Author Interviews, Heart Disease, Weight Research / 24.03.2015

Abhishek Sharma MD (on behalf of all co-authors) Division of Cardiovascular Medicine State University of New York Downstate Medical Center Brooklyn, New YorkMedicalResearch.com Interview with: Abhishek Sharma MD (on behalf of all co-authors) Division of Cardiovascular Medicine State University of New York Downstate Medical Center Brooklyn, New York MedicalResearch: What is the background for this study? Authors: Heart failure (HF) is the second most common cause of hospitalization after child delivery in the US. In general, increasing degrees of obesity have been associated with progressively worse outcomes among individuals without known cardiovascular (CV) diseases. Therefore intentional weight loss, via structured dietary and exercise training programs or bariatric surgery, has been suggested to reverse hemodynamic and cardiac structural changes associated with obesity. However, several recent studies have reported lower mortality and morbidity among heart failure patients who were overweight or obese compared with those whose weight was normal or subnormal. This phenomenon has been commonly labeled the “obesity paradox” or “reverse epidemiology.” These findings question the prognostic significance of BMI and the practice of extrapolating findings derived from the general population to HF patients. Reasons for the association between BMI and all- cause and CV mortality and hospitalizations in HF are not fully understood. Due to contradictory results in various studies and lack of definitive data on prognostic value of BMI and its purposeful alteration in HF, the American College of Cardiology Foundation/American Heart Association do not provide any firm recommendations for purposeful weight loss in heart failure. To further explore the relationship between obesity and outcome in heart failure patients, we systematically examined the association between BMI and all- cause mortality, CV mortality and hospitalizations among patients with chronic heart failure. (more…)
Author Interviews, Nutrition, Weight Research / 23.03.2015

MedicalResearch.com Interview with: Tom Sanders, PhD DSc Emeritus Professor of Nutrition & Dietetics, Diabetes and Nutritional Sciences Division, King’s College London London, UK Medical Research: What is the background for this study? What are the main findings? Dr. Sanders:  Controversy surrounds the effectiveness of dietary guideline for cardiovascular disease (CVD) prevention in healthy middle-aged and older men and women. These dietary guidelines are similar in UK and other Western countries and focus on modifying the overall dietary pattern so that food and nutrient targets are met. However, surprisingly the overall impact of changing the dietary pattern has never been tested in a trial. We conducted a 12-wk controlled dietary trial in 165 healthy non-smoking men and women (aged 40-70 years) to compare a diet conforming to current dietary guidelines with a traditional nutritionally balance British diet on well established (blood pressure measured by 24-h ambulatory monitoring and blood lipids) and newer predictors of cardiovascular disease risk (measures of blood vessel functioning and stiffness, inflammation and the body’s sensitivity to insulin). The dietary guideline targets were to reduce total and saturated fat intake to provide no more than 35% and 10% of the food energy, to cut salt to below 6g/day, to meet the 5-a-day recommendation for fruit and vegetables, to consume at least 1portions of oily fish a week (i.e. mackerel, salmon, sardines), to obtain half of the cereal intake from wholegrains and to restrict intake of non-milk extrinsic sugar to no more than 10% energy. Subjects were counseled by a dietitian and provided with advice tailored to their individual food preferences and were provided with some foods to assist them following the dietary advice. The control diet was a nutritionally balanced traditional British diet without restriction on salt and sugar intake. It was based around refined cereals (white bread, pasta, breakfast cereals, white rice) and potatoes with meat (red meat, meat products or poultry), but with a limited intake of oily fish (less than once a month) and wholegrain cereals.  Participants allocated to control were supplied with a butter-based spread and a liquid unhydrogenated vegetable oil (palm olein) that contained 40 % saturated fatty acids. They were advised to consume three servings of full-fat dairy products (milk, yogurt and cheese), and at least one serving of fruit and two servings of vegetables each day. Both groups were given advice to limit consumption of confectionery, snack foods (chips, cake, cookies) and drink alcohol within safe limits. Food intake records showed few differences in micronutrient intakes between diets with the exception of vitamin D where the intake and plasma 25-OH-vitamin D levels were greater on the dietary guidelines diet owing to the higher intake of oily fish. The average body weight in the group who followed the modified diet fell by 1.3 kg whilst that in the control group rose by 0.6 kg after 12 weeks, resulting in an overall difference in weight of 1.9 kg between the two groups; the equivalent difference in Body Mass Index (BMI) was 0.7 kg/m2 between the groups. Waist circumference was 1.7 cm lower in the dietary guidelines group compared to the control group. The drop-out rate was low, with 80 participants completing on the dietary guidelines diet and 82 on the control. Adherence to the dietary advice was confirmed both with dietary records and by measuring specific biomarkers in the participants’ blood and urine. The latter indicated an increase in potassium and fibre intake in the dietary group along with a drop in sodium (salt) and saturated fat and added sugar intake. However, total sugar intake remained unchanged owing to the increase in sugar intake from fruit. The primary outcomes were changes in day-time systolic blood pressure, endothelial function measured using the flow mediated dilation technique and total cholesterol: HDL cholesterol ratio. All other outcomes were secondary or exploratory outcomes. Significant falls in systolic blood pressure/diastolic blood pressure of 4.2/2.5 mm Hg for daytime and 2.9/1.9 mm Hg for night time were measured in the dietary group compared with the control group; the average heart rate was found to have lowered by 1.8 beats per minute. Causal mediated effects analysis based on urinary sodium excretion indicated that sodium reduction explained 2.4 mm Hg (95% CI 1.0, 3.9) of the fall in blood pressure There were no changes in endothelial dependent or endothelial independent vasodilation but arterial stiffness measured as carotid to femoral pulse wave velocity was 0. 29 m/sec lower on the dietary guidelines diet compared with the control diet. Total cholesterol:HDL cholesterol ratio was 4% lower on the dietary guidelines diet compared to the control low density lipoprotein and triglyceride concentrations were 10% and 9% lower respectively. The reduction in LDL-C (0.30 mmol/L) was greater than that achieved in most community based studies of dietary advice where the average reduction is 0.16 mmol/L but still modest compared with what can be achieved with statins (1.0 mmol/L). Compared with the control diet, the dietary guideline diet decreased low-grade inflammation (C-reactive protein). No significant change was recorded in markers for 24-h insulin secretion or insulin sensitivity, which predicts the risk of developing type 2 diabetes. (more…)
Author Interviews, University Texas, Weight Research / 22.03.2015

