Lower Rates Of Obesity Research Articles

Incidence and Survival Trends of Hepatocellular Carcinoma in Non-Cirrhotics With Ishak Fibrosis Score of 0-4 Between 2005-2014: A SEER Analysis

Introduction: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and one of the leading causes of cancer related deaths. Although HCC occurs most commonly in cirrhotic livers, there is growing concern about HCC in non-cirrhotics, especially those with metabolic syndrome and NAFLD. However, there are limited data regarding HCC incidence and survival among non-cirrhotic patients in the United States. Methods: The Surveillance, Epidemiology, and End Results (SEER) registry was utilized to obtain data for HCC in non-cirrhotic patients with Ishak fibrosis scores of 0-4 from 2005-2014. Results: Overall incidence from 2005-2014 was 0.30 cases per 100,000 persons per year, with higher incidence in males (0.49, 95% CI: 0.47-0.51) compared to females (0.13, 95% CI: 0.12-0.14). For race, incidence was greatest among Asian or Pacific Islanders (APIs) (0.83, 95% CI: 0.77-0.90), but annual percent change (APC) was highest among whites (APC 3.29) and blacks (APC 6.53) (figure 1). APC in APIs has been stable (0.56)(table 1). Incidence analysis by HCC stage (localized, regional, and distant) shows that localized disease has the greatest incidence (0.18, 95% CI: 0.17-0.18) and localized and regional disease have the highest APC (3.24 and 6.51, respectively). Survival analysis showed that females had a higher five-year survival (42.8%, 95% CI: 37.2%-48.2%) than males (36.6%, 95%CI: 33.6%-39.5%). For race, APIs had the highest five-year survival (46.5%, 95% CI: 41.5%-51.2%) and blacks had the lowest (25.3%, 95% CI: 17.9%-33.3%) (figure 2). For stage and AFP levels, survival was highest for localized disease (51.7%, 95%CI: 48.2%- 55.1%) and negative/normal AFP levels (54.06%, 95%CI: 48.44%-59.34%), respectively. Conclusion: The incidence of HCC in non-cirrhotic patients in the US with Ishak fibrosis scores of 0-4 is increasing. Moreover, our findings correlate well with obesity trends in the US, where lower rates of obesity are observed among non-Hispanic Asians (11.7%) than among non-Hispanic white (34.5%), Hispanic (42.5%), and non-Hispanic black (48.1%)[1]. Survival is influenced by gender, race, AFP level, and stage of disease. These findings may help to identify at-risk populations as well as risk factors for improving surveillance for HCC in non-cirrhotics.832_A Figure 1. Incidence Rate, Race 2005-2014; decimal place indicates number of months in year832_B Figure 2. Count, Annual Percent Change and Hazard Ratios for HCC In Non-Cirrhotics with Ishak Fibrosis 0-4832_C Figure 3. Survival Based on Race

Double trouble: Addressing stunting and obesity via school nutrition

Background. South Africa (SA), as a middle-income country, faces the nutrition transition and associated double burden of undernutrition and obesity. School feeding programmes are one way of ensuring that malnutrition in children is addressed, but questions remain about whether they can address both undernutrition and obesity. Objectives. To compare the obesity and stunting outcomes for children receiving different combinations of school feeding programmes in a rural district of SA. Methods. The evaluation involved a comparative design that compared the stunting and obesity levels of three groups of children. Group 1 received one lunch meal a day for a prolonged period, group 2 both lunch and breakfast, and group 3 had started receiving a daily lunch shortly before the commencement of the research. Results. Group 1 had stunting levels in line with the national average. Group 2 had lower stunting levels than those receiving only the lunch meal. Children from group 3 had lower stunting levels than groups 1 and 2. Rates of obesity and overweight were markedly different between the groups. Group 3 had very high rates of overweight and obesity – above the national average of 28%. In contrast, group 1 had far lower rates of overweight and obesity, and group 2 exhibited the lowest levels. There was a significant decrease in the percentage of learners classified as overweight in group 3 over the 6-month period, from 26.1% to 19.2%. Conclusion. One lunch meal a day is associated with positive outcomes in relation to rates of stunting and obesity, and the lowest rates of obesity were measured when a breakfast meal was added. The addition of a breakfast meal to a lunch feeding programme shows promise, but this requires further investigation to understand whether causal linkages exist.

