Load-to-strength ratio at the radius is higher in adolescent and young adult females with obesity compared to normal-weight controls.

BACKGROUND: Among adolescents with extremity fractures, individuals with obesity have greater representation compared with individuals of normal-weight, despite having higher areal and volumetric bone mineral density (aBMD, vBMD) than their normal-weight counterparts. The relative increase in BMD in individuals with obesity may thus be insufficient to support the greater force generated upon falling. The load-to-strength ratio is a biomechanical approach for assessing the risk of fracture by comparing applied force to bone strength, with higher load-to-strength ratios indicating higher fracture risk. OBJECTIVE: To assess the load-to-strength ratio at the distal radius in adolescent and young adult females with severe obesity (OB) compared with normal-weight healthy controls (HC). We hypothesized that OB have a higher load-to-strength ratio compared to HC. METHODS: We examined bone parameters in 65 girls 14-21 years old: 33 OB and 32 HC. We used dual-energy X-ray absorptiometry (DXA) to assess body composition, high resolution peripheral quantitative CT (HR-pQCT) to estimate vBMD, and microfinite element analysis (µFEA) to assess bone strength at the distal radius. To quantify fracture risk, we computed the load-to-strength ratio, where the numerator is defined as the load applied to the outstretched hand during a forward fall and the denominator is the bone strength, as estimated by µFEA. RESULTS: Although OB had higher total vBMD than HC (368.3 vs. 319.9 mgHA/cm3, p = 0.002), load-to-strength ratio at the radius was greater in OB than HC after controlling for age and race (0.66 vs. 0.54, p < 0.0001). In OB, impact force and load-to-strength ratio were associated negatively with % lean mass (r = -0.49; p = 0.003 and r = -0.65; p < 0.0001 respectively) and positively with visceral fat (r = 0.65; p < 0.0001 and r = 0.36; p = 0.04 respectively). CONCLUSIONS: Adolescent and young adult females with obesity have higher load-to-strength ratio at the distal radius due to higher forces applied to bone in a fall combined with incomplete adaptation of bone to increasing body weight. This is differentially affected by lean mass, fat mass, and visceral fat mass.

A longitudinal study to investigate the effects of a 12-week comprehensive lifestyle weight management program on body weight and quality of life.

BACKGROUND & AIMS: The majority of Americans now have overweight or obesity. With limited resources to treat all patients, group programs are emerging as an efficient method for dissemination of evidence-based lifestyle information. The objective of this study was to evaluate change in body weight, biochemical parameters, and quality of life among individuals after completion of a 12-week comprehensive group weight management program at an obesity medicine clinic. METHODS: 204 patients were recruited for the study after enrolling in the Healthy Habits for Life program at the Massachusetts General Hospital Weight Center in Boston and Danvers, MA. Prior to the program, patients met individually with a dietitian and baseline data was collected. Primary outcome measures collected were weight and BMI change over the course of the program. Secondary measures collected included biochemical parameters and quality of life. Weekly group visits consisted of primary outcome collection and 1.5 h of instruction on various lifestyle- and nutrition-related topics. Secondary outcome measures were reassessed at an individual visit with the dietitian after the program concluded. RESULTS: 142 participants were adherent to the protocol (attended 9 out of 12 classes). On average, patients lost 6.4 kg (14.1 lbs.), representing a percent total body weight loss of over 5%. Average BMI decrease was significant at 5.35 ± 4.61%. Improvements were seen in physical function, self-esteem, and sexual life; total QOL scores also improved by a significant 5.79% on average. There were also significant improvements in total cholesterol, triglycerides, and HbA1c. CONCLUSIONS: The Healthy Habits for Life group program was an effective treatment for obesity and related health concerns, including overall quality of life. Group programs of this style may be a more efficient was to disseminate evidence-based lifestyle information and affect change for patients with overweight or obesity.

Comparison of Measured and Estimated Resting Energy Expenditure in Adolescents and Young Adults With Severe Obesity Before and 1 Year After Sleeve Gastrectomy.

