Ensayo clínico aleatorio: papel de la dieta y ejercicios físicos en mujeres con síndrome metabólico

ObjectiveTo evaluate a program of nutritional recommendations and exercise in women with metabolic syndrome.DesignMulticentre randomised controlled trial.LocationPrimary Health Care, Holguin, Cuba.ParticipantsA cluster sample of 150 obese women with metabolic syndrome without glucose disturbances, were randomly assigned to a control (n = 70) or experimental (n = 80) group. A total of 62 women in the control group and 60 in the intervention group completed the study (June 2008-July 2009).InterventionsLow calorie diets and a program of exercises in the experimental group. Usual care in the control group.MeasurementsBody weight, body mass index, waist circumference, blood pressure, blood glucose and lipid profile.ResultsCompared to the control group, after one year, the experimental group had a lower, diastolic blood pressure (78 ± 0.9 vs 91 ± 1.1 mm Hg), total cholesterol (4.7 ± 0.1 vs 6.0 ±0.1 mmol/L), triglycerides (1.9 ± 0.0 vs 2.9 ± 0.1 mmol/L) and LDL cholesterol (2.5 ± 0.0 vs 3.5 ± 0.1 mmol/L), and a higher HDL-cholesterol (1.2 ± 0.0 vs 1.1 ± 0.0 mmol/L). There were no appreciable changes in weight, body mass index, waist circumference, systolic blood pressure and blood glucose.ConclusionsWe demonstrated the effectiveness of the intervention program on blood pressure and blood lipid profile.     

The association of circulating endocannabinoids with appetite regulatory substances in obese women

BackgroundsEndocannabinoids especially anadamide (AEA) and 2‑arachidonoylglycerol (2-AG) together with appetite modulators have recently been of great importance in body weight regulation and obesity incidence. The present study was carried out to investigate AEA and 2-AG levels and their association with leptin, insulin, orexin – A, and anthropometric indices in obese women.MethodsThe demographic and anthropometric data of 180 overweight/ obese women with mean age 34.2 ± 8.27 years old, and mean BMI 32.54 ± 3.73 kg/m² were evaluated. The plasma levels of anadamide and 2‑arachidonoylglycerol levels and also serum levels of leptin, insulin and orexin- A concentrations were measured. Pearson and spearmen correlation tests along with hieratical regression test were used to assess the association of endocannabinoids levels with anthropometric indices and appetite modulators.ResultsSignificant correlations were revealed between AEA and 2-AG with leptin, BMI, waist circumference (WC) and body fat percent (BF%) (P < 0.001). 2-AG levels correlated positively with mean insulin levels (P < 0.001). Neither AEA nor 2-AG correlated significantly with serum orexin - A levels. Leptin, insulin, BMI, WC, and BF% were significant independent predictors of AEA and 2-AG in the hierarchical regression model (P < .001) and explained 65% and 68% of variance in AEA and 2-AG respectively (P < 0.001).ConclusionThe findings showed that levels of AEA and 2-AG were associated with BMI, WC, BF%, and leptin and insulin levels. Also, BMI, WC, BF%, leptin and, insulin levels can have predictive value for determining AEA and 2-AG.     

Multimodal-lifestyle intervention produces reduction of the fat mass rather than body weight loss in men with obesity: A prospective cohort study