Inpatient Outcomes After Elective Lumbar Spinal Fusion for Patients with Human Immunodeficiency Virus in the Absence of Acquired Immunodeficiency Syndrome

To our knowledge, no prior study has evaluated outcomes after elective lumbar spinal surgery in human immunodeficiency virus (HIV) patients without acquired immunodeficiency syndrome (AIDS). This review investigated the impact of HIV-positive status (without AIDS) on outcomes after elective lumbar fusion for degenerative disc disease (DDD). Adult patients registered in the Nationwide Inpatient Sample (2002-2011) undergoing elective lumbar fusion for DDD were extracted. Multivariable regression techniques were used to explore the association of HIV positivity with outcomes after lumbar fusion. This cohort included 612,000 hospitalizations (0.07% were HIV positive) of lumbar fusion for DDD. Compared with HIV-negative patients undergoing lumbar fusion, HIV-positive patients were younger (47 vs. 55 years), male (61% vs. 42%), largely insured by Medicare (30% vs. 5%), and had higher rates of chronic obstructive pulmonary disease (23.7% vs. 14.6%) (all P < 0.001) but had lower rates of obesity, hypertension, and diabetes (all P < 0.001). Multivariable models demonstrated HIV positivity to be associated with higher odds for an adverse event (odds ratio [OR], 1.92; P < 0.001), in-hospital mortality (OR, 39.91; P< 0.001), wound complications (OR, 2.60; P= 0.004), respiratory (OR, 5.43; P < 0.001) and neurologic (OR, 1.96; P= 0.039) complications, and higher costs (7.1% higher; P= 0.011) compared with non-HIV patients. There were no differences in thromboembolic events, cardiac or gastrointestinal complications, discharge disposition, or length of stay. Even in this selected cohort of well-controlled HIV patients, there were high complications, with concerning rates of death and respiratory complications. These data shed new light on elective spine surgery in HIV patients and may influence the treatment algorithm of surgeons who are familiar with older papers.

A comparison of the robust conditional order-m estimation and two stage DEA in measuring healthcare efficiency among California counties

This paper examines cross-county healthcare efficiency rankings using modern non-parametric estimators, while taking into account secondary environmental variables. Results indicate that output-direction efficiency estimates yield counties producing inefficiently for both order-alpha and order-m estimators. After accounting for a variety of secondary environmental variables, unconditional efficiency estimates improve by anywhere between 7.5 and 10-percentage points. Results show that there is little correlation between the highly visible Robert-Woods-Johnson Foundation estimates with those derived here. We also find that counties are more efficient when they possess lower rates of obesity, unemployment, and preventable hospital readmissions. In addition, demographic variables do not play much of a role in explaining cross-county inefficiency. The analysis shows that the two stage DEA is inappropriate and violates several assumptions in comparison to the conditional order-m estimation.

A Comparison of Health Related Fitness Variables between Youths in Singapore and Hong Kong

