Organoleptic and glycemic properties of chickpea-wheat composite breads.

Prevalence of obesity and type-2-diabetes requires dietary manipulation. It was hypothesized that wheat-legume-composite breads will reduce the spike of blood glucose and increase satiety. Four pan bread samples were prepared: White bread (WB) as standard, Whole-wheat bread (WWB), WWB supplemented with chickpea flour at 25 % (25%ChB) and 35 % (35%ChB) levels. These breads were tested in healthy female subjects for acceptability and for effect on appetite, blood glucose, and physical discomfort in digestion. The breads were rated >5.6 on a 9-point hedonic scale with WB significantly higher than all other breads. No difference in area under the curve (AUC) for appetite was found, but blood glucose AUC was reduced as follows: 35%ChB < WB and WWB, WB >25%ChB = WWB or 35%ChB. We conclude that addition of chickpea flour at 35 % to whole wheat produces a bread that is acceptable to eat, causing no physical discomfort and lowers the glycemic response.

Association of Unhealthy Exercise Patterns with Overweight and Obesity in Kuwaiti Adults.

BACKGROUND: Our aim was to investigate the frequency of the behaviors that are most often associated with excess weight gain in Kuwaitis and to determine which gender and age groups are at highest risk for each behavior. METHODS: A questionnaire developed to identify barriers to exercise in western populations was modified for use with Kuwaitis and posted online during September through December 2012. Data from 1370 adults 18 to 59 years old with BMIs ranging from 15.1-70.8 was collected. The prevalence of seven behavior patterns was examined for age, BMI, and gender groups as well as the odds ratio of each behavior for each BMI group. RESULTS: Both individual unhealthy exercise behaviors and the sum of all such behaviors were more frequent in over-weight and obese individuals. For all behaviors the odds ratio was significantly greater for those with BMIs of 30-39 than for those with BMIs below 25 (P< 0.05). Some exercise avoidance behaviors were more frequent in older age groups and in overweight females. CONCLUSION: Unhealthy exercise behavior patterns were highly prevalent in obese individuals. Tailoring programs and counseling to the most common of these patterns in Kuwaiti obese should facilitate greater success in weight management.

Relationship between perceived body image and recorded body mass index among Kuwaiti female university students.

The associations between body image and attitudes toward obesity and thinness and their associations with measured body mass index (BMI) among female students of Kuwait University (n = 137) was examined in 2008. The body image perceptions were assessed using nine female silhouettes figures. The difference between current perceived body image (PBI) and ideal body image (IBI) was used as a measure of body image dissatisfaction (BID). Students tended to have a bigger PBI and smaller IBI than would be expected from their BMI category, leading to high levels of BID in each BMI category. PBI, IBI, BID, RBI were highly correlated with each other, and BMI was significantly correlated with each of them. The coefficients of these associations were not significantly altered in multiple regression analysis by the addition of potential confounding variables, such as age, marital status, physical activity, dieting behavior, parental education, and family size. These results suggest that PBI and a desire to be thinner were strongly related to BID and that thinness is becoming more desired in Kuwaiti society than the plump body image of the past.

Whey protein sweetened beverages reduce glycemic and appetite responses and food intake in young females.

We hypothesized that whey protein (WP) will reduce the blood glucose spike, increase satiety, and reduce subsequent energy intake. The objective of the current study was to investigate WP-glucose mixed drinks relative to glucose or WP alone on glycemic response, appetite and energy intake (EI). In Experiment 1 sweetened beverages of 300-mL solution were given to 12 normal-weight females once a week after an overnight fast at 50 g or 75 g glucose, 25 g WP or 25 g WP with 50 g glucose. In Experiment 2 similar beverages were given to 15 normal-weight and 15 overweight females at 25 g glucose, 25 g WP alone or with 25 g glucose. Blood glucose and appetite were measured simultaneously at 0, 15, 30, 45, 60, 90, 120, 150 and 180 minutes in Experiment 1 and at the same time points but up to 120 minutes in Experiment 2. EI was calculated from a meal served at 180 minutes in Experiment 1. The blood glucose spike and hypoglycemia were reduced after WP and WP supplemented glucose in both normal-weight and overweight subjects resulting in smaller incremental area under the curves compared to the pure glucose (P < .05). EI was reduced after both WP drinks with or without glucose (P < .05). Changes in appetite and blood glucose at 180 minutes and blood glucose area under the curves were associated with EI. In conclusion, WP sweetened beverages attenuated blood glucose and appetite in both normal-weight and overweight females and reduced EI in normal-weight females at a 25 g level.

