Comparison of physical and psychological status in younger and older overweight-obese women.

BACKGROUND AND AIM: Obesity prevalence is noticeably growing, even in the elderly. Most of the studies concerning the impact of obesity in the elderly evaluated physical co-morbidities, whilst very few data are available on psychological co-morbidities in people ≥ 60 years of age. The present study aimed to compare anthropometrical measures, physical co-morbidities and psychosocial factors correlated with overweight and obesity in younger and elderly people. METHODS AND RESULTS: In 456 women in the age range of 18-59 years and 128 women in the age range of 60-80 years with body mass index (BMI) ≥ 25/kg m², body weight, height and waist and hip circumferences were measured. The presence of co-morbidities such as osteoarthritis, hypertension, type 2 diabetes and hypercholesterolaemia was assessed. The Obesity Related Well Being 97 Questionnaire (ORWELL 97), Body Uneasiness Test (BUT), Symptom Check List 90 (SCL 90) and Binge Eating Scale (BES) tests were used to evaluate psychometric variables. BMI was not significantly different between younger overweight-obese subjects and older overweight-obese subjects, whereas waist circumference and waist-to-hip ratio (WHR) were significantly higher in the elderly. Osteoarthritis, hypertension and hypercholesterolaemia were significantly more frequent in the elderly. Older overweight-obese subjects had better scores in most of the psychometric questionnaires. CONCLUSIONS: Our results show that older overweight-obese subjects have generally more physical co-morbidities but a better psychological status than younger adults, despite similar BMI. These data may contribute to a better understanding of obesity consequences in the elderly and may help clinicians to differentiate obesity treatments in relation to patients' age.

Individual versus group therapy for obesity: comparison of dropout rate and treatment outcome.

AIMS: To compare outcome and dropout rates of an individual nutritional counselling (IT) and a cognitive behavioural group therapy (GT) after 6 months of treatment. METHODS: One hundred and twenty-nine women (72 in the IT and 57 in the GT group) aged 18-65 years, with body mass index (BMI) > or =25 kg/m(2). Body weight, height and waist circumference were measured. Obesity Related Well Being 97 questionnaire (ORWELL 97), Body Uneasiness Test (BUT), Symptom Check List 90 (SCL 90) and Binge Eating Scale (BES) tests were used to evaluate psychometrical variables. RESULTS: After 6 months, 37.2% (54.2% of initial IT sample and 15.8% of initial GT sample) of subjects abandoned the treatment programme. Completers were older (p<0.03) and had a worse BUTa General Severity Index score (p<0.04) than non-completers. IT had a higher dropout rate than GT. After 6 months of treatment completers lost 6.39% of initial weight and obtained improvements in all studied variables, except scores of SCL 90 and BUTb Positive Symptom Distress Index questionnaires. IT and GT groups did not differ significantly. CONCLUSIONS: Outcomes of IT and GT were comparable in all studied variables, whereas dropout rate of IT was higher than that of GT, suggesting that some characteristics of GT can contribute to the reduction of attrition. Younger age and better body image (measured by BUT) were associated to dropout. After weight loss we observed improvements in almost all variables in both groups without differences.

The relationship between body image and quality of life in treatment-seeking overweight women.

OBJECTIVE: To test the impact of body image on quality of life in overweight and obese people; to evaluate longitudinally the relationship between changes in body image, anthropometrical measurements and quality of life. DESIGN: A cross-sectional study and a longitudinal study in a sub-sample after 6 months. SUBJECTS: 308 women in the cross-sectional study and 56 in the longitudinal study, aged 21-65, with body mass index (BMI) > 25 kg/m2 and selected from people who had been sought treatment for overweight in our Institute from 1998 to 2001. MEASUREMENTS: Body weight, body height, waist and hip circumferences. The ORWELL 97 questionnaire to evaluate the obesity related quality of life (ORQL) and the BUT questionnaire to assess the body image (BI) were used. RESULTS: The BUT score was the variable that explained the greatest amount of variance of ORWELL 97 both in cross-sectional and longitudinal studies. Despite no significant differences in athropometrical variables were found between subjects who dropped out and those who did not, psychometrical scores were significantly better in patients still in treatment in follow-up. CONCLUSION: BI is related to subjective ORQL independently of anthropometrical measurements both at baseline and after treatment. Better psychometrical scores in people still in treatment after 6 months suggest that BI could be considered one of the variables which influence compliance to the treatment program, this fact needs more investigations and could be of interest in obesity treatment outcome studies.