Physical fitness encompasses health-related fitness (HRF) variables which may reduce cardiovascular risk factors if identified early in youths. PURPOSE: To compare HRF variables between youths in Singapore (SGP) and Hong Kong (HK). METHODS: A total of 1559 youths from SGP (age: 13.49 ± 1.21 years, height: 159.76 ± 8.94 cm, weight: 51.91 ± 13.38 kg, Body Fat (BF) %: 21.51 ± 10.25 %) and 1530 youths from HK (age: 13.51 ± 0.98 years, height: 160.69 ± 8.40 cm, weight: 52.20 ± 12.43 kg, BF%: 21.16 ± 9.99 %) participated in this study. Body Mass Index (BMI) and BF% were measured by bio-electric impedance analysis. Cardiovascular fitness, lower limb flexibility, arm strength, abdominal endurance were tested using the 15m youth Progressive Aerobic Cardiovascular Endurance Run test (PACER), one-legged sit-and-reach test for both legs (SRT), handgrip strength test for both hands (HS), and 1-minute sit-up test (SUT) respectively. RESULTS: Using the Independent T-Test, significant differences were found between SGP and HK youths for height (SGP: 159.76 ± 8.94 cm, HK: 160.69 ± 8.40 cm, p < 0.0005), SRT (SGP: 54.14 ± 10.15 cm, HK: 49.59 ± 12.04 cm, p < 0.0005), HS (SGP: 25.18 ± 7.77 kg, HK: 26.01 ± 6.96 kg, p = 0.002), SUT (SGP: 38.94 ± 11.92, HK: 30.56 ± 10.14, p < 0.0005) and PACER (SGP: 40.93 ± 23.90 laps, HK: 35.49 ± 18.44 laps, p < 0.0005). There were no significant differences in weight, BMI, and BF% between youths in both countries, with low obesity rates in both countries (SGP: 12.7%, HK: 10.32%). CONCLUSION: Results indicated similar body composition results in both countries. SGP youths had lesser arm strength as compared to HK youths. However, SGP youths had higher abdominal endurance, better flexibility and were more aerobically fit as compared to HK youths. Both SGP and HK youths need to maintain their physical activities to improve their cardiovascular fitness as this will help to reduce cardiovascular diseases in youths in the future.

Obesity Stigmas in News Stories and the Role of Sources in Two Leading Newspapers in the United States and South Korea

Regardless of the gap in the number of countries with low versus high obesity rates, a similar degree of negative perceptions about obesity and obese individuals is pervasive throughout the world. Despite the inevitable negative social conception of obesity and obese individuals regardless of their country origins, little research has explored (a) the likelihood that newspapers contributed to the obesity stigmatization in societies and (b) how different, if at all, newspapers in those countries depicted obesity and obese individuals in news stories. Undergirded by the attribution theory and the model of stigma communication, a content analysis of two leading newspapers—one in the United States and one in South Korea—found that the American newspaper produced more stories with obesity stigmas than the Korean newspaper. Unlike the assumption of the attribution theory, news stories with an obesity stigma included not only personal, but also social levels of attributions of obesity in both countries’ newspapers. However, health expert sources might cancel out the potential harms of situating obesity-related stigmas in news stories in both newspapers. Implications of stigma communication are discussed to understand the possibility of biased, unhealthy news production.

Abstract P319: Changes in Perceptions of Neighborhood Environment and Cardiometabolic Outcomes in Two Predominantly African American Neighborhoods

Introduction: Perceived neighborhood characteristics, including neighborhood satisfaction, are associated with lower obesity rates and more favorable cardiovascular risk factor profiles. However, prior studies have not evaluated how longitudinal changes in perceived neighborhood characteristics following revitalization efforts may associate with cardiometabolic health indicators. Methods: Changes in neighborhood perception scales (infrastructure, safety, aesthetics, and satisfaction) were determined from 2013-2016 and categorized into the following groups: improvement, no change, or worsening over the time-period. Multivariate linear regression was used to measure the association between perceived improvement in each of the neighborhood characteristics with cardiometabolic outcomes (BMI, SBP, HbA1c, HDL-c) assessed in 2016. Outcomes were compared for those who perceived neighborhood improvements to those who perceived no change/worsening of neighborhood characteristics. Models were adjusted for age, sex, income, education, marital status, physical function, neighborhood, years spent in neighborhood. Interaction terms for age and sex were tested in the adjusted models. Results: Among the 622 individuals who did not move during the time-period, 93% were African American, 80% were female, and the mean age was 58 years. Many participants reported some improvements in neighborhood environment; infrastructure (48% reporting improvements), safety (47%), aesthetics (46%) and satisfaction (28%). In covariate-adjusted models, those who perceived improvement in their neighborhood aesthetics over the follow-up period had a significantly higher BMI (kg/m 2 ) than those who perceived no improvement/worsening (β=1.2, p=0.05). Similarly, perceived improvements in neighborhood safety were associated with higher BMI (β=1.5, p=0.01); however, they were also significantly associated with lower SBP (mmHg) (β=-3.8, p=0.01). A significant interaction was observed between sex and perceived improvement in safety when predicting BMI (interaction term p=0.04), such that the relationship between perceived improvements in safety and higher BMI was observed only among women (β=2.3, p=0.02). We did not observe any statistically significant interactions by age. We also did not find significant associations between changes in neighborhood characteristics and HDL-c or HbA1c. Conclusions: These findings suggest that perceived neighborhood characteristics may have differing associations with multiple cardiometabolic outcomes (BMI, SBP). This highlights the complexity of the associations between neighborhood characteristics and health as well as the importance of considering how changes in perceived neighborhood characteristics associate with multiple clinically relevant cardiometabolic risk factors, and how associations may be sex dependent.

