Association between fear of hypoglycemia and physical activity in youth with type 1 diabetes: The SEARCH for diabetes in youth study.

BACKGROUND: Youth with type 1 diabetes (T1D) are encouraged to participate in physical activity (PA). Studies have identified fear of hypoglycemia (FOH) as a barrier to participating in PA. OBJECTIVES: To examine (a) PA patterns in youth with T1D by age group and (b) the relationship between both parental and youth FOH and youth PA. METHODS: A cross-sectional analysis from the SEARCH cohort study visit of youth ages 10 to 17 years with T1D (n = 1129) was conducted. Linear regression models estimated the association between self-reported number of days of vigorous PA (VPA) and moderate PA (MPA) and both youth- and parent-reported FOH. Multivariable models were adjusted for age, sex, race, duration of T1D, HbA1c, use of continuous glucose monitoring (CGM), recent severe hypoglycemia, primary insulin regimen, and BMI. RESULTS: Participants were 52% female, had mean (sd) age 14.4 (4.2) years, diabetes duration 7.5 years (1.8), HbA1c 9.2% (1.7). Older youth were less likely to engage in VPA (P < .01), or sports teams (P < .01), but more likely to engage in MPA (P < .01). Higher youth FOH (behavior subscale) was associated with increased levels of VPA (ß (se) 0.30 (0.11), P = .01) but not significantly associated with MPA (P = .06). There was no statistically significant association between parental FOH and youth PA. CONCLUSIONS: In SEARCH participants with T1D, VPA, and team sports participation declined with age, while MPA increased. We observed that higher scores on the youth FOH behavioral subscale were associated with increased VPA levels, suggesting that FOH may be less of a barrier to PA than previously thought.

Longitudinal changes in the dietary inflammatory index: an assessment of the inflammatory potential of diet over time in postmenopausal women.

BACKGROUND/OBJECTIVES: The dietary inflammatory index (DII) measured at one time point is associated with risk of several chronic diseases, but disease risk may change with longitudinal changes in DII scores. Data are lacking regarding changes in DII scores over time; therefore, we assessed changes in the DII in the Women's Health Initiative (WHI). SUBJECTS/METHODS: DII scores were calculated using data from repeated food frequency questionnaires in the WHI Observational Study (OS; n=76 671) at baseline and year 3, and the WHI Dietary Modification trial (DM; n=48482) at three time points. Lower DII scores represent more anti-inflammatory diets. We used generalized estimating equations to compare mean changes in DII over time, adjusting for multiple comparisons, and multivariable-adjusted linear regression analyses to determine predictors of DII change. RESULTS: In the OS, mean DII decreased modestly from -1.14 at baseline to -1.50 at year 3. In the DM, DII was -1.32 in year 1, -1.60 in year 3 and -1.48 in year 6 in the intervention arm and was -0.65 in year 1, -0.94 in year 3 and -0.96 in year 6 in the control arm. These changes were modified by body mass index, education and race/ethnicity. A prediction model explained 22% of the variance in the change in DII scores in the OS. CONCLUSIONS: In this prospective investigation of postmenopausal women, reported dietary inflammatory potential decreased modestly over time. Largest reductions were observed in normal-weight, highly educated women. Future research is warranted to examine whether reductions in DII are associated with decreased chronic disease risk.

Association of adherence to a Mediterranean diet with glycemic control and cardiovascular risk factors in youth with type I diabetes: the SEARCH Nutrition Ancillary Study.

