Long-term effects on weight loss and maintenance by intensive start with diet and exercise.

This 36-month study aimed to determine whether exercise intervention added to weight loss treatment in the beginning or at 6 months is effective for weight loss and long-term weight maintenance. A total of 120 obese adults (body mass index >30) were randomly assigned to intensified behavioral modification (iBM), iBM+ additional exercise from 0 to 3 months (CWT1), iBM+ additional exercise from 6 to 9 months (CWT2), and a control group (CON). Questionnaires and measurements were collected at baseline, 3, 9, 24, and 36 months. The intervention consisted of an 12 months intensified weight-loss period followed by a 24 months weight-maintenance period. Eighty (67%) subjects (mean age 46.0 years, BMI 36.2) completed the trial. Compared with the control group, all three intervention groups had significant weight loss during the 36-month intervention period (p < 0.001). The achieved weight loss remained significant at 36 months in the iBM (-6.8%, p < 0.001), the CWT1 (-5.8%, p < 0.001), and the CWT2 group (-3.9%, p < 0.001). The CWT1 group showed significant reduction in waist circumference at 9 months (-11.3 cm, p < 0.001), at 24 months (-8.8 cm, p < 0.001), and at 36 months (-8.7 cm, p < 0.001). Intensified behavioral modification alone and with exercise resulted in clinically significant weight loss and long-term weight maintenance. The addition of exercise at the onset promoted greater reductions in waist circumference. In the treatment of obesity, including severe obesity, more intensive lifestyle interventions with exercise should be incorporated.

Onset of the climacteric phase by the mid-forties associated with impaired insulin sensitivity: a birth cohort study.

OBJECTIVE: To investigate whether the early-onset menopausal transition is associated with deteriorated glucose tolerance in women in their mid-forties. METHODS: A cross-sectional analysis of a cohort study including 2,632 women of the Northern Finland Birth Cohort 1966. The participants were divided into two groups by their menstrual history and follicle-stimulating hormone values at age 46: climacteric and preclimacteric women. Glucose and insulin parameters, as well as mathematical indices derived from them to evaluate insulin sensitivity, were compared between the groups. The results were adjusted for measured body mass index and smoking. The possible effect of hormone therapy was investigated in subanalyses excluding hormone therapy users. RESULTS: Climacteric women (n = 379) were more often current smokers at age 46 (P = 0.008), and their body mass indices increased more from 31 to 46 years (P = 0.013), compared to preclimacteric women (n = 2,253). In a multivariable generalized linear model, being climacteric at age 46 was associated with several findings suggesting decreased insulin sensitivity: increased glycated hemoglobin (P < 0.001), 2-hour oral glucose tolerance test 30- and 60-minute insulin (P = 0.040 and 0.006, respectively), and area under the insulin curve (P = 0.005). Being climacteric also was associated with a decreased the McAuley (P = 0.024) and Belfiore indices (P = 0.027) and glucose tolerance test 60-minute glucose (P = 0.015). In subanalyses excluding hormone therapy users (n = 94), the results did not change significantly. CONCLUSIONS: Earlier onset of climacteric transition is associated with impaired insulin sensitivity in middle-aged women.

Video Summary:http://links.lww.com/MENO/A648.

Evaluating the 1-h post-load glucose level to predict future type 2 diabetes.

AIMS: To evaluate the predictive ability of 2-h post-load glucose level in addition to fasting and 1-h glucose levels in predicting the risk of type 2 diabetes. METHODS: We examined a prospective population-based cohort study of 654 subjects without type 2 diabetes at baseline. All subjects underwent an oral glucose tolerance test (OGTT), with measurement of glucose at 0, 60, and 120 min at baseline, and after 12 years in a follow-up survey. We evaluated the predictive properties of fasting, 1- and 2-h post-load glucose levels by comparing the areas under the receiver-operating characteristic (ROC) curve. RESULTS: We found that 2-h glucose concentration in the prediction model with fasting and 1-h glucose levels did not significantly increase the predictability of type 2 diabetes compared to a model only including fasting and 1-h glucose levels (AUC 0.83 vs. AUC 0.82, respectively; p = 0.23). The area under the ROC curve was the largest for 1-h glucose level (AUC 0.81), compared to fasting (AUC 0.71; p < 0.01) and 2-h glucose levels (AUC 0.72; p = 0.01). CONCLUSIONS: Adding 2-h glucose to the model with fasting and 1-h glucose levels did not improve the predictability of new onset type 2 diabetes.

Dose-response relation of self-reported and accelerometer-measured physical activity to perceived health in middle age-the Northern Finland Birth Cohort 1966 Study.

