Association between juvenile onset obesity and severe adult obesity in 73, 532 women.

The association between juvenile obesity and severe adult obesity was examined using a questionnaire completed by 73,532 weight conscious women. Relative obesity as an adult was determined by the ratio Weight/Height. The question, "Were you considered a fat child?" determined childhood weight status. Analysis of the data revealed that severely obese women (regardless of age) were 2.4 times more likely than normal weight women to have been fat children. This association was noted for all parity groups. The data also suggests that the risk of a fat child developing severe obesity is substantially greater than that for a non-fat child. Since adult obesity is associated with a number of adult diseases, this study emphasizes the importance of weight control in childhood.     

Analysis of bile and gallstones in 116 patients with symptomatic cholelithiasis

Gallbladder bile and stones were obtained at 116 cholecystectomies for symptomatic gallstone disease. All 33 patients younger than 50 years had cholesterol stones, whereas 40% of the older patients had pigment stones. We compared the reliability for the differentiation between these two stone types of three different bile tests: cholesterol saturation index, examination of fresh gallbladder bile for presence of cholesterol monohydrate crystals, and nucleation time of ultrafiltered gallbladder bile. Only examination of fresh gall bladder bile for presence of cholesterol crystals was specific and reasonably sensitive for cholesterol gallstone disease regardless of bile concentration. Duodenal bile obtained from 16 patients (10 cholesterol, 6 pigment) before cholecystectomy showed cholesterol crystals in 7 of the cholesterol but in none of the pigment stone patients. This examination may be useful for patient selection for non-operative therapy in gallstone disease, which can only be considered in case of cholesterol gallstones.     

Seasonality of symptomatic bacterial urinary infections in women.

Bacterial infections of the female urinary tract (UTI) are a frequent clinical problem. A chance observation, supported by a one year survey reported from another country, suggested that UTI presented to the general practitioner more frequently in the summer. A retrospective survey, covering three consecutive years, was carried out to test this observation. The records of all women reported as attending this practice with a UTI showed that 213 culture positive episodes occurred in the third calendar quarter of each year. Edward's test for cyclic variation showed a significant peaking in August. These results indicate a definite seasonal fluctuation in the frequency with which symptomatic UTIs present to general practitioners in this practice. The clinical and epidemiological significance of this phenomenon remains to be determined.     

Dietary predictors of symptom-associated gallstones in middle-aged women

In 1980, 88,837 women aged 34-59 y completed a semiquantitative food frequency questionnaire and were followed for 4 y. Four hundred thirty-three women reported a cholecystectomy for recent cholecystitis, and 179 reported unremoved, newly symptomatic gallstones diagnosed by ultrasound or x ray. Among the 59,306 women with Quetelet's index of relative weight less than 25 kg/m2, inverse associations were observed between intakes of vegetable fat and vegetable protein and the risk of reportedly symptomatic gallastones, after adjusting for age, Quetelet's index in 1980, weight change between 1976 and 1980, energy intake, and alcohol intake. The relative risk in the highest quintile of vegetable fat intake, as compared with the lowest quintile, was 0.6 [95% confidence interval (CI), 0.4-0.9], and the corresponding relative risk for vegetable protein intake was 0.7 (95% CI, 0.6-0.9). No significant associations were found with energy-adjusted intakes of cholesterol, animal fat, animal protein, carbohydrate, or sucrose.     

Mild but not light or severe food insecurity is associated with obesity among Brazilian women

