Large Weight Gain Research Articles

Markers of Inflammation and Weight Change in Middle‐Aged Adults: Results From the Prospective MONICA/KORA S3/F3 Study

We investigated associations of markers of inflammation such as albumin, fibrinogen, C-reactive protein (CRP), and white blood cell count (WBCC) with future weight gain and weight loss in middle-aged adults in order to further elucidate the relationship between subclinical inflammation and weight change. Data were derived from the third population-based MONICA (Monitoring of Trends and Determinants in Cardiovascular Diseases) Augsburg survey (S3) conducted as part of the multinational World Health Organization MONICA project in 1994-1995 and a follow-up examination, to which all eligible subjects from S3 were invited in 2004-2005 (F3). In total, 2,792 persons (1,391 men, 1,401 women) aged 25-74 years at baseline were analyzed. Subjects with elevated concentrations of inflammatory markers were more prone to gain weight during follow-up. The odds ratios (OR) for a large mean annual weight gain (i.e., on average 1.02 kg/year) was 1.73 (95% confidence interval (CI) 1.27, 2.35) in fully adjusted analyses for subjects in the highest compared to the lowest quartile of fibrinogen. The respective ORs were 1.45 (95% CI, 1.08, 1.94) and 1.37 (95% CI, 1.03, 1.82) for CRP and WBCC. Stratified analyses revealed that associations were strongest among subjects who quitted smoking during the follow-up period (new quitters). Associations of inflammatory markers with large mean annual weight loss were weaker and became nonsignificant after multivariable adjustment. In conclusion, elevated levels of inflammatory markers are independently associated with weight gain in middle-aged adults, particularly among new quitters. This suggests that inflammation plays a key role in the process of weight gain, especially after smoking cessation.

Olanzapine versus other atypical antipsychotics for schizophrenia.