BACKGROUND: Regular physical activity (PA) promotes health and decreases mortality. The positive relationship between PA and perceived health (PH) is well known. However, previous research in the field has often used self-reported PA measures. The aim of this population-based NFBC1966 birth cohort study was to assess the relationship between both self-reported and objectively measured PA and PH in midlife. METHODS: A sample group of 6384 participants (2878 men, 3506 women, response rate 62%) aged 46 completed a questionnaire on PH and health behaviors, including items on weekly leisure time physical activity (LTPA) and daily sitting time (ST). PH was dichotomized as good (very good or good) and other (fair, poor, or very poor). PA was measured with a wrist-worn Polar Active (Polar Electro, Finland) accelerometer for 14 days (n = 5481, 98%) and expressed as daily average time spent in moderate to vigorous intensity PA (MVPA). Odds ratios (OR) and 95% confidence intervals for good PH were calculated using binary logistic regression and adjusted for relevant demographic, socioeconomic, and health characteristics, and ST. RESULTS: The level of PA was positively associated with PH after adjustments with covariates and ST. There was a dose-response relationship across the PA quartiles according to the adjusted multivariable models. Self-reported LTPA was more strongly associated with good PH (OR from 1.72 to 4.33 compared to lowest PA quartile) than objectively measured PA (OR from 1.37 to 1.66 compared to lowest PA quartile). CONCLUSIONS: In this large population-based birth cohort study, we for the first time show a positive dose-response relationship of both self-reported and objectively measured PA to PH, the relationship being stronger for self-reported LTPA. Despite the cross-sectional design of this study, the results from this large sample suggest that both self-reported and objectively measured physical activity are strongly associated with PH, which is a predictor of morbidity and mortality, and regular PA should be encouraged in midlife.

Effective Weight Loss and Maintenance by Intensive Start with Diet and Exercise.

INTRODUCTION: This 24-month study aimed to determine whether exercise intervention added to weight loss treatment at 6 months is effective for weight loss and maintenance. METHODS: A total of 120 obese subjects (body mass index > 30) were randomly assigned to intensified behavioral modification (iBM) (n = 30), behavioral modification + exercise from 0 to 3 months (circuit weight training group 1 [CWT1]) (n = 30), behavioral modification + exercise from 6 to 9 months (CWT2) (n = 30), and a control group (CON) (n = 30). Health behavior, weight, waist circumference, and 2-h glucose tolerance test with insulin measurements were measured at 0, 3, 9, and 24 months. RESULTS: Eighty-five subjects (mean age = 46 yr, body mass index = 36.3, 75.3% women) completed the trial. A significant weight loss occurred in CWT1 (-8.5 kg, P > 0.001), iBM (-5.5 kg, P > 0.001), and CWT2 (-4.4 kg, P = 0.007). CWT1 showed the highest reduction in waist circumference at 9 months (mean difference = -11.5 cm, P < 0.001) and 24 months (mean difference = -8.8 cm, P < 0.001). Both fasting and 2-h insulin values improved in the intervention groups compared with CON. A significant decrease in 2-h insulin values from baseline was found in CWT1 and CWT2. Matsuda index improved in the CWT1 group from the baseline to 24 months (2.03, P = 0.025). CONCLUSION: The most effective weight loss regimen is a combination of iBM and weight training introduced from the very beginning of the weight loss period. Treatment of morbid obesity should include an intensive start with exercise and diet regardless of weight status.

Physical activity and aerobic fitness are positively associated with heart rate variability in obese adults.

BACKGROUND: Autonomic nervous system (ANS) dysfunction and obesity are intrinsically related to each other. In normal-weight subjects physical activity (PA) and fitness are related to cardiovascular autonomic regulation, providing evidence that aerobic training may improve ANS functioning measured by heart rate variability (HRV). The goal of this study was to investigate the association between lifetime PA, aerobic fitness and HRV in obese adults. METHODS: Participants included 107 (87 females) volunteers (mean age 44.5 years, median BMI 35.7) who completed health and lifestyle questionnaires and measurements of maximal aerobic performance, anthropometry and 24 h HRV. RESULTS: In the multivariate linear regression analyses, lifetime physical activity explained 40% of the variance in normal R-R intervals (SDNN). Each 1-category increase in the activity index increased SDNN by 15.4 (P = .009) and 24% of the variance in natural logarithmic value of ultra-low frequency power (P = .050). High measured VO2max explained 45% of the variance in natural logarithmic value of high-frequency power (P = .009) and 25% of the variance in low frequency/high frequency ratio (P < .001). CONCLUSIONS: Lifetime physical activity and aerobic fitness may reduce obesity-related health risks by improving the cardiac autonomic function measured by HRV in obese working-age subjects. This research supports the role of lifetime physical activity in weight management strategies and interventions to reduce obesity-related health risks.

Importance of weight loss maintenance and risk prediction in the prevention of type 2 diabetes: analysis of European Diabetes Prevention Study RCT.