Helen P. Hazuda, Ph.D. Professor of Medicine Division of Nephrology Department of Medicine University of Texas Health Science Center at San Antonio San Antonio, TXMedicalResearch.com Interview with: Helen P. Hazuda, Ph.D. Professor of Medicine Division of Nephrology Department of Medicine University of Texas Health Science Center at San Antonio San Antonio, TX Medical Research: What is the background for this study? What are the main findings? Dr. Hazuda: The long-term effects of diet soda consumption on health outcomes is unclear, and studies in both humans and animals have raised concerns about their potentially harmful health effects including weight gain and increased cardiometabolic risk.  Most human studies have focused on middle-aged or younger adults, rather than focusing specifically on people 65 years and older, a rapidly growing segment of the U.S. population that has a disproportionately high burden of cardiometabolic disease and associated healthcare costs.  Therefore, our study examined prospectively the association between diet soda intake and long-term change in waist circumference in a biethnic cohort of older (65+ years)  Mexican American and European American participants in the San Antonio Longitudinal Study of Aging (SALSA). SALSA included a baseline examination (1992 – 1996) and three follow-up examinations (2000-2001, 2001-2003, and 2003-2004).  The total follow-up period averaged 9.4 years.  Diet soda intake, waist circumference (WC), height and weight were measured at each examination along with sociodemographic factors, leisure physical activity, diabetes mellitus, smoking, and length of follow-up. The main finding is that over the total 9.4-year SALSA follow-up period and after adjustment for multiple potential confounders, daily diet soda users (1+ diet sodas/day) experienced an increase in  waist circumference of 3.2 inches, while occasional diet soda users (>.05 < 1 diet soda/day) experienced a  waist circumference increase of 1.8 inches, and nonusers of diet soda experienced a WC increase of 0.8 inches.  Thus, there was a striking dose-response relationship between chronic diet soda intake and long-term increases in waist circumference. (more…)
Author Interviews, Heart Disease, Weight Research / 18.03.2015

Dr Rajeev Kumar Pathak MBBS, FRACP Cardiologist and Electrophysiology Fellow Centre for Heart Rhythm Disorders | University of Adelaide Cardiovascular Investigation Unit | Royal Adelaide Hospital Adelaide AustraliaMedicalResearch.com Interview with: Dr Rajeev Kumar Pathak MBBS, FRACP Cardiologist and Electrophysiology Fellow Centre for Heart Rhythm Disorders | University of Adelaide Cardiovascular Investigation Unit | Royal Adelaide Hospital Adelaide Australia Medical Research: What is the background for this study? What are the main findings? Response: Obesity and atrial fibrillation (AF) are dual epidemics that frequently coexist. Weight-loss reduces atrial fibrillation burden; however, whether this is sustained, has a dose effect or is influenced by weight-fluctuation is not known. In this study we evaluated the  long-term impact of weight-loss and weight-fluctuation on rhythm control in obese individuals with atrial fibrillation. (more…)
Author Interviews, Exercise - Fitness, Lifestyle & Health, Weight Research / 18.03.2015

MedicalResearch.com Interview with: Sirpa Soini, MHC, researcher Department of General Practice and Primary Health Care University of Helsinki Medical Research: What is the background for this study? Response: Short-term weight loss is often successful, but he obtained results are difficult to maintain. Therefore, a study focusing on obese people who successfully lost weight, with special  emphasis upon methods applied and background factors, is of major importance. Many people are successful in losing weight by themselves without taking part in any organized group activity. The knowledge about their success and the methods applied does not usually reach the health care personnel and is one reason why it is difficult to get reliable information about those who are successful in losing weight. (more…)
Author Interviews, Weight Research / 14.03.2015

Harold P. Erickson Ph.D. James B. Duke Professor, Department of Cell Biology Duke Univ. Med. Center Durham, NC 27710MedicalResearch.com Interview with: Harold P. Erickson Ph.D. James B. Duke Professor, Department of Cell Biology Duke Univ. Med. Center Durham, NC  27710 MedicalResearch: What is the background for this study? Dr. Erickson: In Jan 2012 a paper reported the discovery of irisin, a hormone reportedly lopped off a precursor in muscle and sent through the bloodstream to fat tissue, where it turned white fat into brown fat. Brown fat burns calories, and is what hibernating animals – and even human babies -- use to keep warm. Turning on brown fat had exciting promise for obesity, diabetes, etc. Dozens of labs around the world jumped on the discovery and started trials in animals and humans of how irisin levels in blood were altered by exercise and a variety of metabolic challenges. MedicalResearch: What are the main findings? Early reports. Dr. Erickson: The follow-up studies from different labs reported a huge range of values for the level of irisin in blood, so they could not all be right. And most of them failed to find any significant effect of exercise. In 2013 two papers criticized the irisin study. A commentary article by Harold Erickson (Adipocyte 2:289-93) reported two substantial flaws in the original study. A research paper by S. Raschke, J. Eckel and colleagues (PloS one 8:e73680) concluded that humans did not make significant amount of irisin. The human gene for irisin has a deleterious mutation in the start codon, and Raschke et al showed that this reduced irisin expression to only 1% the level with the normal start. These two reports may have slowed new labs entering the field, but many groups already invested continued to publish. (more…)
Author Interviews, Endocrinology, Weight Research / 11.03.2015

