Associations of body fat and skeletal muscle with hypertension.

Hypertension is known to be associated with obesity, while its relationship to skeletal muscle, SM (SM; a marker of general health and body function), remains uncertain. We analyzed population-based data of 22 591 men (mean age: 51.6 ± 16.9 years) and 27 845 nonpregnant women (50.6 ± 16.9 years) from Scottish Health Surveys (2003, 2008-2011) and Health Surveys for England (2003-2006, 2008-2013) including 2595 non-insulin- and 536 insulin-treated diabetic patients. Compared with normotensive individuals (no hypertension history with normal systolic [SBP < 140 mm Hg] and diastolic blood pressure [DBP < 90 mm Hg]), percent body fat (BF%) was significantly higher and percent SM lower (P < 0.001) in undetected (no hypertension history with raised SBP ≥ 140 and/or DBP ≥ 90 mm Hg), controlled (hypertension history with normal BP), uncontrolled (hypertension history with raised BP), and untreated hypertension. The prevalences of hypertension within BF% quintiles were 11.8%, 24.8%, 41.4%, 56.8%, and 71.6% and SM% quintiles were 67.5%, 53.3%, 39.5%, 27.4%, and 18.5%. Compared to referent groups (lowest BF% quintile or highest SM% quintile), odds ratio (age, sex, smoking, ethnicity, country, survey year, and diabetes adjusted) for having all types of hypertension in the highest BF% quintile was 5.5 (95% confidence interval = 5.0-5.9) and lowest SM% quintile was 2.3 (2.2-2.5). Compared with those without diabetes, individuals with diabetes had a 2.3-fold-2.6-fold greater risk of hypertension, independent of confounding factors and BF% or SM%. The associations of hypertension with BF% were higher than those with body mass index (BMI). In conclusion, both BF and SM should be considered when analyzing results from health surveys, rather than relying on BMI which does not discriminate between the two.

The Effectiveness of a Weight Maintenance Intervention for Adults with Intellectual Disabilities and Obesity: A Single Stranded Study.

BACKGROUND: The evidence base for weight management programmes incorporating a weight loss and a weight maintenance phase for adults with intellectual disabilities (ID) is limited. This study describes the weight maintenance phase of a multicomponent weight management programme for adults with intellectual disability and obesity (TAKE 5). MATERIALS AND METHODS: Thirty-one participants who had completed the 16 week TAKE five weight loss intervention (Phase I) were invited to participate in a 12 month weight maintenance intervention (Phase II). Content included recommendations of the National Weight Control Registry. RESULTS: Twenty-eight participants completed Phase II with 50.4% maintaining their weight (mean weight change -0.5 kg, SD 2.2), 28.7% gaining weight (mean weight gain 5.4 kg, SD 2.2) and 21.6% losing weight (mean weight loss -8.0 kg, SD 3.0) at 12 months. CONCLUSION: Further research is justified to investigate the efficacy of weight loss maintenance interventions in adults with intellectual disability and obesity, using controlled study designs.

Obesity and Maternal Weight Gain.

Pregnancy is a time when women may be receptive to health advice and interventions. This article considers the evidence for interventions to affect body weight in obese and overweight women delivered either or both pre- and post-natally. The increasing prevalence of obesity across the adult population has affected many sectors of society and increasing numbers of obese and overweight pregnant women are evident. Obesity in pregnancy is frequently associated with excessive gestational weight gains and increases the risk of developing adverse pregnancy outcomes in terms of both maternal and infant health. Pregnancy has been described as providing "a teachable moment" when women may be receptive to health advice. Some lifestyle approaches, largely incorporating strategies to alter dietary and physical activity to challenge excess body weight before and during pregnancy, have been developed and tested. While a few have shown promise with limited success in reducing body weight prior to pregnancy and post-natally, and minimising excessive weight gains during pregnancy, all interventions are not sufficiently robust and effective to justify routine inclusion in clinical practice. Weight management pre- and post-natally appears largely overlooked in usual care.

Derivation and validation of simple anthropometric equations to predict adipose tissue mass and total fat mass with MRI as the reference method.