Prevalence of Obesity and Severe Obesity in US Children, 1999-2016.

To provide updated prevalence data on obesity trends among US children and adolescents aged 2 to 19 years from a nationally representative sample. We used the NHANES for years 1999 to 2016. Weight status was determined by using measured height and weight from the physical examination component of the NHANES to calculate age- and sex-specific BMI. We report the prevalence estimates of overweight and obesity (class I, class II, and class III) by 2-year NHANES cycles and compared cycles by using adjusted Wald tests and linear trends by using ordinary least squares regression. White and Asian American children have significantly lower rates of obesity than African American children, Hispanic children, or children of other races. We report a positive linear trend for all definitions of overweight and obesity among children 2-19 years old, most prominently among adolescents. Children aged 2 to 5 years showed a sharp increase in obesity prevalence from 2015 to 2016 compared with the previous cycle. Despite previous reports that obesity in children and adolescents has remained stable or decreased in recent years, we found no evidence of a decline in obesity prevalence at any age. In contrast, we report a significant increase in severe obesity among children aged 2 to 5 years since the 2013-2014 cycle, a trend that continued upward for many subgroups.

Investigating the Association Between Active Transportation to School and Bullying in Canadian Schoolchildren

Bullying, or the act of using direct or indirect physical and verbal tactics to distress or control another, has been recognized as an important problem among child populations internationally. The wide prevalence and deep impact of bullying indicates the need for targeted program implementation to eliminate the bullying epidemic. Focusing on new associations between bullying and other health behaviours will give insight and direction for new, more targeted bullying eradication approaches. The association explored in this undergraduate thesis project is between bullying and active transportation, defined in this study as walking and bicycling. Engagement by students in active forms of transportation to school is generally on the decline in North America. This is of concern, as methods of transportation including cycling and walking are forms of physical activity that can be an important indicator of improved health. Planned analyses will be based on the sixth (2009/10) Canadian cycle of the Health Behaviour in School-Aged Children (HBSC) Study. The HBSC study is a World Health Organization cross-national study focused on the investigation of health behaviours among adolescents in 43 participating countries. A variety of statistical analysis tools will be employed to determine whether a link can be drawn between students who engage in active transportation and their involvement with bullying (whether as a victim, a perpetrator, or both). This will provide foundational information for health promotion efforts. By targeting the concerns of youth and their parents and providing objective evidence about the bullying risks (real or perceived) involved in active transportation, student may be encouraged to adopt a healthier, more active lifestyle that could eventually translate into lower obesity rates and a healthier population.

Assessing Social Contagion in Body Mass Index, Overweight, and Obesity Using a Natural Experiment

