Utilization of Healthcare Resources by HIV-Positive Children in the United States: A National Perspective.

OBJECTIVE: We characterized and estimated the cost of inpatient hospital utilization by US pediatric patients who tested positive for the human immunodeficiency virus (HIV). METHODS: The 2012 Kids' Inpatient Database was analyzed to provide a descriptive assessment of national inpatient hospital utilization. We analyzed a stratified probability sampling of 3.2 million pediatric hospital discharges weighted to 6.7 million national discharges. Descriptive statistics for hospital and patient characteristics were identified and binary variables were analyzed using the Student t test. The Kids' Inpatient Database is the largest available all-payer pediatric (20 years old and younger) inpatient care database in the United States, yielding national estimates of hospital inpatient stays. Children aged 17 years and younger were included in the study and conditions related to pregnancy and delivery. RESULTS: We estimated that 1344 pediatric discharges were associated with an HIV diagnosis, totaling 10,704 inpatient days at a cost of $91 million. Among pediatric patients with HIV, 55% were African American, 20% were white, 15% were Asian/Pacific Islander, 8% were other races (including Hispanics and Native Americans), and 51% were female. Children who were HIV positive were more likely to have longer mean hospital stays, have higher mean hospital charges, be of a higher median age (8 years and older), have Medicaid insurance, come from lower-income families, be treated in urban teaching hospitals, and be more likely to die during hospitalization (P < 0.01 for all). Among non-HIV-related pediatric discharges, 20% occurred in households with a mean annual income >$63,000 compared with only 12% for children who were HIV positive. During hospitalization, at least one procedure was performed in 56.6% of children with HIV compared with 45.65% of hospitalized children without HIV. The most frequently observed diagnoses associated with children infected with HIV were gastrointestinal disorders, mental disorders, and bacterial infections and sepsis. CONCLUSIONS: The results suggest that pediatric patients who were HIV positive were significantly older, from lower-income areas, and members of minority groups. They underwent more procedures during hospitalization, incurred more than twice the total cost, stayed in the hospital twice as long, and had statistically higher in-hospital mortality than children who were HIV negative. As we continue to explore effective and judicious treatment options for patients who are HIV positive, our national estimates of resource utilization can be used to conduct a more detailed examination of current medical practices and specific patterns of diagnoses associated with HIV infection in the US pediatric population.

The effect of an unstructured, moderate to vigorous, before-school physical activity program in elementary school children on academics, behavior, and health.

BACKGROUND: Physical inactivity has been deemed a significant, contributing factor to childhood overweight and obesity. In recent years, many school systems removed recess and/or physical education from their curriculum due to growing pressure to increase academic scores. With the vast majority of children's time spent in school, alternative strategies to re-introduce physical activity back into schools are necessary. A creative yet underutilized solution to engage children in physical activity may be in before-school programs. The objective of the proposed study is to examine the effect of an unstructured, moderate to vigorous, before-school physical activity program on academic performance, classroom behavior, emotions, and other health related measures. METHODS/DESIGN: Children in 3rd-5th grade will participate in a before-school (7:30-8:15 a.m.), physical activity program for 12 weeks, 3 days a week. Children will be able to choose their preferred activity and asked to sustain physical activity of moderate to vigorous intensity with individual heart rate monitored during each session. DISCUSSION: The proposed study explores an innovative method of engaging and increasing physical activity in children. The results of this study will provide evidence to support the feasibility of an unstructured, moderate to vigorous, before-school physical activity program in children and provide insight regarding the ideal physical activity intensity and duration necessary to achieve a positive increase in academic performance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01505244.

Perception of others' body size influences weight loss and regain for European American but not African American women.

OBJECTIVE: The authors investigated whether European American (EA) and African American (AA) women took longer to lose weight, and were less likely to maintain weight loss if they perceived others to be overweight. DESIGN: Overweight EA and AA women completed a Figure Rating Scale and the Three-Factor Eating Questionnaire prior to a weight loss intervention. Body composition was assessed by dual energy X-ray absorptiometry prior to and following weight loss. MAIN OUTCOME MEASURES: rate of weight loss, % body fat at follow-up. RESULTS: For EA, but not AA women, perception of others' body size was inversely associated with rate of weight loss and cognitive restraint, and positively associated with body fat gain following intervention. In linear regression modeling, EA, but not AA, women who perceived others as large, subsequently had greater percent body fat 1 year after weight loss than did those who perceived others as lean, independent of age, baseline body fat, and body size deemed "acceptable." Inclusion of cognitive restraint in the model weakened this effect. CONCLUSION: Among EA but not AA women, perception of others' body size influenced weight loss and maintenance. This effect may have been mediated by cognitive restraint.

