Predictors of abdominal obesity among 31-y-old men and women born in Northern Finland in 1966

OBJECTIVE: To find predictors of abdominal obesity (defined by >90th percentile of waist/hip ratio (WHR)) and related factors among 31-y-old men and women. DESIGN: Longitudinal study of the northern Finland birth cohort of 1966 with measurements obtained at birth, 14 and 31 y. SUBJECTS: A total of 2841 men and 2930 women with data on WHR at 31 y. RESULTS: The most important predictor of abdominal obesity among the 31-y-old men was a high body mass index (BMI), those with normal weight at 14 y who were obese at 31 y having an especially high risk of abdominal obesity at 31 y. Abdominal obesity was independently associated with current weight status, small size for gestational age, a high intake of alcohol at 31 y, physical inactivity at 31 y, unhealthy diet in the sense of infrequent consumption of fiber-rich foods and frequent consumption of sausages, and a low level of occupational training. Physical inactivity and minimal vocational training also tended to be associated with abdominal obesity among women. The analyses were controlled for maternal age and BMI, and also for hormonal contraception and parity among women. CONCLUSIONS: Some aspects of risk of adult abdominal obesity were evident during adolescence, and good advice is needed then, and in early adulthood, in order to reduce the risk of abdominal obesity in their thirties. Those who are small for gestational age are vulnerable to the development of abdominal obesity. Successful weight control from adolescence to adulthood, and healthy eating, alcohol drinking and exercise habits are important for avoiding abdominal accumulation of body fat.     

Association of Calcium Intake and Adiposity in Postmenopausal Women

Objective: The purpose of this study was to examine the relationship between calcium intake and 1) body composition and 2) body fat distribution in postmenopausal women.

Methods: Archived data from a previous study including forty-nine Caucasian women, aged 51–73 and at least three years postmenopausal, were used for analysis. Data included medical and diet history from a questionnaire, average nutrient intake from computerized analysis of a 3-day diet record, anthropometric measures including height, weight, body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR). Calcium intake represented both food and supplement sources of calcium. Lean and fat mass were determined from dual energy x-ray absorptiometry (DXA) total body scans, and abdominal fat mass was defined as fat mass between the top of the iliac crest and L1 on the DXA scan.

Results: Subjects were 60.5 ± 0.9 y/o with an average BMI of 26.9 ± 0.7 and percent body fat of 42.8 ± 1.2. Average calcium intake was 1151 ± 83 g/d. There was a significant inverse relationship between calcium intake and percent body fat (r = ?0.36, p < 0.01) and abdominal fat mass (r = ?0.25, p < 0.05), but there was no significant correlation between calcium intake and body mass index, fat mass, lean mass, waist circumference, or WHR. When kcalories were controlled, the inverse correlation between dietary calcium intake and percent body fat remained (r = ?0.24, p < 0.05). Total fat was significantly greater (p < 0.05) in the low dairy intake (1–2 servings/d) vs. high dairy intake group (3–4 servings/d), but there were no significant differences between the groups in other body composition variables.

Conclusions: Increased calcium intake was associated with lower percent body fat and higher dairy intake was associated with lower fat mass in postmenopausal women, but there was no association between calcium intake and body fat distribution measures in this population.     

Exercise mitigates the association of abdominal obesity with high-density lipoprotein cholesterol in premenopausal women: results from the third National Health and Nutrition Examination Survey

OBJECTIVE: To examine the relationship between abdominal obesity, as measured by waist-to-hip ratio (WHR) and high-density lipoprotein cholesterol (HDL-C) level within the context of age, body fatness, exercise, saturated fat intake, and other plasma lipids. DESIGN/SUBJECTS: Subjects were premenopausal, white, non-Hispanic women from the third National Health and Nutrition Examination Survey. Smokers, heavy drinkers, and women who took lipid-altering drugs were excluded. Of 1,188 subjects who met the inclusion criteria, complete data were available for 435 women. STATISTICAL ANALYSES: Means were calculated using all subjects for each variable, then F-protected t tests and linear contrasts were performed to test differences in means between subgroups. A P < .05 was considered significant. RESULTS: Age was not significantly associated with HDL-C level. Comparisons of HDL-C by WHR, percentage body fat (%BF), and exercise level revealed that HDL-C level was significantly lower at the higher levels of WHR and %BF and higher at the highest levels of exercise. Higher levels of HDL-C were generally accompanied by lower levels of triacylglycerol. When HDL-C was compared by exercise level within each WHR tertile and %BF tertile, the association of exercise with HDL-C diminished. Saturated fat intake was not associated with HDL-C. CONCLUSIONS/APPLICATIONS: Increased exercise is associated with a lower WHR and subsequently a higher HDL-C level. This association between WHR and HDL-C appears to be mediated through %BF. Women exercisers with the highest WHR had consistently more favorable plasma lipid profiles and lower mean body mass index and %BF than nonexercisers. Thus, for women who exhibit abdominal obesity, exercise mitigates the association of WHR with HDL-C level. Vigorous exercise in the premenopausal years may promote a more favorable lipid profile, even in the presence of increased body fat and abdominal girth.     

