Markers of dietary protein intake are associated with successful weight loss in the POUNDS Lost trial.

To assess the association of markers for dietary protein intake, measures of dietary adherence and demographic variables with weight loss in the POUNDS Lost study over the first 6 months and again between 6 and 24 months using data from those who completed each period. This is a secondary analysis of pooled data on completers assigned to one of four diets: 65%C/15%P/20%F (AP/LF), 55%C/25%P/20%F (HP/LF), 45%C/15%P/40%F (AP/HF) or 35%C/25%P40%F (HP/HF) in the POUNDS Lost study. Urinary nitrogen excretion, dietary adherence measured by 24-h recall and attendance at sessions, age (above and below 50 years), gender, race/ethnicity and activity by pedometry were analysed. Increased spread between protein intake at baseline and protein at 6 or 24 months, assessed by urinary nitrogen excretion, was associated with greater weight loss from baseline to 2 years. At 6 and 24 months, older age, male gender, body mass index > 30 kg m-2 and adherence to the fat and protein diets were associated with more weight loss. None of these variables was associated with a regain from 6 to 24 months. Weight regain for women in the highest carbohydrate (65%) group was significantly greater (-4.4 kg [95% CI: -5.9, -3.0]) than for women in the lowest carbohydrate group (-1.8 kg [95% CI: -3.2, -0.4 kg]) (P for interaction = 0.012). An increased spread in the difference between baseline and follow-up protein intake was associated with greater weight loss, consistent with the 'protein spread theory'. Women eating the highest carbohydrate diet regained more weight from 6 to 24 months.

Psychosocial predictors of weight loss by race and sex.

This paper examined the psychosocial predictors of weight loss among race and sex subgroups. Analyses included overweight and obese participants from the PREMIER study, a previously published randomized trial that examined the effects of two multi-component lifestyle interventions on blood pressure among pre-hypertensive and stage 1 hypertensive adults. Both intervention conditions received behavioural recommendations for weight loss and group sessions. Weight and psychosocial measures of self-efficacy and social support for diet and exercise were assessed at baseline and at 6 months. There were 157 African-American (AA) women, 46 AA men, 203 non-AA women and 182 non-AA men with an average age of 50 years and average body mass index of 34 at baseline. Multiple predictor regression models were performed individually by race and sex subgroup. Among AA women, increases in diet self-efficacy were associated with weight loss. Among AA men, increases in diet-related social support and self-efficacy, along with increases in family support to exercise, were associated with weight loss (all Ps <0.05). Among non-AA women, increases in friends' support to exercise and exercise-related self-efficacy were associated with weight loss, and among non-AA men only increases in diet self-efficacy were associated with weight loss (all Ps <0.05). These results emphasize the need for targeted interventions based on race and sex to optimize the impact of lifestyle-based weight loss programmes.

An international comparison of dietary patterns in 9-11-year-old children.

OBJECTIVES: Dietary pattern is defined as a combination of foods and drinks and the frequency of consumption within a population. Dietary patterns are changing on a global level, which may be linked to an increased incidence of chronic diseases. The aim of this study was to identify and compare the dietary patterns among 9-11-year-old children living in urban regions in different parts of the world. METHODS: Participants were 7199 children (54% girls), aged 9-11 years, from 12 countries situated in all major world regions. Food consumption was assessed using a 23-item Food Frequency Questionnaire (FFQ). To identify dietary patterns, principal components analyses (PCA) were carried out using weekly portions as input variables. RESULTS: Both site-specific and pooled PCA resulted in two strong components. Component 1 ('unhealthy diet pattern') included fast foods, ice cream, fried food, French fries, potato chips, cakes and sugar-sweetened sodas with >0.6 loadings. The loadings for component 2 ('healthy diet pattern') were slightly weaker with only dark-green vegetables, orange vegetables, vegetables in general, and fruits and berries reaching a >0.6 loading. The site-specific diet pattern scores had very strong correlations with the pattern scores from the pooled data: r=0.82 and 0.94 for components 1 and 2, respectively. CONCULSIONS: The results suggest that the same 'healthier' and 'unhealthier' foods tend to be consumed in similar combinations among 9-11-year-old children in different countries, despite variation in food culture, geographical location, ethnic background and economic development.

