Musings in the twilight of my career.

I present a summary of my research during the last few decades of research which focused on understanding the biochemical basis for maintaining an optimum metabolism to support long-term health. I realized that adequate levels of ∼40 vitamins and minerals needed as cofactors in thousands of metabolic reactions were critical for maintaining a healthy metabolism, and thus for longevity and prevention of chronic disease. Inadequate dietary intake of vitamins and minerals accelerates the risk of aging-associated diseases, leading to insidious damage. The Triage Theory provides a mechanistic rationale for such damage: shortage of a nutrient triggers a built-in rationing mechanism that allocates the scarce nutrient to proteins needed for immediate survival (survival proteins), at the expense of those needed for long-term survival (longevity proteins). Many as-yet-unknown longevity vitamins and proteins likely remain to be discovered. The fiber and nutrient-rich CHORI-bar was developed to fill gaps in inadequate diets; it yielded broadscale metabolic improvements. The health-related damages resulting from vitamin D deficiency and the positive effects of vitamin D supplementation were connected to numerous health-related problems, including the higher level of deficiency in people of color residing at northern latitudes. In general, prevention of degenerative diseases of aging requires expertise in metabolism, nutrition, biochemistry and regulatory functions.

Overweight adolescents' views on physical activity - experiences of participants in an internet-based intervention: a qualitative study.

BACKGROUND: Overweight and obese adolescents are reported to be less physically active than their peers. Research-based knowledge about their views may contribute to a better understanding of key factors that may foster or undermine motivation for physical activity, and provide knowledge for the future development of interventions. This paper explores experiences of physical activity among overweight adolescents, age 13-14 years, participants in Young & Active, a web-based controlled trial intervention to increase physical activity (ClinicalTrials.gov NCT01700309). The theoretical perspective is based on Self-Determination Theory. METHODS: Two qualitative post-intervention research interviews, with a nine-month interval, were conducted with 21 adolescents, 15 girls and 6 boys to study short-term and long-term changes. The informants were recruited from a total of 84 participants from the Young & Active intervention group. Data were analyzed using qualitative content analysis. RESULTS: The participants associated physical activity with organized sports and physical education classes at school, and as a means of promoting good health and attractive bodies. A majority of the adolescents said that they experienced their health as poorer than other youths, and expressed worries about their fitness and future health. Mastering a physical activity, being together with friends and having fun promoted motivation to perform sports. Not mastering an activity, or not knowing the others made them less motivated. None of the adolescents highlighted the importance of informal active living when asked about their understanding and experiences of physical activity. Consistency was found between the first and second interviews. CONCLUSION: This study adds to limited research on overweight and obese adolescents' experiences of physical activity. The participants' views reflect opinions in society about physical activity, and its importance for health. Viewing physical activity as conducted within organized sports makes it necessary to look into how these are organized, structured and led, and what can be done to support self-esteem, autonomous motivation and participation. The ability to choose among available, affordable and desirable physical activities, together with friends, may promote participation and maintenance.

Effects of a psychological intervention on the quality of life of obese adolescents under a multidisciplinary treatment / Efeitos de uma intervenção psicológica sobre a qualidade de vida de adolescentes obesos em tratamento multidisciplinar

Abstract Objective: To investigate the effects of multidisciplinary treatment with and without psychological counseling on obese adolescents' self-reported quality of life. Methods: Seventy-six obese adolescents (15.87 ± 1.53 y) were allocated into psychological counseling group (PCG; n = 36) or control group (CG; n = 40) for 12 weeks. All participants received the same supervised exercise training, nutritional and clinical counseling. Participants in PCG also received psychological counseling. QOL was measured before and after 12 weeks of intervention by Generic Questionnaire for the Evaluation of Quality of Life (SF-36). Results: The dropout rate was higher in GC (22.5%) when compared with PCG (0.0%) (p < 0.001). After 12 weeks, participants from PCG presents lower body weight, relative fat mass and higher free fat mass (p < 0.001 for all) compared to GC. QOL improved among adolescents from both groups (p < 0.05), however, a better QOL was reported from those adolescents enrolled in PCG. Conclusion: The inclusion of a psychological counseling component in multidisciplinary treatment for adolescent obesity appears to provide benefits observed for improved QOL as compared with treatment without psychological counseling.