Higher eating frequency,but not skipping breakfast,is associated with higher odds of abdominal obesity in adults living in Puerto Rico

Puerto Ricans have a high prevalence of obesity, yet little information is available regarding its association with eating patterns in this population. We hypothesized that higher eating frequency and skipping breakfast would be associated with increased odds of abdominal obesity among adults living in Puerto Rico (PR). In a cross-sectional study of adults living in PR aged 30-75 years (N = 310), participants reported their frequency of eating meals per day including snacks and breakfast. Trained interviewers measured waist (WC) and hip circumferences. We calculated the waist-to-hip ratio (WHR) dividing the waist by the hip measurement. Abdominal obesity was defined as either high WC (men ≥94 cm; women ≥80 cm) or high WHR (men ≥0.90; women ≥0.85). We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) to assess the association of eating frequency (≤1.5; 1.5-3; ≥3 times/day) and breakfast consumption (vs none) with abdominal obesity. Models were adjusted for age, sex, income, smoking, physical activity, TV watching, energy intake, diet quality, and eating frequency (only for breakfast consumption). Most participants consumed breakfast (70%), ate 1.5-3 times/d (47%), and had high WC (75%) and WHR (77%). Participants who ate 1.5-3 (OR: 2.75, 95% CI: 1.23-6.15) and ≥3 times/day (OR: 2.88; 95% CI: 1.14-7.31) were more likely to have high WC compared with participants who ate ≤1.5 times/d (P trend = .04). Breakfast consumption was not associated with abdominal obesity. In conclusion, higher eating frequency, but not skipping breakfast, is associated with abdominal obesity among adults in PR. Consuming less frequent meals may help prevent abdominal obesity in this population.     

Beer and obesity: a cross-sectional study

OBJECTIVE: There is a common notion that beer drinkers are, on average, more 'obese' than either nondrinkers or drinkers of wine or spirits. This is reflected, for example, by the expression 'beer belly'. However, the few studies on the association between consumption of beer and abdominal obesity produced inconsistent results. We examined the relation between beer intake and waist-hip ratio (WHR) and body mass index (BMI) in a beer-drinking population. DESIGN: A cross-sectional study. SETTINGS: General population of six districts of the Czech Republic. SUBJECTS: A random sample of 1141 men and 1212 women aged 25-64 y (response rate 76%) completed a questionnaire and underwent a short examination in a clinic. Intake of beer, wine and spirits during a typical week, frequency of drinking, and a number of other factors were measured by a questionnaire. The present analyses are based on 891 men and 1098 women who where either nondrinkers or 'exclusive' beer drinkers (ie they did not drink any wine or spirits in a typical week). RESULTS: The mean weekly beer intake was 3.1 l in men and 0.3 l in women. In men, beer intake was positively related to WHR in age-adjusted analyses, but the association was attenuated and became nonsignificant after controlling for other risk factors. There appeared to be an interaction with smoking: the relation between beer intake and WHR was seen only among nonsmokers. Beer intake was not related to BMI in men. In women, beer intake was not related to WHR, but there was a weak inverse association with BMI. CONCLUSION: It is unlikely that beer intake is associated with a largely increased WHR or BMI.     