Elizabeth A. Lawson, M.D., M.M.Sc. Assistant Professor of Medicine Harvard Medical School Director, Interdisciplinary Oxytocin Research Program Neuroendocrine Unit Massachusetts General Hospital Boston, MA 02114MedicalResearch.com Interview with: Elizabeth A. Lawson, M.D., M.M.Sc. Assistant Professor of Medicine Harvard Medical School Director, Interdisciplinary Oxytocin Research Program Neuroendocrine Unit Massachusetts General Hospital Boston, MA 02114 Medical Research: What is the background for this study? What are the main findings? Response: Oxytocin is a hormone produced in the brain that has been shown to reduce food intake in animal studies. The role of oxytocin on appetite and food consumption in humans is not well understood. We therefore performed a randomized, placebo controlled cross-over study of single dose administration of intranasal oxytocin (Syntocinon, Novartis) in healthy men. Subjects presented fasting in the early morning and were randomized to receive 24 IU intranasal oxytocin or placebo. They selected breakfast from a menu and were offered double portions. The caloric content of the food they ate was calculated. They returned for a second visit, which was the same except for this time, they received the other treatment (placebo or oxytocin). There was no difference in how much food the men reported eating in the three days leading up to each of the study visits. On average, the men ate 122 fewer calories and about 9 grams less fat after receiving oxytocin compared to placebo. There was also evidence that oxytocin resulted in greater use of fat as a fuel for the body, and improved insulin sensitivity. (more…)
Author Interviews, Psychological Science, Weight Research / 08.03.2015

Margaret C. Campbell, Phd | Professor | Marketing Chair, Doctoral Curriculum Program Committee 437 Leeds School of Business University of Colorado at Boulder Boulder, CO 80309-0419MedicalResearch.com Interview with: Margaret C. Campbell, Phd | Professor | Marketing Chair, Doctoral Curriculum Program Committee 437 Leeds School of Business University of Colorado at Boulder Boulder, CO 80309-0419   Medical Research: What is the background for this study? What are the main findings? Dr. Campbell: People try to maintain healthy body weights, attain academic and career success, save money for a car, a house, or retirement, and achieve a host of other goals that require repeated, goal-consistent behaviors. Unfortunately, consumers’ efforts often fall short. For example, 68% of Americans are overweight (Weight Control Information Network 2010), 46% who begin college do not graduate within six years (Associated Press 2006), and although 93% say that saving for retirement is important, only about 60% are actually saving (TIAA-CREF 2010) and approximately 50% have accumulated less than $25,000 (Helman, VanDehrei and Copeland 2007). Understanding goal pursuit and consumers’ choices to continue effort toward a goal that requires repeated goal-consistent behaviors is thus important. People need to be able to make progress on important goals that substantially impact their quality of life. Monitoring the influence of behavior on distance from a focal goal has been identified as important for successful goal pursuit - such as weight loss. In seven experiments, we find that people tend to have a “progress bias” such that they perceive that goal-consistent behaviors (such as avoiding eating a piece of cake) help progress more than equivalent-sized goal-inconsistent behaviors (such as eating a piece of cake) hurt progress. An experiment on exercise and eating shows that the progress bias can lead to poor understanding of progress and thus, premature release of the goal. In this study, the progress bias resulted in people with a goal of expending more calories than they consumed ended up consuming more than they expended. (more…)
Author Interviews, Nutrition, Weight Research / 06.03.2015

Frances M. Sladek, Ph.D. Professor of Cell Biology and Toxicologist Associate Director, UCR Stem Cell Center Department of Cell Biology and Neuroscience University of California Riverside, CA 92521-0314MedicalResearch.com Interview with: Frances M. Sladek, Ph.D. Professor of Cell Biology and Toxicologist Associate Director, UCR Stem Cell Center Department of Cell Biology and Neuroscience University of California Riverside, CA 92521-0314 Medical Research: What is the background for this study? What are the main findings? Dr. Sladek: In 2011 Blasbalg et al reported in the American Journal of Clinical Nutrition that the consumption of soybean oil was the component of the American diet that had changed the most since the early 1900s. It had in fact increased 1000-fold. Soybean oil is currently not only the main type of vegetable oil used in the U.S. but soybean meal is a major component of the diet of the animals such as cows and pigs, resulting in changes in the fatty acid composition of animal fat. Soybean oil is also increasingly being used worldwide: 40 million tons were produced in 2007 alone. In our previous study we found that a high fat diet containing comparable amounts of soybean oil to what Americans are currently consuming caused mice to become obese, diabetic and insulin resistant and to have large lipid droplets and hepatocyte ballooning in their livers. Others had found similar results and proposed that linoleic acid (an omega 6 polyunsaturated fat) that makes up >55% of the oil was responsible for the negative metabolic effects. DuPont recently generated a genetically modified  soybean oil  that had reduced levels of linoleic acid and hence less of a tendency to generate trans fats. This oil (called Plenish) came onto the market for the first time in 2014. The fatty acid composition of Plenish is similar to that of olive oil (low linoleic acid and high oleic acid), which is a major component of the healthy Mediterranean diet. The implication, therefore, is that Plenish is healthier than conventional soybean oil but that has not been formally proven. In the current study, we found that while a high fat diet containing Plenish also induced obesity, glucose intolerance and fatty liver, it did not induce insulin resistance as did the conventional soybean oil. It also induced somewhat less fat accumulation. Finally, we compared the diet enriched in soybean oil to an isocaloric diet that contained the same amount of total fat (40%kcal, Americans consume 34-37% fat) but with 90% of the fat from coconut oil. Those animals gained very little weight (13% versus 38% with the conventional soybean oil and 30% with the Plenish) and were not diabetic or insulin resistant. Their livers also had less fat than either of the two soybean oil diets and showed no signs of hepatocyte ballooning. Coconut oil has essentially no linoleic acid or other PUFAs. Our results, assuming humans respond in the same way as mice, suggest that people should avoid the consumption of too much soybean oil, either conventional or Plenish. They also show that coconut oil, which is made up of saturated fats (primarily medium chain triglycerides), is much healthier for you than soybean oil. Coconut oil has been noted previously for its beneficial health effects. (more…)
AHA Journals, Author Interviews, Exercise - Fitness, Weight Research / 05.03.2015