The reliability and validity of a short food frequency questionnaire among 9-11-year olds: a multinational study on three middle-income and high-income countries.

OBJECTIVE: The main aim of this study was to assess the reliability and validity of a food frequency questionnaire with 23 food groups (I-FFQ) among a sample of 9-11-year-old children from three different countries that differ on economical development and income distribution, and to assess differences between country sites. Furthermore, we assessed factors associated with I-FFQ's performance. METHODS: This was an ancillary study of the International Study of Childhood Obesity, Lifestyle and the Environment. Reliability (n=321) and validity (n=282) components of this study had the same participants. Participation rates were 95% and 70%, respectively. Participants completed two I-FFQs with a mean interval of 4.9 weeks to assess reliability. A 3-day pre-coded food diary (PFD) was used as the reference method in the validity analyses. Wilcoxon signed-rank tests, intraclass correlation coefficients and cross-classifications were used to assess the reliability of I-FFQ. Spearman correlation coefficients, percentage difference and cross-classifications were used to assess the validity of I-FFQ. A logistic regression model was used to assess the relation of selected variables with the estimate of validity. Analyses based on information in the PFDs were performed to assess how participants interpreted food groups. RESULTS: Reliability correlation coefficients ranged from 0.37 to 0.78 and gross misclassification for all food groups was <5%. Validity correlation coefficients were below 0.5 for 22/23 food groups, and they differed among country sites. For validity, gross misclassification was <5% for 22/23 food groups. Over- or underestimation did not appear for 19/23 food groups. Logistic regression showed that country of participation and parental education were associated (P⩽0.05) with the validity of I-FFQ. Analyses of children's interpretation of food groups suggested that the meaning of most food groups was understood by the children. CONCLUSION: I-FFQ is a moderately reliable method and its validity ranged from low to moderate, depending on food group and country site.

Associations between breakfast frequency and adiposity indicators in children from 12 countries.

OBJECTIVES: Reports of inverse associations between breakfast frequency and indices of obesity are predominantly based on samples of children from high-income countries with limited socioeconomic diversity. Using data from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), the present study examined associations between breakfast frequency and adiposity in a sample of 9-11-year-old children from 12 countries representing a wide range of geographic and socio-cultural variability. METHODS: Multilevel statistical models were used to examine associations between breakfast frequency (independent variable) and adiposity indicators (dependent variables: body mass index (BMI) z-score and body fat percentage (BF%)), adjusting for age, sex, and parental education in 6941 children from 12 ISCOLE study sites. Associations were also adjusted for moderate-to-vigorous physical activity, healthy and unhealthy dietary patterns and sleep time in a sub-sample (n=5710). Where interactions with site were significant, results were stratified by site. RESULTS: Adjusted mean BMI z-score and BF% for frequent breakfast consumers were 0.45 and 20.5%, respectively. Frequent breakfast consumption was associated with lower BMI z-scores compared with occasional (P<0.0001, 95% confidence intervals (CI): 0.10-0.29) and rare (P<0.0001, 95% CI: 0.18-0.46) consumption, as well as lower BF% compared with occasional (P<0.0001, 95% CI: 0.86-1.99) and rare (P<0.0001, 95% CI: 1.07-2.76). Associations with BMI z-score varied by site (breakfast by site interaction; P=0.033): associations were non-significant in three sites (Australia, Finland and Kenya), and occasional (not rare) consumption was associated with higher BMI z-scores compared with frequent consumption in three sites (Canada, Portugal and South Africa). Sub-sample analyses adjusting for additional covariates showed similar associations between breakfast and adiposity indicators, but lacked site interactions. CONCLUSIONS: In a multinational sample of children, more frequent breakfast consumption was associated with lower BMI z-scores and BF% compared with occasional and rare consumption. Associations were not consistent across all 12 countries. Further research is required to understand global differences in the observed associations.

