Maintenance Of Body Mass Index Research Articles

Abstract P616: Implementing a Dietary Energy Density Intervention in Preschool Children

Introduction: The preschool years have been identified as a critical time to intervene on energy balance behaviors to halt the progression of obesity. In children, strategies for achieving physical activity recommendations are well established. Less clear are strategies for implementing an optimal dietary approach—one that maintains a healthy body weight and improves diet quality. Energy density (ED), the amount of energy per unit weight of food (kcal/g), may be a promising dietary approach. Hypothesis: We tested the hypothesis that a lower ED dietary approach will lower ED and energy intake and demonstrate better maintenance of body mass index (BMI z-score) than standard dietary recommendations in young children at risk for obesity. Methods: Thirty-six preschool children (3.5±1.1 years; 52.8% female; 52.8% White; 16.7% Hispanic or Latino; BMI percentile 56.8±22.2) and their parent (35.4±6.2 years; 86.1% female; 55.6% White; 13.9% Hispanic or Latino; BMI 38.2±5.4 kg/m 2 ) participated in a 6-month, 14-session, family-based behavioral intervention. Participants were randomized to a low-ED dietary approach (consume ≥10 foods/day with an ED ≤1.0 kcal/g and ≤2 foods/day with an ED ≥ 3.0 kcal/g; LOW-ED), or standard dietary recommendations (meet recommended daily servings of fruits, vegetables, and whole grains; STANDARD). Both interventions had physical activity goals of 60 minutes/day for children and 150 minutes/week for adults. Dietary and anthropometric assessments occurred at baseline and 6-months. Completer and intent-to-treat (ITT) analyses, with outliers removed, used repeated measures general linear mixed models to examine child change in ED (calculated as both all foods and beverages and food only), kcals, and BMI z-score from baseline to 6 months. Results: ITT analyses showed that the change in ED did not differ between the LOW-ED condition and STANDARD condition when calculated as for foods and beverages (LOW-ED: Δ-0.1 kcal/g vs. STANDARD: Δ+0.1 kcal/g, p = 0.12) or food only (LOW-ED: Δ-0.2 kcal/g vs. STANDARD: Δ+0.1 kcal/g, p = 0.06). There was a significant time by condition interaction with kcals/d decreasing in LOW-ED and increasing in STANDARD over time for completers (LOW-ED: Δ-98 kcals vs. STANDARD: Δ+212 kcals, p = 0.04), but not when using ITT (LOW-ED: Δ+5 kcals vs. STANDARD: Δ+211 kcals, p = 0.09). Under ITT BMI z-score had a main effect of time, with both LOW-ED and STANDARD conditions significantly increasing over time (p=0.03). Conclusion: In conclusion, these data suggest a LOW-ED dietary approach is an alternative way to lower ED and energy intake in young children at risk for obesity.

Migration-Related Weight Changes among African Immigrants in the United States

(1) Background: people who migrate from low-to high-income countries are at an increased risk of weight gain, and excess weight is a risk factor for cardiovascular disease. Few studies have quantified the changes in body mass index (BMI) pre- and post-migration among African immigrants. We assessed changes in BMI pre- and post-migration from Africa to the United States (US) and its associated risk factors. (2) Methods: we performed a cross-sectional analysis of the African Immigrant Health Study, which included African immigrants in the Baltimore-Washington District of the Columbia metropolitan area. BMI category change was the outcome of interest, categorized as healthy BMI change or maintenance, unhealthy BMI maintenance, and unhealthy BMI change. We explored the following potential factors of BMI change: sex, age at migration, percentage of life in the US, perceived stress, and reasons for migration. We performed multinomial logistic regression adjusting for employment, education, income, and marital status. (3) Results: we included 300 participants with a mean (±SD) current age of 47 (±11.4) years, and 56% were female. Overall, 14% of the participants had a healthy BMI change or maintenance, 22% had an unhealthy BMI maintenance, and 64% had an unhealthy BMI change. Each year of age at immigration was associated with a 7% higher relative risk of maintaining an unhealthy BMI (relative risk ratio [RRR]: 1.07; 95% CI 1.01, 1.14), and compared to men, females had two times the relative risk of unhealthy BMI maintenance (RRR: 2.67; 95% CI 1.02, 7.02). Spending 25% or more of life in the US was associated with a 3-fold higher risk of unhealthy BMI change (RRR: 2.78; 95% CI 1.1, 6.97). (4) Conclusions: the age at immigration, the reason for migration, and length of residence in the US could inform health promotion interventions that are targeted at preventing unhealthy weight gain among African immigrants.

