Short-term Weight Change Research Articles

Is abdominal obesity at baseline influencing weight changes in observational studies and during weight loss interventions?

Body fat distribution is a marker of metabolic health independent of body size. Visceral fat accumulation has been suggested to result from a decreased expandability of the subcutaneous fat depots. Furthermore, the visceral fat may be easier to mobilize than the peripheral fat. We examined whether differences in abdominal obesity at baseline influenced prospective body-weight changes. In this study we examined whether body-fat distribution at baseline was associated with long-term and short-term weight changes. We included 3 observational studies (ntotal=7271) with mean follow-up times of 5-9 y and two 8-10-wk weight loss intervention studies (ntotal=1091). We examined the association between baseline waist circumference and weight changes in a substitution regression model, where body weight, height, and fat-free mass were fixed so that a difference in waist circumference would reflect a difference in body fat distribution alone. The results were summarized in meta-analyses. In the observational studies, we found no associations between baseline waist circumference and subsequent weight change in men (β: 0.03 kg; 95% CI: -0.01, 0.08 kg; P=0.19), but a negligible inverse association in women (β: -0.05 kg; 95% CI: -0.08, -0.01 kg; P=0.01). There was no association between baseline waist circumference and weight loss in the intervention studies (men: β: -0.05 kg; 95% CI: -0.13, 0.03 kg; P=0.25; women: β: -0.00 kg; 95% CI: -0.03, 0.03 kg; P=0.84). However, in all studies, the SDs of the weight change residuals were greater, the greater the waist circumference at baseline. This trend was statistically significant in women in most studies as well as in men in 1 of the studies. With narrow CIs in 3 observational studies and 2 weight loss interventions, we did not find any clinically or epidemiologically relevant association between baseline abdominal obesity and weight change. However, the present study suggests that a greater baseline abdominal obesity is a marker for greater weight fluctuations. The CCHS trial was registered at www.clinicaltrials.gov as NCT02993172. The Health2006 trial was registered at www.clinicaltrials.gov as NCT00316667. The ORG study was conducted before trial registration was required. The NUGENOB trial was registered at www.isrctn.com as ISRCTN25867281. The DiOGenes trial was registered atwww.clinicaltrials.gov as NCT00390637.

Recent advances in understanding the relationship between long- and short-term weight change and fertility.

The impact of excess body weight on fertility is well recognized among both women attempting to conceive spontaneously and those attempting to conceive with medical assistance. Although many leading societies of reproductive medicine have proposed weight loss as a means to counteract the negative consequences of obesity on fertility, there is limited research on this topic. In this review, we provide a brief overview of the recent advances in the literature focused on how long- and short-term weight change affects fertility among women. Overall, despite initial hope that weight loss may be beneficial for fertility, two large well-conducted randomized controlled trials have consistently shown that short-term weight loss among overweight and obese women undergoing infertility treatment does not improve a woman’s probability of live birth. The observational evidence among women attempting to conceive without medical assistance also suggests limited benefits of weight loss on fecundity or pregnancy loss. In contrast, substantial weight gain between consecutive pregnancies, in the year prior to pregnancy attempt, and throughout adulthood appears to be harmful for not only time to pregnancy but also pregnancy maintenance. Future research focused on efforts to prevent weight gain during adulthood is needed to better understand whether these types of interventions may have beneficial effects on fertility.

Growth hormone therapy in children with idiopathic short stature – the effect on appetite and appetite-regulating hormones: a pilot study