Effect of vegetarian diet on homocysteine levels.

OBJECTIVE: To compare fasting total plasma homocysteine (tHcy) levels in vegans, lacto-ovovegetarians and control subjects, and to evaluate the relationships between tHcy levels and nutritional variables in vegetarians. METHODS: The study was conducted on 45 vegetarian subjects: 31 vegans (19 males, 12 females, mean age 45.8 +/- 15.8 years); 14 lacto-ovovegetarians (6 males, 8 females, mean age 48.5 +/- 14.5 years), and 29 control subjects (19 males, 10 females, mean age 43.4 +/- 16.7 years). tHcy was evaluated by high-performance liquid chromatography. Serum vitamin B(12) and folate were analyzed by automated chemiluminescence systems. Clinical records, nutritional and anthropometric variables were collected for all vegetarian subjects. RESULTS: tHcy was significantly higher in vegetarian subjects than in controls (23.9 +/- 21.3 vs. 11.6 +/- 4.9 micromol/l, p < 0.001). The prevalence of hyperhomocysteinemia was higher in vegetarians than in controls (53.3 vs. 10.3%, p < 0.001). Serum vitamin B(12) levels were lower in vegetarians than in control subjects (171.2 +/- 73.6 vs. 265.0 +/- 52.2 pmol/l, p < 0.01; normal range 220-740 pmol/l). In vegetarian subjects, significant inverse correlations were found between tHcy and serum vitamin B(12) levels (r = -0.776, p < 0.001) and between tHcy and serum folate levels (r = -0.340, p < 0.05). Positive correlations were found between tHcy and mean red cell volume (r = 0.44, p < 0.01) and between tHcy and fat-free mass (r = 0.36, p < 0.05). CONCLUSION: Vegetarian subjects presented significantly higher tHcy levels, higher prevalence of hyperhomocysteinemia, and lower serum vitamin B(12) levels than controls.

Homocysteine and life-style in the elderly.

Elevated homocysteine increases the risk of vascular diseases but little information is available about this issue in the elderly. The aim of this cross-sectional study was to evaluate the relationships between homocysteinemia and gender, anthropometric, and life-style characteristics in a community-dwelling elderly population (65 men and 120 women; 67-78 years). Basal plasma homocysteine levels were determined by High Performance Liquid Chromatography (HPLC). Clinical records, and nutritional and anthropometric variables were collected in all subjects. Body composition was evaluated in all subjects by Dual energy X-ray Absorptiometry (DXA). Thirty-three percent of women and 66% of men had hyper-homocysteinemia. In women, a positive correlation was present between homocysteinemia, age, diastolic blood pressure and plasmatic creatinine, and a negative correlation between homocysteine, fiber intake and folates. In males, there was a positive correlation between plasma homocysteine, age, and body mass index. Multiple regression analysis showed that fat-free mass, cigarette smoking, fiber intake, vitamin B6 and total kcal intake accounted for 18% of homocysteine variance in males (R2 = 0.18, p<0.05). Significantly higher homocysteine values were found in women with a history of cardiovascular disease than in those without (16.6 +/- 9.4 vs 13.8 +/- 4.4 micromol/L, p<0.05). Homocysteinemia was significantly higher in elderly men compared to women (16.7 +/- 4.7 vs 15.3 +/- 7.6; p<0.05). Gender differences in homocysteine disappeared after adjusting for fat-free mass. This study confirms the age-related increase in plasma homocysteine. Life-style characteristics seem to influence significantly homocysteine levels in the elderly. Our study shows that gender effects on homocysteine may be attributed to differences in body composition.

Resting metabolic rate and thermogenic effect of food in vegetarian diets compared with Mediterranean diets.

