Changes in body weight,blood pressure and selected metabolic biomarkers with an energy-restricted diet including twice daily sweet snacks and once daily sugar-free beverage

BACKGROUND/OBJECTIVES

The type of sweet snack incorporated into an energy-restricted diet (ERD) may produce differential effects on metabolic improvements associated with body weight (BW) loss. This study compared effects of incorporating either twice daily energy-controlled dark chocolate snacks plus once daily sugar-free cocoa beverage (DC) to non-chocolate snacks plus sugar-free non-cocoa beverage (NC) into an ERD on BW loss and metabolic outcomes.

MATERIALS/METHODS

In an 18-week randomized comparative trial, 60 overweight/obese premenopausal women were assigned to DC (n = 30) or NC group (n = 30). Dietary intake was measured at baseline and week 18, and BW, anthropometrics, blood pressure (BP) and serum glucose, insulin and lipid concentrations were measured at baseline, and weeks 6, 12 and 18. Data were analyzed using repeated measures ANOVA.

RESULTS

Using intention-to-treat analysis, women in DC and NC groups reduced energy intake (both P < 0.001) and lost 4.4 ± 0.6 kg and 5.0 ± 0.9 kg (both P < 0.001), respectively. Both groups lowered systolic and diastolic BP [DC = 2.7 (P < 0.05), 2.7 (P < 0.01); NC = 3.4 (P < 0.01), 4.2 (P < 0.01) mmHg, respectively]. Glucose and insulin concentrations decreased by 0.72 mmol/L (P < 0.001) and 13.20 pmol/L (P < 0.01) in DC group and by 0.83 mmol/L (P < 0.001) and 13.20 pmol/L (P < 0.01), respectively, in NC group. Total cholesterol increased in NC group (P < 0.05), with no significant lipid changes in DC group. There were no significant differences in biomarker outcomes between groups.

CONCLUSIONS

Overweight/obese premenopausal women following an 18-week ERD that included either DC or NC sweet snack and sugar-free beverage lost equivalent amounts of BW and improved BP measurements and glucose and insulin concentrations.     

Dynapenic Obesity and Prevalence of Type 2 Diabetes in Middle-Aged Japanese Men

Background

The independent and combined associations of muscle strength and obesity on the prevalence of type 2 diabetes in Japanese men remain unclear.

Methods

Hand grip strength was cross-sectionally evaluated between 2011 and 2013 to assess muscle strength in 5039 male workers aged 40 to 64 years. Weight and height were measured, and overweight/obesity was defined as a body mass index ≥25 kg/m². The prevalence of type 2 diabetes, defined as fasting plasma glucose ≥126 mg/dL and/or hemoglobin A1c ≥6.5% and/or self-reported physician-diagnosed diabetes, was evaluated. Odds ratios (OR) and 95% confidence intervals (95% CI) for the prevalence of type 2 diabetes were obtained using a logistic regression model.

Results

In total, 611 participants had type 2 diabetes, and 1763 participants were overweight/obese. After adjustment for covariates, we found an inverse association between muscle strength and the prevalence of type 2 diabetes (P for trend <0.01). In addition, when the analyses were stratified by obesity status, the multivariable-adjusted OR per 2-standard-deviation increase in muscle strength was 0.64 (95% CI, 0.49–0.83) in the overweight/obese group, compared to a weaker relationship in the normal-weight group (OR 0.79 per 2-standard-deviation increase; 95% CI, 0.60–1.06).

Conclusions

Dynapenia, an age-related decrease in muscle strength, is associated with increased prevalence of type 2 diabetes, and this relationship is stronger in overweight/obese middle-aged Japanese men than in normal-weight men.Key words: muscle strength, hand strength, body mass index, hyperglycemia, dynapenia     

Association Between Serum Uric Acid Level and Metabolic Syndrome

Objectives

Serum uric acid levels have been reported to be associated with a variety of cardiovascular conditions. However, the direct association between uric acid levels and metabolic syndrome remains controversial. Thus, we evaluated the association of serum uric acid levels and metabolic syndrome in a community-based cohort study in Korea.