Trends and risk factors of hyperglycemia and diabetes among Kuwaiti adults: National Nutrition Surveillance Data from 2002 to 2009.

BACKGROUND: Current prevalence estimates for diabetes in Arabian Gulf countries are some of the world's highest, yet regional trends and contributing factors are poorly documented. The present study was designed to determine temporal changes in the prevalence of impaired fasting glucose (IFG) and diabetes and associated factors in Kuwaiti adults. METHODS: Data analysis from the nationally representative cross-sectional Kuwait National Nutrition Surveillance System. 2745 males and 3611 females, aged 20-69 years, attending registration for employment or pensions and Hajj Pilgrimage health check-ups or accompanying children for immunizations from 2002 through 2009 were participated. Socio-demographic and lifestyle information, height and weight, and blood samples were collected. RESULTS: During the 8 years (2002-09), prevalences of IFG in males and females decreased by 7.4% and 6.8% and of diabetes by 9.8% and 8.9% in males and females, respectively. Linear regression for blood glucose level with time, adjusted for age, BMI, blood cholesterol and education level, showed a greater decrease in males than females (1.12 vs 0.93 mmol/L); males also showed an increase in 2002-2003 followed by a marked decrease in 2006-2007 while females showed a significant decrease in 2008-2009. Both males and females showed the largest decrease in the 2nd half of the study accounting for the majority of the overall decrease (1.13 mmol/L for males and 0.87 mmol/l for females for the 4 years). Compared with 2002-03, the OR for IFG in males decreased with time, and becoming significantly lower (OR=0.32; 95% CI: 0.21-0.49) for 2008-09. In females, the OR for IFG decreased significantly with time, except in 2006-07. Similarly, the OR for diabetes in males decreased to 0.34 (95% CI: 0.24-0.49) and in females to 0.33 (95% CI: 0.22-0.50) in 2008-09. For both genders, age and BMI were independently positively associated with IFG and diabetes, while education levels and smoking were negatively associated with IFG and diabetes. No significant association was found for either hypercholesterolemia or exercise in either gender. CONCLUSION: Continued monitoring of blood glucose is needed to see if negative trends observed in 2008-2009 endure and further research of contributing factors is required for development of targeted intervention strategies.

Trends and risk factors of hypercholesterolemia among Kuwaiti adults: National Nutrition Surveillance Data from 1998 to 2009.

OBJECTIVE: To determine temporal changes in hypercholesterolemia prevalence and associated factors in Kuwaiti adults. DESIGN: Analysis of nationally representative cross-sectional population survey data from the Kuwait National Nutrition Surveillance. METHODS: A total of 15,110 men and 17,701 women, aged 20-69 years, registered for employment or pensions, Hajj Pilgrimage health checkups, or were parents accompanying their children for immunization from 1998 through 2009. Sociodemographic and lifestyle information, height and weight, and blood samples were collected. RESULTS: Hypercholesterolemia (HC; serum cholesterol ≥5.20 mmol/L) prevalence increased within the time period until 2006-2007 (men, 56.0%; women, 53.6%), except for 2002-2003, and then declined significantly in both men (33.7%) and women (30.6%). Linear and logistic regression adjusted for age, education level, and body mass index (BMI) also showed a significant upward temporal trend for total cholesterol and prevalence of moderate and high HC (except for high HC in men) until 2004-2007 followed by a significant downward trend in 2008-2009 in both men and women. For both genders, age, BMI, education level, and presence of diabetes were significantly independently associated with high HC, whereas only age and BMI were associated with moderate HC. Female smokers, compared with non-smokers, had significantly higher odds ratios for both moderate and high HC. Current exercise or fruit and vegetable intake showed no significant association for either gender. CONCLUSION: Continued monitoring of serum cholesterol is needed to see if the negative trend observed in 2008-2009 endures and further research of contributing factors is required for the development of targeted intervention strategies.

Secular trends and risk factors of overweight and obesity among Kuwaiti adults: National Nutrition Surveillance System data from 1998 to 2009.

