Metabolic Health Outcomes Research Articles

Participant views on participating in a pragmatic randomised controlled trial: the Aboriginal and Torres Strait Islander Women´s Fitness Program

IntroductionThe inequity of randomising participants to control groups in randomised controlled trials (RCTs) is often considered inappropriate, especially for research trials that include vulnerable populations such as Indigenous peoples. The Aboriginal and Torres Strait Islander Women’s Fitness Program conducted a trial that randomly assigned participants to ‘active’ and ‘waitlisted’ groups. This paper reports on participant views of the randomisation protocol.MethodsA pragmatic RCT was conducted in an urban setting to assess the effectiveness of the 12-week Aboriginal and Torres Strait Islander Women’s Fitness Program on metabolic health outcomes and waist circumference. Qualitative interviews were conducted at follow-up, one of the objectives was to explore participant perspectives on the research protocol, including participant randomisation to ‘Active’ and ‘Waitlisted’ groups.ResultsA total of 49 interviews were conducted (26 Active and 23 Waitlisted participants). Two key factors influenced participant views on the protocol: 1) group assignment; and 2) how well they understood the research design, including the justification for randomisation. ‘Active’ participants were concerned about the inequity of the randomisation process but overall supported the study protocol. Although most Waitlisted participants were disappointed about having to wait 12-months for the program, some participants derived motivation from being waitlisted, whilst others lost motivation. Well-informed participants were more likely to express both support for the randomisation process and an understanding of the research benefits than participants not attending an information session prior to registration.ConclusionsParticipants were more accepting of the research protocol if it was clearly explained to them, if they understood the randomisation process and felt the randomisation was justified in terms of the potential for the results to benefit other Aboriginal and Torres Strait Islander women. Our study suggests that the time and resources required to adequately explain the research protocol in research trials should not be undervalued.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12610000224022).

The muscle mass, omega-3, diet, exercise and lifestyle (MODEL) study - a randomised controlled trial for women who have completed breast cancer treatment.

BackgroundLoss of lean body mass (LBM) is a common occurrence after treatment for breast cancer and is related to deleterious metabolic health outcomes [Clin Oncol, 22(4):281–288, 2010; Appl Physiol Nutr Metab, 34(5):950–956, 2009]. The aim of this research is to determine the effectiveness of long chain omega-3 fatty acids (LCn-3s) and exercise training alone, or in combination, in addressing LBM loss in breast cancer survivors.Methods/designA total of 153 women who have completed treatment for breast cancer in the last 12 months, with a Body Mass Index (BMI) of 20 to 35 kg/m2, will be randomly assigned to one of 3 groups: 3g/d LCn-3s (N-3), a 12-week nutrition and exercise education program plus olive oil (P-LC) or the education program plus LCn-3s (EX+N-3). Participants randomised to the education groups will be blinded to treatment, and will receive either olive oil placebo (OO+N-3) or LCn-3 provision, while the N-3 group will be open label. The education program includes nine 60-75min sessions over 12 weeks that will involve breast cancer specific healthy eating advice, plus a supervised exercise session run as a resistance exercise circuit. They will also be advised to conduct the resistance training and aerobic training 5 to 7 days per week collectively. Outcome measures will be taken at baseline, 12-weeks and 24-weeks. The primary outcome is % change in LBM as measured by the air displacement plethysmograhy. Secondary outcomes include quality of life (FACT-B + 4) and inflammation (C-Reactive protein: CRP). Additional measures taken will be erythrocyte fatty acid analysis, fatigue, physical activity, menopausal symptoms, dietary intake, joint pain and function indices.DiscussionThis research will provide the first insight into the efficacy of LCn-3s alone or in combination with exercise in breast cancer survivors with regards to LBM and quality of life. In addition, this study is designed to improve evidence-based dietetic practice, and how specific dietary prescription may link with appropriate exercise interventions.Trials registrationACTRN12610001005044; and World Health Organisation Universal trial number: U1111-1116-8520.

