Effects of a 12-Week Lifestyle Intervention on Health Outcome and Serum Adipokines in Middle-Aged Korean Men with Borderline High Blood Pressure

Background: High blood pressure, in relation to blood levels of adipokines such as adiponectin and leptin, is highly associated with an unhealthy lifestyle including sedentary behaviors, poor dietary habits such as excess sodium intake, and heavy drinking. Strategies to reduce blood pressure may benefit the levels of adipokines.

Objective: Thus, we aimed to investigate the effects of lifestyle intervention on blood pressure and serum adipokines in middle-aged Korean men with borderline high blood pressure (systolic blood pressure [SBP] ≥ 130 mm Hg or diastolic blood pressure [DBP] ≥ 85 mm Hg).

Methods: Fifty-two men (aged 42.5 ± 8.5 years) with normal weight (body mass index [BMI] < 25 kg/m²) and high BP (NH group) and 40 men (age 42.0 ± 8.4 years) who were obese (BMI ≥ 25 kg/m²) with high BP (OH group) underwent 5 sessions of one-on-one intensive counseling including instruction on a nutritionally balanced diet, a low-sodium diet, how to understand calorie requirements, and strategies to implement regular exercise for blood pressure regulation over 12 weeks. In order to increase the awareness of sodium education, a salt sensory test using an unseasoned soup was performed. Anthropometrics, blood pressure measurements, 24-hour recalls were performed, and blood levels of lipids, fasting plasma glucose, C-reactive protein (CRP), leptin, and adiponectin were analyzed at week 0 and at week 12. Sodium consumption was roughly estimated using the Dish-based Frequency Questionnaire–15.

Results: Weight, BMI, body fat (kg and %), waist circumference, hip circumference, and blood pressure were significantly decreased after 12 weeks (p < 0.05) in all subjects. Similarly, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and CRP were decreased (p < 0.05), but LDL-C/HDL-C was significantly decreased (p < 0.01) only in the obese subjects. At baseline, blood levels of leptin were significantly higher in the obese subjects than in the normal weight subjects. In the obese subjects, a significantly negative correlation was found between leptin levels at baseline and percentage change in DBP (r = –0.338, p < 0.05). After 12 weeks, blood levels of adipokines did not show significant changes.

Conclusions: These results suggest that a short-term (12 weeks) lifestyle intervention had positive effects on blood pressure control and weight reduction in the subjects, but not on their blood levels of adipokines. It is interesting that blood level of baseline leptin was negatively associated with the changes in blood pressure after this short-term intervention.     

The Relationship between Body Esteem,Exercise Motivations,Depression, and Social Support Among Female Free Clinic Patients

PurposeObesity is a significant public health problem in women's health. This study examined relationship between body esteem, exercise motivations, depression, and social support among female free clinic patients. Low-income women who are at risk for obesity and other health concerns would benefit from health education efforts.MethodsWe compared 299 female and 164 male free clinic patients 18 years or older using assessments for body esteem, motivation to exercise, depression, and social support.ResultsAlthough female participants reported lower levels of body esteem and higher levels of depression compared with male participants (p < .01), female participants were more motivated to exercise for weight-related reasons than male participants (p < .05). U.S.-born female participants reported lower exercise motivations compared with non–U.S.-born female participants (p < .01). Social support might be an important factor to increase exercise motivation among female free clinic patients (p < .05); depression lowers levels of body esteem (p < .01).ConclusionsThe results of this study suggest that female free clinic patients should receive gender-specific interventions to promote positive body image and physical activity. It is important for health educators to engage a myriad of physical activity motives to increase the likelihood that clients will experience enjoyment and sustained adoption of exercise into their lifestyle. Future practice and research should warrant the implementation of body image and physical activity programs and the potential impact of using exercise to reducing depression among female patients at free clinics.     