Behavioral mediators of treatment effects in the weight loss maintenance trial.

BACKGROUND: The Weight Loss Maintenance Trial tested strategies for maintenance of weight loss. Personal contact was superior to interactive technology and self-directed conditions. PURPOSE: We aimed to identify behavioral mediators of the superior effect of personal contact vs. interactive technology and of personal contact vs. self-directed arms. METHODS: Overweight/obese adults at risk for cardiovascular disease (n = 1,032) who lost at least 4 kg were randomized to personal contact, interactive technology, or self-directed. After 30 months, 880 participants had data on weight and behavioral strategies. RESULTS: Reported increase of intake of fruits and vegetables and physical activity and more frequent self-weighing met criteria as mediators of the better outcome of personal contact vs. interactive technology. Increased intake of fruits and vegetables, more frequent self-weighing, and decreased dessert consumption were mediators of the difference between personal contact vs. self-directed. CONCLUSION: Inducing changes in the identified behaviors might yield better outcomes in future weight loss maintenance trials.

Diet type and changes in food cravings following weight loss: findings from the POUNDS LOST Trial.

Few well-controlled trials have evaluated the effects that macronutrient composition has on changes in food cravings during weight loss treatment. The present study, which was part of the Preventing Overweight Using Novel Dietary Strategies (POUNDS LOST) trial, investigated whether the fat and protein content of four different diets affected changes in specific food cravings in overweight and obese adults. A sample of 811 adults were recruited across two clinical sites, and each participant was randomly assigned to one of four macronutrient prescriptions: 1) low fat (20% of energy), average protein (15% of energy); 2) moderate fat (40%), average protein (15%); 3) low fat (20%), high protein (25%); 4) moderate fat (40%), high protein (25%). With few exceptions, the type of diet that participants were assigned did not differentially affect changes in specific food cravings. Participants assigned to the high-fat diets, however, had reduced cravings for carbohydrates at month 12 (p<0.05) and fruits and vegetables at month 24. Also, participants assigned to high-protein diets had increased cravings for sweets at month 6 and month 12 (ps<0.05). Participants in all four dietary conditions reported significant reductions in food cravings for specific types of foods (i.e., high fat foods, fast food fats, sweets, and carbohydrates/starches; all ps<0.05). Cravings for fruits and vegetables, however, were increased at month 24 (p<0.05). Calorically restricted diets (regardless of their macronutrient composition) yielded significant reductions in cravings for fats, sweets, and starches whereas cravings for fruits and vegetables were increased.

Effect of diet composition on energy expenditure during weight loss: the POUNDS LOST Study.

BACKGROUND: Weight loss reduces energy expenditure, but the contribution of different macronutrients to this change is unclear. HYPOTHESIS: We tested the hypothesis that macronutrient composition of the diet might affect the partitioning of energy expenditure during weight loss. DESIGN: A substudy of 99 participants from the Preventing Overweight Using Novel Dietary Strategies (POUNDS LOST) trial had total energy expenditure (TEE) measured by doubly labeled water, and resting energy expenditure (REE) measured by indirect calorimetry at baseline and repeated at 6 months in 89 participants. Participants were randomly assigned to one of four diets with either 15 or 25% protein and 20 or 40% fat. RESULTS: TEE and REE were positively correlated with each other and with fat-free mass and body fat, at baseline and 6 months. The average weight loss of 8.1 ± 0.65 kg (least-square mean ± s.e.) reduced TEE by 120 ± 56 kcal per day and REE by 136 ± 18 kcal per day. A greater weight loss at 6 months was associated with a greater decrease in TEE and REE. Participants eating the high-fat diet (HF) lost significantly more fat-free mass (1.52 ± 0.55 kg) than the low-fat (LF) diet group (P<0.05). Participants eating the LF diet had significantly higher measures of physical activity than the HF group. CONCLUSION: A greater weight loss was associated with a larger decrease in both TEE and REE. The LF diet was associated with significant changes in fat-free body mass and energy expenditure from physical activity compared with the HF diet.