Reply to JS White

Dear Sir: Studies using dietary conditions with exaggerated nutritional compositions are often used to define the potential for biological responses and to act as starting points for understanding nutritional effects on health. The monkeys in the study consumed 30% more fructose than the unhealthiest humans, with fructose approximating the 95th percentile of total carbohydrate consumption (1, 2). This intake was modeled on the clinical study by Stanhope et al (3), which showed changes in adiposity, plasma lipids, and insulin sensitivity. Monkeys supplemented with fructose at this same amount (4) similarly experienced detrimental changes in these variables. Thus, our goal was to evaluate the influence of an extreme change in fructose while holding adiposity constant by careful focus on caloric and body weight control. One advantage of animal models, especially Old World monkeys with gastrointestinal tracts more comparable to humans, is sufficient longer-term environmental control to unmask perturbations induced by manipulation of nutritional variables. A potential next step would be to narrow the intake range over which health effects may be seen, while matching all dietary ingredients including protein source. Casein is known to be proatherogenic in the context of cholesterol-loaded dietary experiments (5); however, we actually reported no elevations in plasma or liver cholesterol concentrations (free or esterified) with high-fructose/casein diets, endpoints that are known risk factors for atherosclerosis (6). We therefore believe that the lack of differences seen in these endpoints in our study suggests that protein source did not primarily influence metabolic health, microbial translocation, and liver injury outcomes. We conclude that consumption of very high amounts of simple carbohydrate is likely to impair intestinal integrity and initiate liver and metabolic changes. Human and rodent studies involving exaggerated diets support the greater potency of fructose compared with glucose in initiation of such changes (3, 7), and future experiments should refine these findings using relevant diets in relevant animal studies.

The role of carbohydrate counting in type 1 diabetes

The goal of carbohydrate counting in the management of type 1 diabetes is to match insulin dose to food intake to permit flexibility in food choices without adversely affecting metabolic control and health outcomes.1 In The Lancet Diabetes and Endocrinology, the meta-analysis of carbohydrate counting research in type 1 diabetes by Kirstine Bell and colleagues2 identified some evidence to recommend carbohydrate counting over alternate advice or so-called usual care in adults with type 1 diabetes.

Predictors of Diabetes Self‐care, Metabolic Control, and Mental Health in Youth with Type 1 Diabetes

The purpose of this study was to explore the psychosocial predictors of diabetes self‐care (adherence to care regimes), metabolic control (glycated haemoglobin), and mental health among rural‐ and urban‐dwelling youth with type 1 diabetes. One hundred and twenty three adolescents/young adults (aged 13−25 years, mean = 16 years, standard deviation = 3.8 years) with type 1 diabetes, 50 males and 73 females, completed questionnaires reporting on diabetes self‐care, metabolic control, mental health (negative affect, quality of life), risk‐taking behaviours and attitudes, diabetes self‐efficacy, community engagement, and perceived social support. No rural/urban differences were detected on key predictors or outcome variables. Structural equation modelling revealed that high diabetes self‐efficacy, lower risk behaviour, and more conservative attitudes to risk taking predicted better diabetes self‐care, which in turn predicted better metabolic control and mental health. Social support and engagement in community activities did not influence diabetes self‐care. The study has significance because both diabetes self‐efficacy and propensity towards risk behaviour are potential targets for educational and counselling interventions designed to improve diabetes self‐care regimes and resultant metabolic and mental health outcomes.