ABSTRACTAim: To investigate the effect of growth hormone (GH) therapy on appetite-regulating hormones and to examine the association between these hormones and the response to GH, body composition, and resting energy expenditure (REE).Methods: Nine pre-pubertal children with idiopathic short stature underwent a standard meal test before and 4 months following initiation of GH treatment. Ghrelin, GLP-1, leptin, and insulin levels were measured; area under the curve (AUC) was calculated. Height, weight, body composition, REE, and insulin-like growth factor levels were recorded at baseline and after 4 and 12 months.Results: Following 4 months of GH therapy, food intake increased, with increased height-standard deviation score (SDS), weight-SDS, and REE (p < .05). Significant changes in appetite-regulating hormones included a decrease in postprandial AUC ghrelin levels (p = .045) and fasting GLP-1 (p = .038), and an increase in fasting insulin (p = .043). Ghrelin levels before GH treatment were positively correlated with the changes in weight-SDS (fasting: r = .667, p = .05; AUC: r = .788, p = .012) and REE (fasting: r = .866, p = .005; AUC: r = .847, p = .008) following 4 months of GH therapy. Ghrelin AUC at 4 months was positively correlated with the changes in height-SDS (r = .741, p = .022) and fat-free-mass (r = .890, p = .001) at 12 months of GH treatment.Conclusions: The reduction in ghrelin and GLP-1 following GH treatment suggests a role for GH in appetite regulation. Fasting and meal-AUC ghrelin levels may serve as biomarkers for predicting short-term (4 months) changes in weight and longer term (12 months) changes in height following GH treatment. The mechanisms linking GH with changes in appetite-regulating hormones remain to be elucidated.Abbreviations: SDS: standard deviation score; REE: resting energy expenditure; SMT: standard meal test; AUC: area under the curve; ISS: idiopathic short stature; SGA: small for gestational age; FFM: fat-free-mass; FM: fat mass; EER: estimated energy requirements; DRI: dietary reference intakes; IQR: inter-quartile range

Longitudinal patterns and associated factors of postdiagnosis weight changes in Korean breast cancer survivors with normal body mass index.

This study aimed to describe longitudinal patterns of weight changes from diagnosis to within 5years after diagnosis and investigate factors associated with short- and long-term weight changes among Korean breast cancer survivors with initially normal body mass index (BMI). Body weights at diagnosis for 1546 breast cancer survivors were compared with those at 12, 24, 36, 48, and 60months after diagnosis. Absolute weight change (kg) and relative weight changes (%) were analyzed. Logistic regression was used to identify factors associated with short-term (1year) and long-term (5years) weight changes. A significant decrease in mean weight was predominant at 12months postdiagnosis. In subgroup analysis, the younger age group showed significant weight gains after 36months. The older age group and chemotherapy (CT) group showed significant weight losses after 24months. About 40% of weight gainers and 60% of weight losers at 12months returned to their initial weight by 60months postdiagnosis. CT and lower educational levels were associated with short-term weight loss and gain, respectively. For long-term changes, age at diagnosis was the sole associated factor. Korean breast cancer survivors treated with CT mainly experienced postdiagnosis weight loss rather than weight gain. Short-term weight change was independently associated with chemotherapy and educational level. However, long-term weight change was associated with age at diagnosis. Breast cancer survivors with normal BMI may be categorized according to the time-dependent risk for postdiagnosis weight change.

Abstract P290: Short-term Weight Change and Long-term Mortality in the Trials of Hypertension Prevention

Introduction: Although weight loss has favorable effects on intermediate outcomes, such as blood pressure and insulin resistance, few studies have examined its effects on long-term outcomes including total mortality. Methods: In the Trials of Hypertension Prevention (TOHP) individuals aged 30-54 years with high normal BP were randomized to a weight loss intervention, to one of several other lifestyle or dietary supplement interventions, or to usual care. All participants from Phase 1 (1987-90) and Phase 2 (1990-5) were followed for mortality through 2013. The association of weight change during any of the interventions with long-term mortality up to 18-24 years after the trial periods was examined among 3828 participants who fell into a high baseline weight stratum, defined as body mass index at least 26 kg/m2 in men and 24 kg/m2 in women. Results and Conclusions: There were 1477 high-weight participants in Phase 1 and 2351 in Phase 2, of whom 21% and 50%, respectively, were assigned to a weight loss intervention. Overall, mean weight change during the trial period was -1.8 lbs (-0.8% of baseline body weight) over 1.5 years in Phase 1 and 1.6 lbs (0.8%) over 3-4 years in Phase 2. A total of 556 (15%) lost &gt; 5%, 1,101 (29%) lost &lt;=5%, 1,567 (41%) gained less than 5%, and 604 (16%) gained &gt; 5% in body weight. Corresponding hazard ratios (HRs) for total mortality were 0.82 (95% confidence interval (CI)=0.57-1.18), 0.94 (95% CI=0.72-1.23), 1.00 (reference), and 1.29 (95% CI=0.92-1.80) (p-trend = 0.046). There was a direct linear relationship with percent change in weight during the trial period and later mortality (HR=1.14 per 5% change, 95% CI=1.02-1.28, p=0.019). This association persisted throughout the course of mortality follow-up (Figure). In these healthy individuals taking part in lifestyle and nutrition supplement trials , short-term weight change was directly associated with mortality about two decades later. These results are consistent with a long-term beneficial effect of presumed intentional weight loss on total mortality.