BACKGROUND: Prevalence of type 2 diabetes (T2D) is increasing worldwide. T2D prevention by lifestyle intervention is effective. Pragmatic scalable interventions are needed, with evidence to efficiently target and monitor such interventions. We report pooled analyses of data from three European trial cohorts: to analyse T2D incidence, sustained weight loss and utility of risk predictors. METHODS: We analysed data on 749 adults with impaired glucose tolerance (278 men and 471 women, mean age 56 years, mean BMI 31 kgm(-2)) recruited between 1993 and 2003, and randomised to intensive lifestyle intervention (I) or lifestyle advice control (C). The intervention aimed to increase physical activity, modify diet, and promote weight loss≥5%. Using Cox-regression survival analysis, we assessed T2D incidence and the impact on T2D incidence of sustained weight loss, and of baseline cut-point values of FINDRISC score, fasting plasma glucose (FPG), and HbA1c. RESULTS: Mean follow-up duration was 3.1 years. T2D was diagnosed in 139 participants (I = 45/379, C = 94/370). Cumulative T2D incidence was 57% lower in the intervention compared with the control group (HR 0.42 (95% CI 0.29 to 0.60) P<0.001). Participants with ≥5% weight loss at one year had 65% lower T2D incidence (HR 0.35 (95% CI 0.22 to 0.56) P<0.001); maintaining ≥5% weight loss for two and three years further reduced T2D incidence. Recommended cut-points to identify those at high risk for T2D would have identified different proportions of European Diabetes Prevention Study (EDIPS) participants with similar hazard-ratios for intervention effect. CONCLUSIONS: Pooled analysis of EDIPS trial data reinforces evidence for T2D prevention by lifestyle intervention. Analysis showed the preventive effect of ≥5% weight loss, especially if maintained long term, which has utility for intervention monitoring. Analysis of proposed cut-points demonstrates difficulties in balancing risk and benefit, to efficiently target interventions and suggests evidence is needed to define clinical policy. TRIAL REGISTRATIONS: THE FINNISH DIABETES PREVENTION STUDY, HELSINKI, FINLAND: ClinicalTrials.gov; NCT00518167 The SLIM diabetes prevention study, Maastricht, The Netherlands: Clinical Trials.gov; NCT00381186 The EDIPS-Newcastle diabetes prevention study, Newcastle upon Tyne, UK: International Standard Randomised Controlled Trial Number; ISRCTN15670600.

Factors associated with parental recognition of a child's overweight status--a cross sectional study.

BACKGROUND: Very few studies have evaluated the association between a child's lifestyle factors and their parent's ability to recognise the overweight status of their offspring. The aim of this study was to analyze the factors associated with a parent's ability to recognise their own offspring's overweight status. METHODS: 125 overweight children out of all 1,278 school beginners in Northern Finland were enrolled.Weight and height were measured in health care clinics. Overweight status was defined by BMI according to internationally accepted criteria. A questionnaire to be filled in by parents was delivered by the school nurses. The parents were asked to evaluate their offspring's weight status. The child's eating habits and physical activity patterns were also enquired about. Factor groups of food and physical activity habits were formed by factor analysis. Binary logistic regression was performed using all variables associated with recognition of overweight status in univariate analyses. The significant risk factors in the final model are reported using odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS: Fifty-seven percent (69/120) of the parents of the overweight children considered their child as normal weight. Child's BMI was positively associated with parental recognition of overweight (OR 3.59, CI 1.8 to 7.0). Overweight boys were less likely to be recognised than overweight girls (OR 0.14, CI 0.033 to 0.58). Child's healthy diet (OR 0.22, CI 0.091 to 0.54) and high physical activity (OR 0.29, CI 0.11 to 0.79) were inversely related to parental recognition of overweight status. CONCLUSIONS: Child's healthy eating habits and physical activity are inversely related to parental recognition of their offspring's overweight. These should be taken into account when planning prevention and treatment strategies for childhood obesity.

Physical activity and body composition changes during military service.

PURPOSE: To examine how body composition changes in different body mass index (BMI) categories among young Finnish men during military service, which is associated with marked changes in diet and physical activity. In addition, this study examined how reported previous physical activity affected the body composition changes. METHODS: Altogether 1003 men (19 yr) were followed throughout their military service (6-12 months). Height, weight, BMI, waist circumference, and waist-to-hip ratio (WHR) were recorded. Previous physical activity was assessed at the beginning of the service by a questionnaire. Body composition was measured by bioelectrical impedance assessments (BIA) at the beginning and at the end of the service. The measured parameters were fat mass (FM), fat percentage (fat %), fat-free mass (FFM), visceral fat area (VFA), lean body mass (LBM), and skeletal muscle mass (SMM). RESULTS: On average, military training decreased weight by 0.7%, FM by 9.7%, fat % by 6.6%, and VFA by 43.4%. FFM increased by 1.3%, LBM by 1.2%, and SMM by 1.7%. The group of underweight and normal-weight men gained weight, FM, and FFM, whereas overweight and obese men lost weight and FM and gained FFM. FM was most reduced in the groups of overweight (20.8%) and obese (24.9%) men. The amount of VFA was reduced in all BMI groups (38%-44%). Among overweight men who reported being inactive previous to the military service, more beneficial changes in body composition were observed compared with those who reported being physically active. CONCLUSIONS: The lifestyle changes associated with military service markedly reduce fat tissue and increase the amount of lean tissue. These beneficial changes are prominent among previously inactive subjects with high BMI.