BACKGROUND/OBJECTIVES: This study aimed to determine the association between a Mediterranean diet and glycemic control and other cardiovascular risk factors among youth with type I diabetes (TID). SUBJECTS/METHODS: Incident TID cases aged <20 years at diagnosis between 2002 and 2005 were included. Participants were seen at baseline (N=793), 1-year (N=512) and 5-year follow-up visits (N=501). Mediterranean diet score was assessed using a modified KIDMED index (mKIDMED). Multivariate linear regression and longitudinal mixed model were applied to determine the association between mKIDMED score and log-HbA1c, lipids, blood pressure (BP) and obesity. RESULTS: In cross-sectional analyses using baseline data, for individuals with the hemoglobin A1c (HbA1c) of 7.5%, a two-point higher mKIDMED score (1 s.d.) was associated with 0.15% lower HbA1c (P=0.02). A two-point higher mKIDMED score was associated with 4.0 mg/dl lower total cholesterol (TC) (P=0.006), 3.4 mg/dl lower low-density lipoprotein cholesterol (LDL-C) (P=0.004), 3.9 mg/dl lower non-high-density lipoprotein cholesterol (non-HDL-C) (P=0.004) and 0.07 lower LDL-C/HDL-C ratio (P=0.02). Using longitudinal data, a two-point increase in mKIDMED score was associated with 0.01% lower log-HbA1c (P=0.07), 1.8 mg/dl lower TC (P=0.05), 1.6 mg/dl lower LDL-C (P=0.03) and 1.8 mg/dl lower non-HDL-C (P=0.03) than would otherwise have been expected. HbA1c mediated ∼20% of the association for lipids in both cross-sectional and longitudinal models. An unexpected positive association between mKIDMED score and systolic BP was found among non-Hispanic white youth in cross-sectional analyses (P=0.009). Mediterranean diet was not associated with obesity. CONCLUSIONS: Mediterranean diet may improve glycemic control and cardiovascular health in TID youth.

Associations of coffee consumption with markers of liver injury in the insulin resistance atherosclerosis study.

BACKGROUND: Coffee consumption has been associated with reduced risk of developing type 2 diabetes mellitus (T2DM) however, the mechanism for this association has yet to be elucidated. Non-alcoholic fatty liver disease (NAFLD) characterizes and predicts T2DM yet the relationship of coffee with this disorder remains unclear. Our aim was to investigate the associations of coffee with markers of liver injury in 1005 multi-ethnic, non-diabetic adults in the Insulin Resistance Atherosclerosis Study. METHODS: Dietary intake was assessed using a validated 114-item food frequency questionnaire. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and fetuin-A were determined in fasting blood samples and the validated NAFLD liver fat score was calculated. Multivariate linear regression assessed the contribution of coffee to variation in markers of liver injury. RESULTS: Caffeinated coffee showed significant inverse associations with ALT (ß = -0.08, p = 0.0111), AST (ß = -0.05, p = 0.0155) and NAFLD liver fat score (ß = -0.05, p = 0.0293) but not with fetuin-A (ß = 0.04, p = 0.17). When the highest alcohol consumers were excluded, these associations remained (ALT ß = -0.11, p = 0.0037; AST ß = -0.05, p = 0.0330; NAFLD liver fat score ß = -0.06, p = 0.0298). With additional adjustment for insulin sensitivity, the relationship with ALT remained significant (ALT ß = -0.08, p = 0.0400; AST ß = -0.03, p = 0.20; NAFLD liver fat score ß = -0.03, p = 0.27). There were no significant associations of decaffeinated coffee with liver markers. CONCLUSIONS: These analyses indicate a beneficial impact of caffeinated coffee on liver morphology and/or function, and suggest that this relationship may mediate the well-established inverse association of coffee with risk of T2DM.

Associations of dietary intake patterns identified using reduced rank regression with markers of arterial stiffness among youth with type 1 diabetes.

BACKGROUND/OBJECTIVES: Youth with type 1 diabetes (T1DM) are at substantially increased risk for adverse vascular outcomes, but little is known about the influence of dietary behavior on cardiovascular disease (CVD) risk profile. We aimed to identify dietary intake patterns associated with CVD risk factors and evaluate their impact on arterial stiffness (AS) measures collected thereafter in a cohort of youth with T1DM. SUBJECTS/METHODS: Baseline diet data from a food frequency questionnaire and CVD risk factors (triglycerides, low density lipoprotein-cholesterol, systolic blood pressure, hemoglobin A1c, C-reactive protein and waist circumference) were available for 1153 youth aged ⩾10 years with T1DM from the SEARCH for Diabetes in Youth Study. A dietary intake pattern was identified using 33 food groups as predictors and six CVD risk factors as responses in reduced rank regression (RRR) analysis. Associations of this RRR-derived dietary pattern with AS measures (augmentation index (AIx75), n=229; pulse wave velocity, n=237; and brachial distensibility, n=228) were then assessed using linear regression. RESULTS: The RRR-derived pattern was characterized by high intakes of sugar-sweetened beverages (SSB) and diet soda, eggs, potatoes and high-fat meats and low intakes of sweets/desserts and low-fat dairy; major contributors were SSB and diet soda. This pattern captured the largest variability in adverse CVD risk profile and was subsequently associated with AIx75 (ß=0.47; P<0.01). The mean difference in AIx75 concentration between the highest and the lowest dietary pattern quartiles was 4.3% in fully adjusted model. CONCLUSIONS: Intervention strategies to reduce consumption of unhealthy foods and beverages among youth with T1DM may significantly improve CVD risk profile and ultimately reduce the risk for AS.