In many countries of the industrialised world second generation ("atypical") antipsychotics have become the first line drug treatment for people with schizophrenia. The question as to whether, and if so how much, the effects of the various second generation antipsychotics differ is a matter of debate. In this review we examined how the efficacy and tolerability of olanzapine differs from that of other second generation antipsychotics. To evaluate the effects of olanzapine compared to other atypical antipsychotics for people with schizophrenia and schizophrenia-like psychosis. 1. Electronic searching We searched the Cochrane Schizophrenia Group Trials Register (April 2007) which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO.2. Reference searching We inspected the reference of all identified studies for more trials.3. Personal contact We contacted the first author of each included study for missing information.4. Drug companies We contacted the manufacturers of all atypical antipsychotics included for additional data. We included all randomised trials that used at least single-blind (rater-blind) design, comparing oral olanzapine with oral forms of amisulpride, aripiprazole, clozapine, quetiapine, risperidone, sertindole, ziprasidone or zotepine in people with schizophrenia or schizophrenia-like psychosis. We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a random effects model. The review currently includes 50 studies and 9476 participants which provided data for six comparisons (olanzapine compared to amisulpride, aripiprazole, clozapine, quetiapine, risperidone or ziprasidone). The overall attrition from the included studies was considerable (49.2%) leaving the interpretation of results problematic.Olanzapine improved the general mental state (PANSS total score) more than aripiprazole (2 RCTs, n=794, WMD -4.96 CI -8.06 to -1.85), quetiapine (10 RCTs, n=1449, WMD -3.66 CI -5.39 to -1.93), risperidone (15 RCTs, n=2390, WMD -1.94 CI -3.31 to -0.58) and ziprasidone (4 RCTs, n=1291, WMD -8.32 CI -10.99 to -5.64), but not more than amisulpride or clozapine. This somewhat better efficacy was confirmed by fewer participants in the olanzapine groups leaving the studies early due to inefficacy of treatment compared to quetiapine (8 RCTs, n=1563, RR 0.56 CI 0.44 to 0.70, NNT 11 CI 6 to 50), risperidone (14 RCTs, n=2744, RR 0.78 CI 0.62 to 0.98, NNT 50 CI 17 to 100) and ziprasidone (5 RCTs, n=1937, RR 0.64 CI 0.51 to 0.79, NNT 17, CI 11 to 33).Fewer participants in the olanzapine group than in the quetiapine (2 RCTs, n=876, RR 0.56 CI 0.41 to 0.77, NNT 11 CI 7 to 25) and ziprasidone (2 RCTs, n=766, RR 0.65 CI 0.45 to 0.93, NNT 17 CI 9 to 100) treatment groups, but not in the clozapine group (1 RCT, n=980, RR 1.28 CI 1.02 to 1.61, NNH not estimable), had to be re-hospitalised in the trials.Except for clozapine, all comparators induced less weight gain than olanzapine (olanzapine compared to amisulpride: 3 RCTs, n=671, WMD 2.11kg CI 1.29kg to 2.94kg; aripiprazole: 1 RCT, n=90, WMD 5.60kg CI 2.15kg to 9.05kg; quetiapine: 7 RCTs, n=1173, WMD 2.68kg CI 1.10kg to 4.26kg; risperidone: 13 RCTs, n=2116, WMD 2.61kg CI 1.48kg to 3.74kg; ziprasidone: 5 RCTs, n=1659, WMD 3.82kg CI 2.96kg to 4.69kg). Associated problems such as glucose and cholesterol increase were usually also more frequent in the olanzapine group.Other differences in adverse effects were less well documented. Nevertheless, olanzapine may be associated with slightly more extrapyramidal side effects than quetiapine (use of antiparkinson medication (6 RCTs, n=1090, RR 2.05 CI 1.26 to 3.32, NNH 25 CI 14 to 100), but less than risperidone (use of antiparkinson medication 13 RCTs, n=2599, RR 0.78 CI 0.65 to 0.95, NNH 17 CI 9 to 100) and ziprasidone (use of antiparkinson medication 4 RCTs, n=1732, RR 0.70 CI 0.50 to 0.97, NNH not estimable). It may also increase prolactin somewhat more than aripiprazole, clozapine and quetiapine, but clearly less so than risperidone (6 RCTs, n=1291, WMD -22.84 CI -27.98 to -17.69). Olanzapine may be a somewhat more efficacious drug than some other second generation antipsychotic drugs. This small superiority in efficacy needs to be weighed against a larger weight gain and associated metabolic problems than most other second generation antipsychotic drugs, except clozapine. These conclusions are tentative due to the large number of people leaving the studies early which possibly limits the validity of the findings. Further large, well-designed trials are necessary to establish the relative effects of different second generation antipsychotic drugs.

Effect of dietary fatty acid intake on prospective weight change in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition

To evaluate the association between fatty acid (alpha-linolenic acid (ALA), EPA, DHA, palmitic, stearic, oleic, linoleic and arachidonic acids) intake and prospective weight change in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition. Prospective cohort study with mean follow-up time of 6.5 years. In a total of 9182 men and 10867 women aged 35 to 64 years, from body weight measurement at recruitment and calibrated body weight during follow-up, weight change was expressed as mean annual weight change relative to baseline weight (%/year) and categorised into four groups (weight loss, <-2.5%/5 years; stable weight, between -2.5 and +2.5%/5 years; small weight gain, > or =2.5 to <7.5%/5 years; large weight gain, > or =7.5%/5 years). Energy-adjusted dietary fatty acid intake data were estimated from the FFQ completed at baseline. Multivariate linear regression models as well as multinomial logistic regression analyses (carbohydrate replacement models) were conducted. Stearic acid intake was linearly associated with weight gain (P < 0.01) in men and women. Linear associations also existed for ALA and arachidonic acid intake, significantly so in women. In multinomial models, women in the highest tertile of ALA and stearic acid intake showed increased OR (95 % CI) for small weight gain (1.16 (0.94, 1.88) and 1.24 (1.08, 1.43), respectively), and large weight gain (1.39 (1.03, 1.88) and 1.56 (1.27, 1.90), respectively), whereas OR were non-significantly increased in men. Dietary intake of ALA was inversely associated with large (0.80 (0.65, 0.99)) weight gain in women only. These results suggest differential effects of single dietary fatty acids on prospective weight gain in adults.