Little is known about whether the substantial clustering of obesity and overweight within social and geographic networks results from causal pathways, such as social contagion and shared environments, or from self-selection. This study aimed to determine whether exposure to communities with higher rates of obesity increases the body mass index (BMI) of individuals, calculated as weight in kilograms divided by height in meters squared, and their risk of being overweight or obese, and whether social contagion, shared environments, or self-selection can account for identified differences. This natural experiment study used the routine assignment of military service members to installations as a source of exogenous variation in exposure to communities with higher vs lower rates of obesity. The study, which used data collected by the Military Teenagers' Environments, Exercise, and Nutrition Study, examined families from 38 military installations around the United States to determine if individuals had higher BMI and greater odds of overweight and obesity when assigned to installations in counties with higher rates of obesity. The study also examined if the relationship persisted after controlling for shared built environments. The participants included 1 parent and 1 child aged 12 or 13 years from 1519 families of Army-enlisted personnel. Data analysis was completed from November 2016 to October 2017. Adult obesity rate in the county where the assigned installation of the service member was located. Time at installation and location of residence (on-installation vs off-installation) were used to measure the degree of exposure. For parents, outcomes were BMI, overweight/obesity (BMI, ≥25) and obesity (BMI, ≥30). For children, outcomes were BMI z score, overweight/obesity (BMI percentile for age and sex, ≥85), and obesity (BMI percentile for age and sex, ≥95). These outcomes were based on self-reports for parents, self-reports and parent reports for all children, and anthropometric measurements for a subsample of children. Members of 1519 families participated, including 1314 adults (of whom 740, or 56%, were fathers) and 1111 children (of whom 576, or 52%, were boys); anthropometric measurements were performed on 458 children. The sample was 40% white, 22% black, 24% Hispanic, and 14% other races/ethnicities. A 1-percentage point higher county obesity rate was associated with a higher BMI (a difference of 0.08; 95% CI, 0.02-0.13) and greater odds of obesity (adjusted odds ratio [aOR], 1.05; 95% CI, 1.02-1.08) in parents, and a higher BMI z score (0.01; 95% CI, 0.003-0.02) and greater odds of overweight/obesity (aOR, 1.04; 95% CI, 1.01-1.06) in children. The evidence supported stronger associations among families with more time at installation and off-installation residence. Associations persisted even after controlling for shared built environments. Exposure to counties with higher rates of obesity was associated with higher BMI and higher odds of overweight and/or obesity in parents and children. There was no evidence to support self-selection or shared built environments as possible explanations, which suggests the presence of social contagion in obesity.

Evaluating the Contribution of the Built Environment on Obesity Among New York State Students.

One third of school-aged children in New York State (NYS) are overweight or obese, with large geographic disparities across local regions. We used NYS student obesity surveillance data to assess whether these geographical variations are attributable to the built environment. We combined NYS Student Weight Status Category Reporting System 2010-2012 data with other government publicly available data. Ordinary least squares regression models identified key determinants of school district-level student obesity rates for elementary and middle/high schools. Geographical weighted regression models explored spatial variations in local coefficients of the built environment predictors. From ordinary least squares models, higher farmers' market density was only significantly associated with lower obesity rates among elementary school students (b = -0.116; p < .01). Higher fast-food restaurant density was significantly associated with higher obesity rates (b = 0.014; p < .05), and higher land use mix was only significantly associated with lower obesity rates (b = -0.054; p < .01) among middle/high school students. In geographical weighted regression analyses, the inverse association between market density and obesity rates among elementary school students was more pronounced in the eastern portion of the state. The relationship between higher fast-food restaurant density and higher obesity rates among middle/high school students was found in the southeastern portion of the state. Different patterns of food consumption may explain varying determinants of obesity between younger and older students. Regional variations in local associations between the built environment variables and obesity may suggest differences in how healthy food sources are accessed locally.

Abstract A02: Comparative analysis of breast density among Black, White, and Hispanic women presenting for screening mammography