The purpose of our work is to compare the resting metabolic rate (RMR) and thermogenic effect of food (TEF) in a group of vegetarians and a group of subjects consuming a Mediterranean diet. The composition of the diets was similar. Thirty-two subjects were studied: 16 vegetarians (age 34 +/- 9 years, BMI 21 +/- 2) and 16 omnivors (age 30 +/- 5 years, BMI 22 +/- 3). All were in excellent general health. Each subject consumed a dish of pasta (100 g) and bread (30 g) after RMR had been measured. TEF was measured over the next 3 h and calculated as the incremental area above RMR. Energy (vegetarians and omnivors 7,727 +/- 3,516 vs 8,970 +/- 2,273 kJ/day, respectively) and carbohydrate (vegetarians and omnivors 285.1 +/- 141.3 vs. 300.1 +/- 74 g/day, respectively) intakes of the 2 groups were similar. The vegetarian group consumed a higher quantity of fiber (30.5 +/- 16.7 vs. 16.5 +/- 7.9) and a lower amount of protein (44.9 +/- 18.3 vs. 70.1 +/- 14.9) than the omnivorous group. No significant differences were observed in RMR (4.23 +/- 0.96 vs. 4.06 +/- 0.54 kJ/min) and TEF (0.50 +/- 0.25 vs. 0.38 +/- 0.25 Delta kJ/min) between the groups. Results did not change after correcting for weight, age and gender. Our study failed to show any significant differences in RMR and TEF between vegetarians and subjects consuming a Mediterranean diet. We conclude that vegetarianism per se is not accompanied by a difference in RMR and TEF when the carbohydrate content of the diet is similar to a control group of nonvegetarians.

Effect of altitude on body composition during mountaineering expeditions: interrelationships with changes in dietary habits.

Loss of body weight occurs during high mountain expeditions but whether it is due to inadequate diet or other factors is unknown. Moreover the composition of the weight loss is unclear. The aim of our study was to compare the nutritional, anthropometric and metabolic changes during a mountaineering expedition in two groups of climbers, whose dietary energy intake was ad libitum, one given a lacto-fish-ovo-vegetarian diet and one an omnivorous diet. The intake of various nutrients, body weight, body composition and metabolic variables were evaluated before and during high altitude exposure and after the return to low altitude. The two groups were matched for age, body mass index and gender. No significant differences were found for nutritional variables between the two groups. Energy, animal and vegetable protein and fiber intake were significantly lower at climbing quote than before the beginning of the expedition. Significant differences between before the beginning and base camp in all variables were found. Energy and animal protein intake, but not vegetable protein and fiber intake, were significantly lower at climbing quote than at base camp. All subjects significantly reduced body weight, body mass index, waist and hip circumferences but not fat-free mass and fat mass. Metabolic variables significantly improved after the mountaineering expedition. Our study seems to confirm that a mountaineering expedition decreases energy and protein intake, reduces body weight and improves metabolic variables. Because our subjects spontaneously tended to have the same food intake despite the different dietary recommendations, our study failed to observe any differences between the two groups. However, our study shows that a low protein diet, in which the type of protein is mostly vegetable protein, could be adapted for climbers determining only a small decrease of fat-free mass.

Alcohol consumption, smoking habits and body fat distribution in Italian men and women aged 20-60 years.

The study was performed on 601 patients (294 males and 307 females) of a general practitioner. Alcohol intake and smoking habits were compared with other anthropometric measurements including waist-to-hip girth ratio. Patients were divided into non-smokers and smokers (subdivided into three groups according to the number of cigarettes smoked per day) and into non-drinkers and drinkers (subdivided into three groups with different alcohol intakes). Ex-smokers were excluded from the study. Analysis of covariance using age, body mass index, physical activity and menopausal status as covariates, showed that: (1) cigarette smoking is not accompanied by a specific pattern for body fat distribution; (2) waist-to-hip ratio was significantly different for the four classes of alcohol intake for women (non-drinkers: 0.809, < 11 g: 0.805, 11-20 g: 0.809, > 20 g: 0.826; F = 2.8, P < 0.05) but not for men (non-drinkers: 0.944, < 20 g: 0.934, 21-40 g: 0.940, > 40 g: 0.943; F = 0.9); (3) increased alcohol intake corresponds to an increased lipid and energy supply.