Severe hyperemesis gravidarum affects offspring metabolism in childhood

Hyperemesis gravidarum leads to alterations in maternal (and possibly fetal) nutrition throughout pregnancy, but there are no data on the long-term metabolic health outcomes in the offspring. We hypothesized that hyperemesis gravidarum could lead to fetal nutritional compromise or physiological stress, which may programme later metabolism and body composition. Two groups of healthy pre-pubertal children born at term, aged 4–11 years were studied: offspring of mothers who suffered hyperemesis gravidarum (HG group; n=36) and controls (n=54). Recruited HG children were born to mothers admitted to hospital with metabolic disturbance during pregnancy. Following an overnight fast, a frequently sampled intravenous glucose tolerance test modified by insulin was performed, and insulin sensitivity was measured using Bergman’s minimal model. Other assessments included fasting lipid and hormonal profiles, as well as body composition using whole-body dual-energy x-ray absorptiometry. Data were analysed separately using linear mixed models, controlling for appropriate confounders. Data are expressed as mean±SEM. Children born to mothers with severe HG had reduced SI (10.4±0.6 vs 13.4±0.9 x10 -4 min �1 ·(mU/L); p=0.016), increased fasting insulin (6.5±0.6 vs 4.9± 0.3 mIU/L; p=0.023), reduced IGFBP1 (13.0±1.3 vs 18.0±1.6 ng/ml; p=0.029) and IGFBP3 (3017±106 vs 3497±102 ng/ml; p=0.008) in comparison to controls. Baseline cortisol was higher in HG children (251±13 vs 218±11 nmol/l; p=0.007). DEXA-derived body composition was similar in HG and control groups. Children born to mothers who experienced severe hyperemesis gravidarum were less insulin sensitive and had elevated baseline cortisol compared to controls. We postulate that severe hyperemesis gravidarum reduces insulin sensitivity in the offspring due to fetal programming of the fetal hypothalamic-pituitary-adrenal (HPA) axis. Long-term follow up of these offspring is essential to determine later risk of metabolic disease.

Comparison of physical and mental health status between cancer survivors and the general population: a Korean population-based survey (KNHANES II-IV)

To compare the physical and mental health status of the general population with that of cancer survivors in South Korea. We analyzed 19,035 subjects (age ≥40years), who participated in the 2001-2009 Korea National Health and Nutrition Examination Survey II-IV. We compared metabolic syndrome components, health behaviors, and mental health outcomes between cancer survivors and non-cancer controls. Cancer survivors accounted for 1.68% (n = 316) of total population. Cancer survivors did not show low occurrence of hypertension and diabetes compared to the control group. Both cancer survivors and the general population had high risks of physical inactivity (75.4% and 75.5%, respectively) and inadequate sleep (52.5% and 60.7%, respectively). In the unadjusted model, depression was more common in cancer survivors (odds ratio [OR], 1.61; 95% CI, 1.22-2.74), so was suicidal ideation (OR, 1.51; 95% CI, 0.16-1.96) than non-cancer controls. After adjustment for attributable socioeconomic factors, the elevated adjusted odds ratios (aORs) among cancer survivors were reduced by 23% in depression and 45% in suicidal thought. Cancer survivors at <5years from diagnosis showed a high occurrence of depression (aOR, 1.77; 95% CI, 1.09-2.85) while the magnitude of aOR decreases after ≥5years from cancer diagnosis (aOR, 1.38; 95% confidence interval, 0.97-1.98, respectively). The physical and mental health of South Korean cancer survivors was not optimal. Their control rates of modifiable risk factors were similar or even lower than those for the non-cancer groups. Depression was highly prevalent in cancer survivors which can be ascribed, at least in part, to socioeconomic environment. A better-targeted intervention to improve the health of this population may be needed.

Insulin resistance and “Lipotoxic Liver Diseases”