Translational research: are community-based child obesity treatment programs scalable?

BackgroundCommunity-based obesity treatment programs have become an important response to address child obesity; however the majority of these programs are small, efficacy trials, few are translated into real-world situations (i.e., dissemination trials). Here we report the short-term impact of a scaled-up, community-based obesity treatment program on children’s weight and weight-related behaviours disseminated under real world conditions.MethodsChildren age 6–15 years with a body mass index (BMI) ≥85th percentile with no co-morbidities, and their parents/carers participated in a twice weekly, 10-week after-school child obesity treatment program between 2009 and 2012. Outcome information included measures of weight and weight-related behaviours. Analyses were adjusted for clustering and socio-demographic variables.ResultsOverall, 2,812 children participated (54.2 % girls; Mage 10.1 (2.0) years; Mattaendance 12.9 (5.9) sessions). Beneficial changes among all children included BMI (−0.65 kg/m2), BMI-z-score (−0.11), waist circumference (−1.8 cm), and WtHtr (−0.02); self-esteem (+2.7units), physical activity (+1.2 days/week), screen time (−4.8 h/week), and unhealthy foods index (−2.4units) (all p < 0.001). Children who completed ≥75 % of the program were more likely to have beneficial changes in BMI, self-esteem and diet (sugar sweetened beverages, lollies/chocolate, hot chips and takeaways) compared with children completing <75 % of the program.ConclusionsThis is one of the few studies to report outcomes of a government-funded, program at scale in a real-world setting, and shows that investment in a community-based child obesity treatment program holds potential to produce short-term changes in weight and weight-related behaviours. The findings support government investment in this health priority area, and demonstrate that community-based models of child obesity treatment are a promising adjunctive intervention to health service provision at all levels of care.

Abstract P6-09-01: Recent weight gain and increased breast cancer risk varies by receptor classification among pre and postmenopausal women

Abstract Obesity is well established as a cause of postmenopausal breast cancer incidence and mortality. Furthermore, adiposity in early life – through premenopausal years reduces breast cancer incidence. However, studies using measures of adiposity at age 18 also report inverse relations with premenopausal breast cancer and for some but not all subtypes of breast cancer defined by molecular status. To assess the relations of adiposity in childhood, in late adolescence, and in adult years as well as change in weight in relation to total invasive breast cancer and subtype defined by receptor status we fit models based on the Rosner-Colditz log-incidence model of breast cancer. The Nurses’ Health Study cohort was established in 1976 when 121,701 female US registered nurses ages 30-55 responded to a mail questionnaire inquiring about risk factors for breast cancer including reproductive factors, hormone use, anthropometric variables, benign breast disease (BBD), and family history of breast cancer. The risk factors have been updated by repeat questionnaires every 2 years. We followed a cohort of 77,232 women from 1980 to 2006 (1,445,578 person-years) documenting 4,196 incident cases of invasive breast cancer. ER and PR status were obtained from pathology reports and medical records. A total of 2,033 ER+/PR+ tumors, 595 ER-/PR- tumors, 512 ER+/PR- tumors were identified among women with complete information on breast cancer risk factors. Overall, weight at age 18 was inversely related to incidence. The relative risk per 25 lb weight difference was 0.89 (0.85, 0.93). After controlling for weight at age 18, long-term weight change was positively related to total incident breast cancer risk among both premenopausal (RR per 25 lb weight gain since age 18=1.08; 95% CI=1.05-1.12) and postmenopausal women (RR per 25 lb weight gain since menopause=1.16; 95% CI=1.09-1.23). In addition, we focus on the effect of short-term weight gain (over past 4 years) on breast cancer risk while controlling for weight at age 18 and long-term change in weight during premenopause and postmenopause. We found a significant effect of short-term weight change and breast cancer risk (RR=1.20; 95% CI=1.09-1.33) for a 4-year weight gain of ≥ 15 lbs vs no change (≤ 5lbs) (RR per 25 lb weight gain=1.13; 95% CI=1.06-1.21, p&amp;lt;0.001). However, the effect was stronger for premenopausal women (≥ 15 lb weight gain vs no change, RR=1.38; 95% CI=1.13-1.69) (RR per 25 lb weight gain=1.26; 95% CI=1.08-1.48, p=0.004) than for postmenopausal women (≥ 15 lb weight gain vs no change, RR=1.10; 95% CI=0.97-1.25) (RR per 25 lb weight gain=1.08; 95% CI=1.00-1.16, p=0.063). The effect of short-term weight gain during premenopause was stronger for ER+/PR- (RR per 25 lb weight gain=2.19; 95% CI=1.33-3.61, p=0.002) and ER-/PR- breast cancer (RR per 25 lb weight gain=1.61; 95% CI=1.09-2.38, p=0.016) than for ER+/PR+ breast cancer (RR per 25 lb weight gain=1.13; 95% CI=0.89-1.43, p=0.32). In conclusion, adiposity in childhood has a protective lifelong relation to breast cancer risk, though mechanisms remain largely unexplained. There are long-term deleterious effects of weight change both pre- and post-menopause and deleterious effects of short-term weight gain during premenopausal years. Citation Format: Graham A Colditz, Heather Eliassen, Adetunji T Toriola, Susan E Hankinson, Walter C Willett, Loki Natarajan, Bernard Rosner. Recent weight gain and increased breast cancer risk varies by receptor classification among pre and postmenopausal women [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-09-01.