Methods

We performed cross-sectional analysis of baseline data of 889 males and 1491 females (aged 38 to 87) who participated in baseline examinations of the Korean Genome and Epidemiology Study: Kanghwa study. Blood samples were collected after at least an 8 hour fast. Uric acid quartiles were defined as follows: <4.8, 4.8-<5.6, 5.6-<6.5, ≥6.5 mg/dL in males; and <3.8, 3.8-<4.3, 4.3-<5.1, ≥5.1 mg/dL in females. Metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III Criteria with adjusted waist circumference cutoffs (90 cm for males; 80 cm for females). The association between serum uric acid quartiles and metabolic syndrome was assessed using multivariate logistic regression.

Results

The odds ratio for having metabolic syndrome in the highest versus lowest quartiles of serum uric acid levels was 2.67 (95% confidence interval [CI], 1.60 to 4.46) in males and 2.14 (95% CI, 1.50 to 3.05) in females after adjusting for age, smoking, alcohol intake, body mass index, total cholesterol, HbA1c, albumin, γ-glutamyltransferase, blood urea nitrogen, and log C-reactive protein. The number of metabolic abnormalities also increased gradually with increasing serum uric acid levels (adjusted p for trend < 0.001 in both sexes).

Conclusions

Higher serum uric acid levels are positively associated with the presence of metabolic syndrome in Korean males and females.     

Cholesterol-induced inflammation and macrophage accumulation in adipose tissue is reduced by a low carbohydrate diet in guinea pigs

BACKGROUND/OBJECTIVES

The main objective of this study was to evaluate the effects of a high cholesterol (HC) dietary challenge on cholesterol tissue accumulation, inflammation, adipocyte differentiation, and macrophage infiltration in guinea pigs. A second objective was to assess whether macronutrient manipulation would reverse these metabolic alterations.

MATERIALS/METHODS

Male Hartley guinea pigs (10/group) were assigned to either low cholesterol (LC) (0.04g/100g) or high cholesterol (HC) (0.25g/100g) diets for six weeks. For the second experiment, 20 guinea pigs were fed the HC diet for six weeks and then assigned to either a low carbohydrate (CHO) diet (L-CHO) (10% energy from CHO) or a high CHO diet (H-CHO) (54% CHO) for an additional six weeks.

RESULTS

Higher concentrations of total (P < 0.005) and free (P < 0.05) cholesterol were observed in both adipose tissue and aortas of guinea pigs fed the HC compared to those in the LC group. In addition, higher concentrations of pro-inflammatory cytokines in the adipose tissue (P < 0.005) and lower concentrations of anti-inflammatory interleukin (IL)-10 were observed in the HC group (P < 0.05) compared to the LC group. Of particular interest, adipocytes in the HC group were smaller in size (P < 0.05) and showed increased macrophage infiltration compared to the LC group. When compared to the H-CHO group, lower concentrations of cholesterol in both adipose and aortas as well as lower concentrations of inflammatory cytokines in adipose tissue were observed in the L-CHO group (P < 0.05). In addition, guinea pigs fed the L-CHO exhibited larger adipose cells and lower macrophage infiltration compared to the H-CHO group.

CONCLUSIONS

The results of this study strongly suggest that HC induces metabolic dysregulation associated with inflammation in adipose tissue and that L-CHO is more effective than H-CHO in attenuating these detrimental effects.     

Lifestyle and Overweight Among Japanese Adolescents: The Toyama Birth Cohort Study

Objective

To investigate the effects of lifestyle factors on overweight among Japanese adolescents.

Methods

We studied 5753 junior high school students (2842 boys and 2911 girls) aged 12 to 13 years. The students were residents of Toyama prefecture, Japan and completed a questionnaire about their height, weight, and lifestyle factors, in June and July 2002. Subjects with a body-mass index (BMI) higher than age- and sex-specific cut-off points were defined as obese. Parental overweight was defined as a BMI of 25 or higher. Logistic regression analysis was used to examine associations between lifestyle factors and overweight.

Results

Skipping breakfast, eating quickly, excessive eating, physical inactivity, and long hours of TV watching were positively and significantly associated with overweight in both sexes. There was a negative association between snacking and overweight in girls (P < 0.001); no such association was found in boys (P > 0.05). Nighttime snacking was negatively associated with overweight in boys and girls (P < 0.05). Extended video game playing (≥2 hours; OR = 2.00, P = 0.012) and short sleep duration (<7 hours; OR = 1.81, P = 0.004) were significantly associated with overweight in girls only. The respective risks of overweight that derived from the subjects’ fathers and mothers were 2.0 and 2.5 times, respectively, in boys and 1.9 and 3.0 times in girls.