Intake of macronutrients as predictors of 5-y changes in waist circumference

BACKGROUND: The diet may influence the development of abdominal obesity, but the few studies that have prospectively examined the relations between diet and changes in waist circumference (WC) have given inconsistent results. OBJECTIVE: Associations between total energy intake, energy intake from macronutrients, and energy intake from macronutrient subgroups based on different food sources and 5-y differences in WC (DWC) were investigated. DESIGN: A Danish cohort of 22 570 women and 20 126 men aged 50-64 y with baseline data on WC, diet, BMI, and potential confounders reported their WC 5 y later. Associations of baseline diet with DWC were assessed by multiple linear regression analysis. RESULTS: Neither total energy intake nor energy intake from each of the macronutrients was associated with DWC, except for an inverse association with protein, especially animal protein. In women, positive associations with DWC were seen for carbohydrate from refined grains and potatoes and from foods with simple sugars, whereas carbohydrate from fruit and vegetables was inversely associated and significantly different from any other carbohydrate subgroup. The results for men resembled those for women, although none were significant. Vegetable fat was positively associated with DWC for both men and women in a combined analysis. A U-shaped association between alcohol from wine and DWC was present for both sexes, and alcohol from spirits was positively associated with DWC in women. CONCLUSIONS: Although no significant associations with total energy or energy from fat, carbohydrate, or alcohol were observed, protein intake was inversely related to DWC, and some macronutrient subgroups were significantly associated with DWC.     

Relationships between 3-y longitudinal changes in body mass index, waist-to-hip ratio, and metabolic variables in an active French female population.

Three-year longitudinal changes in body mass index (BMI), waist-to-hip ratio (WHR), and metabolic variables were examined in 209 active French women. For the entire group, a weak but significant positive association was found between change in BMI and change in WHR. However, analysis of covariance according to the degree of abdominal fat distribution showed a heterogeneity of this association that was confined to women with abdominal fat distribution. Changes in BMI were positively associated with changes in total cholesterol (P less than 0.05), triglycerides (P less than 0.10), and blood pressure (P less than 0.001), whereas changes in WHR were associated with changes in triglycerides (P less than 0.05) and diastolic blood pressure (P less than 0.10). These longitudinal results suggest that a more favorable body-fat pattern and metabolic profile might be achieved by reducing weight, or at least by preventing weight gain, particularly in women with high abdominal-fat distribution.     

Calcium intake is associated with adiposity in Black and White men and White women of the HERITAGE Family Study

Calcium (Ca(2+)) intake may play a role in the regulation of body weight. Increased Ca(2+) intake has been associated with lower body weight, BMI, and adiposity measures in cross-sectional studies. We examined the association between Ca(2+) intake, derived from the Willett FFQ, and overall and abdominal adiposity in Black and White men and women of the HERITAGE Family Study. BMI, the percentage of body fat (%FAT), the sum of 8 skinfold thicknesses, computerized tomography total abdominal fat (TAF), abdominal visceral (AVF) and abdominal subcutaneous (ASF) fat, and waist circumference were measured in 362 men (109 Blacks, 253 Whites) and 462 women (201 Blacks, 261 Whites). Subjects were divided into tertiles of energy-adjusted Ca(2+) intake. Adiposity measures across tertiles were compared by ANOVA and also regressed against the energy-adjusted Ca(2+) intake to test for a linear trend. The strongest inverse associations appeared in Black men and White women. Black men in the high Ca(2+) intake group were leaner than those in the low Ca(2+) intake group: BMI 23.4 +/- 0.9 vs. 26.7 +/- 1.1 kg/m(2) (P = 0.01); for all other adiposity measures, P < 0.05. In White women, regression analyses showed significant inverse associations between Ca(2+) intake and BMI (P = 0.02), %FAT (P = 0.001), TAF (P = 0.006), AVF (P = 0.03), and ASF (P = 0.01). The percentage of fat of White men in the highest Ca(2+) intake group was significantly lower than in the lowest Ca(2+) group (P = 0.04). No significant associations were found in Black women. Low Ca(2+) intake may be associated with higher adiposity, particularly in men and White women.     