Incidence of diabetes mellitus in a population-based cohort of HIV-infected and non-HIV-infected persons: the impact of clinical and therapeutic factors over time.

AIMS: To examine incidence density rate and correlates of incident diabetes mellitus in a cohort of HIV-infected individuals compared with matched non-HIV-infected persons. METHODS: Data were obtained from the South Carolina Medicaid system and the enhanced HIV/AIDS Reporting System surveillance database for persons ≥ 18 years of age who had been attended to during the period 1994 to 2011. Time-dependent proportional hazards analysis and marginal structural models were used to analyse the data. RESULTS: A total of 13 632 individuals (6816, 1:1 matched HIV-infected and non-HIV-infected persons; median age 39 years; 57% male) contributed 88 359 person-years of follow-up. Incidence rate of diabetes was higher in the non-HIV-infected group compared with the HIV-infected group (13.60 vs. 11.35 per 1000 person-years). Multivariable hazards analysis suggested a significantly lower risk of incident diabetes among HIV-infected persons treated with combination antiretroviral therapy compared with the matched non-HIV-infected persons (adjusted hazards ratio 0.55; 95% CI 0.46-0.65). Among HIV-infected persons, marginal structural modelling suggested a significantly higher risk of diabetes with cumulative exposure to protease inhibitors over the observation period (adjusted relative risk 1.35; 95% CI 1.03-1.78), but this association was not significant for exposure to non-nucleoside reverse transcriptase inhibitors. Overall, female gender, older age, non-white race/ethnicity, and pre-existing hypertension, dyslipidaemia, obesity and hepatitis C infection were associated with higher risk of diabetes incidence. CONCLUSIONS: HIV infection may not be independently associated with increased risk of diabetes. Among HIV-infected persons, exposure to protease inhibitor-based regimens may increase the risk of diabetes. Healthcare providers should make every effort to use combination antiretroviral therapy regimens with a better cardiometabolic profile.

Change in DASH diet score and cardiovascular risk factors in youth with type 1 and type 2 diabetes mellitus: The SEARCH for Diabetes in Youth Study.

Youth with diabetes are at an increased risk of cardiovascular disease (CVD). Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet has been shown to improve CVD risk. In this study, we evaluated whether changes in diet quality as characterized by DASH are associated with changes in CVD risk factors in youth with diabetes over time. Longitudinal mixed models were applied to data from 797 participants in the SEARCH for Diabetes in Youth Study representing three time points: baseline, 12- and 60-month follow-up. Data were restricted to youth whose diabetes was first diagnosed in 2002-2005. DASH-related adherence was poor and changed very little over time. However, an increase in DASH diet score was significantly associated with a decrease in HbA1c levels in youth with type 1 diabetes (ß=-0.20, P-value=0.0063) and a decrease in systolic blood pressure among youth with type 2 diabetes (ß=-2.02, P-value=0.0406). Improvements in dietary quality may be beneficial in youth with type 1 or type 2 diabetes. However, further work in larger groups of youth with type 1 and 2 diabetes is desirable.

Factors associated with development of excessive fatness in children and adolescents: a review of prospective studies.