MedicalResearch.com Interview with Christopher C. Imes, PhD, RN Assistant Professor, Acute and Tertiary Care University of Pittsburgh, School of Nursing MedicalResearch: What is the background for this study? Dr. Imes: Increased physical activity (PA) with reduced energy intake is the key strategy to achieve weight loss. However, in research, there are challenges to obtaining accurate PA data. Many studies rely on self-report, which is easily accessible and inexpensive but is known to have numerous limitations. Pedometers are a relatively inexpensive and accessible method to objectively measure certain aspects of physical activity. The purpose of this analysis was to examine the associations between self-reported physical activity, pedometer step count data and weight loss during the first 6-months of the Self-Efficacy Lifestyle Focus (SELF) trial. All participants in this trial were instructed to reduce their calorie and fat intake, were encouraged to engage in at least 150 minutes of moderately intense PA/week or 7500 steps/day, and to self-monitor their diet and physical activity. MedicalResearch: What are the main findings? Dr. Imes: Change in self-reported physical activity from baseline to 6 months was not associated with weight change. However, average daily step count, derived from pedometers given to participants during the same time period, was associated with weight loss. More daily steps results in more weight loss. The participants who averaged over 7500 steps/day lost about 9.5% of their initial body weight; whereas, the participants who averaged less than 5000 steps/day only lost about 5.0%. (more…)
Author Interviews, Hepatitis - Liver Disease, Menopause, Nutrition, Weight Research / 01.03.2015

Colette Nicole Miller FDN Department of Foods and Nutrition Edgar L. Rhodes Center for Animal and Dairy Science University of Georgia, Athens, GeorgiaMedicalResearch.com Interview with: Colette Nicole Miller FDN Department of Foods and Nutrition Edgar L. Rhodes Center for Animal and Dairy Science University of Georgia, Athens, Georgia Medical Research: What is the background for this study? Response: Our laboratory has been interested for quite some time in the relationship that natural, plant-derived compounds have on various tissues in the body. Both bone and adipocytes are derived from the same progenitor cell, mesenchymal stem cells. Thus, if a drug or compound affects one type of cell, it may affect both. When women transition through menopause, and see a reduction in their female sex hormones like estrogen, they can see adverse changes in both how much fat they store and their bone density. Thus our lab is interested in compounds that can be used to prevent the bone loss and visceral adipogenesis that menopausal women often experience. Previous work both in vivo and in vitro has shown that phytochemicals have synergistic effects and thus can ultimately work together to reduce the dosages needed to promote overall health. Through this work we have identified a combination of genistein, resveratrol, quercetin and Vitamin D that improve bone density in addition to promoting apoptosis of adipocytes. However, the health of the liver had never been addressed with our phytochemical blend. We know that supplements are sometimes toxic to the liver for many different reasons. Thus, it was very important for us to address the toxicity and potential risk of non-alcoholic fatty liver disease with our phytochemical blend in a menopausal rat model. (more…)
Aging, Author Interviews, Brigham & Women's - Harvard, Nutrition, Weight Research / 28.02.2015

William Mair, Ph.D Assistant Professor Department of Genetics and Complex Diseases Harvard T. H Chan School of Public Health Boston, MA 02115MedicalResearch.com Interview with: William Mair, Ph.D Assistant Professor Department of Genetics and Complex Diseases Harvard T. H Chan School of Public Health Boston, MA 02115 MedicalResearch: What is the background for this study? What are the main findings? Dr. Mair: Dietary restriction, the reduction of food intake without malnutrition has been known for 80 years to prolong lifespan in organisms ranging from single celled yeast to non human primates, and early signs suggest improvement of metabolic parameters in patients undergoing clinical trials. However, negative side effects associated with low calorie intake remain, and compliance and lifestyle factors make it an unappealing therapeutic. Since calorie restriction (CR) can have remarkable protective effects against multiple age onset diseases in mouse models - ranging from cancer to neurodegeneration to metabolic disease - finding molecular mechanisms though which calorie restriction functions might provide novel therapeutic targets that promote healthy aging. Using a model system, the nematode worm C. elegans, we show that perception of energy intake in the nervous system may be as critical for the effects of low energy on aging as actual calorie intake itself. Animals expressing an active form of a protein called AMPK, which is a cellular energy sensor, were long lived despite eating normally but this longevity could be turned off or on by changes to a neurotransmitter in just a few neurons. This suggests that therapeutic targets that modulate the perception of energy status in the nervous system might provide novel ways to gain the benefit of calorie restriction and promote healthy aging. (more…)
Author Interviews, Diabetes, Karolinski Institute, NEJM, OBGYNE, Weight Research / 27.02.2015