Food Addiction: A Barrier for Effective Weight Management for Obese Adolescents.

BACKGROUND: Findings from studies of food addiction in adults suggest those with food addiction are less successful in weight-loss interventions. Little is known about food addiction in obesity treatment-seeking adolescents; therefore, the purpose of this study was to explore the prevalence of food addiction and correlates of food addiction symptoms in obese adolescents entering an outpatient, weight management program. METHODS: Obese adolescents (n = 26) were administered the Yale Food Addiction Scale for Children (YFAS-C), measures of appetitive responsiveness, and health-related quality of life (HRQOL) before and following a 12-week, outpatient, behavioral weight management program. Descriptive statistics and correlations between YFAS-C symptoms and study variables were performed and further examined with linear regression. Baseline differences were compared between those meeting criteria for food addiction to those who did not (independent t-tests) and pre-postweight management program changes were examined (paired t-tests). RESULTS: 30.7% met criteria for food addiction and 50% reported ≥3 symptoms. Number of YFAS-C symptoms was correlated with appetitive responsiveness (r = 0.57, p < 0.05) and inversely correlated with all domains of HRQOL (r = 0.47-0.53, p < 0.05). Attrition rate was higher in adolescents with food addiction compared to those without (62.5% vs. 44.4%, p < 0.05). CONCLUSIONS: Adolescents with food addiction or with a higher number of food addiction symptoms may warrant additional resources to support adherence to and retention with a weight management program. Implementing screening measures for food addiction before enrolling in a weight management program may be an effective strategy to identify adolescents who may benefit from adjunct modalities.

Comparison of Borg- and OMNI-RPE as markers of the blood lactate response to exercise.

PURPOSE: To examine the utility of the Borg (6-20) and adult OMNI walk/run (0-10) ratings of perceived exertion (RPE) scales as markers of the blood lactate response to exercise. METHODS: Thirty-six (26 females and 10 males) individuals with the metabolic syndrome (mean+/-SEM: age, 45.8+/-2.0 yr; height, 168.4+/-1.3 cm; weight, 100.4+/-3.6 kg) completed a continuous peak oxygen uptake (VO2peak)/lactate threshold (LT) treadmill protocol. VO2 (mL.kg.min), blood lactate concentration (BLC, mM), and heart rate (bpm) were measured at the end of each stage. RPE were assessed at 2:15 and 2:45 of each 3-min stage using both RPE scales presented in a counterbalanced order. Participants were read standardized instructions specific to each scale. The LT and BLC of 2.5 and 4.0 mM were determined from the blood lactate-velocity relationship. RESULTS: The mean Borg, OMNI, and standardized (to the Borg scale) OMNI-RPE values at the LT and BLC of 2.5 mM, 4.0 mM, and peak ranged from 10.1 to 16.9, 3.1 to 8.2, and 9.9 to 17.1, respectively. No differences were observed between Borg and standardized OMNI-RPE at any exercise intensity. The correlation within and between Borg- and OMNI-RPE and the velocities associated with LT, BLC of 2.5 mM, 4.0 mM, and peak ranged from r=0.82 to 0.93 (P<0.01). Mean differences (95% CI) between the Borg- and standardized OMNI-RPE at LT, and BLC of 2.5 mM, 4.0 mM, and peak were 0.27 (-2.26, 2.80), -0.48 (-3.14, 2.18), -0.29 (-2.92, 2.35), and 0.10 (-1.65, 1.84), respectively. CONCLUSION: Both the Borg and OMNI walk/run scales demonstrate predictive utility as markers of the blood lactate response to incremental exercise in individuals with the metabolic syndrome.

Heart Rate and Perceived Exertion in Healthy Weight and Obese Children During a Self-Selected Physical Activity Program.