Gender difference among smoking, adiponectin, and high-sensitivity C-reactive protein.

BACKGROUND: Subclinical inflammation is a novel risk factor of cardiovascular diseases and type 2 diabetes. An inverse association between plasma adiponectin and insulin resistance has been previously shown. Elevated levels of high-sensitivity C-reactive protein (hs-CRP) predict future cardiovascular events. Smoking has been proven to connect with inflammatory markers. There is also evidence of a difference between genders in pro-inflammation. This study aimed to examine the connections among adiponectin, hs-CRP, and smoking and to determine possible gender differences in these associations. METHODS: Included were 365 men and 476 women; all were nondiabetic and middle-aged. Daily smoking subjects were considered to be smokers. Adiponectin and hs-CRP were analyzed. Data were collected in 1997-1998, and cytokines were analyzed in 2003. RESULTS: Thirty-five percent of the men and 22% of the women were smokers. In women, the adiponectin level was significantly lower in smokers (6.94+/-3.27 microg/ml) compared to nonsmokers (8.27+/-4.72 microg/ml, p=0.0017). This association remained significant after adjustment for age and BMI (p=0.0061). The hs-CRP level was significantly higher in smoking men (1.59+/-1.71 pg/ml) compared to nonsmoking men (1.17+/-1.41 pg/ml, p=0.018). This result remained after adjustment for age and BMI (p=0.0056). When smokers were compared to nonsmokers, there was no difference in adiponectin among men or in hs-CRP among women. CONCLUSIONS: In the nondiabetic population, smoking associates differently with subclinical inflammation between genders, with a decreased adiponectin level in women and with an increased hs-CRP level in men.

Long-term effectiveness of bone-setting, light exercise therapy, and physiotherapy for prolonged back pain: a randomized controlled trial.

BACKGROUND: Chiropractic manipulation and strenuous exercise therapy have been shown effective in the treatment of nonspecific back pain. Bone-setting, the predecessor of modern manual therapies, still survives in some parts of Finland and was compared with a light exercise therapy and non-manipulative, pragmatic physiotherapy in a year-long randomized controlled trial on patients with long-term back pain. METHODS: One hundred fourteen ambulatory patients of working age with back pain for 7 weeks or more were randomly assigned to the therapies, which were offered in up to 10 sessions during a 6-week treatment period. The outcome was measured by the Oswestry Disability Questionnaire. Sick-leaves and visits to health centers were recorded for 1 year before and after the therapy. RESULTS: The Oswestry disability scores improved most in the bone-setting group (P =.02, Kruskall-Wallis test). Visits to health centers for back pain were reduced only in the physiotherapy group (P =.01, Wilcoxon test). Sick-leaves were not significantly different between groups. A secondary analysis based on the use of additional therapies after the intervention showed a possible subgroup with an enhanced effect from bone-setting. CONCLUSIONS: Traditional bone-setting seemed more effective than exercise or physiotherapy on back pain and disability, even 1 year after therapy.

Total selective deficiency of serum and secretory IgA associated with farmer's lung.

We present a case of total IgA deficiency associated with farmer's lung. The IgA deficiency is combined with the IgE one. IgA are absent both in the serum and in the bronchial secretions; they are present on the surface of B-lymphocytes, also after the enzymatic surface digestion and resynthesis test is performed. With intravenous perfusion of human gamma globulins, during repeated courses, IgA reach a normal level and exceed it, despite the IgA concentration in the perfused compound is very low and despite the fact that injected gamma globulins are not detectable with electrophoretic method. IgA never appear in the bronchial secretion. The association between both IgA and IgE deficiency, with this pulmonary disease, differential diagnostics, and therapeutical features, are discussed.

RDT with acetate-free bicarbonate buffered dialysis fluid: long-term effects on lipid pattern, acid-base balance and oxygen delivery.

Thirteen uraemic patients with hypertriglyceridaemia were treated for 9 months with acetate-free, bicarbonate containing dialysis fluid. With this treatment more physiological correction of acid-base balance and better tissue oxygenation were obtained. This fact can explain the better tolerance to treatment we have seen. In 9 of these patients triglyceride levels fell significantly on bicarbonate treatment; they shifted back to higher values after return to acetate dialysis. No changes were found in the other 4 patients.