Intimate partner violence and academic performance: the role of physical,mental, behavioral,and financial health

Undergraduate students of all gender identities are at risk of experiencing intimate partner violence (IPV) victimization. It is known that IPV negatively affects academic performance, yet little is known about the role of health. This study examined if past-year IPV victimization was associated with an increase in students’ self-perception of health interfering with academic performance. Data were drawn from the 2011–2014 National College Health Assessment (N = 84,734). Structural equation modeling was used to examine the relationship between a latent variable of IPV and health impediments to academic performance. The model was a good fit for the data (RMSEA = .012, CFI = .994, TLI = .981). Undergraduate survivors of past-year IPV – and transgender students – were more likely to report impediments to their academic performance: physical assault (0.66, p < .001), sexual assault (0.57, p < .001), sexually transmitted infections (0.42, p < .001), pregnancy (0.38, p < .001), depression (0.38, p < .001), disordered eating (0.36, p < .001), financial problems (0.33, p < .001), anxiety (0.32, p < .001), sleep problems (0.32, p < .001), chronic health problems (0.29, p < .001), drug use (0.29, p < .001), injury (0.25, p < .001), and alcohol use (0.25, p < .001). This demonstrates that IPV has a spiral effect, such that IPV’s impact on health is perceived by students as detrimental to their academics.     

Weight Gain and Increased Concentrations of Receptor Proteins for Tumor Necrosis Factor After Patients With Symptomatic HIV Infection Received Fortified Nutrition Support

Objective To determine whether certain nutrients and dietary factors act as modulators of the immune system and improve the nutritional status of immunocompromised patients.Design Controlled, double-blind, crossover phase trials of the effects of a fortified formula in patients infected with the human immunodeficiency virus (HIV). Patients consumed a control formula for 4 months and a study formula for 4 months.Subjects Ten men with symptomatic HIV infection who were following stable medication regimens and had no malignancies, mycobacteriosis, or additional virus infection requiring systemic treatment.Intervention Formula fortified with α-linolenic acid (1.8 g/day), arginine (7.8 g/day), and RNA (0.75 g/day) and a standard formula.Main outcome measures Nutritional status determined by anthropometric, bioelectrical, biochemical, and dietary assessment; energy expenditure determined by indirect calorimetry; disease progression; CD4 lymphocyte counts; HIV p24 antigen plasma concentrations; tumor necrosis factor (TNF) receptor proteins; and compliance control parameters.Statistical analyses performed Student's t tests for paired and unpaired data.Results Fortified nutrition resulted in a weight gain (+2.9 kg/ 4 months vs −0.5 kg/4 months with the control formula, P<.05), an incorporation of eicosaenoic acid into erythrocyte cell membranes (+47% of baseline values, P<.05), and increased plasma arginine concentrations (96.8±45.1 vs 51.8±20.9 μmol/L, P<.01). The serum concentrations of the soluble tumor necrosis factor receptor (sTNFR) proteins increased during the study period (sTNFR 55=+0.23 vs −0.40 ng/mL, P<.001; sTNFR 75=+0.90 vs −0.36 ng/mL, P<.01), whereas no changes in CD4+ lymphocyte counts were observed.Conclusion Increasing dietary intakes of n-3 polyunsaturated fatty acids, L-arginine, and RNA increased body weight, possibly by modulating the negative effects of TNF. J Am Diet Assoc. 1996; 96:565-569.     

Putting the diabetes prevention program into practice: A program for weight loss and cardiovascular risk reduction for patients with metabolic syndrome or type 2 diabetes mellitus

Background: The increasing incidence and prevalence of metabolic syndrome and type 2 diabetes mellitus (DM) have significant implications on health world-wide. Large clinical trials have demonstrated the effectiveness of a comprehensive lifestyle program with a goal of moderate weight loss (5–7%) and regular exercise (150 minutes/week), resulting in a significant decrease in the incidence of type 2 DM and cardiovascular risk.Methods: This study reports on the translation of the multi-center Diabetes Prevention Program (DPP) into a cardiac rehabilitation program, utilizing the expertise and experience of a cardiac rehabilitation program staff. The study adapted materials from the DPP to develop a program that fit local needs for diabetes prevention.Results: Most participants completed the program (11 months) and their moderate weight loss was maintained for 11–12 months. At 11–12 months, waist circumference was reduced by approximately 2 inches, percent body fat was reduced by 5% (11% relative decrease, p<.05), weight was decreased by 10.1 pounds (p<.05), and blood pressure was reduced 8/3 mm Hg (p<.05). Exercise, nutrition, glucose, triglycerides, LDL-cholesterol and HDLcholesterol were all were significantly improved at 11–12 months (p<.05).Conclusions: Efforts to improve lifestyle and reduce body weight are important to patients at risk of developing diabetes. This program demonstrates that an intensive effort can significantly improve lifestyle and reduce body weight in patients with DM or at risk for DM. A program that simulates cardiac rehabilitation, translated from a successful clinical trial into practice, resulted in significant reduction and improvement in metabolic outcomes and cardiovascular risk. Support for cardiac rehabilitation from insurers to develop similar programs is encouraged and deserves further study.     

