abnormality for Australian Aboriginal men and women even when lean

The aim of this study was to investigate the relationship of the prevalence and risk of the metabolic syndrome to body mass index (BMI) in Australian Aboriginal people. It was a cross-sectional, secondary analysis of data obtained from population-based screenings in Aboriginal communities in central and northern Australia (913 participants recruited between 1993 and 1997). Forty-one percent of men and 48% of women conformed to the National Cholesterol Education Program definition for the metabolic syndrome (chi2=3.72, P=0.054). The prevalence of low high-density lipoprotein-cholesterol was high in all BMI categories (89 and 95% in men and women, respectively). The prevalence of all other metabolic abnormalities increased linearly with BMI. The metabolic syndrome is highly prevalent in Aboriginal communities and is strongly associated with BMI. Low high-density lipoprotein-cholesterol was the predominant component of the metabolic syndrome across sex groups and BMI strata.

Prognostic impact of body mass index and effect of overweight and obesity on surgical and adjuvant treatment in early-stage epithelial ovarian cancer

The present study was performed to find out if the body mass index (BMI) was associated with clinical and pathologic features (age, histology, tumor grade, and substages) and prognosis in early stages (FIGO I-II) of epithelial ovarian cancer. Further aims of the study were to evaluate if overweight or obesity affected the feasibility of optimal surgery and postoperative adjuvant therapy. A total of 635 patients were included in this study. Four percent of the patients were underweight (BMI <18.5), 53% were of ideal body weight (BMI 18.5-25), 31% were overweight (BMI 25-30), and 12% were obese (BMI >30). Overweight and obese patients were significantly (P = 0.006) older than underweight and ideal body weight patients. Tumor grade and histologic type distributions were not different across the BMI strata. FIGO stage (P = 0.011) and presence of ascites (P = 0.007) at primary surgery were associated with the BMI status. A history of cardiovascular disease was significantly (P = 0.006) more common in overweight and obese patients. Survival analyses in the four BMI subgroups did not show any significant differences with regard to recurrence-free survival. The 5-year recurrence-free survival of the complete series was 72%. Overweight and obese patients did not have worse survival than normal weight and underweight patients. Perioperative or postoperative morbidity and adjuvant oncologic treatment were not affected by the BMI. In a multivariate Cox analysis, FIGO substage and tumor grade, but not BMI, were independent and significant prognostic factors with regard to all types of survival rates.

Disentangling causal paths between obesity and in vitro fertilization outcomes: an intractable problem?

Research questions should be appropriate for the available data. Disentangling causal paths between obesity and in vitro fertilization outcomes may be an intractable problem, but other research questions of clinical importance can be addressed through appropriate study designs and analytic methods.

A ‘Weight-Listing’ Paradox for Candidates of Renal Transplantation?

Research suggests that end-stage renal disease patients with elevated body mass index (BMI) have superior outcomes on dialysis. In contrast, low and high BMI patients represent the highest risk cohorts for kidney transplant recipients. The important question remains concerning how to manage transplant candidates given the potentially incommensurate impact of BMI by treatment modality. We conducted a retrospective analysis of waitlisted and transplanted patients in the United States from 1990 to 2003. We constructed Cox models to evaluate the effect of BMI on mortality of waitlisted candidates and identified risk factors for rapid weight change. We then assessed the impact of weight change during waitlisting on transplant outcomes. Decline in BMI on the waiting list was not protective for posttransplant mortality or graft loss across BMI strata. Substantial weight loss pretransplantation was associated with rapid gain posttransplantation. The highest risk for death was among listed patients with low BMI (13-20 kg/m(2), adjusted hazard ratio = 1.47, p < 0.01). Approximately one-third of candidates had a change in BMI category prior to transplantation. While observed declines in BMI may be volitional or markers of disease processes, there is no evidence that candidates have improved transplant outcomes attributable to weight loss. Prospective trials are needed to evaluate the efficacy of weight loss protocols for candidates of kidney transplantation.