Short-term weight gain and breast cancer risk by hormone receptor classification among pre- and postmenopausal women.

Obesity is well established as a cause of postmenopausal breast cancer incidence and mortality. In contrast, adiposity in early life reduces breast cancer incidence. However, whether short-term weight change influences breast cancer risk is not well known. We followed a cohort of 77,232 women from 1980 to 2006 (1,445,578 person-years), with routinely updated risk factor information, documenting 4196 incident cases of invasive breast cancer. ER and PR status were obtained from pathology reports and medical records yielding a total of 2033 ER+/PR+ tumors, 595 ER−/PR− tumors, 512 ER+/PR− tumors. The log incidence breast cancer model was used to assess the association of short-term weight gain (over past 4 years) while controlling for average BMI before and after menopause. Short-term weight change was significantly associated with breast cancer risk (RR 1.20; 95 % CI 1.09–1.33) for a 4-year weight gain of ≥15 lbs versus no change (≤5 lbs) (P_trend < 0.001). The association was stronger for premenopausal women (RR 1.38; 95 % CI 1.13–1.69) (P_trend = 0.004) than for postmenopausal women (RR 1.10; 95 % CI 0.97–1.25) (P_trend = 0.063). Short-term weight gain during premenopause had a stronger association for ER+/PR− (RR per 25 lb weight gain = 2.19; 95 % CI 1.33–3.61, P = 0.002) and ER−/PR− breast cancer (RR per 25 lb weight gain = 1.61; 95 % CI 1.09–2.38, P = 0.016) than for ER+/PR+ breast cancer (RR per 25 lb weight gain = 1.13; 95 % CI 0.89–1.43, P = 0.32). There are deleterious effects of short-term weight gain, particularly during pre-menopause, even after controlling for average BMI before and after menopause. The association was stronger for ER+/PR− and ER−/PR− than for ER+/PR+ breast cancer.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-015-3344-0) contains supplementary material, which is available to authorized users.

Residential property values predict prevalent obesity but do not predict 1-year weight change.

ObjectiveLower socioeconomic status (SES) has been linked with higher obesity rates but not with weight gain. This study examined whether SES can predict short-term weight change.Design and MethodsThe Seattle Obesity Study II was based on an observational cohort of 440 adults. Weights and heights were measured at baseline and at 1 y. Self-reported education and incomes were obtained by questionnaire. Home addresses were linked to tax parcel property values from the King Co. tax assessor. Associations among SES variables, prevalent obesity, and 1 y weight change were examined using multivariable linear regressions.ResultsLow residential property values at tax parcel predicted prevalent obesity at baseline and at 1 y. Living in the top quartile of house prices reduced obesity risk by 80% at both time points. At 1 year, about 38% of the sample lost >1kg body weight; 32% maintained (± 1kg), and 30% gained >1kg. In adjusted models, none of the baseline SES measures had any impact on 1 y weight change.ConclusionsSES variables, including tax parcel property values predicted prevalent obesity but did not predict short-term weight change. These findings, based on longitudinal cohort data, suggest other mechanisms are involved in short-term weight change.

