Sugar-containing beverage intake in toddlers and body composition up to age 6 years: the Generation R study.

BACKGROUND/OBJECTIVE: Intake of sugar-containing beverages (SCBs) has been associated with higher body mass index (BMI) in childhood. The potential effect of SCB intake during infancy is unclear. We examined the association of SCB intake at 13 months with BMI development until 6 years and body composition at age 6 years. SUBJECTS/METHODS: This study included 2371 Dutch children from a population-based prospective cohort study. SCB intake at 13 months was assessed using a Food Frequency Questionnaire with validation against 24-h recalls and was standardized for total energy. BMI was calculated from repeated weight and height measurements, and age- and sex-specific s.d. scores were calculated. Adiposity was measured using Dual-energy X-ray absorptiometry. RESULTS: In girls, higher SCB intake at 13 months was significantly associated with higher BMI at ages 2, 3, 4 and 6 years (at age 6 years BMI (s.d. score) increase 0.11 (95% confidence interval (CI) +0.00; 0.23), high versus low intake). We observed a tendency towards higher android/gynoid fat ratio in girls with high intake (s.d. increase 0.14 (95% CI -0.02; 0.29), versus low intake) but not with body fat percentage. In boys, there was no association with BMI or body composition, but boys with high SCB intake at 13 months were taller at age 6 years (s.d. increase 0.14 (95% CI +0.00; 0.27), versus low intake). CONCLUSIONS: Higher SCB intake at 13 months was associated with higher BMI up to age 6 years in girls but not in boys. Our results imply that the unfavorable effects of SCB intake start early in life and that dietary advice regarding limiting SCB intake should already be given early in life.

Maternal fish consumption during pregnancy and risks of wheezing and eczema in childhood: the Generation R Study.

BACKGROUND/OBJECTIVES: Maternal fish consumption during pregnancy might influence the fetal immune system through anti-inflammatory effects of omega-3 fatty acids, and might affect the risks of childhood asthma and atopy. In Generation R, a prospective cohort study in the Netherlands, we examined the associations of first trimester fish consumption with childhood wheezing and eczema in the first 4 years of life. METHODS: In total, 2976 mothers completed a 293-item semiquantitative food frequency questionnaire covering dietary intake in the first trimester. The occurrence of wheezing and eczema was yearly assessed by questionnaires. RESULTS: Median weekly fish consumption was 83 (95% range 0-316) grams per week. We observed no consistent associations of maternal total-, lean- or fatty-fish consumption during pregnancy with the risks of childhood wheezing. Maternal shellfish consumption of 1-13 g per week was associated with overall increased risks of childhood wheezing and eczema (OR 1.20 (1.04, 1.40) and OR 1.18 (1.01, 1.37), respectively). Maternal fatty fish consumption of 35-69 g per week was associated with increased overall risks of childhood eczema (OR 1.17 (1.00, 1.38)), but maternal total- or lean-fish consumption was not. CONCLUSIONS: During pregnancy, shellfish consumption was associated with increased risks of wheezing and eczema, while fatty fish consumption was associated with a higher risk of eczema only. Maternal total fish or lean fish consumption were not associated with wheezing or eczema. Further studies are needed to replicate these findings and to explore underlying mechanisms.

Exercise management of obesity.

When dealing with overweight patients, it is important to treat obesity as a chronic condition requiring long-term management. Physicians do not send a patient with hypertension home with just one bottle of pills and expect blood pressure to be managed forever. Similarly, it is naive to think that sending an overweight patient home with only a single word of advice to "lose weight" will solve the problem. Medical staff would be wise to adopt the attitude that obesity requires long-term intervention and management, just as hypertension requires ongoing monitoring and management. Continued attention to patients' physical activity is required. It is important for physicians to spend a few minutes discussing physical activity with their patients. The patient's current and past levels of physical activity should be assessed as well as the barriers to and benefits of activity. Normal-weight patients should accumulate at least 30 minutes of moderate-intensity activity on most days of the week, and overweight patients should accumulate 60 to 80 minutes per day, every day. The physician can provide some simple tools, such as a step counter and self-monitoring forms, to promote increases in activity and can follow up with the patient after the office visit. This information may sound like a lot to cover, especially given the limited time available for each patient. By spending 3 to 5 minutes intervening, however, physicians can play a critical role in promoting health. Physicians should set a goal to address one specific topic (e.g., a brief discussion of exercise benefits and barriers) and try one strategy (e.g., introduce self-monitoring) during the next counseling session with patients. It is also important for physicians to remember that their success in changing behavior may be in small increments. These small changes can and do eventually lead to success for many patients and physicians.

Effects of exercise-focused versus weight-focused maintenance programs on the management of obesity.