Conclusions

Parental overweight, skipping breakfast, eating quickly, excessive eating, long hours of TV watching, long hours of video game playing, physical inactivity, and short sleep duration were associated with adolescent overweight. Furthermore, there were significant negative associations between adolescent overweight and snacking in girls and nighttime snacking in both sexes.Key words: overweight, lifestyle factors, adolescents, Japan, Toyama birth cohort study     

Relationship Between Decayed Teeth and Metabolic Syndrome: Data From 4716 Middle-Aged Male Japanese Employees

Background

Epidemiological findings regarding the relationship between decayed teeth (DT) and metabolic syndrome (MetS) are scarce. We evaluated the relationship of DT with MetS, obesity, and MetS components in early middle-aged male Japanese employees.

Methods

We cross-sectionally analyzed dental and medical health checkup results from a total of 4716 participants aged 42 or 46 years. Logistic regression models were employed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for age, breakfast consumption frequency, drinking habits, smoking status, and physical activity.

Results

Significant differences in the prevalence of MetS, obesity determined by body mass index, and the components of MetS between participating men with and without DT were detected (all P < 0.01). The adjusted OR of MetS was 1.41 (95% CI, 1.14–1.74) for those with 1 or 2 DT, and 1.66 (95% CI, 1.28–2.16) for those with ≥3 DT (P for trend = 0.01), and this significant relationship was observed even in those without periodontal pocket formation (P for trend = 0.03) or missing teeth (P for trend = 0.02). DT was significantly related to overweight/obesity and the MetS components of hypertension, dyslipidemia, and hyperglycemia, with adjusted ORs of 1.35 (95% CI, 1.19–1.53), 1.22 (95% CI, 1.07–1.39), 1.18 (95% CI, 1.03–1.34), and 1.33 (95% CI, 1.13–1.56), respectively. In addition, even in non-overweight/non-obese men, DT was found to be related to dyslipidemia and hyperglycemia, though with marginal significance (P < 0.05).

Conclusions

Our findings suggest that having DT is related to MetS in early middle-aged Japanese men directly and through obesity and is independent of health behaviors, periodontal condition, and tooth loss.Key words: dental caries, dyslipidemia, hyperglycemia, hypertension, obesity     

Nutrition knowledge,outcome expectations,self-efficacy,and eating behaviors by calcium intake level in Korean female college students

BACKGROUND/OBJECTIVES

Calcium is important but deficient in diets of young adult women. This study aimed to examine if cognitive factors and eating behaviors differ according to calcium intake based on the Social Cognitive Theory.

SUBJECTS/METHODS

Subjects were female college students in Seoul, Korea. Three hundred students completed the questionnaire regarding calcium intake, nutrition knowledge, outcome expectations, self-efficacy and eating behaviors. Data on 240 students were analyzed using t-test or χ²-test. Subjects were categorized into two groups, high calcium intake (HC, ≥ 650 mg/day) and low calcium intake (LC, < 650 mg/day), according to recommended intakes of calcium for women aged 19-29 years.

RESULTS

The LC group constituted 77.9% of total subjects. Nutrition knowledge was not different according to calcium intake. Three out of 12 outcome expectations items were significantly different between the HC and LC groups. Subjects in the HC group agreed more strongly with the practical benefits of consuming calcium-rich foods, including ''taste'' (P < 0.01) and ''going well with other snacks'' (P < 0.05), compared to those in the LC group. Negative expectations of ''indigestion'' were stronger in the LC group than HC group (P < 0.001). Among self-efficacy items, perceived ability of ''eating dairy foods for snacks'' (P < 0.001), ''eating dairy foods every day'' (P < 0.01), and ''eating calcium-rich side dishes at meals'' (P < 0.05) differed significantly between the HC and LC groups. Eating behaviors including more frequent consumption of dairy foods, fruits or fruit juice (P < 0.001), anchovy, seaweeds, green vegetables, protein-rich foods (P < 0.05), and less frequent consumption of sweets or soft drinks (P < 0.01) were significantly related to calcium intake.