An expanded dysfunctional adipose tissue that fails to accommodate, utilise and store as much fat as it should has emerged as the prime mover of the patho physiological sequence that leads to accumulation of fat at ectopic sites – including the liver, in metabolic syndrome and cluster of disorders that include Non alcoholic fatty Liver Disease(NAFLD). Non alcoholic steato hepatitis ( NASH) represent the aggressive subset of NAFLD that can progress to cirrhosis . Insulin is the key driver of metabolic homeostasis, particularly glucose flux across cell membrane – a phenomenon that have connotations for survival and evolution of the organism. An impaired sensitivity to insulin action at the adipocyte level is a characteristic biological event in metabolic syndrome. ,7 The associations of Insulin resistance(IR) with metabolic syndrome is nearly universal – so that the two often have interchangeable pathophysiological inferences, a classical example being type 2 diabetes and the other example is NAFLD/NASH. IR through metabolic syndrome is the template that provide a point of convergence for linked clinical conditions diabetes, obesity, dyslipidemia, hypertension and NAFLD/NASH. IR needs to be conceptualised not as a fixed cellular event – exerting an all or none effect like many biological processes, rather as a dynamic and regulated physiological response to a host of environmental factors and triggers including inflammation. IR possibly challenges energy homeostasis, nutrient availability and handling and connects metabolism with immune phenomenon. 12 There are different methods for measurement of IR, of which HOMA-IR is the simplest and the most widely used one in clinical and epidemiological studies. Ever since its’ initial descriptions, NAFLD has been strongly correlated with obesity; body mass index (BMI) has been the most widely used marker of adiposity in clinical studies. Large epidemiological studies on prevalence of fatty liver have also demonstrated this association , while other studies on the impact of BMI on health outcomes have upheld the connection between BMI , socio economic affluence and overall mortality in a population. BMI has been an independent predictor of fat infiltration in the liver with increasing BMI being associated with increased prevalence of NASH in subjects with NAFLD. Ethnic and racial differences in body composition suggest that Asians( Indians , more specifically): a) Have a lower BMI in general as compared to Caucasians yet , b) Have an increased percentage of body fat as well as a higher proportion of fat in the visceral fat(VF) compartments, c) Are predisposed to metabolic abnormalities and adverse health outcomes at a comparatively lower BMI. The signifcance of these observations is the shift of spotlight on waist circumference as a more meaningful and relevant measure of body composition. It soon became evident that a subset of non overweight (BMI<25 ) individuals do have NAFLD along with metabolic syndrome related metabolic dysfunction including diabetes. ,25,26 This entity, “lean” NAFLD, has subsequently been shown to be a distinct phenotype , described primarily amongst Asians – particularly Indians although it has been reported from occidental populations subsequently. Since fatty liver, NASH and even cirrhosis have been shown to occur with subtle anthropometric markers of obesity and a spectrum of metabolic

Implications of market integration for cardiovascular and metabolic health among an indigenous Amazonian Ecuadorian population

Background: Market integration (MI), the suite of social and cultural changes that occur with economic development, has been associated with negative health outcomes such as cardiovascular disease; however, key questions remain about how this transition manifests at the local level.Aim: The present paper investigates the effects of MI on health among Shuar, an indigenous lowland Ecuadorian population, with the goal of better understanding the mechanisms responsible for this health transition.Subjects and methods: This study examines associations between measures of MI and several dimensions of cardiovascular and metabolic health (fasting glucose, lipids [LDL, HDL and total cholesterol; triglycerides] and blood pressure) among 348 adults.Results: Overall, Shuar males and females have relatively favourable cardiovascular and metabolic health. Shuar who live closer to town have higher total (p < 0.001) and HDL cholesterol (p < 0.001), while Shuar in more remote regions have higher diastolic blood pressure (p = 0.007). HDL cholesterol is positively associated with consumption of market foods (r = 0.140; p = 0.045) and ownership of consumer products (r = 0.184; p = 0.029).Conclusions: This study provides evidence that MI among Shuar is not a uniformly negative process but instead produces complex cardiovascular and metabolic health outcomes.