Risk factors of deaths related to cardiovascular diseases in World Health Organization (WHO) member countries

This study aims to identify the risk factors affecting deaths related to cardiovascular diseases. The research population comprised of 194 World Health Organization (WHO) member countries, but the data analysis was conducted with the data from 152 countries as 42 of them do not have any data on study variables. Multivariable regression analysis was utilised for this study to analyse the effect of factors regarding metabolism, lifestyle, economic, socio-demographic and health system on the cardiovascular diseases related to deaths. As a result of regression analysis, the number of deaths related to cardiovascular diseases increases with the increase in blood pressure (p < .001), blood glucose (p = .032), obesity rate (p < .001), salt consumption (p < .001), GINI index (p = .002) and dependent age ratio (p < .001); the frequency of cardiovascular disease-related deaths is higher in the countries within low (p < .001) and high (p < .001) middle-income levels; yet, the number of deaths based on cardiovascular diseases diminishes with the increase in the number of doctors (p = .005) and health expenditures per capita (p = .044). The research findings are considered to guide the countries in the determination of their steps towards the prevention of deaths related to cardiovascular diseases.     

Exposure to famine during gestation, size at birth, and blood pressure at age 59 y: evidence from the dutch famine

We compared blood pressure of individuals (mean age 59 y) born in western Holland between January 1945 and March 1946 (mothers exposed to the Dutch Famine before or during gestation; n = 359) to blood pressure of unexposed individuals born before or conceived after the famine (n = 299) or same-sex siblings of subjects in series 1 or 2 (n = 313). Mean (SD) systolic and diastolic blood pressure were 140.3 (20.3) and 85.8 (11.0) mmHg, respectively; prevalence of hypertension (prior diagnosis of hypertension or with measured systolic/diastolic blood pressure above 140/90 mmHg) was 61.8%. Birth weight was inversely related to systolic (−4.14 mmHg per kg; 95% confidence interval (CI) −7.24, −1.03; p < 0.01) and diastolic (−2.09 mmHg per kg; 95% CI −3.77, −0.41; p < 0.05) blood pressure and to the prevalence of hypertension (odds ratio 0.67 per kg, 95% CI: 0.49, 0.93) (all age- and sex-adjusted). Any famine exposure of at least 10 weeks duration was associated with elevated systolic (2.77 mmHg; 95% CI 0.25, 5.30; p < 0.05) and diastolic (1.27 mmHg; 95% CI −0.13, 2.66; p = 0.08) blood pressure and with hypertension prevalence (odds ratio 1.44; 95% CI 1.04, 2.00; p < 0.05) in age- and sex-adjusted models. Exposure to famine during gestation may predispose to the development of hypertension in middle age.     

Blood zinc levels in nursing women from different regions of the West Bank of Palestine

Pregnant and nursing women are at higher risk of zinc deficiency which can have detrimental consequences on health. We assessed blood zinc levels in 72 nursing women from the West Bank of Palestine and investigated the association between sociodemographic variables and blood zinc levels. Blood samples were analyzed for their zinc contents using graphite furnace atomic absorption spectrophotometry. Blood and data collection were performed between July and December 2016. The median blood zinc level was 4.53 mg/L (interquartile range of 0.38 mg/L). In unadjusted analyses, blood zinc levels were higher in nursing women who lived in cities (p-value <.001), had higher household income (p-value <.001), whose husbands had a white collar job (p-value <.05), were nonsmokers (p-value <.05), did not use hair dyes (p-value <.05), and consumed energy beverages (p-value <.001). Multiple linear analysis showed that living in cities and consuming energy beverages remained significantly associated with higher blood zinc levels (p-value <.05). Blood zinc levels were in the range previously reported for similar non-malnourished populations. Nursing women living in cities and those consuming energy beverages tended to have higher blood zinc levels. Urbanized lifestyle might have enhanced blood zinc levels in nursing women.     