Our aim was to determine whether food insecurity was associated with a higher prevalence of obesity in a large random sample of Brazilian women of reproductive age. The data were derived from the 3rd edition of the Children's and Women's National Demographic and Health Survey conducted in 2006-07. This was a nationally representative cross-sectional study. Obesity (BMI ≥ 30 kg/m(2)) was the outcome variable. Associations were measured using crude and adjusted prevalence ratios (PR) with 95% CI through Poisson regression models taking into account the complex sampling design. The sample included 10,226 women from 18 to 45 y of age. The prevalence of any level of food insecurity measured by the Brazilian Food Insecurity Scale was 40.9%, with 25.5% light, 10.1% mild, and 5.3% severe food insecurities. The prevalence of obesity was 17.4%. We found a borderline effect of light food insecurity and increased prevalence of obesity in Brazil (PR = 1.16; 95% CI = 0.98-1.38; P = 0.08). Women with mild food insecurity had a higher risk of being obese than their food-secure counterparts (PR = 1.49; 95% CI = 1.17-1.90; P = 0.010) after adjustment for skin color/ethnicity, years of schooling, geographical region, income, age, and marital status. In conclusion, this study suggests that mild but not light or severe food insecurity was associated with obesity as assessed by BMI, even after adjusting for various confounding factors in this large cross-sectional survey performed in a middle-income country undergoing the nutrition transition.     

胆结石患者术后医院感染的危险因素分析

目的 分析200例胆结石患者临床资料,探讨胆结石患者术后医院感染的危险因素,以预防胆结石术后医院感染.方法 将2008年7月-2012年7月住院的100例胆结石术后感染患者作为研究组,另选择同期收治的100例胆结石术后未发生感染的患者作为对照组,对感染致病菌进行分析,采用Pearson单因素分析方法,对引起胆结石术后感染的单因素进行分析,采用logistic多元回归分析方法,筛选影响胆结石术后感染的危险因素.结果 200例胆结石患者发生医院感染100例,感染率为50.0％;共分离出病原菌100株,其中革兰阴性菌42株占42.0％、革兰阳性菌50株占50.0％,真菌8株占8.0％;经Pearson单因素分析,对照组与研究组在手术时间、术中出血量、切口分类、住院时间、放置引流管根数、胆汁培养及胆红素等差异有统计学意义(P＜0.05);经多元logistic回归分析,最终筛选出手术时间、切口分类、胆汁培养及胆红素为引起胆结石术后感染的危险因素.结论 手术时间、切口分类、胆汁培养及胆红素为胆结石术后感染的危险因素,应注意加强对其进行监测,从而为预防胆结石术后感染提供一定的依据.     

Risk in childhood of development of severe adult obesity: retrospective, population-based case-cohort study

Recent studies have shown a weak continuity of fatness from childhood through adulthood within the central part of the population distribution. This study presents body mass index values (weight/height2) from ages 7-13 years for the 429 severely obese young males with a body mass index of at least 31 kg/m2 among 93,800 draftees born between 1930 and 1956 inclusive who attended school and underwent draft board examination in Copenhagen. This group was compared with a random 1% sample from the same draftee population. At age seven years, the obese group already had a much higher body mass index than did the population sample, and the deviation increased as the children grew older. The risk of becoming a severely obese adult increased exponentially over the entire range of body mass index in childhood. Logistic regression analysis showed that 13-year-old overweight children who had either decreased or increased in percentile level since age seven years had a higher risk of developing severe adult obesity than did 13-year-old children who had maintained their percentile level. However, most obese children did not develop severe obesity in adulthood, and only a few had been severely obese throughout.     

Risk of overweight and obesity among semivegetarian, lactovegetarian, and vegan women

BACKGROUND: Observational studies suggest that a plant-based diet is inversely related to body mass index (BMI), overweight, and obesity. OBJECTIVE: Our objective was to examine the BMI (kg/m(2)) and risk of overweight and obesity of self-defined semivegetarian, lactovegetarian, and vegan women. DESIGN: Data analyzed in this cross-sectional study were from 55459 healthy women participating in the Swedish Mammography Cohort. Women were asked whether they considered themselves to be omnivores (n = 54257), semivegetarians (n = 960), lactovegetarians (n = 159), or vegans (n = 83), and this question was the main exposure variable in this study. In secondary analyses, we reclassified women as lactovegetarians on the basis of food intakes reported on the food-frequency questionnaire. RESULTS: The prevalence of overweight or obesity (BMI >/= 25) was 40% among omnivores, 29% among both semivegetarians and vegans, and 25% among lactovegetarians. In multivariate, adjusted logistic regression analyses, self-identified vegans had a significantly lower risk of overweight or obesity [odds ratio (OR) = 0.35; 95% CI: 0.18, 0.69] than did omnivores, as did lactovegetarians (OR = 0.54; 95% CI: 0.35, 0.85) and semivegetarians (OR = 0.52; 95% CI: 0.43, 0.62). Risk of overweight or obesity remained significantly lower among lactovegetarians classified on the basis of the food-frequency questionnaire (OR = 0.48; 95% CI: 0.30, 0.78). CONCLUSIONS: Even if vegetarians consume some animal products, our results suggest that self-identified semivegetarian, lactovegetarian, and vegan women have a lower risk of overweight and obesity than do omnivorous women. The advice to consume more plant foods and less animal products may help individuals control their weight.     

