Large Weight Gain Research Articles

Individualized dialysate sodium prescriptions using sodium gradients for high-risk hemodialysis patients lowered interdialytic weight gain and achieved target weights.

Large interdialytic weight gain (IDWG) is associated with increased morbidity and mortality in chronic hemodialysis patients. Over 50% of patients at our inner city tertiary academic center dialysis unit had IDWG and target weights (TW) above goal. We conducted an open-label nonrandomized study to explore the effects of an individualized dialysate sodium (DNa) prescription using Na gradients in patients at high risk for large IDWG. Thirty-three patients receiving chronic hemodialysis received individualized DNa prescriptions with a DNa bath of 0 to -2 meq/L below their serum Na level in the intervention group, while patients in the control group were prescribed the standard dialysate Na at 138 mmol/L. Serum Na level, predialysis SBP, symptomatic hypotensive episodes, and %hemodialysis treatments with large IDWG (%TxAIDWG) and above TW(%TxATW) were recorded before and three months after the intervention. We used student t tests to compare continuous variables and Chi-square tests to compare binary variables between the groups at baseline and after the intervention. Age- and sex-adjusted linear regression models were also constructed to assess the differences in each continuous outcome between the groups. Multivariable logistic regression models were conducted by modeling IDWG decrease and above estimated-dry-weight (EDW) decrease as binary dependent variables with adjustment for age, sex, and EDW change. Patients with individualized DNa concentrations had 3.6 times greater odds of having lower IDWG than those with standard dialysate Na concentration. This significant association remained after adjustment for age, sex, and changes in EDW (OR: 3.63; 95% CI, 1.03-12.9). There was no difference in predialysis BP or symptomatic hypotensive episodes between the two groups. Individualized DNa prescriptions appeared to be well tolerated and may be effective for optimal fluid management in high-risk hemodialysis patients.

Effect of weight change and lifestyle modifications on the development or remission of nonalcoholic fatty liver disease: sex-specific analysis

The effects of changes in various lifestyle habits on nonalcoholic fatty liver disease (NAFLD) have not been well elucidated. We aimed to clarify how weight change and lifestyle modifications were associated with the development or remission of NAFLD. In this longitudinal cohort study, we reviewed the periodic health checkup data of 1,421 subjects with no causes of liver disease besides NAFLD who had received at least two health checkups between 2009 and 2018. The prevalence of NAFLD at baseline was 34.1% (484/1,421). During follow-up period (4.6 ± 2.8 years), 104 subjects developed NAFLD and 127 subjects demonstrated NAFLD remission. The frequency of NAFLD development or that of NAFLD remission significantly increased as the larger weight gain or weight loss was, respectively (both, p < 0.001). Approximately 40% of the subjects who maintained ≥ 1%/year weight loss achieved NAFLD remission. By multivariate analysis, quitting smoking were independently associated with NAFLD development (adjusted odds ratio [AOR], 2.86; 95% CI, 1.24–6.62). Subjects who quit smoking demonstrated large weight gain (≥1%/year) significantly more frequently than the other subjects (p < 0.001). In sex-specific analysis, starting to exercise was independently associated with NAFLD remission in men (AOR, 2.38; 95% CI, 1.25–4.53).

Public health deworming programmes for soil-transmitted helminths in children living in endemic areas.

Public health deworming programmes for soil-transmitted helminths in children living in endemic areas.

Protonthérapie des carcinomes épidermoïdes des voies aérodigestives supérieures : de la physique à la clinique

Intensity-modulated radiation therapy (IMRT) is presently the recommended technique for the treatment of locally advanced head and neck carcinomas. Proton therapy would allow to reduce the volume of irradiated normal tissue and, thus, to decrease the risk of late dysphagia, xerostomia, dysgeusia and hypothyroidism. An exhaustive research was performed with the search engine PubMed by focusing on the papers about the physical difficulties that slow down use of proton therapy for head and neck carcinomas. Range uncertainties in proton therapy (±3 %) paradoxically limit the use of the steep dose gradient in distality. Calibration uncertainties can be important in the treatment of head and neck cancer in the presence of materials of uncertain stoichiometric composition (such as with metal implants, dental filling, etc.) and complex heterogeneities. Dental management for example may be different with IMRT or proton therapy. Some uncertainties can be somewhat minimized at the time of optimization. Inter- and intrafractional variations and uncertainties in Hounsfield units/stopping power can be integrated in a robust optimization process. Additional changes in patient's anatomy (tumour shrinkage, changes in skin folds in the beam patch, large weight loss or gain) require rescanning. Dosimetric and small clinical studies comparing photon and proton therapy have well shown the interest of proton therapy for head and neck cancers. Intensity-modulated proton therapy is a promising treatment as it can reduce the substantial toxicity burden of patients with head and neck squamous cell carcinoma compared to IMRT. Robust optimization will allow to perform an optimal treatment and to use proton therapy in current clinical practice.