This study examined the effects of two maintenance programs on exercise participation, energy expenditure, energy consumption, and weight change in 67 obese adults undergoing behavioral weight-loss treatment. Following an initial 6-month treatment phase which produced a mean weight loss of 8.8 kg, participants were assigned randomly to an exercise-focused maintenance program or to a weight-focused maintenance program. Both maintenance programs included 6 months of biweekly group sessions. The exercise-focused program included supervised group walking sessions, individual and group contingencies for exercise completion, and relapse prevention training targeted specifically at the maintenance of physical activity. The weight-focused program contained a general focus on the maintenance of weight-loss through therapist-led group problem-solving of weight-related problems presented by individual participants. At the completion of the maintenance program and at long-term follow-up, there were no significant differences between conditions in exercise participation or energy expenditure. However, during the year following initial treatment, participants in the weight-focused program demonstrated significantly greater reductions in fat consumption and significantly better maintenance of weight losses than subjects in the exercise-focused program.

Reducing postpartum weight retention through a correspondence intervention.

OBJECTIVE: Since post-pregnancy weight retention may contribute to the development of obesity, we sought to determine whether a behavioral weight loss intervention was effective in returning women to their pre-pregnancy weight. METHOD: Ninety women who had given birth in the past 3-12 months and whose weight exceeded their pre-pregnancy weight by at least 6.8 kg were randomly assigned to either: a) a six-month behavioral weight loss intervention, delivered via correspondence or b) a no-treatment control group. Assessments of body weight, physical activity and eating patterns were conducted at pre-treatment and six months (post-treatment). RESULTS: During the six month treatment, subjects in the correspondence condition lost significantly more weight than control subjects (7.8 kg vs 4.9 kg, P = 0.03) and lost a greater percentage of their excess postpartum weight (79% vs 44%, P = 0.01). Furthermore, a significantly greater percentage of correspondence subjects than controls returned to their pre-pregnancy weight (33% vs 11.5%, P < 0.05). Weight loss in the correspondence group was correlated with completion of self-monitoring records (r = 0.50, P < 0.005). CONCLUSIONS: A behavioral weight loss intervention, delivered via correspondence, appears to be effective in reducing women's postpartum weight retention. Future studies should examine the acceptability and the long-term impact of a correspondence postpartum weight loss intervention.

Effects of a personalized system of skill acquisition and an educational program in the treatment of obesity.

This study tested whether the efficacy of behavioral treatment of obesity (BT) might be improved through the use of a personalized system of skill acquisition (PSA) with reinforcement contingent on the mastery of changes in eating and exercise behaviors. A total of 108 obese adults were randomly assigned to one of three conditions: (1) BT + PSA; (2) BT; or (3) a weight-loss educational (WLE) program. At posttreatment, the BT + PSA and BT conditions demonstrated significant beneficial changes in caloric consumption, intake of fats, and level of physical activity. Both conditions also produced equivalent reductions in body weight (Ms = 7.9 kg for BT + PSA and 9.5 kg for BT) that were significantly greater than the reduction accomplished in the WLE condition (M = 1.7 kg). These findings suggest that the addition of a PSA may not produce better outcome than standard behavioral treatment and that education alone is not sufficient to produce weight loss.

Effects of group- versus home-based exercise in the treatment of obesity.

This study examined the effects of 2 aerobic exercise regimens on exercise participation, fitness, eating patterns, treatment adherence, and weight change in 49 obese women undergoing a year-long behavioral weight loss program. Participants were assigned randomly to weight loss treatment plus either group- or home-based exercise. All participants were instructed to complete a moderate-intensity walking program (30 min/day, 5 days/week). Group exercise participants were provided with 3 supervised group exercise sessions per week for the first 26 weeks and with 2 sessions per week thereafter. Home exercise participants were instructed to complete all exercise in their home environment. After 6 months, both conditions displayed significant improvements in exercise participation, fitness, eating patterns, and weight loss. At 12 months, the home-based program showed superior performance to the group condition in exercise participation and treatment adherence; at 15 months, participants in the home program demonstrated significantly greater weight losses than those in the group program.

Assessment of sexual beliefs and information in aging couples with sexual dysfunction.

The incidence and prevalence of sexual dysfunction indicate that a large portion of the U.S. population will experience a sexual dysfunction, with older individuals being particularly at risk. Cognitive factors (e.g., attitudes, misinformation, beliefs) may contribute to the development of sexual dysfunction or influence response to treatments. The purpose of the current study was to evaluate the psychometric properties of a brief instrument designed to assess information and beliefs regarding sexual functioning in an aging population. Results indicate that the Sexual Beliefs and Information Questionnaire (SBIQ) had adequate test-retest reliability and is an internally consistent measure of sexual knowledge and beliefs. MOst individuals had adequate knowledge regarding sexual functioning as indicated by correct responses to most items; however, there were several items missed more often than expected. Exploratory factor analysis suggests an underlying five-factor structure of the SBIQ. Scores were not correlated with years of education, mood, or marital satisfaction. Scores on the SBIQ improved after a brief standardized educational intervention. The SBIQ is a simple and psychometrically sound measure of sexual knowledge and myths that can assist clinicians to identify and possibly rectify knowledge deficits.