Abstract Background: Data on ethnic variations in breast density are limited and often not inclusive of underrepresented minorities, including Black and Hispanic women. As breast density is associated with elevated breast cancer risk, investigating racial and ethnic difference may elucidate the observed differences in breast cancer risk among different populations. Methods: We reviewed breast density recorded at the initial mammographic screening study in women presenting to the Capital Breast Care Center (CBCC) and Georgetown University Hospital (GUH) from 2010 to 2014. Patient demographics including race, age at screening, education and menopausal status were abstracted in addition to body mass index (BMI). From imaging reports, we recorded the BI-RADS density categories: 1-fatty, 2-scattered fibroglandular densities, 3-heterogeneously dense and 4-extremely dense. Multivariable unconditional logistic regression was used to identify predictors of breast density. Results: Density categorization was recorded for 2,146 women over the five-year period, with 940 (43.8%) Black, 893 (41.6%), Hispanic and 314 (14.6%) White. Analysis of subject characteristics by low density (categories 1 and 2) and high density (categories 3 and 4) show that high category is observed in younger, Hispanic, nulliparous, premenopausal and non-obese women (P-values &amp;lt;.0001). Obese women are 70% less likely to have high breast density compared to non-obese women. Being Hispanic, premenopausal, and non-obese were predictive of high mammographic density on logistic regression. Conclusion: In this analysis of density distribution in a diverse sample of women presenting for mammography, Hispanic women have the highest breast density, followed by Black women with Whites having the lowest. Unique in our findings is women who identify as Hispanic having the highest breast density and lower rates of obesity. Further investigation of the impact of obesity on breast density in minority women, especially in the understudied Hispanic group is needed. Citation Format: Bridget A. Oppong, Chiranjeev Dash, Suzanne Oneill, Kepher Makambi, Tesha Coleman, Lucile L. Adams-Campbell. Comparative analysis of breast density among Black, White, and Hispanic women presenting for screening mammography [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr A02.

Yogurt, Its Relationship to Cardiometabolic Outcomes, and Patterns of Consumption

Regular yogurt consumption has been associated with significant health benefits, including reducing weight gain and preventing obesity, prevention of diabetes, and improved overall diet quality. While yogurt has been aggressively marketed in recent years and consumption has increased, little is known about consumers of yogurt, including their health characteristics and nutrition attitudes and related behaviors. Our purpose was to summarize clinical studies on the health benefits of yogurt and also to report the results of an analysis of market research data on patterns and trends in consumption. A number of observational studies have reported associations of higher yogurt consumption with lower rates of obesity, weight gain, and diabetes. We analyzed detailed dietary intake surveys for 9560 adults and children. Women are more likely to be yogurt consumers than men (49.3 vs. 29.6%). Compared with non-consumers, consumers are more affluent and highly educated. 28.9% of yogurt consumers were obese, compared to 34.7% of non-consumers (p = 0.014). Consumers were more likely to be dieting at the time of the survey (22.9 vs. 17.7%, p = 0.02). There were substantial differences in nutrition attitudes, beliefs, and behaviors between consumers and non-consumers. Compared with non-consumers, yogurt consumers reported being more knowledgeable about nutrition (3.69 vs. 3.29, 5-point scale, p < 0.01) and also checking nutrition food labels (5.61 vs. 5.15, 7-point scale, p < 0.01). Consumers were less likely to agree than non-consumers that how a food tastes is more important than its nutritional value (4.08 vs. 4.45, 7-point scale, p < 0.01). Greek yogurt consumption increased from 1.8 mean annual eating occasions per capita in 2010 to 17.9 in 2015 (p < 0.01). Greek yogurt consumers were more likely than traditional yogurt consumers to live in households with annual incomes of $70,000 or more (45.6 vs. 33.2% for traditional yogurt consumers, p < .0.001). Yogurt consumption has been associated with lower rates of obesity and better health in prior studies. Our new work suggests that these observations may be mediated by education, income, and more favorable attitudes toward highly nutritious foods.

Obesity and elevated blood pressure in suburban student athletes

ObjectiveTo assess the prevalence of obesity and elevated blood pressure in a suburban population of middle school and high school student athletes and examine the differences from the previously published...

Temporal trends, center-level variation, and the impact of prevalent state obesity rates on acceptance of obese living kidney donors.