Measures of Nutritional Status and Quality of Life in Adult People Living with HIV/AIDS at a Tertiary Hospital in Nigeria

Background & Aims: The study investigated the relationship between objective and subjective nutritional status parameters and quality of life in HIV seropositive patients. Methods: Retrospective review of clinic records of 150 HIV seropositive patients at a teaching hospital in Nigeria. Nutritional status was evaluated objectively with anthropometry including body mass index (BMI), subjectively with malnutrition universal screening tool (MUST) and subjective global assessment (SGA) tool. Data on quality of life (QOL) assessed with WHOQOL (Bref), and CD4 count were extracted. Correlation analysis and linear regression were done to investigate the relationship between variables, level of significance set at p < 0.05 respectively. The CD4 count correlated with percentage body fat (r = 0.224), MUST (r = -0.186) and SGA (r = -0.192), p < 0.05 respectively, but not with any of the QOL domains. Weight, MUST, SGA, percentage body fat were significant predictors of the percentage weight change in 6 months. Conclusions: BMI has significant positive association with psychological domain of QOL. MUST and SGA have significant negative association with certain domains. QOL did not predict short-term weight changes, as did the current weight, MUST, and SGA.

A comparison of outcomes of three reconstruction methods after laparoscopic distal gastrectomy.

PurposeThe aim of this study was to compare the short-term surgical and long-term functional outcomes of Billroth I, Billroth II, and Roux-en-Y reconstruction after laparoscopic distal gastrectomy.Materials and MethodsWe retrospectively collected data from 697 patients who underwent laparoscopic distal gastrectomy for operable gastric cancer between January 2009 and December 2012. The patients were classified into three groups according to the reconstruction methods: Billroth I, Billroth II, and Roux-en-Y. The parameters evaluated included patient and tumor characteristics, operative details, and postoperative complications classified according to the Clavien-Dindo classification. Endoscopic findings of the remnant stomach were evaluated according to the residue, gastritis, bile (RGB) classification and the Los Angeles classification 1 year postoperatively.ResultsBillroth I, Billroth II, and Roux-en-Y were performed in 165 (23.7%), 371 (53.2%), and 161 patients (23.1%), respectively. Operation time was significantly shorter (173.4±44.7 minute, P<0.001) as was time to first flatus (2.8±0.8 days, P=0.009), time to first soft diet was significantly faster (4.3±1.0 days, P<0.001), and postoperative hospital stay was significantly shorter (7.7±4.0 days, P=0.004) in Billroth I in comparison to the other methods. Postoperative complications higher than Clavien-Dindo grade III occurred in 61 patients (8.8%) with no statistically significant differences between groups (P=0.797). Endoscopic findings confirmed that gastric residue, gastritis, bile reflux, and reflux esophagitis were significantly lower in Roux-en-Y (P<0.001) patients.ConclusionsRoux-en-Y reconstruction after laparoscopic distal gastrectomy for middle-third gastric cancer is beneficial in terms of long-term functional outcome, whereas Billroth I reconstruction for distal-third gastric cancer has a superior short-term surgical outcome and postoperative weight change.

Body Weight Changes in A Large Cohort of Patients Subjected to Thyroidectomy for A Wide Spectrum of Thyroid Diseases

Patients undergoing thyroidectomy often complain of weight gain. The aim of this study was to longitudinally evaluate body-weight changes in patients thyroidectomized for euthyroid and hyperthyroid conditions in order to identify predictive factors. Anthropometric data and thyroid function parameters were retrospectively reviewed for 267 thyroidectomized patients before and 40 to 60 days and 9 months after surgery. Presurgery diagnoses included benign (Graves disease, nodular toxic goiter, nodular nontoxic goiter) and malignant (differentiated thyroid cancer) conditions. Mean preintervention weight of the entire study group significantly increased (P<.0001) 9-months after thyroidectomy, from 70.8 ± 16.0 to 72.5 ± 16.4 kg. Body weight increased in 156 (58.4%) patients, decreased in 59 (22.1%) patients, and remained stable in 52 (19.5%) patients. A multiple regression model was constructed by entering the percentage of body-weight change 9 months postsurgery as the dependent variable and age, sex, presurgery body mass index, percentage of weight change 40 to 60 days postsurgery, presurgery thyroid-stimulating hormone (TSH) level, TSH level 40 to 60 days postsurgery, TSH level 9 months postsurgery, thyroid disease driving thyroidectomy, and type of surgical intervention as the covariates. No significant relationship was found for any of the covariates tested, with the exception of percentage of body-weight change at 40 to 60 days postsurgery (correlation coefficient, 0.869; [95% confidence interval, 0.692 to 1.046; P<.0001]). Thyroidectomy is associated with a significant increase in body weight, which is not limited to patients with Graves disease. Postsurgery TSH levels do not account for subsequent body-weight changes. Short-term changes (40 to 60 days postsurgery) in body weight are highly predictive of the outcome at 9 months, suggesting that early factors related to thyroidectomy per se might play a role.

