How often parents make decisions with their children is associated with obesity.

BACKGROUND: Evidence supports that better parental involvement and communication are related to reduced obesity in children. Parent-child collaborative decision-making is associated with lower BMI among children; while child-unilateral and parent-unilateral decision-making are associated with overweight children. However, little is known about associations between joint decision-making and obesity among Hispanic youth. The purpose of this analysis was to determine the relationship between parent-child decision making and obesity in a sample of predominantly Hispanic adolescents. METHODS: Data from two studies focused on risk for type II diabetes were analyzed. A total of 298 adolescents 10-14 years of age and their parent/legal guardian were included. Parents completed questionnaires related to psychosocial, family functioning, and environmental factors. Multiple logistic regression was used to determine the association between obesity (≥ 95th percentile for age and gender), the dependent variable, and how often the parent felt they made decisions together with their child (rarely/never, sometimes, usually, always), the primary independent variable. Covariates included gender, age, ethnicity, total family income, and days participated in a physical activity for at least 20 min. ORs and 95% CIs were calculated. RESULTS: Adolescent participants were predominantly Hispanic n = 233 (78.2%), and approximately half n = 150 (50.3%) were female. In multivariate analyses, adolescents who rarely/never made decisions together with their family had significantly higher odds (OR = 3.50; 95% CI [1.25-9.83]) of being obese than those who always did. No association was observed between either those who sometimes make decisions together or those who usually did and those that always did. CONCLUSIONS: Parents and children not making decisions together, an essential aspect of parent-child communication, is associated with increased childhood obesity. The results of our study contribute to evidence of parental involvement in decision-making as an important determinant of adolescent health. Further studies should explore temporal relationships between parenting or communication style and obesity.

Efficacy of curcumin for age-associated cognitive decline: a narrative review of preclinical and clinical studies.

Processes such as aberrant redox signaling and chronic low-grade systemic inflammation have been reported to modulate age-associated pathologies such as cognitive impairment. Curcumin, the primary therapeutic component of the Indian spice, Turmeric (Curcuma longa), has long been known for its strong anti-inflammatory and antioxidant activity attributable to its unique molecular structure. Recently, an interest in this polyphenol as a cognitive therapeutic for the elderly has emerged. The purpose of this paper is to critically review preclinical and clinical studies that have evaluated the efficacy of curcumin in ameliorating and preventing age-associated cognitive decline and address the translational progress of preclinical to clinical efficacy. PubMed, semantic scholar, and Google scholar searches were used for preclinical studies; and clinicaltrials.gov , the Australian and New Zealand clinical trials registry, and PubMed search were used to select relevant completed clinical studies. Results from preclinical studies consistently demonstrate curcumin and its analogues to be efficacious for various aspects of cognitive impairment and processes that contribute to age-associated cognitive impairment. Results of published clinical studies, while mixed, continue to show promise for curcumin's use as a therapeutic for cognitive decline but overall remain inconclusive at this time. Both in vitro and in vivo studies have found that curcumin can significantly decrease oxidative stress, systemic inflammation, and obstruct pathways that activate transcription factors that augment these processes. Future clinical studies would benefit from including evaluation of peripheral and cerebrospinal fluid biomarkers of dementia and behavioral markers of cognitive decline, as well as targeting the appropriate population.

Liver Biomarkers and Lipid Profiles in Mexican and Mexican-American 10- to 14-Year-Old Adolescents at Risk for Type 2 Diabetes.