The reference organ-level body composition measurement method is MRI. Practical estimations of total adipose tissue mass (TATM), total adipose tissue fat mass (TATFM) and total body fat are valuable for epidemiology, but validated prediction equations based on MRI are not currently available. We aimed to derive and validate new anthropometric equations to estimate MRI-measured TATM/TATFM/total body fat and compare them with existing prediction equations using older methods. The derivation sample included 416 participants (222 women), aged between 18 and 88 years with BMI between 15·9 and 40·8 (kg/m2). The validation sample included 204 participants (110 women), aged between 18 and 86 years with BMI between 15·7 and 36·4 (kg/m2). Both samples included mixed ethnic/racial groups. All the participants underwent whole-body MRI to quantify TATM (dependent variable) and anthropometry (independent variables). Prediction equations developed using stepwise multiple regression were further investigated for agreement and bias before validation in separate data sets. Simplest equations with optimal R (2) and Bland-Altman plots demonstrated good agreement without bias in the validation analyses: men: TATM (kg)=0·198 weight (kg)+0·478 waist (cm)-0·147 height (cm)-12·8 (validation: R 2 0·79, CV=20 %, standard error of the estimate (SEE)=3·8 kg) and women: TATM (kg)=0·789 weight (kg)+0·0786 age (years)-0·342 height (cm)+24·5 (validation: R (2) 0·84, CV=13 %, SEE=3·0 kg). Published anthropometric prediction equations, based on MRI and computed tomographic scans, correlated strongly with MRI-measured TATM: (R (2) 0·70-0·82). Estimated TATFM correlated well with published prediction equations for total body fat based on underwater weighing (R (2) 0·70-0·80), with mean bias of 2·5-4·9 kg, correctable with log-transformation in most equations. In conclusion, new equations, using simple anthropometric measurements, estimated MRI-measured TATM with correlations and agreements suitable for use in groups and populations across a wide range of fatness.

Calorie-labelling in catering outlets: acceptability and impacts on food sales.

OBJECTIVE: Obesity is the biggest challenge facing preventive medicine. Calorie-labelling has been suggested as a way of changing the architecture of an 'obesogenic' environment without limiting consumer choice. This study examined the effect of calorie-labelling on sales of food items at catering outlets on a city-centre university campus. METHODS: Sales data were collected for two consecutive months in 2013 on three UK university sites (two with calorie-labelling during second month, one control) and analysed with chi-square 'Goodness-of-Fit' tests. A questionnaire seeking consumers' views and use of the calorie-labelling was administered and analysed at group-level with chi-square tests. RESULTS: In intervention vs control sites, total sales of all labelled items fell significantly (-17% vs -2%, p<0.001) for the month with calorie-labelling. Calorie-labelling was associated with substantially reduced sales of high-calorie labelled items, without any compensatory changes in unlabelled alternative items. Among 1166 student- and 646 staff-respondents, 56% reported using the calorie-labels, 97% of them to make lower-calorie choices. More females (63%) than males (40%) reported being influenced by calorie-labels when choosing foods (p=0.01). CONCLUSIONS: This study provides evidence, beyond that from single-meal exposures, for the acceptability of meal calorie-labelling and its potential as an effective low-cost anti-obesity measure.

Predicting muscle mass from anthropometry using magnetic resonance imaging as reference: a systematic review.

Identification and management of sarcopenia are limited by lack of reliable simple approaches to assess muscle mass. The aim of this review is to identify and evaluate simple methods to quantify muscle mass/volume of adults. Using Cochrane Review methodology, Medline (1946-2012), Embase (1974-2012), Web of Science (1898-2012), PubMed, and the Cochrane Library (to 08/2012) were searched for publications that included prediction equations (from anthropometric measurements) to estimate muscle mass by magnetic resonance imaging (MRI) in adults. Of 257 papers identified from primary search terms, 12 studies met the inclusion criteria. Most studies (n = 10) assessed only regional/limb muscle mass/volume. Many studies (n = 9) assessed limb circumference adjusted for skinfold thickness, which limits their practical applications. Only two included validation in separate subject-samples, and two reported relationships between whole-body MRI-measured muscle mass and anthropometry beyond linear correlations. In conclusion, one simple prediction equation shows promise, but it has not been validated in a separate population with different investigators. Furthermore, it did not incorporate widely available trunk/limb girths, which have offered valuable prediction of body composition in other studies.

What, not just salad and veg? Consumer testing of the eatwell week.