Background and the objectiveBody composition changes throughout the multimodal-lifestyle intervention of obesity is underinvestigated. This study evaluated the effectiveness of the multimodal-lifestyle intervention in reduction of fat mass together with preservation of fat free mass.MethodsAdult male subjects with overweightness or obesity (n = 99) were enrolled in a prospective cohort study for 12 months. Patients were educated about healthy diet, physical activity, and some behavioral changes. Anthropometric measurements and body composition analysis by bioelectric impedance analysis (InBody-720) were reported before, during and after the study period.ResultsConcerning adherent subjects, the mean ± standard error of the mean (SEM) of percent weight loss, percent fat mass loss, percent fat free mass and total body water changes after 6 months were 7.24 ± 0.98, 16.28 ± 2.35, 0.76 ± 0.64 and 0.82 ± 0.65, respectively, and after 1 year they were 10.14 ± 0.78, 25.22 ± 3.59, 1.22 ± 1.06 and 1.27 ± 1.07, respectively. There were significant changes between before- and after-measurements of weight, BMI, waist circumference, fat mass and percent body fat (P < 0.05) for all studied intervals.ConclusionsMultimodal-lifestyle intervention might be effective in loss of fat mass rather than reduction of the total body weight together with preservation of the lean body mass.     

Night eating behavior and metabolic heath in mothers and fathers enrolled in the QUALITY cohort study

BackgroundDesynchrony between eating and sleeping patterns and poor sleep quality have been associated with obesity and metabolic abnormalities. This study examined the metabolic health correlates of night eating syndrome in adults enrolled in the QUALITY cohort study.MethodsNight eating symptoms were assessed in 310 women (mean age = 40.3 ± 5.1 years, mean BMI = 28.8 ± 6.2 kg/m²) and 305 men (mean age = 42.5 ± 5.9 years, mean BMI = 30.3 ± 5.0 kg/m²). Anthropometric measures, fasting blood samples and blood pressure were used to diagnose metabolic syndrome (MetS) and type 2 diabetes (T2D) diagnosis was self-report. Correlational and case/control comparisons assessed night eating symptoms in persons with and without MetS and T2D.ResultsNight eating questionnaire (NEQ) scores were positively correlated with BMI. When controlling for BMI, NEQ scores were significantly negatively correlated with blood pressure in women and positively correlated with waist circumference and triglycerides in men. MetS diagnosis was associated with morning anorexia in both women and men and urges to eat at night in women only. T2D was associated with a depressed mood in women and with insomnia in men.ConclusionSymptoms of night eating syndrome are associated with higher BMI and poor metabolic health. Future research is needed to determine if night eating syndrome per se is a unique causal pathway in the development of obesity and metabolic disease.     

Urinary triclosan concentrations are inversely associated with body mass index and waist circumference in the US general population: Experience in NHANES 2003–2010

BackgroundHumans are extensively exposed to triclosan, an antibacterial and antifungal agent. Triclosan's effects on human health, however, have not been carefully investigated.ObjectiveTo examine whether triclosan exposure is associated with obesity traits.MethodsThis study included 2898 children (6–19 years old) and 5066 adults (20 years or older) who participated in the National Health and Nutrition Examination Surveys (NHANES) 2003–2010 and had a detectable level of urinary triclosan. Multiple linear regression models were used to examine the association between urinary triclosan and both body mass index (BMI) and waist circumference.ResultsEach standard deviation increase in urinary triclosan was associated with a 0.34 (95% confidence interval, CI: 0.05, 0.64) kg/m² lower level of BMI (P = 0.02) and 0.92 (95% CI: 0.09, 1.74) cm smaller waist circumference (P = 0.03) in boys, and a 0.62 (95% CI: 0.31, 0.94) kg/m² lower level of BMI (P = 0.0002) and 1.32 (95% CI: 0.54, 2.09) cm smaller waist circumference in girls (P = 0.001); a 0.42 (95% CI: 0.06, 0.77) kg/m² lower level of BMI (P = 0.02) and 1.35 (95% CI: 0.48, 2.22) cm smaller waist circumference (P = 0.003) in men, and a 0.71 (95% CI: 0.34, 1.07) kg/m² lower level of BMI (P = 0.0002) and 1.68 (95% CI: 0.86, 2.50) cm smaller waist circumference (P = 0.0001) in women. In both children and adults, there was a consistent trend for lower levels of BMI and smaller waist circumference with increasing levels of urinary triclosan, from the lowest to the highest quartile of urinary triclosan (P ≤ 0.001 in all cases).ConclusionTriclosan exposure is inversely associated with BMI and waist circumference. The biological mechanisms linking triclosan exposure to obesity await further investigation.     