Improved diet quality with peanut consumption

OBJECTIVE: To evaluate the diet quality of free-living men, women, and children choosing peanuts and peanut products. DESIGN: Using data reported in the Continuing Survey of Food Intake by Individuals and Diet and Health Knowledge Survey (CSFII/DHKS) from 1994-1996, food codes were used to sort respondents by use or nonuse of peanuts. SUBJECTS: A nationally representative sample of 4,751 men, 4,572 women, and 4,939 children (boys and girls, 2-19 yrs) who completed 2-day intake records. Measures of Outcome: The two-sample t test was used to analyze differences between peanut users and nonusers for energy, nutrient intakes, Health Eating Index (HEI) scores, and body mass index (BMI). RESULTS: Peanut users (24% of CSFII/DHKS) had higher intakes (p < 0.001) of protein, total fat, polyunsaturated fat (PUFA), monounsaturated fat, (MUFA) (p < 0.01), fiber, vitamin A, vitamin E, folate, calcium, magnesium, zinc, and iron. Percent of energy from saturated fat was not significantly different for men, women or girls and was slightly lower (p < 0.01) for boys. Dietary cholesterol of peanut users was lower for all population groups; this decrease was significant for both men (p < 0.01) and children (p < 0.001). The HEI was calculated as a measure of overall nutrient profile of the diets and was significantly greater for peanut users (men 61.4, women, 65.1, children 66.8) compared to nonusers (men 59.9, women 64.1, children 64.7) for men (p = 0.0074) and children (p < 0.001). Energy intake was significantly higher in all population groups of peanut users (p < 0.001; boys: p < 0.01); however mean BMI for peanut users was lower for all gender/age categories (women: p < 0.05; children: p < 0.001). CONCLUSIONS: These results demonstrate improved diet quality of peanut users, indicated by the higher intake of the micronutrients vitamin A, vitamin E, folate, calcium, magnesium, zinc, and iron and dietary fiber, and by the lower intake of saturated fat and cholesterol. Despite a higher energy intake over a two-day period, peanut consumption was not associated with a higher BMI.     

Assessment of adipose tissue distribution by computed axial tomography in obese women: association with body density and anthropometric measurements

1. Abdominal obesity is associated with numerous metabolic complications. Deep abdominal adipose tissue is critical in the association between the level of abdominal obesity and cardiovascular risk factors. 2. Adipose tissue localization was assessed by computed axial tomography (CAT), and its association with body density and anthropometric measurements was investigated in a sample of fifty-one obese women (percentage body fat 45.9 (SD 5.6)) aged 35.7 (SD 5.5) years. The CAT scans were performed at three levels: lower chest, abdomen and mid-thigh. 3. The total adipose tissue volume computed from these three scans was highly correlated with body fat mass (r 0.94, P less than 0.001). The proportion of deep abdominal fat as measured by the ratio of deep: total adipose tissue areas at the abdominal level was not significantly correlated with body fat mass, but it was moderately associated with the ratio of waist: hip circumferences (WHR) (r 0.49, P less than 0.001). The absolute amount of deep abdominal fat was, however, significantly correlated with body fat mass (r 0.72, P less than 0.001). 4. The subscapular (r 0.38) and the abdominal (r 0.38) skinfolds were the only two skinfolds that were significantly associated with the proportion of deep abdominal fat (P less than 0.01). These skinfolds were also those which showed the highest correlation with the absolute amount of deep abdominal fat (r 0.65, P less than 0.001, for both skinfolds). 5. A three-site CAT-scan procedure can be used for the estimation of body fat mass in premenopausal obese women. 6. In these obese women, there was no significant association between total adiposity and the proportion of deep adipose tissue at the abdominal level. 7. In premenopausal obese women, the absolute amount of deep abdominal fat can be predicted from anthropometric measurements with more accuracy than the relative amount of deep abdominal fat.     

Associations of fat distribution and obesity with hypertension in a bi-ethnic population: the ARIC study. Atherosclerosis Risk in Communities Study

OBJECTIVE: To examine associations of hypertension with obesity and fat distribution among African American and white men and women. RESEARCH METHODS AND PROCEDURES: The analysis sample included 15,063 African American and white men and women between the ages of 45 and 64 years who were participants in the 1987 through 1989 examination of the Atherosclerosis Risk in Communities Study (ARIC). Odds ratios and adjusted prevalences of hypertension were calculated across sex-specific quintiles of body mass index (BMI), waist-to-hip ratio (WHR), waist circumference, and waist-to-height ratio (waist/ height) and adjusted for age, research center, smoking, education, physical activity, alcohol consumption, hormone replacement therapy, and menopausal status. RESULTS: The prevalence of hypertension was higher among African Americans than whites. In the lowest quintile of BMI, 41% of African American women and 43% of African American men had hypertension compared with 14% of white women and 19% of white men. Elevated BMI, WHR, waist circumference, and waist/height were associated with increased odds of hypertension in African American and white men and women. In women, but not in men, there were significant interactions between ethnicity and the anthropometric variables studied here. The direction of the interaction indicated larger odds ratios for hypertension with increasing levels of anthropometric indices in white compared with African American women. DISCUSSION: Obesity and abdominal fat preponderance were associated with increased prevalence of hypertension in African American and white men and women. Associations were similar among African American and white men, but obesity and fat patterning were less strongly associated with hypertension in African American than in white women.     