OBJECTIVE: To test the appeal of the eatwell week, a nutritionally balanced 7 d menu which satisfies nutritional guidelines of the Food Standards Agency in Scotland; determine the clarity and understanding of the main messages; and gather views on the usability and acceptability of the eatwell week resource format. DESIGN: Focus group discussions with consumers and health professionals. SETTING: Four locations across the UK. RESULTS: The eatwell week was considered realistic by consumers as it contained foods they recognised and already ate. A preconceived idea had been that there would be more fruit and vegetables and fewer 'treats'. Consumers found the recipes simple and lack of cooking skills was not an apparent barrier. However, the message of 'balance' was poorly understood. Consumers often lacked the knowledge to make informed substitutions in the week. Both the general public and some health professionals felt the menu contained too much carbohydrate. Health professionals felt it was unclear who the eatwell week was intended for and what purpose it served. CONCLUSIONS: Use of familiar foods and the provision of simple, easy-to-follow recipes have the potential to overcome some barriers to healthy eating encountered by the general public and encourage improvements in dietary intakes. The eatwell week shows promise as a resource to facilitate implementation of the principles of the eatwell plate and supports government priorities and policies for health.

Designing the eatwell week: the application of eatwell plate advice to weekly food intake.

OBJECTIVE: To develop a menu and resource to illustrate to consumers and health professionals what a healthy balanced diet looks like over the course of a week. DESIGN: Development and analysis of an illustrative 7 d 'eatwell week' menu to meet current UK recommendations for nutrients with a Dietary Reference Value, with a daily energy base of 8368 kJ (2000 kcal). Foods were selected using market research data on meals and snacks commonly consumed by UK adults. Analysis used the food composition data set from year 1 (2008) of the UK National Diet and Nutrition Survey rolling programme. The eatwell week menu was developed using an iterative process of nutritional analysis with adjustments made to portion sizes and the inclusion/exclusion of foods in order to achieve the target macronutrient composition. RESULTS: Three main meals and two snacks were presented as interchangeable within the weekdays and two weekend days to achieve adult food and nutrient recommendations. Main meals were based on potatoes, rice or pasta with fish (two meals; one oily), red meat (two meals), poultry or vegetarian accompaniments. The 5-a-day target for fruit and vegetables (range 5-6·7 portions) was achieved daily. Mean salt content was below recommended maximum levels (<6 g/d). All key macro- and micronutrient values were achieved. CONCLUSIONS: Affordable foods, and those widely consumed by British adults, can be incorporated within a 7 d healthy balanced menu. Future research should investigate the effect of using the eatwell week on adults' dietary habits and health-related outcomes.

Changes in body weight and food choice in those attempting smoking cessation: a cluster randomised controlled trial.

BACKGROUND: Fear of weight gain is a barrier to smoking cessation and significant cause of relapse for many people. The provision of nutritional advice as part of a smoking cessation programme may assist some in smoking cessation and perhaps limit weight gain. The aim of this study was to determine the effect of a structured programme of dietary advice on weight change and food choice, in adults attempting smoking cessation. METHODS: Cluster randomised controlled design. Classes randomised to intervention commenced a 24-week intervention, focussed on improving food choice and minimising weight gain. Classes randomised to control received "usual care". RESULTS: Twenty-seven classes in Greater Glasgow were randomised between January and August 2008. Analysis, including those who continued to smoke, showed that actual weight gain and percentage weight gain was similar in both groups. Examination of data for those successful at giving up smoking showed greater mean weight gain in intervention subjects (3.9 (SD 3.1) vs. 2.7 (SD 3.7) kg). Between group differences were not significant (p = 0.23, 95% CI -0.9 to 3.5). In comparison to baseline improved consumption of fruit and vegetables and breakfast cereal were reported in the intervention group. A higher percentage of control participants continued smoking (74% vs. 66%). CONCLUSIONS: The intervention was not successful at minimising weight gain in comparison to control but was successful in facilitating some sustained improvements in the dietary habits of intervention participants. Improved quit rates in the intervention group suggest that continued contact with advisors may have reduced anxieties regarding weight gain and encouraged cessation despite weight gain. Research should continue in this area as evidence suggests that the negative effects of obesity could outweigh the health benefits achieved through reductions in smoking prevalence.

Reproducibility of 24-h post-exercise changes in energy intake in overweight and obese women using current methodology.