Pro-inflammatory HDL in women with obesity and nonalcoholic steatohepatitis

BackgroundIndividuals with non-alcoholic fatty liver disease (NAFLD), which includes non-alcoholic steatohepatitis (NASH), are at increased risk for cardiovascular events, independent of traditional risk factors. Limited data on pro-inflammatory high density lipoprotein (HDL) in NASH exists in the literature. We hypothesized that HDL from individuals with NASH would be more pro-inflammatory than HDL from individuals without NASH.MethodsStudy participants were individuals with obesity who had undergone bariatric surgery with wedge liver biopsy. Using HDL isolated from serum obtained from study participants at the time of surgery, HDL-elicited macrophage cytokine expression (TNF-α, IL-1β, and IL-6) from THP-1 macrophages, HDL-associated receptor expression (ABCA1 and ABCG1) from apolipoprotein E deficient (apo E^−/−) mouse peritoneal macrophages, and isolevuglandin (isoLG) modified HDL were measured.Results11 women with NASH and 15 women without NASH were included in the study. Both TNF-α (P = 0.032) and IL-1β (P = 0.029) were significantly more expressed by THP-1 macrophages exposed to HDL from women with NASH compared to women without NASH. ABCA1 and ABCG1 expression by apo E^−/− mouse peritoneal macrophages was not significantly different when exposed to HDL from either women with NASH or women without NASH. IsoLG-modified HDL isolated from the serum of women with NASH trended higher than women without NASH.ConclusionOur study suggests a more pro-inflammatory HDL in women with obesity and NASH compared to women with obesity and without NASH.     

Development of obesity in parous women

The relationship between obesity, age, and parity was studied in 35 556 Cardiff resident parturients in the years 1965-79. The effects of age and parity on obesity were both real but were considerably confounded with each other. The aging effect differed among social classes while the effect of parity depended on smoking habits.     

Body composition measurement in severe obesity

PURPOSE OF REVIEW: Severe obesity is accompanied by large increases in fat mass and alterations in the composition of fat free mass, in particular total body water and its extracellular compartment. The physical size limitations imposed by severe obesity, and variations in body composition from that of normal weight, pose tremendous challenges to the measurement of body composition. This review focuses on some of the methodological and practical issues associated with the use of common body composition methods, and identifies available published information on feasible methods for use in the severely obese. RECENT FINDINGS: There is little published research regarding what body composition methods can be used with confidence in the severely obese populations. A simple three-compartment model combining measurements of body density by air displacement plethysmography and total body water by bio-electrical impedance can provide measurements of percentage body fat in the severely obese that are comparable with a traditional, highly technical three-compartment model requiring facilities such as isotope ratio mass spectrometry along with a substantial technical expertise. SUMMARY: This review highlights some of the basic challenges faced by researchers and clinicians when conducting body composition assessments in severely obese patients. A simple three-compartment model that is accurate and easy to perform appears to be promising for use in this population. Further research is needed, however, on this and other feasible methods of body composition assessment in a diverse group of severely obese people.     