The purpose of this review was to examine the factors that predict the development of excessive fatness in children and adolescents. Medline, Web of Science and PubMed were searched to identify prospective cohort studies that evaluated the association between several variables (e.g. physical activity, sedentary behaviour, dietary intake and genetic, physiological, social cognitive, family and peer, school and community factors) and the development of excessive fatness in children and adolescents (5-18 years). Sixty-one studies met the eligibility criteria and were included. There is evidence to support the association between genetic factors and low physical activity with excessive fatness in children and adolescents. Current studies yielded mixed evidence for the contribution of sedentary behaviour, dietary intake, physiological biomarkers, family factors and the community physical activity environment. No conclusions could be drawn about social cognitive factors, peer factors, school nutrition and physical activity environments, and the community nutrition environment. There is a dearth of longitudinal evidence that examines specific factors contributing to the development of excessive fatness in childhood and adolescence. Given that childhood obesity is a worldwide public health concern, the field can benefit from large-scale, long-term prospective studies that use state-of-the-art measures in a diverse sample of children and adolescents.

Comparison of two waist circumference measurement protocols: the SEARCH for diabetes in youth study.

BACKGROUND: Reports comparing waist circumference (WC) measurements from young populations are scarce. OBJECTIVES: We compared two protocols for measuring waist circumference in a sample of youth with diabetes. METHODS: Participants were enrolled in the SEARCH for Diabetes in Youth Study (SEARCH). WC was measured at least twice by the National Health and Nutrition Examination Survey (NHANES) protocol and twice by the World Health Organization (WHO) protocol. Method-specific averages were used in these analyses. RESULTS: Among 6248 participants, the mean NHANES WC (76.3 cm) was greater than the mean WHO WC (71.9 cm). Discrepancies between protocols were greater for females than males, among older participants, and in those with higher body mass index (BMI). In both sexes and four age strata, the WCs using either method were highly correlated with BMI z-score. The within-method differences between the first and second measurements were similar for the two methods. CONCLUSIONS: These analyses do not provide evidence that one of these two methods is more reproducible or is a better indicator of obesity as defined by BMI z-scores.

Spatial accessibility and availability measures and statistical properties in the food environment.

Spatial accessibility is of increasing interest in the health sciences. This paper addresses the statistical use of spatial accessibility and availability indices. These measures are evaluated via an extensive simulation based on cluster models for local food outlet density. We derived Monte Carlo critical values for several statistical tests based on the indices. In particular we are interested in the ability to make inferential comparisons between different study areas where indices of accessibility and availability are to be calculated. We derive tests of mean difference as well as tests for differences in Moran's I for spatial correlation for each of the accessibility and availability indices. We also apply these new statistical tests to a data example based on two counties in South Carolina for various accessibility and availability measures calculated for food outlets, stores, and restaurants.

Associations between the intake of caffeinated and decaffeinated coffee and measures of insulin sensitivity and beta cell function.

AIMS/HYPOTHESIS: Although protective relationships between coffee consumption and type 2 diabetes mellitus have consistently been observed, few studies have examined the relationships between coffee consumption and underlying pathophysiological defects that characterise diabetes aetiology. The aim of this study was to explore the associations between caffeinated and decaffeinated coffee consumption and measures of insulin sensitivity and secretion. METHODS: The study population included 954 multi-ethnic non-diabetic adults from the Insulin Resistance Atherosclerosis Study (IRAS). Multiple regression analyses were performed to examine the cross-sectional relationships between caffeinated and decaffeinated coffee intake and insulin sensitivity and acute insulin response, measured by a frequently sampled intravenous glucose tolerance test, 2 h postload glucose measured by OGTT, fasting insulin, and proinsulin to C-peptide ratios. RESULTS: Caffeinated coffee intake was positively associated with insulin sensitivity (ß = 0.054; SE = 0.026; p = 0.04) and inversely related to 2 h postload glucose (ß = -0.37; SE = 0.10; p = 0.0003) in fully adjusted models. Caffeinated coffee intake was not associated with acute insulin response or proinsulin ratios. Decaffeinated coffee intake was inversely related to 2 h postload glucose (ß = -0.47; SE = 0.18; p = 0.0096) and positively related to acute insulin response (ß = 0.191; SE = 0.077; p = 0.0132). Decaffeinated coffee intake was inversely related to the ratios of both intact and split proinsulin to C-peptide (ß = -0.150; SE = 0.061; p = 0.0148; ß = -0.254; SE = 0.068; p = 0.0002, respectively). CONCLUSIONS/INTERPRETATION: In this cross-sectional study, caffeinated coffee was positively related to insulin sensitivity and decaffeinated coffee was favourably related to measures of beta cell function. These results provide pathophysiological insight as to how coffee could impact the risk of type 2 diabetes mellitus.