Kari Johansson, Phd Department of Medicine Solna, Karolinska Institutet Clinical Epidemiology Karolinska University Hospital Stockholm, SwedenMedicalResearch.com Interview with: Kari Johansson, PhD Department of Medicine Solna, Karolinska Institutet Clinical Epidemiology Karolinska University Hospital Stockholm, Sweden   MedicalResearch: What is the background for this study? What are the main findings? Dr. Johannson: The number of women who are obese in early pregnancy has increased dramatically over the last decades. Consequently, there has been a dramatic rise in the number of women becoming pregnant after bariatric surgery. In Sweden the number of births of women with a history of bariatric surgery has increased from 150 (≈0.15%) to more than 500 (0.5%) per year between 2006 and 2011. The positive effects of bariatric surgery on health outcomes, such as diabetes and cardiovascular disease, are reasonably well-studied, but less is known about the effects on pregnancy and perinatal outcomes. We therefore conducted a population-based study, using data from nationwide Swedish registers. The main findings are that women who had a history of bariatric surgery were much less likely to develop gestational diabetes (2% compared to 7%; P<0.001) and give birth to large-for-gestational age babies (9% vs 22%; P<0.001). On the other hand, the operated women were twice as likely to give birth to babies who were small for gestational age (16% vs 8%), and have pregnancies of shorter duration (273 vs 277.5; P<0.001).  (more…)
Author Interviews, Nutrition, NYU, Pediatrics, Weight Research / 26.02.2015

Brian Elbel, PhD, MPH Associate Professor, Department of Population Health; Associate Professor, Department of Medicine Population Health NYU School of MedicineMedicalResearch.com Interview with: Brian Elbel, PhD, MPH Associate Professor, Department of Population Health; Associate Professor, Department of Medicine Population Health NYU School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Elbel: This study tried to determine whether a new supermarket that received tax and zoning credits from New York City, locating in a high need area, impacted healthy eating for children.  No previous controlled study has looked at children, and supermarkets are tool being increasingly used to improve healthy eating.  We did not find, at least one year after the store opened, any appreciable change in shopping or eating. (more…)
Author Interviews, BMJ, NIH, Pediatrics, Weight Research / 21.02.2015

Yeyi Zhu, PhD IRTA Postdoctoral Fellow Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIHMedicalResearch.com Interview with: Yeyi Zhu, PhD IRTA Postdoctoral Fellow Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH MedicalResearch: What is the background for this study? What are the main findings? Dr. Zhu: Currently in the US, nearly two thirds of reproductive-aged women are overweight or obese. Moreover, the amount of weight gained during pregnancy can have immediate and long-lasting impacts on health of a woman and her infant. Previous evidence implicates that excessive gestational weight gain above the Institute of Medicine guidelines is related to high birthweight (>4000 g), a marker of intrauterine over-nutrition which may impose a greater risk of offspring’s obesity and metabolic diseases in later life. Given that more than one third of children and adolescents are overweight or obese in the US, it is of great public health significance to improve our understanding of determinants and mediators of childhood obesity. The length of breast feeding and age at introduction of solid foods are infant feeding practices that are potentially modifiable in early life. We therefore examined whether birthweight and infant feeding practices, specifically length of breast feeding, mediate the relationship between maternal gestational weight gain and childhood growth in the National Children’s Study Formative Research in Anthropometry, a cross-sectional multi-ethnic study of 1387 mothers and their children aged 0-5.9 years in the US (2011-2012). We illustrated that the intergenerational relationship between maternal gestational weight gain and early childhood growth (i.e., z scores for weight-for-age, weight-for-height, and body mass index-for-age) largely acts through birthweight rather than directly on childhood growth. Further, given the negative association of breastfeeding duration with childhood anthropometrics, longer length of breastfeeding suppressed the positive associations of gestational weight gain and birthweight with childhood growth. In addition, analysis by ethnicity revealed that these associations were only significant in non-Hispanic White and non-Hispanic Black participants as opposed to Hispanics and other ethnicities. (more…)
Author Interviews, Diabetes, Exercise - Fitness, Pain Research, Weight Research / 20.02.2015

Dan White PT , ScD, Msc University of DelawareMedicalResearch.com Interview with: Dan White PT , ScD, Msc University of Delaware Medical Research: What is the background for this study? What are the main findings? Dr. White: We know that diet and exercise are beneficial to reduce knee pain, however it is not known whether diet and exercise can actually prevent the development of knee pain in people at high risk.  We found that an intensive program of diet and exercise had a small but statistically significant protective effect with preventing the development of knee pain in overweight and obese people with diabetes. (more…)
Author Interviews, Weight Research / 17.02.2015

Dr. med. Laurence Genton, FMH Médecine Interne Médecin adjointe agrégée, chargée de cours Nutrition Clinique Hôpitaux universitaires de Genève GenèveMedicalResearch.com Interview with: Dr. med. Laurence Genton, FMH Médecine Interne Médecin adjointe agrégée, chargée de cours Nutrition Clinique Hôpitaux universitaires de Genève Genève Medical Research: What is the background for this study? What are the main findings? Response: Several studies have shown that body mass index is linked to mortality through a U- or J-curve, i.e. that a low and maybe a high body mass index are related to a higher risk of mortality in elderly people. However, body mass index consists of fat mass and fat-free mass, and the former studies cannot differentiate the impact of these body compartments. However, this differentiation may be important to guide our public health care strategies. For instance, fat and fat-free mass can both be reduced by hypocaloric diet and endurance exercise, while fat-free mass can be increased with adequate calorie and protein intakes, resistance exercise and anabolic treatments. Thus, this study aimed at evaluating the impact of fat mass and fat-free mass on mortality. We found that body mass index and body composition did not predict mortality in older women. However, a high fat-free mass was associated with a lower risk of mortality in men, even when adjusting for body mass index. (more…)
Author Interviews, JAMA, Surgical Research, Weight Research / 09.02.2015