胆石症合并巨脾型晚血、重度脾亢的治疗

目的：总结胆石症合并巨脾型晚期血吸虫（晚血）、重度脾功能亢进（脾亢）患者外科手术治疗的经验与体会。方法：对10例胆石症合并巨脾型晚血、重度脾亢患者的临床资料进行回顾性分析。结果：2例急诊行胆囊切除术,1例行胆囊造瘘术,5例同期行脾切除＋贵门周围血管离断＋胆囊切除术,2例同期行脾切除＋胆囊切除术＋胆总管切开取石T管外引流术,10例患者围手术期均输注血浆或红细胞悬液,全部治愈。结论：胆石症合并巨脾型晚血、重度脾亢患者手术治疗是可行的,但要做好充分的围手术期准备,尤其是充足的血源,如何减少出血是手术的关键。     

Visceral obesity and insulin resistance are associated with plasma aldosterone levels in women.

OBJECTIVE: Both obesity and insulin resistance increase the risk of hypertension and other cardiovascular diseases, but the mechanisms linking these abnormalities are unknown. The current study was undertaken to examine the effects of obesity, fat distribution, and insulin resistance on plasma levels of aldosterone and other adrenal steroids that might contribute to sequelae of obesity. RESEARCH METHODS AND PROCEDURES: Twenty-eight normotensive premenopausal women and 27 normotensive men with a wide range of body fat underwent measurements of visceral adipose tissue by CT scan, total fat mass by dual energy X-ray absorptiometry, blood pressure, insulin sensitivity, and plasma levels of three adrenal steroid hormones. RESULTS: Plasma aldosterone in women correlated directly with visceral adipose tissue (r=0.66, p<0.001) and inversely with insulin sensitivity (r=-0.67, p<0.001), and these associations were independent of plasma renin activity. There were no corresponding correlations in men. Plasma aldosterone was significantly correlated with plasma cortisol and dehydroepiandrosterone sulfate in women. Seventeen women and 15 men completed a weight-reduction regimen, losing an average of 15.1+1.2 kg. After weight loss, plasma aldosterone was significantly lower and insulin sensitivity higher; however, the correlations of aldosterone with visceral adipose tissue and insulin sensitivity in women persisted (p = 0.09 and 0.07, respectively). Although none of the women were hypertensive, blood pressure correlated with plasma aldosterone both before and after weight loss. DISCUSSION: We conclude that visceral adiposity and insulin resistance are associated with increased plasma aldosterone and other adrenal steroids that may contribute to cardiovascular diseases in obese women.     

Racial differences in metabolic predictors of obesity among postmenopausal women.

OBJECTIVE: This study determined whether there are racial differences in resting metabolic rate (RMR), fat oxidation, and maximal oxygen consumption (VO2max) in obese [body mass index (BMI = 34+/-2 kg/m2)], postmenopausal (58+/-2 years) women. RESEARCH METHODS AND PROCEDURES: Twenty black and 20 white women were matched for fat mass and lean mass (LM), as determined by dual energy X-ray absorptiometry. RMR and fat oxidation were measured by indirect calorimetry in the early morning after a 12-hour fast using the ventilated hood technique. VO2max was measured on a treadmill during a progressive exercise test to voluntary exhaustion. RESULTS: RMR, adjusted for differences in LM, was 5% higher in white than black women (1566+/-27 and 1490+/-26 kcal/day, respectively; p<0.05); and fat oxidation rate was 17% higher in white than black women (87+/-4 and 72+/-3 g/day, respectively; p<0.01). VO2max (L/minute) was 150 mL per minute (8%) higher (p<0.05) in white than black women. VO2max correlated with LM in black (r=0.44, p=0.05) and white (r=0.53, p<0.05) women, but the intercept of the regression line was higher in white than black women (p<0.05), with no significant difference in slopes. In a multiple regression model including race, body weight, LM, and age, LM was the only independent predictor of RMR (r2 = 0.46, p<0.0001), whereas race was the only independent predictor of fat oxidation (r2 = 0.18, p<0.05). The best predictors of VO2max were LM (r2 = 0.22, p<0.05) and race (cumulative r2 = 0.30, p<0.05). DISCUSSION: These results show there are racial differences in metabolic predictors of obesity. Determination of whether these ethnic differences lead to, or are an effect of, obesity status or other lifestyle factors requires further study.     