Increased visceral fat and decreased energy expenditure during the menopausal transition.

OBJECTIVE: This study assessed longitudinal changes in body composition, fat distribution and energy balance in perimenopausal women. We hypothesized that total fat and abdominal body fat would increase at menopause due to decreased energy expenditure (EE) and declining estrogen, respectively. DESIGN: Observational, longitudinal study with annual measurements for 4 years. SUBJECTS: Healthy women (103 Caucasian; 53 African-American), initially premenopausal. During follow-up, lack of menstruation for 1 year and follicle-stimulating hormone >30 mIU ml(-1) defined a subject as postmenopausal. MEASUREMENTS: Fat and lean mass (dual-energy X-ray absorptiometry), visceral (VAT) and subcutaneous abdominal fat (SAT) (computed tomography), dietary intake (4-day food record), serum sex hormones and physical activity (tri-axial accelerometry). Twenty-four hour EE was measured by whole-room calorimeter in a subset of 34 women at baseline and at year 4. RESULTS: Body fat and weight increased significantly over time only in those women who became postmenopausal by year 4 (n=51). All women gained SAT over time; however, only those who became postmenopausal had a significant increase in VAT. The postmenopausal group also exhibited a significant decrease in serum estradiol. Physical activity decreased significantly 2 years before menopause and remained low. Dietary energy, protein, carbohydrate and fiber intake were significantly higher 3-4 years before the onset of menopause compared with menopause onset. Twenty-four hour EE and sleeping EE decreased significantly with age; however, the decrease in sleeping EE was 1.5-fold greater in women who became postmenopausal compared with premenopausal controls (-7.9 vs -5.3%). Fat oxidation decreased by 32% in women who became postmenopausal (P<0.05), but did not change in those who remained premenopausal. CONCLUSION: Middle-aged women gained SAT with age, whereas menopause per se was associated with an increase in total body fat and VAT. Menopause onset is associated with decreased EE and fat oxidation that can predispose to obesity if lifestyle changes are not made.

Anodic oxidation and hydrothermal treatment of commercially pure titanium surfaces increases expression of bone morphogenetic protein-2 in the adherent macrophage cell line J774A.1.

The surface property of commercially pure titanium (cpTi) was improved by forming a thin hydroxyapatite (HA) layer by anodic oxidation and hydrothermal treatment (HA/cpTi). We hypothesize that the adhesion of macrophages to HA/cpTi surfaces is important to the process of osseointegration. This study investigates the effect of adhesion of macrophages to HA/cpTi surfaces on the expression of bone morphogenetic protein-2 (BMP-2). The murine macrophage cell line J774A.1 was cultured on HA/cpTi and polished cpTi (S/cpTi). Macrophage cell adhesion was examined by SEM, 0-72 h following plating onto HA/cpTi and S/cpTi. BMP-2 gene expression was examined by RT-PCR analysis. The level of BMP-2 secreted into the supernatant was measured using an ELISA assay. The extent of macrophage adhesion increased with time on both the HA/cpTi and S/cpTi surfaces, with a" higher degree of spreading observed on HA/cpTi than onS/cpTi surfaces after 24 or 72 h. The ratio of BMP-2 mRNA was higher on HA/cpTi than on S/cpTi after 24 h (0.348 vs. 0, p < 0.05) and 72 h (0.584 vs. 0.189, p < 0.05). After 24 h, secretion of BMP-2 was detected in cultures grown on HA/cpTi, but not on S/cpTi. After 72 h, secretion of BMP-2 was detected in cultures grown on S/cpTi, but the levels were higher in cultures grown on HA/cpTi. These findings show that macrophages have the capacity to adhere to HA/cpTi endosseous implants and provide a source of osteoinductive cytokines that may play a key role in the process of osseointegration.

Titanium surface topography alters cell shape and modulates bone morphogenetic protein 2 expression in the J774A.1 macrophage cell line.