Weight change and all-cause, cancer and cardiovascular disease mortality in Japanese men and women: the Japan Public Health Center-Based Prospective Study

It is unclear whether weight change during adulthood influences subsequent mortality in Asian populations, who have a relatively lean body mass. To assess the relation of weight change over 5 years to all-cause, cancer and cardiovascular disease mortality among Japanese men and women. Subjects were 36 220 men and 44 091 women aged between 45 and 75 years without a history of serious disease at baseline. Weight change was calculated as the difference of body weight between two surveys with a 5-year interval. During 699 963 person-years of follow-up, we identified 4232 deaths of all-cause, 1872 cancer deaths and 1021 cardiovascular deaths. The relation between weight change and all-cause mortality was reverse J-shaped. Multivariate hazard ratios (95% confidence interval) for weight loss of 5 kg or more versus weight change of less than 2.5 kg were 1.62 (1.45-1.81) in men and 1.76 (1.51-2.05) in women, whereas those for weight gain of 5 kg or more were 1.40 (1.22-1.59) in men and 1.25 (1.02-1.54) in women. These associations remained statistically significant even after the exclusion of deaths in the first 3 years of follow-up. The weight change-mortality association was pronounced in underweight persons or in nonsmoking men. The risk of cancer mortality increased in both men and women who lost weight by 5 kg or more. With regard to cardiovascular disease, mortality risk tended to increase with weight loss both in men and women, whereas its increase with weight gain was observed only in women. A large weight change, both loss and gain, was associated with an increased risk of mortality. Weight loss and gain may be predictors of early death in apparently healthy adult Japanese.

Weight Change, Initial BMI, and Mortality Among Middle- and Older-aged Adults

It is not known how the relationship between weight change and mortality is influenced by initial body mass index (BMI) or the magnitude of weight change. We use the nationally representative Health and Retirement Study (n = 13,104; follow-up 1992-2006) and Cox regression analysis to estimate relative mortality risks for 2-year weight change by initial BMI among 50- to-70-year-old Americans. We defined small weight loss or gain as a change of 1-2.9 BMI units and large weight loss or gain as a change of 3-5 BMI units. Large and small weight losses were associated with excess mortality for all initial BMI levels below 32 kg/m (eg, hazard ratio [HR] for large weight loss from BMI of 30 = 1.61 [95% confidence interval = 1.31-1.98]; HR for small weight loss from BMI of 30 = 1.19 [1.06-1.28]). Large weight gains were associated with excess mortality only at high BMIs (eg, HR for large weight gain from BMI of 35 = 1.33 [1.00-1.77]). Small weight gains were not associated with excess mortality for any initial BMI level. The weight loss-mortality association was robust to adjustments for health status and to sensitivity analyses considering unobserved confounders. Weight loss is associated with excess mortality among normal, overweight, and mildly obese middle- and older-aged adults. The excess risk increases for larger losses and lower initial BMI. These results suggest that the potential benefits of a lower BMI may be offset by the negative effects associated with weight loss. Weight gain may be associated with excess mortality only among obese people with an initial BMI over 35.