Early weight gain after stopping smoking: a predictor of overall large weight gain? A single-site retrospective cohort study

ObjectivesMost people gain weight on stopping smoking but the extent of weight gain varies greatly. Interventions aimed at all quitters to prevent weight gain on cessation have proven unpopular but...

Development of an Inflammatory Food Index and Association with Inflammatory Markers and Diabetes—Longitudinal Study of Adult Health (ELSA-Brasil)

Introduction: Diet plays a central role in the regulation of inflammation and is closely related to the development of chronic diseases. Dietary patterns portray eating habits more comprehensively than nutrients or foods alone, and provide better understanding and predictive power in relation to causal processes. The objective was to develop an Index of Food Inflammation (IFI) derived from Reduced Rank Regression (RRR) based on its relation with inflammatory markers in the ELSA-Brasil population, and to evaluate its association with weight gain and incidence of diabetes. Methods: Food consumption data were obtained from a food frequency questionnaire of 9778 participants, after exclusions. The RRR methodology initially involved 42 food groups. Spearman’s correlation coefficients were used to evaluate the associations between quantitative variables, and, for the IFI, linear regression to evaluate its association with weight gain, logistic regression with large gains, and Cox regression with incident diabetes. Results: The inflammatory dietary pattern was composed of 17 pro-inflammatory food groups, including processed or red meat, pork, sugary soft drinks, and hotdogs, and seven anti-inflammatory groups, notably fruits, nuts and wine. The IFI was associated with weight gain, risk of a large weight gain (quartile 4 vs. 1: adjusted OR=1.42; 95% CI 1.15-1.76) and risk of developing diabetes (quartile 4 vs. 1: adjusted HR=1.29; 95% CI 1.01-1.65). Conclusion: The associations, although small, suggest that subclinical inflammation could be one of the ways by which diet causes certain chronic diseases. Ultra-processing of foods could be an important determinant in the pro-inflammatory aspect of some current dietary patterns. Disclosure B.P. Riboldi: None. V.C. Luft: None. M.I. Schmidt: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company. B.B. Duncan: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company.

Associations of body weight and weight change with cardiovascular events and mortality in patients with coronary heart disease

Background and aimsIt is recommended that patients with coronary heart disease (CHD) pursue a normal body weight, while the effects of body weight and weight change on prognosis are still controversial. The present study was to assess these effects using a large-scale population with CHD in China. MethodsA total of 5276 patients with CHD were included from Jan 2000 to Dec 2014. Baseline and endpoint weights were measured. Outcomes including mortality and cardiovascular events were obtained. ResultsRelative to patients with normal weight, risks for adverse outcomes were lowest in overweight patients and similar in obese patients. Hazard ratios (HRs) and 95% confidence interval (95% CI) for all-cause death were 1.42 (1.06, 1.91) if overweight turned into normal weight and were 2.01 (1.28, 3.16) or 5.33 (2.81, 10.1) if obese turned into overweight or normal weight. Death risk increased with the extent of weight loss and moderate or large weight gain (p<0.05 for all). Similar results were found when risks for cardiovascular mortality and events were considered. Furthermore, these results remained significant when the patients were stratified by several covariates and even when several definitions of weight change were considered. ConclusionsObesity did not increase adverse outcome risks in patients with CHD. Both weight loss and weight gain increased adverse outcome risks regardless of baseline body weight. The findings suggest that maintaining a stable weight may be a better strategy for the reduction of risks for cardiovascular outcomes and all-cause death in patients with CHD.