BACKGROUND: Compared with structured/organized activities, unstructured, self-selected physical activity (PA) may be more appealing for children in particular obese (OB) children. We examined whether both healthy-weight (HW) and OB children would engage in moderate to vigorous intensity PA during an unstructured PA program and compared heart rate (HR) and rate of perceived exertion (RPE) between the children. METHODS: Twenty-one children [9 OB (≥95th BMI percentile, 12 HW (5th - <85th), 8.6 ± 0.8 years; 9 males, 12 females] participated in before-school (7:30 AM to 8:15 AM) PA for 18 weeks, 3 consecutive days/week. Each child wore a Polar E600 HR monitor and was provided a vigorous, age-targeted heart rate (THR) of 70%. RESULTS: Mean HR ≥ vigorous THR for all children in 65.3% of the sessions and exceeded moderate intensity in 100%. Over the 18-weeks, no significant difference was observed in the overall mean HR between the HW (171.4 ± 12.0) and OB (169.3 ± 13.0), however the OB reported significantly lower RPEs than the HW (16.9 ± 2.6 vs. 17.6 ± 1.5, respectively; P < .05). CONCLUSIONS: Both the HW and OB children consistently sustained PA of moderate and vigorous intensity. The current study provides insight regarding the physiological capabilities and perceptual responses of HW and OB children participating in PA programs.

Resting energy expenditure and systolic blood pressure relationships in women across 4.5 years.

Recent studies have reported a strong association between blood pressure (BP) and resting energy expenditure (REE). However, it is not known whether this relationship persists over time. Therefore, the authors examined the temporal relationship between REE and systolic BP. In addition, the impact of sympathetic tone and anthropometric variables on this relationship was examined. All testing was performed on healthy, overweight African American and European American women aged 25 to 45 years over 4.5 years in the University of Alabama at Birmingham General Clinical Research Center. Repeated-measures mixed-models revealed REE as a significant determinant of systolic BP (ß=0.0155, P<.0001), independent of catecholamines, leg fat, visceral fat, fat-free mass, fat mass, height, relative skeletal muscle index, and resting heart rate. Observations that REE is predictive of systolic BP across 4.5 years support previous findings that REE may potentially mediate resting BP, independent of anthropometric variables and a marker for sympathetic tone.

Influence of resting energy expenditure on blood pressure is independent of body mass and a marker of sympathetic tone.

Two recent examinations reported a strong association between blood pressure (BP) and resting energy expenditure (REE), independent of body mass and body composition. Both reports postulate that neurohumoral processes that contribute to variation in REE may partly mediate the body mass effect on BP. Therefore, we examined the relationship of REE and BP in 108 asymptomatic women (a) to confirm previous findings in a novel population and (b) to examine the impact of a marker of sympathetic tone on this relationship, as this was indicated as a potentially salient intermediary in previous reports. All testing was performed during a 4-day admission to the General Clinical Research Center. Resting energy expenditure was measured by indirect calorimetry, body composition was determined by dual-energy x-ray absorptiometry, and 24-hour fractionated urinary norepinephrine was determined by high-performance liquid chromatography. Multiple linear regression revealed REE as a significant predictor of systolic BP (ß = 0.30, P = .04), independent of race (ß = 0. 28, P = .01), age (ß = -0.02, P = .80), height (ß = -0.38, P = .08), fat mass (ß = 0.22, P = .20), fat-free mass (ß = 0.08, P = .65), and 24-hour fractionated urinary norepinephrine (ß = 0.06, P = .57); and the same model using diastolic BP as the dependent variable approached significance (ß = 0.24, P = .09). This study affirms previous findings that REE may be a potential mediator in resting BP, independent of many well-cited factors and, additionally, a marker of sympathetic tone.

Physical activity-induced improvements in markers of insulin resistance in overweight and obese children and adolescents.

Childhood obesity is a significant, worldwide, public health problem. Coinciding with the increasing prevalence of obesity in youth, Type 2 diabetes has emerged as a critical health condition in this population. In the U.S. alone, approximately 215,000 U.S. youth under the age of 20 were diagnosed with diabetes, with the majority of 10-19 years old diagnosed with Type 2 diabetes. Additionally, the exact number of youth that may have Type 2 diabetes yet remain undiagnosed is unknown. Increasing physical activity to encourage weight loss among youth may reduce the incidence of Type 2 diabetes in youth; however, several recent studies reported positive associations between physical activity and components of Type 2 diabetes without weight loss in youth. These findings support previous studies in adults which observed physical activity-induced improvements in insulin dynamics without changes in body fat. The purpose of this review was to identify studies which examined the effect of physical activity without dietary intervention on markers of insulin resistance in overweight and obese youth. These studies provide strong evidence that physical activity alone, without dietary intervention, can have a positive, significant impact on insulin resistance risk and potentially prevent the development of type 2 diabetes in overweight and obese youth. The studies reviewed provide support for future interventions to shift the focus from reducing obesity to increasing physical activity for the prevention of type 2 diabetes in obese youth.