An effective lifestyle intervention in overweight children: one-year follow-up after the randomized controlled trial on "Obeldicks light"

Background & aims

Lifestyle interventions address primarily obese children, while interventions tailored to overweight but not obese children are scarce. The effectiveness of the lifestyle intervention “Obeldicks light” based on physical activity training, nutrition education, and behavior counseling for overweight children and their parents has been demonstrated by a randomized controlled trial. Here, we present the 12 months follow-up analysis of these children after end of intervention.

Methods

Degree of overweight (BMI and SDS-BMI), waist circumference, skinfold thickness, bioimpedance analyses (BIA), and blood pressure were determined in 76 overweight (BMI>90^th≤97^th percentile) children (mean age 11.8 ± 1.8years, 67% females, mean BMI 24.3 ± 1.9 kg/m²) participating in the evaluation study of “Obeldicks light” at onset of intervention (T0), end of 6 months intervention (T1), 6 months after end of intervention (T2) and 12 months after end of intervention (T3). Comparisons were performed on an intention-to-treat approach.

Results

The drop-out rate was 4% in the intervention period and additional 3% during follow-up. The children reduced significantly (p < 0.001) their SDS-BMI in the intervention period between T0 and T1 (−0.27 ± 0.23; p < 0.001). This SDS-BMI reduction remained stable at T2 (T0-T2:-0.26 ± 0.31; p < 0.001) and T3 (T0-T3:-0.26 ± 0.39; p < 0.001). SDS-BMI reductions were independent from age and gender. Body fat measured by skinfold thickness and BIA, waist circumference, and blood pressure decreased significantly in the intervention period and remained stable in the follow-up period as well.

Conclusions

The lifestyle intervention “Obeldicks light” was effective in reducing degree of overweight, fat mass, waist circumference, and blood pressure both at end of intervention and in a 12 months follow-up period.     

Can EGCG Reduce Abdominal Fat in Obese Subjects?

Objective: To evaluate metabolic effects of epigallocatechin gallate (EGCG) supplementation when combined with a program of regular aerobic exercise in overweight/obese post-menopausal women.

Methods: Thirty-eight overweight or obese postmenopausal women exercised at moderate intensity, viz. walking three times per week for 45 min at 75% of age-predicted maximum heart rate (HR), and took a 150 mg capsule of EGCG (Teavigo®) or placebo (lactose) twice daily for 12 weeks. Blood parameters (lipids, glucose and insulin), blood pressure, heart rate, arterial function and anthropometry were assessed at 0, 6 and 12 wk. At wk 0 and 12, body composition was assessed by dual energy X-ray absorptiometry (DXA) and abdominal fat was assessed by DXA and computed tomography (CT).

Results: Waist circumference (p < 0.01), total body fat (p < 0.02), abdominal fat (by DXA) (p < 0.01) and intra abdominal adipose tissue (by CT) (p < 0.01) were reduced in both treatment groups, with no difference between placebo and Teavigo®. Teavigo® significantly decreased resting HR (p < 0.01) and reduced plasma glucose in subjects with impaired glucose tolerance (p < 0.05).

Conclusions: Moderate consumption of EGCG can improve the health status of overweight individuals undergoing regular exercise by reducing HR and plasma glucose concentrations. Loss of body fat, however, may require a higher intake of EGCG, other catechins or addition of metabolic stimulants.     