Levels of physical activity and relationship with markers of diabetes and cardiovascular disease risk in 5474 white European and South Asian adults screened for type 2 diabetes

ObjectiveInvestigate levels of physical activity and their association with health in a white European (WE) and South Asian (SA) population.MethodsThis study reports data from a diabetes screening programme, 2004–2007, Leicester, UK. Physical activity was measured using the International Physical Activity Questionnaire; additional outcomes included fasting and 2-h post-challenge glucose, lipid profile, body mass index (BMI) and waist circumference.Results1164 SA (female = 48%) and 4310 WE (female = 53%) were included. SAs were more likely fall below the minimum physical activity recommendations for health compared to WEs (age-adjusted OR for SA men = 2.35; 95% CI = 1.89–2.93, age adjusted OR for SA women = 2.25; 95% CI = 1.81–2.80). There were significant associations between levels of physical activity and BMI (men and women), waist circumference (men and women), 2-h glucose (women), HDL-cholesterol (men) and triglycerides (men) in WEs and waist circumference (women) and HDL-cholesterol (men) in SAs. Significant interactions between ethnicity and physical activity existed in the relationship with BMI and waist circumference in men.ConclusionsSAs are substantially less physically active than WEs. There may also be differences between SAs and WEs in the health benefits associated with higher physical activity that warrant further investigation.     

Daily physical activity,cardiorespiratory fitness,nutritional status,endothelial function,and autonomic modulation in school-age adolescents: A principal component analysis

PurposeThis study evaluated the association between cardiorespiratory fitness, abdominal obesity, blood pressure, endothelial function, and autonomic modulation in school-age adolescents exhibiting different levels of habitual physical activity and nutritional status, through a multivariate statistical approach.Methods101 adolescents aged 15–18 years (54 females) underwent assessments of daily physical activity, body mass index, cardiorespiratory fitness, reactive hyperemia, and heart rate variability. Based on BMI adjusted for age and sex (z-BMI), 21 adolescents were classified as ‘overweight’ (9 girls), and 9 as ‘obese’ (4 girls). The common variation between those variables was assessed through Principal Component Analysis (PCA).ResultsMain axis of common variation of outcomes analyzed defined four principal components (PCs) accounting for 69.7% of overall variance, related to ‘abdominal obesity and blood pressure’ (PC1; eigenvalue = 2.76), ‘cardiorespiratory fitness, endothelial function, and autonomic modulation’ (PC2, eigenvalue = 1.98), ‘cardiorespiratory fitness’ (PC3, eigenvalue = 1.21), and ‘sedentary behavior’ (PC4, eigenvalue = 1.02). Girls reported longer screen time and sedentary behavior than boys. Notwithstanding, in both sexes poorer cardiorespiratory fitness corresponded to lower reactive hyperemia and vagal modulation, irrespective of the nutritional status. Overall, adolescents classified as ‘obese’ and ‘sedentary’ exhibited poorer CRF concomitantly to autonomic and endothelial dysfunctions.ConclusionIn school-age adolescents, endothelial and autonomic dysfunctions related to poor cardiorespiratory fitness, irrespective of the nutritional status and physical activity level. However, endothelial and autonomic dysfunctions were more prevalent among adolescents combining poor cardiorespiratory fitness, reduced levels of daily physical activity, and overweight/obesity.     