The impact of pre-donation obesity on long-term outcomes of living kidney donors remains controversial. Published guidelines offer varying recommendations regarding BMI (kg/m2 ) thresholds for donor acceptance. We examined temporal and center-level variation in BMI of accepted donors across US transplant centers. Using national transplant registry data, we performed multivariate hierarchical logistic regression modeling using pairwise comparisons (overweight, BMI: 25-29.9; mildly obese, BMI: 30-34.9; very obese, BMI: ≥35; versus normal BMI: 18.5-24.9). Metrics of heterogeneity, including median odds ratio (MOR), were calculated. Among 90013 living kidney donors, 2001-2016, proportions who were very obese decreased and proportions who were mildly obese or overweight increased. Significant center-level heterogeneity was noted in BMI of accepted donors; the MOR varied from 1.10 for overweight to 1.93 for very obese donors. At centers located in the 10 states with the highest general population obesity rates, adjusted odds of very obese donor status were 185% higher (reference: normal BMI) than in states with the lowest obesity rates. Although there is a declining trend in acceptance of very obese living kidney donors, variation across centers is significant. Furthermore, local population obesity rates may affect the decision to accept obese individuals as donors.

Breast density in multiethnic women presenting for screening mammography.

Data on ethnic variations in breast density are limited and often not inclusive of underrepresented minorities. As breast density is associated with elevated breast cancer risk, investigating racial and ethnic difference may elucidate the observed differences in breast cancer risk among different populations. We reviewed breast density from initial screening of women from the Capital Breast Care Center and Georgetown University Hospital from 2010 to 2014. Patient demographics including race, age at screening, education, menopausal status, and body mass index were abstracted. We recorded the BI-RADS density categories: (1) "fatty," (2) "scattered fibroglandular densities," (3) "heterogeneously dense," and (4) "extremely dense." Multivariable unconditional logistic regression was used to identify predictors of breast density. Density categorization was recorded for 2146 women over the 5-year period, comprising Blacks (n=940), Hispanics (n=893), and Whites (n=314). Analysis of subject characteristics by breast density showed that high category is observed in younger, Hispanic, nulliparous, premenopausal, and nonobese women (t-test or chi-square test, P-values <.0001). Obese women are 70% less likely to have high density. Being Hispanic, premenopausal, and nonobese were predictive of high density on logistic regression. In this analysis of density distribution in a diverse sample, Hispanic women have the highest breast density, followed by Blacks and Whites. Unique in our findings is women who identify as Hispanic have the highest breast density and lower rates of obesity. Further investigation of the impact of obesity on breast density, especially in the understudied Hispanic group is needed.

Association of residential greenness with obesity and physical activity in a US cohort of women

There is evidence of several health benefits associated with neighborhood greenness, but reasons for this are unclear. Studies have found that those who live in greener neighborhoods are more physically active, and have lower rates of obesity. Relatively few studies have attempted to characterize associations between greenness and both obesity and physical activity concurrently, or among women who are at higher risk of developing cancer and for whom physical activity may be important for primary prevention. To address these gaps, we undertook a cross-sectional analysis of data from 50,884 women who enrolled in the Sister Study between 2003 and 2009. This cohort includes women aged 35–74 whose sister had been diagnosed with breast cancer. Residential measures of greenness were determined using the US National Land Cover database. Logistic regression was used to characterize associations between greenness, obesity, and physical activity. Adjustments were made for other possible confounders. Women who lived in areas with the highest tertile of greenness (based on a 500m buffer) had a reduced risk of obesity (body mass index (BMI) ≥ 30) relative to those in the lowest tertile (odds ratio (OR) = 0.83, 95% CI = 0.79–0.87). We also found that those the upper tertile of greenness were 17% more likely to expend more than 67.1 metabolic equivalent (MET) hours per week when compared to those in the lowest tertile (OR = 1.17, 95% CI = 1.10–1.23). Beneficial associations between greenness and both obesity and physical activity were observed in urban and rural areas, and regionally, stronger associations were observed in the western census region in the US. Mediation analyses indicated that physical activity attenuated the association between greenness and obesity by 32%. Our findings indicate that, amongst US adult women at higher risks of breast cancer, residential proximity to greenness may help mitigate against sedentary behaviors that increase the risk of chronic disease.