Cardiorespiratory fitness and body mass index of 9–11-year-old English children: a serial cross-sectional study from 1998 to 2004

To examine the changes over time in cardiorespiratory fitness and body mass index (BMI) of children. Serial cross-sectional, population-based study. Primary schools in Liverpool, UK. A total of 15,621 children (50% boys), representing 74% of eligible 9-11-year olds in the annual school cohorts between 1998/9 and 2003/4, who took part in a 20m multi-stage shuttle run test (20mMST). Weight, height, BMI (kg/m(2)) and obesity using the International Obesity Taskforce definition. Median (95% confidence interval) 20mMST score (number of runs) fell in boys from 48.9 (47.9-49.9) in 1998/9 to 38.1 (36.8-39.4) in 2003/4, and in girls from 35.8 (35.0-36.6) to 28.1 (27.2-29.1) over the same period. Fitness scores fell across all strata of BMI (P<0.001). Moreover, BMI increased over the same 6-year period even among children in fittest third of 20mMST. In a series of uniform cross-sectional assessments of school-aged children, BMI increased whereas cardiorespiratory fitness levels decreased within a 6-year period. Even among lean children, fitness scores decreased. Public health measures to reduce obesity, such as increasing physical activity, may help raise fitness levels among all children - not just the overweight or obese.

Serum organochlorines and breast cancer: a case–control study among African-American women

This population-based case-control study of African-American women (355 breast cancer case patients, 327 controls) examined the association between breast cancer and circulating levels of PCBs and dichlorodiphenyldichloroethene (DDE), a metabolite of DDT. Case patients were diagnosed with invasive breast carcinoma and interviewed between June 1995 and July 1998, and control subjects were identified by random digit dialing methods. Serum levels of DDE and total PCBs were adjusted for total lipid content. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable unconditional logistic regression methods. Effect modification by tumor receptor status and cancer treatment was investigated. Breast cancer risk was not associated with increasing quintiles of lipid-adjusted PCBs or DDE (highest versus lowest quintile adjusted for age, body mass index (BMI) and breastfeeding for DDE: OR = 1.02, 95% CI = (0.61, 1.72), p-trend = 0.74; for PCBs: OR = 1.01, 95% CI = (0.63, 1.63), p-trend = 0.56). Risk did not differ by strata of BMI, breastfeeding, parity, menopausal status or tumor receptor status. This study, the largest study of African-American women to date, does not support a role of DDE and total PCBs in breast cancer risk at the levels measured.

Aspirin may be more effective in preventing colorectal adenomas in patients with higher BMI (United States)

Obesity is a risk factor for colon cancer, possibly due to elevated levels of circulating cytokines derived from adipose tissue. Aspirin, which may affect the levels of these cytokines, has been shown in randomized controlled trials to decrease the risk of colorectal adenomas. We hypothesized that the chemopreventive effect of aspirin might be greater in individuals with higher body mass index (BMI). Data were available from the Aspirin/Folate Polyp Prevention Study, a randomized controlled trial of aspirin and folic acid to prevent recurrent colorectal adenomas. Obesity was defined as BMI > or = 30 (kg/m2), overweight as BMI of 25-29 (kg/m2) and normal weight as BMI <25 (kg/m2). For the analysis of the effect of aspirin on the recurrence of colorectal adenoma by BMI, we computed risk ratios for aspirin versus placebo within the three BMI strata using a modified Poisson model. Overall the risk reduction of adenomas with a daily dose of 325 mg aspirin was greater among subjects with higher BMI. Among obese subjects the risk ratio (RR) for advanced adenomas compared with placebo was 0.44 (95% CI 0.17-1.10), versus RR = 1.23 (95% CI 0.55-2.77) among those with normal weight. However, 81 mg aspirin daily did not interact with BMI to modify the risk of adenomas in such a fashion. The more pronounced effect of 325 mg aspirin in individuals with higher BMI suggests a possible protective role of anti-inflammatory aspirin against increased adipose-driven cytokines among obese subjects.