Body Weight and Breast Cancer: Nested Case–Control Study in Southern Brazil

BackgroundCurrent studies have shown that fast weight gain may be more important than body mass index on the incidence of breast cancer. The aim of this study was to evaluate the association between body weight and breast cancer. Patients and MethodsThis was a case–control study nested in a cohort of a breast cancer mammography screening program in Southern Brazil. A trained investigator administered a standardized interview to collect sociodemographic and clinical data, and body weight history (weight at menarche, at marriage, at first and last pregnancy, and at menopause). Current anthropometric measurements were also made. ResultsFifty-seven women with cancer (66.7% postmenopausal) and 159 controls were included. Current age (60.3 ± 10.4 vs. 55.8 ± 8.4 years, P < .01), marital status (49.1% vs. 64.8% with a partner, P = .03), and physical activity (48.2% vs. 32.3% sedentary, P = .01) were significantly different between cases and controls, respectively. Odds ratio showed that age and current waist circumference were associated with postmenopausal cancer. No difference was found in relation to body weight at different stages of life. ConclusionWomen with social vulnerability recruited at a mammography screening program in Southern Brazil showed a large weight gain during life, but no significant differences were found in body weight between women with or without breast cancer.

Microstructure and High-Temperature Oxidation Behavior of Dy-Doped Nb–Si-Based Alloys

Microstructures and oxidation behaviors of four Dy-doped Nb–Si-based alloys at 1250 °C were investigated. The nominal compositions of the four alloys are Nb–15Si–24Ti–4Cr–2Al–2Hf–xDy (at.%), where x = 0, 0.05, 0.10 and 0.15, respectively. Results showed that the four alloys all consisted of Nbss, αNb5Si3 and γNb5Si3, and the addition of Dy produced no obvious effect on the phase constitution and the microstructures of Nb–Si-based alloys. After oxidation at 1250 °C for 58 h, it was found that the addition of Dy accelerated the oxidation rate of Nb–Si-based alloys and caused a larger weight gain, accompanied by the formation of a more porous and less protective oxide scale. The oxides of Nb2O5, Ti2Nb10O29, TiNb2O7, Ti0.4Cr0.3Nb0.3O2 and glassy SiO2 were formed on Dy-doped Nb–Si-based alloys. The high-temperature oxidation mechanism of Dy-doped Nb–Si-based alloys was discussed.

A Program Aimed at Reducing Anxiety in Pregnant Women Diagnosed With a Small-for-Gestational-Age Fetus: Evaluative Findings From a Spanish Study.

The objective of this study was to evaluate the effect of anxiety-reducing techniques including music therapy, sophrology, and creative visualization in pregnant women with a fetus diagnosed as small for gestational age and improved fetal and neonatal weight. This was a quasi-experimental study with a nonrandomized clinical trial design. We compared 2 groups of pregnant women with a fetus diagnosed as small for gestational age with no abnormalities on Doppler studies. The control group (n = 93) received standard care, and the intervention group (n = 65), in addition to standard care, underwent a program of 6 sessions led by a midwife or nurse who taught anxiety-reduction techniques. The State-Trait Anxiety Inventory (STAI) including trait and state subscales were completed by both groups at the start of the study, and only the STAI-State subscale was completed again at the end of the study. Comparisons between the 2 groups regarding fetal weight and centile and maternal STAI scores were performed using the t test and the χ test. There were no significant differences in the STAI-Trait scores between the 2 groups. There were statistically significant differences in the intervention group's STAI-State score percentiles between the start and the end of the study, being lower at the end of the study (P < .001). There were significant differences between the 2 groups in fetal weight trajectory on the basis of fetal weight: the intervention group had a larger weight gain (P < .005). The program designed to reduce anxiety in pregnant women was effective at reducing anxiety in the women in the intervention group, leading to a favorable fetal weight trajectory in this group.

Accelerated thermo-oxidative aging for carbon fiber reinforced polycyanate under high pressure atmosphere