Dietary Intake and Diet Quality of Adult Survivors of Childhood Cancer and the General Population: Results from the SCCSS-Nutrition Study

Childhood cancer survivors (CCSs) are at increased risk of developing chronic health conditions. This may potentially be reduced by a balanced diet. We aimed to compare dietary intake and diet quality using the Alternative Healthy Eating Index (AHEI) of adult CCSs and the general Swiss population. A food frequency questionnaire (FFQ) was completed by CCSs with a median age of 34 (IQR: 29–40) years. We compared dietary intake of 775 CCSs to two population-based cohorts who completed the same FFQ: 1276 CoLaus and 2529 Bus Santé study participants. CCSs consumed particular inadequate amounts of fiber and excessive amounts of sodium and saturated fat. Dietary intake was similar in CCSs and the general population. The mean AHEI was low with 49.8 in CCSs (men: 47.7, women: 51.9), 52.3 in CoLaus (men: 50.2, women: 54.0), and 53.7 in Bus Santé (men: 51.8, women: 54.4) out of a maximum score of 110. The AHEI scores for fish, fruit, vegetables, and alcohol were worse in CCSs than in the general population, whereas the score for sugar-sweetened beverages was better (all p < 0.001). Diet quality at follow-up did not differ between clinical characteristics of CCSs. Long-term CCSs and the general population have poor dietary intake and quality in Switzerland, which suggests similar population-based interventions for everyone.     

Relationship of abdominal obesity with alcohol consumption at population scale

Background The high energy content of alcohol makes its consumption a potential contributor to the obesity epidemic. Aim of the study To determine whether alcohol consumption is a risk factor for abdominal obesity, taking into account energy underreporting. Methods The subjects were Spanish men (n = 1491) and women (n = 1563) aged 25–74 years who were examined in 1999–2000, in a population-based cross-sectional survey in northeastern Spain (Girona). Dietary intake, including alcohol consumption, was assessed using a food frequency questionnaire. Anthropometric variables were measured. Results The mean consumption of alcohol was 18.1 ± 20.7 g/d in men and 5.3 ± 10.4 g/d in women. 19.3% of men and 2.3% of women reported alcohol consumption of more than 3 drinks per day. The consumption of alcohol was directly associated with total energy intake in men (P < 0.001) and women (P = 0.001). The proportion of energy underreporting significantly (P < 0.001) decreased with higher amounts of alcohol drinking in both genders. Multiple logistic regression analysis, controlled for energy underreporting, smoking, educational level, leisure-time physical activity, energy, and diet quality, revealed that consuming more than 3 drinks of alcohol (>30 g ethanol) was significantly associated with the risk of abdominal obesity (Odds ratio 1.80; 1.05, 3.09) and exceeding recommended energy consumption (Odds ratio 1.97; 1.32, 2.93) in men. A very small number (2.13%) of women in this population reported high levels of alcohol consumption. Conclusions Alcohol consumption in elevated amounts was associated with risk of abdominal obesity in men, independent of energy underreporting.     

简易体脂参数估测腹内型肥胖的可靠性评价

目的：评价体重指数（BMI）、腰围（WC）、腰臀比（WHR）估测腹内型肥胖的最佳临界点及敏感度、特异度。方法：应用核磁共振（MRI）对690名受试者（男305人，女385人）进行腹内脂肪（VA）测量，同时测量BMI、WC、WHR。以受试者工作特性（ROC）曲线评价简易体脂参数对腹内型肥胖的诊断价值。结果：①经MRI诊断，超重／肥胖者中61．7％，正常体重者中14．2％呈腹内型肥胖（VA≥100cm^2）；②BMI、WC、WHR与腹内脂肪面积呈显著正相关，尤以WC的相关性最好;③简易体脂参数估测腹内脂肪积聚的最佳切割点为BMI：26kg/m^2,WC:90cm,WHR:0.93;④BMI≥28kg/m^2、WC≥95cm时，95％的男性及90％左右的女性呈腹内型肥胖。结论：BMI、WC及WHR都可估测腹内型肥胖，但以腰围的准确率稍高。     