Macrophage cytokine expression significantly affects wound healing. Macrophage secretion of transforming growth factor beta 1 (TGFbeta1) and bone morphogenetic proteins (BMP) may affect osteogenesis at endosseous implant surfaces. The aim of this investigation was to determine the effect of commercially pure titanium (cpTi) substrate topography on adherent macrophage osteogenic and osteoinductive cytokine expression. J774A.1 murine macrophage cell adhesion was examined by scanning electron microscopy, 0-72 h following plating onto polished, machined, and grit-blasted cpTi surfaces. TGFbeta1 and BMP-2 gene expression by adherent macrophages was determined by the reverse transcription polymerase chain reaction. Macrophage adhesion increased with time on all surfaces and spreading increased with increasing surface roughness (polished < machined < grit-blasted). BMP-2 expression was not evident for cells adherent to polished cpTi at 24 h. In contrast, BMP-2 expression occurred at 24 h in cells adherent to machined and grit-blasted cpTi. BMP-2 expression was evident on all surfaces at 72 h and was greatest in grit-blasted titanium adherent cells. Increasing concentrations of cytochalasin B (0-50 microM) inhibited macrophage spreading and reduced BMP-2 mRNA expression, suggesting a relationship between cell shape and BMP-2 expression. This was further characterized using anti-beta1 and anti-beta3 integrin antibodies. The anti-beta1 integrin antibodies inhibited adherent macrophage BMP-2 mRNA expression. Anti-beta3 integrin antibody treatment only modestly reduced BMP-2 mRNA expression. Endosseous implant surface topography induced changes in macrophage shape that were associated with changes in BMP-2 expression in J774A.1 mouse macrophage cell line. This first demonstration of BMP-2 expression by cpTi adherent macrophages suggests that the macrophage may contribute surface-specific osteoinductive signals during bone formation at implanted alloplastic surfaces.

Macrophage cell lines produce osteoinductive signals that include bone morphogenetic protein-2.

Bone wound healing requires osteoinductive signals that are attributed to (the) bone morphogenetic proteins (BMPs). The cellular origin of such osteoinductive signals has only been partially elucidated. Because of the central role of the macrophage in cutaneous wound healing, we hypothesized that the macrophage could play a similar role in osseous healing. It was the aim of the present investigation to examine the possible expression of BMP by the macrophage, and to evaluate the contribution of macrophage products to an early step of bone formation modeled in an in vitro culture system. The synthesis of BMP-2 and BMP-6 by cultured human and murine macrophages was evaluated by reverse transcription-polymerase chain reaction (RT-PCR). When human mesenchymal stem cells (hMSCs) were grown in conditioned media from J774A.1 cells, alkaline phosphatase expression increased. This induction was blocked by anti-BMP-2 antibody and by anti-transforming growth factor-beta1 (TGF-beta1) antibody. Modeling of the macrophage expression of osteoinductive signals by potential physiological situations was evaluated by treatments with lipopolysaccharide (LPS) or macrophage chemotactic peptide-1 (MCP-1). Macrophage BMP-2 expression was reduced by proinflammatory LPS stimulation (which was confirmed to induce release of the proinflammatory cytokine, TNF-alpha), and conditioned media from LPS-treated macrophages had no ability to increase alkaline phosphatase activity in hMSCs. This first study of macrophage BMP-2 expression indicates that the macrophage is capable of physiological regulation consistent with a key role in osteoinduction for osseous wound healing.

Body composition of African American and white children: a 2-year follow-up of the BAROC study.