CONCLUSIONS

This study found that outcome expectations, self-efficacy in consuming calcium-rich foods, and eating behaviors are important in explaining calcium intake. Nutrition education needs to address practical benefits, reduce negative expectations of calcium-rich foods, increase self-efficacy, and modify eating behaviors contributing to calcium intake.     

Improvement in metabolic parameters in obese subjects after 16 weeks on a Brazilian-staple calorie-restricted diet

BACKGROUND/OBJECTIVES

The standard pattern of Brazilian food consumption is based on the combination of rice and beans served together in the main meals. This study assessed the effects of Brazilian-staple calorie-restricted (BS-diet) dietary advice, with brown rice and beans, on metabolic parameters, body composition, and food intake in overweight/obese subjects.

SUBJECTS/METHODS

Twentyseven subjects were randomly assigned to a conventional-type calorie-restricted diet (CT-diet) (n = 13) or a BS-diet (n = 14). Glucose metabolism, lipid profile, anthropometric and body composition parameters, and food intake were measured before and after 16 weeks. Paired t-tests/Wilcoxon tests were used for comparison of differences from baseline and unpaired t-tests/Mann-Whitney tests were used for comparison of differences between the groups.

RESULTS

After 16 weeks, both groups showed reductions in weight and waist circumference (P < 0.02), and the BS-diet group showed a decrease in body fat (P = 0.0001), and significant improvement in glucose metabolism (fasting plasma glucose, glucose and insulin areas under the curve, Cederholm index, and HOMA2-%β) (P ≤ 0.04) and lipid profile (cholesterol, triacylglycerol, LDL-c, VLDL-c, and cholesterol/HDL-c ratio) (P ≤ 0.05). In addition, the BS-diet group showed significant improvement in HOMA2-%β, compared to the CT-diet group (P = 0.03). The BS-diet group also showed a significant reduction in energy, lipids, carbohydrate, and cholesterol intake (P ≤ 0.04) and an increase in fiber intake (P ≤ 0.001), while the CT-diet group showed a significant reduction in intake of energy, macronutrients, PUFA, and cholesterol (P ≤ 0.002).

CONCLUSIONS

These results demonstrate the benefits of the BS-diet on metabolic parameters in obese subjects.     

Associations Between Polymorphisms in the Glucocorticoid-Receptor Gene and Cardiovascular Risk Factors in a Chinese Population

Background

Glucocorticoid is an important regulator of energy homeostasis. Glucocorticoid receptor (GR) gene polymorphisms that contribute to variability in glucocorticoid sensitivity have been identified. We explored the associations of single-nucleotide polymorphisms (SNPs) of the GR gene with traditional cardiovascular risk factors in the Chinese Han population.

Methods

We recruited 762 consecutive adults who underwent a regular physical examination at Beijing Xuanwu Hospital. Blood pressure, glucose, lipid levels (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein [LDL] cholesterol and triglycerides), body mass index (BMI), and waist-to-hip ratio were measured. Fourteen tag SNPs and 5 functional SNPs were selected and genotyped using the high-throughput Sequenom genotyping platform. Differences between genotypes/alleles for each SNP were adjusted for sex and age and tested using a general linear model procedure. Various models of inheritance, including additive, dominant, and recessive, were tested.

Results

Among the 19 SNPs examined, 5 markers were associated with cardiovascular risk factors. The rs41423247 GG genotype and the rs7701443 AA genotype were associated with higher BMI and systolic blood pressure (P < 0.0004), and the rs17209251 GG genotype was associated with higher systolic blood pressure (P < 0.0004). Lower systolic blood pressure, total cholesterol, and LDL cholesterol were observed among rs10052957 A allele carriers (P < 0.0004), and lower plasma glucose and LDL-cholesterol concentrations were observed among rs2963156 TT carriers (P < 0.0004).

Conclusions

Polymorphism of the GR gene was associated with cardiovascular risk factors and may contribute to susceptibility to cardiovascular disease.Key words: glucocorticoid receptor gene, polymorphism, cardiovascular disease, risk factor     

Comparison of sodium content of workplace and homemade meals through chemical analysis and salinity measurements

BACKGROUND/OBJECTIVES

Most Koreans consume nearly 70-80% of the total sodium through their dishes. The use of a salinometer to measure salinity is recommended to help individuals control their sodium intake. The purpose of this study was to compare sodium content through chemical analysis and salinity measurement in foods served by industry foodservice operations and homemade meals.