Prognostic Value of Change in Albumin and Body Mass Index during and after Definitive Radiotherapy in Patients with Locally Advanced Cervical Cancer

<h3>Purpose/Objective(s)</h3> Definitive radiotherapy (RT) is the standard treatment in patients with locally advanced cervical cancer (LACC). Many studies have shown that in addition to the intrinsic characteristics of the tumor, there are many other factors can also affect the prognosis, such as baseline nutritional and inflammation status. However, which of these factors, or their alterations during radiotherapy, has a greater impact on prognosis is unclear on survival is unknown. Therefore, the purpose of this study was to observe changes in these factors during RT and to evaluate the prognostic impact of these factors and their changes in clinical practice. <h3>Materials/Methods</h3> A total of 229 patients were involved in this retrospective study. All patients received definitive RT at a single institution. Clinical pathological characteristics and eight inflammatory and nutritional factors (albumin, weight, Body Mass Index (BMI), neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, etc.) of patients were collected at pre-, during and post-radiation. Changes in those parameters at different radiotherapy periods were evaluated, and the association between those parameters and their changes with progression-free survival (PFS) and overall survival (OS) were assessed at 3 years. <h3>Results</h3> The median follow-up periods were 42.3 months for all patients. During RT, almost all the parameters reduced significantly, and after RT, albumin levels returned to pre-treatment levels, but the body weight was further significantly reduced compare with that during RT (p < 0.001). In univariate analysis, neither baseline nutritional nor inflammatory factor levels were shown to be associated with prognosis, whereas changes in albumin and body weight during RT were associated with prognosis. In multivariate analysis, non-SCC (HR 2.747 for PFS, <i>p</i> =0.016; HR 2.983 for OS, p=0.016), a decrease >0.2kg/m² in BMI during and post RT (HR 2.595 for PFS, <i>p</i> <0.001; HR 2.579 for OS, <i>p</i> =0.002), and albumin <35g/L (defined as hypoalbuminemia) during RT (HR 2.208 for PFS, <i>p</i> =0.004; HR 2.069 for OS, <i>p</i> =0.021), were independent predictors of poor prognosis for both PFS and OS, ranking with gradually decreased hazard ratios. Hypoalbuminemia during RT was more common in patients with older age, lower baseline hemoglobin and albumin levels, BMI <25kg/m², concurrent chemotherapy with weekly cisplatin and higher incidence of diarrhea during treatment. However, the decrease in BMI during and post RT showed no significant association with patients' baseline characteristics. <h3>Conclusion</h3> Changes in albumin and BMI during or after RT showed more prognostic value than their baseline levels or other hematological and inflammatory parameters in LACC. Therefore, prevention of hypoalbuminemia during RT and maintenance of BMI in the middle and later stages of RT are the management priorities in the clinical practice of LACC.

Community-Clinical Linkages: The Effects of the Healthy Here Wellness Referral Center on Chronic Disease Indicators Among Underserved Populations in New Mexico.