A comparative evaluation of two different approaches to estimating age at adiposity rebound.

OBJECTIVE: To compare different approaches (visual estimation of individual BMI curves with polynomial models) to estimate age at adiposity rebound (AR), as different approaches might lead to different results. AR has been suggested as a critical period between intra-uterine life and early adulthood, and recent data showed that early age at AR is associated with higher body mass later in life. METHODS: Longitudinal anthropometric data from the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study were used to obtain individual BMI growth curves. We then compared the visual estimation approach to polynomial models in three different scenarios reflected by different data sets: an idealistic, an realistic, and a realistic scenario with imputed values. RESULTS: In all three scenarios, the visual estimation yielded significantly higher estimates than the polynomial models of 2nd or 3rd order. Cross-tabulations of groups of age at AR (early, medium, and late) showed that truly concordant classification was low, ranging only from 51 to 63%. A closer examination of the data indicated that the differences in estimates were mainly due to differences in the underlying definitions: the polynomial models select the nadir in the growth curve as the age at AR, whereas the visual estimation deviates from this concept in those cases where there is plateau in the growth curve. In the latter instance, the turning point of the growth curve before its increase is selected as the age at rebound. CONCLUSIONS: Estimating AR with the visual approach appears to best reflect the physiological basis of the AR, and is also preferable, because it resulted in the lowest number of children with missing estimates for age at AR. Only when the underlying criteria for the estimation of AR with the visual approach were modified, could concordant results between the two approaches be obtained. Considering the underlying physiological basis, it became clear that approaches which determine AR by simply identifying the nadir in the BMI curve do not reflect AR appropriately. This refers to those cases in which the nadir in the growth curve and the turning point at the onset of the adiposity increase are not identical.

Associations of short-term weight changes and weight cycling with incidence of essential hypertension in the EPIC-Potsdam Study.

The aim of this study was to examine the relationships of short-term weight gain, weight loss, and weight cycling on the odds of developing hypertension. Normotensive middle-aged German men and women (n=12,362) of the European Prospective Investigation into Cancer and Nutrition-Potsdam Study were assigned to categories of 2-year short-term weight changes that were self-reported to have occurred prior to recruitment into the study (gain only, loss only, weight cycling, stable). After 2 years of follow-up after recruitment, 180 cases of incident essential hypertension were identified. In logistic regression models, odds ratios were estimated for the associations between short-term weight changes and risk of developing hypertension. Obesity status (BMI>or=30 or BMI<30 kg/m2) modified the associations between short-term weight change and incidence of diagnosed hypertension. Among obese individuals, short-term weight gain occurring during the 2 years prior to recruitment (OR=2.79, 95% CI 1.19-6.56), weight loss (OR=6.74, 95% CI 2.58-17.6) and weight cycling (OR=4.29, 95% CI 1.55-11.9) were strongly positively associated with incident hypertension, adjusted for age and gender, compared to obese individuals with short-term stable weight. No significant associations between short-term weight changes and risk of diagnosed hypertension were detected among non-obese individuals. Short-term weight changes appeared to present strong risk factors for developing hypertension among obese individuals. The effect seen for weight cycling supports the hypothesis that weight cycling increases the risk of hypertension. The finding for short-term weight loss may be explained by subsequent weight regain and needs further investigation.

[Classical risk factors for myocardial infarction and total mortality in the community--13-year follow-up of the MONICA Augsburg cohort study]. / Klassische Risikofaktoren für Herzinfarkt und Gesamtsterblichkeit in der Bevölkerung. 13-Jahres-Follow-up der MONICA Augsburg-Kohortenstudie.