The aim of this study is to accelerate thermo-oxidative aging in carbon fiber reinforced plastics (CFRP) submitted to high temperature atmospheric pressure. In this study, long-term thermo-oxidative aging test was conducted to examine the effect of high pressure atmospheric environment on the weight and mechanical properties of CFRP to accelerate the rate of thermo-oxidative degradation. The effect of thermo-oxidative environment under high atmospheric pressure on the change in weight, strength, and shrinkage behavior of a CFRP with polycyanate (FSD-M-08178) was investigated. The aging test was conducted at 180 °C up to 8,000 h under atmospheric pressure and the test result was used as a reference data. Other aging tests were also conducted under elevated pressure conditions (0.3 and 0.5 MPa) at the same exposure temperature up to 2,000 h and the test results were treated as the accelerated aging test data. Unidirectional laminates [0]8 and [90]8 for tensile specimens and angle ply laminates [±45]2S for off-axis tensile specimens were aged in oven, and then mechanical tests were carried out on them. The results indicated that elevated pressure would cause faster and larger weight gain in earlier aging period. The outcomes of these experiments were changes in weight, strength, and local shrinkage deformation were changed quickly under elevated atmospheric pressure environment. Same micro damage onset and extension irrespective of pressure during thermo-oxidative aging and subsequent loading test were observed. The test results indicate that the change in weight, strength, and local shrinkage deformation could be accelerated by elevated pressure without change in thermo-oxidative degradation mechanism. Therefore, the elevated pressure testing would be a better method to accelerate thermo-oxidative degradation. On the other hand, the change in strength under elevated pressure conditions is faster than local shrinkage deformation. Equivalent acceleration rate of degradation could not be obtained.

Obesity, weight change, and chronic kidney disease in patients with type 2 diabetes mellitus: A longitudinal study in Taiwan.

The aim of the present study was to investigate relationships between the risk of chronic kidney disease (CKD) and obesity and weight changes in Asian patients with type 2 diabetes. At baseline (2003-05), 1187 diabetic patients aged 30-70 years were recruited to the study, with follow-up surveys completed in 2008, 2009, and 2010. Chronic kidney disease was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2 ; body mass index (BMI) was categorised as normal (18.5-22.9 kg/m2 ), overweight (23-27.4 kg/m2 ), or obese (≥27.5 kg/m2 ); waist circumference (WC) ≥80 cm for women and ≥90 cm for men was taken to indicate abdominal obesity. Changes in weight and WC were calculated from baseline to each follow-up survey. Relative risk (RR) and 95% confidence intervals (CIs) of CKD were estimated. To estimate the risk for incident CKD, associations were examined in patients without CKD at baseline (n = 881). Over 7 years of follow-up, obesity (RR 1.48; 95% CI 1.08-2.04; P = 0.015) and high WC (RR 1.23; 95% CI 1.00-1.52; P = 0.049) were associated with CKD after adjusting for covariates. Among participants without CKD at baseline, those who gained >10% weight (RR 1.43; 95% CI 1.07-1.90; P = 0.015) and in whom WC increased >15% (RR 1.37; 95% CI 1.01-1.85; P = 0.045) had a higher risk of incident CKD than those who remained stable (±5% changes in weight or WC). Diabetic patients who are obese and those with excessive central fat were more likely to have CKD. Large weight gain (>10%) and increases in WC (>15%) independently predicted incident CKD.

Effects of body mass index and weight change on mortality in older men with impaired glucose regulation

ObjectivesTo assess the effect of baseline body mass index (BMI) status and weight change on mortality in older men with impaired glucose regulation (IGR). MethodsEight hundred eighty-five men with IGR aged 60 to 90 were included. Baseline and endpoint weight were measured. All-cause and cardiovascular mortality were observed during a median follow-up period of 10years. Multivariate Cox regressions were used to estimate associations between BMI, weight change and mortality. ResultsRelative to normal weight, overweight was associated with lower all-cause mortality (hazard ratios, HRs [95% confidence interval, 95% CI]: 0.57 [0.41, 0.78]) and cardiovascular mortality (0.52 [0.29, 0.93]), whereas obesity did not significantly decrease or increase the mortality risk. Furthermore, compared to weight stability, all types of weight change led to increased mortality risk, except small weight gain. Specifically, after adjustment for covariates and the initial weight, the HRs (95% CI) of large weight loss were 1.64 (1.15, 2.34) for all-cause mortality and 1.85 (1.10, 3.14) for cardiovascular mortality, and the HRs (95% CI) of large weight gain were 1.55 (1.01, 2.40) for all-cause mortality and 2.11 (1.04, 4.30) for cardiovascular mortality. Similar associations were observed when weight change was redefined in sensitivity analyses. ConclusionsBoth BMI at baseline and weight change have independent U-shaped associations with all-cause and cardiovascular mortality among older men with IGR. The present study suggests that older men with IGR may ensure their best survival by being overweight at baseline or by maintaining their weight regardless of their baseline weight status.

Body mass index, weight change, and risk of second primary breast cancer in the WECARE study: influence of estrogen receptor status of the first breast cancer.