Liver enzymes alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) are markers for type 2 diabetes mellitus (T2DM); alkaline phosphatase is a marker of liver disease. Mexican-American adolescents are disproportionately affected by T2DM, while in Mexico its prevalence is emerging. We assessed liver biomarkers and lipid profiles among Mexican and Mexican-American adolescents 10-14 years old with high/low risk of T2DM through a cross-sectional, descriptive study (Texas n = 144; Mexico n = 149). We included family medical histories, anthropometry, and blood pressure. Obesity was present in one-third of subjects in both sites. ALT (UL) was higher (p < 0.001) in high-risk adolescents (23.5 ± 19.5 versus 17.2 ± 13.4 for males, 19.7 ± 11.6 versus 15.1 ± 5.5 for females), in Toluca and in Texas (26.0 ± 14.7 versus 20.0 ± 13.2 for males, 18.2 ± 13.4 versus 14.6 ± 10.1 for females), as well as GGT (UL) (p < 0.001) (18.7 ± 11.1 versus 12.4 ± 2.3 for males, 13.6 ± 5.8 versus 11.5 ± 3.9 for Mexican females; 21.0 ± 6.8 versus 15.4 ± 5.5 for males, 14.3 ± 5.0 versus 13.8 ± 5.3 for females in Texas). We found no differences by sex or BMI. Total cholesterol and HDL were higher among Mexican-Americans (p < 0.001). In conclusion, multiple risk factors were present in the sample. We found differences by gender and between high and low risk for T2DM adolescents in all liver enzymes in both sites.

Correlation of Lipid Profile and Risk of Developing Type 2 Diabetes Mellitus in 10-14 Year Old Children.

BACKGROUND/AIMS: The role of lipid profile in predicting the risk of Type 2 diabetes mellitus (T2DM) in children is not clearly established. Our aim is to screen non-diabetic children aged 10-14 years for risk of developing T2DM and evaluate the association of abnormal lipids and socioeconomic status (SES). METHODS: Data on race/ethnicity, family history, body mass index percentile, blood pressure and presence of neck pigmentation (acanthosis nigricans) were collected from 149 non-diabetic children. Using these factors, children were classified into low risk (<3 risk factors) and high risk (>3 risk factors) groups. Logistic regression model and chi-square tests were used to evaluate the association of blood lipid profile and demographic variables. Independent t-test was used to compare the ratio of Total Cholesterol (TC) and High Density Lipids (HDL) with T2DM risk. RESULTS: 60% of children were at high risk for developing T2DM. HDL (p<0.001), triglycerides (p=0.02) and TC/HDL ratio (p<.001) were significantly abnormal in high risk group. Low SES showed a marginal association with high risk group. There were no gender or age differences between high and low risk groups. CONCLUSIONS: The significant determinants associated with high risk group were modifiable factors providing an opportunity for early intervention and prevention.

Association Between Healthcare Provider Type and Intent to Breastfeed Among Expectant Mothers.

BACKGROUND: The primary purpose of this study was to determine the association between type of healthcare provider delivering prenatal care and intent to exclusively breastfeed. METHODS: A self-report survey was administered to 455 expectant mothers. Logistic regression was performed to determine the association between prenatal care provider type [obstetrician; other primary care physician (family doctor/general practitioner/internist/or other physician); midwife/nurse midwife; more than one provider; and other] with intent to breastfeed (exclusive/non-exclusive). RESULTS: Having a midwife/nurse midwife as a prenatal care provider was associated with intent to breastfeed compared to having an obstetrician (OR 2.544, 95 % CI 1.385-4.675). There was no difference in intent between women with another primary care physician and an obstetrician. Women with another type of health care provider, no prenatal care from a health professional, or no knowledge of who is providing prenatal care were less likely to intend to breastfeed (OR 0.228, CI 0.068-0.766) as compared to those with an obstetrician. DISCUSSION/CONCLUSIONS: Provider type is associated with intent to breastfeed among pregnant women. Women's intent to breastfeed is an important predictor of breastfeeding initiation, continuation, and duration that may be assessed by healthcare providers during the prenatal period. A consideration of what features of provider care are associated with improved breastfeeding outcomes and characteristics of women seeking prenatal care with midwives may serve to formulate future prenatal care policies and education during prenatal care visits.

Levels of acculturation and effect on glycemic control in Mexicans and Mexican Americans with type 2 diabetes.