Relationship between body mass index,serum cholesterol,leisure-time physical activity,and diet in a Mediterranean Southern-Europe population

The aim of the present study was to determine the relationship of BMI with other cardiovascular risk factors, leisure-time physical activity and diet. Participants were recruited in a cross-sectional population-based survey in a southern-Europe Mediterranean population (Spain); cardiovascular risk factors were measured, and leisure-time physical activity and diet intake were evaluated. Linear regression analysis adjusted for several confounders showed a significant, direct association of BMI and total cholesterol (P<0.005) and LDL-cholesterol (P<0.006), in men. HDL-cholesterol was inversely related to BMI in both sexes (P<0.0001). Higher BMI was more frequent in less-active men (P<0.04) but not in women. BMI increased significantly (P<0.0001) by 1.92 kg/m(2) with each 4.18 MJ consumed in men but not in women. Dietary intakes of carbohydrate (P<0.03), total fat (P<0.03) and saturated fatty acids (P<0.02) were directly associated with BMI in men but not in women, in whom protein intake was correlated (P<0.001) with BMI. Linear regression models including dietary components explained up to 10.6 and 21.1 % of BMI variability in men and women, respectively. Sex differences in the association of BMI with total cholesterol, and LDL-cholesterol, may account for the lower risk for CHD in women compared with men of similar BMI reported in the literature for the southern-Europe Mediterranean region. An increases of BMI may be more deleterious in populations in which it is accompanied by other risk factors such as a higher intake of total fat and, particularly, of saturated fatty acids, or lower leisure-time physical activity.     

The effect of gender on the relationship between body fat distribution and lung function

Although abdominal obesity, as measured by waist-to-hip ratio (WHR), has long been recognized as a risk factor for metabolic and cardiovascular diseases, little is known about the effect of WHR on pulmonary function, especially in women. In this study of 1094 men and 540 women (18-102 years) from the Baltimore Longitudinal Study of Aging (BLSA), we examined the effect of WHR on forced expiratory volume in 1 s (FEV(1)). Cross-sectional analyses, after accounting for body mass index (BMI) and other variables, showed a strong inverse association of WHR with FEV(1) in men (beta = -1.338, P=.0001) but not in women. Furthermore, larger values of WHR were associated with greater reductions of forced vital capacity (FVC) in men (beta = -1.383, P =.0005) compared to women (beta = -0.679, P =.02). Thus, body fat distribution has independent effects on lung function that are more prominent in men than women.     

Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death

BACKGROUND: Guidelines for optimal weight in older persons are limited by uncertainty about the ideal body mass index (BMI) or the usefulness of alternative anthropometric measures. OBJECTIVE: We investigated the association of BMI (in kg/m(2)), waist circumference, and waist-hip ratio (WHR) with mortality and cause-specific mortality. DESIGN: Subjects aged >/=75 y (n = 14 833) from 53 family practices in the United Kingdom underwent a health assessment that included measurement of BMI and waist and hip circumferences; they also were followed up for mortality. RESULTS: During a median follow-up of 5.9 y, 6649 subjects died (46% of circulatory causes). In nonsmoking men and women (90% of the cohort), compared with the lowest quintile of BMI (<23 in men and <22.3 in women), adjusted hazard ratios (HRs) for mortality were <1 for all other quintiles of BMI (P for trend = 0.0003 and 0.0001 in men and women, respectively). Increasing WHR was associated with increasing HRs in men and women (P for trend = 0.008 and 0.0002, respectively). BMI was not associated with circulatory mortality in men (P for trend = 0.667) and was negatively associated in women (P for trend = 0.004). WHR was positively related to circulatory mortality in both men and women (P for trend = 0.001 and 0.005, respectively). Waist circumference was not associated with all-cause or circulatory mortality. CONCLUSIONS: Current guidelines for BMI-based risk categories overestimate risks due to excess weight in persons aged >/=75 y. Increased mortality risk is more clearly indicated for relative abdominal obesity as measured by high WHR.     