OBJECTIVE: To evaluate the 2-year changes in body composition of white and African American boys and girls. RESEARCH METHODS AND PROCEDURES: A total of 114 boys and girls ages 12 to 14 years with equal sex and ethnic distribution between African American and white races participated in measurements of body composition using DXA, underwater weighing (densitometry), skinfold thickness, corporal diameters, circumferences, isotope dilution (H(2)(18)O), and bioelectric impedance. RESULTS: Sixty-eight of the 114 children advanced from Tanner Stages 1 and 2 to Tanner Stages 3 to 5 over a 2-year period. More than 50% of the children were in the top 15th percentile according to normative data for body mass index but not for triceps skinfold. All measures except for percentage of fat, density, and four of the six skinfolds increased significantly during the 2 years, with no differences between races, genders, or fat group. The boys who advanced in Tanner Stage reduced their percentage of fat and a number of skinfolds and increased their lean body mass, but the girls did not. The percentage of water was significantly higher in the fatter children and declined significantly over 2 years. Most children remained in the same quartile of body fat, lean body mass, and bone mineral content over 2 years. DISCUSSION: The data are consistent with the hypothesis that over 2 years, growth is the major determinant of changing body composition, with body-fat group and sexual maturation being additional variables.

Ethnic differences in dietary intakes, physical activity, and energy expenditure in middle-aged, premenopausal women: the Healthy Transitions Study.

BACKGROUND: Menopause is a time of increased risk of obesity in women. The effect of menopause in African American women, in whom obesity is already highly prevalent, is unknown. OBJECTIVE: We compared dietary intakes and energy expenditure (EE) between middle-aged, premenopausal African American and white women participating in a longitudinal study of the menopausal transition. DESIGN: Dietary intakes by food record, EE by triaxial accelerometer, physical activity by self-report, and body composition by dual-energy X-ray absorptiometry were compared in 97 white and 52 African American women. Twenty-four-hour and sleeping EE were measured by whole-room indirect calorimetry in 56 women. RESULTS: Sleeping EE (adjusted for lean and fat mass) was lower in African American than in white women (5749 +/- 155 compared with 6176 +/- 75 kJ/d; P = 0.02); however, there was no significant difference in 24-h EE between groups. Reported leisure activity over the course of a week was less in African American than in white women (556 +/- 155 compared with 1079 +/- 100 kJ/d; P = 0.02), as were the daily hours spent standing and climbing stairs. Dietary intakes of protein, fiber, calcium, magnesium, and several fatty acids were significantly less in African Americans, whereas there were no observed ethnic differences in intakes of fat or carbohydrate. Body fat within the whole group was positively correlated with total, saturated, and monounsaturated fat intakes and inversely associated with fiber and calcium intakes. Fiber was the strongest single predictor of fatness. CONCLUSION: Ethnic differences in EE and the intake of certain nutrients may influence the effect of menopausal transition on obesity in African American women.

Incorporating new recipes into the Armed Forces Recipe File: determination of acceptability.

As part of a project of decrease fat, cholesterol, and sodium in soldiers' diets, new ethnic and breakfast items were developed and standardized for 100 portions. Acceptability data were collected after initial recipe development, during recipe validation at a collaborating university, and in an actual Army garrison. Acceptability was determined using a nine-point hedonic scale; products rating > or = 6.0 in initial tests were prepared in garrison. Acceptability data were compared among test settings, ethnic categories, and food type. When grouped by ethnic categories, acceptability ratings varied more than when grouped by food type. Ratings varied most between development and validation settings (7.2 vs. 6.6; p < 0.05) and least between validation and actual Army settings (6.6 vs. 6.6; not significant). Because acceptability ratings were similar between the validation site and the Army garrison, future recipe development may continue without additional testing at actual Army garrisons, leading to more timely armed forces recipe file additions.

Relationship of dietary fat and serum cholesterol ester and phospholipid fatty acids to markers of insulin resistance in men and women with a range of glucose tolerance.