BACKGROUND: Acculturation of Mexican Americans toward the predominant American culture has been shown to influence health outcomes. Little is known about the role of acculturation in diabetes control. OBJECTIVE: To measure the association between acculturation and diabetes control in Mexicans and Mexican Americans with type 2 diabetes mellitus (T2DM). DESIGN: Cross-sectional survey and chart review. SETTING: Ambulatory family medicine clinics. PATIENTS: Sixty-six Mexican and Mexican American adults with T2DM for ≥ 1 year. INSTRUMENT AND OUTCOMES: A survey tool was developed that included the General Acculturation Index developed by Balcazar et al to measure acculturation. Basic demographics, psychosocial factors, patient satisfaction, and patients' most recent hemoglobin A(1c) (HbA(1c)) levels were also obtained. RESULTS: There was no significant correlation between acculturation score and HbA(1c) levels. On binary logistic regression, HbA(1c) levels were associated with patient satisfaction in having their questions answered (odds ratio [OR], 0.44; P < 0.05), interference of diabetes with daily life (OR, 1.4; P < 0.05), male gender (OR, 3.93; P < 0.01), and number of diabetes complications (OR, 1.81; P < 0.05). In the multivariate linear regression model, age (beta, -0.348; P < 0.05) and frequency of physician visits (beta, -0.403; P < 0.05) were the only variables significantly associated with glycemic control. Variables included in the model that were not associated with glycemic control include family history of diabetes and confidence in diabetes treatment efficacy. CONCLUSIONS: Acculturation was not associated with glycemic control in this population. Family physicians should not assume that acculturation difficulties explain poor glycemic control in their Mexican American patients with T2DM.

Positive relationship between support group attendance and one-year postoperative weight loss in gastric banding patients.

BACKGROUND: Few empirical reports of studies examining the association between bariatric after care support group attendance and weight loss outcomes have been published. The present study investigated the association between the number of support group meetings attended and percentage of excess weight loss at 12 months after gastric banding surgery. The setting was a private practice at which no-cost, professionally led support group meetings were held weekly. METHODS: The medical records and support group attendance logs were examined for the dates of attendance, frequency of attendance (or no attendance) in relation to the percentage of excess weight loss (n = 102; 88.2% women; mean age 45.6 ± 11.3 years; mean baseline body mass index 46.4 ± 8.8 kg/m(2)). Linear regression models were used to assess the relationship between the number of group meetings attended and the percentage of excess weight of loss with age and baseline body mass index used as optional independent variables. RESULTS: A significant linear relationship was found between support group meeting attendance and the percentage of excess weight loss with simple regression analysis (adjusted R(2) = .061, P = .007), with age (adjusted R(2) = .100, P = .002) and the baseline body mass index added to the model (adjusted R(2) = .072, P = .011). CONCLUSION: The results of the present study add to the growing evidence of the positive relationship between the frequency of support group attendance and the percentage of excess weight loss. Future studies should examine patient motivational characteristics in relation to support group participation and other aspects of compliance with aftercare recommendations to investigate unique effects of each part of the treatment program on weight loss outcomes.

Postinjury personality and outcome in acquired brain injury: the Millon Behavioral Medicine Diagnostic.

OBJECTIVE: To examine the relationship between postinjury personality and outcome in individuals with acquired brain injury. It was hypothesized that patients with differing levels of Introversive, Dejected, and Oppositional coping styles as described by Millon's Theory of Personality would show different outcomes after completion of a rehabilitation program. DESIGN: A retrospective chart review and completion of an outcome assessment was undertaken to examine study hypotheses. SETTING: A postacute brain injury rehabilitation program. PARTICIPANTS: Fifty patients who completed the rehabilitation program between 2005 and 2008, who were 18 years of age or older, who possessed at least a sixth-grade reading level, and who completed a valid Millon Behavioral Medicine Diagnostic (MBMD) were selected. Rehabilitation therapists who worked with these patients were also recruited to assess patient outcomes. METHODS: Charts of patients that met inclusion criteria were reviewed. Rehabilitation therapists completed the outcome measure retrospectively. The MBMD was used to predict outcome. The MBMD is a self-report questionnaire designed to assess psychosocial factors that relate to the course of medical treatment in chronic illness. MAIN OUTCOME MEASUREMENTS: The Mayo-Portland Adaptability Inventory (MPAI-4) was used to assess patient outcome. It is a 29-item assessment designed to evaluate the common physical, cognitive, emotional, behavioral, and social issues after acquired brain injury. RESULTS: Findings supported our hypotheses that patients with differing levels of Introversive and Oppositional Coping Styles would have significantly different outcomes after rehabilitation. Thus, individuals with mild/moderate to moderate/severe limitations had significantly greater scores on the Introversive and Oppositional coping compared with individuals with more successful outcomes. CONCLUSIONS: The results of this study support the idea that postinjury personality is an important factor in understanding outcome after completion of a brain-injury rehabilitation program. Personality variables accounted for significant variance above and beyond variance accounted for by the severity of the injury alone. These findings have important implications for the development and implementation of rehabilitation treatment planning.