Resumo Objetivo: Investigar os efeitos do tratamento multidisciplinar com e sem aconselhamento psicológico voltado para a qualidade de vida de adolescentes obesos. Métodos: Foram alocados 76 adolescentes obesos (15,87 ± 1,53 ano) em um grupo de aconselhamento psicológico (GAP; n = 36) e um grupo de controle (GC; n = 40) por 12 semanas. Todos receberam o mesmo treinamento físico supervisionado e aconselhamento nutricional e clínico. Os participantes no GAP também receberam aconselhamento psicológico. A qualidade de vida foi avaliada antes e depois das 12 semanas de intervenção por meio do Questionário Genérico de Avaliação da Qualidade de Vida (SF-36). Resultados: O abandono do tratamento foi maior no GC (22,5%) em comparação com o GAP (0,0%) (p < 0,001). Após 12 semanas, os participantes do GAP apresentam menor peso corporal, massa gorda relativa e maior massa livre de gordura (p < 0,001 para todos) em comparação com o GC. A qualidade de vida melhorou entre os adolescentes de ambos os grupos (p < 0,05); contudo, uma melhor qualidade de vida foi relatada pelos adolescentes incluídos no GAP. Conclusão: A inclusão de aconselhamento psicológico no tratamento multidisciplinar dos adolescentes obesos parece proporcionar benefícios observados na melhoria da qualidade de vida, em comparação com o tratamento sem aconselhamento psicológico.

Relation between plasma antioxidant vitamin levels, adiposity and cardio-metabolic profile in adolescents: Effects of a multidisciplinary obesity programme.

BACKGROUND & AIMS: In vivo and in vitro evidence suggests that antioxidant vitamins and carotenoids may be key factors in the treatment and prevention of obesity and obesity-associated disorders. Hence, the objective of the present study was to determine the relationship between plasma lipid-soluble antioxidant vitamin and carotenoid levels and adiposity and cardio-metabolic risk markers in overweight and obese adolescents participating in a multidisciplinary weight loss programme. METHODS: A therapeutic programme was conducted with 103 adolescents aged 12-17 years old and diagnosed with overweight or obesity. Plasma concentrations of α-tocopherol, retinol, ß-carotene and lycopene, anthropometric indicators of general and central adiposity, blood pressure and biochemical parameters were analysed at baseline and at 2 and 6 months of treatment. RESULTS: Lipid-corrected retinol (P < 0.05), ß-carotene (P = 0.001) and α-tocopherol (P < 0.001) plasma levels increased significantly, whereas lipid-corrected lycopene levels remained unaltered during the treatment. Anthropometric indicators of adiposity (P < 0.001), blood pressure (P < 0.01) and biochemical parameters (P < 0.05) decreased significantly, whereas fat free mass increased significantly (P < 0.001). These clinical and biochemical improvements were related to changes in plasma lipid-corrected antioxidant vitamin and carotenoid levels. The adolescents who experienced the greatest weight loss also showed the largest decrease in anthropometric indicators of adiposity and biochemical parameters and the highest increase in fat free mass. Weight loss in these adolescents was related to an increase in plasma levels of lipid-corrected α-tocopherol (P = 0.001), ß-carotene (P = 0.034) and lycopene (P = 0.019). CONCLUSIONS: Plasma lipid-soluble antioxidant vitamin and carotenoid levels are associated with reduced adiposity, greater weight loss and an improved cardio-metabolic profile in overweight and obese adolescents.

Anti-Müllerian Hormone in Obese Adolescent Girls With Polycystic Ovary Syndrome.

PURPOSE: Anti-Müllerian hormone (AMH) is proposed as a biomarker of polycystic ovary syndrome (PCOS). This study investigated: (1) AMH concentrations in obese adolescents with PCOS versus without PCOS; (2) the relationship of AMH to sex steroid hormones, adiposity, and insulin resistance; and (3) the optimal AMH value and the multivariable prediction model to determine PCOS in obese adolescents. METHODS: AMH levels were measured in 46 obese PCOS girls and 43 obese non-PCOS girls. Sex steroid hormones, clamp-measured insulin sensitivity and secretion, body composition, and abdominal adiposity were evaluated. Logistic regression and receiver-operating characteristic curve analyses were used, and multivariate prediction models were developed to test the utility of AMH for the diagnosis of PCOS. RESULTS: AMH levels were higher in obese PCOS versus non-PCOS girls (8.3 ± .6 vs. 4.3 ± .4 ng/mL, p < .0001), of comparable age and puberty. AMH concentrations correlated positively with age in both groups, total and free testosterone in PCOS girls only, abdominal adipose tissue in non-PCOS girls, with no correlation to in vivo insulin sensitivity and secretion in either groups. A multivariate model including AMH (cutoff 6.26 ng/mL, area under the curve .788) together with sex hormone-binding globulin and total testosterone exhibited 93.4% predictive power for diagnosing PCOS. CONCLUSIONS: AMH may be a useful biomarker for the diagnosis of PCOS in obese adolescent girls.