MedicalResearch.com Interview with: Torsten Olbers MD, PhD Assistant Professor of Surgery Sahlgrenska University Hospital Gothenburg, Sweden Medical Research: What is the background for this study? What are the main findings? Dr. Olbers: Until now there has been no consensus regarding preferred bariatric procedure for patients with a body mass index (BMI) above 50 kg/m2. We report on the 5-year outcomes from a randomized clinical trial of gastric bypass and duodenal switch published online by JAMA Surgery on February 4th. (more…)
Author Interviews, CDC, OBGYNE, Weight Research / 07.02.2015

Jonetta L. Johnson, PhD, MPH Epidemiologist Division of Reproductive Health, CDC. MedicalResearch.com Interview with: Jonetta L. Johnson, PhD, MPH Epidemiologist Division of Reproductive Health, CDC. Medical Research: What is the background for this study? Dr. Johnson: Achieving adequate gestational weight gain (GWG) is important for optimal health of the infant and mother. Women who gain below or above Institute of Medicine (IOM) recommendations are more likely to experience maternal complications and negative infant birth outcomes. Realizing the importance of  gestational weight gain to maternal and infant health, the IOM established recommendations for  gestational weight gain based on a woman’s prepregnancy body mass index (BMI) in 1990 and updated them in 2009. Trends in GWG are particularly of interest since prepregnancy BMI has increased over time in the U.S and little data was available on how  gestational weight gain has changed over time. Medical Research: What are the main findings? Dr. Johnson: Our findings show that from 2000-2009, the majority of women did not gain weight within IOM GWG recommendations and that women were more likely to gain outside recommendations in more recent years. In fact, from 2000–2009, there was a gradual decrease (1.0 percentage point every 2 years) in women gaining within IOM  gestational weight gain recommendations  and a gradual increase (0.8 percentage points every 2 years) in women gaining above IOM recommendations while the percentage of women gaining weight below IOM recommendations remained relatively constant.  Although there were slight differences in mean gestational weight gain by BMI group,  gestational weight gain was about 31 pounds on average. The decreasing percentage of women gaining within IOM recommendations during our study period may be influenced by increases in prepregnancy BMI during the same time period because women in higher BMI groups are recommended to gain less weight during pregnancy compared to women in lower BMI groups.  Thus, even with no change in gestational weight gain over time, an increase in the proportion of women who are obese could result in a decrease in the proportion of women gaining within gestational weight gain recommendations. (more…)
Author Interviews, Gastrointestinal Disease, mBio, Weight Research / 06.02.2015

Senior Principal Investigator - Systems Biology Singapore Institute for Clinical Sciences Brenner Centre for Molecular Medicine SingaporeMedicalResearch.com Interview with: Joanna Holbrook PhD Senior Principal Investigator - Systems Biology Singapore Institute for Clinical Sciences Brenner Centre for Molecular Medicine Singapore Medical Research: What is the background for this study? Dr. Holbrook: Bacteria in the human gut may influence many aspects of our health; however, it is not fully known what determines the composition of the gut microbiota. Rapid bacterial colonisation of the infant gut could be influenced by the environment of the baby before birth, and microbiota content has been associated with the development of obesity and insulin resistance. Medical Research: What are the main findings? Dr. Holbrook: The rate of bacterial colonisation of the gut is influenced by external factors such as the method of delivery and duration of gestation. Also, infants with a mature gut bacteria profile at an early age gained normal levels of body fat, while infants with less mature gut bacteria profiles displayed a tendency to gain lower levels of body fat at the age of 18 months, indicating that gut bacteria could be related to normal development and healthy weight gain. (more…)
Author Interviews, Exercise - Fitness, Weight Research / 31.01.2015

Xuemei Sui, MD, MPH, PhD Assistant Professor, Department of Exercise Science Division of Health Aspects of Physical Activity Arnold School of Public Health University of South Carolina Columbia, SC 29208MedicalResearch.com Interview with: Xuemei Sui, MD, MPH, PhD Assistant Professor Department of Exercise Science Graduate Director Division of Health Aspects of Physical Activity Arnold School of Public Health University of South Carolina Columbia, SC 29208 Medical Research: What is the background for this study? Dr. Sui: Previous studies have established that low levels of cardiorespiratory fitness (CRF), an indicator of regular physical activity, and body compositions with higher fat mass serve as risk factors for cardiovascular disease and predictors of deaths related to cardiovascular disease. These studies have examined long-term trends of fatness (i.e., body fat) and cardiorespiratory fitness in children, adolescents and men, but few have looked at these factors in female populations. Therefore, the aim of this study was to investigate secular change of cardiorespiratory fitness and body composition during 35 years in a large sample of women enrolled in the Aerobics Center Longitudinal Study. 13 037  women aged 20 to 64 were enrolled in our study from January first, 1970, through December 31st, 2004. We divided our participants into 2 age groups, and divided 35 years into 7 time groups. Cardiorespiratory fitness was assessed by maximal treadmill testing using a modified Balke protocol, and the percentage of body fat was assessed by hydrostatic weighing or the sum of 7 skinfold measures, following standardized protocols. According to percent body fat, we divided body composition into fat mass and fat free mass. Medical Research: What are the main findings? Dr. Sui: The data showed that body mass index (BMI) increased over the 35-year period even though cardiorespiratory fitness levels rose as well. By looking at the body composition of the participants along with their BMIs, the researchers were able to observe that their body fat did not increase. This finding suggests that the weight gains that led to higher BMIs over time were not necessarily comprised of body fat. Participants may have been putting on muscle mass due to their increased physical activity, as indicated by their higher cardiorespiratory fitness. Another interesting finding was that when leisure-time physical activity (LTPA) reaches 668.5 MET min/wk, cardiorespiratory fitness stays at a higher level. So in order to improve cardiorespiratory fitness for physically inactive women, we should encourage them to meet this level. The drift downward in cardiorespiratory fitness among women indicates the need for continuing efforts to promote their physical activity and fitness. (more…)
Author Interviews, BMJ, Pediatrics, Weight Research / 30.01.2015