The majority of U.S. adults are living with at least one chronic condition, and people of color bear a disproportionate burden of chronic disease. Prior research identifies community-clinical linkages (CCLs) as a strategy for improving health. CCLs traditionally use health care providers to connect patients to community-based self-management programs. The purpose of this study was to examine the effectiveness of a centralized CCL system on health indicators and health disparities. Administrative health data were merged with referral system data to conduct a quasi-experimental comparative time series study with a comparison group of nonreferred patients. Interrupted time-series comparisons within referred patients were also conducted. Of the 2,920 patients meeting inclusion criteria, 972 (33.3%) received a referral during the study period (January 2019-September 2021). Hemoglobin A1c levels, used to diagnose diabetes, declined significantly among referred patients, as did disparities among Hispanic/Latinx participants compared with non-Hispanic White participants. No changes were observed in body mass index (BMI). Blood pressure increased among both referred and nonreferred patients. CCLs with a centralized referral system can effectively reduce markers of diabetes and may contribute to the maintenance of BMI. The observed increase in blood pressure may have been affected by the COVID-19 pandemic and warrants further study. Practitioners can work with community partners to implement a centralized CCL model, either on its own or to enhance existing clinician or community health worker-based models.

Body mass index change in relation to longitudinal systolic blood pressure: An age- and sex-matched and repeated measures study

Background and aimsThe positive association between mean systolic blood pressure (SBP) and body mass index (BMI) diminished or reversed over the past four decades. The primary aim of this study was to evaluate effects of BMI change on longitudinal SBP. Methods and resultsA total of 3638 participants who had annual health examination from 2015 to 2019 were included and matched by age and sex according to BMI levels. BMI and SBP were measured annually and their association were assessed by a linear mixed-effects regression model. The normal weight participants had a sustained weight gain as well as SBP increase during the study period (all Ptrend <0.001). The obese participants had a sustained weight loss but SBP did not decrease simultaneously. If BMI change was considered, the obese participants with BMI loss had a significant decrease of SBP during the study period (Ptrend = 0.0012). Mixed-effects models showed that weight gain was more influential on longitudinal SBP in the normal weight participants and weight loss was in the obese participants. The obese group with BMI loss had a decrease of SBP by 5.01 mmHg (95% confidence interval: 2.56 mmHg, 7.46 mmHg) compared to their counterparts with BMI maintenance from 2015 to 2019. ConclusionsThe effect of weight change on longitudinal SBP was varied among BMI groups. With the increase of baseline BMI level, the positive effect of weight loss on SBP became greater and the negative effect of weight gain on SBP were attenuated.

The Statin Target Hmgcr Regulates Energy Metabolism and Food Intake through Central Mechanisms.

The statin drug target, 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), is strongly linked to body mass index (BMI), yet how HMGCR influences BMI is not understood. In mammals, studies of peripheral HMGCR have not clearly identified a role in BMI maintenance and, despite considerable central nervous system expression, a function for central HMGCR has not been determined. Similar to mammals, Hmgcr is highly expressed in the Drosophila melanogaster brain. Therefore, genetic and pharmacological studies were performed to identify how central Hmgcr regulates Drosophila energy metabolism and feeding behavior. We found that inhibiting Hmgcr, in insulin-producing cells of the Drosophila pars intercerebralis (PI), the fly hypothalamic equivalent, significantly reduces the expression of insulin-like peptides, severely decreasing insulin signaling. In fact, reducing Hmgcr expression throughout development causes decreased body size, increased lipid storage, hyperglycemia, and hyperphagia. Furthermore, the Hmgcr induced hyperphagia phenotype requires a conserved insulin-regulated α-glucosidase, target of brain insulin (tobi). In rats and mice, acute inhibition of hypothalamic Hmgcr activity stimulates food intake. This study presents evidence of how central Hmgcr regulation of metabolism and food intake could influence BMI.

Association between BMI variability and risk of fracture among Korean men and women: a population based study.