Reproducibility of an in-laboratory test meal to assess ad libitum energy intake in adolescents with obesity.

AIM: The aim of the present work was to test the reproducibility of a personalized in-laboratory ad libitum buffet meal in assessing energy and macronutrient intake in obese adolescents. METHODS: Twelve 13.5 ± 1.5 years old obese adolescent girls were asked to complete three identical experimental sessions during which an ad libitum buffet meal was presented at lunch time. The buffet was personalized based on food preference questionnaires, presented usually consumed food items and excluded preferred foods. Total energy intake and the energy ingested derived from each macronutrient were assessed by investigators using the Bilnuts nutritional software. RESULTS: Mean body mass was 87.0 ± 13.7 kg and mean BMI was 32.2 ± 4.9 kg/m(2). Mean FM percentage was 39.1 ± 4.4% and FFM was 50.6 ± 7.7 kg. There was no significant difference between total energy intake, the percentage of intake related to fat, protein or Carbohydrates (CHO) between the three sessions. The Intraclass Correlations (ICC) observed for total energy intake was 0.99. ICC for Protein, Fat and CHO were 0.38; 0.96 and 0.81 respectively. The Bland & Altman visual analysis revealed an important agreement between meals. CONCLUSION: The proposed personalized in-laboratory ad libitum test meal produces is a reproducible methods to assess energy and macronutrients intake in obese adolescent girls.

Distinguishing characteristics of metabolically healthy versus metabolically unhealthy obese adolescent girls with polycystic ovary syndrome.

OBJECTIVE: To investigate the key physical, metabolic, hormonal and cardiovascular characteristics of metabolically healthy obese (MHO) versus unhealthy obese (MUHO) girls with polycystic ovary syndrome (PCOS). DESIGN: Cross-sectional study. SETTING: Research center. PATIENT(S): Seventy obese girls with PCOS were divided into 19 MHO and 51 MUHO based on cutoff points for in vivo insulin sensitivity (within and < 2 SDs of the mean of the insulin sensitivity of the normal-weight girls, respectively). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Body composition, abdominal fat, in vivo insulin sensitivity and secretion (hyperinsulinemic-euglycemic and hyperglycemic clamps respectively), hormonal profile, and cardiovascular disease risk markers. RESULT(S): MUHO-PCOS girls had higher waist circumference, visceral adipose tissue, leptin, and free testosterone, lower SHBG and E2, higher non-high-density lipoprotein (HDL) cholesterol and atherogenic lipoprotein particle concentrations, smaller HDL particle size, and higher high-sensitivity C-reactive protein compared with MHO-PCOS girls. Hepatic and peripheral insulin sensitivity were lower with higher first- and second-phase insulin secretion, but ß-cell function relative to insulin sensitivity was lower in MUHO versus MHO. Pair matching of MHO and MUHO regarding age and body mass index revealed similar findings. MUHO-PCOS girls had larger visceral adiposity, lower insulin sensitivity and ß-cell function, worse hormonal profile, and severely atherogenic lipoprotein concentrations compared with MHO-PCOS girls. CONCLUSION(S): MHO-PCOS girls have favorable physical, metabolic, hormonal, and cardiovascular disease (CVD) characteristics and lower risk biomarkers for type 2 diabetes compared with their MUHO-PCOS peers. A greater understanding of the contrast in this risk phenotype in obese girls with PCOS may have important implications for therapeutic interventions, their outcomes, and their durability.

Persimmon vinegar ripening with the mountain-cultivated ginseng ingestion reduces blood lipids and lowers inflammatory cytokines in obese adolescents.