Residential proximity to urban centres,local-area walkability and change in waist circumference among Australian adults

Consistent associations have been observed between macro-level urban sprawl and overweight/obesity, but whether residential proximity to urban centres predicts adiposity change over time has not been established. Further, studies of local-area walkability and overweight/obesity have generated mixed results. This study examined 4-year change in adults' waist circumference in relation to proximity to city centre, proximity to closest suburban centre, and local-area walkability. Data were from adult participants (n = 2080) of a cohort study on chronic conditions and health risk factors in Adelaide, Australia. Baseline data were collected in 2000–03 with a follow-up in 2005–06. Multilevel regression models examined in 2015 the independent and joint associations of the three environmental measures with change in waist circumference, accounting for socio-demographic covariates. On average, waist circumference rose by 1.8 cm over approximately 4 years. Greater distance to city centre was associated with a greater increase in waist circumference. Participants living in distal areas (20 km or further from city centre) had a greater increase in waist circumference (mean increase: 2.4 cm) compared to those in proximal areas (9 km or less, mean increase: 1.2 cm). Counterintuitively, living in the vicinity of a suburban centre was associated with a greater increase in adiposity. Local-area walkability was not significantly associated with the outcome. Residential proximity to city centre appears to be protective against excessive increases in waist circumference. Controlled development and targeted interventions in the urban fringe may be needed to tackle obesity. Additional research needs to assess behaviours that mediate relationships between sprawl and obesity.     

Change in general and central adiposity measures in prediction of incident dysglycemia; Tehran Lipid and Glucose Study

ObjectivesTo examine the change in general and central adiposity measures as a predictor of incident dysglycemia during a 6-year follow-up.SubjectsA total of 4029 (2333 women and 1696 men) non-dysglycemic Iranians aged ≥ 20 years, underwent standard fasting and 2-h post-challenge plasma glucose tests at baseline and follow-up.ResultsDuring follow-up, 458 new cases of dysglycemia occurred. In multivariable models including baseline values of each anthropometric measure, odds ratios (ORs) for dysglycemia incidence corresponding to a 1-SD increase in changes of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and hip circumference (HC), were 1.32, 1.56, 1.39, 1.51 and 1.39 for men and 1.59, 1.50, 1.37, 1.47, and 1.38, for women, respectively (all P < 0.05). After controlling for weight change and WC change among men and women, respectively, HC change did not remain as a predictor. Using the paired homogeneity test, there was no superiority for changes in central obesity measures compared to changes in BMI to predict dysglycemia.ConclusionThe association between HC changes and incident dysglycemia was dependent upon changes in central and general adiposity measures, where the former did not have higher predictability than the latter in prediction of dysglycemia.     

Incidence and potential risk factors of obesity among Tehranian adults

AimEvaluating the incidence of obesity and its risk factors among Tehranian adults.Material & methodsIn this population-based cohort, non-obese participants, aged ≥ 20 years, were followed for development of obesity (Body Mass Index (BMI) ≥ 30). Incidence density and cumulative incidence rates of obesity were calculated for each sex. Cox proportional hazard regression was used to determine the association of potential obesity risk factors including: age, BMI, metabolic syndrome, waist circumference (WC), smoking, marital status, education, and physical activity.ResultA total of 7257 participants (3536 men) were followed for a median of 8 years. At baseline, mean age, BMI and WC were 41.3 ± 14.6 years, 25.1 ± 2.9 kg/m² (24.9 ± 3 kg/m² men and 25.2 ± 3 kg/m² women), and 84.8 ± 9.8 cm (87.06 ± 9.2 cm men and 82.6 ± 9.9 cm women) respectively. During the follow-up, 1345 participants (876 women) developed obesity contributing to cumulative incidences of 31.3% (CI: 29.9%–32.7%), 38.1% (CI: 36.2%–40.1%), and 23.4% (CI: 21.6%–25.3%) for the whole population, women, and men, respectively. Corresponding incidence density rates per 1000 person-year were 25.9 (CI: 24.5–27.3), 33.67 (CI: 31.5–36.0), and 18.0 (CI: 16.5–19.7), respectively. Highest incidence rates were observed during their 40s and 20s for women and men, respectively. Participants with metabolic syndrome, lower educational level, higher BMI and WC, were at higher risk of obesity development in both sexes.ConclusionHigh incidence of obesity was observed among Tehranian adults with higher incidence of obesity in women. Different modifiable variables may act as risk factors for obesity development which should be targeted to control the epidemic of obesity.     

