Reduction of misclassification rates of obesity by body mass index using dual-energy X-ray absorptiometry scans to improve subsequent prediction of per cent fat mass in a Caucasian population.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: • Body mass index (BMI) is not accurate in the classification of excess body fat, failing to identify as many as half of individuals with excess per cent fat mass. • Normal-weight obesity, which goes undiagnosed when BMI is the only measure of adiposity utilized, has been shown to be associated with an increased risk of cardiovascular comorbidities and mortality. • Dual-energy X-ray absorptiometry (DXA) is an accurate and relatively inexpensive method for indirect assessment of body composition. WHAT THIS STUDY ADDS: • The formulae developed allow the clinician to utilize information from one baseline DXA scan to calculate a patient's per cent fat mass with a future change in weight, thus allowing the clinician to more accurately determine whether and when an individual patient should be classified as obese and thus be managed appropriately. • The formulae developed enable the clinician to calculate a patient-specific BMI treatment goal, below which the patient would no longer meet the per cent fat mass criteria for obesity. SUMMARY: Recognition is increasing for the errors of body mass index (BMI) in classification of excess body fat. Dual-energy X-ray absorptiometry (DXA) is accurate to assess body fat mass per cent (%FM), but is underutilized clinically. We examined the prevalence of obesity misclassification by BMI in comparison to body %FM by DXA scanning, and whether there is a time-stable individual relation between the %FM and the BMI in patients scanned several times. We aimed to develop a formula where, based on a single DXA scan, %FM could be predicted following a change in weight, and a patient-specific BMI threshold could be calculated (BMIT ), above which the patient would be obese by %FM criteria. Data were collected from individuals who had a DXA scan as part of a nutritional research study at the University of Copenhagen. BMI incorrectly classified 48/329 (14.6%) of men and 52/589 (8.8%) of women. The majority of men with BMI 25-27 kg m(-2) and women with BMI 24-26 kg m(-2) were misclassified. Using multiple scan data (189 men, 311 women) and calculating the patient-specific constant C = (1 - %FM/100)(3/2) × BMI from baseline BMI and %FM, misclassification rates were halved for both genders when a personal threshold, BMIT , was used ([BMIT = C/(0.75)(3/2) ] for men and [BMIT = C/(0.65)(3/2) ] for women). We conclude that simple formulae allow evaluation of fatness of individual patients more accurately than BMI, with the use of one baseline DXA scan, and enable the establishment of patient-specific obesity treatment targets in clinical practice.

[Antibiotic resistance of E coli isolated from healthy persons]. / Antibiotikaresistens hos E. coli isoleret fra raske normalpersoner.

INTRODUCTION: The aim of the study was to determine the antibiotic susceptibility of E. coli isolates in stools from healthy Danes. METHODS: Sixty-nine persons from Copenhagen participated in the study. Three faecal samples from each participant were examined by culture for each of three periods. E. coli was isolated selectively and tested for sensitivity against sulfamethizole, trimethoprim, the combination of sulfamethizole and trimethoprim, ampicillin, mecillinam, cefuroxime, nitrofurantoin, and ciprofloxacin. RESULTS: Altogether, 184 strains of E. coli were isolated from 66 of the 69 persons. Fifty-eight (31.5%) of the strains isolated from 30 persons (43.5%) were resistant to sulfamethizole, 32 (17.4%) strains isolated from 18 persons (26.1%) were resistant to trimethoprim, 31 (16.8%) strains isolated from 17 persons (24.6%) were resistant to trimethoprim + sulfamethizole, 57 (31%) strains from 31 persons (44.9%) were resistant to ampicillin, 29 (15.8%) of the strains from 24 persons (34.8%) were resistant to nitrofurantoin, two (1.1%) strains from two persons (2.9%) were resistant to cefuroxime, whereas none of the strains was resistant to mecillinam and ciprofloxacin. DISCUSSION: The high prevalence of resistance to sulfamethizole, ampicillin, trimethoprim, and nitrofurantoin is surprising, as none of the persons had been treated with antibiotics, but it may reflect the widespread use of antibiotics in animals for food production. The consequences of the results for empiric antibiotic treatment of, for instance, urinary tract infection are discussed.

[Slimming behavior among Danes assessed by telephone interviews in 1992 and 1998]. / Danskernes slankeadfaerd målt ved telefoninterview i 1992 og 1998.