OBJECTIVE: To determine trends in prevalence of overweight and obesity in Kuwaiti adults, and to examine their association with selected sociodemographic and lifestyle factors. DESIGN: Analysis of cross-sectional population survey data from the Kuwait National Nutrition Surveillance System. SETTING: Social and health facilities in Kuwait. SUBJECTS: Males (n 17 491) and females (n 21 120) aged 20-69 years attending registration for employment or pensions, or Hajj Pilgrimage health check-ups, or parents accompanying their children for immunization 1998 through 2009. Sociodemographic, lifestyle and anthropometric data were collected. RESULTS: Prevalence of BMI ≥ 25 kg/m2 rose from 61·8 % and 59·3 % in females and males respectively, peaked in 2004-2005 (81·4 % and 79·2 %) and fell slightly in 2008-2009 (77·3 % and 77·4 %). Obesity prevalence in females exceeded males for all years and age groups; by 2009, it had increased by 11·3 % in males and 14·6 % in females. Overweight and obesity prevalences in both genders increased until 2004-2005 but fell thereafter, with significant falls for females in 2008-2009. Logistic and linear regression analyses confirmed these temporal changes for both prevalence and BMI in both genders. The odds of obesity increased with age until the fifth decade for both genders and then declined significantly for males. Education level was negatively associated with obesity prevalence in females, while participation in leisure-time exercise was negatively associated with obesity prevalence in males. CONCLUSIONS: Although the combined prevalence of overweight and obesity (BMI ≥ 25 kg/m2) seemed to decrease from 2005 to 2009 among Kuwaiti adults, further research to clarify the identified confounders and continued monitoring are needed to confirm the decrease observed.

Major dietary patterns, ethnicity, and prevalence of type 2 diabetes in rural Hawaii.

OBJECTIVE: The association of type 2 diabetes (T2DM) with the overall dietary pattern and its relation with ethnicity was examined. METHODS: A cross-sectional study with 1257 participants with four ethnicities (Caucasian, Filipino, Native Hawaiian, and Japanese) in the North Kohala region of Hawaii was conducted. Participants 18-95 y of age were surveyed for their ethnic and demographic backgrounds, dietary intakes, and biochemical indexes of glucose intolerance between 1997 and 2000. RESULTS: Three dietary patterns from the food-frequency questionnaire were identified by factor analysis. Factor 1 was characterized by a healthy diet with a frequent intake of vegetables and fruits, and factor 2 was dominated by animal foods and local ethnic dishes. Factor 3 was characterized by a Western diet, which was dominated by French fries, fast-food hamburgers, pizza, and chips. Multivariate logistic regression model for T2DM prevalence included ethnicity and three dietary factors after adjustment for age, sex, income, physical activity, smoking status, and energy intake. Ethnicity was significantly associated with T2DM, with an odds ratio of 1.83 (95% confidence interval [CI] 1.12-3.00) for Native Hawaiians and 1.92 (95% CI 1.12-3.29) for Filipinos compared with Caucasians 1.92 (95% CI 1.12-3.29). Among the three dietary factors, factor 2 was positively associated with T2DM (odds ratio 1.30, 95% CI 1.03-1.68), but the significance disappeared after adjustment for energy intake. CONCLUSION: The findings show that ethnicity is a stronger risk factor for T2DM than dietary patterns when energy intake is adjusted for. Reducing energy intake to prevent T2DM deserves more attention during health promotion for the multiethnic population of Hawaii.

Prevalence of diabetes and glucose intolerance in an ethnically diverse rural community of Hawaii.

BACKGROUND: We report the prevalence of diabetes in a rural, multiethnic community in Hawaii, of predominantly Asian and Native Hawaiian ancestry, by using 1997 World Health Organization diagnostic criteria applied to a two-hour oral glucose tolerance test. METHODS: This cross-sectional survey included 1452 men and nonpregnant women who were >18 years of age. Blood was drawn in the fasting and postchallenge states. Individuals under pharmacologic treatment for diabetes were excluded. Information obtained included demographics, medical history, dietary intake, physical activity, and anthropometric measurements. RESULTS: Prevalence of diabetes was approximately three-fold higher among Asian and Native Hawaiian ancestry groups than among Caucasians, even after adjusting for other risk factors. Furthermore, diabetes prevalence was similar among all non-Caucasian ethnic groups despite significant differences in body mass indices. CONCLUSIONS: These findings indicate that earlier reports of high prevalence of diagnosed diabetes among Asians and Hawaiian ethnic groups were not due to detection bias, since our study revealed similar prevalence of previously unrecognized diabetes. Furthermore, similar prevalence among these groups was observed despite significant differences in body mass indices, diet, and physical activity. This apparent paradox may reflect limitations in the measurement of these risk factors; differences in the impact of these risk factors on diabetes risk in different ethnic groups; or ethnic differences in lifestyle, biochemical, or genetic factors that were not examined in this study.

Cardiorespiratory fitness, macronutrient intake, and the metabolic syndrome: the Aerobics Center Longitudinal Study.