Fat distribution, aerobic fitness, blood lipids, and insulin sensitivity in African-American and European-American women.

The purpose of this study was to determine independent relationships of intra-abdominal adipose tissue (IAAT), leg fat, and aerobic fitness with blood lipids and insulin sensitivity (S(i)) in European-American (EA) and African-American (AA) premenopausal women. Ninety-three EA and ninety-four AA with BMI between 27 and 30 kg/m(2) had IAAT by computed tomography, total fat and leg fat by dual-energy X-ray absorptiometry, aerobic fitness by a graded exercise test, African admixture (AFADM) by ancestry informative markers, blood lipids by the Ektachem DT system, and S(i) by glucose tolerance test. Independent of age, aerobic fitness, AFADM, and leg fat, IAAT was positively related to low-density lipoprotein-cholesterol (LDL-C), cholesterol-high-density lipoprotein (HDL) ratio, triglycerides (TGs), and fasting insulin (standardized beta varying 0.16-0.34) and negatively related to HDL-cholesterol (HDL-C) and S(i) (standardized beta -0.15 and -0.25, respectively). In contrast, independent of age, aerobic fitness, AFADM, and IAAT, leg fat was negatively related to total cholesterol, LDL-C, cholesterol-HDL ratio, TGs, and fasting insulin (standardized beta varying -0.15 to -0.21) and positively related to HDL-C and S(i) (standardized beta 0.16 and 0.23). Age was not independently related to worsening of any blood lipid but was related to increased S(i) (standardized beta for S(i) 0.25, insulin -0.31). With the exception of total cholesterol and LDL-C, aerobic fitness was independently related to worsened blood lipid profile and increased S(i) (standardized beta varying 0.17 to -0.21). Maintenance of favorable fat distribution and aerobic fitness may be important strategies for healthy aging, at least in premenopausal EA and AA women.

Perception of exercise difficulty predicts weight regain in formerly overweight women.

It has been previously reported that overweight and obese individuals perceive exercise as more difficult than their lean counterparts, and this difference may not be solely attributed to physiological differences. Therefore, we tested the hypothesis that individual differences in the perception of exercise difficulty during exercise, independent of concurrently measured physiological markers of exertion, are predictive of weight regain, after completion of a weight loss program. A total of 113 formerly overweight women who had previously completed a weight-loss program to achieve a normal body weight (BMI <25 kg/m(2)) underwent a submaximal aerobic exercise task while measures of physiological and perceived exertion (rating of perceived exertion (RPE)) were recorded. Weight gain was assessed following a subsequent 1-year free-living period. Average weight regain 1 year following the intervention was 5.46 +/- 3.95 kg. In regression modeling, RPE (beta = 0.21, P = 0.01), but not physiological exertion (beta = 0.02, P = 0.81), during the submaximal exercise task was positively associated with 1-year weight regain following weight loss in premenopausal women, independent of measured confounding variables. The association between RPE and weight regain suggests that perception of exercise difficulty is an important predictor of weight regain following a weight-loss intervention.

Exercise training prevents regain of visceral fat for 1 year following weight loss.

The purpose of this study was to determine what effect aerobic and resistance exercise training has on gain of visceral fat during the year following weight loss. After being randomly assigned to aerobic training, resistance training, or no exercise training, 45 European-American (EA) and 52 African-American (AA) women lost 12.3 +/- 2.5 kg on a 800 kcal/day diet. Computed tomography was used to measure abdominal subcutaneous and visceral adipose tissue, whereas total fat and regional fat (leg, arm, and trunk) were measured by dual energy X-ray absorptiometry after weight loss and 1 year following the weight loss. Because not all the subjects adhered to the 2 time/week 40 min/day exercise training during the 1-year follow-up, subjects were divided into five groups for analysis: aerobic adherers, aerobic nonadherers, resistance adherers, resistance nonadherers, and no exercise. No significant differences were observed between the aerobic training and resistance training adherers for any variable. However, the aerobic (3.1 kg) and resistance (3.9 kg) exercise adherers gained less weight than any of the other three groups (all >6.2 kg). In addition, the two exercise adherence groups did not significantly increase visceral fat (<0.8%) as compared with the 38% increase for the two nonadhering exercise groups and the 25% for the nonexercise group. In conclusion, as little as 80 min/week aerobic or resistance training had modest positive effects on preventing weight regain following a diet-induced weight loss. More importantly, both aerobic and resistance training prevented regain of potentially harmful visceral fat.