Factors associated with abdominal obesity among childbearing-age women

OBJECTIVE: To investigate variables potentially associated with abdominal obesity among childbearing-age women. METHODS: A total of 781 women were studied based on data from the Nutrition and Health Survey conducted in 1996 in the municipality of Rio de Janeiro, Brazil. Abdominal obesity was defined as waist girth (WG) > 80 cm or waist:hips girth ratio (WHR) > 0.85. Statistical analysis involved calculation of central trend measures. Calculating the odds ratio using multivariate logistic regression tested the association between abdominal obesity and BMI, age, parity, and tobacco use. RESULTS: The highest frequencies of abdominal obesity were observed in women over 35 years of age and those with two or more children (50.7%). OR showed the effect of interaction between parity and age for WG>80 cm when only the effect of these two variables was controlled. Based on the logistic regression models, the study showed that when the population was categorized into women with and without overweight, schooling was the only factor associated with WHR, while the association with age and parity disappeared for WG>80 cm. CONCLUSIONS: Abdominal obesity in this population group is independent of age and parity when adjusted by relative weight, with overall adiposity and schooling as the greatest determinant. Having more schooling meant having a smaller WHR. It is crucial to implement strategies to prevent the development of obesity in childbearing-age women.     

Screening for obesity in reproductive-aged women

Although obesity screening and treatment are recommended by the US Preventive Services Task Force, 1 in 5 women are obese when they conceive. Women are at risk for complications of untreated obesity particularly during the reproductive years and may benefit from targeted screening. Risks of obesity and potential benefits of intervention in this population are well characterized. Rates of adverse pregnancy outcomes including gestational diabetes, preeclampsia, cesarean delivery, and stillbirth increase as maternal body mass index increases. Offspring risks include higher rates of congenital anomalies, abnormal intrauterine growth, and childhood obesity. Observational data suggest that weight loss may reduce risks of obesity-related pregnancy complications. Although obesity screening has not been studied in women of reproductive age, the effect of obesity and the potential for significant maternal and fetal benefits make screening of women during the childbearing years an essential part of the effort to reduce the impact of the obesity epidemic.     

Objectively-measured sedentary time and cardiometabolic health in adults with severe obesity

It is unknown whether sedentary behavior is independently associated with the cardiometabolic health of adults with severe obesity. Additionally, there is debate regarding how best to derive meaningful indices of sedentary time (ST) from activity monitor data. A convenience sample of adults with severe obesity (N = 927; 79% female, median age 45 y, median body mass index (BMI) 46 kg/m²) completed a research assessment at one of ten US hospitals in 2006–2009 prior to bariatric surgery. Cardiometabolic health was assessed via physical measures, fasting blood samples and medication use. Indices of ST were derived from StepWatch™ activity monitor data with minimum bout durations of 1 min, 10 min and 30 min. Cross-sectional associations were examined. Median (25th, 75th percentile) ST was 9.3 h/d (8.1, 10.5) in ≥ 1 min bouts, 6.5 h/d (5.2, 8.0) in ≥ 10 min bouts, or 3.2 h/d (2.1, 4.5) in ≥ 30 min bouts. Associations with ST were generally strongest with the ≥ 10 min bout duration. Independent of moderate-to-vigorous intensity physical activity, BMI and other potential confounders, 1 h/day ST in ≥ 10 min bouts was associated with higher odds of diabetes by 15% (95%CI: 1.05–1.26), metabolic syndrome by 12% (95%CI: 1.01–1.24) and elevated blood pressure by 14% (95%CI: 1.02–1.26), and was associated with 1.4 cm (95%CI: 0.9–1.9) larger waist circumference. Findings indicate the importance of considering ST as a distinct health risk among adults with severe obesity, and suggest a 10 min minimum duration may be preferable to 1 min or 30 min for establishing ST from activity monitor data.