INTRODUCTION: With the increasing prevalence of overweight and obesity, it is assumed that slimming is on the increase. The aim of the present study was to elucidate the prevalence of slimming attempts, the methods used, and whether the weight loss was maintained. METHODS: Two independent telephone interviews were conducted in 1992 and in 1998. About 1200 adults selected at random were entered in each survey in a balanced design, which ensured an equal distribution of age, gender, and geographical regions in Denmark. RESULTS: The prevalence of obesity increased from 10% to 13% between 1992 and 1998. The proportion of subjects who had been slimming at least once in their lives increased from 45% to 47%, with a distribution of 25% in the underweight, 38% in those of normal weight, 54% of the overweight, and 76% of the obese (p < 0.0001). The use of anti-obesity medicine on prescription and support by a primary care physician or dietician increased with increasing body mass index. Subjects who chose to change their diet or increase their physical activity were more successful in achieving and maintaining a weight loss than those who did not. Changes in diet rose significantly from 1992 to 1998, whereas the use of prescription medicine and over-the-counter protein formulas and supplements decreased. The use of prescription medicine by subjects of normal weight decreased from 11% to 2%. CONCLUSION: About half of all adult Danes have been on a slimming diet. Those who choose to change their diet or increase physical activity are more successful in achieving a weight loss and maintaining it. Notably, one in four underweight subjects have been on a slimming diet, and one in four obese subjects have never dieted, particularly obese males. The use of prescription slimming compounds by individuals of normal weight seems to be a decreasing problem.

[The effect of sibutramine for the maintenance of weight loss. A randomized controlled clinical trial]. / Effekt af sibutramin til vaegttabsvedligeholdelse. En randomiseret klinisk kontrolleret undersøgelse.

INTRODUCTION: Sibutramine is a tertiary amine that has been shown to induce dose-dependent weight loss and enhance the effects of a low-calorie diet for up to a year. We did a randomised, double-blind trial to assess the usefulness of sibutramine in maintaining substantial weight loss over 18 months. METHODS: Eight European centres recruited 605 obese patients (BMI 30-45 kg/m2) for a 6-month period of weight loss with sibutramine (10 mg/day) in combination with an individualised dietary deficit programme of 600 kcal/day based on the measured resting rates of energy expenditure. Of these 605, 467 (77%) patients with more than a 5% weight loss were then randomly assigned to 10 mg/day sibutramine (n = 352) or placebo (n = 115) for a further 18 months. Sibutramine was increased up to 20 mg/day if a weight regain occurred. RESULTS: One hundred and forty-eight (42%) subjects in the sibutramine group and 58 (50%) in the placebo group dropped out. Of the 204 subjects receiving sibutramine who completed the trial, 89 (43%) maintained 80% or more of their original weight loss, compared with nine (16%) of the 57 subjects in the placebo group (odds ratio 4.64, p < 0.001). Substantial decreases were seen over the first six months in triglycerides, VDL cholesterol, insulin, C peptide, and uric acid; changes, which were sustained in the sibutramine group, but not in the placebo group. Concentrations of HDL cholesterol rose substantially in the second year: overall increases were 20.7% (sibutramine) and 11.7% (placebo, p < 0.001). Twenty (3%) patients were withdrawn because of raised blood pressure; in the sibutramine group, from baseline to two years systolic blood pressure rose by 0.1 mmHg (SD 12.9), diastolic blood pressure by 2.3 mmHg (9.4), and pulse rate by 4.1 beats/min (11.9). CONCLUSION: This individualised management programme achieved a weight loss in 77% of obese patients and a sustained weight loss in most patients continuing therapy for two years. Changes in the concentrations of HDL cholesterol, VDL cholesterol, and triglyceride, but not in the LDL cholesterol, exceed those expected either from a weight loss alone or when induced by other selective therapies for low concentrations of HDL cholesterol relating to coronary heart disease.

Monitoring of dietary changes by telephone interviews: results from Denmark.