Understanding Long-term Effects of Weight Loss

The majority of Americans enter midlife overweight or obese. With this excess weight come other cardiometabolic risk factors, and an inc easing propor ion of adults are living with chronic disease. For the growing segment of the middle-aged and older population who are overweight or mildly obese, the question might reasonably be asked, Does losing weight improve longevity? Conversely, Is it harmful for persons who are already overweight to continue gaining weight into old age? In this issue of Epidemiology, Myrskyla and Chang1 report that large weight loss was related to elevated mortality, with a much stronger association in persons with low body mass index (BMI) at baseline. Large weight gain was associated with mortality, but only in persons who were initially obese. No data were available to indicate whether subjects intended to lose weight. Although the authors do not state explicitly that they were evaluating the effects of purposeful or intentional weight loss, their extensive efforts to exclude the influence of disease-related weight loss in their analyses suggest that this was their aim. They concluded that they found no benefits to mortality from weight loss, whereas weight gain seemed to be harmless except in very obese persons. Can observational studies, using only observed body weight change and limited behavioral and health data, answer questions about the long-term benefits and harms of weight loss? Many previous studies have reported elevated risk of death in persons who have lost weight. Problems with interpreting these studies have been well described.2-7 The fundamental issue is that unintentional weight loss is common in older people8'9 and often caused by underlying disease or psychosocial problems that are themselves associ ated with increased mortality. If these conditions are undetected (or if necessary data are not available to the researcher), it is difficult to account for their effects. More recent studies have asked subjects whether they intended to lose weight. This strategy represents an advance, but it only partially disentangles intentional from unintentional weight loss7: among persons expressing the intent to lose weight, a substantial proportion of actual weight loss is likely the result of other causes such as stress or disease.7'10 To move the field forward, it will be necessary to collect much richer, denser, and more biologically relevant data. Others have already described the data and design elements needed to advance our understanding of the long-term harms and benefits of weight change.3'6'7'11 I will highlight 3 of these elements. In a commentary in Epidemiology 10 years ago, Tim Byers stated that epidemiol ogists had reached the limits of what could be learned in observational studies that simply estimate associations between undifferentiated weight loss and mortality.11 Byers called on epidemiologists to engage a major effort to uncover the specific reasons for weight change. Similar comments have been made by others.3 Byers noted that episodes of substantial weight loss, including unintentional weight loss, are common but poorly understood. He suggested the possibility of unintentional weight loss syndromes that could be precursors to chronic disease. Researchers now recognize and are beginning to understand several weight loss syndromes in older persons and in those with disease.12-14

Normalization of hypocretin-1 in narcolepsy after intravenous immunoglobulin treatment

In May 2006, a 28-year-old woman abruptly experienced excessive daytime sleepiness (EDS) and 2 to 3 short, refreshing but irresistible naps per day. She also reported increased nighttime sleep duration of more than 3 hours. Her Epworth Sleepiness Scale score was 22, indicating severe sleepiness. She also developed clear-cut generalized and partial cataplexy provoked by laughter but also by stress with a frequency of more than 1 attack per day. A rapid but large weight gain was noted up to 6 kg within 2 weeks, without a clear change in appetite. She never experienced sleep paralysis, hypnagogic hallucinations, or mood disorders. She had no personal or familial history of a particular disease, and no treatment. She was seen by us 15 days after the first cataplexy episode to confirm the diagnosis of narcolepsy with cataplexy.1 Nighttime polysomnography results were unremarkable; a multiple sleep latency test (PSG-MSLT) indicated a mean sleep latency of 5 minutes and 2 sleep-onset REM periods. She was positive for HLA DRB1*1501 and DQB1*0602. Brain …

Corrosion behavior of Hastelloy C-276 in supercritical water

The corrosion behavior of a nickel-based alloy Hastelloy C-276 exposed in supercritical water at 500–600 °C/25 MPa was investigated by means of gravimetry, scanning electron microscopy/energy dispersive X-ray spectroscopy, X-ray diffraction and X-ray photoelectron spectroscopy. An oxide scale with dual-layer structure, mainly consisting of an outer NiO layer and an inner Cr 2O 3/NiCr 2O 4-mixed layer, developed on C-276 after 1000 h exposure. Higher temperature promoted oxidation, resulting in thicker oxide scale, larger weight gain and stronger tendency of oxide spallation. The oxide growth mechanism in SCW seems to be similar to that in high temperature water vapor, namely solid-state growth mechanism.