Gender differences in height, weight and BMI on self-esteem among rural school-aged children in China

3,344 Children aged between 10 to 16 years from grade 4 to 10 were recruited to explore potential explanatory variables of low self-esteem among rural school-aged children in China. The results showed that the RSE scores were slightly higher for girls than for boys and higher academic achievement didn't contribute higher RSE scores in rural China. A lower height Z-scores resulted in a lower self-esteem in girls, and low SE was associated with height Z-score less than -1 versus scores more than -1 (OR=1.69, 95% CI 1.19-2.38, P=0.003). The findings indicated that it was height and BMI rather than weight to girls and weight to boys that were significantly associated with low self-esteem in rural China under the premise of very low rate of obesity.

A5321 - The comparison of adipokines and inflammatory factors between Chinese bariatric candidates and normal weight population

Obesity and type 2 diabetes, dyslipidemia and related metabolic disease has become a threat to our national life and health which is showing a trend. Compared with countries such as the UK and USA, China had a lower rate of obesity in adults in 2013, but the absolute number of obese people in China is exceeded only by that in the USA. In addition, we are wonder whether adipokines and inflammatory cytokines have some correlation in different severity obese patients. It is worth to explore adipokines and inflammatory factors levels guide us to choice the different surgical approach to different severity obese patientst.

Is urban-rural location associated with weight status in school children? An examination of 42 small and rural Californian counties.

Studies have identified geographic variation in overweight and obesity rates among children, with higher rates of overweight and obesity often found among children living in rural compared to urban areas. A small number of studies have explored differences in overweight and obesity based on more nuanced gradations along the urban-rural continuum. The purpose of the present study was to identify differences in overweight and obesity based on gradations along the urban-rural continuum among children in 42 Californian counties with populations less than 500 000. An observational study was conducted using FITNESSGRAM data collected from 5th, 7th and 9th grade students in public schools in California during 2010-2011. The FITNESSGRAM dataset was merged with the 2011 Public Elementary/Secondary School Universe Survey Data from the National Center for Educational Statistics Common Core of Data, which includes an 'urban-centric locale' code for each school, consisting of four broad classifications - city, suburb, town, and rural - each of which is further broken down into three subcategories. Multivariate analyses using a general linear model were conducted to compare differences in body mass index (BMI) between geographic regions of schools (city, suburb, town and rural) as well as 11 urban-centric locale code subcategories; none of the schools were located in large cities. The percentage of students who were overweight and/or obese was compared by grade level, gender, and race/ethnicity across geographic regions using multivariate logistic regression models. Analyses were adjusted for student age, grade, gender, race/ethnicity (African-American, Asian, Hispanic, Indian/Alaskan, White, two or more races or unknown), eligibility for free or reduced price meals, and clustering of students by school. When a stratified analysis was done, the variable of stratification (ie grade, gender, race/ethnicity) was not included among the covariates. When significant differences in BMI or prevalence of overweight or obesity were found between geographic regions, Tukey's method was applied to adjust for multiple comparisons at a 5% procedure-wise error rate. A p-value at or less than 0.05 was used to indicate statistical significance. Students in suburban schools had significantly lower mean BMI and lower prevalence of overweight than students in other geographic areas (p<0.0001). Among 5th and 7th grade students, prevalence of obesity (but not overweight) varied by urban-rural status (p<0.0001, p=0.01, respectively), with 7th grade students in suburbs having lower rates of obesity than those in towns. Among 9th grade students, prevalence of overweight (but not obesity) varied by urban-rural status (p=0.02). Among females, prevalence of overweight and obesity varied (p=0.006, p<0.0001, respectively), with suburbs having lower rates than cities and towns. Among males, prevalence of obesity varied (p<0.0001), with suburbs having lower rates. Among whites, there were differences in prevalence of overweight and obesity by urban-rural status (p=0.01, p <0.0001, respectively). Among Hispanics, the prevalence of obesity varied by urban-rural status (p=0.001). Large suburban areas had the lowest rates of obesity compared to all other subcategories. Students attending schools in suburban, especially larger suburban, areas appear to have lower prevalence of obesity than their peers at schools in other geographic areas. Further research is needed to understand the factors associated with differences in weight status between urban, suburban, town and rural areas.