Effects of cognitive-behavioral treatment for weight loss in family members

The possibility that lifestyle changes may be shared by the family members of subjects with obesity attending cognitive-behavioral treatment (CBT) for weight loss has been scarcely evaluated. The purpose of this study was to measure the changes in body weight, lifestyle habits, and stage of change toward physical activity in the family members of 149 subjects with overweight/obesity enrolled into a weekly group CBT for weight management in the years 2007-2008. 230 adult (aged >18 years) family members (129 spouses, 72 children (43 female, 29 male), 29 with a different family relationship) completed a self-administered questionnaire at baseline and soon after the end of the completion of their relatives' program (approximately 6 months later). The questionnaire consisted of qualitative information regarding food choices, estimation of energy and food intake, self-report of height and weight, and motivation toward physical activity. At baseline, self-reported body mass index was normal in 115 cases, in the range 25 to 29.9 in 80 and ≥30 in 35. Following CBT of their relatives, the family members significantly reduced their average daily energy intake (−232 kcal/day; P<0.001) and the reported body weight decreased on average by 1 kg (P=0.001). The analysis of food choices revealed a reduced average daily amount of energy from dressings (−40 kcal, P<0.001), main courses with cheese or fat meat (−24 kcal, P=0.002), refined carbohydrates (−16 kcal, P<0.001), bread (−58 kcal, P<0.001), breakfast biscuits (−23 kcal, P=0.005), chocolate (−7 kcal, P=0.024), and nonalcoholic beverages (fruit juices and carbonated drinks; −10 kcal; P=0.013), whereas fruit consumption was increased (+10 kcal; P=0.023). There was also a shift in the stage of change toward exercising. Body mass index changes of family members and CBT subjects were significantly correlated, mainly within spouses. In conclusion, CBT for weight loss positively influences the lifestyle habits of family members of participants, reducing energy intake and promoting a more favorable attitude toward physical activity.     

Effects of 12-month exercise on health-related quality of life: a randomized controlled trial

Objective

We investigated exercise effects on health-related quality of life (HRQOL) and exercise self-efficacy, and tested effect modification by baseline body mass index (BMI) and gender.

Methods

Middle-aged women (n = 100) and men (n = 102) were randomly assigned to either exercise (360 min/week of moderate-to-vigorous aerobic exercise) or control in Seattle, WA, from 2001 to 2004. Demographics, anthropometrics, exercise self-efficacy (5-item self-efficacy questionnaire) and HRQOL (SF-36) were assessed at baseline and 12 months. Analysis of covariance adjusting for baseline scores was used to compare HRQOL and exercise self-efficacy scores between the exercise and control groups.

Results

At 12 months, exercisers demonstrated higher exercise self-efficacy than controls (percent change from baseline: − 6.5% vs. − 15.0%, p < 0.01), without differences in HRQOL. Baseline BMI category and gender did not modify these effects. In exploratory analyses comparing exercisers and controls within subgroups defined by gender and BMI, 12-month HRQOL scores [role-physical (+7.0% vs. − 13.1%), vitality (+15.6% vs. − 4.2%), social functioning (+ 10.0% vs. − 3.5%), and mental health (+6.8% vs. − 2.9%)] were higher only among overweight male exercisers (p < 0.05, vs. control).

Conclusion

Three hundred and sixty minutes per week of exercise, recommended for weight maintenance, did not have negative effects on exercise self-efficacy or HRQOL. This level of exercise may increase HRQOL among overweight men.Trial registration. NCT00668161.     

Neurodevelopment and growth of institutionalized children with vertically transmitted human immunodeficiency virus