Weight and body composition changes during oral contraceptive use in obese and normal weight women.

Oral contraceptive (OC) use seems to have little effect on weight change in normal weight women. Most previous studies have excluded obese women, so the effect of OC use on weight change in obese women is unknown. This analysis evaluates weight and body composition change with OC use among obese (body mass index [BMI] 30.0-39.9) and normal weight (BMI 19.0-24.9) women who were randomly assigned to two OC doses: 20 μg ethinyl estradiol (EE) and 100 μg levonorgestrel (LNG) OCs or 30 μg EE and 150 μg LNG OCs. Follow-up occurred after three to four OC cycles. Weight and body composition were measured at baseline and at follow-up using a bioelectrical impedance analyzer. Among 150 women (54 obese and 96 normal weight) who used OCs for 3 to 4 months, there were no clinically or statistically significant weight or body composition changes in the overall group or by BMI or OC formulation group. These findings add to evidence that EE/LNG OCs are not associated with short term weight or body composition change for normal weight women and suggest that OCs are also are not associated with short term weight or body composition change in obese women.

A mobile health intervention for weight management among young adults: a pilot randomised controlled trial

Today's generation of young adults are gaining weight faster than their parents; however, there remains insufficient evidence to inform interventions to prevent this weight gain. Mobile phones are a popular means of communication that may provide a convenient, inexpensive means to deliver health intervention programmes. This pilot study aimed to measure the effect of a 12-week mobile health (mHealth) intervention on body weight, body mass index and specific lifestyle behaviours addressed by the programme. University students and staff aged 18-35 years (n = 51) were randomised (ratio 1 : 1, intervention : control). Both groups received a printed diet booklet with instructions prepared by a dietitian. The intervention group also received Short Message Service (SMS) text messages (four per week), e-mails (four per week), and had access to smartphone applications and Internet forums. Pre- to post-intervention, participants in the intervention group decreased their body weight [mean (SD)] [-1.6 (2.6) kg], increased their light intensity activity [34 (35) min day(-1)] and reported an increased vegetable (1.0 median serving day(-1)) and decreased sugar-sweetened beverage intake [-355 (836) mL week(-1)]. Despite this, post-intervention changes in outcomes were not significantly different from controls. The piloted mHealth programme provided some short-term positive changes in weight, nutrition and physical activity using a low cost, convenient delivery method for this population. However, changes were no different from those observed among controls. This might partly be explained by intervention participants' low engagement with the programme, which is likely to require further modification to provide more regular, personalised, monitored support.

Variation at the melanocortin 4 receptor gene and response to weight‐loss interventions in the diabetes prevention program

ObjectiveTo assess associations and genotype × treatment interactions for melanocortin 4 receptor (MC4R) locus variants and obesity-related traits.Design and MethodsDiabetes Prevention Program (DPP) participants (N=3,819, of whom 3,356 were genotyped for baseline and 3,234 for longitudinal analyses) were randomized into intensive lifestyle modification (diet, exercise, weight loss), metformin or placebo control. Adiposity was assessed in a subgroup (n=909) using computed tomography. All analyses were adjusted for age, sex, ethnicity and treatment.ResultsThe rs1943218 minor allele was nominally associated with short-term (6 month; P=0.032) and long-term (2 year; P=0.038) weight change. Eight SNPs modified response to treatment on short-term (rs17066856, rs9966412, rs17066859, rs8091237, rs17066866, rs7240064) or long-term (rs12970134, rs17066866) reduction in body weight, or diabetes incidence (rs17066829) (all Pinteraction <0.05).ConclusionThis is the first study to comprehensively assess the role of MC4R variants and weight regulation in a weight loss intervention trial. One MC4R variant was directly associated with obesity-related traits or diabetes; numerous other variants appear to influence body weight and diabetes risk by modifying the protective effects of the DPP interventions.