PURPOSE: The MONICA (MONItoring of trends and determinants in CArdiovascular disease) project in the region of Augsburg, Southern Germany, is the first population-based cohort study in Germany investigating the association of the risk factors hypertension, hypercholesterolemia and smoking with incident myocardial infarction and total mortality, and to assess their impact at the population level. METHODS: At baseline, 1074 men and 1013 women aged 45-64 years were randomly selected from the population in the Augsburg region and extensively interviewed and examined regarding their cardiovascular risk profile. They were traced over 13 years from 1984-1997. We calculated incidence rates, hazard rate ratios, population attributable risks (PAR), and rate advancement periods (RAP) according to the three risk factors and their combinations. RESULTS: Among men, 107 myocardial infarctions and 204 total mortality events occurred during the study period; in women the number of total mortality cases was 102. The three classical risk factors were associated with incident myocardial infarction in men and with total mortality in men and women over a period of 13 years. Heavily smoking men had a particularly high risk of total mortality (HRR=4.2; 95% CI 2.5-7.0) and myocardial infarction (HRR=3.8; 1.9-7.6). Men with treated hypertension were at equally high risk for both total mortality (HRR=2.4; 1.5-3.7) and myocardial infarction (HRR=2.4; 1.3-4.3). In women, treated hypertension (HRR=2.5; 1.5-4.1) and hypercholesterolemia (HRR=2.0; 1.2-3.3) were most strongly related to total mortality. Regarding the association of risk factor combinations and myocardial infarction among men, the presence of all three risk factors simultaneously (HRR=7.9; 3.6-17.3) and the combination smoking/hypercholesterolemia (HRR=5.8; 3.2-10.5) were particularly hazardous. In total, the three risk factors contributed 54% of the burden of myocardial infarction in the male study population. The rate advancement periods for myocardial infarction related to treated hypertension, hypercholesterolemia and heavy smoking were 10.5, 5.8 and 15.8 years, respectively. CONCLUSIONS: Our results confirm the outstanding impact of the classical risk factors on myocardial infarction and total mortality in a southern German population. Coronary heart disease is largely preventable through risk factor reduction. Therefore, risk factor counselling, education and treatment are crucial to prevent people from developing the disease or dying prematurely.

[Secondary prevention of coronary heart disease. Results from EuroASPIRE I and II in the region of Münster, Germany]. / Sekundärprävention der koronaren Herzkrankheit - Ergebnisse der EuroASPIRE I- und II-Studien in der Region Münster, Germany.

BACKGROUND: EuroASPIRE (European Action on Secondary Prevention through Intervention to Reduce Events) is a European multicenter study on secondary prevention in patients with coronary heart disease (CHD). The first cross-sectional survey was undertaken in 1995/96 among 3569 patients from nine countries. A second cross-sectional survey (EuroASPIRE II) was conducted in 1999/2000 among 5556 patients from 15 countries to evaluate among others whether coronary prevention had improved since the first. METHODS: The present study was conducted in the region of Münster, Germany, as part of the EuroASPIRE study. Consecutive patients, men and women up to 70 years of age with established CHD, were identified retrospectively. A total of 392 (EuroASPIRE I) and 402 (EuroASPIRE II) patients participated. Information on cardiovascular risk factors, lifestyle and medication were obtained through medical records, interviews and examinations. RESULTS: Both studies demonstrate a high prevalence of risk factors among CHD patients. At the time of the interview more than 60% of the patients in both surveys had two or more risk factors. The comparison of EuroASPIRE I and II reveals a substantial decrease of 20% in the prevalence of hypercholesterolemia, but an increase in the prevalence of hypertension and obesity. ACE-inhibitors, betablockers and lipid lowering drugs, especially statins, were used more frequently in EuroASPIRE II. CONCLUSIONS: We conclude that secondary prevention of CHD in the region of Münster like in the other European study regions is less than optimal and has not substantially improved between 1996 and 2000. Potential reasons are discussed.

Recent weight changes and weight cycling as predictors of subsequent two year weight change in a middle-aged cohort.