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in sub-Saharan Africa has resulted in millions of children being infected with the virus and/or orphaned as a consequence of the virus. This is compounded by the fact that this area also has a high incidence of poverty, limited basic resources and malnutrition. Because HIV is both neurotrophic and lymphotrophic, infected children are at risk of developmental delays and growth impairments. Limited height-for-age (stunting) is a commonly reported finding. The objective of this study was to compare the neurodevelopment and anthropometric measurements of vertically infected HIV children not on antiretroviral treatment and HIV-uninfected children, as well as changes within the groups over 6–8 months. A comparative longitudinal study was conducted of 16 HIV-infected and 24 HIV-uninfected children between the ages of 16 and 42 months. The study sample was derived from two institutions in Gauteng, South Africa. Bayley Scales of Infant Development II were used to evaluate the children's mental and motor development. Growth was assessed using mean Z-scores for weight-for-age, height-for-age, weight-for-height and head circumference-for-age. Evaluations were carried out at two time-points, 6–8 months apart. The results showed that HIV-infected children scored significantly lower than HIV-uninfected children at both time-points in neurodevelopment (mental developmental index p < 0.02 and p < 0.00; psychomotor developmental index p < 0.00 and p < 0.00) and also in anthropometric measurements (weight p < 0.00 and p < 0.01; height p < 0.00 and p < 0.00; head circumference p < 0.00 and p < 0.07). It is concluded that HIV affects the neurodevelopment (both mental and motor) and growth of HIV-infected children, particularly height-for-age.     

Depressed Adolescents Treated with Exercise (DATE): A pilot randomized controlled trial to test feasibility and establish preliminary effect sizes

The Depressed Adolescents Treated with Exercise (DATE) study evaluated a standardized aerobic exercise protocol to treat nonmedicated adolescents that met DSM-IV-TR criteria for major depressive disorder. From an initial screen of 90 individuals, 30 adolescents aged 12–18 years were randomized to either vigorous exercise (EXER) (>12 kg/kcal/week [KKW]) or a control stretching (STRETCH) activity (<4 KKW) for 12 weeks. The primary outcome measure was the blinded clinician rating of the Children's Depression Rating Scale – Revised (CDRS-R) to assess depression severity and Actical (KKW) accelerometry 24hr/7days a week to assess energy expenditure and adherence. Follow-up evaluations occurred at weeks 26 and 52. The EXER group averaged 77% adherence and the STRETCH group 81% for meeting weekly target goals for the 12 week intervention based on weekly sessions completed and meeting KKW requirements. There was a significant increase in overall weekly KKW expenditures (p < .001) for both groups with the EXER group doubling the STRETCH group in weekly energy expenditure. Depressive symptoms were significantly reduced from baseline for both groups with the EXER group improving more rapidly than STRETCH after six weeks (p < .016) and nine weeks (p < .001). Both groups continued to improve such that there were no group differences after 12 weeks (p = .07). By week 12, the exercise group had a 100% response rate (86% remission), whereas the stretch group response rate was 67% (50% remission) (p = .02). Both groups had improvements in multiple areas of psychosocial functioning related to school and relationships with parents and peers. Anthropometry reflected decreased waist, hip and thigh measurements (p = .02), more so for females than males (p = .05), but there were no weight changes for either gender. The EXER group sustained 100% remission at week 26 and 52. The STRETCH group had 80% response and 70% remission rates at week 26 and by week 52 only one had not fully responded. The study provides support for the use of exercise as a non-medication intervention for adolescents with major depressive disorders when good adherence and energy expenditure (KKW) are achieved.     

The relationship between the bone mineral density and urinary cadmium concentration of residents in an industrial complex

Background

An association between cadmium exposure and bone mineral density (BMD) has been demonstrated in elderly women, but has not been well studied in youths and men. Some studies report either no or a weak association between cadmium exposure and bone damage.

Objectives

This study was designed to investigate the relationship between the urinary cadmium (U-Cd) levels and BMD of females and males of all ages.

Methods

A total of 804 residents near an industrial complex were surveyed in 2007. U-Cd and BMD on the heel (non-dominant calcaneus) were analyzed with AAS-GTA and Dual-Energy X-ray absorptiometry, respectively. Demographic characteristics were collected by structured questionnaires. Osteoporosis and osteopenia were defined by BMD cut-off values and T-scores set by the WHO; T score>−1, normal; −2.5<T score <−1, osteopenia; and T score <−2.5, osteoporosis. Logistic and multiple linear regressions were applied to estimate the association between U-Cd levels and BMD.