MATERIALS/METHODS

Workplace and homemade meals consumed by employees in 15 cafeterias located in 8 districts in Daegu were collected and the sodium content was measured through chemical analysis and salinity measurements and then compared. The foods were categorized into 9 types of menus with 103 workplace meals and 337 homemade meals.

RESULTS

Workplace meals did not differ significantly in terms of sodium content per 100 g of food but had higher sodium content via chemical analysis in roasted foods per portion. Homemade meals had higher broth salt content and higher salt content by chemical analysis per 100 g of roasted foods and hard-boiled foods. One-dish workplace meals had higher salinity (P < 0.05), while homemade broths and stews had higher sodium content (P < 0.05 and P < 0.01, respectively). The sodium content per 100 g of foods was higher in one-dish workplace meals (P < 0.05) and in homemade broths and stews (P < 0.01 and P < 0.05, respectively).

CONCLUSIONS

The use of a salinometer may be recommended to estimate the sodium content in foods and control one''s sodium intake within the daily intake target as a way to promote cooking bland foods at home. However, estimated and actual measured values may differ.     

Oral Supplement Containing Hydroxytyrosol and Punicalagin Improves Dyslipidemia in an Adult Population without Co-Adjuvant Treatment: A Randomized,Double-Blind,Controlled and Crossover Trial

Hydroxytyrosol (HT) and punicalagin (PC) exert cardioprotective and antiatherosclerotic effects. This study evaluated the effect of an oral supplement containing HT and PC (SAx) on dyslipidemia in an adult population. A randomized, double-blind, controlled, crossover trial was conducted over a 20-week period. SAx significantly reduced the plasma levels of triglycerides (TG) in subjects with hypertriglyceridemia (≥150 mg/dL) (from 200.67 ± 51.38 to 155.33 ± 42.44 mg/dL; p < 0.05), while no such effects were observed in these subjects after the placebo. SAx also significantly decreased the plasma levels of low-density lipoprotein cholesterol (LDL-C) in subjects with high plasma levels of LDL-C (≥160 mg/dL) (from 179.13 ± 16.18 to 162.93 ± 27.05 mg/dL; p < 0.01), while no such positive effect was observed with the placebo. In addition, the placebo significantly reduced the plasma levels of high-density lipoprotein cholesterol (HDL-C) in the total population (from 64.49 ± 12.65 to 62.55 ± 11.57 mg/dL; p < 0.05), while SAx significantly increased the plasma levels of HDL-C in subjects with low plasma levels of HDL-C (<50 mg/dL) (from 44.25 ± 3.99 to 48.00 ± 7.27 mg/dL; p < 0.05). In conclusion, the supplement containing HT and PC exerted antiatherosclerotic and cardio-protective effects by considerably improving dyslipidemia in an adult population, without co-adjuvant treatment or adverse effects.     

The Dose-Response Relationship Between Body Mass Index and the Risk of Incident Stage ≥3 Chronic Kidney Disease in a General Japanese Population: The Ibaraki Prefectural Health Study (IPHS)

Purpose

To examine the relationship between body mass index (BMI) and the risk of stage ≥3 chronic kidney disease (CKD) in a general Japanese population.

Methods

A total of 105 611 participants aged 40–79 years who completed health checkups in Ibaraki Prefecture, Japan, and were free of CKD in 1993 were followed-up through 2006. Stage ≥3 CKD was defined by an estimated glomerular filtration rate <60 mL/min/1.73 m² reported during at least 2 successive annual surveys or as treatment for kidney disease. Hazard ratios (HRs) for the development of stage ≥3 CKD relative to the BMI categories were calculated using the Cox proportional hazards regression model, which was adjusted for possible confounders and mediators.

Results

During a mean follow-up of 5 years, 19 384 participants (18.4%) developed stage ≥3 CKD. Compared to a BMI of 21.0–22.9 kg/m², elevated multivariable-adjusted HRs were observed among men with a BMI ≥23.0 kg/m² and women with a BMI ≥27.0 kg/m². Significant dose-response relationships between BMI and the incidence of stage ≥3 CKD were observed in both sexes (P for trend <0.001).