Long- and Short-term Weight Change and Incident Coronary Heart Disease and Ischemic Stroke: The Atherosclerosis Risk in Communities Study

Weight gain increases the prevalence of obesity, a risk factor for cardiovascular disease. Nevertheless, unintentional weight loss can be a harbinger of health problems. The Atherosclerosis Risk in Communities Study (1987-2009) included 15,792 US adults aged 45-64 years at baseline and was used to compare associations of long-term (30 years) and short-term (3 years) weight change with the risks of coronary heart disease (CHD) and ischemic stroke. Age-, gender-, and race-standardized incidence rates were 4.9 (95% confidence interval (CI): 4.6, 5.2) per 1,000 person-years for CHD and 2.5 (95% CI: 2.3, 2.8) per 1,000 person-years for stroke. After controlling for baseline body mass index and other covariates, long-term weight gain (since age 25 years) of more than 2.7% was associated with elevated CHD risk, and any long-term weight gain was associated with increased stroke risk. Among middle-aged adults, short-term (3-year) weight loss of more than 3% was associated with elevated immediate CHD risk (hazard ratio = 1.46, 95% CI: 1.18, 1.81) and stroke risk (hazard ratio = 1.45, 95% CI: 1.10, 1.92). Risk tended to be larger in adults whose weight loss did not occur through dieting. Avoidance of weight gain between early and middle adulthood can reduce risks of CHD and stroke, but short-term, unintentional weight loss in middle adulthood may be an indicator of immediate elevated risk that has not previously been well recognized.

Short‐term body weight fluctuations in older well‐hydrated hospitalised patients

The usual daily weight fluctuations of well-hydrated older hospitalised people have not been documented internationally. To date, dehydration assessments based on a short-term body weight change defined as >2% have been drawn from healthy population data. The present pilot study aimed to describe usual body weight fluctuation at the same time of day over a 3-day time frame in well-hydrated older hospitalised adults. An observational study of non-acute inpatients (n = 10) admitted to a Geriatric and Rehabilitation Unit, aged ≥60 years, assessed as well-hydrated, mobile, non-amputee and without conditions that influenced fluid status, was conducted. Participants were weighed hourly over a 9-h period for 3 days. Food and fluid intake, clothing items added or removed, and urine and faecal output were recorded. Weight fluctuation for each participant [mean (SD) 80.2 (4.2) years; male 60.0%, n = 10] over 3 days ranged from 1.1% to 3.6%. Over 3 days, 40.0% (4/10) of participants had weight fluctuations of >2% and 20% (2/10) had weight fluctuations of >3%. Time of weigh-in accounted for 99.8% of the variation in weight fluctuation (P < 0.05), with the lowest fluctuations observed when weights were compared at the same time each day (≤0.4 kg). Weights recorded at the same time daily had the greatest accuracy. Given that the range 1.1-3.6% was within normal weight fluctuations for well-hydrated older hospitalised participants, the weight change indicative of dehydration remains to be established in this setting but appears greater than conventionally used figures.

Impact of body mass index (BMI) and weight changes on recurrence and survival in stage III colon cancer (CC).