Results

The U-Cd levels in females (0.64 μg/g creatinine) were higher than those in males (0.48 μg/g creatinine) (p<0.001). With the logistic regression model, osteopenia was associated with high U-Cd levels (≥1.0 μg/g creatinine) in females (OR=2.92; 95% CI, 1.51–5.64) and in males (OR=3.37; 95% CI, 1.09–10.38). With the multiple linear regression model, the BMD of the adult group was negatively associated with U-Cd (<0.05), gender (female, p<0.001) and age (p<0.001). The BMD of participants who were ≤19 years of age was negatively associated with gender (female, p<0.01), whereas it was positively associated with age and BMI (p<0.001). BMD was not associated with exercise, smoking habits, alcohol consumption, job or parental education.

Conclusion

Results suggested that U-Cd might be associated with osteopenia as well as osteoporosis in both male and female adults. Age and female gender were negatively associated with BMD in the adult group, whereas age was positively associated with BMD in the youth group. Cadmium exposure may be a potential risk factor for lower-BMD and osteopenia symptoms as well as for osteoporosis symptoms.     

Is two days of intermittent energy restriction per week a feasible weight loss approach in obese males? A randomised pilot study

Aim

The 5:2 diet (two non‐consecutive days of 2460 KJ (600 calories) and 5 days of ad libitum eating per week) is becoming increasingly popular. This pilot study aimed to determine whether the 5:2 diet can achieve ≥5% weight loss and greater improvements in weight and biochemical markers than a standard energy‐restricted diet (SERD) in obese male war veterans.

Methods

A total of 24 participants were randomised to consume either the 5:2 diet or a SERD (2050 KJ (500 calorie) reduction per day) for 6 months. Weight, waist circumference (WC), fasting blood glucose, blood lipids, blood pressure and dietary intake were measured at baseline, 3 and 6 months by a blinded investigator.

Results

After 6 months, participants in both groups significantly reduced body weight (P = <0.001), WC (P = <0.001) and systolic blood pressure (P = 0.001). Mean weight loss was 5.3 ± 3.0 kg (5.5 ± 3.2%) for the 5:2 group and 5.5 ± 4.3 kg (5.4 ± 4.2%) for the SERD group. Mean WC reduction for the 5:2 group was 8.0 ± 4.5 and 6.4 ± 5.8 cm for the SERD group. There was no significant difference in the amount of weight loss or WC reduction between diet groups. There was no significant change in diastolic blood pressure, fasting blood glucose or blood lipids in either dietary group.

Conclusions

Results suggest that the 5:2 diet is a successful but not superior weight loss approach in male war veterans when compared to a SERD. Future research is needed to determine the long‐term effectiveness of the 5:2 diet and its effectiveness in other population groups.     

Relationship of monocyte chemoattractant protein 1 (MCP-1) with insulin resistance and body mass index,but not with thermogenetic hormones in obesity

Monocyte chemoattractant protein 1 (MCP-1) has been implicated in the recruitment of monocytes to atheroma and of monocytes and macrophages to adipose tissue. The aim of the study was to examine whether MCP-1 levels are associated independently with the main thermogenetic hormones (serum TSH and thyroid hormones and 24-h urinary catecholamines) and insulin resistance in a population mainly represented by overweight and obese women. A cohort of 100 consecutive euthyroid women, aged 18–65 years, and with a wide range of BMI, was examined. Central fat accumulation (indirectly measured by waist circumference), fasting MCP-1 plasma levels, and TSH, FT₃, FT₄, insulin, glucose, and lipid (cholesterol, HDL-cholesterol and triglyceride) serum concentrations, and 24-h urinary catecholamines were measured. Insulin resistance was estimated by homeostasis model assessment (HOMA_IR). MCP-1 levels were directly associated with BMI (p < 0.001), waist circumference (p < 0.001), insulin (p < 0.001), HOMA_IR (p < 0.001), diastolic blood pressure (DBP) (p < 0.001), systolic blood pressure (SBP) (p < 0.001), triglycerides (TG) (p < 0.05), and 24-h urinary noradrenaline (p < 0.05), and negatively correlated with HDL-cholesterol (p < 0.01). When a multiple regression analysis was performed with MCP-1 as the dependent variable, and only parameters showing a significant univariate association with MCP-1 were considered as the independent variables, MCP-1 maintained an independent positive association with insulin (p < 0.01), and DBP (p < 0.05). When insulin was replaced by HOMA_IR in the regression analysis, MCP-1 maintained an independent positive association with HOMA_IR (p < 0.05), DBP (p < 0.05), and BMI (p < 0.05). In conclusion, this study suggests that insulin, BMI, and diastolic blood pressure cooperate independently in increasing MCP-1 levels, whereas thyroid hormones and catecholamines have no apparent influence on this chemokine.     