Visceral adipose tissue loss and insulin resistance 6 months after laparoscopic gastric banding surgery: a preliminary study.

BACKGROUND: Increased visceral adipose tissue (VAT) is thought to be a risk factor for cardiovascular and metabolic diseases. There are only limited data on whether VAT loss after laparoscopic gastric banding surgery (LGBS) is related to risk factor reduction. This study determined whether improvements in risk markers, in particular insulin resistance, were related to VAT reduction at 6 months after LGBS (T2). METHODS: Thirty-four LGBS patients and 17 normal weight controls underwent initial and T2 testing. Fasting venous blood samples were taken to evaluate glucose, insulin, hemoglobin A(1c), lipids, C-reactive protein (CRP), and hormone profiles. Insulin resistance was estimated using the homeostasis model assessment (HOMA) index. VAT was measured using CT techniques. Data were analyzed using repeated measures ANOVA and regression analysis. RESULTS: Results at T2 showed that patients had significant improvements in body composition, HOMA, and hemoglobin A(1c). There were also reductions in plasma renin activity and leptin, and increases in ghrelin and GLP-1. Reductions in VAT were significantly correlated with reductions in insulin, HOMA, and glucose. While high density lipoprotein cholesterol, triglycerides, CRP, and the apolipoprotein A1/B ratio were also improved, VAT reduction was significantly correlated only with an increased apolipoprotein A1/B ratio. CONCLUSION: These data indicate that 6 months after LGBS there were significant improvements in many cardiovascular and metabolic risk markers. However, VAT reduction was most strongly associated with reductions in insulin resistance. Body weight loss was not associated with markers of improved insulin sensitivity.

Influence of BMI and gender on postprandial hormone responses.

OBJECTIVE: Influences of gender and body weight on the hormonal response to eating are not well understood. This study was conducted to determine a convenient time-point to evaluate peak postprandial hormone responses and to test the hypothesis that gender and BMI interact to produce differences in postprandial secretion of selected humoral markers implicated in hunger and satiety. RESEARCH METHODS AND PROCEDURES: Fasting blood glucose, insulin, leptin, ghrelin, glucagon-like peptide-1, and glucagon were measured in normal-weight (20 or= 30 kg/m2) men (n = 9) and women (n = 11). A standard liquid meal was consumed, and humoral measurements were repeated every 10 minutes for 1 hour. Data were analyzed using repeated measures ANOVA with BMI and gender as main effects. RESULTS: Obese subjects had delayed peak insulin responses (p = 0.004), whereas obese men had a delayed nadir ghrelin response (p = 0.05). Obese subjects had higher and more sustained postprandial glucose (p = 0.02), and greater fasting (p = 0.0004) and postprandial insulin (p = 0.0001). Ghrelin decreased after the meal (p = 0.003); the percent change from fasting tended to be reduced in obese subjects (p = 0.07). Men had greater fasting (p = 0.02) and postprandial (p = 0.03) glucagon and a subtle postprandial decline in plasma leptin (p = 0.01). DISCUSSION: Peak hormone responses occurred 20 to 40 minutes after eating. Measurements made during this interval may be useful in evaluating postprandial response magnitude. Peak/nadir responses and time courses of postprandial responses are influenced by gender and BMI. Nutritional studies need to account for variability introduced by these factors.