Dr Cornelia HM van Jaarsveld and Prof Martin C Gulliford, Department of Primary Care and Public Health Sciences King’s College London, London, UKMedicalResearch.com Interview with: Dr Cornelia HM van Jaarsveld and Prof Martin C Gulliford Department of Primary Care and Public Health Sciences King’s College London, London, UK Medical Research: What is the background for this study? What are the main findings? Response: Overweight and obesity in children have increased dramatically since the 1960s with important clinical and economic impacts, especially among those who become obese adults. Consequently, understanding trends in obesity is of increasing importance for monitoring population health and informing policy initiatives. Current trends suggest that a majority of the world’s population will be either overweight or obese by 2030. However, recent reports suggest that the increasing trend in overweight and obesity in children may have leveled off since 2000. But, in many countries data are based on a limited number of time points and relatively small surveys, limiting definitive conclusions and not allowing examining trends in subgroups by sex and age. Moreover, only a few countries have data on younger children (aged under 6 years). Our study aimed to use primary care electronic health records to examine prevalence of overweight and obesity in 2 to 15 year old children in England and to compare trends over two decades, from 1994 to 2003 and from 2004 to 2013. Medical Research: What are the main findings? Response: We found that currently about a third of children in the UK are overweight or obese. We also found that overweight and obesity prevalence increased during decade 1 (1994-2003) but stabilized in decade 2 (2004-2013). This was observed in both sexes and the in younger age groups (2-5 year and 6-10 year). However, rates continued to increase in older children (11-15 year), albeit at a slower speed than in decade 1 (1994-2003). (more…)
Author Interviews, Weight Research / 17.01.2015

Sue Shapses, PhD Professor, Department of Nutritional Sciences Acting Chair, Department of Exercise Sciences and Sports Studies Rutgers, The State University New Brunswick, NJ 08901-8525MedicalResearch.com Interview with: Sue Shapses, PhD Professor, Department of Nutritional Sciences Acting Chair, Department of Exercise Sciences and Sports Studies Rutgers, The State University New Brunswick, NJ 08901-8525 MedicalResearch: What is the background for this study? Dr. Shapses: Improving health outcomes through dieting and weight loss is encouraged for the majority of Americans who are either overweight or obese. However, while most studies show that a moderate reduction in body weight decreases obesity related comorbidities, there may also be loss of bone and muscle in older individuals. Specifically in postmenopausal women, intentional moderate weight loss results in a 1-2.5% bone loss when compared to a weight stable group. Studies in men, designed to address the effect of weight reduction at multiple bone sites, compartments and geometry, are currently lacking. In addition, while a higher body weight is associated with higher bone mass, evidence indicates that bone quality, a predictor of fracture risk, is compromised in the obese. It is possible that frequent dieting or weight cycling in these obese individuals may have deleterious effects on bone. Therefore, understanding whether bone quality changes with weight loss, is important to better predict osteoporosis risk in this population. In this controlled trial, the effect of dietary restriction on bone mineral density (BMD), geometry and strength were examined in middle aged and older obese/overweight men. In addition, we addressed whether endocrine changes associated with weight loss explain bone changes. (more…)
Author Interviews, Endocrinology, Weight Research / 16.01.2015

Caroline M. Apovian, MD Chair of the Endocrine Society task force that developed “Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline” Boston University School of Medicine Boston Medical CenterMedicalResearch.com interview with: Caroline M. Apovian, MD Chair of the Endocrine Society task force that developed “Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline” Boston University School of Medicine Boston Medical Center MedicalResearch: What is the background for this report? Dr. Apovian: The Food and Drug Administration has approved four new anti-obesity drugs – lorcaserin, phentermine/topiramate, naltrexone/bupropion and liraglutide – in the past two years. To help clinicians navigate this changing landscape, the Endocrine Society developed its Clinical Practice Guideline to provide strategies for prescribing drugs to manage obesity and promote weight loss. MedicalResearch: What are the main findings? Dr. Apovian: In the Clinical Practice Guideline, the Endocrine Society recommends that diet, exercise and behavioral modifications be part of all obesity management approaches. Other tools such as weight loss medications and bariatric surgery can be combined with behavioral changes to reduce food intake and increase physical activity, in appropriate patients. Patients who have been unable to successfully lose weight and maintain a goal weight may be candidates for prescription medication if they meet the criteria on the drug’s label as well as BMI criteria (BMI greater than or equal to 30 or greater than or equal to 27 with at least one comorbidity). Other recommendations from the CPG include:
  • If a patient responds well to a weight loss medication and loses 5 percent or more of their body weight after three months, the medication can be continued. If the medication is ineffective or the patient experiences side effects, the prescription should be stopped and an alternative medication or approach considered.
  • Since some diabetes medications are associated with weight gain, people with diabetes who are obese or overweight should be given medications that promote weight loss or have no effect on weight as first- and second-line treatments. Doctors should discuss medications’ potential effects on weight with patients.
  • Certain types of medication – angiotensin converting enzyme inhibitors, angiotensin receptor blockers and calcium channel blockers – should be used as a first-line treatment for high blood pressure in obese people. These are effective blood pressure treatments that are less likely to contribute to weight gain than an alternative medication, beta-adrenergic blockers.
  • When patients need medications that can have an impact on weight such as antidepressants, antipsychotic drugs and medications for treating epilepsy, they should be fully informed and provided with estimates of each option’s anticipated effect on weight. Doctors and patients should engage in a shared-decision making process to evaluate the options.
  • In patients with uncontrolled high blood pressure or a history of heart disease, the medications phentermine and diethylpropion should not be used.
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Author Interviews, JACC, Weight Research / 06.01.2015