Conclusions

Obesity was associated with the risk of developing stage ≥3 CKD among men and women.Key words: chronic kidney disease, body mass index, obesity, dose-response relationship, epidemiology     

Associations of Serum Concentrations of Persistent Organic Pollutants with the Prevalence of Periodontal Disease and Subpopulations of White Blood Cells

Background

Persistent organic pollutants (POPs), which are endocrine disruptors that accumulate in adipose tissue, can increase the risk of periodontal disease through the disturbance of the immune system.

Objective

We examined associations of background exposure to POPs with periodontal disease in the general population.

Design

Cross-sectional associations of concentrations of serum POPs with the prevalence of periodontal disease were investigated in 1,234 adults ≥ 20 years of age in the National Health and Nutrition Examination Survey 1999–2002.

Results

Among several POPs, organochlorine (OC) pesticides were most strongly associated with periodontal disease. Adjusted odds ratios across quintiles of OC pesticides were 1.0, 1.3, 1.7, 2.4, and 2.7 (p for trend < 0.01) for the presence in any site of clinical attachment loss ≥ 4 mm and 1.0, 1.7, 2.6, 3.4, and 3.7 (p for trend < 0.01) for the presence of pocket depth ≥ 4 mm. Polychlorinated biphenyls and polychlorinated dibenzo-p-dioxins also showed significant positive associations with one or both definitions of periodontal disease. Results did not materially change when continuous variables of clinical attachment loss or pocket depth were used as outcomes. Although participants with periodontal disease had higher white blood cell and neutrophil counts, neutrophil counts were inversely related to OC pesticides (p for trend < 0.01). These inverse associations did not change after excluding subjects with C-reactive protein ≥ 3 mg/L.

Conclusion

POPs, especially OC pesticides, were positively associated with periodontal disease, possibly through immunomodulation due to OC pesticides.     

Eating habits and eating behaviors by family dinner frequency in the lower-grade elementary school students

BACKGROUND/OBJECTIVES

Recently, there has been an increased interest in the importance of family meals on children''s health and nutrition. This study aims to examine if the eating habits and eating behaviors of children are different according to the frequency of family dinners.

SUBJECTS/METHODS

The subjects were third-grade students from 70 elementary schools in 17 cities nationwide. A two-stage stratified cluster sampling was employed. The survey questionnaire was composed of items that examined the general characteristics, family meals, eating habits, eating behaviors, and environmental influence on children''s eating. The subjects responded to a self-reported questionnaire. Excluding the incomplete responses, the data (n = 3,435) were analyzed using χ²-test or t-test.

RESULTS

The group that had more frequent family dinners (≥ 5 days/week, 63.4%), compared to those that had less (≤ 4 days/week, 36.6%), showed better eating habits, such as eating meals regularly, performing desirable behaviors during meals, having breakfast frequently, having breakfast with family members (P < 0.001), and not eating only what he or she likes (P < 0.05). Those who had more frequent family dinners also consumed healthy foods with more frequency, including protein foods, dairy products, grains, vegetables, seaweeds (P < 0.001), and fruits (P < 0.01). However, unhealthy eating behaviors (e.g., eating fatty foods, salty foods, sweets, etc.) were not significantly different by the frequency of family dinners.

CONCLUSIONS

Having dinner frequently with family members was associated with more desirable eating habits and with healthy eating behaviors in young children. Thus nutrition education might be planned to promote family dinners, by emphasizing the benefits of having family meals on children''s health and nutrition and making more opportunities for family meals.     

Treatment adjustment and medication adherence for complex patients with diabetes, heart disease, and depression: a randomized controlled trial

PURPOSE

Medication nonadherence, inconsistent patient self-monitoring, and inadequate treatment adjustment exacerbate poor disease control. In a collaborative, team-based, care management program for complex patients (TEAMcare), we assessed patient and physician behaviors (medication adherence, self-monitoring, and treatment adjustment) in achieving better outcomes for diabetes, coronary heart disease, and depression.

METHODS

A randomized controlled trial was conducted (2007–2009) in 14 primary care clinics among 214 patients with poorly controlled diabetes (glycated hemoglobin [HbA_1c] ≥8.5%) or coronary heart disease (blood pressure >140/90 mm Hg or low-density lipoprotein cholesterol >130 mg/dL) with coexisting depression (Patient Health Questionnaire-9 score ≥10). In the TEAMcare program, a nurse care manager collaborated closely with primary care physicians, patients, and consultants to deliver a treat-to-target approach across multiple conditions. Measures included medication initiation, adjustment, adherence, and disease self-monitoring.