PURPOSE: This study investigated the effect of the vinegar, which is made of 4-year-old mountain-cultivated ginseng ripened into 4-year-matured persimmon vinegar, on the blood lipids level and inflammatory cytokines concentration in obese female adolescents. METHODS: Subjects ingested the vinegar, so-called 'mountain-cultivated ginseng persimmon vinegar (MPV)', without meals every day for 6 weeks with activities control. Subjects were grouped into control (CON), persimmon vinegar (PV), and MPV with 10 people in each group. Blood lipids, triglyceride (TG), total-cholesterol (TC), and high density lipoprotein-cholesterol (HDL-C) were analyzed. Also, glutamic oxaloacetic transaminase (GOT) and glutamate pyruvate transaminase (GPT) were analyzed for the hepatotoxicity. Blood cytokines, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) were analyzed. RESULTS: Subjects showed a high reduction in body weight and body fat. Their blood lipid level was effectively improved, and the secretion of inflammatory cytokine was suppressed as well, except for TNF-α. However, the change ratio of the cytokines was high in PV and MPV. Such results were similar to those from research subjects who took persimmon vinegar only (PV), but the effect of the vinegar (MPV) was more remarkable. Besides, this mixture was found to have no effect on the hepatotoxicity. CONCLUSION: The significance of this study is that all the experiments were conducted without controlling research subjects' daily lives, and it is suggested that the vinegar may be recommended as a kind of health supplement food to suppress obesity. Especially, since these two products are traditional foods of Korean people, which have been taken for ages, it is expected that the fusing of two foods may be better applied to ordinary people who are concerned about obesity.

Clinical performance of 3-body fat measurements in obese adolescents 15 to 18 years-old / Medidas da gordura corporal em adolescentes obesos de 15 a 18 anos

There is a lack of information about the performance and clinical use of body fat measurements in children and adolescents, particularly in obese people. Objective: the purpose of this study was to compare percentage body fat (%BF) among 3 different methodologies, including hydrostatic weighing (HW), dual energy x-ray absorptiometry (DXA) and air displacement plethysmography (ADP), in obese adolescents. Subjects: A total of 36 obese adolescents were evaluated, which 15 males (16.00 + 0.9 yrs, 105.0 + 10.9 kg, 179.9 + 7.2 cm, 34.9 + 4.4 kg/m2) and 21 females (16.5 + 1.5 yrs, 91.1 + 10.5 kg, 163.6 + 4.2 cm, 34.1 + 3.7 kg/m2). All of them performed HW, total body DXA and ADP. Results: For males, the means of %BF regarding HW, DXA and ADP were 45.7 + 9.0, 42.3 + 5.2 and 35.6 + 7.9, respectively. For females, the means of %BF were 47.7 + 6.8, 50.7 + 4 and 42.4 + 5.3, respectively. No significant difference was found between HW and DXA. In general, the %BF values provided by ADP measurements were lower than other two methods. Conclusion: There was a good agreement between DXA and HW methods, but ADP measurements can underestimate the %BF in obese adolescents.

Adiposidad abdominal, insulino-resistencia, hipertensión y sodio urinarioen adolescentes obesos / Abdominal adiposity, insulin resistance, hypertension and urinary sodium in obese adolescents / Adiposidade abdominal, insulino-resistência, hipertensão e sódio urinário em adolescentes obesos

El objetivo de este estudio fue evaluar la relación entre adiposidad abdominal con insulino-resistencia, hipertensión arterial y excreción urinaria de sodio en adolescentes obesos. Se realizó un estudio transversal descriptivo que incluyó 107 adolescentes obesos, entre 10 y 14 años, sin restricción dietaria, provenientes del Hospital de Pediatría-Posadas, Misiones, durante los años 2011-2012. Se definió obesidad abdominal según: perímetro de cintura ≥p90, hipertensión arterial: presión arterial sistólica y/o diastólica ≥p95 y prehipertensión ≥p90 y

The aim of this study was to assess abdominal adiposity relationship with insulin resistance, high blood pressure and urinary sodium excretion in an obese adolescent population. A descriptive cross sectional study that included 107 obese teenagers from 10 to 14 years of age without any dietary restriction was performed during 2011 and 2012 at the Pediatric Hospital, in Posadas, Misiones. Abdominal obesity was defined as: waist perimeter ≥p90, hypertension: systolic and/or diastolic pressure ≥p95 and prehypertension ≥p90 and

O objetivo deste estudo foi avaliar a relação de adiposidade abdominal com insulino-resistência, hipertensão arterial e excreção urinária de sódio em adolescentes obesos. Foi realizado um estudo transversal descritivo que incluiu 107 adolescentes obesos, entre 10 e 14 anos, sem restrição na dieta, provenientes do Hospital de Pediatría Posadas, Misiones, durante os anos 2011-2012. Definiu-se obesidade abdominal conforme o perímetro de cintura ≥p90, hipertensão arterial: pressão arterial sistólica e/ou diastólica ≥p95 e pré-hipertensão ≥p90 e