The bone-health-related outcome, such as fractures due to BMI fluctuation, has been understudied within Asian populations. In this large-scale, population-based cohort study in Korea, we aimed to investigate the relationship between variability in body mass index (BMI) and the risk of fractures. The study included 166,932 subjects aged ≥ 50 years from the National Health Insurance Service-Health Screening Cohort. The BMI variability value from three follow-up examinations during 2002-2007 was categorized into quartiles. The hazard ratios (HRs) with 95% confidence intervals (CIs) for the effects of BMI variability on the risk of admission from hip, spine, and upper extremity fractures during 2008-2015 were evaluated using a Cox proportional hazards regression analysis. Compared to those in the lowest BMI variability (1st quartile), men in the highest BMI variability (4th quartile) showed an increased risk of spinal fractures (aHR 1.21, 95% CI 1.07-1.36) with a significant linear trend (P for trend = 0.021). Compared to those in the lowest BMI variability (1st quartile), women in the highest BMI variability (4th quartile) showed an increased risk of hip and spinal fractures (aHR 1.35, 95% CI 1.05-1.69; aHR 1.16, 95% CI 1.05-1.28) with significant linear trends (P for trend = 0.021; P for trend = 0.003, respectively). There was no association between BMI variability and incidents of upper extremity fractures for men or women. Association between BMI variability and increased fracture risk depended on sex and fracture types. BMI maintenance, instead of high BMI fluctuation, may be beneficial in terms of lowering the overall fracture risk for Korean adults over 50 years old.

Smoking Cessation, Weight Change, and Risk of Parkinson's Disease: Analysis of National Cohort Data.

Background and PurposeTo determine whether the postcessation weight gain modifies the protective effect of smoking on the development of Parkinson's disease (PD).MethodsThis nationwide cohort study included 3,908,687 Korean males aged ≥40 years who underwent at least 2 health checkups biennially between 2009 and 2015. They were grouped into current smokers; quitters with body mass index (BMI) increase, maintenance, and decrease; and never smokers. The occurrence of incident PD was tracked, and Cox proportional-hazard models were used to adjust for potential confounding factors. We also analyzed the impact of weight change regardless of smoking status in the study population.ResultsThere were 6,871 incident PD cases observed during the 13,059,208 person-years of follow-up. The overall risk of PD was significantly lower in quitters than in never smokers [hazard ratio (HR)=0.78, 95% confidence interval (CI)=0.70–0.86]. The risk of PD was still lower in quitters with BMI increase (HR=0.80, 95% CI=0.65–0.98) and in those with BMI maintenance (HR=0.77, 95% CI=0.68–0.87). This tendency was also observed in quitters with BMI decrease (HR=0.76, 95% CI=0.55–1.06), although it was not as robust as in the other two groups. With respect to weight change alone, BMI increase (HR=1.10, 95% CI=1.02–1.18) but not BMI decrease (HR=1.06, 95% CI=0.98–1.14) significantly increased the PD risk compared to BMI maintenance.ConclusionsPostcessation weight gain in males did not offset the protective impact of smoking on PD development, although overall weight gain predicted an increased risk of PD.

Factors associated with maintenance of body mass index in the Jackson Heart Study: A prospective cohort study secondary analysis.

The purpose of this study was to compare the relationship of diet quality, physical activity, and environmental factors with body mass index (BMI) maintenance in African American adults. We analyzed data from 4041 participants in the Jackson Heart Study, a prospective cohort study based in Jackson, Mississippi. Exposures were baseline American Heart Association diet quality score, American Heart Association physical activity categories, the built environment, the food environment, and neighborhood safety. The outcome was weight maintenance or loss (no BMI increase ≥1.0kg/m2) versus weight gain (BMI increased ≥1.0kg/m2) over a mean of 5.0years. We found that 63% of participants maintained or lost weight and 37% gained weight. In multivariable analyses, ideal diet quality was associated with a 6% greater likelihood of BMI maintenance (incidence rate ratio [IRR] 1.06, 95% confidence interval [CI]: 1.03, 1.10). Living in an unsafe neighborhood was associated with a 2% lower likelihood of BMI maintenance (IRR 0.98, 95% CI: 0.96, 0.99), as was poor built environment (IRR 0.98, 95% CI: 0.97, 0.998). Physical activity and poor food environment were not associated with BMI maintenance. In conclusion, among African American adults in Jackson, Mississippi, high quality diet was the strongest factor associated with BMI maintenance.