OBJECTIVES: To monitor trends in Danish food habits with respect to selected key elements, from 1995 to 1998, and to evaluate the appropriateness of the method developed for that purpose. DESIGN AND METHOD: Two cross-sectional population surveys, in 1995 and 1998. Data collection by computer-assisted telephone interviews including 10 food-frequency questions, questions on type of fat used on sandwiches and drinking milk, and check questions on the previous day. Reproducibility was tested in a subgroup (n = 222) in the 1998 survey. SETTING: The Danish Nutrition Council initiated the survey. SUBJECTS: Men and women aged 15-90 years, 1007 in 1995 and 1024 in 1998. Samples of private telephone numbers were drawn from regional telephone registers, geographically stratified. Participation rates were 62%. RESULTS: Significant differences were observed between 1995 and 1998, some of these in accordance with dietary guidelines (decreased use of whole milk and fat spread on bread, increased use of skimmed milk, salad vegetables, rice/pasta and fish). Other changes were opposite to dietary guidelines (increased use of soft butter, decreased use of soft margarine and low-fat spreads, potatoes, and fresh fruit). Differences in average consumption frequency amounted to 4-13%. Several results were confirmed by comparison with other data, and the reproducibility of the method was acceptable. Data were suitable for analysis of food use patterns, a relevant approach when assessing food habits in a lifestyle context. CONCLUSIONS: The changes observed illustrate the dynamics of food habits and the need for frequent monitoring. This simple telephone method may be a valuable tool for that purpose, as a supplement to national dietary surveys, also in a public health context.

[Proper advice on nutrition. Recommendations concerning the conduct of the nutritional news]. / Redelig ernaeringsoplysning. Anbefalinger om hvordan ny viden om ernaering kan formidles.

The Committee on Proper Conduct in Public Advice on Nutrition, set up by the Danish Nutrition Council, has produced recommendations to persons involved in communicating results of nutrition research. The guidelines are targeted on scientists, industry, journalists and publishers as well as consumers to facilitate proper conduct in communication of own or other scientists' research results, which might influence consumers' choice and intake of food. The results are presented as recommendations and checklists providing the necessary requirements to bring people in a position to make the best possible evaluation of the new scientific results and to put the results into their proper perspective. The aim of this report is to improve the process so that the communicator focuses on the background information necessary for the reader/listener/viewer in the current situation to achieve a balanced view and benefit from the new scientific result.

[Dietary guidelines on obesity at Danish pharmacies. Results of a 12-week course with a 1-year follow-up. Research Group on Human Nutrition, Frederiksberg]. / Diaetetisk adipositasvejledning på danske apoteker. Resultater af et 12-ugers-kursus med etårsopfølgning.

The increasing prevalence of obesity has created a need for alternative counselling sites. This retrospective study evaluates the results of a 12 week slimming course for obese subjects held at Danish pharmacies at one year follow-up. Two hundred and sixty-nine obese (BMI > 25 kg/m2, 32 +/- 4.5 [mean +/- SD]) paid 550 Dkr each for a 12 weeks slimming course held at 19 Danish pharmacies with groups of 8-20 subjects each. The age was between 18 to 81 years, 259 were females. The course included eight sessions of 1 1/2 hour education in nutrition and physiology aiming for a dietary change toward a low-fat, high carbohydrate diet. Self-reported body weight was assessed on at the pharmacy scale before and after the course and again after three, six and 12 months follow-up. One hundred and ninety-one or 71% of subjects completed the 12 week slimming programme. The average weight loss was 5.3 and 6.2 kg among females and males, respectively. The weight loss maintenance was assessed at one year follow-up in 122 (45%) of the subjects who entered the course and was 4.0 and 6.7 kg in 118 females and four males, respectively. At one year follow-up 40 subjects (20%) of the subjects who completed the course had maintained a weight loss > 5 kg. In conclusion, the initial weight loss, and maintenance and drop-out rate are comparable with results from general practitioners and hospital out-patient clinics, but the costs are substantially lower.

[Changes in food habits among the population from 1995 to 1998]. / Aendringer i befolkningens fødevareforbrug 1995-1998.

In order to survey trends in food habits the Danish Nutrition Council initiated two food frequency surveys, comprising ten nutritionally important foods, in 1995 and in 1998. Participants were men and women, 15-90 yrs, from similar population samples (n = 1007 in 1995, 1024 in 1998). Participation rate was 62% in 1995 and 63% in 1998. Data were collected by telephone interview. For six of the ten foods significant changes in consumption frequencies were observed: salad/raw vegetables, rice/pasta and fish were consumed more frequently in 1998, whereas consumption of meat, potatoes and fresh fruit had become less frequent. Average frequencies differed by 4-13%. In 1998 low-fat milk had become more common, whereas whole milk was now less common. More subjects now skipped fat spreads on their bread, but more chose spreads containing butterfat. Some, but not all, of the observed changes point in the right direction compared to recommendations. The results demonstrate that food habits are currently in a dynamic process.