An approach to the prediction of neonatal Erb palsy

We devised a method to predict risk of neonatal Erb palsy using variables ascertainable before delivery. Multiple logistic regression modeling was used to construct an Erb palsy risk score from a case-control study of 45 consecutive Erb palsy cases and 90 controls. Receiver-operator characteristics identified a range of scores for which likelihood ratios were determined for calculation of predictive values across a range of prior probabilities. In the final model, large estimated fetal weight, gestational diabetes, large maternal body mass index, large weight gain, and black race were associated with 2.3-4.8 times greater odds of Erb palsy. A long second stage had a modest effect on the odds (OR=2.7, P=0.13), unless preceded by a long deceleration phase, which combination increased the odds of Erb palsy to 20.1 (P=0.001). A risk score of 0.72 had a sensitivity of 36% and a specificity of 99%. In a theoretical population with a birth prevalence of brachial plexus palsy of 2.5/1000, application of the risk score would prevent 36% of cases and result in about 14 cesareans for every nerve injury prevented. We conclude that risk scoring using multiple logistic regression coefficients of variables that can be known in time to affect decision-making about mode of delivery has the potential to guide intervention to prevent some Erb palsies.

Oxidation behavior of novel rail steels at 500°C

Thermo gravimetric analysis (TGA) was used to study isothermal oxidation behavior of four novel rail steels at 500∧C in static air condition. These steels contained different combinations of microalloying elements, Cu, Cr, Ni and Si. The results were compared with the oxidation behavior of three rail steels already in commercial application (C-Mn, Cr-Mn and Cu-Mo). The lowest parabolic rate constant was obtained in case of Cr-Cu-Ni-Si contained rail steel. Spallation of the oxide layer was not observed in any of the rail steels. C-Mn, Cu-Mo and Cu-Si rail steels showed higher values of parabolic rate constants kp. In contrast to others Cu-Si exhibited linear rate law and larger weight gain compared to all other rail steels. X-ray diffraction (XRD) analysis confirmed that the major phase in the oxides was magnetite (Fe3O4). The surface morphology of the oxide scales were correlated with the oxidation rate.

The effect of hydrogen on copper nitride thin films deposited by magnetron sputtering

Copper nitride thin films were deposited on Si (1 0 0) wafers by reactive magnetron sputtering at various H 2/N 2 ratios. X-ray diffraction measurements show that the films are composed of Cu 3N crystallites with anti-ReO 3 structure and exhibit preferred orientation of [1 0 0] direction. Although the relative composition of the films has obviously changes with the H 2/N 2 ratios, the orientations of the films keep almost no changes. However, the grain size, lattice parameter and composition of the films are strongly dependent on the H 2/N 2 ratios. The copper nitride films prepared at 10% H 2/N 2 ratios show poor stability and large weight gain compared to the copper nitride films prepared at 0% H 2/N 2 ratios.

Investigation of the Cause of Readmission to the Intensive Care Unit for Patients with Lung Edema or Atelectasis