MedicalResearch.com Interview with: Dr. Joshua Bell PhD Candidate Epidemiology & Public Health University College London, UK Medical Research: What is the background for this study? What are the main findings? Dr. Bell: When viewed at single points in time, about one-third of obese adults show normal metabolic profiles, that is, they have normal blood pressure, cholesterol and blood sugar levels. These adults have been labeled as 'healthy', but until now we have lacked evidence on the long-term stability of this state over time. By viewing theDr. Joshua Bell PhD Candidate Epidemiology & Public Health University College London, UK natural course of healthy obesity over two decades we found that about half of healthy obese adults become unhealthy obese after 20 years, with a clear trend for increasing progression to ill-health over time. Healthy obese adults are also much more likely to become unhealthy obese than healthy or unhealthy non-obese adults, indicating that healthy obesity is often just a phase. (more…)
Author Interviews, JAMA, Surgical Research, Weight Research / 06.01.2015

David Arterburn, MD, MPH, FACP Associate Investigator Group Health Research Institute Seattle, WA 9810MedicalResearch.com Interview with: David Arterburn, MD, MPH, FACP Associate Investigator Group Health Research Institute Seattle, WA 98101   and David L. Maciejewski PhD Center for Health Services Research in Primary Care Durham VA Medical Center, Durham, North CarolinaDavid L. Maciejewski PhD Center for Health Services Research in Primary Care Durham VA Medical Center, Durham, North Carolina MedicalResearch.com: Why was this study needed? Response: There were several reasons to conduct this study.  First, although complications and death during and soon after bariatric surgery have progressively declined over the past several decades, there is simply very little long-term evidence on the survival benefits of bariatric surgery in Americans having surgical procedures that are being used today in routine practice. Second, we felt that it was important to look at the impact of bariatric surgery among veterans because they represent an older male cohort often with multiple medical comorbidities, which is different from the typical bariatric patient in the United States, who is often younger and female. MedicalResearch.com: How was your study conducted? Response: We conducted a retrospective observational study using high-quality data from national Department of Veterans Affairs electronic databases and the VA Surgical Quality Improvement Program. We identified veterans who underwent bariatric surgery in VA medical centers from 2000 to 2011. Three quarters of them were men. We matched them to control patients using an algorithm that included age, sex, VA geographic region, body mass index (BMI), diabetes, and Diagnostic Cost Group. We then compared survival across bariatric patients and matched controls using Kaplan-Meier estimators and stratified, adjusted Cox proportional hazards analyses.  MedicalResearch.com: What were the main findings of your study? Response: This study had three important results: 1)      Our analysis showed no significant association between bariatric surgery and death from all causes in the first year of follow-up. In other words, having bariatric surgery was not significantly related to a veteran’s chance of dying in the first year compared to not having surgery. 2)      We had an average follow-up of 6.9 years in the surgical group and 6.6 years in the matched control group. After one to five years, adjusted analyses showed significantly lower mortality in the patients who had surgery: 55% lower, with a hazard ratio of 0.45. The finding was similar at 5 or more years, with a hazard ratio of 0.47. This means that bariatric surgery was associated with lower long-term mortality – that is, better long-term survival among veterans, which is consistent with limited non-VA research that has addressed this same question. 3)      Finally, we also found that the relationship between surgery and survival were similar comparing men and women, patients with and without diagnosed diabetes, and patients who had bariatric surgery before versus after year 2006. (more…)
Author Interviews, JAMA, Surgical Research, Weight Research / 31.12.2014

Jeffrey A. Gusenoff, MD Associate Professor of Plastic Surgery Co-Director, Life After Weight Loss Program Co-Director, BodyChangers Director, Post-Bariatric Body Contouring Fellowship UPMC Department of Plastic SurgeryMedicalResearch.com Interview with: Jeffrey A. Gusenoff, MD Associate Professor of Plastic Surgery Co-Director, Life After Weight Loss Program Co-Director, BodyChangers Director, Post-Bariatric Body Contouring Fellowship UPMC Department of Plastic Surgery Medical Research: What is the background for this study? What are the main findings? Dr. Gusenoff: With the rise in massive weight loss patients from bariatric surgery or diet and exercise, more patients are choosing to have a thighplasty to remove excess skin of the inner thigh. Many techniques exist for treating this, but there aren't many studies that look into the safety of these procedures in massive weight loss patients. What we found is that  many patients have scars that go all the way down the thigh with a fairly high complication rate of almost 70%. (more…)