Change in general and central adiposity measures in prediction of incident dysglycemia; Tehran Lipid and Glucose Study

ObjectivesTo examine the change in general and central adiposity measures as a predictor of incident dysglycemia during a 6-year follow-up.SubjectsA total of 4029 (2333 women and 1696 men) non-dysglycemic Iranians aged ≥ 20 years, underwent standard fasting and 2-h post-challenge plasma glucose tests at baseline and follow-up.ResultsDuring follow-up, 458 new cases of dysglycemia occurred. In multivariable models including baseline values of each anthropometric measure, odds ratios (ORs) for dysglycemia incidence corresponding to a 1-SD increase in changes of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and hip circumference (HC), were 1.32, 1.56, 1.39, 1.51 and 1.39 for men and 1.59, 1.50, 1.37, 1.47, and 1.38, for women, respectively (all P < 0.05). After controlling for weight change and WC change among men and women, respectively, HC change did not remain as a predictor. Using the paired homogeneity test, there was no superiority for changes in central obesity measures compared to changes in BMI to predict dysglycemia.ConclusionThe association between HC changes and incident dysglycemia was dependent upon changes in central and general adiposity measures, where the former did not have higher predictability than the latter in prediction of dysglycemia.     

Vitamin D,cardio-inflammation,and endothelial dysfunction in older adults after orthopedic surgery: Results from an open-label trial to ameliorate cardiac function

ObjectivesAfter orthopedic surgery, clinical outcomes are affected by comorbid cardiovascular diseases (CVDs) and low 25-hydroxy-vitamin D (25-(OH)D). Myocardial function was suggested to be influenced by both the pro-inflammatory cytokine tumour necrosis factor alpha (TNFα) and the marker of endothelial dysfunction asymmetric dimethylarginine (ADMA).Material and methodsWe investigated TNFα and ADMA changes in association with serum levels of vitamin D and cardiac function in 47 older adults after major orthopedic surgery. Subjects were characterized for biochemical profiles and transthoracic echocardiographic measures. Assessments were done before and after the correction of hypovitaminosis D through a 6-month supplementation with calcifediol started at post-operative rehabilitation.ResultsThe means serum levels of both TNFα and ADMA reduced from 1.39 ± 0.47 pg/mL to 1.30 ± 0.37 pg/mL (P < 0.05) and from 0.69 ± 0.05 μmol/L to 0.68 ± 0.04 μmol/L (P < 0.05), respectively. Significant treatment effects were observed for systolic blood pressure (P < 0.05), left ventricular ejection function (P < 0.01), global longitudinal strain (P < 0.0001), 25-(OH)D (P < 0.001), and calcemia (P < 0.001).ConclusionAfter the normalization of low levels of vitamin D, we were able to observe a reduction of circulating TNFα and ADMA together with the amelioration of cardiac function. Even if our results suggest that vitamin D might exert cardiac effects indirectly through the decrease in cardio-inflammation and endothelial dysfunction, a better understanding of the precise molecular regulations should be better investigated.     

Preventing obesity among Brazilian adolescent girls: Six-month outcomes of the Healthy Habits,Healthy Girls–Brazil school-based randomized controlled trial