Low-n-6 and low-n-6 plus high-n-3 diets for use in clinical research

Few trials have evaluated the metabolic effects and health outcomes of lowering dietary n-6 PUFA. The objectives of the present paper were (1) to report the methods employed to lower dietary n-6 PUFA, while either increasing or maintaining n-3 PUFA intake and (2) to validate our methods with 24 h recalls and erythrocyte fatty acid analyses. A total of sixty-seven subjects were randomised to either (1) an average-n-3 PUFA, low-n-6 PUFA (L6) intervention designed to lower linoleic acid (LA; #2·5% of energy (en%)) and arachidonic acid (#60 mg/d), while maintaining an average US intake of n-3 PUFA or (2) a high-n-3 PUFA, low-n-6 PUFA (H3-L6) intervention designed to lower n-6 LA, while increasing the n-3 PUFA a-linolenic acid (ALA; $1·5 en%) and EPA þ DHA ($1000 mg/d). Pre- and intraintervention nutrient intakes were estimated with six 24 h dietary recalls per subject. Both groups achieved the targeted reductions in dietary LA to #2·5 en% (median LA 2·45 (2·1, 3·1); P,0·001). Intakes of n-3 PUFA did not change for the L6 group. Target increases in n-3 ALA (median 1·6 en%, (1·3, 2·0), P,0·001) and EPA þ DHA (1482 mg, (374, 2558), P,0·001) were achieved in the H3-L6 group. Dietary changes were validated by corresponding changes in erythrocyte n-6 and n-3 fatty acid composition. Dietary LA can be lowered to #2·5 en%, with or without concurrent increases in dietary n-3 PUFA, in an outpatient clinical trial setting using this integrated diet method.

Breaks in Sedentary Time during Childhood and Adolescence

The frequency of interruptions in sedentary time (sedentary breaks) is an aspect of sedentary behaviors that may be associated with metabolic health outcomes. The aim of this study was to describe the change in the frequency of sedentary breaks during a 10-yr period from ages 5 to 15 yr. The longitudinal Iowa Bone Development Study has collected accelerometry data at approximately 5, 8, 11, 13, and 15 yr. Data from participants who wore an accelerometer at least 10 h·d(-1) and 3 d per data collection episode were used (423 children at age 5 yr, 550 children at age 8 yr, 520 children at age 11 yr, 454 children at age 13 yr, and 344 children at age 15 yr). The frequency of sedentary breaks was determined based on accelerometry data and compared by weekday/weekend, period during the day, gender, and data collection episode. The frequency of sedentary breaks decreased by >200 times per day during a 10-yr period from ages 5 to 15 yr. Linear regression models estimated a 1.84-times-per-hour decrease per year for boys and a 2.04-times-per-hour decrease per year for girls (P values < 0.0001). Both boys and girls showed significantly fewer breaks on weekdays from morning to 3:00 p.m. than on weekends from morning to 3:00 p.m. (P values < 0.0001). The frequency of sedentary breaks was slightly higher among boys than among girls (gender difference ≤ 2 times per hour; P values < 0.01 at ages 11, 13, and 15 yr). Breaks in sedentary time notably decrease during childhood and adolescence. During school hours, boys and girls have fewer breaks in sedentary time than during any other period of weekday or weekend day.

Short-term regional meal fat storage in nonobese humans is not a predictor of long-term regional fat gain

Although body fat distribution strongly predicts metabolic health outcomes related to excess weight, little is known about the factors an individual might exhibit that predict a particular fat distribution pattern. We utilized the meal fatty acid tracer-adipose biopsy technique to assess upper and lower body subcutaneous (UBSQ and LBSQ, respectively) meal fat storage in lean volunteers who then were overfed to gain weight. Meal fatty acid storage in UBSQ and LBSQ adipose tissue, as well as daytime substrate oxidation (indirect calorimetry), was measured in 28 nonobese volunteers [n = 15 men, body mass index = 22.1 ± 2.5 (SD)] before and after an ∼8-wk period of supervised overfeeding (weight gain = 4.6 ± 2.2 kg, fat gain = 3.8 ± 1.7 kg). Meal fat storage (mg/g adipose tissue lipid) in UBSQ (visit 1: 0.78 ± 0.34 and 1.04 ± 0.71 for women and men, respectively, P = 0.22; visit 2: 0.71 ± 0.24 and 0.90 ± 0.37 for women and men, respectively, P = 0.08) and LBSQ (visit 1: 0.60 ± 0.23 and 0.48 ± 0.29 for women and men, respectively, P = 0.25; visit 2: 0.62 ± 0.24 and 0.65 ± 0.23 for women and men, respectively, P = 0.67) adipose tissue did not differ between men and women at either visit. Fractional meal fatty acid storage in UBSQ (0.31 ± 0.15) or LBSQ (0.19 ± 0.13) adipose tissue at visit 1 did not predict the percent change in regional body fat in response to overfeeding. These data indicate that meal fat uptake trafficking in the short term (24 h) is not predictive of body fat distribution patterns. In general, UBSQ adipose tissue appears to be a favored depot for meal fat deposition in both sexes, and redistribution of meal fatty acids likely takes place at later time periods.