PurposeFor patients with acute respiratory failure due to lung edema or atelectasis, Surplus lung water that is not removed during an initial stay in the Intensive Care Unit (ICU) may be related to early ICU readmission. Therefore, we performed a retrospective study of patient management during the first ICU stay for such patients.Materials and MethodsOf 1,835 patients who were admitted to the ICU in the 36 months from January, 2003 to December, 2005, 141 were patients readmitted, and the reason for readmission was lung edema or atelectasis in 21 patients. For these 21 patients, correlations were investigated between body weight gain at the time of initial ICU discharge (weight upon discharge from the ICU ÷ weight when entering the ICU) and the time to ICU readmission, between body weight gain and the P/F ratio at ICU readmission, between the R/E ratio (the period using a respirator (R) ÷ the length of the ICU stay after extubation (E)) and the time to ICU readmission, between the R/E ratio and body weight gain, and between body weight gain until extubation and the time to extubation.ResultsA negative linear relationship was found between body weight gain at the time of initial ICU discharge and the time to ICU readmission, and between body weight gain at the time of ICU discharge and the P/F ratio at ICU readmission. If body weight had increased by more than 10% at ICU discharge or the P/F ratio was below 150, readmission to the ICU within three days was likely. Patients with a large R/E ratio, a large body weight gain, and a worsening P/F ratio immediately after ICU discharge were likely to be readmitted soon to the ICU. Loss of body weight during the period of respirator support led to early extubation, since a positive correlation was found between the time to extubation and body weight gain.ConclusionFluid management failure during the first ICU stay might cause ICU readmission for patients who had lung edema or atelectasis. Therefore, a key to the prevention of ICU readmission is to ensure complete recovery from lung failure before the initial ICU discharge. Strict water management is crucial based on body weight measurement and removal of excess lung water is essential. In addition, an apparent improvement in respiratory state may be due to respiratory support, and such an improvement should be viewed cautiously. Loss of weight at the refilling stage of transfusion prevents ICU readmission and may decrease the length of the ICU stay.

Brazing of yttria-stabilized zirconia (YSZ) to stainless steel using Cu, Ag, and Ti-based brazes

Copper and silver-base active metal brazes containing Ti (Cu-ABA, Ticusil, and Ticuni) were tested for oxidation resistance to 750–850 °C, and for their effectiveness in joining yttria-stabilized-zirconia (YSZ) to a corrosion-resistant ferritic stainless steel. The braze oxidation behavior was characterized using thermogravimetric analysis (TGA), optical and scanning electron microscopy (SEM), and energy dispersive spectrometry (EDS). Ticusil and Ticuni at 750 °C exhibited sluggish oxidation kinetics whereas Copper-ABA at 850 °C displayed the fastest kinetics and relatively large weight gain. The SEM and EDS examination of the steel/braze and YSZ/braze interfaces showed the dissolution of Y and Zr from YSZ in braze, diffusion of Ag in the YSZ, and formation of a thin Ti-rich interphase between YSZ and Ti-base brazes. These compositional changes and interface reconstruction yielded metallurgically sound joints. The Knoop microhardness profiles showed a rather abrupt discontinuity across the YSZ/braze interfaces and a more uniform distribution across the steel/braze interface.

Maternal weigh gain during pregnancy and overweight in Portuguese children

The objective of our study was to assess the association between maternal weight gain during pregnancy and childhood overweight. This study was a cross-sectional analysis. The data were derived from a community-based survey of children from primary schools of Portugal. The study was performed in a sample of 6-12-year-old Portuguese school children (2445 girls and 2400 boys; age was 8.5+/-0.91 years). Height and weight were measured according to international standards, and body mass index (BMI) was calculated. The definition of overweight was based on average centiles according to the International Obesity Task Force cutoffs. Children's parents completed a self-administered questionnaire, which provided information on general family background characteristics, maternal weight gain during pregnancy and children's physical activity. The response rate was 70.6%. Children's dietary intake was measured using a 24-h dietary recall. Logistic regression models were fitted to estimate the magnitude of the association between maternal weight gain during pregnancy and overweight in their children, adjusting for confounders (gender, age, birthweight, order of birth, breastfeeding, smoking during pregnancy, physical activity, parental BMI, parental education, calcium to protein ratio and energy intake). The prevalence of overweight (including obesity) was 29% in boys and 33% in girls. The odds favouring overweight (including obesity) increased significantly for those women who gained > or =16 kg during pregnancy, compared to those with <9 kg , even after adjustment for confounders (crude odds ratio (OR)=1.53, confidence interval (CI) 95% 1.27-1.84, P-trend <0.001; Adjusted OR=1.27, CI 95% 1.01-1.61, P-trend=0.038). Large maternal weight gain during pregnancy (> or =16 kg) was significantly associated with higher risk of overweight in Portuguese children.