Studies examining the relationship between body mass index (BMI) and risk of contralateral breast cancer (CBC) have reported mixed findings. We previously showed that obese postmenopausal women with estrogen receptor (ER)‐negative breast cancer have a fivefold higher risk of CBC compared with normal weight women. In the current analysis, we reexamined this relationship in the expanded Women's Environmental Cancer and Radiation Epidemiology (WECARE) Study, focusing on the impact of menopausal status and ER status of the first breast cancer. The WECARE Study is a population‐based case–control study of young women with CBC (cases, N = 1386) and with unilateral breast cancer (controls, N = 2045). Rate ratios (RR) and 95% confidence intervals (CI) were calculated to assess the relationship between BMI and risk of CBC stratified by menopausal and ER status. Positive associations with obesity and weight gain were limited to women who became postmenopausal following their first primary breast cancer. Among those with an ER‐negative first breast cancer, obesity (vs. normal weight) at first diagnosis was associated with an increased risk of CBC (RR = 1.9, 95% CI: 1.02, 3.4). Also, weight gain of ≥10 kg after first diagnosis was associated with an almost twofold increased risk of CBC (RR = 1.9, 95% CI: 0.99, 3.8). These results suggest that women with an ER‐negative first primary cancer who are obese at first primary diagnosis or who experience a large weight gain afterward may benefit from heightened surveillance. Future studies are needed to address the impact of weight loss interventions on risk of CBC.

Prediction of excessive weight gain in insulin treated patients with type 2 diabetes.

Weight gain is an ongoing challenge when initiating insulin therapy in patients with type 2 diabetes mellitus (T2DM). However, if prediction of insulin-associated weight gain was possible on an individual level, targeted initiatives could be implemented to reduce weight gain. The aim of the present study was to identify predictors of weight gain in insulin-treated patients with T2DM. In all, 412 individuals with T2DM were, in addition to metformin or placebo, randomized into 18-month treatment groups with three different insulin analog treatment regimens (biphasic, aspart, detemir). Participants with excessive weight gain were defined as the group with weight gain in the 4th quartile (>6.2 kg).We developed a pattern classification method to predict individuals prone to excessive weight gain. Over the 18-month treatment period, median weight gain among all 412 patients was 2.4 kg (95% prediction interval [PI] -5.6, 12.4 kg), whereas median weight gain for those in the upper 4th quartile (n = 103) was 8.9 kg (95% PI 6.3, 15.2 kg). No clinical baseline data were strong predictors of excessive weight gain. However, the weight gain during the first 3 months of the trial and the subsequent dose of insulin yielded a useful predictor for weight gain at the 18-month follow-up. Combining these two predictors into a prediction model with other clinical available information produced a receiver operating characteristic area under the curve of 0.80. We have developed a prediction model that could help identify a substantial proportion of individuals with T2DM prone to large weight gain during insulin therapy.

Determinants of thirst distress in patients on hemodialysis.

Thirst sensation can induce nonadherence with fluid restriction in patients on hemodialysis (HD) and may lead to large interdialytic weight gain (IWG). This study aimed to evaluate thirst distress and its determinants and to explore fluid management strategies used by patients on HD. A cross-sectional study was conducted in a sample of 203 patients who were followed in three HD centers in Turkey, from January 2015 to June 2015. Data were collected by a personal information form, the Thirst Distress Scale (TDS) and the Visual Analogue Scale (VAS) for thirst and xerostomia. Data analysis was performed using descriptive statistics, Student's t test, the one-way analysis of variance, Pearson's correlation coefficients, and linear regression analysis. The mean TDS score was 20.71±8.34, which is a higher than moderate level of thirst distress. The significant determinants of thirst distress of the patients were the VAS thirst score (unstandardized β=1.73, p<0.001), the VAS xerostomia score (unstandardized β=0.42, p<0.001), and the IWG values (unstandardized β=1.20, p=0.003), after controlling for specific variables. The most common strategies used to reduce fluid intake or relieve thirst were avoiding salty foods (70.9%), limiting salt on food (70.9%), and spacing liquids over the entire day (57.6%). Patients with higher levels of thirst and xerostomia and those with a high IWG were more likely to have higher thirst distress. A greater understanding of thirst distress and its related factors could contribute to more effective interventions that improve health and well-being in patients on HD.