Children's binge eating and development of metabolic syndrome

Binge eating predisposes children to excessive weight gain. However, it is unknown if pediatric binge eating predicts other obesity-associated adverse health outcomes. The objective of this study was to investigate the relationship between binge eating and metabolic syndrome (MetS) in children. Children aged 5-12 years at high risk for adult obesity, either because they were overweight/obese when first examined or because their parents were overweight/obese, were recruited from Washington, DC and its suburbs. Children completed a questionnaire assessment of binge eating at baseline and underwent measurements of MetS components at baseline and at a follow-up visit approximately 5 years later. Magnetic resonance imaging was used to measure the visceral adipose tissue (VAT) in a subset. In all, 180 children were studied between July 1996 and August 2010. Baseline self-reported binge eating presence was associated with a 5.33 greater odds of having MetS at follow-up (95% confidence interval (CI): 1.47, 19.27, P=0.01). The association between binge eating and body mass index (BMI) only partially explained changes in MetS components: baseline binge eating predicted higher follow-up triglycerides, even after accounting for baseline triglycerides, baseline BMI, BMI change, sex, race, baseline age and time in study (P = 0.05). Also, adjusting for baseline VAT and demographics, baseline binge eating predicted greater follow-up L(2-3) VAT (P = 0.01). Children's reports of binge eating predicted development of MetS, worsening triglycerides and increased VAT. The excessive weight gain associated with children's binge eating partly explained its adverse metabolic health outcomes. Reported binge eating may represent an early behavioral marker upon which to focus interventions for obesity and MetS.

Healthcare resource utilization, adherence and persistence with antipsychotic therapy among schizophrenia patients with vs. without pre-existing metabolic syndrome

Objective:To assess the association between pre-existing metabolic syndrome and health outcomes among veterans with schizophrenia.Methods:The Veterans Integrated Service Network 16 data (VISN16) for 10/2002 – 08/2005 were used to identify patients (n = 593) with schizophrenia (ICD-9 codes: 250.xx) who were switched to a new antipsychotic agent in response to metabolic monitoring as part of a VISN 16 metabolic monitoring program. Two groups (patients with pre-existing metabolic syndrome [MetSyn+] and without [MetSyn−]) were compared on resource utilization, antipsychotic adherence (medication possession ratio: MPR) and persistence (time to all-cause discontinuation of the switched antipsychotic) over 1 year.Results:About one-third of the patients who have undergone metabolic monitoring before the medication switch (35.2%) had metabolic syndrome. The two groups did not significantly differ on healthcare resource utilization, MPR, or time to all-cause medication discontinuation. Adherence and persistence levels were relatively poor for both groups (mean MPR = 0.33 for MetSyn+; MPR = 0.38 for MetSyn−). The median time to all-cause medication discontinuation was 50 days for both groups.Conclusions:In this retrospective study of patients with schizophrenia, the presence of pre-existing metabolic syndrome did not appear to impact patients’ healthcare resource utilization or their adherence and persistence with antipsychotic medication.