BackgroundSchool-based trials to prevent and reduce prevalence of pediatric obesity in low-income countries are necessary. In Brazil, addressing adolescent obesity is a public health priority.ObjectiveTo evaluate the impact of a group randomized controlled trial involving a 6-month multicomponent school-based obesity prevention program targeting adolescent girls.MethodsThe Healthy Habits, Healthy Girls–Brazil program recruited participants (n = 253; 16.05 ± 0.05 years) from ten eligible public technical schools in São Paulo, Brazil. The program was adapted from an Australian intervention study, which is based on the Social Cognitive Theory. The primary outcome measure was body mass index (BMI), and secondary outcomes included BMI z score, waist circumference, and various sedentary and dietary health-related behaviours.ResultsAlthough changes in BMI were not statistically significant, differences favored the intervention group (adjusted mean difference, − 0.26 kg/m²,se SE = 0.018, p = 0.076). Statistically significant intervention effects were found for waist circumference (− 2.28 cm; p =, p = 0.01), computer screen time on the weekends (0.63 h/day, p; p = 0.02), total sedentary activities on the weekends (− 0.92 h/day, p < 0.01), and vegetable intake (1.16 servings/day, p = 0.01).ConclusionThese findings provide some evidence for the benefit of a school-based intervention to prevent unhealthy weight gain in adolescent girls living in low-income communities.     

Effect of pistachio diet on lipid parameters,endothelial function,inflammation, and oxidative status: A prospective study

ObjectiveRecent studies have suggested that nuts have favorable effects beyond lipid lowering. We aimed to investigate effect of the Antep pistachio (Pistacia vera L.) on blood glucose, lipid parameters, endothelial function, inflammation, and oxidation in healthy young men living in a controlled environment.MethodsA Mediterranean diet was administered to normolipidemic 32 healthy young men (mean age 22 y, range 21–24) for 4 wk. After 4 wk, participants continued to receive the Mediterranean diet but pistachio was added for 4 wk by replacing the monounsaturated fat content constituting ≈20% of daily caloric intake. Fasting blood samples and brachial endothelial function measurements were performed at baseline and after each diet.ResultsCompared with the Mediterranean diet, the pistachio diet decreased glucose (P < 0.001, ?8.8 ± 8.5%), low-density lipoprotein (P < 0.001, ?23.2 ± 11.9%), total cholesterol (P < 0.001, ?21.2 ± 9.9%), and triacylglycerol (P = 0.008, ?13.8 ± 33.8%) significantly and high-density lipoprotein (P = 0.069, ?3.1 ± 11.7%) non-significantly. Total cholesterol/high-density lipoprotein and low-density lipoprotein/high-density lipoprotein ratios decreased significantly (P < 0.001 for both). The pistachio diet significantly improved endothelium-dependent vasodilation (P = 0.002, 30% relative increase), decreased serum interleukin-6, total oxidant status, lipid hydroperoxide, and malondialdehyde and increased superoxide dismutase (P < 0.001 for all), whereas there was no significant change in C-reactive protein and tumor necrosis factor-α levels.ConclusionIn this trial, we demonstrated that a pistachio diet improved blood glucose level, endothelial function, and some indices of inflammation and oxidative status in healthy young men. These findings are in accordance with the idea that nuts, in particular pistachio nuts, have favorable effects beyond lipid lowering that deserve to be evaluated with prospective follow-up studies.     

Dietary ω-3 fatty acid and ω-3: ω-6 fatty acid ratio predict improvement in glucose disturbances in Japanese Brazilians

ObjectiveWe investigated whether lifestyle-induced changes in dietary fat quality are related to improvements on glucose metabolism disturbances in Japanese Brazilians at high risk of type 2 diabetes.MethodsOne hundred forty-eight first- and second-generation subjects with impaired glucose tolerance or impaired fasting glycemia who attended a lifestyle intervention program for 12 mo were studied in the city of Bauru, State of São Paulo, Brazil. Dietary fatty acid intakes at baseline and after 12 mo were estimated using three 24-h recalls. The effect of dietary fat intake on glucose metabolism was investigated by multiple logistic regression models.ResultsAt baseline, mean ± standard deviation age and body mass index were 60 ± 11 y and 25.5 ± 4.2 kg/m², respectively. After 12 mo, 92 subjects had normal plasma glucose levels and 56 remained in prediabetic conditions. Using logistic regression models adjusted for age, gender, generation, basal intake of explanatory nutrient, energy intake, physical activity, and waist circumference, the odds ratios (95% confidence intervals) for reversion to normoglycemia were 3.14 (1.22–8.10) in the second tertile of total ω-3 fatty acid, 4.26 (1.34–13.57) in the second tertile of eicosapentaenoic acid, and 2.80 (1.10–7.10) in the second tertile of linolenic acid. Similarly, subjects in the highest tertile of ω-3:ω-6 fatty acid ratio showed a higher chance of improving glucose disturbances (2.51, 1.01–6.37).ConclusionsOur findings support the evidence of an independent protective effect of ω-3 fatty acid and of a higher ω-3:ω-6 fatty acid ratio on the glucose metabolism of high-risk individuals.     