High-fat diets are associated with insulin resistance, however, this effect may vary depending on the type of fat consumed. The purpose of this study was to determine the relationship between intakes of specific dietary fatty acids (assessed by 3-day diet records and fatty acid composition of serum cholesterol esters [CEs] and phospholipids [PLs]) and glucose and insulin concentrations during an oral glucose tolerance test (OGTT). Nineteen men and 19 women completed the study. Nine subjects had type 2 diabetes or impaired glucose tolerance. Fasting insulin correlated with reported intakes of total fat (r = .50, P < .01), monounsaturated fat (r = .44, P < .01), and saturated fat (r = .49, P < .01), but not with trans fatty acid intake (r = .11, not significant [NS]). Fasting glucose also correlated with total (r = .39, P < .05) and monounsaturated fat intakes (r = .37, P < .05). In multivariate analysis, both total and saturated fat intake were strong single predictors of fasting insulin (R2 approximately .25), and a model combining dietary and anthropometric measures accounted for 47% of the variance in fasting insulin. Significant relationships were observed between fasting insulin and the serum CE enrichments of myristic (C14:0), palmitoleic (C16:1), and dihomo-gamma-linolenic (C20:3n-6) acids. In multivariate analysis, a model containing CE 14:0 and percent body fat explained 45% of the variance in fasting insulin, and C14:0 and age explained 30% of the variance in fasting glucose. PL C20:3n-6 explained 30% of the variance in fasting insulin, and a model including PL C18:1n-11 cis, C20:3n-6, age and body fat had an R2 of .58. In conclusion, self-reported intake of saturated and monounsaturated fats, but not trans fatty acids, are associated with markers of insulin resistance. Furthermore, enhancement of dihomo-gamma-linolenic and myristic acids in serum CE and PL, presumably markers for dietary intake, predicted insulin resistance.

Maternal periodontitis and prematurity. Part I: Obstetric outcome of prematurity and growth restriction.

Oral Conditions and Pregnancy (OCAP) is a 5-year prospective study of pregnant women designed to determine whether maternal periodontal disease contributes to the risk for prematurity and growth restriction in the presence of traditional obstetric risk factors. Full-mouth periodontal examinations were conducted at enrollment (prior to 26 weeks gestational age) and again within 48 hours postpartum to assess changes in periodontal status during pregnancy. Maternal periodontal disease status at antepartum, using a 3-level disease classification (health, mild, moderate-severe) as well as incident periodontal disease progression during pregnancy were used as measures of exposures for examining associations with the pregnancy outcomes of preterm birth by gestational age (GA) and birth weight (BW) adjusting for race, age, food stamp eligibility, marital status, previous preterm births, first birth, chorioamnionitis, bacterial vaginosis, and smoking. Interim data from the first 814 deliveries demonstrate that maternal periodontal disease at antepartum and incidence/progression of periodontal disease are significantly associated with a higher prevalence rate of preterm births, BW < 2,500 g, and smaller birth weight for gestational age. For example, among periodontally healthy mothers the unadjusted prevalence of births of GA < 28 weeks was 1.1%. This was higher among mothers with mild periodontal disease (3.5%) and highest among mothers with moderate-severe periodontal disease (11.1%). The adjusted prevalence rates among GA outcomes were significantly different for mothers with mild periodontal disease (n = 566) and moderate-severe disease (n = 45) by pair-wise comparisons to the periodontally healthy reference group (n = 201) at P = 0.017 and P < 0.0001, respectively. A similar pattern was seen for increased prevalence of low birth weight deliveries among mothers with antepartum periodontal disease. For example, there were no births of BW < 1000 g among periodontally healthy mothers, but the adjusted rate was 6.1% and 11.4% for mild and moderate-severe periodontal disease (P = 0.0006 and P < 0.0001), respectively. Periodontal disease incidence/progression during pregnancy was associated with significantly smaller births for gestational age adjusting for race, parity, and baby gender. In summary, the present study, although preliminary in nature, provides evidence that maternal periodontal disease and incident progression are significant contributors to obstetric risk for preterm delivery, low birth weight and low weight for gestational age. These studies underscore the need for further consideration of periodontal disease as a potentially new and modifiable risk for preterm birth and growth restriction.

Differential oxidation of individual dietary fatty acids in humans.