BMI ≥ 50 kg/m2is associated with a younger age of onset of overweight and a high prevalence of adverse metabolic profiles

To study the demographic and clinical parameters of three different categories of obesity, with particular focus on a cohort of individuals with BMI > or = 50 kg/m2, the fastest growing category of obesity. Over 700 obese individuals were studied (186 with BMI = 30-39 kg/m2, 316 with BMI = 40-49 kg/m2 and 290 with BMI > or = 50 kg/m2). Median BMI was 51 kg/m2 for patients who reported onset of overweight before 15 years of age, 47 kg/m2 for patients who reported onset between 15 and 30 years, and 42 kg/m2 for patients who became overweight after 30 years of age. The BMI > or = 50 kg/m2 group was notably younger than the group with BMI = 30-39 kg/m2 (44 (SD 11) years v. 50 (SD 15) years; P < 0.0001). Eighteen per cent of obese patients studied were considered metabolically healthy according to standard cut-off points for blood pressure, fasting glucose and lipid profiles. However, the proportion of metabolically healthy individuals was significantly higher in the BMI = 30-39 kg/m2 group than in the BMI = 40-49 kg/m2 and BMI > or = 50 kg/m2 groups (31% v. 17% and 12% respectively; P < 0.05 and P < 0.005). When compared with people of similar age in the general population, individuals with BMI > or = 50 kg/m2 had lower rates of marriage (51% v. 72%) and a higher prevalence of unemployment (14% v. 5%). The current study suggests that the increasing prevalence of childhood obesity worldwide will lead to many more individuals achieving a higher BMI at a younger age. Furthermore, an earlier onset of overweight does not appear to prevent the adverse metabolic health outcomes associated with extreme obesity.

Levels and Patterns of Physical Activity in Children and Adolescents With Type 1 Diabetes and Associated Metabolic and Physiologic Health Outcomes

The current study objectively assessed physical activity (PA) levels and patterns in children and adolescents with type 1 diabetes and compared the metabolic and physiologic health profiles of those achieving and those not achieving the current recommendation of 60 minutes a day (minutes x D(-1)) of at least moderate intensity PA. 37 children and adolescents (20 boys, 17 girls) aged 12.7 +/- 2.1 years (mean +/- SD), disease duration 5.9 +/- 3.0 years participated. PA was assessed using heart rate monitoring. Peak VO(2), BMI, sum of 5 skinfolds, HbA(1c), and daily insulin dosage were also determined. Mean accumulated time in moderate-to-vigorous intensity PA was 53.6 +/- 31.4 minutes x D(-1). Levels of vigorous-intensity PA were low, mean 8.3 +/- 10.2 minutes x D(-1). When controlling for age, no differences in metabolic or physiologic health outcomes were evident between those individuals achieving, and those not achieving, 60 minutes x D(-1) of moderate-to-vigorous intensity PA. PA predominantly occurred in short bouts lasting 5 minutes or less. The efficacy of accumulating 60 minutes x D(-1) of moderate-to-vigorous intensity PA, in the form of short duration, intermittent bouts of largely unplanned PA, to promote health gains in children and adolescents with type 1 diabetes is questionable.

Objectively measured physical activity and sedentary time of breast cancer survivors, and associations with adiposity: findings from NHANES (2003–2006)

Obesity and physical inactivity are poor prognostic indicators for breast cancer. Studies to date have relied on self-report measures of physical activity, which tend mainly to assess moderate-to-vigorous intensity leisure-time physical activity. We report the cross-sectional associations of objectively assessed physical activity and sedentary time with adiposity in a sample of breast cancer survivors from the United States. One hundred and eleven women from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2005-2006 reported a history of breast cancer. Participants wore an accelerometer for 7 days, and activity levels were summarized as moderate-to-vigorous intensity (accelerometer counts/min > or =1,952), light intensity (counts/min 100-1,951), and sedentary time (counts/min <100). Anthropometric measures were taken by study staff at examination centers. Participants spent the majority of their day in sedentary time (66%) or in light intensity activities (33%). Log moderate-to-vigorous intensity physical activity was negatively associated with adiposity (waist circumference beta = -9.805 [95% CI: -15.836, -3.775]; BMI beta = -3.576 [95% CI: -6.687, -0.464]). Light intensity physical activity was negatively associated with adiposity; however, the fully adjusted models did not retain statistical significance. Similarly, sedentary time was positively associated with adiposity, but the fully adjusted models were not statistically significant. This is the first study to describe the objectively assessed physical activity and sedentary time of breast cancer survivors. Increasing moderate-to-vigorous and light intensity physical activity, and decreasing sedentary time, may assist with weight management and improve other metabolic health outcomes for breast cancer survivors.