Adverse associations of car time with markers of cardio-metabolic risk

ObjectiveTo examine associations of time spent sitting in cars with markers of cardio-metabolic risk in Australian adults.MethodData were from 2800 participants (age range: 34–65) in the 2011–12 Australian Diabetes, Obesity and Lifestyle Study. Self-reported time spent in cars was categorized into four groups: ≤ 15 min/day; > 15 to ≤ 30 min/day; > 30 to ≤ 60 min/day; and > 60 min/day. Markers of cardio-metabolic risk were body mass index (BMI), waist circumference, systolic and diastolic blood pressure, triglycerides, HDL (high-density lipoprotein)-cholesterol, fasting plasma glucose, 2-h plasma glucose, a clustered cardio-metabolic risk score, and having the metabolic syndrome or not. Multilevel linear and logistic regression analyses examined associations of car time with each cardio-metabolic risk outcome, adjusting for socio-demographic and behavioral variables and medication use for blood pressure and cholesterol/triglycerides.ResultsCompared to spending 15 min/day or less in cars, spending more than 1 h/day in cars was significantly associated with higher BMI, waist circumference, fasting plasma glucose, and clustered cardio-metabolic risk, after adjusting for socio-demographic attributes and potentially relevant behaviors including leisure-time physical activity and dietary intake. Gender interactions showed car time to be associated with higher BMI in men only.ConclusionsProlonged time spent sitting in cars, in particular over 1 h/day, was associated with higher total and central adiposity and a more-adverse cardio-metabolic risk profile. Further studies, ideally using objective measures of sitting time in cars and prospective designs, are needed to confirm the impact of car use on cardio-metabolic disease risk.     

Feasibility and effects of a group-based resistance and aerobic exercise program for individuals with severe schizophrenia: A multidisciplinary approach

PurposePeople with schizophrenia/schizoaffective disorders have a higher risk of morbidity and premature mortality compared to the general population in part due to sedentary lifestyles. The aim of this pilot study was to investigate the feasibility and effects of aerobic (AT) and resistance training (RT) on individuals with schizophrenia/schizoaffective disorders.MethodsEight males and five females (mean age 44.6 ± 3 years) were randomized to either twice weekly exercise (n = 7) or usual care (control) (n = 6). Functional exercise capacity (six minute walk distance (6MWD)), muscular strength, anthropometric measures, and domains of mental health were measured at baseline and after 12 weeks. Data are presented as means ± SEM.ResultsThe exercise group demonstrated a 27.7 ± 22.3 m increase in 6MWD while the control group showed a decrease of 28.3 ± 26.6 m (between-group difference, p = 0.1). There was a significant strength increase for exercise (28.3 ± 8.8%, p = 0.01) but not for control (12.5 ± 8.5%, p = 0.2). The exercise group had a significant improvement in total Mental Health Inventory (MHI) score (p < 0.03) with no change for control. Gain in 6MWD was directly associated with improvement in total MHI score (r = 0.8, p = 0.009) as was reduction in depressive symptoms (r = ?0.9, p < 0.001) among all participants. Attendance at exercise sessions averaged 72 ± 4.4% with no dropouts. Reduction in depressive symptoms correlated with greater adherence to exercise (r = ?0.93, p = 0.02).ConclusionsA 12-week community-based AT and RT program results in significant improvements in overall mental health, muscular strength and a trend for improvement in functional exercise capacity. Among all participants, improvement in functional exercise capacity was associated with improvement in overall mental health as well as a reduction in depressive symptoms. Reduction in depressive symptoms was associated with greater adherence to exercise. A group exercise program for individuals with schizophrenia/schizoaffective disorder is feasible when implemented by a multidisciplinary team.     