Endocrine disruptors and obesity: an examination of selected persistent organic pollutants in the NHANES 1999-2002 data.

Recent evidence suggests that endocrine disrupting chemicals (EDCs) may cause perturbations in endogenous hormonal regulation that predispose to weight gain. Using data from NHANES (1999-2002), we investigated the association between body mass index (BMI), waist circumference (WC) and selected persistent organic pollutants (POPs) via multiple linear regressions. Consistent interaction was found between gender, ln oxychlordane and ln p,p' DDT. Also, we found an association between WC and ln oxychlordane and ln hpcdd in subjects with detectable levels of POPs, whereas an association between WC and ln p,p' DDT was observed in all subjects. Furthermore, ln Ocdd showed an increase with higher WC and BMI, whereas, ln trans-nonachlor decreased with higher BMI. Hence, BMI and WC are associated with POPs levels, making the chemicals plausible contributors to the obesity epidemic.

Self-reported low vitality, poor mental health, and low dietary restraint are associated with overperception of physical exertion.

Objective. We investigated whether perceived exertion, in comparison to the physiological response to exercise, was associated with self-reported vitality, mental health, and physical function during daily activities, or weight control behaviors. Design. Weight-reduced, formerly overweight women (n = 126, aged 22-46 years), completed health and dietary control questionnaires, and underwent a treadmill-walking task while heart rate, ventilation, respiratory exchange ratio, and ratings of perceived exertion were recorded. Results. Overperception of exertion (perceived exertion physiological exertion) was inversely associated with vitality (r = -0.190, P < .05), mental health (r = -0.188, P < .05), and dietary control (r values range -0.231 to -0.317, P < .05). In linear regression modeling, vitality or mental health, and cognitive dietary restraint were independently associated with accuracy of perceived exertion, independent of age, ethnicity, and engagement in exercise during weight loss. Each model explained 7%-8% of the variance in accuracy of perceived exertion. Conclusion. Women with low vitality or poor mental health, and poor dietary control may overperceive exertion. Such overperception may be a barrier to engage in physical activity and thus increase susceptibility to weight gain.

Ethnicity-specific anthropometric predictors of metabolic risk in women.

OBJECTIVE: The objective of this study was to determine associations of anthropometric measures of thigh and abdominal adipose tissue with metabolic risk factors, and whether these associations differed with ethnicity. We hypothesized that thigh circumference (ThC) would have an independent favorable association with insulin sensitivity, lipids, and blood pressure, whereas waist circumference (WC) would have an independent deleterious association with these variables in both African Americans (AA) and European Americans (EA). METHODS: Subjects were 228 healthy, overweight, premenopausal AA and EA women. Insulin sensitivity was assessed by intravenous glucose tolerance test and minimal modeling. Simple relationships between anthropometric measures and risk factors were determined by Pearson correlation analysis. Partial correlation coefficients were determined for circumference measures adjusted for thigh and abdominal skinfolds to differentiate relationships between thigh and abdominal subcutaneous fat from thigh muscle and deeper abdominal fat, respectively. RESULTS: In EA but not AA, ThC was positively associated with insulin sensitivity, independent of thigh skinfold. In both EA and AA, ThC was associated with a desirable lipid profile. In AA but not EA, WC was associated with lower insulin sensitivity and a less desirable metabolic profile. CONCLUSION: Results suggest that thigh muscle (ThC adjusted for thigh skinfold) may be metabolically protective in EA but not AA. In contrast, WC was a better indicator of insulin sensitivity and metabolic health in AA. Further investigation is needed to verify the association between thigh muscle and metabolic health, and to probe the reason for the observed ethnic specificity of the associations between anthropometric measures and metabolic risk factors.