Regular Consumption from Fast Food Establishments Relative to Other Restaurants Is Differentially Associated with Metabolic Outcomes in Young Adults

Although away-from-home eating is adversely associated with weight, other comorbidities have not been examined; therefore, we sought to determine the associations of fast food (e.g. Wendy’s, McDonalds) and restaurant (sit-down style) consumption (times per week) with weight and multiple metabolic outcomes, including homeostatic model assessment insulin resistance (HOMA-IR), waist circumference, and plasma triglycerides (TG), LDL cholesterol, and HDL cholesterol (HDL-C). We used 3 waves of data (exam y 7, 10, and 20) from the Coronary Artery Risk Development in Young Adults Study, a prospective cohort study of black and white young adults [aged 25–42 y in 1992–93, n = 3643 (men, 1659; women, 1984)]. Individuals in the highest (vs. lowest) quartile of baseline (defined as the mean of y 7 and 10) fast food consumption had higher y 20 weight [adjusted mean (95% CI): 5.6 kg (CI, 2.1, 9.2); P = 0.002], HOMA-IR [0.9 (CI, 0.4, 1.3); P < 0.001], waist circumference [5.3 cm (CI, 2.8, 7.9); P < 0.000], TG concentrations [0.25 mmol/L (CI, 0.10, 0.40), 22.7 mg/dL (CI, 9.1, 36.3); P = 0.001], and lower HDL-C concentrations [−0.014 mmol/L (CI, −0.215, −0.067), 5.4 mg/dL (CI, −8.3, -2.6); P < 0.000]. Baseline restaurant consumption was unrelated to y 20 outcomes. Adjusted change in weekly restaurant (P < 0.05) and fast food intake (P < 0.001) was associated with 13-y changes in body weight [0.09 kg (CI, 0.02, 0.17) and 0.15 kg (CI, 0.06, 0.24), respectively] and waist circumference [0.08 cm (CI, 0.02, 0.14) and 0.12 cm (CI, 0.04, 0.20), respectively]. Fast food consumption may be an important target for the prevention of adverse metabolic health outcomes.

Developmental Trajectories of Girls' BMI Across Childhood and Adolescence

This study describes qualitatively distinct trajectories of BMI change among girls participating in a longitudinal study of non-Hispanic, white girls (n = 182) and their parents, assessed at daughters' ages 5, 7, 9, 11, 13, and 15 years. Height, weight, body fat, fasting blood glucose and lipids, blood pressure, waist circumference, and pubertal status were measured, and participants self-reported dietary, physical activity, and television (TV) viewing patterns. Growth mixture models were used to model heterogeneity in girls' BMI trajectories over 10 years. Statistical support was strongest for four distinct BMI trajectories: (i) upward percentile crossing (UPC; n = 25, 14%); (ii) delayed downward percentile crossing (DDPC; n = 37, 20%); (iii) 60th percentile tracking (60PT; n = 52, 29%); and (iv) 50th percentile tracking (50PT; n = 68, 37%). Girls in the UPC group had more metabolic risk factors at age 15 years, even after adjusting for concurrent weight status. Girls in the UPC group had mothers with the highest BMIs at study entry and were breast-fed for a shorter duration. This novel approach for examining differences in growth trajectories revealed four distinct BMI trajectories that predicted adolescent metabolic health outcomes in girls. The present study provides support for BMI monitoring in girls and for the potential utility of combining data on BMI tracking with data on familial characteristics for the early identification of girls at elevated risk for obesity and metabolic syndrome.

P.1.g.005 Improving metabolic health outcomes in mentally ill populations with the Mieux-Être Wellness program

P.1.g.005 Improving metabolic health outcomes in mentally ill populations with the Mieux-Être Wellness program