RESULTS

Pharmacotherapy initiation and adjustment rates were sixfold higher for antidepressants (relative rate [RR] = 6.20; P <.001), threefold higher for insulin (RR = 2.97; P <.001), and nearly twofold higher for antihypertensive medications (RR = 1.86, P <.001) among TEAMcare relative to usual care patients. Medication adherence did not differ between the 2 groups in any of the 5 therapeutic classes examined at 12 months. TEAMcare patients monitored blood pressure (RR = 3.20; P <.001) and glucose more frequently (RR = 1.28; P = .006).

CONCLUSIONS

Frequent and timely treatment adjustment by primary care physicians, along with increased patient self-monitoring, improved control of diabetes, depression, and heart disease, with no change in medication adherence rates. High baseline adherence rates may have exerted a ceiling effect on potential improvements in medication adherence.     

Effect of Calcium Supplementation on Blood Lead Levels in Pregnancy: A Randomized Placebo-Controlled Trial

Background

Prenatal lead exposure is associated with deficits in fetal growth and neurodevelopment. Calcium supplementation may attenuate fetal exposure by inhibiting mobilization of maternal bone lead and/or intestinal absorption of ingested lead.

Objective

Our goal was to evaluate the effect of 1,200 mg dietary calcium supplementation on maternal blood lead levels during pregnancy.

Methods

In a double-blind, randomized, placebo-controlled trial conducted from 2001 through 2003 in Mexico City, we randomly assigned 670 women in their first trimester of pregnancy to ingest calcium (n = 334) or placebo (n = 336). We followed subjects through pregnancy and evaluated the effect of supplementation on maternal blood lead, using an intent-to-treat analysis by a mixed-effects regression model with random intercept, in 557 participants (83%) who completed follow-up. We then conducted as-treated analyses using similar models stratified by treatment compliance.

Results

Adjusting for baseline lead level, age, trimester of pregnancy, and dietary energy and calcium intake, calcium was associated with an average 11% reduction (0.4 μg/dL) in blood lead level relative to placebo (p = 0.004). This reduction was more evident in the second trimester (−14%, p < 0.001) than in the third (−8%, p = 0.107) and was strongest in women who were most compliant (those who consumed ≥ 75% calcium pills; −24%, p < 0.001), had baseline blood lead > 5 μg/dL (−17%, p < 0.01), or reported use of lead-glazed ceramics and high bone lead (−31%, p < 0.01).

Conclusion

Calcium supplementation was associated with modest reductions in blood lead when administered during pregnancy and may constitute an important secondary prevention effort to reduce circulating maternal lead and, consequently, fetal exposure.     

Relationships of Cigarette Smoking and Alcohol Consumption to Metabolic Syndrome in Japanese Men

Background

Cigarette smoking is an important, aggravating factor in metabolic syndrome (MetS). In addition, some studies have reported that MetS is related to alcohol consumption irrespective of the amount consumed. However, the relationship of the combination of the 2 habits to MetS has not been fully described.

Methods

In this cross-sectional survey, a questionnaire was used to collect information on cigarette smoking and alcohol consumption from 3904 Japanese men aged 20 years or older. MetS was defined according to Japanese criteria. Logistic regression analysis was used to analyze relationships of cigarette smoking and alcohol consumption with MetS, after adjustment for potential confounding factors.

Results

Among the subjects, 581 (14.9%) had MetS. Daily cigarette and alcohol consumption were significantly associated with the prevalence of MetS (P < 0.0001, P = 0.030 for trend). The multivariate-adjusted odds ratio for the prevalence of MetS was 1.89 (95% confidence interval: 1.34–2.65) for subjects who smoked ≥30 cigarettes/day, as compared with nonsmokers; 1.54 (1.06–2.23) for those who consumed ≥69 grams of ethanol/day, as compared with nondrinkers; and 3.63 (1.91–6.90) for those who smoked ≥30 cigarettes/day and consumed ≥69 grams of ethanol/day, as compared with those who neither smoked nor drank. The interaction of smoking ≥30 cigarettes/day with drinking ≥69 grams/day was 2.03 (1.02–4.01, P = 0.043).