OBJECTIVE: To evaluate the influence of recent weight changes (weight gain, loss and cycling) on subsequent weight changes. DESIGN: Prospective cohort study with 2 y of follow-up. Data analysis with a polytomous logistic regression model. SUBJECTS: A total of 18 001 non-smoking subjects, 6689 men and 11 312 women, from the general population. MEASUREMENTS: Body height and weight measurements and interview data on lifestyle habits and medical history at baseline. For follow-up, self-administered questionnaires for assessment of body weight and incident diseases. RESULTS: Recent changes in body weight, that is weight gain, weight loss and weight cycling, were significant predictors of subsequent weight changes in both men and women after controlling for age, baseline BMI and several lifestyle and behavioural characteristics as potential confounding factors. Weight cycling before baseline was the strongest predictor of subsequent large weight gain (> or =2 kg) with an odds ratio (OR) of 4.84 (95% confidence interval (CI) 3.34-7.02) in men. In women, prior weight loss was the strongest predictor of subsequent large weight gain (OR 4.77; 95% CI 3.63-6.03), followed by weight cycling (OR 3.02; 95% CI 2.15-4.25). CONCLUSION: These data indicate the need for thorough weight history assessment to identify those who are most likely to gain weight. Effective weight control before the development of obesity or after intentional weight loss due to obesity should be a primary goal in the management of obesity.

Inverse association of overweight and breast feeding in 9 to 10-y-old children in Germany.

OBJECTIVE: To evaluate whether breast feeding is associated with prevalent overweight in pre-adolescent children. METHODS: Cross-sectional studies of 9 to 10-y-old children attending fourth grade in 1995/1996 in Dresden (n=1046) and Munich (n=1062), Germany, according to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II protocol. A comprehensive questionnaire including detailed breast feeding history was filled out by the child's parent. Height and weight were measured in a random subsample of children undergoing spirometry. Overweight was defined as body mass index > or =90th age- and sex-specific percentile of the German reference. RESULTS: While the prevalence of overweight differed substantially between Dresden (girls 9.1%, boys 12.5%) and Munich (17% both), we observed a markedly lower overweight prevalence among breast fed than non-breast fed children in both cities. Controlling for age, sex and city, breast-fed children were substantially less likely to be overweight at 9-10 y (OR 0.55, 95% CI 0.41-0.74). Results were slightly attenuated after adjustment for nationality, socio-economic status, number of siblings, parental smoking (OR 0.66, 95% CI 0.52-0.87). A longer overall duration and duration of exclusive breast feeding was associated significantly with decreasing prevalence of overweight. CONCLUSION: The results highlight the importance and possible preventive potential of early nutrition in the development of overweight in children. Both feeding behaviors acquired by the nursing infant and metabolic effects may contribute to the observed inverse association of breast feeding and overweight in children.

Can inaccuracy of reported parental history of diabetes explain the maternal transmission hypothesis for diabetes?

BACKGROUND: The mode of inheritance of type 2 diabetes mellitus is still under discussion. Several studies have suggested an excess maternal transmission, however, more recent studies could not always confirm these findings. METHODS: We investigated the frequency of a maternal and paternal history of diabetes among diabetic and non-diabetic subjects and assessed the association between diabetes and a parental history of diabetes among participants of the MONICA Augsburg study. As an extension to previous studies, unknown parental status was taken into account. RESULTS: Of the 542 diabetic probands, 25.3% reported a positive maternal history of diabetes and 10.9% reported a positive paternal history of diabetes. Among the 12,209 non-diabetic participants a positive maternal history was also more common than a positive paternal history (12.5% versus 7.1%). Conversely, an unknown paternal status was more common than an unknown maternal status in both groups (diabetic subjects: 27.9% versus 16.8%, non-diabetic subjects: 16.8% versus 8.4%). Adjusted odds ratios (OR) for the association between a parental history of diabetes and diabetes status were similar for a positive maternal (OR = 2.9, 95% CI : 2.3-3.6) and paternal history (OR = 2.8, 95% CI : 2.1-3.8) and for an unknown maternal (OR = 1.3, 95% CI : 1.0-1.8) and paternal history (OR = 1.5, 95% CI : 1.2-1.9). CONCLUSION: Our findings do not support a strong excess maternal transmission of diabetes. Epidemiological biases and failure to account for 'don't know' responses may in part explain the previously observed predominance of a maternal history of diabetes.