OBJECTIVE: This study examines the cross-sectional associations between cardiorespiratory fitness and the metabolic syndrome with adjustment for macronutrient intake from 3-day dietary records. DESIGN: Cross-sectional study. SUBJECTS/SETTING: Women and men who had a comprehensive medical examination, including a symptom-limited maximal treadmill exercise test, and completed 3-day dietary records at the Cooper Clinic, Dallas, TX. MAIN OUTCOME MEASURES: Metabolic syndrome as defined by the National Cholesterol Education Program Adult Treatment Panel III criteria. STATISTICAL ANALYSES PERFORMED: Analysis of variance was used to examine differences in continuous data. General linear analysis was used to examine linear trends. Mantel-Haenszel chi(2) analyses were used to examine differences in categorical data. Logistic regression was used to estimate odds ratios and 95% confidence intervals. RESULTS: After adjusting for sex and age, cardiorespiratory fitness was inversely associated with the prevalence of metabolic syndrome (P<0.001). Adjustment for macronutrient intake and other potential confounding variables did not alter the association between cardiorespiratory fitness and prevalent metabolic syndrome. CONCLUSIONS: Cardiorespiratory fitness is inversely associated with the prevalence of metabolic syndrome. Patients should be encouraged to increase their physical activity to decrease their risk for metabolic syndrome and coronary heart disease.

Are remnant-like particles independent predictors of coronary heart disease incidence? The Honolulu Heart study.

BACKGROUND: Remnant-like particles have been proposed as a new risk factor for coronary heart disease (CHD). This is the first long-term prospective investigation of the relationship between remnant-like particles and a cardiovascular disease outcome in healthy men. METHODS AND RESULTS: A cohort of 1156 Japanese-American men aged 60 to 82 from the Honolulu Heart Program was followed for 17 years. During that period 164 incident cases of CHD were identified. In multivariate Cox regression analyses, baseline remnant-like particle cholesterol (RLP-C) and triglyceride (RLP-TG) levels were significantly related to CHD incidence independently of nonlipid cardiovascular risk factors and of total cholesterol or high-density and low-density lipoprotein cholesterol levels. Total triglyceride levels were an independent predictor of CHD incidence. However, in models including RLP and triglyceride level simultaneously, neither variable was significant when adjusted for the other. This finding can be attributed to the strong correlation between RLP-C and RLP-TG levels and total triglycerides. When individuals with normal triglyceride levels (n=894) were separated from those with elevated triglycerides (n=260), the association between RLPs and CHD relative risk was only significant for the group with elevated triglyceride levels. CONCLUSIONS: RLP levels predicted CHD incidence independently of nonlipid risk factors and of total cholesterol or high-density and low-density lipoprotein cholesterol levels. However, RLP levels did not provide additional information about CHD incidence over and above total triglyceride levels. Therefore, this study does not support the need for testing of remnants in men if measures of fasting triglycerides are available.

Ethnic differences in the prevalence of overweight among young children in Hawaii.

OBJECTIVES: To compare the prevalence of overweight among young children of different ethnic backgrounds and describe the age pattern of overweight in early childhood. METHODS: Cross-sectional study of 21,911 children, 12 to 59 months old, participating in the Hawaii Special Supplemental Nutrition Program for Women, Infants, and Children in 1997-1998. They were grouped in eight ethnic categories. For 1-year-olds we defined overweight as weight-for-age at the 95th percentile or more and underweight as weight-for-age at less than the 10th percentile. For 2- to 4-year-olds overweight was defined as body mass index (BMI) at the 95th percentile or more, underweight as BMI less than 10th percentile, tall stature as height-for-age at the 95th percentile or more, and short stature as height-for-age at less than the 10th percentile. The National Center for Health Statistics 2000 growth charts were the reference values. The analysis included bivariate and multivariate methods. RESULTS: Large differences were found among ethnic groups. Among 1-year-olds, Samoans were the heaviest (17.5% overweight) and Filipinos the lightest (30.2% underweight). Among 2- to 4-year-olds, Samoans were the heaviest (27.0% overweight) and the tallest (16.9% tall), whereas Asians were the lightest (12.2% underweight), and Filipinos the shortest (19.0% short). Hawaiians and Asians also had a high percentage of short children (13.6% and 12.2%, respectively). Prevalence of overweight in all 2- to 4-year-olds was more than the expected 5%, especially for Samoans, Filipinos, Hawaiians, and Asians. At age 2 to 4 years, overweight was almost twice as prevalent as at age 1. Multivariate analysis showed that ethnicity (Samoan) had the strongest independent association with weight-for-age percentile, BMI, and overweight in the two age groups, followed by birth weight. CONCLUSIONS: This is the first study of overweight among children of Asian and Pacific Island backgrounds in Hawaii. It identified important characteristics of growth and will be helpful in the design of appropriate activities to prevent overweight.