BACKGROUND: Dietary fatty acids that are more prone to oxidation than to storage may be less likely to lead to obesity. OBJECTIVE: The aim of this study was to determine the effect of chain length, degree of unsaturation, and stereoisomeric effects of unsaturation on the oxidation of individual fatty acids in normal-weight men. DESIGN: Fatty acid oxidation was examined in men consuming a weight-maintenance diet containing 40% of energy as fat. After consuming the diet for 1 wk, subjects were fed fatty acids labeled with (13)C in the methyl or carboxyl position (10 mg/kg body wt). The fatty acids fed in random order were laurate, palmitate, stearate, oleate, elaidate (the trans isomer of oleate), linoleate, and linolenate blended in a hot liquid meal. Breath samples were collected for the next 9 h and the oxidation of each fatty acid was assessed by examining liberated (13)CO(2) in breath. RESULTS: Cumulative oxidation over the 9-h test ranged from a high of 41% of the dose for laurate to a low of 13% of the dose for stearate. Of the 18-carbon fatty acids, linolenate was the most highly oxidized and linoleate appeared to be somewhat conserved. (13)C recovery in breath from the methyl-labeled fatty acids was approximately 30% less than that from the carboxyl-labeled fatty acids. CONCLUSIONS: In summary, lauric acid is highly oxidized, whereas the polyunsaturated and monounsaturated fatty acids are fairly well oxidized. Oxidation of the long-chain, saturated fatty acids decreases with increasing carbon number.

Periodontal medicine: emerging concepts in pregnancy outcomes.

The term periodontal medicine encompasses the study of the contribution of periodontal infections on several systemic conditions such as atherosclerosis, myocardial infarction, stroke, diabetes, and premature delivery. The early reports of a linkage between periodontitis and systemic conditions are gaining further support from additional epidemiological studies. The evidence continues to suggest that maternal periodontitis may bean important risk factor or risk indicator for pregnancies culminating in preterm low birth-weight deliveries. Potential mechanisms by which infectious challenge of periodontal origin and systemic inflammation may serve as a potential modifier of parturition are discussed. Furthermore, preliminary data are presented, supporting a hypothetical model in which periodontal pathogens disseminate systemically within the mother and gain access to the foetal compartment. Several aspects of this hypothetical model remain to be elucidated. Only the clarification of the mechanisms of pathogenesis of both periodontitis and premature deliveries will ultimately allow for accurate diagnoses and successful therapies. The concept of diagnosing and treating a periodontal patient to minimise the deleterious effects of this chronic infectious and inflammatory condition on systemic conditions represents both an unprecedented challenge and opportunity to our profession.

Descriptive characteristics of the dietary patterns used in the Dietary Approaches to Stop Hypertension Trial. DASH Collaborative Research Group.

The Dietary Approaches to Stop Hypertension trial was a randomized, multicenter, controlled feeding study to compare the effect on blood pressure of 3 dietary patterns: control, fruits and vegetables, and combination diets. The patterns differed in selected nutrients hypothesized to alter blood pressure. This article examines the food-group structure and nutrient composition of the study diets and reports participant nutrient consumption during intervention. Participants consumed the control dietary pattern during a 3-week run-in period. They were then randomized either to continue on the control diet or to change to the fruits and vegetables or the combination diet for 8 weeks. Sodium intake and body weight were constant during the entire feeding period. Analysis of variance models compared the nutrient content of the 3 diets. Targeting a few nutrients thought to influence blood pressure resulted in diets that were profoundly different in their food-group and nutrient composition. The control and fruits and vegetables diets contained more oils, table fats, salad dressings, and red meats and were higher in saturated fat, total fat, and cholesterol than was the combination diet. The fruits and vegetables and combination diets contained relatively more servings of fruits, juices, vegetables, and nuts/seeds, and were higher in magnesium, potassium, and fiber than was the control diet. Both the fruits and vegetables and combination diets were low in sweets and sugar-containing drinks. The combination diet contained a greater variety of fruits, and its high calcium content was obtained by increasing low-fat dairy products. In addition, the distinct food grouping pattern across the 3 diets resulted in substantial differences in the levels of vitamins A, C, E, folate, B-6, and zinc.