Impact of a short,culturally relevant training course on cancer knowledge and confidence in Western Australia's Aboriginal Health Professionals

Objective: To develop, deliver and evaluate a cancer education course for Indigenous Health Professionals. Method: The cancer education course combines expert presentations, interactive sessions and visits to local cancer treatment centres. Three four‐day courses have been run, in both metropolitan and regional Western Australia (WA). Cancer knowledge and confidence were measured at baseline, course completion and at follow‐up (six to eight months). Data were analysed within subject. Results: Thirty‐five Aboriginal Health Professionals have completed the program, most from rural or remote WA. All confidence items significantly improved at course completion (p<0.005), but improvements for only two items, ‘I know what cancer is’ and ‘I can describe the different common cancers’, were sustained at follow‐up (p<0.05). Knowledge of treatment (p<0.05), screening (p<0.05) and the most common cancers in women (p<0.005) were significantly greater after course completion, but increased knowledge was not sustained at follow‐up. Conclusion: Demand for places suggests that Aboriginal Health Professionals are interested in developing knowledge, skills and confidence in cancer control. Attendance increased understanding of cancer and improved cancer knowledge however this was not maintained. Implications: A short, culturally relevant training course increases cancer knowledge and confidence, however, ongoing education is needed to maintain this.     

Determinants of Physician Discussion Regarding Tobacco and Alcohol Abuse

The U.S. Preventive Services Task Force recommends that clinicians screen adults for tobacco and alcohol abuse and provide appropriate interventions. This study employed direct observation and interactional analysis of medical visits to investigate factors associated with physician discussion of tobacco and alcohol use with patients. New adult patients were randomly assigned to primary care at a university medical center. Videotapes of the visits were analyzed using the Davis observation code. Regression equations related discussions of substance use (alcohol and other substances), smoking, and health promotion to patient health status, depression, age, education, income, gender, alcohol abuse, and current smoking. Patients reporting better physical health were more likely to have their physicians employ a practice style emphasizing addiction behaviors (p = .0186). Substance use (p = .0117) and health promotion counseling (p = .0130) occurred more frequently with younger patients. Physicians discussed substance use (p = < .0001) and addiction (p < .0001) more often with male patients. Problem drinkers were more likely to have physicians address their substance use (p = .0069) and focus on addiction behaviors (p = .0017). Physicians adopted an addiction-oriented practice style (p < .0001), addressing substance use (p = .0009) and smoking (p < .0001), more often with patients who smoked. Physicians appear more apt to discuss these behavioral risk factors with healthier, younger, male patients who abuse tobacco and alcohol.     

Postpartum Depression Prevalence and Impact on Infant Health,Weight, and Sleep in Low-Income and Ethnic Minority Women and Infants

This study aimed to investigate the prevalence of maternal depressive symptoms at 5 and 9 months postpartum in a low-income and predominantly Hispanic sample, and evaluate the impact on infant weight gain, physical health, and sleep at 9 months. Participants included 132 low-income mother-infant pairs who participated in a larger investigation on prenatal care utilization. Mothers were interviewed in person 24–48 h after birth and by phone at 5 and 9 months postpartum. Clinically significant levels of depressive symptoms were reported in 33% of the women at 5 months postpartum, and 38% at 9 months postpartum. Higher depressive symptoms at 5 months were associated with less infant weight gain from 5 to 9 months, p = .002, increased infant physical health concerns, p = .05, and increased infant nighttime awakenings at 9 months, p = .001. Results suggest a striking prevalence of clinically significant depressive symptoms through 9 months postpartum in this very low income, largely ethnic minority sample. Further, the effects of postpartum depression include significant ramifications for infant physical health.