Comparison of a Patient-Centered Weight Loss Program starting before versus after knee replacement: A pilot study

BackgroundMost patients risk gaining weight in the years after knee replacement, adding further concern to a population that is mostly overweight/obese prior to surgery.ObjectiveVia a randomised pilot study, we assessed changes in weight during a Patient Centered Weight Loss Program (PACE) initiated either before or after knee replacement, while simultaneously examining the feasibility of recruiting and retaining participants over 26 weeks.MethodsRecruitment outreach was made to 133 patients scheduled for knee replacement. Sixteen participants were randomised to a 14-session weight loss program that started either ≤6 weeks before surgery (PACE) or at 12 weeks post-op (Delayed PACE). Repeated measures ANOVAs were used to examine preliminary changes in weight, function, patient-reported outcomes, and physical activity across time (baseline/pre-op, 12 and 26 weeks after surgery) and group.ResultsRetention was 75% and 69% at 12 and 26 weeks after surgery, respectively. Weight significantly decreased across the 26 weeks (P < 0.001). A group by time interaction (P = 0.03) demonstrated Delayed PACE [−7.6 ± 5.9 kg (−7.9 ± 5.9%)] lost significantly more weight than PACE [−2.5 ± 2.7 kg (−2.6 ± 2.6%)] participants at 26 weeks. Significant improvements across time were seen for all function and patient reported outcomes, however activity did not change.ConclusionConducting a behavioural intervention was challenging but feasible in a knee replacement population, with preliminary evidence suggesting that initiating a program 12 weeks after surgery produces greater weight losses at 26 weeks compared to a program starting before knee replacement.     

Acute EGCG Supplementation Reverses Endothelial Dysfunction in Patients with Coronary Artery Disease

Background: Epidemiological studies demonstrate an inverse relation between dietary flavonoid intake and cardiovascular risk. Recent studies with flavonoid-containing beverages suggest that the benefits of these nutrients may relate, in part, to improved endothelial function.

Objective: We hypothesized that dietary supplementation with epigallocatechin gallate (EGCG), a major catechin in tea, would improve endothelial function in humans.

Design: We examined the effects of EGCG on endothelial function in a double blind, placebo-controlled, crossover design study. We measured brachial artery flow-mediated dilation by vascular ultrasound at six time points: prior to treatment with EGCG or placebo, two hours after an initial dose of EGCG (300 mg) or placebo, and after two weeks of treatment with EGCG (150 mg twice daily) or placebo. The order of treatments (EGCG or placebo) was randomized and there was a one-week washout period between treatments.

Results: A total of 42 subjects completed the study, and brachial artery flow-mediated dilation improved from 7.1 ± 4.1 to 8.6 ± 4.7% two hours after the first dose of 300 mg of EGCG (P = 0.01), but was similar to baseline (7.8 ± 4.2%, P = 0.12) after two weeks of treatment with the final measurements made approximately 14 hours after the last dose. Placebo treatment had no significant effect, and there were no changes in reactive hyperemia or the response to sublingual nitroglycerin. The changes in vascular function paralleled plasma EGCG concentrations, which increased from 2.6 ± 10.9 to 92.8 ± 78.7 ng/ml after acute EGCG (P < 0.001), but were unchanged from baseline after two weeks of treatment (3.4 ± 13.1 ng/ml).

Conclusion: EGCG acutely improves endothelial function in humans with coronary artery disease, and may account for a portion of the beneficial effects of flavonoid-rich food on endothelial function.