Direct observation(s) of energy intake (EI) via buffet meals served in the laboratory are often carried out within short-term exercise intervention studies. The reproducibility of values obtained has not been assessed either under resting control conditions or post-exercise, in overweight and obese females. A total of fourteen sedentary, pre-menopausal females (BMI 30.0 (SD 5.1) kg/m²) completed four trials; two exercise and two control. Each trial lasted 24 h spanning over 2 d; conducted from afternoon on day 1 and morning on day 2. An exercise session to expend 1.65 MJ was completed on day 1 of exercise trials, and three buffet meals were served during each trial. Reproducibility of post-exercise changes in energy and macronutrient intakes was assessed at each individual buffet meal by intraclass correlation coefficient (r(i)). Only the r(i) values for post-exercise changes in energy (r(i) 0.44 (95 % CI - 0.03, 0.77), P = 0.03) and fat intake (r(i) 0.51 (95 % CI 0.04, 0.81), P = 0.02) at the lunch buffet meal achieved statistical significance; however, these r i values were weak and had large associated 95 % CI, which indicates a large degree of variability associated with these measurements. Energy and macronutrient intakes at the breakfast and evening buffet meals were not reproducible. This study concludes that the frequently used laboratory-based buffet meal method of assessing EI does not produce reliable, reproducible post-exercise changes in EI in overweight and obese women.

An open study of the effectiveness of a multi-component weight-loss intervention for adults with intellectual disabilities and obesity.

Adults with intellectual disabilities experience high rates of obesity. Despite this higher risk, there is little evidence on the effectiveness of weight-loss interventions for adults with intellectual disabilities and obesity. The present study examined the effectiveness of the TAKE 5 multi-component weight-loss intervention. Adults with obesity were invited using specialist intellectual disability services to participate in the study. Obesity was defined as a BMI of 30 kg/m2 or greater. TAKE 5 included a daily energy-deficit diet of 2510 kJ (600 kcal), achieved via a personalised dietary prescription. Participants' body weight, BMI, waist circumference and levels of physical activity and sedentary behaviour were measured before and after the intervention. A total of fifty-four individuals consented to participate, of which forty-seven (87 %) completed the intervention in the study period. There was a significant decrease in body weight (mean difference - 4·47 (95 % CI - 5·91, - 3·03) kg; P < 0·0001), BMI (- 1·82 (95 % CI - 2·36, - 1·29) kg/m(2); P < 0·0001), waist circumference (- 6·29 (95 % CI - 7·85, - 4·73) cm; P < 0·0001) and daily sedentary behaviour of participants (- 41·40 (95 % CI - 62·45, - 20·35) min; P = 0·00 034). Of the participants who completed the intervention, seventeen (36·2 %) lost 5 % or more of their initial body weight. Findings from the study suggest that TAKE 5 is an effective weight-loss intervention for adults with intellectual disabilities and obesity. The effectiveness of TAKE 5 should be examined further in a controlled study.

Smoking combined with overweight or obesity markedly elevates cardiovascular risk factors.

AIMS: Overweight, obesity and smoking are well-established risk independent factors for cardiovascular diseases. The combination of overweight or obesity with smoking may modify other cardiovascular disease risk factors. We examined the impacts of smoking, overweight and obesity on cardiovascular risk factors: total cholesterol, high-density lipoprotein (HDL)-cholesterol, non-HDL-cholesterol, C-reactive protein and fibrinogen. METHODS AND RESULTS: Data from 5460 adults who participated in the cross-sectional Scottish Health Survey 1998 were analysed. In multivariable analysis body mass index and smoking were the most important risk factors for cardiovascular disease. Smoking was independently associated with higher C-reactive protein and fibrinogen concentrations in both sexes, and lower HDL cholesterol and higher non-HDL cholesterol in females (P<0.001). Overweight or obesity (body mass index 25-30 or > or = 30 kg/m) were independently associated with higher C-reactive protein, total cholesterol, non-HDL-cholesterol and lower HDL-cholesterol in both sexes, and higher fibrinogen in females (P<0.001). Overweight or obese current smokers had higher C-reactive protein and fibrinogen and lower HDL-cholesterol concentrations than the reference group of never-smokers with body mass index below 25 kg/m (P<0.001). Obese current smokers had the highest mean value and odds ratio (OR) for the risk factors across the categories, particularly for lower HDL cholesterol (OR=11) and elevated C-reactive protein (OR=9) (P<0.001). CONCLUSION: The combination of smoking and overweight or obesity aggravates cardiovascular disease risk factors, particularly HDL-cholesterol and C-reactive protein. These results justify early intervention for overweight/obese current smokers.