Resting Energy Expenditure and Body Composition of Women with Weight Regain 24Months After Bariatric Surgery.

Weight regain 24months after Roux-en-Y gastric bypass (RYGB) and low protein intake in patients without protein supplementation can favor fat-free mass loss and reduce resting energy expenditure (REE). We aimed to assess REE and its association with the body composition of women with weight regain and no protein supplementation in the late postoperative period of RYGB. We determined the body mass index (BMI), REE by indirect calorimetry, body composition by tetrapolar bioelectrical impedance analysis, and energy intake by two 24-h recalls of 34 patients with at least 5% of weight regain and no protein supplementation. The software SPSS v.17 analyzed the data calculating measures of central tendency and dispersion and using Pearson's correlation to test the association between the variables and the multivariate linear regression model at a p < 0.05 significance level. Postoperative period was positively associated with weight regain (r = 0.39; p = 0.023). The mean percentages of fat and fat-free masses were 45.1 ± 8.3% and 54.3 ± 8.1%, respectively. The mean REE was 1424.7 ± 187.2kcal (14kcal/kg of the current weight), mean energy intake was 1258.6 ± 454.3kcal, and mean protein intake was 0.9g/kg of the ideal weight ± 0.3. Fat-free mass was positively associated with REE regardless of protein intake and postoperative period. Female bariatric patients with weight regain and no protein supplementation lose fat-free mass, lowering their REE. Health practices that promote maintenance of BMI and body composition may lead to improved outcomes of bariatric surgery.

Dieting Increases the Likelihood of Subsequent Obesity and BMI Gain: Results from a Prospective Study of an Australian National Sample.

Diet is a major determinant of obesity; however, findings from the studies examining how dieting to lose weight affects weight gain have been inconclusive. Our aim was to examine the longitudinal association of frequency of dieting for weight loss with (a) obesity status and (b) body mass index (BMI) change. We used data from Waves 9 (2009) and 10 (2010) of the Household Income and Labour Dynamics in Australia (HILDA) survey. Binominal logistic regression estimated the association of frequency of dieting in 2009 on probability of obesity in 2010. Multinomial logistic regression estimated the association of frequency of dieting in 2009 on the probability of BMI gain versus BMI maintenance and BMI loss between 2009 and 2010. The analysis sample size was 8824. Compared to those who were never on a diet in the previous year, the odds of obesity were 1.9, 2.9, and 3.2 times higher among those who were on a diet once, more than once, and always, respectively. Similarly, the odds of BMI gain versus BMI maintenance and also versus BMI loss were higher among those who dieted than those who did not. Dieting to lose weight can contribute to the risk of future obesity and weight gain. Losing weight requires a commitment to change one's lifestyle and a sustained effort to maintain a healthy diet and engage in physical activity.

Weight loss and nutritional anemia in patients submitted to Roux-en-Y gastric bypass on use of vitamin and mineral supplementation.

BackgroundObesity is a chronic disease with high growth in population and bariatric surgery is currently considered the most effective treatment for weight reduction; on the other hand, nutritional deficiencies are observed after this procedure.AimTo analyze weight loss progression and nutritional anemia in patients submitted to Roux-en-Y gastric bypass on use of vitamin and mineral supplementation.MethodsRetrospective analysis of 137 patients of both sexes, aged between 18-60 years, using supplemental multivitamins and minerals, were included; personal information, anthropometric and laboratory data in the preoperative, 12, 24, 36 and 48 months postoperatively were collected.ResultsPostoperatively, in both sexes, occurred weight loss compared to the pre-operative weight gain at 48 months and maintenance of body mass index. There was a decrease in the percentage of excess weight loss at 48 months postoperatively compared to the time of 12, 24 and 36 months in men and decreased at 48 postoperative months compared to the time of 24 months in females. There was a decreased in serum ferritin in both sexes and increased serum iron at 48 months postoperatively in males. There was a decreased in vitamin B12 and folic acid increased serum at 48 postoperative months in females.ConclusionsSurgical treatment was effective for reducing weight, body mass index reduction and achievement of success in the late postoperative period along with multivitamin and mineral supplementation on prevention of serious nutritional deficiencies and anemia.