Sample size in obesity trials: patient perspective versus current practice.

OBJECTIVE: To evaluate patient opinions on acceptable risks in exchange for a given degree of weight loss and their implications for sample size determination in obesity randomized clinical trials (RCTs). DESIGN: . Survey of patients entering RCTs for weight loss in a university-based clinical research setting and power calculations based on their responses. Participants. Men (n = 8) and women (n = 66) between 24 and 73 years of age with body mass indices ranging from 26.8 to 40.5 kg/m(2). Measurements. Survey responses to questions assessing the added risk of serious adverse events (SAEs) or death one is willing to assume for a given degree of weight loss. RESULTS: For 5% and 10% weight loss against risk for death per se, the mean acceptable risk tended to be about 3.5%, but the median (0.00) and mode (0.00) suggested that for most individuals, only a risk of < or = 1% would be acceptable. Figures, estimated dropout rates, and base rates of SAEs (including deaths) from recent obesity trials indicate that 1-year 2-group obesity RCTs would need tens of thousands of participants per group to have 80% power to detect risks that are meaningful to patients at the 2-tailed 0.05 alpha level. CONCLUSION: Patient education is needed to explain which risks are realistically detectable in RCTs so that patients may provide truly informed consent, or RCT standards should be modified to meet patients' implicit expectations.

Association between insufficiently physically active and the prevalence of obesity in the United States.

BACKGROUND: Numerous public health organizations have adopted national physical activity recommendations. Despite these recommendations, over half of the US population does not meet the minimum recommendation for physical activity, with large variations across individual US states. METHODS: Using the 2005 Behavioral Risk Factor Surveillance System (BRFSS) prevalence data for physical activity and obesity by state, we performed a weighted least squares regression using prevalence of obesity (BMI>or=30 kg/m2) as the dependent variable and insufficiently physically active (included completely sedentary), age, race, gender, and median household income as the independent variables. RESULTS: The unadjusted weighted least squares regression revealed a strong correlation between a state's prevalence of obesity and the prevalence of insufficiently physically active (R=.76, R2=.58, P<.0001). After adjusting for age, gender, race, and median household income, the prevalence of insufficiently physically active is still a significant predictor of the state prevalence of obesity (partial R=.44, R2=.19 P=.004). CONCLUSION: Macroenvironmental and sociopolitical disparities between individual US states that transcend simple state-level demographic factors need to be examined more rigorously to identify unique barriers and promoters of physical activity.

Effects of exercise training intensity on nocturnal growth hormone secretion in obese adults with the metabolic syndrome.

CONTEXT: Abdominal adiposity is associated with reduced spontaneous GH secretion, and an increased incidence of the metabolic syndrome, type 2 diabetes, and cardiovascular disease. Exercise training increases GH secretion, induces abdominal visceral fat loss, and has been shown to improve the cardiometabolic risk factor profile. However, little is known about the effects of endurance training intensity on spontaneous GH release in obese individuals. OBJECTIVE: Our objective was to examine the effects of 16 wk endurance training on spontaneous 12-h overnight GH secretion in adults with the metabolic syndrome. DESIGN AND SETTING: This randomized, controlled exercise intervention was conducted at the University of Virginia. PARTICIPANTS: A total of 34 adults with the metabolic syndrome (mean +/- sem: age: 49.1 +/- 1.8 yr) participated. INTERVENTION: Participants were randomized to one of three groups for 16 wk: no exercise training (control), low-intensity exercise training, or high-intensity training. MAIN OUTCOME MEASURE: Change in nocturnal integrated GH area under the curve (AUC) was calculated. RESULTS: Both exercise training conditions augmented within-group nocturnal GH AUC pretrain to post-training (low-intensity exercise training approximately (upward arrow) 49%, P < 0.05; and high-intensity training approximately (upward arrow) 65%, P < 0.01), and these changes were also greater than the changes in the control group (P < 0.01). The change in nocturnal GH AUC was inversely associated with the change in fat mass across the entire sample (r = -0.34; P = 0.051; n=34) but was not significantly associated with the change in abdominal visceral fat (r = 0.02; P = 0.920; n = 34). CONCLUSIONS: Sixteen wk of supervised exercise training in adults with the metabolic syndrome increases spontaneous nocturnal GH secretion independent of exercise training intensity.