Conclusions

Cigarette smoking and alcohol drinking had independent relations to the prevalence of MetS. In addition, the prevalence of MetS was higher among Japanese men who smoked and drank heavily.Key words: metabolic syndrome, cigarette smoking, alcohol consumption, cross-sectional study, Japan     

Relationships between milk consumption and academic performance,learning motivation and strategy,and personality in Korean adolescents

BACKGROUND/OBJECTIVES

A healthy diet has been reported to be associated with physical development, cognition and academic performance, and personality during adolescence. This study was performed to investigate the relationships among milk consumption and academic performance, learning motivation and strategies, and personality among Korean adolescents.

SUBJECTS/METHODS

The study was divided into two parts. The first part was a survey on the relationship between milk consumption and academic performance, in which intakes of milk and milk products and academic scores were examined in percentiles among 630 middle and high school students residing in small and medium-sized cities in 2009. The second part was a survey on the relationships between milk consumption and learning motivation and strategy as well as personality, in which milk consumption habits were collected and Learning Motivation and Strategy Test (L-MOST) for adolescents and Total Personality Inventory for Adolescents (TPI-A) were conducted in 262 high school students in 2011.

RESULTS

In the 2009 survey, milk and milk product intakes of subjects were divided into a low intake group (LM: ≤ 60.2 g/day), medium intake group (MM: 60.3-150.9 g/day), and high intake group (HM: ≥ 151.0 g/day). Academic performance of each group was expressed as a percentile, and performance in Korean, social science, and mathematics was significantly higher in the HM group (P < 0.05). In the 2011 survey, the group with a higher frequency of everyday milk consumption showed significantly higher "learning strategy total," "testing technique," and "resources management technique" scores (P < 0.05) in all subjects. However, when subjects were divided by gender, milk intake frequency, learning strategy total, class participation technique, and testing technique showed significantly positive correlations (P < 0.05) in boys, whereas no correlation was observed in girls. Correlations between milk intake frequency and each item of the personality test were only detected in boys, and milk intake frequency showed positive correlations with "total agreeability", "organization", "responsibility", "conscientiousness", and "intellectual curiosity" (P < 0.05).

CONCLUSION

Intakes of milk and milk products were correlated with academic performance (Korean, social science, and mathematics) in Korean adolescents. In male high school students, particularly, higher milk intake frequency was positively correlated with learning motivation and strategy as well as some items of the personality inventory.     

Evaluation of diet quality and its associated factors among adolescents in Kuala Lumpur,Malaysia

BACKGROUND/OBJECTIVES

This study aims to determine contribution of meal frequency, self-efficacy for healthy eating, and availability of healthy foods towards diet quality of adolescents in Kuala Lumpur, Malaysia.

SUBJECTS/METHODS

This study was conducted among 373 adolescents aged from 13 to 16 years old. Diet quality of the respondents was assessed using the Healthy Eating Index for Malaysians. Meal frequency, self-efficacy for healthy eating, and availability of healthy foods were assessed through the Eating Behaviours Questionnaire (EBQ), self-efficacy for healthy eating scale, and availability of healthy foods scale, respectively.

RESULTS

The majority of the respondents (80.7%) were at risk of poor diet quality. Males (mean = 34.2 ± 8.2%) had poorer diet quality than females (mean = 39.9 ± 9.0%) (t = -5.941, P < 0.05). Malay respondents (mean = 36.9 ± 8.7%) had poorer diet quality than Indian respondents (mean = 41.3 ± 10.0%) (F = 2.762, P < 0.05). Age (r = 0.123, P < 0.05), self-efficacy for healthy eating (r = 0.129, P < 0.05), and availability of healthy foods (r = 0.159, P < 0.05) were positively correlated with the diet quality of the respondents. However, meal frequency was not correlated with the diet quality of the respondents. Multiple linear regression analysis showed that being a male, being a Malay, low self-efficacy for healthy eating, and low availability of healthy foods contributed significantly towards poor diet quality among respondents.

CONCLUSIONS

In short, sex, ethnicity, self-efficacy for healthy eating, and availability of healthy foods were associated with diet quality among adolescents. Health practitioners should take into consideration of differences in sex and ethnicity during implementation of nutrition-related intervention programs. Self-efficacy for healthy eating and availability of healthy foods should be included as important components in improving diet quality of adolescents.