355 Background: Research suggests that physical activity can lower the risk of relapse and mortality from CC. However, it is unclear if such benefits are mediated through an effect on weight. Our aims were to (1) evaluate the impact of pre-treatment BMI on recurrence and survival in early stage CC, (2) examine how changes in weight from baseline may affect outcomes, and (3) explore if the effects of different body compositions are modified by adjuvant therapy (AT). Methods: Patients (pts) diagnosed with stage III CC from 2006 to 2008, evaluated at any 1 of 5 cancer centers in British Columbia, and who had their weights measured serially throughout their AT period were reviewed. Using Cox proportional hazards models, we compared outcomes among (a) BMI&lt;25 [normal] vs. 25-30 [overweight] vs. &gt;30 [obese] and (b) weight increase or decrease of &lt; vs. &gt;/=5% and &lt; vs. &gt;/=10%, while controlling for confounders. Results: A total of 821 pts were included: median age was 65 years, 50% were men, and 83% were ECOG 0/1. At baseline, 43, 37, and 20% were normal, overweight, and obese, respectively. Compared to pts with normal BMI, those who were overweight or obese did not show an increased risk of recurrence (HR 0.81, 95%CI 0.42-1.58 and HR 1.09, 95%CI 0.48-2.51, respectively, p trend=0.74) or death (HR 0.54, 95%CI 0.26-1.13 and HR 0.62, 95%CI 0.22-1.74, respectively, p trend=0.24). A number of pts experienced weight gain or loss during their AT period, but none of these weight changes affected outcomes (Table). Receipt of AT did not modify the effects of BMI or weight change on outcomes. In Cox models, advanced age and poor performance status were the main factors that consistently correlated with an increased risk of recurrence and death (p&lt;0.05). Conclusions: Neither baseline BMI nor short-term weight changes during AT appear to affect outcomes in stage III CC. Physical activity likely exerts its benefit on relapse and survival by influencing long-term weight changes or by alternative mechanisms. [Table: see text]

Long- and Short-term Weight Change and Incident Coronary Heart Disease and Ischemic Stroke: The Atherosclerosis Risk in Communities Study

Long- and Short-term Weight Change and Incident Coronary Heart Disease and Ischemic Stroke: The Atherosclerosis Risk in Communities Study

Abstract B77: Short-term weight change and colon and rectal cancer risk in the EPIC cohort

Abstract Background: BMI (Body Mass Index) has been considered as a risk factor for colon cancer but not for rectal cancer. Less is known about the association between weight change and colon and rectal cancer risk. In this study we investigated how risk for colon and rectal cancer develops for weight change within the follow-up period of the European Prospective Investigation into Cancer and nutrition (EPIC) cohort. Methods: We investigated the relationship between weight change and subsequent colon and rectal cancer risk among 328.781 participants aged between 25 and 70 years from the EPIC cohort. EPIC is a large ongoing European study in 23 centres in 10 European countries. At recruitment (1992-2000), weight, height and waist circumference were measured and detailed dietary and lifestyle data were collected through questionnaires. Body weight was reassessed on average 5 years after recruitment (range 0.3 - 13 years) and was mainly self-reported. In the subsequent years, participants were followed for the occurrence of cancer for up to 13 years. We used Cox regression analysis, with age as the time variable, and stratified the models according to study center and age, with further adjustment for body mass index (BMI) and waist circumference at recruitment, smoking status and intensity, physical activity, educational level, alcohol intake and intake of fibres, vegetables, fruits, fish and meat. In women we additionally adjusted for menopausal status, use of oral contraceptives and use of hormone replacement therapy. Weight change (kg/year) was defined as sex specific quintiles, with the combined quintiles 2 and 3 as the reference category defined as those with stable weight (i.e. weight change of -2.9 to 1.4 kg per 5 years in men; and -1.9 to 1.9 kg per 5 years in women). Results: During 2.1 million person-years (mean duration of follow-up 6.4 years) after the second assessment of weight, 480 and 781 incident colon cancer and 354 and 393 rectal cancer cases were identified in men and women, respectively. Moderate weight gain was associated with an increased risk of colon cancer in men (weight gain of 1.4 -3.8kg/ 5 years; 4th quintile, HR 1.32; 95% CI 1.03; 1.69) and women (weight gain of 1.9-4.2 kg/ 5 years; 4th quintile, HR 1.29; 95% CI 0.99; 1.68). No effects were found for higher weight gain, or for the relationship between weight gain and rectal cancer risk in both men and women. There was no interaction between weight change and BMI, waist circumference or hormone replacement therapy. Conclusion: Our preliminary results indicate that the risk on colon cancer is increased in men and women with moderate short term weight gain, but not in those with high weight gain. The latter might be due to competing risks in men with high weight gain. This finding needs further investigation and will be discussed at the conference in more detail. Citation Format: Charlotte Noelle Steins Bisschop, Carla H. van Gils, Marleen J. Emaus, Bas Bueno de Mesquita, Krasimira Aleksandrova, Heiner Boeing, Mazda Jenab, Elio Riboli, Teresa Norat, Petra H.M. Peeters, Anne M. May. Short-term weight change and colon and rectal cancer risk in the EPIC cohort. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B77.