Voluntarism in Consultation Psychiatry: The Forgotten Capacity

Voluntarism in Consultation Psychiatry: The Forgotten Capacity

Pathophysiologic Mechanisms of Obesity and Related Metabolic Disorders: An Epidemiologic Study using Questionnaire and Serologic Biomarkers

BACKGROUNDIt is still unclear whether individuals with the same degree of obesity but different weight histories since young adulthood have different insulin concentration, prevalence of metabolic syndrome components and their clustering.METHODSA cross-sectional study was conducted on 3,399 (for weight difference analysis) and 1,879 (for weight fluctuation analysis) Japanese men aged 40-59 years. Weight difference was calculated by subtracting the recalled weight at about 25 years old from the current weight. The root mean square error around the slope of weight on age (weight - RMSE) was calculated by a simple linear regression model, in which the subject's actual weights at ages 20, 25, 30, 40 years and 5 years prior to the study, as well as current weight, were dependent variables against the subject's age as the independent variable. Each metabolic syndrome component was defined as follows: serum triglycerides ≥150 mg/dL; HDL-cholesterol <40 mg/dL; fasting glucose ≥110 mg/dL; and blood pressure ≥140/90 mm Hg.RESULTSThose who gained <10%, <20%, or 20% or more in weight had a significantly higher than unity odds ratio of having two or more metabolic syndrome components in relation to those whose weight remained stable: 1.28 (95% confidence interval: 0.95-1.73), 2.49 (1.91-3.24), and 5.30 (3.97-7.07), respectively. Weight-RMSE was significantly and positively associated with fasting insulin concentration independent of current weight, weight-slope or other lifestyle-related factors.CONCLUSIONSMetabolic syndrome components would likely tend to cluster more in individuals with large weight gain on a physiologic basis characterized by high fasting insulin concentration. Furthermore, weight fluctuation was suggested to increase the risk of fasting hyperinsulinemia.

Body size, weight change, fat distribution and breast cancer risk in Hispanic and non-Hispanic white women

The incidence of breast cancer varies among women living in the Southwestern part of the US. We evaluate how body size influences breast cancer risk among these women. Cases (n = 2,325) diagnosed with breast cancer between October 1, 1999 and May 2004 residing in Arizona, Colorado, New Mexico, or Utah were matched to controls (n = 2,525). Participants were interviewed; height, weight, waist, and hip circumference were measured at the time of interview; blood was drawn. A large body mass index (BMI) at age 15 was inversely associated with pre-menopausal breast cancer risk in both non-Hispanic white (NHW) and Hispanic women (Odds ratio, ORs 0.68 95% CI 0.44, 1.04, and 0.65 95% CI 0.39, 1.08, respectively); BMI at age 15 also had an impact on subsequent breast cancer associated with obesity after menopause. Among post-menopausal women, recent exposure to hormones was an important modifier of risk associated with body size. Among women not recently exposed to hormones risk associated with obesity was 1.61 (95% CI 1.05, 2.45) for NHW women; gaining > or = 25 kg between 15 and age 50 was inversely associated with breast cancer among Hispanic women (OR 0.51, 95% CI 0.23, 1.14). A large weight gain and a large waist-to-hip ratio (WHR) was associated with an increased odds of having an estrogen receptor negative tumor among NHW only (OR 1.81, 95% CI 1.07, 3.08, and 2.04 95% CI 1.20,3.50). These findings suggest that the metabolic consequences of obesity on breast cancer risk differ between NHW and Hispanic women living in the Southwest.