Abstract P1-07-06: Weight gain during pre- and postmenopausal years results in earlier onset of breast cancer. The Tromsø cohort study

Abstract Background: Obesity is both an independent risk factor, and a prognostic factor of postmenopausal breast cancer. In contrast, the association between premenopausal obesity/leanness, and subsequent weight gain and breast cancer outcomes, is still unclear. Furthermore, the association between adult weight gain, weight and age at diagnosis, and tumor characteristics is less studied. Methods: During 1979-2007, a total of 18 990 women, aged 18-87 years, answered questionnaires and underwent clinical examination at a total of five repeated health surveys (attendance rate 68-82%). Height and weight were measured at each survey, and before surgery, among those women diagnosed with breast cancer during follow-up. Careful review of the respective medical records, including histopathological workup, was performed. Multivariate Cox Proportional Hazard models were used to study the importance of Body Mass Index (BMI kg/m2) and weight change on breast cancer risk, and to evaluate variation in breast tumor characteristics. Results: During a median follow-up of 23.3 years, 579 women with invasive breast cancer were identified, and the cases were histologically verified. These breast cancer cases had a mean age at diagnosis of 56.3 years, and mean BMI at diagnosis of 25.3 kg/m2. Most (67 %) of the breast cancer patients had estrogen receptor (ER) positive tumors, 48 % had progesterone receptor (PgR) positive tumors, and 41 % had lymph node positive disease. We divided all participating women in three groups of weight change (&amp;lt; 5kg, 5-15 kg, &amp;gt;15 kg). When we compared women with less than 5 kg weight gain, to women with weight gain 5-15 kg, and to women with weight gain above &amp;gt;15kg, we observed a RR of 1.43 (95% CI 1.07-1.90) and a RR of 1.86 (95% CI 1.30-2.68), respectively, for postmenopausal breast cancer. We divided women by quartiles of BMI (kg/m2) at entry, and observed that women in the lowest quartile of BMI (≤ 21.45 kg/m2), who had a subsequent weight gain &amp;gt;15 kg, had a RR of 2.40 (95% CI 1.07-5.38) for postmenopausal breast cancer compared to women with the same BMI at entry, but who remained stabile in weight. We observed a 6 year difference in age at diagnosis for women diagnosed with breast cancer, who at study entry were in the same BMI group (&amp;lt; 25kg/m2), but subsequently either experienced a large weight gain (&amp;gt;15 kg), or remained stabile in weight (59.5 years vs. 64.4 years, p=0.007). Furthermore, we observed a 15 year difference in age at diagnosis for women diagnosed with breast cancer, who at study entry were in the same BMI group (≥ 25kg m2), but subsequently either experienced a large weight gain (&amp;gt; 15 kg), or remained stabile in weight (60.3 years vs. 74.9 years, p=0.007). Conclusion: Avoiding large weight gain during pre- and postmenopausal years may both protect against, and delay onset of postmenopausal breast cancer. Our findings support the importance of weight gain as a modifiable lifestyle factor for early onset of breast cancer. Citation Format: Lofterød T, Frydenberg H, Flote VG, Risberg T, Eggen AE, McTiernan A, Mortensen E, Wist EA, Akslen LA, Reitan JB, Wilsgaard T, Thune I. Weight gain during pre- and postmenopausal years results in earlier onset of breast cancer. The Tromsø cohort study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-07-06.

Change in active transportation and weight gain in pregnancy

BackgroundPregnancy is characterised by large weight gain over a short period, and often a notable change in mode of transportation. This makes pregnancy suitable for examining the plausible, but in the scientific literature still unclear, association between active transportation and weight gain. We hypothesize that women continuing an active mode of transportation to work or school from pre- to early pregnancy will have a lower gestational weight gain (GWG) than those who change to a less active mode of transportation.MethodsWe analysed prospective data from the Norwegian Fit for Delivery (NFFD) trial. Between September 2009 and February 2013 606 women were consecutively enrolled in median gestational week 16 (range; 8–20). Of 219 women who used an active mode of transportation (biking, walking, public transportation) pre-pregnancy, 66 (30 %) converted to a less active mode in early pregnancy (“active-less active” group), and 153 (70 %) continued with active transportation (“active-active” group). Pre-pregnancy weight was self-reported. Weight at gestational (GA) weeks 16, 30, 36, and at term delivery was objectively measured. Weight gain was compared between the two groups. Linear mixed effects analysis of the repeated weight measures was performed including the group*time interaction.ResultsA significant overall group effect was observed for the four time points together (“active-active” group: 77.3 kg vs. “active-less active” group: 78.8 kg, p = 0.008). The interaction term group*time was significant indicating different weight gain throughout pregnancy for the two groups; the mean differences between the groups were 0.7 kg at week 16, 1.4 kg at week 30, 2.1 kg at week 36, and 2.2 kg at term delivery, respectively.ConclusionThe findings indicate that active transportation is one possible approach to prevent excessive weight gain in pregnancy.