Introduction: Resting energy expenditure (REE) is often evaluated in adults and adolescents with obesity to estimate caloric requirements when advising dietary changes. However, data are lacking regarding the accuracy of methods used to clinically assess REE in adolescents with severe obesity. Moreover, there are no data regarding the effects of sleeve gastrectomy (SG) on REE in adolescents. We evaluated the accuracy and error rate between estimated and measured REE in adolescents with severe obesity and changes in REE following (SG). Materials and Methods: Cross-sectional study (CSS): 64 adolescents and young adults, 14-22 years old, with moderate to severe obesity were enrolled. We measured REE (mREE) by indirect calorimetry and estimated REE (eREE) using Derumeaux (Deru), Mifflin-St Jeor (MS), Harris Benedict (HB), and World Health Organization (WHO) equations. DXA was used to determine body composition. Bland Altman analysis evaluated agreement between eREE and mREE. Longitudinal study: 12 subjects had repeat indirect calorimetry and DXA 1 year after SG. Longitudinal analysis was used to assess changes in REE and body composition. Results: CSS: Median BMI was 45.2 kg/m2 and median age was 18.0 (16.3-19.9) years. mREE correlated strongly with eREE . Bland Altman analysis demonstrated that only a few points were beyond the 1.96 SD limit of disagreement. However, there was considerable overestimation of mREE by most equations. Longitudinal Study: In the subset that underwent SG, after 12-months, absolute REE decreased from 1709 (1567.7-2234) to 1580.5 (1326-1862.5) Calories (p = 0.002); however, the ratio of REE/Total Body Weight (TBW) increased from 13.5 ± 2.3 at baseline to 15.5 ± 2.2 at 1 year (p = 0.043). When evaluating parameters affecting % total weight loss, we found that it correlated positively with REE/TBW at 12 months (R = 0.625; p = 0.03) and negatively with % fat mass at 12 months (R = -0.669; p = 0.024). Discussion: In adolescents with moderate-severe obesity, despite a correlation between mREE using indirect calorimetry and eREE using the Deru, MS, HB, and WHO equations, there is significant over-estimation of REE at the individual level, challenging their clinical utility. One year after SG, REE/TBW increased and strongly correlated with % total weight loss in adolescents.

Cyclophosphamide eradicates murine immunogenic tumor coding for a non-self-antigen and induces antitumor immunity.

Although the majority of cancers respond to chemotherapy, most cancer types relapse, at least in part, due to the poor immunogenicity of most tumor. We have reported before that treatment of tumor bearing mice with a combination of the anti-cancer chemotherapy cyclophosphamide (CTX) and immunotherapy can result in complete tumor regression using T-cell receptor (TCR) transgenic CD8+ T cells specific to antigens. This study aimed to determine whether chemotherapy can cure immunogenic tumor which expresses non-self-tumor antigen and result in antitumor immunity. Either EL4 cell line, a poorly immunogenic thymoma, or EG7, a clone of EL4 cells transfected with ovalbumin (OVA), as a non-self-antigen were inoculated subcutaneously into wild type or splenectomized C57BL/6 mice and then treated once with intraperitoneal (i.p.) injection of 4 mg CTX/mouse. In certain experiments, the mice were rechallenged with the same tumor type 1-2 months after the primary challenge. Treatment of EL4 bearing mice with CTX induced transient antitumor effect followed by tumor progression. Interestingly, however, treatment of EG7-bearing mice with CTX resulted in regression of early and advanced tumors. EG7 tumor-free mice rejected the second and the third challenges with EG7 cells, but not with challenge EL4 cells. These antitumor effects did not require spleen, since splenectomized mice showed similar antitumor effects of CTX on EG7 cells. Taken together, these data indicate that expression of non-self-antigen by poorly immunogenic tumor might be a reliable means to increase its immunogenicity and its response to chemotherapy.

Participants' perceptions of a group based program incorporating hands-on meal preparation and pedometer-based self-monitoring in type 2 diabetes.

BACKGROUND: Nutrition education (portion sizes, balanced meals) is a cornerstone of diabetes management; however, moving from information to behavior change is challenging. Through a single arm intervention study, we recently demonstrated that combining education with group-based meal preparation training has measureable effects on weight, eating behaviour, and glycemic control in adults with type 2 diabetes. In the present study, we conducted an in-depth examination of participants' perceptions of this strategy, through focus group discussion, to delineate effective elements of the strategy from participants' perspectives. METHODS: Participants who had completed the nutrition education/meal preparation training program were invited to attend one of four focus group discussions. These were led by experienced facilitators and guided by questions addressing experiences during the intervention and their perceived impact. Audiotapes were transcribed and qualitative content analysis of transcripts was performed. We report herein themes that achieved saturation across the four discussions. RESULTS: Twenty-nine (80.6%, 29/36) attended a focus group discussion. The program elements perceived as effective by participants included the hands-on interactive learning approach to meal preparation, the grocery store tour, pedometer-based self-monitoring, experiencing the link between food consumption/physical activity and glucose changes during the program, and peer support. Discussants reported changes in eating and walking behaviour, greater confidence in ability to self-manage diabetes, reductions in glucose levels and/or need for glucose-lowering medications, and, in some cases, weight loss. Family members and friends were facilitators for some and barriers for others in terms of achieving health behavior changes. CONCLUSIONS: Among adults with type 2 diabetes, a group based program that included hands-on meal preparation and pedometer-based self-monitoring was perceived as effective in conveying information, developing skills, building confidence, and changing health behaviors.