Dietary Patterns and Changes in Body Weight in Women

Our objective was to examine the association between adherence to dietary patterns and weight change in women. Women (51,670, 26 to 46 years old) in the Nurses' Health Study II were followed from 1991 to 1999. Dietary intake and body weight were ascertained in 1991, 1995, and 1999. A Western pattern, characterized by high intakes of red and processed meats, refined grains, sweets and desserts, and potatoes, and a prudent pattern, characterized by high intakes of fruits, vegetables, whole grains, fish, poultry, and salad dressing, were identified with principal component analysis, and associations between patterns and change in body weight were estimated. Women who increased their Western pattern score had greater weight gain (multivariate adjusted means, 4.55 kg for 1991 to 1995 and 2.86 kg for 1995 to 1999) than women who decreased their Western pattern score (2.70 and 1.37 kg for the two time periods), adjusting for baseline lifestyle and dietary confounders and changes in confounders over time (p < 0.001 for both time periods). Furthermore, among women who increased their prudent pattern score, weight gain was smaller (multivariate-adjusted means, 1.93 kg for 1991 to 1995 and 0.66 kg for 1995 to 1999) than among women who decreased their prudent pattern score (4.83 and 3.35 kg for the two time periods) (p < 0.001). The largest weight gain between 1991 and 1995 and between 1995 and 1999 was observed among women who decreased their prudent pattern score while increasing their Western pattern score (multivariate adjusted means, 6.80 and 4.99 kg), whereas it was smallest for the opposite change in patterns (0.87 and -0.64 kg) (p < 0.001). Adoption of a Western dietary pattern is associated with larger weight gain in women, whereas a prudent dietary pattern may facilitate weight maintenance.

Sodium modeling attenuates rises in whole-blood viscosity during chronic hemodialysis in children with large inter-dialytic weight gain

Elevated whole-blood viscosity (WBV) is a risk factor for atherosclerosis and thrombosis. We analyzed WBV during hemodialysis (HD) in children and tested the hypothesis that sodium modeling (NaM) attenuates an increase in WBV. Each of six children underwent two control (C) and two NaM HD sessions, B and E. Rapid decline in sodium (Na) concentration occurred at the beginning of HD in B and at the end in E. We measured WBV at different shear rates (SRs) and documented the amount of fluid removed (FR), change in blood volume (BV), and hematocrit (Hct) before, during, and after HD. The percent increase of WBV in control sessions was significantly different at 2 h and 3 h during and after HD from baseline values. The mean percent change in WBV from baseline increased linearly over time during HD (R2>0.90). Hct, FR, and BV correlated with WBV (P<0.05). The effects of NaM on attenuation of WBV were statistically significant in three subjects with >5% inter-dialytic weight gain (IDWG) (P<0.05). WBV increased during HD in children. NaM appears to attenuate the rise in WBV in children with large IDWG.

Post-diagnosis weight gain and breast cancer recurrence in women with early stage breast cancer

To examine whether weight gain after diagnosis of breast cancer affects the risk of breast cancer recurrence. Patients included 3215 women diagnosed with early stage breast cancer (Stage I >1 cm., II, and IIIA) who were enrolled either in an observational cohort of breast cancer survivors or were part of the comparison group of a dietary intervention trial to prevent breast cancer recurrence. We computed weight change from 1 year prior to diagnosis to study enrollment. Delayed entry Cox proportional hazards models were used to evaluate associations of categories of weight change with time to recurrence, controlling for known prognostic factors. Neither moderate (5-10%) nor large (> 10%) weight gain (HR 0.8, 95% CI, 0.6-1.1; HR 0.9, 95% CI, 0.7-1.2, respectively) after breast cancer diagnosis was associated with an increased risk of breast cancer recurrence in the early years post-diagnosis (median time of 73.7 months from diagnosis). Our research provides evidence that weight gain commonly seen in the first several years following a breast cancer diagnosis does not increase a woman's risk for breast cancer recurrence in the first 5-7 years post-diagnosis. However, this research does not address the effects of weight gain on overall survival or on the risk of other new cancers, other prognostic outcomes of concern to the breast cancer survivor.