Time-dependent Changes of Atherosclerotic LDL Complexes after Smoking Cessation.

Aim: The α1-antitrypsin – low-density lipoprotein complex (AT-LDL) and serum amyloid A-LDL complex (SAA-LDL) are oxidatively modified LDL complexes that promote atherosclerosis. The serum levels of AT-LDL and SAA-LDL are suggested to be increased by obesity and smoking. We have previously demonstrated that larger weight gain after smoking cessation (SC) perturbs a decrease in the serum level of AT-LDL at 3 months after SC. However, changes of these atherosclerotic makers >3 months after SC are unknown. This study investigated post-SC time-dependent changes in two atherogenic lipoproteins, AT-LDL and SAA-LDL, and in the extent of abdominal obesity.Methods: In 50 outpatients who had continued SC for 1 year, we measured serum AT-LDL and SAA-LDL levels by the enzyme-linked immunosorbent assay before SC, and at 3 months and 1 year after SC.Results: Both body mass index and waist circumstance significantly increased from pre-SC to 3 months after SC and from 3 months after SC to 1 year after SC. Although the serum levels of AT-LDL and SAA-LDL were unchanged from pre-SC to 3 months after SC, these levels decreased significantly from 3 months after SC to 1 year after SC.Conclusions: The extent of abdominal obesity and levels of two atherogenic lipoproteins time-dependently change after SC. Although abdominal obesity progressively worsened after SC, the beneficial effect of non-smoking overcomes the potential vascular risks by cessation-associated obesity at 1 year after SC.

Abstract P632: The Blood Pressure in Dialysis (BID) Pilot Study

Background: The optimal blood pressure (BP) target for hypertensive hemodialysis (HD) patients is unknown. Current KDOQI guidelines have been extrapolated from data in the general population. The BID pilot, funded by NIDDK and DCI, is the first trial to randomize hypertensive HD patients to intensive (110-140 mm Hg) vs. usual (155-165 mm Hg) control of systolic blood pressure (SBP). The study’s goal is to assess the feasibility of conducting a full-scale trial. Methods: BID consortium consists of 5 clinical centers, a cardiac MRI reading center and a data coordinating center. Standardized predialysis SBP, measured in the dialysis unit in accord with AHA recommendations (SDUSBP), guide therapy. To be eligible for randomization patients needed a 2-week running mean SDUSBP ≥ 155 mm Hg. Home BP measurements (HBPM) are obtained twice on the day after the midweek dialysis. Ambulatory Blood Pressure Monitoring (ABPM) during a 44h interdialytic period is obtained quarterly. We compared SDUSBP, HBPM and ABPM. Results: We enrolled 281 and randomized 126 participants. Major reasons for drop out during the baseline period were 2-week mean SDUSBP &lt; 155 mm Hg (40.6%), no cardiac MRI (13.0%) and perception of protocol as burdensome (11.2%). Adherence with prescribed SDUSBP was satisfactory. The percent of patients with ≥ 4, ≥ 8 and ≥12 SBP per month were 96, 88 and 57% in month 1 and 78, 68 and 37% in month 12. In a constant cohort of participants followed ≥ 330 days 2-week mean SDUSBP were 144 ± 17.4 and 156 ± 15.2 mm Hg in the intensive and usual arms, respectively. Major reasons that participants in the intensive arm did not achieve target SBP included large interdialytic weight gain (27.2%), non-adherence with medications or dialysis prescription (40.9%), and intradialytic hypotension (31.9%). Differences between the SDUSBP and both HBPM and ABPM were often ≥ 10 mm Hg. Optimal control of BP requires measurements in and out of the dialysis unit. Rates of adverse events were similar to those in other NIDDK funded ESRD studies. Conclusion: The difference in BP between arms was achieved and maintained throughout the study. It is feasible to conduct a full-scale clinical trial of intensive vs. usual treatment of hypertension in HD patients.