Nutrition Intervention Program Improves Serum Lipid Profile of Obese Children in Select Schools from Chennai

Objective: The objective of this study was to devise an intervention program to improve body mass index (BMI) and serum lipid profile of obese school children in the age group of 10 to 15 years. Materials and Methods: The study comprised of a survey and pretest and posttest experimental design and was conducted over the course of a year. The total of 4289 children from 11 schools were screened for obesity based on age and gender specific cut-off values for BMI. Of the 193 children found to be obese, 49 children enrolled for the intervention program and were assigned to three specific groups using purposive sampling. Group I (Control), Group II (Nutrition Counseling) and Group III (Nutrition counseling and Exercise) comprised of 13, 19, and 17 children-at-risk, respectively. Descriptive analysis was used for assessing details regarding their dietary and physical activity pattern. Paired t-test was used to assess data pertaining to anthropometric measurements such as height, body weight, BMI, waist circumference and serum lipid parameters (total cholesterol [TC], high-density lipoprotein-cholesterol [HDL-C], low-density lipoprotein-cholesterol [LDL-C], very low-density lipoprotein cholesterol, ratio of TC/HDL-C and serum triglycerides). Results: Post intervention, BMI was found to be stable, and there was a significant increase (P < 0.01) in serum HDL-C levels and a significant decrease (P < 0.01) in the ratio of TC/HDL-C in Group III and a significant increase (P < 0.05) in serum HDL-C levels alone in Group II subjects. Conclusion: The intervention study highlights the maintenance of BMI and improvement in serum lipid parameters of children-at-risk who received periodic nutrition counseling.

Identification and management of overweight and obesity by internal medicine residents: Christopher B. Ruser, Lisa Sanders et al.

To the editor:—Similar to Ruser et al.,1 our Internal Medicine residency has also been studying obesity identification and management. In addition to an ambulatory chart review, for 3 years incoming residents were surveyed. In our chart review of resident practices at the Norwalk Community Health Center, structured similarly to a federally qualified health center,2 weight was documented in 63% of the charts reviewed and body mass index (BMI) in only 4%.3 There has been a trend of increasing awareness of obesity and its management among surveyed physicians in training. Over the last 3 years, 56 of 75 incoming residents (74.6%) completed a survey adapted from the literature using a 5-point Likert scale.3 Residents reported that maintenance of BMI in healthy range is important (98.2%) and that treatment for obese patients should be offered (67.8% when BMI>25 compared with 32.1% when BMI>30). Futhermore, 80.3% disagreed when asked whether treatment for overweight should be offered only when other risk factors such as Type II diabetes or hypertension are present. Residents noted their lack of training in managing overweight and obesity (only 32.1% and 26.7% felt that they are professionally well trained to manage overweight and obese patients, respectively). Finally, residents compared self-rated importance of different approaches for weight management with their personal use of these approaches with their patients. As expected, self-reported practice fell short of self-rated importance: patient weight history (usually done 10.7% vs important 80.3%); dietary habits (usually done 10.7% vs important 482.1%); physical activity habits (usually done 12.5% vs important 85.7%); and readiness for change at first contact (usually done 5.35% vs important 80.3%). As seen with other physicians, it is challenging to integrate weight management into medical practice.4–6 These results expand on the study published recently in JGIM and reinforce the importance of improving practice among Internal Medicine residents toward obesity. It is critical that trainees become prepared to deal with what is one of the largest growing epidemics facing health care today and in the future.