Nutritional education through internet-delivered menu plans among adults with type 2 diabetes mellitus: pilot study.

BACKGROUND: A potential barrier to weight loss and vascular risk reduction is difficulty in operationalizing dietary education into a concrete plan. Although a variety of Internet-based software tools are now available to address this issue, there has been little formal evaluation of these tools. OBJECTIVE: The aim of this single-arm pilot study is to determine the effect of a 24-week Internet-based menu-planning program, by examining pre- to postintervention changes in the body weight, blood pressure, and glycemia, specifically among overweight adults with type 2 diabetes mellitus (DM2), a clinical population at high risk for vascular diseases. METHODS: A total of 33 adults with DM2 were recruited by collaborating registered dietitians to a 24-week Internet-based menu-planning program. Individualized dietary prescriptions were operationalized into weekly Internet-delivered menu plans through an adapted version of a commercially available service. Adherence was defined as logging into the program at least once per week for a minimum of 18 of the 24 weeks. Multiple imputations were used for missing data. Using baseline and postintervention assessments, we calculated the weight changes (mean, 95% CI) and investigated the corresponding effects (linear regression models) on blood pressure (systolic, diastolic) and hemoglobin A1C (ie, glycemia). RESULTS: The mean age was 58 (SD 7) years and the mean baseline body mass index was 34.4 (SD 4.6) kg/m(2). The results of this study showed that ≥5% weight reduction was achieved by 6/33 participants (18%) and by 5/18 adherent participants (28%). A mean weight change of -2.0% (95% CI -2.6 to -1.4) was observed, with changes occurring in the adherent (-3.6%, 95% CI -4.5 to -2.8) but not in the nonadherent (0%, 95% CI -0.6 to 0.7). It was found that each 1% reduction in body weight was associated with a -2.4 mmHg change in systolic (95% CI -3.5 to -1.2) and a -0.8 mmHg change in diastolic blood pressure (95% CI -1.4 to -0.2). Percent weight change was not found to be related to changes in A1C. CONCLUSIONS: In adults with DM2, an Internet-based menu-planning program has the potential to lead to clinically important weight reductions in more than one quarter of those who adhere, with corresponding improvements in blood pressure.

Differences in food intake among obese and nonobese women and men with type 2 diabetes.

OBJECTIVE: Weight reduction is a key goal for the prevention of vascular complications in obese individuals with type 2 diabetes, but a nutritionally balanced intake is also important in this regard. We compared dietary intakes and vitamin supplement use between obese and nonobese women and men with type 2 diabetes to identify gaps in adherence to nutritional management guidelines. METHODS: We analyzed data from a longitudinal study of adults with type 2 diabetes, wherein participants were assessed once per season over 1 year. Dietary data were collected using a validated semiquantitative, self-administered food-frequency questionnaire. Given the absence of seasonal variations in anthropometric variables and dietary intake, data from multiple visits were averaged for each individual. Associations of both intake of fruit and vegetables and nutrients related to cardiovascular disease risk were compared between obese (body mass index ≥ 30 kg/m²) and nonobese individuals through multivariable linear regression with adjustments for age, education, and energy intake. RESULTS: Among the 200 participants (93 women and 107 men), 53% of women and 43% of men were obese. Compared with nonobese women, obese women consumed more saturated fat (mean difference, 1.2% of total energy intake; 95% confidence interval [CI], 3% to 2.2%) and sodium (mean difference, 0.3 g; 95% CI, 0.04 to 0.5 g), and they had a lower intake of fiber (mean difference, -2.7 g; 95% CI, -4.4 to -0.9 g) and magnesium (mean difference, -33.6 mg; 95% CI, -55.2 to -12.0 g). No differences in dietary intake were observed between obese and nonobese men, but the intakes of men overall were similar to those of obese women. Compared with nonobese participants, fewer obese individuals used vitamin/mineral supplements (women: 37% vs 48%, men: 26% vs 38%). CONCLUSIONS: Obese women and both obese and nonobese men appeared to have poorer dietary quality compared with nonobese women. Our findings support the need to emphasize dietary composition in addition to weight control in diabetes.