Cross-sectional association between total level and type of alcohol consumption and glycosylated haemoglobin level: the EPIC-Norfolk Study

OBJECTIVE: To investigate the association between total level and type of alcohol consumed and glycaemia. DESIGN: Cross-sectional study. SETTING: The EPIC-Norfolk Study, a population-based cohort study of diet and chronic disease. SUBJECTS AND METHODS: Non-diabetic men (n=2842) and women (n=3572), aged 40-78 y. Alcohol intake was assessed by self-reported questionnaire, and glycaemia measured by glycosylated haemoglobin (HbA(1c)). RESULTS: Ten percent of men and 18% of women reported drinking no alcohol. Among drinkers, median alcohol intake was 8 units/week for men and 3 units/week for women. In analyses stratified by sex and adjusted for age, total energy intake, education, fruit and vegetable intake, smoking, family history of diabetes, physical activity, body mass index and waist:hip ratio, alcohol intake was inversely associated with HbA(1c) in men and women, although the association was stronger in women. A 1 unit/week increase in alcohol intake was associated with 0.0049% (s.e.=0.00223; P-value=0.028) and 0.017% (s.e.=0.00343; P-value <0.001) reduction in HbA(1c) in men and women respectively. In similar multivariate analyses, wine intake was inversely associated with HbA(1c) in men, and wine, spirits and beer intake were inversely associated with HbA(1c) in women. When also adjusted for total alcohol intake, only the association between wine intake and HbA(1c) in men remained significant. CONCLUSION: Alcohol intake was associated with lower HbA(1c) level, an association not explained by confounding. The distinction between type of alcohol consumed was particularly important in men.     

Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek European Prospective Investigation into Cancer and Nutrition Study

BACKGROUND: Adherence to a Mediterranean diet has been reported to increase longevity, but concerns have been expressed that such a diet may promote overweight and obesity. OBJECTIVE: The objective was to investigate whether adherence to the traditional Mediterranean diet, as operationalized in a Mediterranean diet score, is associated with body mass index (BMI) and waist-to-hip ratio (WHR). DESIGN: In a general population sample of 23,597 adult men and women participating in the Greek European Prospective Investigation into Cancer and Nutrition Study, a validated food-frequency questionnaire was interviewer-administered, and anthropometric, sociodemographic, physical activity, and other lifestyle characteristics were recorded. BMI and WHR were regressed on a score that reflects adherence to the traditional Mediterranean diet and potentially confounding variables. RESULTS: In models in which total energy intake was included, adherence to the Mediterranean diet was unrelated to BMI in both sexes and was weakly related to WHR only in women. When energy intake was not controlled for, a 2-point increase in the score was found to correspond to increases of approximately 650 and 150 g in the weight of an average-height man and woman, respectively, whereas the WHR was found to increase by approximately 0.001 units in men and 0.004 units in women. CONCLUSIONS: Adherence to a Mediterranean diet was essentially unrelated to BMI, with small differences depending on model choice and having no practical consequences. Overweight is a genuine problem in Greece and perhaps other Mediterranean countries, but it is likely to be related to limited physical activity in conjunction with excessive positive energy balance.     

The influence of calcium consumption on weight and fat following 9 months of exercise in men and women

BACKGROUND: There is some evidence that calcium consumption improves weight loss during energy restriction but the effects of calcium consumption in conjunction with chronic exercise are unknown. OBJECTIVE: The purpose of the study was to determine the degree to which calcium consumption influences weight and fat weight change as a result of 9 months of verified supervised exercise in the absence of energy restriction. METHODS: Participants were 50 previously sedentary, overweight and moderately obese men (n=20) and women (n=30). Exercise of moderate intensity was performed for 45 min/d, 5 d/wk, under supervision. Diet intake was ad libitum and was measured for energy, macronutrient and micronutrient composition at baseline, 4 and 9 months by use of observer recorded weighed plate waste and multiple-pass 24-h dietary recall procedures. RESULTS: Average calcium consumption was 987 +/- 389 mg/day for men and 786 +/- 276 mg/day for women. Weight change over the 9 months was -4.6 +/- 4.6 kg for men and 0.2 +/- 3.3 kg for women. Calcium consumption was associated with weight change (r =-0.47, p<0.05) in men. The calcium to protein ratio was associated with weight change (r=0.56) and fat weight change (r=-0.53) in men. There was no observed association between calcium and weight or fat weight change in women. CONCLUSION: Weight and fat weight loss as a result of nine months of moderate intensity exercise may be improved by increased calcium consumption in men but was not observed in women.